S3U6

immunoglobulin

Any of five structurally distinct classes of proteins that function as antibodies in the serum and external secretions of the body. In response to specific antigens, immunoglobulins are formed in the bone marrow, spleen, and all lymphoid tissues except the thymus.

extravasation

escape of blood from the blood vessel into the tissue

nonspecific response

general reaction of immune system by Leukocytes and proteins to infection

fibrous repair

healing by means of the formation of scar tissue

immunocompromised

impaired immunologic defenses caused by an immunodeficiency disorder or by therapy with immunosuppressive agents

anasarca

severe generalized edema

Fluoxetine (Prozac)

Antidepressant, SSRI; the only FDA-approved antidepressant for treating BN. It may not be appropriate for all patients with BN.

lupus erythematosus

Any of a group of autoimmune connective tissue disorders that commonly produce red scaly lesions and are accompanied by fever, malaise, myalgias, fatigue, and weight loss.

Biological theorists suggest that the cause of eating disorders may be related to which factor? A. Normal weight phobia B. Body image disturbance C. Serotonin imbalance D. Dopamine excess

C. Serotonin imbalance The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse. None of the remaining options are currently supported by any biological theories.

Pyelonephritis Assessment

Cause/Mechanism 1. Ascending Urethral Bacteria Assessment 2. Dysuria 3. Fever 4. Fatigue 5. Flank Pain 6. Costovertebral Tenderness 7. Nausea and Vomiting

exudates

Fluid, cells, or other substances that have been slowly exuded, or discharged, from cells or blood vessels through small pores or breaks in cell membranes.

Cirrhosis Assessment

Mechanism 1. Degeneration and Destruction of Liver Cells Signs and Symptoms 2. Jaundice 3. Fatigue 4. Palmar Erythema 5. Spider Angiomas 6. Hepatosplenomegaly 7. Edema 8. Gynecomastia 9. Change in LOC

glomerulonephritis

An inflammation of the glomerulus of the kidney, characterized by proteinuria, hematuria, decreased urine production, and edema.

sarcopenia

A loss of skeletal muscle mass that may accompany aging. Studies indicate that the loss of skeletal muscle for the average normally healthy person amounts to about 20% between about 30 and 70 years of age. The late loss may accelerate as aging progresses. The muscle loss is replaced by fat, usually in a subtle way that is not noticed by the individual. Muscle-strengthening and -building exercises can prevent or reverse much of this problem.

acquired immunity

Any form of immunity that is not innate and is obtained during life. It may be naturally or artificially acquired and actively or passively induced. Naturally acquired immunity is obtained by the development of antibodies resulting from an attack of infectious disease or by the transmission of antibodies from the mother through the placenta to the fetus or to the infant through colostrum and breast milk. Artificially acquired immunity is obtained by vaccination or by the injection of immune globulin.

A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. For which condition is it most important for the nurse to assess this client? 1. Nausea 2. Blood in the stool 3. Food intolerances 4. Hourly urinary output

2. Blood in the stool Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although food intolerances should be identified, there is no immediate threat to life. Although increased intraabdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Hourly urine output measurements are unnecessary.

A patient with end-stage renal disease (ESRD) secondary to diabetes has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? 1. Level of consciousness 2. Blood pressure and fluid balance 3. Temperature, heart rate, and blood pressure 4. Assessment for signs and symptoms of infection

2. Blood pressure and fluid balance Although all the assessments are relevant to the care of a patient receiving hemodialysis, fluid removal during the procedure will require monitoring blood pressure and fluid balance prior, during, and after.

A nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? 1. Decreased amylase 2. Decreased ammonia 3. Increased potassium 4. Increased hemoglobin

2. Decreased ammonia Lactulose destroys intestinal flora that break down protein and in the process give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

Normal creatinine levels

0.8-1.4 mg/dL

Chronic Glomerulonephritis Interventions

1. Corticosteroids 2. Antihypertensives 3. Erythropoietin 4. Cytotoxic Agents 5. Dialysis 6. Plasmapheresis 7. Transplant

Complications of Cirrhosis

1. Portal Hypertension 2. Ascites 3. Esophageal Varices 4. Coagulation Defects 5. Portal-Systemic Encephalopathy 6. Hepatorenal Syndrome

The principal feature of ARF is oliguria associated with ?

azotemia, metabolic acidosis, and diverse electrolyte disturbances.

A nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit which symptom? 1. Hypotension 2. Hypokalemia 3. Hypervolemia 4. Hypercalcemia

3. Hypervolemia Hypervolemia results when the kidneys have failed and are no longer able to maintain homeostasis, the blood pressure is high, and cardiac overload is imminent. Hypertension, not hypotension, is present when kidney failure occurs. Hyperkalemia, not hypokalemia, occurs with kidney failure. Hypocalcemia, not hypercalcemia, is present when kidney failure occurs.

ESRD GFR

<15 ml/min

Which coping mechanism is used excessively by clients diagnosed with bulimia nervosa to cope with their obsession with their body image? A. Denial B. Humor C. Altruism D. Projection

A. Denial Denial of incongruence between body reality, body ideal, and body presentation is the mainstay of the client diagnosed with bulimia nervosa. None of the other mechanisms are as vital to their coping technique.

Anorexia Nervosa Assessment

Key Facts 1. Adolescent Girls 2. Fear of Gaining Weight Assessment 3. Excessive Dieting 4. Distorted Body Image 5. Decreased Bone Density 6. Stress Fractures 7. Lanugo 8. Amenorrhea 9. Anemia Diagnostic Criteria 10. BMI <18.5

azotemia

Retention of excessive amounts of nitrogenous compounds in the blood. This toxic condition is caused by failure of the kidneys to remove urea from the blood and is characteristic of uremia.

macronutrients

a chemical substance that an organism must obtain in relatively large amounts; carbohydrates, proteins, and fats

The nurse should recognize which laboratory value as being abnormal? A. pH: 4 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

pH: 4 The expected pH is 4.8 to 7.8. This is within the normal specific gravity range of 1.016 to 1.022. Protein should not be present in the urine. If present, it would indicate an abnormality in glomerular filtration. Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

primary immunodeficiency

result of a genetic abnormality; congenital

phytochemicals

the pharmacologically active ingredients in herbal remedies; compounds in plant-derived foods

micronutrients

vitamins and minerals

Marasmus

1. Deficiency of all Nutrients 2. Body Weight < 60% of Normal 3. Tissue and Muscle Wasting 4. Loss of Subcutaneous Fat (Buttocks and Thighs) 5. Variable Edema

Menopause Symptoms

1. HAVOCS Mnemonic 2. Hot Flashes 3. Atrophy of Vagina 4. Osteoporosis 5. Coronary Artery Disease (CAD) 6. Sleep Disturbances

Dialysis

1. Hemodialysis 2. Rapid Shifts of Fluid and Electrolytes 3. Disequilibrium Syndrome 4. Hypotension 5. NO BP IN ARM with Shunt or Fistula 6. Assess for Thrill and Bruit 7. Peritoneal Dialysis 8. Slow Process 9. Peritonitis 10. Loss of Protein 11. Hyperglycemia

Chronic Kidney Disease Late Symptoms Assessment

1. Metabolic Acidosis 2. Severe Uremia 3. Arrhythmias 4. Edema 5. CNS Depression 6. Anemia 7. Oliguria 8. Pruritus Considerations 9. End Stage Renal Disease (ESRD) 10. GFR < 15 mL/min

Which manifestations may indicate a client has systemic lupus erythematosus (SLE)? Select all that apply. 1. Pericarditis 2. Esophagitis 3. Fibrotic skin 4. Discoid lesions 5. Pleural effusions

1. Pericarditis 4. Discoid lesions 5. Pleural effusions SLE is a chronic, progressive inflammatory connective tissue disorder that can cause major organs and systems to fail. Pericarditis is a cardiovascular manifestation of SLE. Discoid lesion is a skin manifestation that is a key indicator of the presence of SLE. Pleural effusion, a pulmonary manifestation, is a key indicator of the presence of SLE. Esophagitis is one of the gastrointestinal manifestations of systemic sclerosis. Fibrotic skin is one of the skin manifestations of systemic sclerosis.

Kwashiorkor

1. Protein Deficiency 2. Swollen Belly 3. MEALS 4. Malnutrition 5. Edema 6. Anemia 7. Liver Malfunction 8. Skin Lesions

Pyelonephritis Interventions

1. Urinalysis 2. NSAIDs 3. Antibiotics 4. Increase Fluid Intake 5. Avoid Catheterization Consideration 6. Urosepsis

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? 1. Increasing the pressure gradient 2. Increasing osmolality of the dialysate 3. Decreasing the glucose in the dialysate 4. Decreasing the concentration of the dialysate

2. Increasing osmolality of the dialysate Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

The nurse is caring for a patient who is in the oliguric phase of acute kidney disease. Which action would be appropriate to include in the plan of care? 1. Provide foods high in potassium. 2. Restrict fluids based on urine output. 3. Monitor output from peritoneal dialysis. 4. Offer high-protein snacks between meals.

2. Restrict fluids based on urine output. Fluid intake is monitored during the oliguric phase. Fluid intake is determined by adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake may be limited in the oliguric phase to avoid hyperkalemia and elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if dialysis is needed.

A client is experiencing an exacerbation of systemic lupus erythematosus. To reduce the frequency of exacerbations, what would be important for the nurse to include in the client's teaching plan? 1. Basic principles of hygiene 2. Techniques to reduce stress 3. Measures to improve nutrition 4. Signs of an impending exacerbation

2. Techniques to reduce stress Systemic lupus erythematosus is an autoimmune disorder, and physical and emotional stresses have been identified as contributing factors to the occurrence of exacerbations. Although basic principles of hygiene should be performed, inadequate hygiene is not known to produce exacerbations. Although measures to improve nutrition should be done, nutritional status is not significantly correlated to exacerbations. Knowledge of the symptoms will not decrease the occurrence of exacerbations.

A nurse is working with clients with a variety of eating disorders. Which characteristic unique to bulimia nervosa differentiates this disorder from anorexia nervosa? 1. The client is obese and attempting to lose weight. 2. The client behaves appropriately and looks normal. 3. The client has a distorted body image and sees the body as fat. 4. The client is struggling with a conflict of dependence versus independence.

2. The client behaves appropriately and looks normal. Bulimic clients hide much of their bingeing and purging behaviors and, unlike clients with anorexia, may have near-ideal body weights. Clients with bulimia nervosa are usually not obese. Distorted body image and conflict of dependence versus independence are associated with both anorexic and bulimic clients.

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? 1. Give hypertonic saline. 2. Initiate a blood transfusion. 3. Decrease the rate of fluid removal. 4. Administer antiemetic medications.

3. Decrease the rate of fluid removal. The patient is having hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? 1. Hypokalemia 2. Hyponatremia 3. Large urine output 4. Leukocytosis with cloudy urine output

3. Large urine output Patients often have diuresis in the hours and days immediately after a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority? 1. Weigh the client daily. 2. Restrict the client's oral fluid intake. 3. Measure the client's urine specific gravity. 4. Observe the client for increasing confusion.

4. Observe the client for increasing confusion. An increased serum ammonia level impairs the central nervous system, causing an altered level of consciousness. Increasing ammonia levels are not related to weight. An alteration in fluid intake will not affect the serum ammonia level. Measuring the client's urine specific gravity is not the priority; the priority is to monitor the client's neurological status.

hypoalbuminemia

A condition of abnormally low levels of albumin in the blood

anorexia nervosa

A disorder characterized by a prolonged refusal to eat, resulting in emaciation, amenorrhea, emotional disturbance concerning body image, and fear of becoming obese.

perimenopause

A span of 4 to 6 years preceding menopause when menstrual cycles and blood flow may be irregular. As estrogen levels decline, osteoporosis begins to develop and women are at increased risk for cardiovascular disease.

glomerulus

A structure composed of blood vessels or nerve fibers, such as a renal glomerulus.

A client hospitalized with anorexia nervosa has a weight that is 65% of normal. For this client, what is a realistic short-term goal for the first week of hospitalization regarding the physical impact of his/her weight? A. Gain a maximum of 3 lb. B. Develop a pattern of normal eating behavior. C. Discuss fears and feelings about gaining weight. D. Verbalize awareness of the sensation of hunger.

A. Gain a maximum of 3 lb. The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema. While all the remaining goals are appropriate, none have the physical focus that is the initial priority.

The client experiencing bulimia differs from the client diagnosed with anorexia nervosa by exhibiting which characteristic? A. Maintaining a normal weight B. Holding a distorted body image C. Doing more rigorous exercising D. Purging to keep weight down

A. Maintaining a normal weight Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight. The other characteristics are commonly shared among persons with either disorder.

Which statement is true of the eating disorder referred to as bulimia? A. Patients with bulimia often appear at a normal weight. B. Patients with bulimia binge eat but do not engage in compensatory measures. C. Patients with bulimia severely restrict their food intake. D. One sign of bulimia is lanugo.

A. Patients with bulimia often appear at a normal weight. Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

In patients who are experiencing acute glomerulonephritis, the glomerulus is permeable to what substances? A. Red blood cells and protein B. Protein and white blood cells C. Red blood cells, protein, and lipids D. Proteins

A. Red blood cells and protein The answer is A. The glomerulus is inflamed and permeable to red blood cells and protein.

hyperemia

An excess of blood in part of the body, caused by increased blood flow, as in the inflammatory response, local relaxation of arterioles, or obstruction of the outflow of blood from an area. Skin overlying a hyperemic area usually becomes reddened and warm.

Bulimia Nervosa Assessment

Assessment 1. Normal Body Weight 2. Binge and Purge 3. Electrolyte Disturbances 4. Alkalosis 5. Hypokalemia 6. Parotitis 7. Enamel Erosion 8. Russell's Sign Diagnosis 9. Once Weekly for 3 Months

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa? A. Weigh 2 times daily first week, then three times weekly. B. Weigh fully clothed before breakfast. C. Do not reweigh client when client requests. D. Permit no oral intake before weighing.

B. Weigh fully clothed before breakfast. Clients should be weighed daily first week, then three times weekly wearing only bra and panties or underwear before ingesting any food or fluids in the morning. Reweighing is not a request that should be afforded to the client.

Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? A. "I purge only once a day now instead of twice." B. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." C. "I am a hard worker and I am very compassionate toward others." D. "I always purge when I'm alone so that I'm not a bad role model for my younger sister."

C. "I am a hard worker and I am very compassionate toward others." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.

A 6-year-old child with acute renal failure is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the MOST appropriate roommate for this child? A. 6-year-old child with pneumonia B. 4-year-old child with gastroenteritis C. 5-year-old child who has a fractured femur D. 7-year-old child who had surgery for a ruptured appendix

C. 5-year-old child who has a fractured femur These children have potentially infectious disease processes. The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin.

A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be most prominent during the? A. Evening B. Afternoon C. Morning D. Bedtime

C. Morning The answer is C. Patients will experience the most prominent swelling in the face in the morning when they awake. This is a common finding with kidney disorders. The skin of the eyes is fragile, folded, and pocketed which makes it easier for fluid to collect around the eyes. In addition, this is where the swelling looks more noticeable.

Which subjective symptom should the nurse would expect to note during assessment of a client diagnosed with anorexia nervosa? A. Lanugo B. Hypotension C. 25-lb weight loss D. Fear of gaining weight

D. Fear of gaining weight Fear of weight gain is the only subjective data listed, and it is universally true of clients diagnosed with anorexia nervosa.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when which assessment data is observed? A. Weighs 10% below ideal body weight. B. Has serum potassium level of 3 mEq/L or greater. C. Has a heart rate less than 60 beats/min. D. Has systolic blood pressure less than 70 mm Hg.

D. Has systolic blood pressure less than 70 mm Hg. Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise. None of the remaining options represent data aligned with the criteria for hospitalization.

Kidney Transplant

Indications 1. End Stage Renal Disease (ESRD) Considerations 2. Selective Candidacy 3. Close Compatibility 4. Immunosuppressants 5. Monitor for Rejection 6. Monitor for Infection 7. Monitor Urine Output

Glomerulonephritis Assessment

Mechanism 1. Group A Beta-Hemolytic Streptococcal Infection Signs and Symptoms 2. Hypertension 3. Hematuria 4. Proteinuria 5. Oliguria 6. Generalized Edema 7. Increased BUN and CR 8. Flank Pain

Systemic Lupus Erythematosus (SLE) Assessment

Mechanism 1. Multisystem Inflammatory Disorder Assessment 2. Malar Rash 3. Discoid Rash 4. Arrhythmias 5. Arthritis 6. Hemolytic Anemia 7. Seizures 8. Glomerulonephritis Considerations 9. Periods of Exacerbation and Remission 10. Diagnosed by ANA (Anti-Nuclear Antibody Assay)

malnutrition

a state of poor nutrition; inadequate diet

kilocalorie

a unit of energy of 1,000 calories (equal to 1 large calorie)

costovertebral angle

angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney

While caring for a patient preparing for a kidney transplant, the nurse knows that the patient understands teaching on immunosuppression when she states which of the following? a. "My body will treat the new kidney like my original kidney." b. "I will have to make sure that I avoid being around people." c. "The medications that I take will help prevent my body from attacking my new kidney." d. "My body will only have a problem with my new kidney if the donor is not directly related to me."

c. "The medications that I take will help prevent my body from attacking my new kidney." Immunosuppressant therapy is initiated to inhibit optimal immune response. This is necessary in the case of transplantation, because the normal immune response would cause the body to recognize the new tissue as foreign and attack it. The body will identify the new kidney as foreign and will not treat it as the original kidney. While patients with transplants must be careful about exposure to others, especially those who are or might be ill, and practice adequate and consistent infection control techniques, they don't have to avoid people or social interaction. The new kidney brings foreign cells regardless of relationship between donor and recipient.

The nurse is assisting a 79-year-old patient with information about diet and weight loss. The patient has a body mass index (BMI) of 31. How should the nurse instruct this patient? a. "Your weight is within normal limits. Continue maintaining with current lifestyle choices." b. "You are a little overweight. Cut down on calories and increase your activity, and you should be fine." c. "You are morbidly obese, and we would like to schedule you an appointment to speak with a bariatric specialist about surgery." d. "You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight."

d. "You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight." This patient is at an increased risk for sarcopenia and should be instructed to increase activity that includes strength training to prevent muscle loss. Diet is not indicated. A BMI of 31 is considered obese; however, this patient does not qualify for surgical intervention until BMI reaches over 35.

bulimia nervosa

A disorder characterized by an insatiable craving for food, often resulting in episodes of continuous eating and often followed by purging, depression, and self-deprivation.

A client who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. Which nursing diagnosis addresses this assessment data? A. Death anxiety B. Ineffective denial C. Disturbed sensory perception D. Imbalanced nutrition: less than body requirements

D. Imbalanced nutrition: less than body requirements A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of this diagnosis. There is no support in the data as presented to justify any of the other nursing diagnoses.

An important nursing consideration when caring for a child with end-stage renal disease (ESRD) is that: A. children with ESRD usually adapt well to the minor inconveniences of treatment. B. children with ESRD require extensive support until they outgrow the condition. C. multiple stresses are placed on children with ESRD and their families until the illness is cured. D. multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means.

D. multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed. This is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization.

A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). Which recommendations are essential for the nurse to include? Select all that apply. 1. "Wear a large-brimmed hat." 2. "Take your temperature daily." 3. "Balance periods of rest and activity." 4. "Use a strong soap when washing the skin." 5. "Expose the skin to the sun as often as possible."

1. "Wear a large-brimmed hat." 2. "Take your temperature daily." 3. "Balance periods of rest and activity." A fever is the major sign of an exacerbation. A balance of rest and activity conserves energy and limits fatigue. Malaise, fatigue, and joint pain are associated with SLE. SLE can cause alopecia, and hair care recommendations include the use of mild protein shampoos and avoidance of harsh treatments, like permanents or highlights, and use of large-brimmed hat for skin protection. Mild, not strong, soap and other skin products should be used on the skin. The skin should be washed, rinsed, and dried well and lotion should be applied. Exposing the skin to the sun as often as possible is not recommended. Exposure to ultraviolet light may damage the skin and aggravate the photosensitivity associated with SLE.

Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? (Select all that apply.) 1. Anemia 2. Dehydration 3. Hypertension 4. Hypercalcemia 5. Increased fracture risk 6. Elevated white blood cells

1. Anemia 3. Hypertension 5. Increased fracture risk When the kidney fails, erythropoietin is not excreted, so anemia is expected. Dehydration and hypercalcemia are not expected in chronic renal disease. Fluid volume overload with hypertension and hypocalcemia are expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing the risk of pathological fracture. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.

A with stage 3 CKD is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? 1. Apple, green beans, and a roast beef sandwich 2. Granola made with dried fruits, nuts, and seeds 3. Watermelon and ice cream with chocolate sauce 4. Bran cereal with ½ banana and milk and orange juice

1. Apple, green beans, and a roast beef sandwich When the patient selects an apple, green beans, and a roast beef sandwich, the patient shows understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have high levels of potassium, at or above 200 mg per 1/2 cup.

A client with systemic lupus erythematosus is taking prednisone. The nurse anticipates that the steroid may cause hypokalemia. What food will the nurse encourage the client to eat? 1. Broccoli 2. Oatmeal 3. Fried rice 4. Cooked carrots

1. Broccoli Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

Menopause Lab Findings

1. Decreased Estrogen 2. Lack of Negative Feedback 3. Increased FSH 4. Increased LH 5. Increased GnRH 6. Small Amount of Estrogen From Androgen Conversion 7. Increased Androgens = Hirsutism

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI)? (Select all that apply.) 1. Dehydration 2. Hypokalemia 3. Hypernatremia 4. BUN increases 5. Urine output increases 6. Serum creatinine increases

1. Dehydration 2. Hypokalemia 5. Urine output increases The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease.

When caring for clients with the diagnosis of anorexia nervosa or bulimia nervosa, it is important that the nurse understand the sociocultural influences related to eating disorders in the United States. What are these influences? Select all that apply. 1. Diet industry 2. Fashion trends 3. Fast food industry 4. Over-the-counter medications 5. Competitive women's athletics

1. Diet industry 2. Fashion trends 5. Competitive women's athletics Weight management moved into the mainstream in the 1950s and increased its momentum with the fitness industry in the 1980s and 1990s. In the new century, women are constantly bombarded by the media with products and programs that are designed to help them attain the perfect body, which for most women is unrealistic. Since the 1960s the trend in fashion has been toward thinness, with fabrics that cling and styles that reveal the body. Print and movie media, including advertising, are focused on a thin, perfect ideal that is unattainable for most women. Several women's sports, such as gymnastics and figure skating, emphasize low body weights, and so does ballet. These demands may lead to eating disorders in girls and women who wish to compete. Although some people with bulimia nervosa may eat fast food, the fast food industry is unrelated to the origin of anorexia nervosa or bulimia nervosa. Although some people with eating disorders use over-the-counter medications, particularly laxatives, over-the-counter medications are unrelated to the origin of eating disorders.

A child being treated with cardiac drugs developed vomiting, bradycardia, anorexia, and dysrhythmias. Which drug toxicity is responsible for these symptoms? 1. Digoxin 2. Nesiritide 3. Dobutamine 4. Spironolactone

1. Digoxin Digoxin helps improve pumping efficacy of the heart, but overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias. The side effects of nesiritide may include effects like headache, insomnia, and hypotension. Dobutamine does not cause nausea or vomiting but may cause hypertension and hypotension. Spironolactone may cause edema.

A patient is admitted with anorexia nervosa and a serum potassium level of 2.4 mEq/L. What complication is most important for the nurse to observe for in this patient? 1. Dysrhythmias 2. Muscle weakness 3. Increased urine output 4. Anemia and leukopenia

1. Dysrhythmias A serum potassium level less than 2.5 mEq/L indicates severe hypokalemia, which can lead to life-threatening dysrhythmias (e.g., bradycardia, tachycardia, ventricular dysrhythmias). Other manifestations of potassium deficiency include muscle weakness and renal failure. Patients with anorexia nervosa often have iron-deficiency anemia and an elevated blood urea nitrogen level related to intravascular volume depletion and abnormal renal function.

A nurse, the family, and an adolescent client with anorexia nervosa are planning appropriate outcomes for the client. What is an appropriate short-term goal for the client? 1. Eat planned nutritious meals. 2. Gain 10 lb (4.5 kg) within 1 month. 3. Continue the same diet eaten at home. 4. Add 100 calories of carbohydrates to each meal.

1. Eat planned nutritious meals. Ingesting planned nutritious meals is a realistic goal that is likely to evoke the least anxiety in the short term. A person with anorexia nervosa has great anxiety about weight gain and responds best to nutritious foods when he or she has input into planning. The thought of gaining 10 lb (4.5 kg) within 1 month will overwhelm the client and increase anxiety. The diet eaten at home was probably a very low-calorie diet that promoted weight loss. Adding 300 calories a day will increase the client's anxiety and probably result in nonadherence to the planned regimen.

A client past menopause undergoes an anteroposterior colporrhaphy. What should the nurse include in the client's discharge teaching? 1. Eating a high-fiber diet 2. Limiting daily activities 3. Reporting signs of urine retention 4. Being alert to signs of a rectovaginal fistula

1. Eating a high-fiber diet Immediately after this type of surgery, pain is associated with bearing down; the client should be instructed to increase fluid, fiber, and activity to prevent constipation. Exercise is encouraged. The anteroposterior colporrhaphy is expected to reduce incontinence; urine retention is not expected. The colporrhaphy involves only the vaginal wall; the rectum should not be involved.

The physical examination of a client reveals moon face, buffalo hump, and truncal obesity. The laboratory report reveals salivary cortisol level of 3.0 ng/mL (9.54 nmol/L). Which other manifestations would be present in the client? Select all that apply. 1. Edema 2. Osteoporosis 3. Hypogonadism 4. Muscle atrophy 5. Barrel-shaped chest

1. Edema 2. Osteoporosis 4. Muscle atrophy Hypercortisolism may result in sodium and water reabsorption and retention, leading to hypervolemia and edema. Hypercortisolism may also cause mineral loss, which leads to osteoporosis. This condition may also cause musculoskeletal changes caused by nitrogen depletion and mineral loss. This may lead to muscle atrophy. Moon face, buffalo hump, and truncal obesity are clinical manifestations of hypercortisolism. A normal salivary cortisol is 2.0 ng/mL (6.36 nmol/L); a higher level also indicates hypercortisolism. Hypogonadism is a loss of secondary sexual characteristics, which may occur due to increased prolactin secretion. A barrel-shaped chest is seen in clients with acromegaly (due to increased growth hormone secretion) and chronic obstructive pulmonary disease.

Chronic Kidney Disease Early Symptoms Assessment

1. GFR < 60 mL/min 2. Accumulation of Waste Products 3. General Malaise 4. Hypertension 5. Proteinuria 6. Hyperkalemia 7. Mineral and Bone Disorders 8. Neuropathy

The nurse is providing education to a client with systemic lupus erythematosus. Which education will the nurse consider as high priority? 1. Instructing about ways to protect the skin 2. Helping the client to identify coping strategies 3. Teaching methods to monitor body temperature 4. Teaching about the effects of the disease on lifestyle

1. Instructing about ways to protect the skin A client with systemic lupus erythematosus is first taught to protect the skin to prevent infections. Helping the client with identifying coping strategies is given low priority. Different methods are taught to monitor body temperature because fever is a major sign of exacerbation. Teaching about the effects of the disease on lifestyle occurs after teaching ways to protect the skin.

What clinical manifestations does a nurse expect a client with systemic lupus erythematosus (SLE) most likely to exhibit? Select all that apply. 1. Joint pain 2. Facial rash 3. Pericarditis 4. Weight gain 5. Hypotension

1. Joint pain 2. Facial rash 3. Pericarditis SLE is a chronic, autoimmune disease that affects connective tissue; joint pain is common. A butterfly rash on the face is characteristic of SLE. Pericarditis is the most common cardiac indicator of SLE. Weight loss, not gain, is a classic sign of SLE because of gastrointestinal effects. Renal impairment with SLE may cause hypertension, not hypotension.

A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess this client? Select all that apply. 1. Mental confusion 2. Increased cholesterol 3. Brown-colored stools 4. Flapping hand tremors 5. Musty, sweet breath odor

1. Mental confusion 4. Flapping hand tremors 5. Musty, sweet breath odor An accumulation of nitrogenous wastes affects the central nervous system, causing mental confusion. An accumulation of nitrogenous wastes in hepatic encephalopathy affects the nervous system. Flapping tremors and generalized twitching occur in the second and third stages, respectively. Fetor hepaticus is the musty, sweet odor of the client's breath. Increased cholesterol levels are not necessarily present. Stool is often clay-colored because of lack of bile caused by biliary obstruction.

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? 1. Monitor the patient's cardiac status. 2. Teach the patient about hand washing. 3. Obtain a serum specimen for electrolytes. 4. Increase direct observation of the patient.

1. Monitor the patient's cardiac status. The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.

Acute Glomerulonephritis Interventions

1. Rest 2. Restrict Salt and Fluid Intake 3. Restrict Protein 4. Antihypertensives 5. Diuretics 6. Antibiotics

A 16-year-old girl has been admitted to the pediatric eating disorders unit with a diagnosis of anorexia and is undergoing behavioral therapy. Unit privileges are based on weight gain and have been explained to the client. What is the most appropriate intervention for the nurse to use when taking the lunch tray to the client's room? 1. Setting the tray down and saying nothing 2. Reminding the client that eating will be rewarded 3. Commenting on the client's thinness and need to gain weight 4. Threatening the client that if she doesn't eat she won't gain any privileges

1. Setting the tray down and saying nothing The client uses eating/weight gain as a means of controlling the environment. The client has been told the rules of the unit and must make the personal decision to try to win privileges. The nurse needs to take the focus away from eating. The client knows that gaining weight will be rewarded and does not need reminders. The client is used to everyone commenting on her weight. Although the client appears thin to others, the client's self-perception is that she needs to lose a little bit of weight. Threats should not be used in any circumstance.

The nurse is providing teaching to a group of perimenopausal women. Which herbs and supplements would the nurse include in a discussion about effective alternative therapies for menopausal symptoms? (Select all that apply.) 1. Soy 2. Garlic 3. Gingko 4. Vitamin A 5. Cinnamon 6. Black cohosh

1. Soy 6. Black cohosh There is good scientific evidence that soy is useful in decreasing menopausal hot flashes and that black cohosh is safe to use for up to 6 months to decrease menopausal symptoms. Garlic, gingko, vitamin A, and cinnamon do not affect menopausal symptoms.

The nurse is teaching a client with decreased ovarian production of estrogen due to menopause about self-management and prevention of complications. Which actions performed by the client would help to reduce the complications? Select all that apply. 1. Walking for 30 minutes per day 2. Performing weight-bearing activities 3. Dressing warmly in cool or cold weather 4. Urinating immediately after sexual intercourse 5. Keeping within 10 pounds of ideal body weight

1. Walking for 30 minutes per day 2. Performing weight-bearing activities 4. Urinating immediately after sexual intercourse Because decreased ovarian production of estrogen leads to low bone density, regular exercises are advised, such as walking for 30 minutes per day and performing weight-bearing activities. Decreased ovarian production of estrogen increases the risk of cystitis; therefore, female clients are advised to reduce the risk by urinating immediately after sexual intercourse. Dressing warmly in cool weather would be beneficial to a client with decreased general metabolism as they may have less tolerance to cold. Maintaining body weight within 10 lbs of ideal would be beneficial to a client with decreased glucose tolerance.

A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response? 1. "It prevents the development of serious heart problems." 2. "It helps perform some of the work usually done by the kidneys." 3. "It removes toxic chemicals from the body so you will not get worse." 4. "It speeds recovery because the kidneys are not responding to regulating hormones."

2. "It helps perform some of the work usually done by the kidneys." Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis "removes toxic chemicals from the body so you will not get worse" is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolytes; the nephrons are damaged in acute kidney injury, so it may or may not speed recovery.

Which statement about continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? 1. "Maintain a daily written record of blood pressure and weight." 2. "It is essential that you maintain aseptic technique to prevent peritonitis." 3. "You will be allowed a more liberal protein diet once you complete CAPD." 4. "Continue regular medical and nursing follow-up visits while performing CAPD."

2. "It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of prevention. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality that peritonitis does.

The home care nurse visits a patient receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? 1. "Drain time is faster if I rub my abdomen." 2. "The fluid draining from the catheter is cloudy." 3. "The drainage is bloody when I have my period." 4. "I wash around the catheter with soap and water."

2. "The fluid draining from the catheter is cloudy." The primary manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

Which patient has the most significant risk factors for CKD? 1. A 50-yr-old white woman with hypertension 2. A 61-yr-old Native American man with diabetes 3. A 28-yr-old black woman with a urinary tract infection 4. A 40-yr-old Hispanic woman with cardiovascular disease

2. A 61-yr-old Native American man with diabetes The nurse identifies the 61-year-old Native American with diabetes as the most at risk. Diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD 6 times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. Blacks have the highest rate of CKD because hypertension is significantly increased in blacks. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply. 1. Adhering to a low-carbohydrate diet 2. Avoiding aspirin and aspirin-containing products 3. Limiting alcohol consumption to two drinks weekly 4. Avoiding acetaminophen and products containing acetaminophen 5. Avoiding coughing, sneezing, and straining to have a bowel movement

2. Avoiding aspirin and aspirin-containing products 4. Avoiding acetaminophen and products containing acetaminophen 5. Avoiding coughing, sneezing, and straining to have a bowel movement Aspirin can damage the gastric mucosa and precipitate hemorrhage when esophageal or gastric varices are present. Acetaminophen is hepatotoxic and should not be used by the client with cirrhosis. The client with cirrhosis should avoid coughing, sneezing, and straining to have a bowel movement. These activities increase pressure in the portal venous system and increase the client's risk of variceal hemorrhage. A high-carbohydrate diet is encouraged as the diseased liver's ability to synthesize and store glucose is diminished. To decrease the risk of complications, the client must abstain from alcohol.

What nursing intervention is the priority in the period immediately after an emaciated 13-year-old child's admission to the hospital for starvation resulting from anorexia nervosa? 1. Ensuring that rest and nutrition needs are met 2. Correcting the child's fluid and electrolyte imbalances 3. Obtaining more data about the child's diet and exercise program 4. Completing an assessment of the child's physical and mental status

2. Correcting the child's fluid and electrolyte imbalances Anorexic children are usually severely malnourished and have severe fluid and electrolyte imbalances. Unless these imbalances are corrected, cardiac irregularities and death may occur. Rest and nutrition, information on diet and exercise, and assessment of physical and mental status are important, but none is the priority at this time.

A client with the diagnosis of bulimia nervosa, purging type, is admitted to the mental health unit after an acute episode of bingeing. Which clinical manifestation is most important for the nurse to assess? 1. Weight gain 2. Dehydration 3. Hyperactivity 4. Hyperglycemia

2. Dehydration The nurse should be alert for dehydration caused by fluid loss through vomiting in the binge-purge cycle. Weight gain is not expected because purging frequently follows a binge. Hyperactivity is not expected because many individuals with bulimia withdraw and vomit after a binge. Hyperglycemia is not expected because of the vomiting that follows a binge.

A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Select all that apply. 1. Skin rash 2. Dehydration 3. Hypovolemia 4. Hyperkalemia 5. Metabolic acidosis

2. Dehydration 3. Hypovolemia In the diuretic phase, fluid retained during the oliguric phase is excreted and may reach 3 to 5 L daily; dehydration and hypovolemia may occur unless fluids are replaced. Skin rash is not associated with the diuretic phase. Hyperkalemia develops in the oliguric phase when glomerular filtration is inadequate. Metabolic acidosis occurs in the oliguric, not diuretic, phase.

When caring for a client with bulimia nervosa, the nurse remembers that bulimia nervosa follows a cyclical pattern. What does the nurse identify as the first pattern in this cycle? 1. Hunger resulting from food deprivation and stress 2. Dieting in an attempt to maintain control of one's life 3. Binge eating to numb physical and emotional discomforts 4. Purging in another attempt to regain control and alleviate guilt

2. Dieting in an attempt to maintain control of one's life Dieting may be one area of control the person has in her life, and she elects to exercise control over it. The body does experience hunger, and binge eating serves as emotional comfort when the person ingests large amounts of calories. Purging is the final phase in this cycle; individuals are unaware often that purging rids fewer than 50% of the calories ingested.

A patient with type 2 diabetes and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? 1. Fatigue 2. Dysrhythmias 3. Hypoglycemia 4. Elevated triglycerides

2. Dysrhythmias Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Fatal dysrhythmias can occur when the serum potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyceridemia may be present but do not require urgent intervention. Hypoglycemia is a complication related to diabetes control, not hyperkalemia. However, administration of insulin and dextrose is an emergency treatment for hyperkalemia.

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? 1. Facial flushing 2. Edema and pruritus 3. Dribbling after voiding and dysuria 4. Diminished force and caliber of stream

2. Edema and pruritus The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

A patient donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is having significant pain and refuses to get up to walk. How should the nurse respond? 1. Allow the patient to rest and try again tomorrow. 2. Encourage a short walk around the patient's room. 3. Have the transplant psychologist convince her to walk. 4. Tell the patient she is lucky she did not have an open nephrectomy.

2. Encourage a short walk around the patient's room. Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney; postoperative care is the nurse's role. Telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery. Early ambulation should be encouraged, waiting until tomorrow is too long.

A patient is being admitted with anorexia nervosa. Which clinical manifestations should the nurse anticipate? 1. Sensitivity to heat, fatigue, and polycythemia 2. Hair loss; dry, yellowish skin; and constipation 3. Tented skin turgor, hyperactive reflexes, and diarrhea 4. Dysmenorrhea, hypoactive bowel sounds, and hunger

2. Hair loss; dry, yellowish skin; and constipation The patient with anorexia nervosa, along with abnormal weight loss, is likely to have hair loss; dry, yellow skin; constipation; sensitivity to cold, and absent or irregular menstruation. Other signs of malnutrition may also be noted during physical examination.

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? 1. Peritonitis 2. Hepatitis B 3. Renal calculi 4. Bladder infection

2. Hepatitis B Hepatitis type B is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.

A client with a history of cirrhosis of the liver develops heart failure. When ventricular bigeminy develops, the provider orders lidocaine. What alterations in lidocaine dosages does the nurse anticipate? 1. Higher to compensate for the impaired liver function 2. Lower because the drug is metabolized at a diminished rate 3. Reduced because other organs will compensate for the sluggish liver 4. Equal to that needed for other clients to provide a loading dose for the myocardium

2. Lower because the drug is metabolized at a diminished rate The client has heart failure, which causes liver congestion, further compromising liver function; therefore, less than the usual adult dose will be prescribed because the liver will not be able to break down lidocaine as effectively as necessary. A dose higher to compensate for the impaired liver function increases the concentration of lidocaine in the blood, leading to toxicity. Lidocaine is metabolized by the liver; other organs cannot assist in the process. This may be life threatening because the client cannot metabolize lidocaine at the required rate, and toxicity may result.

A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply. 1. Polyuria 2. Paresthesias 3. Hypertension 4. Metabolic alkalosis 5. Widening pulse pressure

2. Paresthesias 3. Hypertension Paresthesias occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.

The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder? 1. Ham sandwich with cheese, whole milk, and potato chips 2. Penne pasta, spinach, banana, and decaffeinated iced tea 3. Baked lasagna with sausage, salad, and milkshake 4. Hamburger, french fries, and cola

2. Penne pasta, spinach, banana, and decaffeinated iced tea A client with cirrhosis and ascites will require moderate to low fat and low sodium (penne pasta, spinach, banana, and decaffeinated iced tea). Caffeine can stimulate and cause distention. Ham, cheese, whole milk, potato chips, baked lasagna with sausage, milkshake, hamburger, french fries, and cola all have more fat and sodium than a client with cirrhosis should consume.

A nurse is assessing the condition of a school-aged child with acute glomerulonephritis. What clinical finding does the nurse anticipate? 1. Ketonuria 2. Periorbital edema 3. Increased appetite 4. Decreased blood pressure

2. Periorbital edema The glomerular filtration rate is reduced; this results in sodium retention, protein loss, and fluid accumulation, producing edema that is most noticeable around the eyes. Ketonuria is not a manifestation of glomerulonephritis. Usually the appetite decreases because of general malaise, and the blood pressure is increased because of kidney involvement.

A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information? 1. Prevention of uremic frost 2. Prevention of chronic fatigue 3. Prevention of tubular necrosis 4. Prevention of dependent edema

2. Prevention of chronic fatigue Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathologic condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.

An adolescent with the diagnosis of anorexia nervosa is admitted to the psychiatric unit of a local hospital. What should the nurse include in the plan of care? 1. Limited opportunities for decision-making 2. Provision of supervision during and after mealtimes 3. Arrangements for a physical exercise program and time to complete it 4. A request that parents keep their visits to a minimum early in treatment

2. Provision of supervision during and after mealtimes Clients with anorexia nervosa often throw out or hide food and purge after eating. The client should be supervised to ensure that the client eats and does not vomit after meals. Limiting opportunities for decision-making fosters dependence, which is not desirable. The client's physical expenditure should be reduced because of malnutrition; exercise is usually limited. The parents are an important part of treatment and should be encouraged to visit unless visiting privileges are revoked because of insufficient weight gain.

The nurse is aware of potential complications related to cirrhosis. Which interventions would be included in a safe plan of care? (Select all that apply.) 1. Provide a high-protein, low-carbohydrate diet. 2. Tell the patient to use soft-bristle toothbrush and electric razor. 3. Teach the patient to avoid vigorous blowing of nose and coughing. 4. Apply gentle pressure for the shortest possible time after venipuncture. 5. Use the smallest gauge needle possible when giving injections or drawing blood. 6. Teach the patient to avoid aspirin and nonsteroidal antiinflammatory (NSAIDs).

2. Tell the patient to use soft-bristle toothbrush and electric razor. 3. Teach the patient to avoid vigorous blowing of nose and coughing. 5. Use the smallest gauge needle possible when giving injections or drawing blood. 6. Teach the patient to avoid aspirin and nonsteroidal antiinflammatory (NSAIDs). Using the smallest gauge needle for injections, using a soft bristle toothbrush and an electric razor will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding. A low-salt, low-protein, high-carbohydrate diet may be recommended.

Obesity in children is an ever-worsening problem. What concept should a nurse consider when caring for school-aged children who are obese? 1. Enjoyment of specific foods is inherited. 2. There are familial influences on childhood eating habits. 3. Childhood obesity is usually not a predictor of adult obesity. 4. Children with obese parents are destined to become obese themselves.

2. There are familial influences on childhood eating habits. Studies have demonstrated that culture and family eating habits have an impact on a child's eating habits. Inheritance is not known to influence eating habits, although it is believed that other hereditary factors are associated with obesity. Childhood obesity is a known predictor of adult obesity. Children with obese parents are not necessarily destined to become obese themselves.

A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen? 1. To stimulate sodium excretion 2. To help prevent potassium loss 3. To increase urine specific gravity 4. To reduce arterial blood pressure

2. To help prevent potassium loss Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. Both medications stimulate sodium excretion. Both medications increase urine specific gravity and reduce arterial blood pressure.

The nurse is completing a comprehensive health assessment on a 15-year-old female who weighs 75 kg and is 64 inches tall. The adolescent s body mass index (BMI) is _.

28.3 Body mass index (BMI) is currently considered the best method to assess weight in children and adolescents. The calculation is based on the individual s height and weight. In adults, BMI definitions are fixed measures without regard for sex and age. The BMI in children and adolescents varies to accommodate age- and gender-specific changes in growth. The formula for BMI calculation is: Weight in lbs ÷ (Height in inches)2 × 703. Weight in lbs = 75 kg × 2.2 = 165 lbs. Height in inches2 = 4096 inches 165 ÷ 4096 × 703 = 28.3

The nurse provides discharge instructions for a patient with ascites and peripheral edema related to cirrhosis. Which patient statement indicates teaching was effective? 1. "Lactulose should be taken every day to prevent constipation." 2. "It is safe to take acetaminophen up to four times a day for pain." 3. "Herbs and other spices should be used to season my foods instead of salt." 4. "I will eat foods high in potassium while taking spironolactone (Aldactone)."

3. "Herbs and other spices should be used to season my foods instead of salt." A low-sodium diet is indicated for patients with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided because these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.

Upon interacting with the parent of an 8-month-old infant, the nurse anticipates that the infant is at risk of childhood obesity. Which statement from the parent supports the nurse's assumption? 1. "I often feed my child cereal." 2. "I often feed my child oatmeal." 3. "I often give my child potato chips." 4. "I feed my child mashed ripe banana."

3. "I often give my child potato chips." Foods like potato chips, candy, ice cream, cake, soda pop, and other sweetened drinks increase cholesterol levels and result in obesity. High-protein cereals do not increase cholesterol levels in the body, and do not contribute to childhood obesity. Mashed ripened banana does not increase cholesterol levels in the body and does not contribute to childhood obesity. Oatmeal reduces the risk of obesity in the child.

A nurse provides instructions to a group of adolescents about ways to prevent obesity. Which statements made by an adolescent indicates a need for further learning? Select all that apply. 1. "I should avoid trans fats." 2. "I should limit portion sizes." 3. "I should consume a high-fat diet." 4. "I should take highly refined starch food." 5. "I should watch television for four hours only."

3. "I should consume a high-fat diet." 4. "I should take highly refined starch food." 5. "I should watch television for four hours only." A high-fat diet should be avoided by adolescents. Highly refined starches and sugars should be avoided because they are rich in calories. Adolescents should be advised to watch less than two hours of television per day. Most dieticians and nutrition experts recommend a diet with no trans fats. Adolescents should limit portion sizes to improve body weight.

The nurse educates an obese adolescent about healthy dietary habits and risk associated with obesity. Which statement by the adolescent indicates the need for further counseling? 1. "I should do exercise." 2. "I should play more outdoor games." 3. "I should watch more TV to reduce the stress." 4. "I should modify my diet and have lots of vegetables and water."

3. "I should watch more TV to reduce the stress." The cause of obesity can be stress, but rather than watching TV to reduce the stress, some other activities like dancing, which involve physical movements, can be done. Any type of physical exercise helps in fat burning. Playing outdoor games not only is a physical exercise but also helps to reduce the stress. Reducing the consumption of fat-rich diet and replacing it with vegetables will reduce the amount of fat consumed by one and drinking high amount of water helps to detoxify the body.

A frail 86-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? 1. Aspirin 2. Acetaminophen 3. Diphenhydramine 3. Aluminum hydroxide

3. Aluminum hydroxide Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

A 9-year-old child with chronic kidney disease is undergoing peritoneal dialysis. For which associated complication should the nurse monitor the child? 1. Petechiae 2. Abdominal bruit 3. Cloudy return dialysate 4. Increased blood glucose level

3. Cloudy return dialysate The returned dialysate should be clear; cloudy return dialysate solution is indicative of infection. Petechiae do not occur during dialysis treatments. There is no danger of developing an abdominal bruit during dialysis. Dialysis does not affect the blood glucose level.

The provider has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? 1. Hemodialysis (HD) three times per week 2. Automated peritoneal dialysis (APD) 3. Continuous venovenous hemofiltration (CVVH) 4. Continuous ambulatory peritoneal dialysis (CAPD)

3. Continuous venovenous hemofiltration (CVVH) CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD three times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do.

Which test would the client undergo to receive a diagnosis of systemic lupus erythematosus? 1. Patch test 2. Photo patch test 3. Direct immunofluorescence test 4. Indirect immunofluorescence test

3. Direct immunofluorescence test A direct immunofluorescence test is used in the diagnosis of systemic lupus erythematosus. The patch test and photo patch test are used to evaluate allergic dermatitis and photo allergic reactions. An indirect immunofluorescence test is performed on a blood sample.

A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? Select all that apply. 1. Acidosis 2. Lethargy 3. Fractures 4. Osteomalacia 5. Eye calcium deposits

3. Fractures 4. Osteomalacia 5. Eye calcium deposits Because of calcium loss from the bone, fractures, osteomalacia, and eye calcium deposits occur. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia.

A nurse is caring for an 8-year-old child with acute poststreptococcal glomerulonephritis (APSGN). What medications does the nurse expect the practitioner to prescribe? Select all that apply. 1. Penicillin 2. Morphine 3. Furosemide 4. Labetalol 5. Phenobarbital

3. Furosemide 4. Labetalol The child with APSGN is oliguric; diuretics are used to increase urine output. The child with APSGN is hypertensive; antihypertensives are used to reduce the blood pressure. Penicillin is administered if there is evidence of streptococcal infection; however, the strep infection is usually not active when APSGN develops. Children with APSGN do not experience pain; therefore morphine is not needed. If the hypertension is controlled, seizures are not expected, and phenobarbital is not necessary.

Which clinical findings indicate to the nurse that a 6-year-old child has nephrotic syndrome (NS) rather than acute glomerulonephritis (AGN)? Select all that apply. 1. Lethargy 2. Gross hematuria 3. Generalized edema 4. Massive proteinuria 5. Unchanged blood pressure

3. Generalized edema 4. Massive proteinuria 5. Unchanged blood pressure The child with NS is grossly edematous because the glomerular membrane becomes permeable, leading to decreased filtration of plasma and resulting in the accumulation of fluid and sodium. Although the child with AGN has edema, the nephritic edema is most noticeable in the face, especially around the eyes. Massive proteinuria occurs mainly in children with NS because the permeable capillary membrane allows protein to be excreted by the kidneys. The blood pressure of a child with NS is unchanged or may be decreased. Hypertension is typical of children with AGN, most likely because of renal arteriole vasospasm. Lethargy occurs in children with nephrotic syndrome (NS) because the gross edema increases oxygen demands. Children with acute glomerulonephritis (AGN) become irritable and lethargic because of malaise, hypertension, and headaches. Gross hematuria occurs in children with AGN because capillary lumens of the affected glomeruli become occluded, altering the permeability of the capillary membrane, which allows large molecules to pass through.

A nurse is planning health teaching for a 14-year-old girl hospitalized with the diagnosis of anorexia nervosa. What does the nurse assume is likely true of the client? 1. Is somewhat concerned that the eating behavior may threaten life 2. Has some understanding of anorexia nervosa because of media publicity 3. Has minimal awareness that reduced caloric intake has lethal implications 4. Is demonstrating an unconscious desire for death by selecting refusal of food as the method

3. Has minimal awareness that reduced caloric intake has lethal implications Even though anorexia nervosa is a popular media topic and people with the disorder may intellectually understand the lethal implications of not eating, they do not recognize it as their problem even when they are dying of starvation. People with anorexia nervosa are unconcerned with the physiologic danger of the consequences of their behavior and focus only on being fat. Adolescents typically feel indestructible and immortal; also, individuals with anorexia nervosa believe being fat is unhealthy and must be avoided at any cost.

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for? 1. Bruising 2. Tachycardia 3. Hyperkalemia 4. Hypoglycemia

3. Hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

A 6-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute glomerulonephritis. What does the nurse expect the laboratory report to reveal? 1. Low sedimentation rate 2. Increased serum complement 3. Increased antistreptolysin O titer 4. Decreased blood urea nitrogen level

3. Increased antistreptolysin O titer An increased antistreptolysin O (ASO) titer indicates the presence of a previous streptococcal infection; levels are highest with acute glomerulonephritis, bacterial endocarditis, and scarlet fever. The sedimentation rate is increased in glomerulonephritis; it signifies an inflammatory process. A reduction in serum complement (C3) activity occurs early in the disease process of glomerulonephritis; activity increases as the child improves. The blood urea nitrogen level is increased, not decreased, with glomerulonephritis because of impaired glomerular function, with azotemia occurring as a result.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? 1. It equals the expected urinary output for the next 24 hours. 2. It will prevent the development of pneumonia and a high fever. 3. It will compensate for both insensible and expected output over the next 24 hours. 4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

3. It will compensate for both insensible and expected output over the next 24 hours.

A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first? 1. Alert the cardiac arrest team. 2. Call the laboratory to repeat the test. 3. Take vital signs and notify the primary healthcare provider. 4. Obtain an electrocardiogram (ECG) strip and obtain an antiarrhythmic medication.

3. Take vital signs and notify the primary healthcare provider. Vital signs monitor the cardiopulmonary status; the primary healthcare provider must treat this hyperkalemia to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Although obtaining an ECG strip is appropriate, obtaining an antiarrhythmic is premature; vital signs and medical attention is needed first.

A client is admitted with systemic lupus erythematosus (SLE). The laboratory report shows the presence of neutrophils and monocytes as mediators of injury. Which type of hypersensitivity reaction most likely occurred in the client? 1. Type I 2. Type II 3. Type III 4. Type IV

3. Type III Type III hypersensitivity reaction involves immunoglobulin IgG- and IgM-mediated release of neutrophils and monocytes as mediators of injury. It is an immune complex-mediated hypersensitivity reaction that occurs in SLE or rheumatoid arthritis. Allergic rhinitis and asthma may occur when mediators such as histamine and prostaglandins are involved, resulting in a type I hypersensitivity reaction. Type II hypersensitivity reaction is cytotoxic mediated, which occurs in transfusion reaction and Goodpasture syndrome. Type IV hypersensitivity reaction is a delayed hypersensitivity reaction that may occur in contact dermatitis involving T cytotoxic cells.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs further teaching? 1. "A scrotal support may be more comfortable when I have scrotal edema." 2. "I need to take good care of my belly and ankle skin where it is swollen." 3. "I can use pillows to support my head to help me breathe when I am in bed." 4. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."

4. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." If the patient with cirrhosis develops a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider because this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response? 1. "The staff will provide total care, because the infection causes severe fatigue." 2. "Mood elevators will be prescribed to improve depression and irritability." 3. "Vitamin B₁₂ will be prescribed for the anemia, and the stools will be dark." 4. "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

4. "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products." One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron and folic acid supplements are used for anemia in chronic kidney disease; Vitamin B 12 is used for pernicious anemia and does not make the stools dark; iron makes the stools dark.

A 45-year-old client is scheduled to undergo a hysterectomy and expresses concern because she has heard from friends that she will experience severe symptoms of menopause after surgery. What is the nurse's most appropriate response? 1. "You're right, but there are medicines you can take that will ease the symptoms." 2. "Sometimes that happens in women of your age, but you don't need to worry about it right now." 3. "You should probably talk to your surgeon, because I am not allowed to discuss this with you." 4. "Women may experience symptoms of menopause if their ovaries are removed with their uterus."

4. "Women may experience symptoms of menopause if their ovaries are removed with their uterus." A hysterectomy involves only removal of the uterus. The ovaries, which secrete estrogen and progesterone, are not removed. Therefore menopause will not be precipitated but will occur naturally. Surgical menopause is precipitated by the removal of the ovaries, not the uterus. When the ovaries are removed, an older woman might have less severe symptoms than a younger woman; however, in this instance the ovaries are not removed. Telling the client that she needs to talk to her surgeon does not answer the question. The nurse should serve as a resource.

A client with systemic lupus erythematosus (SLE) is at 39 weeks' gestation. What does the nurse anticipate regarding this client? 1. A large-for-gestational age newborn 2. The possible need for postpartum dialysis 3. Greater prominence of the butterfly-shaped rash 4. A need to discontinue the client's salicylate therapy

4. A need to discontinue the client's salicylate therapy Salicylate therapy is used because clients with SLE have an increased risk of thrombus formation; as the time of birth approaches salicylate therapy should be discontinued to reduce the possibility of bleeding in the newborn. There is a greater probability that the newborn will be small for gestational age. There is no need for dialysis during the postpartum period. The butterfly-shaped rash that may occur with SLE does not become more prominent during late pregnancy.

The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess? 1. Urine 2. Stool 3. Hands 4. Breath

4. Breath The client's breath has a sweet odor (fetor hepaticus) because the liver is not metabolizing the food, especially proteins. The urine is dark. The stool is clay-colored. The hands develop asterixis or flapping tremors.

A patient with a 25-year history of type 1 diabetes is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood glucose levels. Which diagnostic study is most indicative of chronic kidney disease (CKD)? 1. Serum creatinine 2. Serum potassium 3. Microalbuminuria 4. Calculated glomerular filtration rate (GFR)

4. Calculated glomerular filtration rate (GFR) The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

After identifying that a patient has possible nutritional deficits, which action will the nurse perform next? 1. Provide supplements between meals. 2. Encourage eating meals with others. 3. Have family bring in food from home. 4. Complete a full nutritional assessment.

4. Complete a full nutritional assessment. A full nutritional assessment includes history and physical examination and laboratory data. The nutritional assessment will need to be done to provide the basis for nutrition intervention. The interventions may include supplements if ordered, family bringing food from home, and socializing with meals.

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? 1. IV tobramycin 2. Incompatible blood transfusion 3. Poststreptococcal glomerulonephritis 4. Dissecting abdominal aortic aneurysm

4. Dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststreptococcal glomerulonephritis are intrarenal causes of AKI.

Because of the risks, a 50-yr-old patient does not want hormone replacement therapy for perimenopausal symptoms. She asks the nurse how to minimize hot flashes and night sweats. What should the nurse recommend first? 1. Increase warmth to avoid chills. 2. Good nutrition to avoid osteoporosis 3. Vitamin B complex and vaginal lubrication 4. Keep the bedroom cool and limit alcohol use.

4. Keep the bedroom cool and limit alcohol use. To avoid hot flashes and sweating at night, decrease heat production with a cool environment, limit caffeine and alcohol, and practice relaxation techniques. Heat loss may be facilitated with increased circulation in the room, avoidance of heavy bedding, and wearing loose-fitting clothes. Warmth will facilitate hot flashes. Nutrition, vitamin B complex, and vaginal lubrication will help with other complications of perimenopause but not hot flashes and sweating at night.

The nurse preparing to give a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? 1. Sodium 2. Potassium 3. Magnesium 4. Phosphorus

4. Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels.

A patient with cirrhosis has increased abdominal girth from ascites. Which statements describe the pathophysiology of ascites? (Select all that apply.) 1. Hepatocytes are unable to convert ammonia to urea. 2. Osmoreceptors in the hypothalamus stimulate thirst. 3. An enlarged spleen removes blood cells from the circulation. 4. Portal hypertension causes leaking of protein and water into the peritoneal cavity. 5. Aldosterone is released to stabilize intravascular volume by saving salt and water. 6. Inability of the liver to synthesize albumin reducing intravascular oncotic pressure.

4. Portal hypertension causes leaking of protein and water into the peritoneal cavity. 5. Aldosterone is released to stabilize intravascular volume by saving salt and water. 6. Inability of the liver to synthesize albumin reducing intravascular oncotic pressure. Ascites related to cirrhosis is caused by decreased colloid oncotic pressure. The liver does not produce albumin that holds fluid in the vascular space, so fluid shifts into interstitial and third spaces. Portal hypertension causes back pressure in the vessels, shifting protein and fluids into the peritoneal cavity. Decreased intravascular volume stimulates the release of aldosterone, which increases sodium and fluid retention. Oral intake of fluids and removal of blood cells by the spleen do not directly contribute to ascites.

A nurse is caring for an adolescent with the diagnosis of anorexia nervosa. The plan of care should include helping the client do what? 1. Plan nutritious meals. 2. Change attitudes about nutrition. 3. Understand that more food must be eaten. 4. Recognize how the need to control influences behavior.

4. Recognize how the need to control influences behavior. The client's focus on controlling eating redirects attention away from those areas that are felt to be out of the client's control. This is how life's more difficult problems and challenges are avoided. Planning nutritious meals may not be productive, because these clients believe that they are eating nutritious meals. It is not the client's attitudes or beliefs about food but instead the distorted self-image that is the problem. Understanding that more food must be eaten may not be productive, because these clients believe that they are eating enough food.

When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? 1. Weigh patient three times weekly. 2. Increase dietary sodium and potassium. 3. Provide a low-protein, high-carbohydrate diet. 4. Restrict fluids according to previous daily loss.

4. Restrict fluids according to previous daily loss. Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.

The nurse notes that a young client with anorexia nervosa telephones home just before each mealtime. The client ignores reminders to eat and continues talking until the other clients are finished eating. The client then refuses to eat food that has gotten cold. What should the nurse do initially? 1. Insist that the client eat the food. 2. Revoke the client's telephone privileges. 3. Hang up the telephone when meals are served. 4. Schedule a family meeting to discuss the problem.

4. Schedule a family meeting to discuss the problem. By talking to the client on the telephone at mealtimes, the family is enabling the client to continue the self-destructive behavior; the client and family must be included in discussion of and possible solutions to the problem. Insisting that the client eat the food is a punitive approach that does not address the underlying problem. Revoking the client's telephone privileges is a behavior modification approach that may be used if talking to the family does not produce needed change. Hanging up the telephone when meals are served is a punitive approach that does not address the underlying problem.

systemic lupus erythematosus (SLE)

A chronic inflammatory disease affecting many systems of the body. It is an example of a collagen disease. The pathophysiologic characteristics of the disease include severe vasculitis, renal involvement, and lesions of the skin and nervous system. The initial manifestation is often arthritis. An erythematous rash ("butterfly rash") over the nose and malar eminences, weakness, fatigue, and weight loss also are frequently seen early in the disease. Photosensitivity, fever, skin lesions on the neck, and alopecia where the skin lesions extend beyond the hairline may occur. The skin lesions may spread to the mucous membranes and other tissues of the body. They do not ulcerate but cause degeneration of the affected tissues. Depending on the organs involved, the patient also may have glomerulonephritis, pleuritis, pericarditis, peritonitis, neuritis, or anemia. Renal failure and severe neurologic abnormalities are among the most serious manifestations of the disease. The primary cause of the disease has not been determined; viral infection or dysfunction of the immune system has been suggested. Diagnosis of SLE is made by subjective and objective findings based on physical examination and laboratory findings. In many cases SLE may be controlled with corticosteroid medication administered systemically. Care and treatment vary with the severity and nature of the disease and the body systems that are affected. Fatigue and stress are prevented, and all body surfaces are protected from direct sunlight. As in any disease marked by chronic remission and exacerbation of many distressing symptoms, the patient may require extensive emotional and psychologic support.

A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after revealing which symptoms? (Select all that apply.) A. Muscle aches B. Hyperactivity C. Weight changes D. Fever E. Hypotension

A. Muscle aches C. Weight changes D. Fever Fatigue, rather than hyperactivity is a common sign of systemic lupus erythematosus (SLE). Hypotension is not a characteristic sign of SLE. Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As is the case with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions.

When caring for a youngster with anorexia nervosa, the MOST important nursing intervention is to: A. encourage weight gain. B. correct malnutrition. C. limit fluid intake. D. prevent depression.

B. correct malnutrition. The individual with anorexia nervosa would probably not be receptive to encouragement because of the complex etiology of the disorder. This is the priority goal of treatment. Fluids are often restricted by the individual with anorexia. It is important to correct fluid and electrolyte imbalances if present. Depression may be a component of the process.

Nursing responsibilities in the management of adolescent obesity include: A. planning a low-calorie, low-protein diet. B. incorporating favorite foods into the child's diet. C. encouraging diversional activities during mealtimes. D. using nutritious foods as a method of reward.

B. incorporating favorite foods into the child's diet. A food plan high in nutrients, with calories and fats kept at a healthy level, is recommended. Incorporating small amounts of the adolescent's favorite foods will increase adherence to the nutritional plan. Diversional activities such as television watching may contribute to overeating. Foods should not be used as a reward.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's BEST reply is: A. "Blood pressure changes are a common side effect of antibiotic therapy." B. "Blood pressure changes are a sign that the condition has become chronic." C. "Acute hypertension, or high blood pressure, must be anticipated and identified." D. "Hypotension, or low blood pressure, leading to sudden shock can develop at any time."

C. "Acute hypertension, or high blood pressure, must be anticipated and identified." Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations do not indicate chronic disease. Most children with glomerulonephritis fully recover. Vital signs, in particular blood pressure, provide information about the severity of the disease and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Hypertension is more likely with glomerulonephritis.

An advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents that require dialysis is that: A. hospitalization is only required several nights per week. B. dietary restrictions are no longer necessary. C. adolescents can carry out procedures themselves. D. insertion of catheter does not require surgical placement.

C. adolescents can carry out procedures themselves. Procedure can be done at home. Dietary restrictions are still required but are less strict. This type of dialysis provides the most independence for adolescents with ESRD and their families. Adolescents can carry out the procedure themselves. The catheter is surgically implanted in the abdominal cavity.

A toddler is hospitalized with acute renal failure secondary to severe dehydration. The nurse should assess the child for what possible complication? A. Hypotension B. Hypokalemia C. Hypernatremia D. Water intoxication

D. Water intoxication The child needs to be monitored for hypertension. Hyperkalemia is a concern in acute renal failure. Hyponatremia may develop in acute renal failure. The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes.

SCOFF Questionnaire

Each question scores 1 point. A score of 2 or more indicates the person may have anorexia nervosa or bulimia. 1. Do you make yourself Sick (i.e., induce vomiting) because you feel too full? 2. Do you worry about loss of Control over the amount you eat? 3. Have you recently lost more than One stone (6.4 kg [14 lbs]) in a 3-month period? 4. Do you think you are too Fat even if others think you are too thin? 5. Does Food dominate your life?

Anorexia Nervosa and Bulimia Nervosa Interventions

Interventions 1. Build Trust 2. Plan Caloric Intake 3. Supervise Meals 4. Supervise Elimination 5. Enciurage Liquids 6. Daily Weights 7. Use Matter-of-Fact Statements 8. Give Feelings of Control Considerations 9. Tube Feedings if Further Weight Loss

innate immunity

Natural, native, or innate resistance and protection conferred by inflammation

2. Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component. a. skeletal protein. b. glycogen. c. visceral protein. d. fat stores.

b, a, c, d

5. A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.

b. 5% dextrose solution.

Clinical Manifestations of Anorexia Nervosa

• Severe and profound weight loss • Secondary amenorrhea (if menarche attained) • Primary amenorrhea (if menarche not attained) • Sinus bradycardia • Lowered body temperature • Hypotension • Intolerance to cold • Dry skin and brittle nails • Appearance of lanugo hair • Thinning hair • Abdominal pain • Bloating • Constipation • Fatigue • Lightheadedness • Evidence of muscle wasting (cachectic appearance) • Bone pain with exercise

What advice is appropriate for a growing child to prevent obesity? Select all that apply. 1. "You should eat small meals throughout the day." 2. "You should put a video game system in your bedroom." 3. "You should drink fewer sweetened beverages every day." 4. "You should watch television for less than 2 hours every day." 5. "You should skip breakfast and eat a healthy lunch and dinner."

1. "You should eat small meals throughout the day." 3. "You should drink fewer sweetened beverages every day." 4. "You should watch television for less than 2 hours every day." Sweetened beverages are high in sugar and calories, which increase the risk of obesity. Therefore, the nurse instructs the client to avoid sweetened beverages. Eating small meals at regular intervals keeps the person feeling full, reduces overeating, and improves metabolism. A sedentary lifestyle also increases the risk of obesity. The nurse should instruct the client to reduce television watching to less than 2 hours a day. Playing video games is primarily a sedentary activity. Breakfast is a very important meal, and the nurse should instruct the client to eat a healthy breakfast every day.

A patient with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? 1. Assess the patient's hydration status. 2. Insert a urinary catheter for the expected diuresis. 3. Evaluate the patient's lower extremities for edema. 4. Check the patient's urine for the presence of ketones.

1. Assess the patient's hydration status. Preexisting kidney disease is the most important risk factor for the development of contrast-associated nephropathy and nephrotoxic injury. If contrast media must be administered to a high-risk patient, the patient needs to have optimal hydration. The nurse should assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease the risk of infection.

Systemic Lupus Erythematosus (SLE) Interventions

1. Avoid Sunlight Drug Therapy 2. Glucocorticoids 3. Methotrexate 4. NSAIDs 5. Hydroxychloroquine 6. Azathioprine Considerations 7. Monitor for Renal Failure (ARF) 8. Manage Pain

A nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which common responses to this disease can the nurse expect the client to exhibit? Select all that apply. 1. Butterfly facial rash 2. Firm skin fixed to tissue 3. Inflammation of the joints 4. Muscle mass degeneration 5. Inflammation of small arteries

1. Butterfly facial rash 3. Inflammation of the joints The connective tissue degeneration of SLE leads to involvement of the basal cell layer, producing a butterfly rash over the bridge of the nose and in the cheek region. Polyarthritis occurs in most clients, with joint changes similar to those seen in rheumatoid arthritis. Firm skin fixed to tissue occurs in scleroderma; in an advanced stage the client has the appearance of a living mummy. Muscle mass degeneration occurs in muscular dystrophy; it is characterized by muscle wasting and weakness. Inflammation of small arteries occurs in polyarteritis nodosa, a collagen disease affecting the arteries and nervous system.

When determining whether a client has anorexia nervosa or bulimia nervosa, the nurse should identify those characteristics that relate only to anorexia nervosa. Select all that apply. 1. Cachexia 2. Binge eating 3. Constipation 4. Decreased blood pressure 5. Delayed psychosexual development

1. Cachexia 5. Delayed psychosexual development A state of malnutrition with muscle wasting, weakness, and emaciation (cachexia) occurs with anorexia nervosa; clients usually are 15% to 30% below ideal body weight. Many clients with anorexia nervosa exhibit psychological symptoms, including a lack of age-appropriate interest in sex and relationships. Recurrent episodes of the rapid consumption of a large amount of food in a discrete period (binge eating) are associated with bulimia nervosa. Constipation can occur with both anorexia nervosa and bulimia nervosa, usually because of a lack of adequate fluids and intestinally stimulating foods. Hypotension can occur with both anorexia nervosa and bulimia nervosa, usually because of dehydration.

A nurse who works in a mental health facility determines that what is the priority nursing intervention for a newly admitted client with bulimia nervosa? 1. Check on the client continually. 2. Observe the client during meals. 3. Teach the client to measure intake and output. 4. Involve the client in developing a daily meal plan.

1. Check on the client continually. Bulimic clients often hide food or force vomiting; therefore they must be carefully observed. Observing the client during meals is insufficient, because these clients may induce vomiting after eating. Fluid and electrolyte balance can become a problem for these clients, and monitoring is required, but at this time it is the responsibility of the nurse, not the client, to measure intake and output. These clients will not become involved in planning meals; this is a long-term goal.

The laboratory results of a client with a pulmonary hemorrhage and glomerulonephritis reveal the presence of IgG antibodies. Which type of hypersensitivity reaction should a nurse suspect? 1. Cytotoxic reaction 2. Immediate reaction 3. Immune-complex reaction 4. Delayed hypersensitivity reaction

1. Cytotoxic reaction A client with a pulmonary hemorrhage and glomerulonephritis with deposits of IgG antibodies in the lungs and kidneys may have Goodpasture's syndrome. This reaction is a type 2 cytotoxic reaction that involves the lungs and kidneys. Immediate reactions are type 1 hypersensitivity reactions that include IgE antibody reactions. Immune-complex reactions such as systemic lupus erythematosus and rheumatoid arthritis are type 3 hypersensitivity reactions that include IgG and IgM antibodies. Delayed hypersensitivity reactions are type 4 reactions that involve cytokine and cytotoxic T-cell mediated immunity.

Chronic Kidney Disease Interventions

1. Daily Weights 2. Strict I/O 3. Renal Diet 4. Strict Medication Regimen 5. Erythropoietin 6. Manage Hyperkalemia 7. Manage CKD-MBD 8. Dialysis 9. Kidney Transplant

After an assessment, a nurse suspects that an adolescent has anorexia nervosa. Which characteristics may have been observed in the adolescent? Select all that apply. 1. Denying illness 2. Seeking intimacy 3. Being extroverted 4. Dismissing food 5. Maintaining rigid body control

1. Denying illness 4. Dismissing food 5. Maintaining rigid body control Anorexia nervosa is a complex disorder that can result in morbidity and mortality. Denying the illness, dismissing food, and maintaining rigid control of the body are characteristics observed in adolescents with anorexia nervosa. Seeking intimacy and being extroverted are characteristics of bulimia nervosa.

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would best help determine if the patient has developed liver cancer? 1. MRI scanning 2. Serum α-fetoprotein level 3. Ventilation/perfusion scan 4. Abdominal girth measurement

1. MRI scanning Hepatic ultrasonography, CT scan, and MRI scanning are used to screen for and diagnose liver cancer. Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans are used to diagnose pulmonary emboli. Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.

Normal BUN levels

10-20 mg/dL

GFR normal

125 mL/min

A nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client's questions? 1. A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses. 2. Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis. 3. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. 4. Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

3. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys, which should be prevented. Adequate calories are provided to prevent tissue catabolism that also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high-protein diet, which is to be avoided. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.

serum albumin level

3.5-5.5 g/dL

After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. What is the nurse's most appropriate response? 1. "It's best to wait until after the surgery because you may not have any symptoms." 2. "It's comforting to know that hormones are available if you should ever need them." 3. "You have to wait until symptoms are severe; otherwise the hormones will have no effect." 4. "Discuss this with your primary healthcare provider because it is important to verbalize your concerns."

4. "Discuss this with your primary healthcare provider because it is important to verbalize your concerns." The nurse cannot prescribe medication. In addition, the use of hormones is controversial and depends on the primary healthcare provider's beliefs and the client's needs. Telling the client that hormones are available if she should ever need them is an evasive response; it does not answer the client's question. Advising the client to wait until after surgery or wait until symptoms are severe conveys information that the nurse is not legally licensed to provide.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? 1. Fluid imbalance 2. Impaired tissue integrity 3. Impaired nutritional status 4. Ineffective breathing pattern

4. Ineffective breathing pattern Although all these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.

peritoneal dialysis

A dialysis procedure performed to correct an imbalance of fluid or of electrolytes in the blood or to remove toxins, drugs, or other wastes normally excreted by the kidney. The peritoneum is used as a diffusible membrane.

passive immunity

A form of acquired immunity resulting from antibodies that are transmitted naturally through the placenta to a fetus, through the colostrum to an infant, or artificially by injection of antiserum for treatment or prophylaxis. Passive immunity is not permanent.

active immunity

A form of long-term, acquired immunity. It protects the body against a new infection as the result of antibodies that develop naturally after an initial infection or artificially after a vaccination.

glomerular filtration rate

A kidney function test in which results are determined from the amount of ultrafiltrate formed by plasma flowing through the glomeruli of the kidney. The amount may be calculated from inulin and creatinine clearance, serum creatinine, and BUN. The GFR can also be estimated from equations that include creatinine, age, gender, and ethnicity.

hemodialysis

A procedure in which impurities or wastes are removed from the blood, used in treating patients with renal failure and various toxic conditions. The patient's blood is shunted from the body through a machine for diffusion and ultrafiltration and then returned to the patient's circulation. Hemodialysis requires access to the patient's bloodstream, a mechanism for the transport of the blood to and from the dialyzer, and a dialyzer.

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by implementing which intervention? A. Teaching the family about the disorder and the client's behaviors B. Stressing the need to suppress overt conflict within the family C. Urging the family to demonstrate greater caring for the client D. Encouraging the family to use their usual social behaviors at meals

A. Teaching the family about the disorder and the client's behaviors Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member. While the other options may be appropriate for specific client families, they are not as fundamental as the correct option.

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa? A. Weight restoration B. Improving interpersonal skills C. Learning effective coping methods D. Changing family interaction patterns

A. Weight restoration Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status. The other options are addressed are secondary to the physiological goal of weight restoration.

acute tubular necrosis

Acute renal failure with mild to severe damage or necrosis of tubule cells, usually as a result of either nephrotoxicity, ischemia after major surgery, trauma, severe hypovolemia, sepsis, or burns.

nephrotic syndrome

An abnormal condition of the kidney characterized by marked proteinuria, hypoalbuminemia, and edema. It occurs in glomerular disease and thrombosis of a renal vein and as a complication of many systemic diseases, DM, amyloidosis, SLE, and multiple myeloma. The presenting symptoms include anorexia, weakness, proteinuria, hypoalbuminuria, and edema.

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? A. Mood stabilizers B. Antidepressants C. Anxiolytics D. Atypical antipsychotics

B. Antidepressants The antidepressant fluoxetine (Prozac, an SSRI) has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders.

A client diagnosed with bulimia nervosa uses enemas and laxatives to purge to maintain weight. What is the likely physiological outcome of this practice? A. Increase in the red blood cell count B. Disruption of the fluid and electrolyte balance C. Elevated serum potassium level D. Elevated serum sodium level

B. Disruption of the fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. There would be a decrease in potassium and sodium levels while the concentration of but not actual red cell count would be affected.

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to support which electrolyte imbalance? A. Hypernatremia B. Hypokalemia C. Hypercalcemia D. Hypolipidemia

B. Hypokalemia Vomiting causes loss of potassium, leading to hypokalemia. Vomiting is not the trigger for any of the other options presented.

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? A. It will reduce the need for cognitive therapy. B. It will be prescribed at a higher than typical dose. C. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. D. Long-term management of symptoms is best achieved with tricyclic antidepressants.

B. It will be prescribed at a higher than typical dose. Research has shown that antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. Fluoxetine (Prozac), an Selective serotonin reuptake inhibitors (SSRI) antidepressant, has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression. Although no other drugs have FDA approval for this disorder, tricyclic antidepressants helped reduce binge eating and vomiting over short terms.

According to current theory, which statement regarding eating disorders is accurate? A. Eating disorders are psychotic disorders in which patients experience body dysmorphic disorder. B. Eating disorders are frequently misdiagnosed. C. Eating disorders are possibly influenced by sociocultural factors. D. Eating disorders are rarely comorbid with other mental health disorders.

C. Eating disorders are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders.

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa? A. Disturbed body image B. Chronic low self-esteem C. Risk for injury: electrolyte imbalance D. Ineffective coping: impulsive responses to problems

C. Risk for injury: electrolyte imbalance The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss. This electrolyte imbalance is potentially life threatening. While appropriate none of the other options are as likely to risk the client's life.

Assessment of a client suspected of experiencing bulimia nervosa calls for the nurse to perform A. a range of motion assessment. B. inspection of body cavities. C. inspection of the oral cavity. D. body fat analysis.

C. inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries. None of the other options represent frequently engaged dysfunctional behaviors.

Cirrhosis Interventions

Interventions 1. Maintain Nutrition 2. Paracentesis Esophageal and Gastric Varices 3. Drug Therapy 4. Endoscopic Band Ligation or Sclerotheapy 5. Balloon Tamponade 6. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy 7. Lactulose 8. Antibiotics

menopause

Strictly, the cessation of menses, but commonly referring to the period of the female climacteric. Menses stop naturally with the decline of cyclic hormonal production and function usually between 45 and 55 years of age but may stop earlier in life as a result of illness, surgery, or for unknown reasons. As the production of ovarian estrogen and pituitary gonadotropins decreases, ovulation and menstruation become less frequent and eventually stop. Fluctuations in the circulating levels of these hormones occur as the levels decline. Hot flashes are a common symptom of menopause.

The percentage of daily calories for a healthy person consists of a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.

a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids.

During a nutritional assessment, the nurse calculates that a female patient's BMI is 27. The nurse would advise the patient to follow which of these recommendations? a. This measurement indicates that the patient is overweight and should follow a plan of diet and exercise to lose weight. b. This measurement indicates that the patient is underweight and will need to take measures to gain weight. c. This measurement indicates that the patient is morbidly obese and may be a candidate for bariatric surgery. d. This measurement indicates that the patient is of normal weight and should continue with current lifestyle.

a. This measurement indicates that the patient is overweight and should follow a plan of diet and exercise to lose weight. A BMI of 25 to 29.9 is in the overweight range. A BMI of <18.5 is in the underweight range. A BMI of 30 to 34.9 is obesity class I, a BMI of 35 to 39.9 is obesity class II, and a BMI of >40 is obesity class III (morbid obesity). A BMI of 19 to 24 is in the normal range.

4. Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. X-ray b. Air insertion c. Observing patient for coughing d. pH measurement of gastric aspirate

a. X-ray

6. A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia.

a. hypokalemia. d. hypomagnesemia. e. hypophosphatemia.

The nurse teaches a patient with chronic kidney disease about prevention of complications. What should the nurse include in the teaching plan? a. Monitor for proteinuria daily with a urine dipstick. b. Perform self-catheterization every 4 hours to measure urine. c. Take calcium-based phosphate binders on an empty stomach. d. Check weight daily and report a gain of greater than 4 pounds.

d. Check weight daily and report a gain of greater than 4 pounds.

3. A complete nutritional assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2. b. reports episodes of nightly nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months.

d. reports an unintentional weight loss of 10 lb in 2 months.

Abnormalities in CRF are ?

waste product retention, water and sodium retention, hyperkalemia, acidosis, calcium and phosphorus disturbance, anemia, and growth disturbances.