Adults 2-Exam 1 SAs
A patient with a family history of breast cancer asks the nurse what is the most important risk factor for breast cancer. Which of the following risk factors should the nurse discuss? - Family history - Lifestyle choices - Age - Menopause or hormonal events
Family history
Interprofessional management of ovarian cancer includes which of the following? (Select all that apply.) - Combination chemotherapy to cure ovarian cancer - Bilateral salpingo-oophorectomy to remove diseased organs - Radiation therapy to eliminate all cancer cells - Referral to social services for supportive care - Nutrition therapy for parenteral lipids
- Bilateral salpingo-oophorectomy to remove diseased organs - Referral to social services for supportive care
A cause of transient urinary incontinence that can be reversed is: - Poor pelvic support causing hypermobility of the base of the bladder - Lower urinary tract problems such as cancer - Cystocele or uterine prolapse in women - Certain medications, such as sedatives, diuretics and anticholinergic agents
- Certain medications, such as sedatives, diuretics and anticholinergic agents Many older people experience transient episodes of incontinence that tend to be abrupt in onset. The nurse should interview the patient, (and the family if indicated), about onset of symptoms and related changes in other organ systems. Acute UTI, infection elsewhere in the body, constipation, decreased fluid intake, and change in chronic disease patterns, such as elevated blood glucose levels in diabetics or decreased estrogen levels in menopausal women, can provoke urinary incontinence. Early recognition and treatment of contributing factors may resolve incontinence. Although the bladder of the older person is more vulnerable to altered detrusor activity, age alone is not a risk factor for incontinence.
The health care provider orders a 24-hour urine collection. Which of the following actions is necessary to ensure proper collection of the specimen? - Collect the urine in a preservative-free container and keep it on ice - Inform the patient to discard the last voided specimen at the conclusion of urine collection - Assess the patients weight before beginning the collection of urine - Obtain an order for insertion of indwelling urinary catheter
- Collect the urine in a preservative-free container and keep it on ice Collect the urine in a preservative-free container and keep it on ice to avoid preservative contamination and breakdown of urine sample. Follow institutional protocols for specimen collection.
A patient has just returned to the floor following a transurethral resection of the prostate (TURP). A triple lumen urinary catheter is in place for continuous bladder irrigation. One lumen is for balloon inflation, what is the function of the other lumens? - Continuous inflow and outflow of irrigation solution - Intermittent inflow and continuous outflow of irrigation solution - Continuous inflow and intermittent outflow of irrigation solution - Intermittent flow of irrigation solution and prevention of hemorrhage
- Continuous inflow and outflow of irrigation solution Drainage of the bladder may be accomplished by gravity through a closed sterile drainage system. A three-way drainage system is useful in irrigating the bladder and preventing clot formation (Fig. 59-5). Continuous irrigation may be used with TURP. Some urologists leave an indwelling catheter attached to a dependent drainage system. Gentle irrigation of the catheter may be prescribed to remove any obstructing clots
A patient is sent to the emergency department with probable acute pyelonephritis. What findings would the nurse anticipate on initial assessment of the patient? (Select all that apply.) - Fever - Oliguria - Urinary frequency - Flank pain - Tachypnea - Leukocytosis
- Fever - Urinary frequency - Flank pain - Leukocytosis ESWL(Extracorporeal shock wave lithotripsy) is a noninvasive procedure used to break up stones in the calyx of the kidney which are fragmented to the size of grains of sand and spontaneously excreted in the urine.
The patient with chronic renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability? - In health, the kidneys absorb and regulate carbonic acid to maintain stable pH - In health, the kidneys buffer acids through changes in electrolytes - In health, the kidneys regenerate and absorb bicarbonate to maintain stable pH - In health, the kidneys combine carbonic acid and bicarbonate to maintain stable pH
- In health, the kidneys regenerate and absorb bicarbonate to maintain stable pH The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. The kidneys obviously cannot compensate for the metabolic acidosis created by renal failure. Renal compensation for imbalances is relatively slow (a matter of hours or days).
You are caring for a patient with acute kidney injury. What is the most common clinical manifestation of acute kidney injury? - Decrease in blood urea nitrogen - Anuria - Oliguria - Decrease serum creatinine
- Oliguria The initiation period begins with the initial insult and ends when oliguria develops. Oliguria is accompanied by increases serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL per day.. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.
The nurse is providing a community education presentation about ovarian cancer. Which topic should receive priority attention in the lesson plan? - Ovarian cancer signs and symptoms are often vague until late in development. - Ovarian cancer should be considered in any woman older than 30 years of age. - A rigid board-like abdomen is the most common sign. - Methods for early detection have made a dramatic reduction in the mortality rate of ovarian cancer.
- Ovarian cancer signs and symptoms are often vague until late in development.
The cell responsible for activation of the immune response is: Band neutrophil T4 lymphocyte Segmented neutrophil B lymphocytes
B lymphocytes B Lymphocytes are responsible for humoral immunity; many mature into plasma cells to form antibodies
In teaching a patient with anemia to include food rich in iron in the diet, the nurse encourages the patient to eat: Cheese, milk and yogurt Red beans, whole-grain bread, and bran cereal Tomatoes, cabbage and citrus fruits Beef, spinach and peanut butter
Beef, spinach and peanut butter Food sources high in iron include organ meats (e.g., beef or chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances absorption of iron.
The nurse is caring for a patient with acute kidney injury. The health care provider prescribes hypertonic glucose, insulin, and sodium bicarbonate infusion. The nurse knows that this is intended to treat - Elevated blood glucose - Diabetic ketoacidosis - Renal tubular acidosis - Hyperkalemia
Hyperkalemia Elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (water loss via the GI tract). If a Kayexalate retention enema is administered (the colon is the major site of potassium exchange), a rectal catheter with a balloon may be used to facilitate retention if necessary. The patient should retain the Kayexalate for at least 30 minutes (preferable several hours) to promote potassium removal. Afterward, a cleansing enema may be prescribed to remove remaining medication as a precaution against fecal impaction.If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to drive potassium back into the cells. The shift of potassium into the intracellular space is temporary, so arrangements for dialysis need to be made on an emergent basis
You are caring for a patient with anemia. The patient asks you where blood cells come from. Where would you tell him blood cells are formed? In the spleen In the kidney In the liver In the bone marrow
In the bone marrow The hematologic system consists of blood and sites where blood is produced, including bone marrow and the reticuloendothelial system (RES). Blood is a specialized organ that differs from other organs in that it exists in a fluid state. Blood is composed of plasma and various types of cells. Plasma is the fluid portion of blood containing various proteins, such as albumin, globulin, fibrinogen, and other factors necessary for clotting, as well as electrolytes, waste products, and nutrients. About 55% of blood volume is plasma
Patient education about common antigens that cause anaphylaxis includes: Extreme weather Insect venom Pungent odors Dust mites
Insect venom People who are allergic to insect venom may require venom immunotherapy, which is used as a control measure and not a cure. The most common serious allergic reactions to insect stings are from the Hymenoptera family, which includes honeybees, fire ants, and wasps. Immunotherapy administered after an insect sting is very effective in reducing the risk of anaphylaxis from future stings. Insulin-allergic patients with diabetes and those who are allergic to penicillin may require desensitization. Desensitization is based on controlled anaphylaxis, with a gradual release of mediators. Patients who undergo desensitization are cautioned to avoid lapses in therapy as this may lead to reappearance of the allergic reaction when the medication is resumed.
A patient presents to the GYN clinic with a complaint of heavy menses and fatigue. The nurse knows that the patient most likely has which type of anemia? Iron deficiency anemia Hemolytic anemia Vitamin B12 or folate deficiency Anemia of chronic disease
Iron deficiency anemia The most common causes of iron deficiency anemia in premenopausal women are menorrhagia (i.e., excessive menstrual bleeding) and pregnancy with inadequate iron supplementation. The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease, or GI tumors.
Iron deficiency anemia is an example of: Macrocytic, normochromic anemia Macrocytic, hypochromic anemia Microcytic, hypochromic anemia Megaloblastic, hypochromic anemia
Microcytic, hypochromic anemia Iron deficiency anemia is an example of microcytic, hypochromic anemia. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls. The diminished iron stores cause smaller erythrocytes to be produced by the marrow. Therefore, as anemia progresses, the MCV, which measures size of erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin level
In caring for a patient with allergic rhinitis, what information should be included for self-care? Monitor air quality and the allergy index Use a surgical type mask when going outdoors Remain indoors during allergy season Avoid working in the yard or garden
Monitor air quality and the allergy index The nurse instructs the patient with allergic rhinitis to avoid or reduce exposure to allergens and irritants, such as dusts, molds, animals, fumes, odors, powders, sprays, and tobacco smoke. Teaching the patient about medications and reading OFC labels is essential to prevent possible drug interactions
A patient admitted with thrombocytopenia asks you to explain the disease to her. What would you tell the patient about this condition? There could be an attack on the platelets by antibodies There could be increased production of platelets There could be decreased platelet production in the liver There could be increased production of white blood cells
There could be an attack on the platelets by antibodies Thrombocytopenia is a condition where the platelet count is lower than normal which can be due to various factors: decreased production of platelets within the bone marrow, increased destruction of platelets, or increased consumption of platelets (e.g., the use of platelets in clot formation). Having enough platelets is essential to normal clot formation which prevents bleeding. The risk of bleeding increases when the platelet count is lower than 50,000. If the platelet count drops lower than 20,000 there is an increased risk for spontaneous bleeding which will be treated with platelet transfusions .Although laboratory test results confirm the diagnosis of thrombocytopenia, the patient who is developing thrombocytopenia may display early signs and symptoms. Observe for early signs of bleeding such as petechiae and ecchymoses, due to low platelet levels.
Risk factors associated with testicular malignancies include: - Age greater than 40 years - African-American race - Residing in a rural area - Undescended testes
Undescended testes
Which of the following lab values should the nurse report to the health care provider? Hemoglobin 14 gm/dL Mean corpuscular volume 86 White cell count 2,000/cu mm Reticulocytes 0.7%
White cell count 2,000/cu mm Neutropenia (a neutrophil count of less than 2,000/mm3) results from decreased production of neutrophils or increased destruction of these cells. Neutrophils are essential in preventing and limiting bacterial infection. A patient with neutropenia is at increased risk for infection from both exogenous and endogenous sources.
