Nursing 123 (N. 2) Final PrepU Q's

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? 3 AM 5 AM 7 AM 9 AM

*3 AM* During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? 2 weeks 4 weeks 7 to 10 days 2 to 3 days

*7-10 days* Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the client may be at increased risk for bleeding.

The nurse is caring for an asthmatic patient hospitalized with an acute asthma exacerbation. What drugs would the nurse anticipate being ordered for this patient to gain underlying control of persistent asthma? Rescue inhalers Anti-inflammatory drugs Antibiotics Antitussives

*Anti-inflammatory drugs* Because the underlying pathology of asthma is inflammation, *control of persistent asthma* is accomplished primarily with regular use of anti-inflammatory medications. Rescue inhalers, antibiotics, and antitussives *do not aid in the control* of persistent asthma.

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to Take deep breaths Exhale slowly Perform upper chest breaths Increase the flow of oxygen

*Exhale slowly* When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform *pursed-lip breathing, which includes exhaling slowly*. Deep breaths or upper chest breathing is an inefficient breathing technique and should be changed to diaphragmatic breathing for the client with COPD. Some clients with COPD cannot tolerate much oxygen without developing hypercapnia.

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? Iron deficiency anemia Aplastic anemia Megaloblastic anemia Sickle cell anemia

*Megaloblastic anemia * Strict vegetarians are at risk for megaloblastic anemias, which are characterized by the presence of abnormally large, nucleated RBCs, if they do not supplement their diet with vitamin B12.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? Protein metabolism Blood glucose level Weight loss Carbohydrate intake

*Weight loss* *Weight loss is the focus of nutrition* intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency in the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. a. Elevated blood urea nitrogen (BUN) and creatinine b. Rapid onset c. More common in type 1 diabetes Absent ketones d. Normal arterial pH level

*a. Elevated blood urea nitrogen (BUN) and creatinine b. Rapid onset c. More common in type 1 diabetes Absent ketones * DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.

A nurse has established a nursing diagnosis of *ineffective airway clearance*. The datum that best supports this diagnosis is that the client a. Has wheezes in the right lung lobes b. Has a respiratory rate of 28 breaths/minute c. Reports shortness of breath d. Cannot perform activities of daily living

*a. Has wheezes in the right lung lobes * Of the data listed, wheezing, an adventitious lung sound, is the *best datum* that supports the diagnosis of ineffective airway clearance. An ↑ respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

The nurse is caring for a *female* client who has been diagnosed with Neisseria *gonorrhoeae*. The nurse is aware that if this client had not received treatment, what other *serious issues could have resulted* from this disease? Select all that apply. a. Increased risk of HIV infection b.Urethral stricture c. Infection and scarring of the Fallopian tubes d. Eye infection in an infant born to a woman with this disease e. Infection of the epididymis

*a. Increased risk of HIV infection b.Urethral stricture c. Infection and scarring of the Fallopian tubes d. Eye infection in an infant born to a woman with this disease * Complications of untreated Neisseria gonorrhea in a woman are: - infection of the cervix, endometrium, and Fallopian tubes. It has been shown to facilitate the transmission of HIV and it may transmitted to the eyes of a newborn. The development of infection of the epididymis and urethral strictures can only be seen in *men*.

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. a. Inflamed airways obstruct airflow. b. Mucus secretions block airways. c. Overinflated alveoli impair gas exchange. d. Dry airways obstruct airflow.

*a. Inflamed airways obstruct airflow. b. Mucus secretions block airways. c. Overinflated alveoli impair gas exchange. * Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall *airway narrowing* (obstructive bronchiolitis). The airways are actually *moist*, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to *hypersecretion of mucus*.

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? a. Suggest fluid intake of at least 2 L/day b. Instruct the client to avoid prune or apple juice c. Assist the client regarding the correct diet or to minimize food intake d. Instruct the client to keep a record of food intake

*a. Suggest fluid intake of at least 2 L/day* The nurse should suggest a fluid intake of at least 2 L/day to help the client avoid constipation. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the client to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the client to keep a record of food intake in case of diarrhea, because this helps identify specific foods that irritate the gastrointestinal tract.

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? a. Take 1 hour before breakfast b. Take with dairy products c. Decrease intake of fruits and juices d. Decrease intake of dietary fiber

*a. Take 1 hour before breakfast * Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the *medication on an empty stomach*. Instructions also include that there is *↓ absorption of iron* with food, *particularly dairy products*. The client is to *↑ vitamin C* intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.

Which statement holds true? Untreated genital warts: a. may resolve on their own, remain unchanged, or increase in size or number. b. may lead to AIDS. c. do not resolve on their own and increase in size with abscess formations. d. do not lead to any other illness and resolve on their own without treatment.

*a. may resolve on their own, remain unchanged, or increase in size or number.* Untreated genital warts do not lead to AIDS. Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. *They may lead to cervical or other pelvic reproductive types of cancer.*

A client with chronic obstructive pulmonary disease *(COPD)* is recovering from a myocardial infarction. Because the client is extremely weak and *can't produce an effective cough*, the nurse should monitor closely for: pleural effusion. pulmonary edema. atelectasis. oxygen toxicity.

*atelectasis. * In a client with COPD, an *ineffective cough impedes secretion removal*. This, in turn, causes *mucus plugging*, which leads to localized airway obstruction — a known cause of *atelectasis*. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

A nurse is teaching a group of college-aged men about the *risks of Chlamydia trachomatis and Neisseriae gonorrhoeae*. A participant has implied that men do not need to be particularly concerned about these diseases since the health consequences for men are comparatively minor. The nurse counters that *men may in fact become infertile because* these diseases can cause: a. Priapism b. Epididymitis c. Incarcerated hernias d. Hydrocele

*b. Epididymitis* In men younger than 35 years of age, the major cause of epididymitis or orchitis is C. trachomatis. Both conditions can result in infertility. Priapism, hernias, and hydrocele are not sequelae of C. trachomatis and N. gonorrhoeae.

A student nurse is developing a teaching plan for a patient with chronic obstructive pulmonary disease (COPD). What should the student include as a priority area of teaching? a. Avoiding extremes of heat and cold b. Setting and accepting realistic short-term and long-range goals c. Adopting a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity d. Avoiding emotional disturbances and stressful situations that might trigger a coughing episode

*b. Setting and accepting realistic short-term and long-range goals * A major area of teaching involves setting and accepting realistic short-term and long-range goals. The other options should also be included in the teaching plan, but they are not areas that are as significant as setting and accepting realistic goals.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called a. blast cells. b. megaloblasts. c. mast cells. d. monocytes.

*b. megaloblasts.* Megaloblasts are abnormally large erythrocytes. Blast cells are primitive white blood cells (WBCs). Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

A nurse has been asked to be a guest speaker at a local high school. The topic is STIs. When preparing the presentation, which *STI* would the nurse identify as *most common in young, sexually active people*? a.genital herpes b.HPV c.chlamydia d.gonorrhea

*b.HPV * Human papillomavirus (HPV) infection is the most common STI among young, sexually active people. Millions of Americans are infected with HPV, many unaware they carry the virus. *Chlamydia* trachomatis and Neisseria *gonorrhoeae* are the *most commonly reported STIs*. Genital herpes is not the most common.

The nurse is performing health education-related lifestyle modifications for a patient who has been newly diagnosed with hypertension. As a component of these modifications, the DASH (Dietary Approaches to Stop Hypertension) eating plan has been recommended to the patient. Which of the nurse's recommendations is most congruent with this eating plan? a. "Try to buy and consume as many organic and natural foods as you can." b. "Try to replace the complex carbohydrates in your diet with protein-rich foods." c. "Try to reduce the overall amount of fat that is in your diet." d. "If you eat four of five small meals each day, you'll find that you're able to reduce your calorie intake."

*c. "Try to reduce the overall amount of fat that is in your diet." * The DASH eating plan emphasizes fruits, vegetables, fiber, potassium, and *low-fat* dairy products, and a *reduction in animal protein, fat, and saturated fat*. Organic foods and small, frequent meals are not components of the DASH eating plan.

A nurse understands that a major concern with type 2 diabetes is: a. Older age (> 60 years). b. Obesity (>20% of IBW). c. Insulin resistance. d. Overactive insulin secretion.

*c. Insulin resistance. * A major concern with type 2 diabetes is insulin resistance, which refers to decreased tissue sensitivity to insulin. Age and body weight contribute to the diagnosis.

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? a. It is part of the required assessment information. b. It is important for the nurse to determine what type of foods the patient will eat. c. It may indicate deficiencies in essential nutrients. d. It will determine what type of anemia the patient has.

*c. It may indicate deficiencies in essential nutrients. * A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.

How should a nurse teach a patient to perform deep breathing and coughing to use postoperatively? a. The patient should take three deep breaths and cough hard three times. b. The patient should take three deep breaths and exhale forcefully, take a quick short breath and cough from deep in the lungs. c. The patient should take a deep breath in through the mouth and exhale all the air out through the mouth, take a short breath, and cough from deep in the lungs. d. The patient should rapidly inhale, hold for 30 seconds, and exhale slowly.

*c. The patient should take a deep breath in through the mouth and exhale all the air out through the mouth, take a short breath, and cough from deep in the lungs. * The patient assumes a sitting position to enhance lung expansion. The nurse then demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing deep breathing several times, the patient is instructed to breathe deeply, exhale through the mouth, take a short breath, and cough from deep in the lungs.

A 58-year-old smoker is undergoing lung function testing because of his recent history of progressive dyspnea and a productive cough. Which of the following assessment findings during spirometry would be consistent with a diagnosis of chronic obstructive pulmonary disease (COPD)? a. The patient's vital capacity is ≤75% of expected norms for his age and gender. b. The patient's SaO2 does not increase with the application of supplementary oxygen. c. The patient's ability to forcibly exhale is significantly diminished. d. The patient exhibits adventitious lung sounds during inhalation.

*c. The patient's ability to forcibly exhale is significantly diminished. * Spirometry is used to evaluate airflow obstruction. *With obstruction, the patient has difficulty exhaling or cannot forcibly exhale air from the lungs*, reducing the forced expired volume in 1 second (FEV1). Spirometry is not used to assess for adventitious lung sounds or changes in SpO2 with supplementary oxygen, although these are relevant assessment parameters for individuals suspected of having COPD. Vital capacity is a component of spirometry, but the diagnosis of COPD is not based on vital capacity in isolation.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best *promotes adequate gas exchange*? a. Encouraging the client to drink three glasses of fluid daily b. Keeping the client in semi-Fowler's position c. Using a Venturi mask to deliver oxygen as ordered d. Administering a sedative as ordered

*c. Using a Venturi mask to deliver oxygen as ordered* The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

For a client with Hodgkin lymphoma, who is at a *risk for ineffective airway clearance* and *impaired gas exchange*, the nurse places the client in a high Fowler's position to a. reduce deficits in the blood oxygen concentration. b. detect compromised ventilation. c. increase lung expansion. d. anticipate the need for airway management.

*c. increase lung expansion. * For a client with Hodgkin disease who is at a risk for *ineffective airway clearance and impaired gas exchange*, the nurse keeps the neck in the midline and places the client in a *high Fowler's* position if respiratory distress develops. *Avoiding unnecessary pressure on the trachea and positioning for increased lung expansion improve air exchange.* The nurse administers oxygen, per the physician's orders, to reduce deficits in the blood oxygen concentration. The nurse assesses the client's respiratory status during each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.

A nursing assessment of a client with *peritonitis* reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? a. tenderness and pain in the right upper abdominal quadrant b. jaundice and vomiting c. severe abdominal pain with direct palpation or rebound tenderness d. rectal bleeding and a change in bowel habits

*c. severe abdominal pain with direct palpation or rebound tenderness * Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? a. Avoid unprocessed bran. b. Avoid daily exercise. c.Drink 8 to 10 glasses of fluid daily. d. Use laxatives weekly.

*c.Drink 8 to 10 glasses of fluid daily.* The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day bc constipation can cause diverticulitis. The client should *include unprocessed bran in the diet because it adds bulk*, and should *avoid the use of laxatives* or enemas except when recommended by the physician. In addition, *regular exercise* should be encouraged if the client's current lifestyle is somewhat inactive.

Which manifestation would most likely be identified when assessing a client with *primary syphilis*? chancre fever extremity rash weight loss

*chancre* Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. *A painless lesion at the site of a primary syphilis infection is called a chancre.* *Secondary* syphilis: *Rash* on the extremities, fever, and hair loss

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the intial appropriate action by the nurse? a. Notify the health care provider. b. Irrigate the client's NG tube. c. Place the client in the high-Fowler's position. d. Assess the client's abdomen and vital signs.

*d. Assess the client's abdomen and vital signs* Signs and symptoms of perforation includes: sudden, severe upper abdominal pain (persisting and increasing in intensity); *pain may be referred to the shoulders*, especially the *right shoulder*, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

A 30-year-old type 1 diabetic has been admitted to the critical care unit with a diagnosis of diabetic ketoacidosis following a drinking binge over the course of a weekend. The nurse should anticipate that this patient will require what immediate intervention? a. IV administration of calcium gluconate b. Subcutaneous administration of 30 units of insulin glargine (Lantus) c. Oral administration of 2 g of metformin (Glucophage) d. Rapid administration of intravenous normal saline

*d. Rapid administration of intravenous normal saline* In dehydrated patients with DKA, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate. Metformin is insufficient to resolve DKA. Insulin glargine is inappropriate because of its long-acting characteristics. Administration of calcium gluconate is not a relevant intervention.

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? a. Pulse rate of 110 beats/min b. Respiratory rate of 18 breaths/min c. Blood pressure of 104/62 mm Hg d. Temperature of 102.5°F (39°C)

*d. Temperature of 102.5°F (39°C)* Intra operative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia. The pulse rate, respiratory rate, and blood pressure did not indicate a significant concern.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a sedentary lifestyle and smoking. b. a history of hemorrhoids and smoking. c. alcohol abuse and a history of acute renal failure. d. alcohol abuse and smoking

*d. alcohol abuse and smoking* The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include *alcohol abuse, smoking, and stress*. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.