Exam 1 Chronic
Hypertension
•High blood pressure •Most common chronic disease among U.S. adults •Hypertension is defined by the American Society of Hypertension (ASH) and the International Society of Hypertension (ISH) as a systolic blood pressure (SBP) of 140 mm Hg or higher or a diastolic blood pressure (DBP) of 90 mm Hg or higher, based on the average of two or more accurate blood pressure measurements taken 1 to 4 weeks apart by a health care provider
Nursing History and Assessment
•History and risk factors •Assess potential symptoms of target organ damage -Angina, shortness of breath, altered speech, altered vision, nosebleeds, headaches, dizziness, balance problems, nocturne -Cardiovascular assessment: apical and peripheral pulses •Personal, social, and financial factors that will influence the condition or its treatment
Major Risk Factors
•Hypertension •Smoking •Obesity •Physical inactivity •Dyslipidemia •Diabetes mellitus •Microalbuminuria or GFR <60 mL/min •Older age •Family history
Hypertensive Crises
•Hypertensive emergency-Blood pressure >180/120 mm Hg and must be lowered immediately to prevent damage to target organs •Hypertensive urgency -Blood pressure is very elevated but no evidence of immediate or progressive target organ damage
Collaborative Problems and Potential Complications
•Left ventricular hypertrophy •Myocardial infarction •Heart failure •Transient ischemic attack (TIA) •Cerebrovascular disease (CVA, stroke, or brain attack) •Renal insufficiency and chronic kidney disease •Retinal hemorrhage
Gerontologic Considerations
•Medication regimen can be difficult to remember •Expense can be a challenge •Monotherapy, if appropriate, may simplify the medication regimen and make it less expensive •Ensure that older adult patients understand the regimen and can see and read instructions, open medication containers, and get prescriptions refilled •Include family and caregivers in educational program
Hypertensive Urgency
•Oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours •Fast-acting oral agents: -Beta-adrenergic blocker —labetalol -Angiotensin -converting enzyme inhibitor —captopril -Alpha2-agonist—clonidine •Patient requires close monitoring of blood pressure and cardiovascular status •Assess for potential evidence of target organ damage
Interventions
•Support and educate the patient about the treatment regimen •Reinforce and support lifestyle changes •Taking medications as prescribed •Follow-up care
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order?
Nasogastric tube insertion
Definitions of Disability•
•WHO (2001)- International Classification of Functioning, Disability, and Health -Dynamic between a person's health condition and their environment •Americans With Disabilities Act of 1990 -Physical or mental impairment that substantially limits one or more major life activities -Record of, or regarded as, having such an impairment
Manifestations of Hypertension
•Usually no symptoms other than elevated blood pressure •Symptoms related to organ damage are seen late and are serious -Retinal and other eye changes -Renal damage -Myocardial infarction -Cardiac hypertrophy -Stroke
A patient comes to the health center reporting headache, backache, and abdominal pain. Further assessment leads the nurse to suspect that the patient has depression based on an understanding of which of the following?
Most patients experiencing depression seek treatment for somatic problems.
Management of Chronic Conditions
•Learning to live with symptoms or disabilities •Lifestyle changes to control symptoms and prevent complications
A young female client smokes two packs of cigarettes and drinks a six-pack of beer each day. The nurse is attempting to teach the client about smoking cessation and decreasing alcohol intake. The client states, "My grandmother lived to be in her 90s, and she smoked and drank. I come from good genes." The most apropriate statement by the nurse is
"Certain illnesses can be traced to common risk factors and can be prevented."
Prevalence of Disabilities•
•Approximately 60 million in United States •20% of persons in United States have a disability •10% of persons in United States have a severe disability •Numbers expected to increase
A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize?
It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.
Which is a characteristic of right-sided heart failure?
Jugular vein distention Dyspnea, pulmonary crackles, and cough are manifestations of left-sided heart failure.
A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction?
"Avoid aspirin and products that contain aspirin."
A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client?
"Be sure to wear sunscreen while taking this medicine."
A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which of the following explanations from the nurse would be most accurate?
"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."
A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.)
"You may have ingested some irritating foods." "It can be caused by ingestion of strong acids." "Is it possible that you are overusing aspirin."
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems?
Acute gastritis
The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition?
Anal fissure; Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation).
A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. Which of the following would be the most accurate response from the nurse?
Approximately 75%
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to
Assess the client's abdomen and vital signs.
A patient is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What is the name of this surgical procedure for peptic ulcer disease?
Billroth I
Which of the following clients is at highest risk for peptic ulcer disease?
Client with blood type O
A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?
Colonoscopy
A patient sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this patient?
Curling's ulcer-frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.
A nurse caring for a patient in a burn treatment center knows to assess for the presence of which of the following types of ulcer about 72 hours post injury?
Curling's; results from a complication from severe burns that causes reduced plasma volume that affects the gastric mucosa.
A client is being treated for diverticulosis. Which information should the nurse include in this client's teaching plan?
Drink at least 8 to 10 large glasses of fluid every day
A physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist?
Endoscopy
The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?
Familial polyposis
A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed?
Hemorrhage
A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms?
Keep a 1- to 2-week symptom and food diary to identify food triggers.
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?
Low residue, high-protein
A client who is hearing impaired and communicates through sign language only is scheduled for an endoscopy. She does not read lips. It would be best for the nurse to
Obtain a sign interpreter.
Which medication classification represents a proton (gastric acid) pump inhibitor?
Omeprazole
A client with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the client and her family to establish goals for care. What is likely to be a first priority in goal setting for the client?
Pain control
A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?
Perforation of the peptic ulcer
Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: You Selected:
Peritonitis--inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera.
The nurse is caring for a client who communicates via sign language. What should the nurse should do to promote communication?
Provide a sign language interpreter.
Chronic conditions are most acutely experienced by clients and their immediate familiies. Nurses provide direct care especially during actue episodes. Which of the following is an example of what the nurse can do for a client with a chronic illness?
Provide teaching and secure resources and other support systems needed.
When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?
Rectal bleeding
Which of the following is the most successful treatment for gastric cancer?
Removal of the tumor
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?
Right lower quadrant
A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________.
Rovsing's sign; acute appendicitis
Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?
Sudden, sustained abdominal pain
A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?
Test all stools for occult blood.
Which symptom characterizes regional enteritis?
Transmural thickening. Transmural thickening is an early pathologic change of Crohn's disease.
A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse
Turns off the television
A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
alcohol abuse and smoking.
A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:
fissure-is a linear tear in the anal canal tissue
The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is:
gram-negative bacteria.
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:
high-fiber diet.
A typical sign/symptom of appendicitis is:
nausea
An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"?
stool consistency and client comfort
Chronic illness refers to
the human experience of living with a chronic disease or condition
A client from a low socioeonomic background was diagnosed with a chronic health problem. The client states, "Everyone has to die of something." The most appropriate response by this nurse is
"There are things you can do to minimize the effects of this disease on your health."
The nurse is presenting health education to a 48-year-old man who was just diagnosed with type 2 diabetes. The client has a BMI of 35 and leads a sedentary lifestyle. The nurse gives the client information on the risk factors for his diagnosis and begins talking with him about changing behaviors around diet and exercise. The nurse knows that further client teaching is necessary when the client tells you what?
"There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented."
A man and woman are in their early 80s and have provided constant care for their 44-year-old son who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have what concerns around what question?
"Who will care for our son once we're unable?"
A client who has recently been diagnosed with chronic heart failure is being taught by the nurse how to live successfully with her chronic condition. Her ability to meet this goal will primarily depend on her ability to do which of the following?
Adapt her lifestyle to accommodate her symptoms.
Which is the most common presenting symptom of colon cancer?
Change in bowel habits
A patient is complaining of diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea?
Decrease the fat content in the diet.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?
Mental confusion; Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
A community health nurse has drafted a program that will address the health promotion needs of members of the community who live with one or more disabilities. Which of the following areas of health promotion education is known to be neglected among adults with disabilities?
Sexual health
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?
Six small meals daily with 120 mL fluid between meals
In which phase of the trajectory model of chronic illness are symptoms under control and managed?
Stable
This type of disability represents one that occurs any time from birth to 22 years and results in impairment of physical or mental health, cognition, speech, language, or self-care.
Developmental
Symptoms associated with pyloric obstruction include all of the following except:
Diarrhea; The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.
The nurse is caring for a client with a possible psychobiologic illness and knows that which neurotransmitter is responsible for integrating thoughts and helps to enhance judgment?
Dopamine
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client states:
"I have learned some relaxation strategies that decrease my stress."
A client tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be a "chronic condition." She asks the nurse what "chronic condition" means. What would be the nurse's best response?
"Chronic conditions are defined as health problems that require management of several months or longer."
The nurse is caring for an adult paraplegic with an ostomy. Which is an appropriate statement for the nurse to make?
"Do you need assistance managing your ostomy?"
Which question would help the nurse gather information about a client's lifestyle that may be a factor in the client's present illness?
"How many cups of coffee do you drink each day?"
A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?
"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." No gluten allowed
The nurse has been talking to a client who has had difficulty coping with a new situation. The nurse has met with the client a number of times but each time the client is reluctant to talk about the situation or the feelings associated with it. Which statement by the nurse would be MOST helpful to the client in this situation? You Selected:
"Many people who have difficulty talking about a situation are able to write about it. I would suggest spending some time each day writing about your feelings."
A nurse is conducting an assessment of a client. Which client statement would indicate to the nurse that the client has a nonmodifiable risk factor for mental health problems?
"My father was diagnosed with depression in his 40s."
Morbid obesity is defined as being how many pounds over the person's ideal body weight?
100
An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse
Acknowledges the client's achievement when she walks to the bedside commode with her walker
An elderly male client was in an automobile accident 2 weeks ago and incurred a spinal cord injury with resulting paralysis. The nurse assesses this disability as
Acquired
Which condition contributes to secondary hypertension?
Arterial vasoconstriction
A client admitted for a voluntary breast reduction is displaying many signs and symptoms of stress. Which of the following findings would be consistent with this analysis by the nurse?
Bruxism (teeth grinding) and excessive sweating
A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?
Early detection and treatment of diseases
Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred?
Echocardiography
The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.
End-stage renal disease
Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability?
Developmental
A client with gastric cancer is having a resection. What is the nursing management priority for this client?
Correcting nutritional deficits Clients with gastric cancer commonly have nutritional deficits and may have cachexia
A client experienced extensive burns and 72 hours later has developed an ulcer. Which of the following types of ulcer is most likely in this client?
Curling's ulcer
A graduate nurse is assigned to care for a client with an acute exacerbation of chronic obstructive pulmonary disease. The client also has Down syndrome. During the shift, the nurse discovers that the client lives alone and holds a full-time job. Which type of disability would the nurse state the client has?
Developmental
Celiac sprue is an example of which category of malabsorption?
Mucosal disorders causing generalized malabsorption
During assessment of a patient for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, the nurse suspects a diagnosis of:
Pancreatic insufficiency.
Which of the following patients would the nurse identify as LEAST likely to be experiencing loss?
Patient who is abusing substances
A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people?
People-first
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?
Peritonitis
The client with cardiac failure is taught to report which symptom to the physician or clinic immediately?
Persistent cough
A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity?
Potassium level of 2.8 mEq/L potassium level less than 3.5 mEq/L),
A community nurse is working to decrease the incidence of cardiac disease in Nicaragua. The nurse should plan educational health promotion activities around which element?
Smoking cessation
Which is a potassium-sparing diuretic used in the treatment of heart failure?
Spironolactone Chlorothiazide is a thiazide diuretic. Bumetanide and ethacrynic acid are loop diuretics.
The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate?
Stable
A client being discharged from the healthcare facility will be receiving home care services. The home care nurse will assess the incision and complete a dressing change. What other aspects of assessment will be necessary for the home care nurse to perform?
Steps in the house and the client's support system
For patients with uncomplicated hypertension and no specific indications for another medication, what is the initial medication?
Thiazide diuretic For patients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medication is thiazide diuretics for most patients. If blood pressure does not fall to less than 140/90 mm Hg, the dose is increased gradually, and additional medications are included as necessary to achieve control
During the initial physical examination, a client's pulse rate was 71 beats per minute (bpm). Four hours later on reassessment, the pulse rate was 40 bpm. How should the nurse proceed?
Thoroughly assess the client; then notify the physician.
Chronic illness can be monitored using the Trajectory Model. In what phase can the nurse's nursing diagnosis help in care planning?
Trajectory
A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying?
Trajectory onset
Which phase of the Trajectory Model of Chronic Illness is characterized by reactivation of an illness?
Unstable
The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:
hypokalemia--The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea.
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine
increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
increasing fluid intake to prevent dehydration.
While assessing a client's abdomen, the nurse percusses a dull sound, not the expected tympany. Upon further reflection, the nurse realizes she has assessed what?
liver
Challenges of Living With Chronic Illness
•Alleviate, manage symptoms •Psychologically adjust to, physically accommodate disabilities •Prevent, manage crises, complications •Carry out regimens as prescribed •Validate individual self-worth, family functioning •Manage threats to identity •Normalization of personal and family life •Altered time, social isolation, loneliness •Establish networks of support, resources that can enhance quality of life •Return to satisfactory way of life after acute debilitating episode or reactivation of chronic condition •Die with dignity and comfort
Types of Disabilities
•Developmental •Acquired •Age related
When caring for clients with disabilities, nurses need to understand not only pathophysiological issues but also the concept of disability. Which of the following statements to the client demonstrates that the nurse understands the concept of disability?
"I have collaborated with a social worker to assess your needs for after discharge."
According to the U.S. Census (2010), what percentage of people are diagnosed with a disability?
20
When is a medical condition considered chronic?
3 months Rationale: Medical or health problems with associated symptoms or disabilities that require long-term management of 3 months or longer are considered chronic
The nurse is discussing lifestyle changes and weight reduction with a female patient who has excess abdominal fat. What waist circumference should the patient maintain in order to remain healthy?
30 to 34 inches (76 to 86 cm)
A nurse determines that a male patient has an increased risk for diabetes, heart disease, and hypertension based on the patient's waist circumference. Which waist circumference measurement would lead the nurse to suspect this?
41 inches
Among deaths due to chronic disease, what percentage occurs in low- and middle-income countries?
80
A patient comes to the clinic at 8 a.m. for a scheduled visit. The nurse obtains the patient's temperature orally. Which finding would the nurse interpret as a potential indicator of a problem?
99.6 degrees F
A new client walking in to the health care center is actively wheezing and reports frequent episodes of wheezing. Based on the client's responses during the interview, the nurse suspects the client has a variety of food allergies. What nutritional assessment method should the nurse include in the plan of care?
A 3- to 7-day food record
Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension?
A client diagnosed with kidney disease Advanced age and alcohol intake are considered factors for essential hypertension.
A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?
Acquired disability
A nurse practitioner would be applying the pre-trajectory model of chronic illness when she:
Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing.
The nurse recognizes which disorder as a developmental disability in a patient?
Cerebral palsy
A nurse is preparing to conduct a health assessment with a 78-year-old man who wears a hearing aid in his left ear. The patient is accompanied by his wife. Which of the following would be most appropriate?
Check to make sure that the patient has his hearing aid turned on and in place in his left ear.
Which is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance.
A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client?
The interpreter may lag a few words behind--especially if names or technical terms are to be fingerspelled.
A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as
Downward
The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure?
Heart and blood vessels
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?
Hematemesis-Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.
Students are reviewing information about substance abuse and its effects on individuals and families. The students demonstrate understanding of this topic when they identify which of the following?
Individuals with substance abuse often have difficulty using adaptive behaviors.
A client has monthly laboratory tests done. The nurse notes a decrease in the albumin level. What condition in the client's history could alter the albumin level?
Liver disease
After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent?
Loperamide
A nurse prepares a diabetes prevention health seminar for community residents. Her teaching points should emphasize the most important factor influencing metabolic syndrome (pre-diabetes). What is that factor?
Obesity
Which nursing intervention is required when caring for a client with alcoholism who is diagnosed with Imbalanced Nutrition: Less than Body Requirements?
Obtain a baseline weight
The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders?
Older adults are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer.
Omeprazole (Prilosec)
A client who is blind is hospitalized for hip surgery. The nurse notices that the containers on the client's lunch tray are unopened, the client is fumbling with items, and food is on the front of the client's gown. The nurse assists the client by
Opening containers and orienting the client to placement of items on the tray
Which describes difficulty breathing when a client is lying flat?
Orthopnea
Which of the following would be inconsistent as a lifestyle change directive for the patient diagnosed with heart failure?
Push fluids; Lifestyle recommendations include restriction of dietary sodium; avoidance of excessive fluid intake, alcohol, and smoking; weight reduction when indicated; and regular exercise.
The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension?
Renal disease
The nurse is providing teaching for a client in a wheelchair. How will the nurse provide teaching? You Selected:
Sitting down in a chair during the teaching.
The nurse is discussing cardiac hemodynamics with a nursing student, who understands the following formula: CO = HR X SV (cardiac output equals heart rate times stroke volume). The student asks what determines stroke volume. The correct response by the nurse is which of the following?
Stroke volume depends on three factors: preload, afterload, and contractility.
When describing the term "grief" to a group of students, which of the following would the instructor include?
The response experienced by anyone who has suffered a loss
The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction?
The survival of people with severe trauma, chronic disorders, and early-onset disabilites
A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need to accomplish the following. Select all that apply.
Validate family functioning Alleviate and manage symptoms Validate individual self-worth
The patient wants to be prescribed an anti-infective drug for the flu. The nurse understands that anti-infective medications would not be useful against which biologic agents?
Viruses--Viruses are among the smallest living organisms known and survive as parasites of the living cells they invade
Patients diagnosed with malabsorption syndrome may have vitamin and mineral deficiency. Patient who easily bleed have which of the following deficiencies?
Vitamin K
Which nursing intervention should the nurse perform when a client with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta-blockers?
Withhold the drug and inform the primary health care provider.
A nurse correctly instructs a client with peripheral vascular disease that stress-reduction techniques:
are helpful because stress stimulates the release of vasoconstricting catecholamines
A 72-year-old client seeks help for chronic constipation. Constipation is a common problem for elderly clients because of several factors related to aging, including:
decreased abdominal strength.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for?
dizziness
A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has:
peptic ulcer disease.
The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as
prehypertension. A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage II hypertension.
Which client requires immediate nursing intervention? The client who:
presents with a rigid, birdlike abdomen--sign of peritonitis, a possibly life-threatening condition.
Disability is a
restriction or lack of ability to perform an activity in a normal manner
The nurse determines the client's temperature through palpation by
using the back of the hand.
Characteristics of Chronic Conditions
•Managing chronic illness involves more than treating medical problems -Usually involves different phases over a person's lifetime to which the person must adapt •Persistent adherence to therapeutic regimens •One chronic disease can lead to the development of other chronic conditions •Chronic illness affects the entire family •Day-to-day management of illness is largely the responsibility of people with chronic disorders and their families •Management of chronic conditions is a process of discovery •Financial burden •Ethical issues •Living with chronic illness means living with uncertainty
Managing Chronic Conditions
•Prevention •Lifestyle changes •Managing symptoms to avoid complications •Quality of life •Health promotion behaviors
Which nursing measure should be considered when performing a physical examination on a client using the inspection technique?
Maintain standard precautions
When assessing a family, the nurse gathers data about who assumes the primary responsibility for decision making and finances. The nurse is assessing which family function?
Management
Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:
severe abdominal pain with direct palpation or rebound tenderness.
The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first
Collaborates with the client to establish an agreed-upon goal
An 80-year-old client with osteoarthritis and osteoporosis has difficulty ambulating and is seeking a prescription for a walker. The nurse assesses the client's type of disability as
Age-associated
A client has a tentative diagnosis of lung cancer following computed tomography (CT) scanning. He is scheduled for a fiberoptic bronchoscopy with biopsy. In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse
Answers the client's questions about the bronchoscopy procedure
A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?
Assist client to increase dietary fiber.
A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience?
Attitudinal barrier
Which of the following would lead the nurse to identify that a client is experiencing a physiologic response to grief?
Choking sensation
A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?
Chronic constipation with sporadic bouts of diarrhea
Which statement is a misconception about chronic disease?
Chronic illnesses cannot be prevented.
Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness?
Comeback
When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating
orthopnea
Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
Hemoglobin and hematocrit
The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?
Hypotension
Which of the following would be inconsistent as a component of metabolic syndrome?
Hypotension
Which is a cause related to the increasing number of people with chronic conditions?
Improved screening and diagnostic procedures
Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?
Preload
A patient who is at risk for developing a chronic condition because of genetic factors is said to be in which phase of the Trajectory Model?
Pretrajectory
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol (Cytotec). What information from the nurse would be most accurate about misoprostol?
Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following?
The adrenal gland
Which of the following describes the crisis phase of the trajectory model of chronic illness?
The client is experiencing a critical or life-threatening situation requiring emergency treatment.
A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness:
The client stops taking some medications due to side effects that are disturbing to the client.
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?
lack of free water intake
The nurse is reviewing the laboratory test results of a patient who is suspected of having a nutritional deficiency. Which of the following would the nurse identify as helping to support this diagnosis?
low serum albumin levels
A client has been diagnosed with cancer in the descending colon. Which symptoms would the nurse expect the client to report? Select all that apply.
narrowing of stools constipation
Chronic disease refers to
noncommunicable diseases, chronic conditions, or disorders
A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include?
nonpharmacological interventions
Health Promotion
•Do not neglect health promotion issues •Need for healthy diet •Exercise •Social interaction •Preventive health screening
Incidence of Hypertension— "The Silent Killer"
•Primary hypertension: essential-95% of patients; unidentifiable cause •Secondary hypertension-5% of patients; renal disease, sleep apnea, pregnancy related •About 33% of the adult population of the U.S. has hypertension •About 46% do not have it under control •Highest prevalence in African Americans
Gerontologic Considerations
•Rates of disability increase with age •Effects of aging upon disabled •Aging caretakers of individuals with disabilities
Hypertensive Emergency
•Reduce blood pressure 20% to 25% in first hour •Reduce to 160/100 mm Hg over 6 hours •Then gradual reduction to normal over a period of days •Exceptions are ischemic stroke and aortic dissection •Medications -IV vasodilators: sodium nitroprusside, nicardipine, fenoldopam mesylate, enalaprilat, nitroglycerin •Need very frequent monitoring of BP and cardiovascular status
Medication Treatment
•Stage I hypertension: -African American and patients >60 yr : calcium channel blocker or thiazide diuretic -Non African American and patients <60 yr: ACE-I or ARB •Low doses are initiated, and the medication dosage is increased gradually if blood pressure does not reach target goal •Multiple medications may be needed to control blood pressure
The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?
Low-sodium diet
Accessibility of Health Care
•Are health care facilities accessible as legally required? •Has accessibility been verified by a person with a disability? •Is a sign interpreter, other than family, available? •Does the facility have appropriate equipment to provide health care for a person with disabilities?
Nursing Diagnoses
•Deficient knowledge regarding the relation between the treatment regimen and control of the disease process •Noncompliance with therapeutic regimen related to side effects of prescribed therapy
Questions to Ask to Ensure Quality Care
•Does the patient require or prefer special accommodations? •Are special accommodations made to communicate with the patient?•Are efforts made to direct all conversations to the patient rather than to others who have accompanied the patient?
Patient Assessment
•History and physical examination -Retinal exam •Laboratory tests -Urinalysis -Blood chemistry•ECG
Prevalence of Chronic Conditions
•Occurs in every age group, socioeconomic level, race, and culture •7 of the 10 leading causes of death in the United States •Most frequently occurring account for Responsible for 2/3 of the deaths that occur globally •Cardiovascular disease, cancer, diabetes, and chronic lung disease •Increasing in lower income populations
Multiple Chronic Conditions
•One of four adults has two or more chronic health conditions•Increases complexity of care •Risk for conflicting medical advice, adverse effects of medications, unnecessary and duplicative tests, preventable hospitalizations •Costs of care increase with the number of chronic conditions
Planning and Goals
•Understanding of the disease process and its treatment •Participation in a self-care program •Absence of complications •Lower and controlling BP without adverse effects or undue cost
Importance of Language
•Use "people-first" language •The person, not the illness or disability, is most important
Which of the following is considered a bulk-forming laxative?
Metamucil
A 19-year-old client with a diagnosis of Down syndrome is being admitted to the unit for the treatment of community-acquired pneumonia. When planning this client's care, the nurse recognizes that this client's disability is categorized as what?
A developmental disability
Disability is the loss or abnormality of psychological, physiologic, or anatomic structure or function at the organ level
False Rationale: Impairment is the loss or abnormality of a psychological, physiologic, or anatomic structure or function at the organ level. Disability is the restriction or lack of ability to perform an activity in a normal manner
Which medication is classified as a histamine-2 receptor antagonist?
Famotidine Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.
The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following?
Inhibit gastric acid secretions.
Models of Disability
Interface model •Medical model •Rehabilitation model •Biopsychosocial model
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?
Leg edema Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough.
While reviewing a client's records, the nurse notes a reduction in weight of 15 pounds over the last month without dieting. What factor may be associated with this possible nutritional deficit?
Losing a spouse and only child in an accident 2 months ago
Evaluation and Outcomes
Reports knowledge of disease management sufficient to maintain adequate tissue perfusion -Maintains blood pressure at less than 140/90 mm Hg (less than 150/90 mm Hg for adults older than 60 years of age) with lifestyle modifications, medications, or both -Demonstrates no symptoms of angina, palpitations, or vision changes -Has stable BUN and serum creatinine levels -Has palpable peripheral pulses •Adheres to the self-care program -Adheres to the dietary regimen as prescribed: reduces calorie, sodium, and fat intake -Exercises regularly -Takes medications as prescribed and reports side effects -Measures BP routinely -Abstains from tobacco and excessive alcohol intake -Keeps follow up appointments •Has no complications -Reports no changes in vision; exhibits no retinal damage on vision testing -Maintains pulse rate and rhythm and respiratory rate within normal ranges; reports no dyspnea or edema -Maintains urine output consistent with intake; has renal function test results within normal range -Demonstrates no motor, speech, or sensory deficits -Reports no headaches, dizziness, weakness, changes in gait, or falls
The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help?
Stress reduction to lower prehypertensive state
A waist circumference greater than which value is indicative of excess abdominal fat in men?
101.60 cm (40 in)
What is the ideal body weight (IBW) of a woman with a large frame who is 5 feet, 4 inches tall? Enter the correct number ONLY.
132
For a person to be clinically depressed, signs of a depressed mood or depressed interest in pleasurable activities must occur for at least
2 weeks.
A client weighs 215 lbs and is 5' 8" tall. The nurse would calculate this client's body mass index (BMI) as which of the following?
32.7 Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.
A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?
A change in bowel habits
Which of the following would a nurse expect to assess in a client with peritonitis?
Board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.
The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?
Borborygmus
The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition?
Borborygmus
The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness?
Chronic illness affects the entire family
The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?
Clamp the tubing and give the patient a rest period.
A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have?
Class I (Mild)
The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?
Dry skin thoroughly after washing
A patient who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event?
Dumping syndrome
The nurse is preparing an education plan for a patient newly diagnosed with hypertension. What should be included in the education plan?
Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week) Rationale: Exercise is recommended as above. Alcoholic beverages can be consumed in moderation. Sodium should be reduced to no more than 100 mmol/day, and the patient should maintain a normal body weight with a BMI between 18.5 and 24.9 kg/m2
A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?
Essential (primary)
A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure?
Hypertension causes the heart's chambers to enlarge and weaken.
The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?
Hypotension, increased temperature, tachycardia, and elevated ESR.
What is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving intravenous vasodilators?
I&ORationale: Assessing the individual's fluid volume status is recommended because if there is volume depletion secondary to natriuresis caused by the elevated blood pressure, then volume replacement with normal saline can prevent large sudden drops in blood pressure when antihypertensive medications are administered
A nursing instructor is discussing characteristics of chronic illness with a class. The instructor asks the students to name one characteristic. Which of the following answers is correct?
Managing chronic conditions must be a collaborative process.
Which is a true statement regarding characteristics of chronic conditions?
Managing chronic conditions must be a collaborative process.
The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? Select all that apply.
Melena Tachypnea Thirst Mental confusion
Vomiting results in which of the following acid-base imbalances?
Metabolic alkalosis-Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach
Which is a true statement regarding gastric cancer?
Most clients are asymptomatic during the early stage of the disease.
The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following?
Pitting edema--it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response.
An initiative has been launched in a large hospital to promote the use of "people-first" language in formal and informal communication. What is the significance to the client when the nurse uses "people-first" language?
The person is of more importance to the nurse than the disability.
A client experiencing a manic phase of bipolar disorder sustained cuts on the body from falling through a store window. The nurse is preparing to start an intravenous needle insertion and explains the procedure to the client
Using clear and simple terms
The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?
Usual pattern of elimination
The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?
Usual pattern of elimination
A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. The nurse suspects:
Vasomotor symptoms associated with dumping syndrome
A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?
White blood cell (WBC) count 22.8/mm3
An elderly client has presented to the clinic with a new diagnosis of osteoarthritis. The client's daughter is accompanying him and the nurse has explained why the incidence of chronic diseases tends to increase with age. What rationale for this phenomenon should the nurse describe?
With age, biologic changes reduce the efficiency of body systems.
Causes of the Increase in Chronic Conditions
•Decrease in mortality from infectious diseases •Lifestyle factors •Obesity •Longer lifespans •Improved screening, diagnostic procedures
A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. The nurse suspects the client has:
dumping syndrome.
The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:
usual pattern of elimination.
Nursing Process
•Identify specific problems, trajectory phase •Establish, prioritize goals •Plan of action to achieve desired outcomes •Interventions focus:-Regimens to control symptoms, avoid complications-Psychosocial issues affect quality of life •Evaluate outcomes, reassess problems
Medical Management
•Maintain blood pressure -<140/90 mm Hg, -<150/90 mm Hg for older adult patients •Lifestyle modifications -Weight reduction -DASH diet, decreased sodium intake -Regular physical activity -Reduced alcohol consumption •Pharmacologic therapy -Decrease peripheral resistance, blood volume -Decrease strength and rate of myocardial contraction •Diuretics, beta-blockers, alpha1-blockers, combined alpha- and beta-blockers, vasodilators, ACE inhibitors, ARBs, calcium channel blockers, dihydropyridines, and direct renin inhibitors
Definitions of Chronic Diseases or Conditions
•Medical conditions or health problems with associated symptoms or disabilities that require long-term management •Persist for months or years rather than days or weeks•U.S. National Center of Health Statistics "chronic disease is a condition lasting 3 or more months" •World Health Organization "long lasting condition that can usually be controlled but not cured" •Both share the characteristics of being irreversible, having a prolonged course, and unlikely to resolve spontaneously (Larsen, 2016)
Chronic Conditions
•Occurs in people of every age, socioeconomic level, culture •Medical conditions or health problems with associated symptoms that require long-term (3 months or longer) management •Conditions that do not resolve or for which complete cures are rare •Management: people must learn to live with symptoms or disabilities, carry out lifestyle changes or treatment regimens