Patho II TEST 1

An adult with growth hormone deficiency related to severe head trauma will be started on drug therapy with somatropin (Omnitrope). The nurse explains that a parenteral dose would need to be administered with which of the following frequencies? Once per month Once per week Three times per week Daily in the evening

Daily in the evening Somatropin (Omnitrope, Genotropin, Humatrope), which is recombinant human GH, is available for long-term replacement therapy in adults with GH deficiency. Adults with GH deficiency respond well to GH replacement and experience increased energy, increased lean body mass, a feeling of well-being, and improved body image. Mild to moderate side effects include fluid retention with swelling in the feet and hands, myalgia, joint pain, and headache. GH is given daily as a subcutaneous injection (preferably in the evening). The dosing is variable because it is adjusted based on relief of symptoms, IGF-1 levels, and the development of adverse effects.

Suspected pleural effusion findings?

Decreased breath sounds noted in lower lobe Dullness

What does the nurse expect to find in a pt with syndrome of inappropriate antidiuretic hormone? Select all that apply Low blood osmolality Increased serum osmolality Low urine specific gravity Hyponatremia Decreased urine output

Low blood osmolality Hyponatremia Decreased urine output

When managing a chest tube, you must ensure that the drainage system is above, before, or at the same level as the patient's chest.

The chest tube should remain below the chest.

A patient experiencing diabetic ketoacidosis is placed on an insulin drip to control the blood glucose level of 550 mg/dL. The nurse expects the health care provider to order which type of intravenous fluids and insulin? D5W with NPH insulin 0.9% NACL with regular insulin 0.45% NACL with glargine insulin Lactated Ringer's with lispro insulin

0.9% NACL with regular insulin

What is the purpose of pursed lip breathing?

To prevent air trapping or airway collapse during expiration.

For the most complete absorption, the recommended site for insulin injection should be into which area of the body? Abdomen Arm Thigh Buttocks

Abdomen

A patient ask the nurse, "How does acarbose work in my body?" Which information regarding the mechanism of action of acarbose will the nurse provide the patient? Acarbose enhances insulin sensitivity Acarbose slows down absorption of carbohydrates in the small intestine Acarbose increases insulin production from the pancreas Acarbose slows the inactivation of incretin hormones

Acarbose slows down absorption of carbohydrates in the small intestine Acarbose slows down absorption of carbohydrates in the small intestine. Metformin enhances insulin sensitivity. Glipizide increases insulin production from the pancreas. Sitagliptin slows the inactivation of incretin hormones.

The nurse concludes that which of the following medications ordered for a client does not carry the risk of ototoxicity? Furosemide (Lasix) Acetaminophen (Tylenol) Acetylsalicylic acid (Aspirin) Vancomycin (Vancocin)

Acetaminophen (Tylenol) Drugs that are ototoxic include aminoglycosides, erythromycin lactobionate IV, vancomycin, minocycline, Lasix, Edecrin, quinidine, nonsteroidal antiinflammatories, acetylsalicylic acid, Motrin, and antineoplastic agents.

The nurse notes in a patient's medication history that the patient will be taking octreotide (Sandostatin). Based on this finding, the nurse interprets that the patient has which disorder? Diabetes mellitus Diabetes insipidus Hypopituitarism Acromegaly

Acromegaly The most common drug used for acromegaly is octreotide (Sandostatin), a somatostatin analog that reduces GH levels to within the normal range in many patients. Octreotide is given by subcutaneous injection three times a week. The other options are not correct.

Which information is correct regarding teaching related to the use of a metered dose inhaler (MDI)? Avoid shaking the container before use to prevent air accumulation After inhaling the medication, hold breath for 10 seconds if possible Put the canister in water to determine if it is empty Notify health care provider if inhaler indicates the red zone

After inhaling the medication, hold breath for 10 seconds if possible After breathing in slowly to inhale the medication, the patient should hold his/her breath and count to 10 if possible. It is correct to shake the inhaler to activate the medication in the canister. Submerging the canister in water is not an effective way to determine if it is empty because it can cause damage to the inhaler. Inhalers do not have zones. Zones are used with peak flow meters.

Patient with severe asthma has the following VS: Tachycardia >120 bpm Tachypnea >30bpm O2 sat <90% on RA Peak exp Flow < 40% Which medication would you give? Select all that apply Inhaled salmeterol Albuterol inhaler Nebulizer ipratropium IV methamphetamines IV Methylprednisolone

Albuterol inhaler Nebulizer ipratropium IV Methylprednisolone AIM for Acute Asthma Attack A- Albuterol 1st I - Ipratropium 2nd M - Methylprednisolone

When reviewing the medical record of a patient with a new order for a carbonic anhydrase inhibitor, the nurse knows that which condition could be a potential problem for a patient taking this drug? Glaucoma Ocular hypertension Allergy to sulfa drugs Allergy to penicillin

Allergy to sulfa drugs Systemic absorption of these drugs occurs, although systemic adverse effects are unlikely. The same adverse effects listed for sulfonamide antibiotics can theoretically occur with these drugs. Patients with sulfa allergies may develop cross-sensitivities to the carbonic anhydrase inhibitors.

The nurse teaches a client that hydrocortisone is commonly combined with antibiotic ear solutions to offer which of the following effects? Antipyretic Antiinflammatory Antiseptic Antifungal

Antiinflammatory Hydrocortisone is often combined in otic medications for its antiinflammatory, antipruritic, and antiallergic effects.

During admission of a patient diagnosed with non-small cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer (select all that apply)? Asbestos exposure Exposure to uranium Chronic interstitial fibrosis History of cigarette smoking Geographic area in which he was born

Asbestos exposure Exposure to uranium History of cigarette smoking Non-small cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk, but not necessarily where the patient was born.

The nurse completes a history and physical on a patient with asthma. The nurse is most concerned about the use of which drug? Cimetidine (Tagamet) Aspirin (ASA) Hydrocortisone (Solu-Cortef) Ipratropium (Atrovent)

Aspirin (ASA) The correct answer is Aspirin. Salicylates are a known trigger for many asthma patient's because it inhibits adrenergic stimulation of the bronchioles. Since GERD is also a trigger for asthma, the use of cimetidine (Tagamet) would be therapeutic. Hydrocortisone and ipratropium are both prescribed for the treatment of asthma.

The client is brought to the emergency department with severe facial trauma from a fist fight. What is the nurse's priority in caring for this client? Assessing for manifestations of a fractured skull Assessing for a patent airway Controlling facial swelling Preserving vision

Assessing for a patent airway Upper airway obstruction is common with severe facial trauma from soft tissue edema and can be life threatening.

The nurse is caring for a pt admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). When the pt asks why her blood glucose is so high, what would be the best response by the nurse? A. Extreme hyperglycemia results from an absolute insulin deficiency due to Type I diabetes B. Extreme hyperglycemia results from an absolute insulin deficiency due to Type II diabetes C. Extreme hyperglycemia results from an insulin resistance due to type II diabetes D. Extreme hyperglycemia results from an insulin resistance due to Type I diabetes

C. Extreme hyperglycemia results from an insulin resistance due to type II diabetes

How do you dress a chest tube insertion site?

Change according to agency policy and procedure Petroleum gauze Aseptic technique Monitor for infection Document

A patient with chronic obstructive pulmonary disease (COPD) who takes high doses of corticosteroids is most at risk for developing which endocrine problem? Addison's disease Cushing's syndrome Pheochromocytoma Hypoparathyroidism

Cushing's syndrome Prolonged administration of high doses of corticosteroids is a cause of Cushing Syndrome. cushing results from hypersecretion of glucocorticoids (or in this case - high intake of the drug). The othe problems are not associated with high doses of corticosteroids.

The nurse plans to administer propranolol, to a patient hospitalized with Graves disease. Which data indicates the drug has been effective? Serum T3 and T4 increases Decrease in blood pressure and heart rate Agranulocytosis occurs Serum calcium decreases

Decrease in blood pressure and heart rate Propranolol (Inderal) is a Beta Adrenergic Blocker. This classification of medication is prescribed in the patient with Graves or hyperthyroidism to reduce the cardiovascular symptoms associated with the disease. It has not effect on T3 or T4 levels. Agranulocytosis is a serious side effect of propylthiouracil (PTU), not a desired effect. Administration of propranolol is not associated with serum calcium levels.

Which clinical manifestation is a late sign of hypoxia in the patient with chronic obstructive pulmonary disease (COPD)? Mild restlessness Anxiety Increased heart rate Decreased heart rate

Decreased heart rate Decreased heart rate or bradycardia is a LATE sign of hypoxia while mild restlessness, anxiety, and increased heart rate are all early signs.

The nurse is providing education to a 50yr old pt with newly dx type II diabetes. Which will the nurse include in teaching? A. Type II diabetes will be managed entirely with SQ insulin B. Feelings of excess hunger and thirst mean that blood sugar has dropped C. Low BG is best treated with high sugar and fatty snacks like peanut butter, crackers and whole milk D. Proper diet and exercise can reduce the s/s of type II diabetes

D. Proper diet and exercise can reduce the s/s of type II diabetes

A client is beginning drug therapy with desmopressin acetate (DDAVP). The nurse understands that it is being used to treat which of the following conditions? Dwarfism Acromegaly Diabetes insipidus Syndrome of inappropriate antidiuretic hormone release

Diabetes insipidus Desmopressin acetate (DDAVP), an analog of ADH, is the hormone replacement of choice for central DI. DDAVP can be given orally, intravenously, subcutaneously, or as a nasal spray. Assess the response (e.g., weight gain, headache, restlessness, signs of hyponatremia and water intoxication) to DDAVP. Assess the adequacy of treatment by monitoring fluid intake and output and the urine specific gravity. Notify the health care provider immediately if the patient develops increased urine volume with a low specific gravity, because this indicates the need for increased dosing of DDAVP. Teach the patient about the need for close follow-up including laboratory studies.

The nurse is most concerned about which clinical manifestation in a patient with chronic obstructive pulmonary disease? Barrel chest Increased hemoglobin level Clubbing of fingernails Distended neck veins

Distended neck veins Distended neck veins are a sign of Cor Pulmonale, a complication of COPD in which the right side of the heart becomes enlarged. The other data are expected clinical manifestations of the disease.

When administering 30 units regular insulin (Humulin R) and 70 units NPH insulin (Humulin N), the nurse will perform which action? Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Inform the patient that mixing insulins will help increase insulin production. Rotate sites at least once weekly and label the sites used on a diagram. Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption.

Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.

The client with bacterial pharyngitis and tonsillitis is allergic to penicillin. What antibiotic should the nurse be prepared to administer in place of penicillin? Amoxicillin (Amoxil) Erythromycin (E-Mycin) Cephalexin (Keflex) Tetracycline (Sumycin)

Erythromycin (E-Mycin) Cephalosporins have the same chemical structure as penicillin and most people who are allergic to penicillin will also have an allergy to the cephalosporins. Tetracyclines are not usually effective enough against streptococcal species. Erythromycin is usually just as effective as penicillin but has many more gastrointestinal side effects.

While monitoring a patient who is receiving insulin therapy, the nurse observes the awake patient to be cold, clammy, tachycardic, and shaky. Using the glucometer, the nurse assess the patient's blood glucose and notes a value of 55 mg/dL. What is the nurse's next action? Administer 25 mL of 50% glucose Feed the patient 4 ounces of orange juice Start an intravenous infusion of 0.9% NACL Give the patient a peanut butter and jelly sandwich

Feed the patient 4 ounces of orange juice Rule of 15

When caring for a pt with SIAD, what does the nurse expect to implement? Select all that apply IV maintenance fluid 0.9% normal saline Fluid restriction Sodium restriction Seizure precautions Monitor urine I&O Measure weekly weights

Fluid restriction Seizure precautions Monitor urine I&O

Which conditions or factors in a 64-year-old man diagnosed with head and neck cancer are most likely to have contributed to this health problem? He quit school at age 16 and has worked in a butcher shop for over 40 years. He uses chewing tobacco and drinks beer daily. His father also had head and neck cancer. His hobby is oil painting.

He uses chewing tobacco and drinks beer daily. The two most important risk factors are tobacco and alcohol use, especially in combination. Many environmental risk factors contribute to the development of head and neck cancer, although the actual cause is unknown. There does not appear to be a genetic predisposition to this type of cancer. Other risk factors include chewing tobacco, pipe smoking, marijuana, voice abuse, chronic laryngitis, exposure to industrial chemicals or hardwood dust, and poor oral hygiene.

The nurse is caring for a hospitalized patient with complications related to hypothyroidism. The nurse plans to hold the IV dose of levothyroxine (Synthroid) when which sign or symptom is exhibited? The patient reports being "too cold" Blood pressure is 88/56 Fatigue and lethargy Heart rate is 120 beats per minute

Heart rate is 120 beats per minute The goal of levothyroxine (Synthroid) is to replace thyroid hormone. Signs and symptoms of excess may include increased heart rate, angina, weight loss, headache, irritability, diarrhea and heat intolerance. A, B, and C are all signs and symptoms of hypothyroidism, therefore administration of the drug would help these symptoms.

A pt with a brain tumor develops diabetes insipidus, which data should the nurse expect to find? Select all that apply Dark urine with increased specific gravity High blood serum osmolality Weight gain with edema Increased thirst Sodium level below 135 Urine output 30ml/hr or less

High blood serum osmolality Increased thirst

The nurse plans to administer which drug during an Addisonian crisis after an adrenalectomy? Hydrocortisone Levothyroxine Potassium chloride Insulin

Hydrocortisone Addison's crisis is a life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones and is a complication associated with an adrenalectomy. Replacement of glucocorticoid (hydrocortisone) is needed. Levothyroxine is given for hypothyroidism. The patient in addison's crisis typically has hyperkalemia and hypoglycemia therefore potassium chloride and insulin would be contraindicated.

An 82yr old pt with COPD presents with dyspnea, restlessness, pursed lips and in tripod position complaining of anxiety, pain and 'not being able to breathe." The nurse should question which order? Select all that apply Ipratropium Hydromorphone Rescue inhaler O2 via nasal cannula 3L min Diazepam

Hydromorphone Diazepam No opioids or benzos because they depress respiratory rates

The nurse is preparing to administer SQ insulin to a pt with hyperglycemia. The nurse will monitor the pt's lab work closely for which electrolyte imbalance related to insulin administration? Hyponatremia Hypocalcemia Hyperkalemia Hypokalemia

Hypokalemia

When assessing for potential adverse effects of fludrocortisone (Florinef), the nurse monitors for signs and symptoms of which condition? Hypokalemia Hypovolemia Hyponatremia Hypercalcemia

Hypokalemia Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. Thus, a potential adverse effect is hypokalemia. Assessing for signs and symptoms of hypokalemia and close monitoring of electrolytes is needed.

An 8-year-old girl has been diagnosed with true pituitary dwarfism. She is being treated with somatropin (Omnitrope). In follow-up visits, the nurse will monitor for which expected outcome? Increased growth Decreased urinary output Increased muscle strength Increased height during puberty

Increased growth In patients for whom somatropin is indicated, increased growth is expected. Use of somatropin (Omnitrope) requires attention to the growth, motor skills, height, and weight of the pediatric patient. The other options are not correct.

The most commonly prescribed hormone for a preschool pt with idiopathic hypopituitarism?

Growth Hormone

Which action is most appropriate regarding the nurse's administration of rapid-acting insulin to a hospitalized patient? It should be administered after the meal has arrived and the patient has taken the first bite. It should be administered 0 to 15 minutes before the patient begins a meal. It should be administered 30 to 45 minutes before a meal. It should be administered an hour after a meal.

It should be administered 0 to 15 minutes before the patient begins a meal. Rapid-acting insulin is administered 0 to 15 minutes before a meal. Short-acting insulin is administered 30 to 45 minutes before a meal. Intermediate-acting insulin can be administered up to one hour prior to the meal. Long-acting insulin is administered once a day in the morning or at bedtime.

Which is most appropriate regarding the nurse's administration of short-acting insulin to a hospitalized patient? It should be administered with the first bite of the meal. It should be administered 15 minutes before the patient begins a meal. It should be administered 30 minutes before a meal. It should be administered an hour after a meal.

It should be administered 30 minutes before a meal.

The nurse teaches the patient that which drug classification has both bronchodilator and anti-inflammatory effects? Anti-IgEs Aminoglycocides Leukotriene modifiers Oxygen

Leukotriene modifiers Leukotriene modifiers or inhibitors provide bronchodialating effects by blocking the action of leukotrienes which are potent bronchoconstrictors. They also provide anti-inflammatory effects. Anti-IGE's or Monoclonal antibody to IgE's decrease circulating IgE levels. Aminoglycosides (antibiotics) and oxygen and do not provide bronchodilator or anti-inflammatory effects.

The nurse admitting a patient with syndrome of inappropriate antidiuretic hormone (SIADH) knows the most common cause of elevated levels of antidiuretic hormone (ADH) secretion is considered which of the following? An autoimmune disease Lung cancer Pregnancy Heart failure

Lung cancer SIADH occurs when ADH is released despite normal or low plasma osmolarity. SIADH results from an abnormal production or sustained secretion of ADH. This disorder is characterized by fluid retention, serum hypoosmolality, dilutional hyponatremia, hypochloremia, concentrated urine in the presence of normal or increased intravascular volume, and normal renal function. This syndrome occurs more commonly in older adults. SIADH has various causes. The most common cause is malignancy, especially small cell lung cancer. This relationship is strong enough that an evaluation for the presence of such a tumor is recommended when SIADH is otherwise unexplained. SIADH tends to be self-limiting when caused by head trauma or drugs but is chronic in nature when associated with tumors or metabolic diseases.

Would the nurse expect A.W.'s lung to re-expand immediately after the chest tube insertion and initiation of underwater suction?

Not necessarily. It can take hours to days for the lungs to inflate completely.

The nurse cares for a patient who is diagnosed with bacterial pneumonia. Which task is most important for the nurse to complete before administering the prescribed piperacillin / tazobactam (Zosyn)? Teach the patient to cough and deep breathe. Take the temperature, pulse,and respiratory rate. Obtain a sputum specimen for culture and gram stain. Check the patient's oxygen saturation by pulse oximetry.

Obtain a sputum specimen for culture and gram stain. RATIONALE: A sputum specimen for culture and gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks.Antibiotics are taught in NUR3420 Patho/Pharm I in the antibiotic unit. This question includes application of previously learned content to patients with respiratory disorders. It must be emphasized that culture specimens should be obtained before drug therapy is initiated whenever possible. Otherwise, the presence of antibiotics in the tissues may result in misleading culture results. However, sometimes it is not possible to obtain a sample (especially sputum) in a reasonable amount of time, and antibiotic therapy should be begun without a sample in that situation. If an organism is identified in the laboratory, it is then tested for susceptibility to various antibiotics. The results of these tests can confirm whether the empiric therapy chosen is appropriate for eradicating the organism identified. If not, therapy can be adjusted to optimize its efficacy against the specific infectious organism(s). Once the results of culture and sensitivity testing are available (usually in 48 to 72 hours), the antibiotic therapy is then tailored to treat the identified organism by using the most narrow-spectrum, least toxic drug based on sensitivity results. This is known as definitive therapy.

When assessing your patient with a chest tube to dry suction, you find that there is bubbling in the water seal chamber. Is this to be expected? Yes, chest tubes connected to water suction always have bubbling in the water seal chamber. Yes, but only if the patient is at least 24 hours post-op. No, this is indicative of an air leak and must be addressed immediately. Possibly, depending on the type of injury or surgical procedure the patient experienced.

No, this is indicative of an air leak and must be addressed immediately This patient's chest tube is a dry suction chest tube therefore there should not be any bubbling in the water seal chamber. There's no information in the stem as to whether the patient has a new chest tube or not. We only see bubbling with new insertion of chest tubes, coughing, sneezing, or intermittently with exhalation. Bubbling in the water seal chamber should not occur otherwise.

Do you ever "milk" or "strip" a chest tube? Why?

No. You should not "milk" or "strip" the chest tube because doing so increases the intrathoracic pressure and can cause barotrauma. Please connect this back to your Patho/Pharm course. You may see some nurses do this in practice. Please do not do this.

The nurse is most concerned about which clinical manifestation when caring for the hospitalized patient with asthma? Peak flow is in the green zone Loud wheezing Productive cough Patient becomes disoriented

Patient becomes disoriented A new onset of confusion or disorientation indicates decreased oxygenation to the brain and the nurse should take immediate action. A peak flow in the green zone is desirable. Productive cough indicates the patient is clearing his/her own airway and is therapeutic. Loud wheezing indicates some airflow and is less ominous than confusion. A silent chest is an ominous sign.

Chest tube: What do you need to assess? How and why do you assess these things?

Patient's clinical status Assess:Vital signs, lung sounds, pain Drainage amount Drainage site infection Subcutaneous emphysema Encourage:Deep breathing/Incentive spirometry Range-of-motion exercises

A patient is born with an α-antitrypsin deficiency. Which of the following conditions will most likely manifest? Asthma Primary emphysema Pulmonary fibrosis ARDS

Primary emphysema Primary emphysema is the only option that involves an α-antitrypsin deficiency.

To prevent the development of oral candidiasis when using corticosteroid inhalers, which instruction is MOST important for the nurse to teach the patient? Rinse the mouth after each use. Minimize use of an inhaler to every other day. Swish and swallow with Mycostatin after each use. Report any gingival irritation to the health care provider.

Rinse the mouth after each use. It is most important to teach patients to rinse their mouth with lukewarm water after each use of a steroid inhaler to prevent the occurrence of oral candidiasis, a fungal infection. Mycostatin is not routinely used to prevent this infection unless the patient is immunocompromised. Reporting irritation after it has occurred does not prevent the infection. Minimizing the use of the inhaler to every other day negates its therapeutic effect.

The nurse administers a hydrocortisone (Solu-Cortef) IV to a patient with chronic obstructive pulmonary disease (COPD). Which data following administration of the medication requires the most immediate action by the nurse? Serum K+ 2.9 mEq/L Striae and bruising Menstrual irregularities White blood cell count 5000

Serum K+ 2.9 mEq/L This potassium level—Serum K+ 2.9 mEq/L— is dangerously low which puts the patient at risk for cardiac complications and requiring immediate action. Striae and bruising and menstrual irregularities are expected side effects and are not as high priority. Although immunosuppression is a side effect, a WBC of 5000 is still within defined parameters.

What does the nurse need to document regarding A.W.'s chest drainage system?

Most institutions have the nurse document the character, color, and amount of pleural drainage every eight hours and as needed. The nurse needs to note the presence or absence of an air leak every eight hours and the amount of suction being delivered. Mark the level of drainage on chest drainage system columns a minimum of every eight hours and record the amount of output. Related assessment findings that need to be documented include A.W.'s lung sounds, respiratory pattern, pulse oximetry, vital signs, and pain level.

When planning care for a post-op patient with metastatic lung cancer and a 60-pack-per-year history of cigarette smoking, the nurse recognizes that the smoking has most likely decreased the patient's underlying respiratory defenses because of impairment of which of the following? Cough reflex Mucociliary clearance Reflex bronchoconstriction Ability to filter particles from the air

Mucociliary clearance RATIONALE: Cigarette smoke has several direct effects on the respiratory tract. The irritating effect of the smoke causes hyperplasia of cells, including goblet cells, which subsequently results in increased production of mucus. Hyperplasia reduces airway diameter and increases the difficulty in clearing secretions. Smoking reduces the ciliary activity and may cause actual loss of cilia. Smoking also produces abnormal dilation of the distal air space with destruction of alveolar walls. Many cells develop large, atypical nuclei, which are considered a precancerous condition. After a short time of smoking, changes in small airway function can develop. In the early stages these changes are mostly inflammatory with mucosal edema and an influx of inflammatory cells. In later stages, however, thickening of the airway wall occurs by a remodeling process related to tissue repair and the inability of cilia to clear mucus, thus resulting in accumulation of inflammatory exudates in the airway lumen. Quitting smoking can prevent or delay the development of airflow limitation or reduce its progression. Ciliary action is impaired by dehydration, smoking, inhalation of high oxygen concentrations, infection, and ingestion of drugs such as atropine, anesthetics, alcohol, or cocaine. Patients with COPD and cystic fibrosis have repeated lower respiratory infections. Cilia are often destroyed during these infections, resulting in impaired secretion clearance, a chronic productive cough, and chronic colonization by bacteria, which leads to frequent respiratory infections. Pre/Post-op care is taught in NUR3316 Human Need I in the pre/post-op surgical care unit. This question includes application of previously learned content to patients with respiratory disorders. During general anesthesia the lungs are not fully inflated during surgery and the cough reflex is suppressed, so mucus collects within airway passages. After surgery, client may have reduced lung volume and require greater efforts to cough and deep breathe; inadequate lung expansion can lead to atelectasis and pneumonia. Previous chronic lung conditions increase clients' risk for developing respiratory complications. Smoking damages ciliary clearance and increases mucus secretion. Reduced hemoglobin level leads to inadequate oxygenation.

Which intervention should the nurse focus on for self-care for the client who has a simple closed fracture of the nose? Advise the client not to eat or drink for at least 24 hours. Teach the client how to apply ice packs to the area. Urge the client to sleep without a pillow until the swelling has resolved. Reassure the client that his or her appearance will return to normal after the swelling has resolved and the nose has healed.

Teach the client how to apply ice packs to the area. Simple nasal fractures, although painful, do not require surgical intervention or fixation. Swelling can be extensive. Ice packs can help prevent or reduce swelling and relieve some of the discomfort.

While A.W. has a chest drainage system, what instructions does the nurse need to give to the nursing assistive personnel (NAP) who is working with A.W.?

The NAP must keep the drainage system below A.W.'s chest at all times. The patient may ambulate with the chest tube; the drainage system should be kept on the side of insertion. The chest tube tubing should be kept as straight as possible, avoiding kinks and dependent loops. If A.W. has already been taught, the NAP can encourage A.W. to cough, deep breathe, and use the incentive spirometer.

When assessing the patient experiencing the classic symptoms of diabetes insipidus, the nurse recognizes which symptom is directly related to a lack of antidiuretic hormone (ADH)? polyuria. polydipsia. glucosuria. polyphagia.

polyuria Diabetes insipidus (DI) is associated with a deficiency of production of or secretion of ADH or a decreased renal response to ADH. The decrease in ADH results in fluid and electrolyte imbalances caused by increased urinary output and increased plasma osmolality. Individuals with diabetes insipidus have a partial to total inability to concentrate urine. Insufficient ADH activity causes excretion of large volumes of dilute urine (polyuria), leading to increased plasma osmolality. In conscious individuals, the thirst mechanism is stimulated and induces polydipsia—usually a craving for cold drinks.

A patient is admitted to the hospital with a fasting blood glucose of 210 mg/dL. When taking the history, the nurse correctly identifies which clinical manifestations as signs and symptoms of diabetes mellitus? Select all that apply. polyuria polydysplasia polydipsia polyrrhea polyphagia

polyuria polydipsia polyphagia Classic symptoms of diabetes mellitus include: polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger). The other two answers are incorrect.

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure? acarbose (Precose) glipizide (Glucotrol) repaglinide (Prandin) metformin (Glucophage)

metformin (Glucophage)

The nurse's patient care assignment includes three patients diagnosed with diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone (SIADH). The nurse understands these three patients share which of the following clinical manifestations? Polyuria Edema Vomiting Thirst

Thirst Because the onset of type 1 diabetes mellitus is rapid, the initial manifestations are usually acute. The classic symptoms are polyuria, polydipsia, and polyphagia. Diabetes insipidus (DI) is characterized by polydipsia and polyuria. Initially in syndrome of inappropriate antidiuretic hormone (SIADH) patient displays thirst, dyspnea on exertion, and fatigue.

What is tidaling?

Tidaling is the fluctuation of water with pressure changes during respiration. It disappears as the lung re-expands. If it stops suddenly, check for occlusion.

The nurse instructs a patient with a pulmonary embolism about enoxaparin (Lovenox). Which statement by the patient indicates understanding about the instructions? "I will give the injection in my abdomen at least 2 inches away from my navel." "I need to take this medicine at the same time every day with a full glass of water." "I will massage the injection site thoroughly after giving the medication." "I will take this medication the rest of my life to prevent pulmonary embolisms."

"I will give the injection in my abdomen at least 2 inches away from my navel." RATIONALE: Enoxaparin is a low-molecular weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clots. Fibrinolytic agents (e.g., tissue plasminogen activator or alteplase) will dissolve an existing clot. Enoxaparin is administered subcutaneously by injection. Medication administration is taught in NUR3414 Introduction to Professional Nursing Practice. This question includes application of previously learned content to patients with respiratory disorders LMWHs are synthetic and have a smaller molecular structure. These include enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep). All three work similarly to heparin. Heparin primarily binds to activated factors II, X, and IX. LMWHs differ from heparin in that they are much more specific for activated factor X (Xa) than for activated factor II (IIa, or thrombin). This property confers on LMWHs a much more predictable anticoagulant response. As a result, frequent laboratory monitoring of bleeding times using tests such as activated partial thromboplastin time (aPTT), which is imperative with unfractionated heparin, is not required with LMWHs.All LMWHs have a distinct advantage over heparin in that it does not require any laboratory monitoring and can be given at home for the treatment of DVT or pulmonary embolism. This allows patients to be discharged from the hospital sooner. It is also used at home after major orthopedic surgery.With heparin and LMWHs, it is critical to patient safety to continually assess the skin to identify potential subcutaneous injection sites. For these injection sites, the standard is to avoid any area within 2 inches of the umbilicus, open wounds, scars, open or abraded areas, incisions, drainage tubes, stomas, or areas of bruising or oozing, because these sites would be at higher risk for further tissue damage with injection of the anticoagulant. Appropriate sites for injection of subcutaneous heparin and LMWHs include the upper, outer area of the arms, the thigh, and the subcutaneous fatty area across the lower abdomen and between the iliac crests.For injections of heparin or other subcutaneous anticoagulants (LMWH), follow the manufacturer's recommendations for injection technique as needed. Many manufacturers recommend the area of the abdomen known as the "love handles" for injection of anticoagulants. DO NOT ASPIRATE before injecting and DO NOT massage the site after injection. These actions may cause a hematoma at the injection site.Some drugs (i.e., heparin and insulin) must be checked by two licensed nurses.

The nurse is caring for a patient with hyperparathyroidism who had a parathyroidectomy. The nurse is most concerned about which sign or symptom? Tingling of the hands and around the mouth Pain at the surgical incision site Surgical dressing has 5 ml of bloody drainage Decreased appetite

Tingling of the hands and around the mouth Tingling of the hands and around the mouth are symptoms of mild tetany or low calcium. When the parathyroid is removed, the patient is at risk for hypocalcemia. If not noted, this can lead to tonic spasms of the smooth muscle causing laryngospasm and respiratory arrest.

The nurse is caring for a patient with hyperparathyroidism who had a parathyroidectomy. The nurse is most concerned about which sign or symptom? Tingling of the hands and around the mouth Pain at the surgical incision site Surgical dressing has 5 ml of bloody drainage Decreased appetite

Tingling of the hands and around the mouth Tingling of the hands and around the mouth are symptoms of mild tetany or low calcium. When the parathyroid is removed, the patient is at risk for hypocalcemia. If not noted, this can lead to tonic spasms of the smooth muscle causing laryngospasm and respiratory arrest. B, C, and D are all expected in this patient.

When watching a patient self-administer eardrops, the home heath nurse observes all the following actions by the patient. Which patient action indicates a need for more teaching? The patient gets the eardrops out of the refrigerator just before administering the drops. The patient lies down before and for 2 minutes after administering the drops. The patient holds the tip of the dropper 1 cm above the ear while administering the drops. The patient leaves the ear wick in place while administering the drops.

The patient gets the eardrops out of the refrigerator just before administering the drops. Administration of cold ear drops can cause dizziness because of stimulation of the semicircular canals. The other patient actions are appropriate.

What is the best method for minimizing the spread of tuberculosis? Safe sex practices Wearing a HEPA mask Good handwashing technique Frequent rinsing of the nasal mucosa

Wearing a HEPA mask Tuberculosis is very contagious and is transmitted via air droplet, so wearing a HEPA mask would be most appropriate. The other options have no effect on this form of transmission.

The nurse is assessing a pt dx with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which manifestations does the nurse expect? Weight loss, increased urine output, hyperglycemia Weight gain, respiratory acidosis, hyperkalemia Increased urine output, dehydration, metabolic acidosis Hyperglycemia, ketoacidosis, decreased urine output

Weight loss, increased urine output, hyperglycemia Weight loss = water loss High sugar H - Highest sugar over 600+ H - Higher fluid loss, extreme dehydration H - Head change - confusion N - No ab pain No ketones S - Slower onset, Stable K+ (3.5-5.0)

How do you know a patient is ready for the chest tube to come out? How do you assess for readiness to DC the chest tube?

When lungs re-expanded and drainage minimal Pre-medicate prior to removal Valsalva maneuver during removal Apply occlusive dressing Chest x-ray Monitor for respiratory distress

To achieve the most beneficial effect, when should the nurse plan to administer acarbose (Precose)? With the first bit of food. 30 minutes before a meal. 15 minutes postprandial. At bedtime.

With the first bit of food.

AW goes to surgery for major thoracic surgery and comes back to you. Shortly after she arrives to the floor, you assess her and find there is only 10mL of blood in the collection chamber of her chest tube, and the recovery nurse did not report having emptied it. Is this a problem and, if so, what should you do first? Yes, this is a problem; check for clamped tubing. Yes, this is a problem; remove the chest tube. No, this is not a problem unless the patient is complaining of shortness of breath. No, this is not an issue unless the patient reports having chest pain.

Yes, this is a problem; check for clamped tubing. This is a problem because more than likely directly after surgery your patient would have more than just 10 milliliters of blood in a chest tube. There's probably a kink somewhere or a clot caught in it or clamp in the tubing. The nurse needs to check the tubing for any of those things.

When assessing your patient with a chest tube, you feel a "crackling" sensation when palpating the skin surrounding the chest tube. How do you assess this? Why would you assess for this? What is the name of this complication and what causes it?

You assess the "crackling" by feeling gently around the chest tube insertion site. You would want to assess this to check for air leaks under the skin. This complication is called subcutaneous emphysema.

A client with central diabetes insipidus experiences a urine output of 10 liters in 24 hours. The nurse anticipates that the intravenous (IV) therapy that will be used to replace this type of loss is which of the following? 0.45% normal saline (1/2 NS) 10% dextrose (D10) Total parenteral nutrition (TPN) 3% NACL (3% NS)

0.45% normal saline (1/2 NS) For central DI, fluid and hormone replacement is the cornerstone of treatment. Fluids are replaced orally or intravenously, depending on the patient's condition and ability to drink copious amounts of fluids. In acute DI, hypotonic saline {hypotonic solutions include 0.2% NaCl, 0.45% NaCl, and 2.5% dextrose or dextrose 5% in water (D5W) is given intravenously and titrated to replace is urinary output. Adequate fluids should be kept at the bedside.

A client with central diabetes insipidus experiences a urine output of 10 liters in 24 hours. The nurse anticipates which intravenous (IV) therapy will be used to replace this type of fluid loss? 0.45% normal saline (1/2 NS) 10% dextrose (D10) Total parenteral nutrition (TPN) 3% NACL (3% NS)

0.45% normal saline (1/2 NS) For central DI, fluid and hormone replacement is the cornerstone of treatment. Fluids are replaced orally or intravenously, depending on the patient's condition and ability to drink copious amounts of fluids. In acute DI, hypotonic saline {hypotonic solutions include 0.2% NaCl, 0.45% NaCl, and 2.5% dextrose or dextrose 5% in water (D5W) is given intravenously and titrated to replace is urinary output. Adequate fluids should be kept at the bedside.

What is the correct order of Huff coughing technique?

1. Sit upright in a chair 2. Deep slow inhalation through mouth using diaphragm muscle 3. Hold breath 2-3 seconds and then FORCEFULLY exhale 4. Repeat HUFF once or twice more and avoid from normal coughing 5. Rest for 5-10 normal breaths and repeat as needed until secretions clear

A patient is admitted to the emergency room with hypertensive crisis and suspected pheochromocytoma. The nurse expects to teach the patient about which diagnostic test? 24 hour urine collection Thyroid stimulating hormone (TSH) Anti-diuretic hormone (ADH) Serum osmolality

24 hour urine collection A 24 hour urine test is collected to measure urinary fractionated metanephrines and catecholamines in a 24 hour period. With pheochromocytoma, a catecholamine-producing tumor is usually found in the adrenal medulla and secretes epinephrine and norepinephrine which leads to hypertensive crisis.

When administering vasopressin, which vital sign is a priority for the nurse to monitor? temperature pulse respirations blood pressure

blood pressure Vasopressin is available as a nasal spray or as an intramuscular or intravenous injection. Always check the clarity of parenteral solutions before administering the medication. Discard the solution if there are visible particles or any fluid discoloration. Be alert to the adverse effects of elevated blood pressure, fever, nausea, or abdominal cramping. If these worsen or persist, notify the prescriber immediately.

Which patient is at highest risk of aspiration? A 26-year-old patient with continuous enteral tube feedings through a nasogastric tube. A 67-year-old cancer patient who had an exacerbation of herpes simplex virus-2 (HSV-2). A 58-year-old patient with absent bowel sounds a day after abdominal surgery. A 92-year-old patient with viral pneumonia and coarse crackles throughout lung fields.

A 26-year-old patient with continuous enteral tube feedings through a nasogastric tube. RATIONALE: Conditions that increase the risk of aspiration include decreased level of consciousness, difficulty swallowing (dysphagia), and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Herpes simplex virus-2 (HSV-2) is genital herpes. Absent bowel sounds and coarse crackles do not increase the risk for aspiration.Aspiration pneumonia refers to the condition that occurs from abnormal entry of secretions or substances into the lower airway. It usually follows aspiration of material from the mouth or stomach into the trachea and subsequently the lungs. Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, or alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. The dependent portions of the lung are most often affected, primarily the superior segments of the lower lobes and the posterior segments of the upper lobes, which are dependent in the supine position.Aspiration precautions are taught in NUR3414 Professional Practice I in the nutrition unit. This question includes application of previously learned content to patients with respiratory disorders. The client who has a feeding tube is at risk for aspiration. To prevent aspiration, position the client in high-Fowler's position when administering a feeding.

A patient has come to the emergency department with an eye injury. After fluorescein (AK-Fluor) is applied, the nurse notes an area with a green halo. The nurse suspects that the patient has which condition? A corneal blemish A conjunctival lesion A floating contact lens A foreign object

A foreign object Fluorescein (AK-Fluor) is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. It is also used in fitting hard contact lenses. After the instillation of fluorescein, various defects are highlighted in either bright green or yellow-orange, and foreign objects have a green halo around them. Fluorescein is available for use as an ophthalmic injection, solution, and diagnostic applicator strips. Dose determination and drug administration are usually carried out by an ophthalmologist.

The nurse should avoid administering Beta2 adrenergic agonists such as albuterol (Proventil) to the patient with which of the following? A history of cardiac disorders When onset of action is needed in minutes Theophyline level is 18 mcg/ml Dryness of the mouth

A history of cardiac disorders Beta 2 adrenergic agonists can increase B/P and heart rate and increase risk of dysrhythmias so it should be avoided or used with extreme caution in the patient with a history of cardiac disorders. Albuterol is a short-acting B2 adrenergic agonist and has an onset within minutes. Theophylline levels are indicated when administering methylxanthines and an 18 is a desired therapeutic level. Dryness of the mouth is an expected side effect.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? insulin glargine (Lantus) insulin glulisine (Apidra) regular Insulin (Humulin R) NPH insulin (Humulin N)

insulin glargine (Lantus)

Which of the following is a rapid-acting insulin with an onset of action of less than 15 minutes? insulin glargine (Lantus) insulin lispro (Humalog) regular insulin (Humulin R) insulin detemir (Levemir)

insulin lispro (Humalog)

The nurse is observing a student who is preparing to perform an ear examination of a 70-year-old patient. The nurse will need to intervene if the student: pulls the auricle of the ear down and backward. chooses a speculum smaller than the ear canal. stabilizes the hand holding the otoscope on the patient's head. stops inserting the otoscope after observing impacted cerumen.

pulls the auricle of the ear down and backward. The auricle should be pulled up and back when assessing an adult. The other actions are appropriate when performing an ear examination.

Which insulin can be administered by continuous intravenous infusion? insulin glargine (Lantus) insulin aspart (Novolog) regular Insulin (Humulin R) insulin detemir (Levemir)

regular Insulin (Humulin R)

A patient presents to the clinic suffering from shortness of breath, weight loss, excessive sweating, exophthalmos, and irritability. Which hormone would the nurse expect to find elevated in the serum? cortisol thyroxine ACTH 17-ketosteroid

thyroxine The two primary laboratory findings used to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels (<0.4 mU/L) and elevated free thyroxine (free T4) levels. Total T3 and T4 levels may also be assessed, but they are not as definitive. Total T3 and T4 determine both free and bound (to protein) hormone levels. The free hormone is the only biologically active form of these hormones. The RAIU test is used to differentiate Graves' disease from other forms of thyroiditis. The patient with Graves' disease shows a diffuse, homogeneous uptake of 35% to 95%, whereas the patient with thyroiditis shows an uptake of less than 2%. The person with a nodular goiter has an uptake in the high normal range.

The nurse is caring for a pt admitted for DKA. Which is the priority assessment for pts with this diagnosis? urine output daily weights equality of radial pulses rectal temp

urine output To see how dry the pt will get. Dehydration

The nurse prepares to administer the influenza nasal spray to a 35-year-old female patient. The nurse should ask which question before administration of this vaccine? "Are you pregnant?" "Do you have an allergy to poultry meat?" "Have you ever had hepatitis B?" "Have you been exposed to the influenza virus?"

"Are you pregnant?" RATIONALE: The live attenuated influenza vaccine is given by nasal spray and approved for healthy people age 2 years to 49 years. The LAIV is given only to nonpregnant, healthy people. The inactivated vaccine is given by injection and is approved for use in people 6 months or older. The inactivated vaccine can be used in pregnancy, in people with chronic conditions, or in people who are immunosuppressed. Influenza vaccination is contraindicated if the person has a history of Guillain-Barrè syndrome or a hypersensitivity to eggs. Vaccines are taught in NUR3420 Patho/Pharm I in the immunity/autoimmunity unit. This question includes application of previously learned content to patients with respiratory disorders. LIVE ATTENUATED INFLUENZA VACCINE (LAIV) is given by nasal spray, approved for healthy people ages 2 years to 49 years, given only to nonpregnant, healthy people.

A pituitary drug is prescribed for a patient with a hormone deficiency, and the nurse provides instructions about the medication. Which statement by the patient indicates a need for further instructions? "I will call my doctor if I have joint or muscular pain." "I will have my vision checked on an annual basis." "I will have a nightly glass of wine to relax me." "I will a wear medical alert bracelet at all times."

"I will have a nightly glass of wine to relax me." Patient teaching related to pituitary drugs includes: 1. The patient should avoid alcohol while taking any of the pituitary drugs. There should also be instructions about not abruptly discontinuing this drug due to possible negative consequences to the patient and levels of pituitary hormones. 2. Counsel the patient that the medication does not lead to a cure but does help alleviate the symptoms of the disease for which it is being given. 3. As for any medication or illness, the patient should keep a medical alert bracelet, necklace, or wallet card on the person at all times. 4. Any fever, sore throat, joint pain, or muscular pain should be reported to the prescriber immediately. 5. Parents should be educated about the fact that children with endocrine disorders may have an increased risk of bone problems and instructed that if they notice their child limping, this should be reported immediately to the prescriber. 6. Diabetic patients need to be monitored closely for changes in serum glucose levels. 7. Ophthalmologic examinations are recommended.

The nurse teaches a patient who is prescribed budesonide (Rhinocort) intranasal spray for seasonal allergic rhinitis. The nurse determines that medication teaching is successful if the patient makes which statement? "I will use the medication every day whether I have symptoms or not." "The medication will decrease congestion within 3 to 5 minutes after use." "I may develop a serious infection because the medication reduces my immunity. "My liver function will be checked with blood tests every 2 to 3 months.

"I will use the medication every day whether I have symptoms or not." RATIONALE: Budesonide should be started 2 weeks before pollen season starts and used on a regular basis, and not as needed. The spray acts to decrease inflammation and the effect is not immediate, as with decongestant sprays. At recommended doses, budesonide has only local effects and will not result in immunosuppression or a systemic infection. Zafirlukast (Accolate) is a leukotriene receptor antagonist and may alter liver function tests (LFTs). LFTs must be monitored periodically in the patient taking zafirlukast.With intranasal dosage forms of steriods, nasal passages should be cleared before administration. The head should be tilted slightly forward and the spray tip inserted into one nostril and pointed toward the inflamed nasal turbinates. The medication should be pumped into the nasal passage as the patient sniffs inward while holding the other nostril closed. This procedure should then be repeated in the other nostril. Any unused portion should be discarded after 3 months or by the expiration date.Corticosteroids Nasal Sprays, beclomethasone (Vancenase), budesonide (Rhinocort), ciclesonide (Omnaris), flunisolide (Nasalide), fluticasone (Flonase), fluticasone furoate, Veramyst), mometasone (Nasonex), triamcinolone (Nasacort).These drugs inhibit inflammatory response. At recommended dose, systemic side effects are unlikely because of low systemic absorption. Systemic effects may occur with greater than recommended doses. Mild transient nasal burning and stinging may be present. In rare instances, localized fungal infection with Candida albicans may develop.Teach the patient to 1) Begin 2 wk before pollen season starts and use throughout pollen season. 2) Instruct patient to use on regular basis and not PRN. 3) Reinforce that spray acts to decrease inflammation and effect is not immediate, as with decongestant sprays. 4) Discontinue use if nasal infection develops.

The nurse concludes that a patient newly diagnosed with glaucoma knows the purpose for the prescribed beta-adrenergic blocker timolol (Timoptic) when the client makes which statement? "This eyedrop will reduce the intraocular pressure." "I can stop using the eyedrop once my intraocular pressure is normal." "The medicine will help to increase my intraocular pressure." "This eyedrop is the only treatment available for glaucoma."

"This eyedrop will reduce the intraocular pressure." Ophthalmic beta-blockers such as timolol (Timoptic) are administered to reduce intraocular pressure (IOP) by decreasing production of aqueous humor. The medication must be continued as lifelong therapy to maintain a stable IOP. Glaucoma already involves increased IOP so the medication is not given to raise it. Other drug groups may be utilized for the treatment of glaucoma as well as surgical intervention.

The client, a 70-year-old woman who has mild congestive heart failure, asks when she should get a flu shot. What is the nurse's best response? "If you got a flu shot last year, you need to make sure that you get the new shot exactly 1 year later." "You should get a flu shot early in the fall so that you make enough antibodies before the flu season arrives." "Since we don't know if the flu will come this year, you should wait until an outbreak of flu in our area is reported." "Because flu shots are good for five years at a time, if you got a flu shot last year you do not need to get another one this year."

"You should get a flu shot early in the fall so that you make enough antibodies before the flu season arrives." People over age 50 and those with chronic disease should be vaccinated against the flu each year early in the fall. The major flu season is late fall and winter. It takes 3 to 8 weeks to develop enough antibodies from the flu shot to be able to protect against the flu after exposure. If a client waits until the flu season hits to get the flu shot, he or she may be exposed to the flu before sufficient antibodies have been developed. Flu shots appear to be effective for only one flu season, depending on the specific virus causing the flu each year.

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at which time of the day? 10:00 AM 2:00 PM 8:00 PM 11:00 PM

2:00 PM

The head of the bed should be elevated to which degree, when preparing for chest tube insertion? 0 degrees (flat) 0-30 degrees 30-60 degrees 60-90 degrees

30-60 degrees When inserting a chest tube, the patient should be between 30 and 60 degrees.

At 8:00 AM, the nurse administers 12 units of lispro insulin to the patient diagnosed with diabetes. The nurse observes the patient for symptoms of hypoglycemia during which time frame? 8:30 AM -11:00 AM 10:00 AM - 12:00 AM 12:00 PM - 8:00 PM No peak of the medication is expected

8:30 AM -11:00 AM Rapid Acting (lispro, Humalog) Peak 30min-1hr Short acting (Regular, Humulin R) Peak 2-5hr Int. Acting (NPH, Humulin N) Peak 4-12hr Long acting (glargine, Lantus) Not peak

When asked by a new grad about the etiology of Type II diabetes how does the nurse respond? A. Type II diabetes results from a resistance to circulating insulin B. Pts with Type II diabetes require lifelong SQ insulin replacement C. Type II diabetes is an autoimmune d/o in which the beta cells of the pancreas don't produce insulin C. Type II diabetes results from surgical removal of the pancreas

A. Type II diabetes results from a resistance to circulating insulin

When administering levothyroxine, the nurse assesses the patient's heart rate and notes an apical pulse of 67 bpm? What is the nurse's priority action? Call the physician for an increase in dose Administer the levothyroxine as scheduled Return in an hour and reassess the heart rate to see if it has increased Hold the medication and contact the health care provider

Administer the levothyroxine as scheduled The levothyroxine should be administered as scheduled. The patient's heart rate is within normal limits and does not indicate a need to contact the health care provider. If the patient's heart rate is above 100, the levothyroxine should be held and the health care provider contacted.

The nurse would question which medication order for a client with PACG (primary angle-closure glaucoma)? Atropine 1 to 2 drops in each eye now Hydrochlorothiazide 25 mg PO daily Propranolol 20 mg PO two times a day Carbamylocholine eye drops, 1 drop two times a day

Atropine 1 to 2 drops in each eye now Atropine causes mydriasis or pupillary dilation, which can precipitate an attack of acute glaucoma. It should be questioned if it is ordered for a client with glaucoma. The other drugs would be safe for a client with glaucoma. Atropine causes mydriasis or pupillary dilation, which can precipitate an attack of acute glaucoma. It should be questioned if it is ordered for a client with glaucoma. The other drugs would be safe for a client with glaucoma.

The nurse teaches the patient admitted with diabetes mellitus that intracellular dehydration and thirst is the result of which pathological process? Because of elevated blood glucose levels, water is osmotically attracted from body cells. Hyperglycemia acts as an osmotic diuretic, resulting in glycosuria. Depletion of cellular stores of carbohydrates, fats, and protein results in cellular starvation. Weight loss occurs because of fluid loss in osmotic diuresis and loss of body tissue as fats and protein are used for energy.

Because of elevated blood glucose levels, water is osmotically attracted from body cells. Polydipsia - Because of elevated blood glucose levels, water is osmotically attracted from body cells, resulting in intracellular dehydration and stimulation of thirst in hypothalamus Polyuria - Hyperglycemia acts as an osmotic diuretic; amount of glucose filtered by glomeruli of kidney exceeds that which can be reabsorbed by renal tubules; glycosuria results, accompanied by large amounts of water lost in urine Polyphagia - Depletion of cellular stores of carbs, fats, and proteins results in cellular starvation and a corresponding increase in hunger Weight loss - weight loss occurs because of fluid loss in osmotic diuresis and loss of body tissue as fats and proteins are used for energy

Which drug should the nurse plan to administer intravenously if a patient develops signs of tetany after a thyroidectomy? Epinephrine Furosemide (Lasix) Calcium gluconate Alendronate (Fosamax)

Calcium gluconate Tetany indicates dangerously low serum calcium levels. Since the parathyroid are often iatrogenically removed with the thyroid, IV calcium gluconate should be kept on hand for emergency administration. The other drugs are not given for tetany.

A 24-year-old male with a gunshot wound to the right side of the chest walks into the emergency department while leaning on another young man. The patient exhibits severe shortness of breath and decreased breath sounds on the right side. Which action should the nurse take immediately? Apply a pressure dressing over the wound to prevent excessive loss of blood. Pack the chest wound with sterile saline soaked gauze and tape securely. Stabilize the chest wall with tape and initiate positive pressure ventilation. Cover the chest wound with a nonporous dressing taped on three sides.

Cover the chest wound with a nonporous dressing taped on three sides. The patient has a sucking chest wound (open pneumothorax). Air enters the pleural space through the chest wall during inspiration. Emergency treatment consists of covering the wound with an occlusive dressing that is secured on three sides. During inspiration the dressing pulls against the wound preventing air from entering the pleural space. During expiration the dressing is pushed out and air escapes through the wound and from under the dressing.

The nurse plans to administer propranolol (Inderal), to a patient hospitalized with Graves disease. Which data indicates the drug has been effective? Serum T3 and T4 increases Decrease in blood pressure and heart rate Agranulocytosis occurs Serum calcium decreases

Decrease in blood pressure and heart rate Propranolol (Inderal) is a Beta Adrenergic Blocker. This classification of medication is prescribed in the patient with Graves or hyperthyroidism to reduce the cardiovascular symptoms associated with the disease. It has not effect on T3 or T4 levels. Agranulocytosis is a serious side effect of propylthiouracil (PTU), not a desired effect. Administration of propranolol is not associated with serum calcium levels.

Which teaching will the nurse implement for a patient who has just been diagnosed with viral conjunctivitis? Demonstrate appropriate handwashing technique. Explain the purpose of antiviral eye drops. Show how to perform eye irrigation safely. Instruct about how to insert soft contact lenses.

Demonstrate appropriate handwashing technique. Handwashing is the major means to prevent the spread of conjunctivitis. Antiviral drops and eye irrigation will not be helpful in shortening the disease process. Contact lenses should not be used when patients have conjunctivitis because they can further irritate the conjunctiva.

The nurse would question an order for octreotide (Sandostatin) for a client who has a history of which of the following? Kidney stones Urinary tract infections Gallstones Chronic constipation

Gallstones The client taking octreotide should not have active gallbladder disease, gallstones, or a history of these conditions; an increased risk of cholelithiasis exists with octreotide because of decreased gallbladder motility and the alteration of fat absorption. Octreotide acetate use requires assessment of baseline thyroid function test results and plasma serotonin levels. Baseline gallbladder functioning should be noted because of the risk of gallstone formation (cholelithiasis). Patients taking octreotide may require special dosing if they have decreased liver and kidney function, so baseline levels should always be assessed before administering these drugs. The prescriber may also order thyroid function tests and serum glucose and electrolyte levels. Urine specific gravity should also be tested. It is also important to be sure that assessment includes steps to prevent medication errors and awareness of concerns regarding look-alike sound-alike drugs. Octreotide acetate, or Sandostatin and Sandostatin LAR, should not be confused with Sandimmune (cyclosporine) or Sandoglobulin (IV immune globulin).

The nurse teaches a client taking an otic form of hydrocortisone that this preparation will achieve a reduction in which of the following? Inflammation and pain Hearing loss Bacteria Density of cerumen

Inflammation and pain Hydrocortisone is a corticosteroid that will reduce inflammation and pain that accompanies otitis externa. It does not affect cerumen production or density or reduce bacteria or hearing loss.

How does the drug oseltamivir (Tamiflu) prevent influenza or shorten the duration of illness? Preventing the virus from entering respiratory cells Boosting the client's immune system Inhibiting budding virions to escape from infected cells Directly killing the virus

Inhibiting budding virions to escape from infected cells Oseltamivir (Tamiflu) and zanamivir (Relenza) belong to one of the newest classes of antiviral drugs known as neuraminidase inhibitors. These drugs are active against influenza virus types A and B. They are indicated for the treatment of uncomplicated acute illness caused by influenza infection in adults. They have been shown to reduce the duration of influenza infection by several days. This drug can prevent infection if taken soon after exposure and shortens the duration of influenza A or B if taken within 24 to 48 hours after the onset of manifestations. The neuraminidase enzyme enables budding virions to escape from infected cells and spread throughout the body. Neuraminidase inhibitors are designed to stop this process in the body, speeding recovery from infection.

Which assessment findings are seen with hyperpituitarism?

Overgrowth of long bones Thickened, deeply creased skin Malocclusion of teeth & enlarged jaw

During discharge teaching for a 65-year-old patient with chronic obstructive pulmonary disease (COPD) who developed pneumonia this spring, which vaccine should the nurse recommend that this patient receive now? Pneumococcal Staphylococcus aureus Haemophilus influenzae Bacille-Calmette-Guérin (BCG)

Pneumococcal The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 or over, or living in a long-term care facility. Pneumovax is administered any time during the year. (The recommendations for use of Pneumovax are presented in the textbook.) Influenza vaccine should be administered yearly in the fall. A Staphylococcus aureus vaccine has been researched but not yet been effective. The BCG vaccine is for infants in parts of the world where tuberculosis (TB) is prevalent.

When assessing the patient experiencing the classic symptoms of diabetes insipidus, the nurse recognizes that the symptom directly related to a lack of antidiuretic hormone (ADH) is called which of the following? Polyuria Polydipsia Glucosuria Polyphagia

Polyuria Diabetes insipidus (DI) is associated with a deficiency of production of or secretion of ADH or a decreased renal response to ADH. The decrease in ADH results in fluid and electrolyte imbalances caused by increased urinary output and increased plasma osmolality. (Lewis, p. 1260). Individuals with diabetes insipidus have a partial to total inability to concentrate urine. Insufficient ADH activity causes excretion of large volumes of dilute urine (polyuria), leading to increased plasma osmolality. In conscious individuals, the thirst mechanism is stimulated and induces polydipsia—usually a craving for cold drinks.

What technique should the nurse use to obtain a throat culture from a client who is suspected to have a bacterial pharyngitis and tonsillitis? Ask the client to expectorate mucus/sputum into a sterile specimen container upon first arising after a full night's sleep. Ask the client to gargle with a mouthful of sterile normal saline for 30 seconds, and then to expectorate the saline into a sterile container. Rub a sterile swab first over the right tonsillar area, moving across the right arch, the uvula, and the left arch to the left tonsillar area. Dampen a sterile swab with sterile normal saline and then gently rub the hard and soft palates, taking care to avoid areas with a white or cream-colored patch.

Rub a sterile swab first over the right tonsillar area, moving across the right arch, the uvula, and the left arch to the left tonsillar area. The mouth and throat normally harbor many nonpathogenic microorganisms. The purpose of a throat culture is to ensure that the specimen contains only organisms from the infected areas of the tonsils and throat.

The nurse is caring for a patient with Cushing syndrome? Which clinical manifestation should the nurse expect? Sodium 139 mEq/L Potassium 5.7 mEq/L Serum glucose 168 mg/dL Serum calcium 9.7 mg/dL

Serum glucose 168 mg/dL The clinical manifestations of Cushing syndrome can be seen in most body systems and are related to excess levels of corticosteroids. Although manifestations of glucocorticoid excess usually predominate, symptoms of mineralocorticoid and androgen excess may also be seen. Corticosteroid excess causes pronounced changes in physical appearance. Weight gain, the most common feature, results from the accumulation of adipose tissue in the trunk, face, and cervical spine area. Transient weight gain from sodium and water retention may be present because of the mineralocorticoid effects of cortisol. Hyperglycemia occurs because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. Protein wasting is caused by the catabolic effects of cortisol on peripheral tissue. Muscle wasting leads to muscle weakness, especially in the extremities. A loss of protein matrix in the bone leads to osteoporosis with subsequent pathologic fractures (e.g., vertebral compression fractures) and bone and back pain. The loss of collagen makes the skin weaker and thinner, and therefore more easily bruised. Catabolic processes predominate, and wound healing is delayed. Mood disturbances (irritability, anxiety, euphoria), insomnia, irrationality, and occasionally psychosis may occur. Mineralocorticoid excess may cause hypertension (secondary to fluid retention), whereas adrenal androgen excess may cause severe acne, virilization in women, and feminization in men. Menstrual disorders and hirsutism in women and gynecomastia and impotence in men are seen more commonly in adrenal carcinomas. The clinical presentation is the first indication of Cushing syndrome. Of particular importance are (1) centripetal (truncal) obesity or generalized obesity; (2) "moon facies" (fullness of the face) with facial plethora; (3) purplish red striae (usually depressed below the skin surface) on the abdomen, breast, or buttocks; (4) hirsutism in women; (5) menstrual disorders in women; (6) hypertension; and (7) unexplained hypokalemia.

What is your responsibility as the nurse when caring for a patient with a chest tube?

Set-up and InsertionConsent/Aware of procedureGather and set up equipment as per order Drainage systemKeep tubing loosely coiledKeep connections tight; tapedObserve: tidaling, bubbling, air leak, fluid levels Patient's clinical status Assess:Vital signs, lung sounds, pain Drainage amount Drainage site infection Subcutaneous emphysema Encourage:Deep breathing/Incentive spirometry Range-of-motion exercises Chest drainage Keep below chest Mark and measure drainage Report greater than 200 mL/hr in first hour and 100 mL/hr thereafter; replace unit when full Avoid overturning unit Breakage of unit Place distal end of chest tube in 2 cm water in sterile container; replace unit No milking or stripping chest tubes Wet suction chest drainage Monitor:Water levels Suction at—20 cm H2OGentle bubbling Dry suction chest drainage Turn dial to ordered amountIf decrease suction; depress high-negativity vent and check water level in water-seal chamber Chest tube dressings Change according to agency policy and procedure Petroleum gauze Aseptic technique Monitor for infection Document Clamping chest tubes Not advocated during transport or disconnection due to risk for tension pneumothorax May clamp briefly to change drainage unit Monitor for Complications Re-expansion pulmonary edema Hypotension Severe subcutaneous emphysema

An elderly pt with worsening COPD presents to the ED with fatigue and altered level of consciousness. upon assessment the nurse finds O2 sat of 87% and ABG of pH 7.21, Pa CO2 75, and PaO2 55 mmHg. Which immediate intervention is best? Apply oxygen 4 L/pm via nasal cannula Call respiratory for STAT albuterol tx Sit the pt upright and apply Bilevel Positive Airway Pressure BiPAP

Sit the pt upright and apply Bilevel Positive Airway Pressure BiPAP

An older adult patient is admitted to the hospital with a diagnosis of pneumococcal pneumonia. Which clinical manifestation, if observed by the nurse, indicates that the patient is hypoxic? Temperature is 102.3o F (orally) Coarse crackles in lung bases Presence of pleuritic chest pain Sudden onset of confusion

Sudden onset of confusion RATIONALE: Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient. An elevated temperature, coarse crackles, and pleuritic chest pain may occur with pneumonia, but these symptoms do not indicate hypoxia.Usually the onset of pneumonia symptoms is sudden, including fever, shaking chills, shortness of breath, cough productive of purulent sputum (rust-colored sputum may be seen in pneumococcal pneumonia), and sometimes pleuritic chest pain. In the elderly or debilitated patient, confusion or stupor (possibly related to hypoxia) may be the only finding. On physical examination, there are signs of pulmonary consolidation, such as bronchial breath sounds, crackles, dullness to percussion, and increased fremitus (vibration of the chest wall produced by vocalization). This manifestation pattern is related to infections with Streptococcus pneumoniae and Haemophilus influenzae. Hypoxia is taught in NUR3414 Professional Practice I in the oxygenation unit. This question includes application of previously learned content to patients with respiratory disorders.Hypoxia is inadequate tissue oxygenation at the cellular level. This results from a deficiency in oxygen delivery or oxygen utilization at the cellular level. Hypoxia is a life-threatening condition. Untreated, it produces cardiac dysrhythmias that will possibly result in death.Causes of hypoxia include (1) a decreased hemoglobin level and lowered oxygen-carrying capacity of the blood; (2) a diminished concentration of inspired oxygen, which occurs at high altitudes; (3) the inability of the tissues to extract oxygen from the blood, as with cyanide poisoning; (4) decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia; (5) poor tissue perfusion with oxygenated blood, as with shock; and (6) impaired ventilation, as with multiple rib fractures or chest trauma.The clinical signs and symptoms of hypoxia include apprehension, restlessness, inability to concentrate, declining level of consciousness, dizziness, and behavioral changes. The client with hypoxia is unable to lie down and appears fatigued and agitated. Vital sign changes include an increased pulse rate and increased rate and depth of respiration.

The nurse is assessing a diabetic client one hour after administration of a dose of subcutaneous insulin. Which findings alert the nurse that the pt may be experiencing hypoglycemia? Report of hunger and excess urination Tachycardia and new restlessness Elevated body temperature and agitation bradycardia and fatigue

Tachycardia and new restlessness Hypoglycemia=Low Sugar BG of 70 or less Most deadly "Hypogly brain will DIE" S/S of hypoglycemia: Cool Pale "pallor" Sweaty "diaphoretic" "clammy" Nervous "anxious" "trembling" (HIWASH) H- Headache I - Irritable W - Weakness A - Anxious & Trembling S - Sweaty "diaphoresis" H - Hunger

Which client has an increased risk for developing a pulmonary embolus (PE)? (select all that apply) The adult in traction for a fractured femur The woman taking birth control pills The child with exercise-induced asthma The patient receiving intravenous chemotherapy through a Central Line The patient receiving peripheral antibiotics for pneumonia

The adult in traction for a fractured femur The woman taking birth control pills The patient receiving intravenous chemotherapy through a Central Line Risk factors for PE include conditions and disorders that promote blood clotting as a result of venous stasis (immobilization, heart failure), hypercoagulability (inherited coagulation disorders, malignancy, hormone replacement, oral contraceptives), and injuries to the endothelial cells that line the vessels (trauma, caustic intravenous infusions). Genetic risks include factor V Leiden, antithrombin II, protein S, protein C, and prothrombin gene mutations.

The nurse is caring for a client with Type I Diabetes Mellitus. When asked by the pt why she is so thirsty all the time, how should the nurse respond? a. Osmotic fluid shifts cause excessive urine output and leads to dehydration and thirst b. increased blood glucose levels decrease serum osmolality and trigger thirst receptors c. due to your insulin deficiency, your cells become starved causing increased appetite and thirst d. due to your resistance to insulin metabolism and nutritional requirements are increased.

a. Osmotic fluid shifts cause excessive urine output and leads to dehydration and thirst

When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be? fever. glaucoma. ulcer disease. allergic rhinitis.

glaucoma. RATIONALE: Patients taking decongestants, such as pseudoephedrine or phenylephrine, are generally using the drugs for nasal decongestion. These drugs come in oral dosage forms, including sustained-release and chewable forms. Contraindications to the use of decongestants include drug allergy and, in the case of adrenergic drugs, narrow-angle glaucoma, uncontrolled cardiovascular disease, hypertension, diabetes, hyperthyroidism, and prostatitis. The drugs may also be contraindicated in situations in which the patient is unable to close his or her eyes (such as after a cerebrovascular accident), as well as in patients with a history of cerebrovascular accident or transient ischemic attacks, cerebral arteriosclerosis, long-standing asthma, benign prostatic hyperplasia, or diabetes.

Diabetic teaching includes treatment of hypoglycemia with which drug? propranolol (Inderal) bumetanide (Bumex) acarbose (Precose) glucagon (GlucaGen)

glucagon (GlucaGen)