Hurst Review Module 2 Quiz

A community health nurse is presenting a seminar to a group of senior citizens on ways to reduce the risks of peripheral artery disease (PAD). What topics should the nurse include? SATA 1. Daily strenuous exercise 2. How to read food labels 3. Maintaining a BMI less than 30 kg/m2 4. Managing Diabetes 5. Use of anti-embolic stockings

2. How to read food labels 4. Managing Diabetes Senior citizens are at increased risk for peripheral artery disease for a variety of reasons, though many erroneously believe that this process is an unavoidable part of the aging process. Educating clients on preventative activities will help reduce incidence of atherosclerosis and improved mobility along with quality of life. Maintaining a healthy diet is essential. Empower people by helping them understand the food they want to purchase by learning how to read the food label. One way to do this is to follow the DASH diet. Poorly managed diabetes leads to vessel damage. What do you recall about peripheral artery disease? You know that plaque builds up in the arteries, impairing blood flow to extremities and placing the client at risk for multiple health issues. Once atherosclerosis sets in, the arterial lumens narrow and it is very difficult to reverse damage. Obviously, prevention is the key. 1. Incorrect: Clients can increase collateral circulation with a moderate exercise program of at least 30 minutes three times a week. Think about this. Most people are not crazy about scheduled exercise but think about the senior citizen who may already have PAD. Some clients experience "intermittent claudication", and because it hurts to walk, they just don't! Pain in the leg muscles deters exercise, which in turn places the client at greater risk for advancing PAD. The purpose of a moderate exercise program is to improve both conditioning and collateral circulation. A regular program, recommended at as least 30 minutes three times weekly, can halt the progression of atherosclerosis. More importantly, clients find that participating in regular exercise will decrease pain, encouraging even greater participation. 2. Correct: Blood pressure control is definitely an important topic to include when teaching about PAD. High blood pressure further contributes to peripheral artery disease by putting a strain on the arteries, narrowing the lumens and thickening plaque over a period of time. The good news is that if clients eat a healthy diet and exercise they can prevent or decrease PAD effects. It helps if the client understands what is in the products they want to purchase. Learning how to read the nutritional facts panel and ingredients will help the client choose the best food to buy. 3. Incorrect: Reduce caloric intake to achieve a body mass index of 18.5 to 24.9 hg/m2. A BMI greater than 25 indicates the client is overweight or obese. More weight on the body means more pressure on the lower extremities. 4. Correct: Cholesterol and glucose damage vessels. A heart healthy diet low in saturated or trans fats helps to decrease cholesterol as well as control blood pressure, and for clients with diabetes, maintaining an acceptable glucose level will decrease damage to vessels. The nurse should teach clients to increase whole grains and beans along with fish as part of a healthy diet that also focuses on eating more fresh fruits and vegetables. 5. Incorrect: Anti-embolic stockings are ordered to improve venous return in clients with restricted or limited mobility. Think carefully. Many seniors use these stockings as part of a treatment program prescribed by the primary health care provider. But are they appropriate for PAD? You know that anti-embolic stockings are ordered to improve venous return in clients with restricted or limited mobility. But do you really want to squeeze an artery that already has restricted blood flow? (it would restrict blood flow to extremities.)

What potential contributing factors for transient urinary incontinence should a nurse assess in an elderly female client? SATA 1. Chronic urinary retention 2. Fecal Impaction 3. Menopause 4. Restricted Mobility 5. Stroke

2. Fecal Impaction 4. Restricted Mobility Transient incontinence: a temporary type of urinary incontinence caused by an illness or a specific medical condition that is short-lived and is, therefore, quickly remedied by appropriate treatment of the condition and a disappearance of symptoms. The potential causes of transient incontinence may be easily remembered by the mnemonic 'delirium, infection, atrophy, pharmaceuticals, excess urine output, restricted mobility, stool impaction' (DIAPERS). Fecal impaction can compress the urethra resulting in urinary incontinence. Use of diuretics can make it difficult to get to the toilet in time to void, thus causing urinary incontinence. Diabetics have polyuria, which can contribute to urinary incontinence. Vaginitis, a condition caused by an infection or inflammation of the vagina, can contribute to urinary incontinence. 1. Incorrect: Urinary Incontinence that is associated with chronic retention occurs when the bladder does not empty properly, resulting in frequent leakage of small amounts of urine. This is a chronic, rather than a transient condition. 3. Incorrect: After menopause, women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence. This leads to persistent rather than transient incontinence. 5. Incorrect: Multiple sclerosis, Parkinson's disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing persistent urinary incontinence. Look at the clues in this question: "contributing factors", "transient", and "elderly". So what can cause transient or temporary urinary incontinence in an elderly client? Transient urinary incontinence usually arrives suddenly, lasts six months or less, and has reversible causes. Use the "TOILETED" mnemonic to identify possible contributing factors. 1. Thin and dry vaginal and urethral epithelium. (The "T" in the mnemonic is specific only to female clients, who should be assessed for vaginitis and urethritis.) While performing hygiene care, the nurse asks about vaginal pruritis and assesses the external genitalia for evidence of vaginal atrophy, such as thin and dry mucous membranes or tenderness and inflammation. The reduced estrogen level common in older women can have a negative effect on their lower urinary tract, causing periurethral tissue to become atrophied, dry, and less elastic. 2. Obstruction. The nurse should ask the client about normal bowel patterns and the time of the last bowel movement and perform an abdominal assessment. A bowel full of stool may be palpable and dull to percussion over the left side of the abdomen. Hyperactive bowel sounds may indicate increased peristaltic activity (above the point of or proximal to the impaction), as the body attempts to move fecal matter. A fecal impaction can compress the urethra, which can result in a distended bladder and small amounts of urine leakage. If the nurse suspects that the bladder is distended, a post void residual (PRV) urine volume test may be conducted. The PVR volume should be measured a few minutes after the client has voided, either by bladder ultrasonography or catheter insertion. A PVR volume of more than 100mL suggests incomplete bladder emptying. A digital rectal examination is part of the evaluation for fecal impaction and can reveal hardened stool or an absence of fecal matter. Even if no stool is present in the rectum, there may still be an impaction higher in the colon. An abdominal flat plate radiograph may be needed to determine the degree of impaction. 3. Infection-Older adults don't always display the typical signs and symptoms of infection. When transient urinary incontinence occurs, a urinary tract infection (UTI), which can cause increased urinary urgency and frequency, should be suspected. The nurse may need to obtain a urine specimen to test for the presence of nitrites and leukocyte esterase, signs of bacteriuria. 4. Limited Mobility- The nurse should assess for restricted mobility and identify any environmental barriers to toileting, such as the distance of the bed from the toilet, the use of physical restraints, bed rest orders, and the presence of bed rails. 5. Emotional or psychological factors. Research on the relationship between transient urinary incontinence and psychological factors is scant, but depression is strongly associated with chronic urinary incontinence. Depression in older adults can be determined by using a valid and reliable screening tool. 6. Therapeutic medications may contribute to urinary incontinence in some clients. These include hypnotics, narcotics, tranquilizers, antidepressants, laxatives, diuretics, and antibiotics. Diuretics, for example, are associated with urinary urgency and frequency. It's important to ask the client about new medications, both prescribed and over the counter. 7. Endocrine Disorders-Assess for diabetes, which can result in polyuria. Diabetic clients with poor glucose control often produce more urine as the kidneys work to rid the body of excess glucose in the blood. Glucose in the urine is a good medium for the growth of bacteria, which increases the risk of UTI. 8. Delirium, common in hospitalized older adults, increases the likelihood that a client will experience episodes of urinary incontinence.

A client who has been diagnosed with chronic venous insufficiency has received teaching regarding how to prevent venous stasis ulcerations. Which statements by the client indicate to the nurse that teaching has been effective? SATA 1. "Stationary standing should be kept to a minimum." 2."It is important to avoid wearing constricting clothes longer than 2 hours". 3. "Protecting my legs from trauma is very important." 4. " I will wear compression stockings every day." 5. " I will elevate the foot of my bed 6 inches (15.24 cm) when I sleep."

1. "Stationary standing should be kept to a minimum." 3. "Protecting my legs from trauma is very important." 4. " I will wear compression stockings every day." 5. " I will elevate the foot of my bed 6 inches (15.24 cm) when I sleep." Minimize stationary standing as much as possible. Protect legs from trauma as this can lead to ulcerations. Elastic compression stockings are recommended for clients with chronic venous insufficiency to prevent pooling and promote venous return. Leg elevation decreases edema, promotes venous return, and provides symptomatic relief. Legs should be elevated frequently throughout the day (for at least 15-30 minutes every 2 hours). During the night, the client should sleep with the foot elevated approximately 6 inches (15.24 cm). Venous stasis ulcers in the leg are often an indication that venous disease has reached an advanced stage. Because venous disease is progressive, venous reflux can often lead to additional valve failure, and as a result, the pooling of blood can affect a larger area. When blood pools in the lower leg over a long period of time, the condition is referred to as venous stasis. When blood leaks into the tissues of the skin, it can cause swelling and damage to the tissue. Tissue damage can result in wounds, or ulcers, that are chronic and do not heal if the condition is left untreated. Ulcers may be painful or itchy and often require constant care and dressing. People most at risk of developing a venous leg ulcer are those who have previously had a leg ulcer. Prevention includes: 1. Weight loss if obese or overweight. Excess weight leads to high pressure in veins in your legs, which can damage your skin. Venous ulcers are much more common among people who are overweight. 2. Exercise to improve circulation and reduce body fat. 3. Avoid sitting or standing for long periods. Sitting leads to poor circulation in your legs, which can cause swelling in your ankles, varicose veins, and blood clots known as deep vein thrombosis (DVT). 4. Elevate the legs to prevent swelling in the legs 5. Decrease sodium intake, which causes fluid retention. 6. Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency. 2. Incorrect: The client should avoid wearing any constrictive clothing, even for short periods of time. This will decrease blood flow.

What information should the pre-operative nurse include when educating a client about preventing a deep vein thrombus (DVT) formation after abdominal surgery? SATA 1. Anticoagulant medication may be prescribed. 2. Caffeinated beverages will be allowed once able to drink in order to promote hydration 3. Bed rest will be required for at least 5 days. 4. Move feet in a circle 10 times an hour. 5. A sequential compression device (SCD) will be wrapped around the legs.

1. Anticoagulant medication may be prescribed. 4. Move feet in a circle 10 times an hour. 5. A sequential compression device (SCD) will be wrapped around the legs. Anticoagulants can prevent blood clots. Simple exercises while you are resting in bed or sitting in a chair can help prevent blood clots. Move your feet in a circle or up and down. Do this 10 times an hour to improve circulation. Sequential compression device (SCD) or intermittent pneumatic compression (IPC) are wrapped around your legs and connected to a pump that inflates and deflates the sleeves. This applies gentle pressure to promote blood flow in the legs and prevent blood clots. Deep vein thrombosis (DVT) occurs when a thrombus forms in one or more of the deep veins in the body, usually in the legs. A DVT can cause leg pain or swelling, but may occur without any symptoms. Deep vein thrombosis can develop with certain medical conditions that affect how the blood clots. It can also happen if the client does not move for a long time, such as after surgery, following an accident, sitting for long periods of time, such as when driving or flying or when confined to a bed. Deep vein thrombosis is a serious condition because clots can break loose, travel through the bloodstream and lodge in the lungs, blocking blood flow (pulmonary embolism). 2. Incorrect: Alcohol and coffee contribute to dehydration, which can lead to thickened blood and increased risk for clot formation. 3. Incorrect: After surgery, a nurse should help the client out of bed, as soon as possible. Moving around improves circulation and helps prevent blood clots.

What food should the nurse instruct a client to avoid when prescribed digoxin? SATA 1. Black Licorice 2. Coenzyme Q-10 3. Grapefruit 4. Grapes 5. Wheat Bran

1. Black Licorice 5. Wheat Bran Black licorice contains a natural ingredient called glycyrrhiza, which can deplete the body of potassium while causing an increased retention of sodium. Insoluble fiber such as wheat bran, can slow down the absorption of digoxin and lessen its effectiveness. 2. Incorrect: Taking coenzyme Q-10 can decrease the effectiveness of warfarin. Blood pressure may be affected if the client is also taking a calcium channel blocker, such as diltiazem. 3. Incorrect: Grapefruit interacts with statin drugs 4. Incorrect: Grapes do not interact with digoxin

A manufacturing worker comes into the occupational health nurse's clinic reporting a squeezing pain in the chest. What additional signs and symptoms should the nurse monitor for in the client? SATA 1. Dyspnea 2. Dry, flushed skin 3. Indigestion 4. Restlessness 5. Tachycardia

1. Dyspnea 3. Indigestion 4. Restlessness 5. Tachycardia The nurse should be thinking myocardial infarction (MI) All of these are signs of an MI. If you assume the worst when you see the clue "a squeezing pain in the chest", what should you think is happening to the client? The client is having an MI. The question wants to know if the test taker can identify additional signs and symptoms of an MI. Keep in mind that not everyone wants to know if the test taker can identify additional signs and symptoms of an MI. Keep in mind that not everyone presents with the classic signs and symptoms. Common heart attack symptoms and warning signs may include: Chest discomfort that feels like pressure, fullness, or a squeezing pain in the center of the chest that lasts for more than a few minutes, or goes away and comes back. Pain and discomfort that extend beyond the chest to other parts of the upper body, such as one or both arms, back, neck, shoulder, stomach, teeth, and jaw. Unexplained shortness of breath, with or without chest discomfort, dyspnea and tachypnea. Other symptoms, such as cold sweats, cool and clammy skin, nausea or vomiting, lightheadedness, anxiety, restlessness, indigestion, unexplained fatigue, irregular pulse. 2. Incorrect: The skin is not being perfused properly so the skin will be cool and clammy.

What assessment finding would indicate to the nurse that further treatment is needed for a client hospitalized with systolic heart failure? SATA 1. S3 heart sound 2. CVP of 6 mm Hg 3. One day weight loss of 2 pounds (0.91 kg) 4. Hepatomegaly 5. Increasing BNP level 6. Urine output at 50 mL/hr

1. S3 Heart Sound 4. Hepatomegaly 5. Increasing BNP level S3 would indicate that the client is not better. S3 is heard when the client is in fluid overload. Hepatomegaly and tenderness in the right upper quadrant result from venous engorgement of the liver. The client is not better. An increase in BNP level would indicate that the heart failure was getting worse, not better. Systolic heart failure is the most common cause of heart failure and occurs when the heart is weak and enlarged. The muscle of the left ventricle loses some of its ability to contract or shorten. In turn, it may not have the muscle power to pump the amount of oxygenated and nutrient-filled blood the body needs. With diastolic heart failure, the muscle becomes still and loses some of its ability to relax. As a result, the affected chamber has trouble filling with blood during the rest period that occurs between each heartbeat. Often the walls of the heart thicken, and the size of the left chamber may be normal or reduced. Typical signs of heart failure include: Dyspnea-when the heart begins to fail, blood backs up in the veins attempting to carry oxygenated blood from the lungs to the heart. As fluid pools in the lungs, it interferes with normal breathing. These periods of breathlessness may leave the client feeling exhausted and anxious. Fatigue-As heart failure becomes more severe, the heart is unable to pump the amount of blood required to meet all of the body's needs. To compensate, blood is diverted away from less-crucial areas, including the arms and legs, to supply the heart and brain. As a result, people with heart failure often feel weak (especially in their arms and legs), tired and have difficulty performing ordinary activities such as walking, climbing stairs or carrying groceries. Chronic Cough or Wheezing-The fluid buildup in the lungs may result in a persistent cough or wheezing, that may produce phlegm that may be tinged with blood. Rapid or Irregular Heartbeat- The heart may speed up to compensate for its failing ability to adequately pump blood throughout the body. Lack of appetite or nausea- When the liver and digestive system become congested, they fail to receive a normal supply of blood. This can make the client feel nauseous or full. Mental Confusion-Abnormal amounts of certain substances, such as sodium, in the blood and reduced blood flow to the brain can cause memory loss or disorientation. Fluid Buildup and Swelling- Because blood flow to the kidneys is restricted, the kidneys produce hormones that lead to salt and water retention. This causes edema, that occurs most often in the feet, ankles and legs. Rapid Weight Gain- The fluid build-up throughout the body may cause a rapid weight gain. At the same time, the heart, as well as other parts of the body, attempt to adapt and make up for the deteriorating pumping ability. For example- Heart Grows Larger-The muscle mass of the heart grows in an attempt to increase its pumping power, which works for a while. Heart Pumps Faster-In an attempt to circulate more blood throughout the body, the heart speeds up. Blood Vessels Narrow- As less blood flows through the arteries and veins, blood pressure can drop to dangerously low levels. To compensate, the blood vessels become narrower, which keeps blood pressure higher, even as the heart loses power. Blood Flow is diverted- When the blood supply is no longer able to meet all of the body's needs, it is diverted away from less-crucial areas, such as the arms and legs, and given to the organs that are most important for survival, including the heart and brain. In turn, physical activity becomes more difficult as heart failure progresses. 2. Incorrect: Normal CVP is 2-6 mm Hg. This CVP is within normal range so treatment is effective 3. Incorrect: Weight loss indicates that fluid is being removed 6. Incorrect: A urine output of 50 mL/hr indicates that renal perfusion is adequate.

A client has sublingual (SL) nitroglycerin prn added to the medication regimen. Which statement made by the client indicates to the nurse that teaching has been effective? SATA 1. "If the medication burns in my mouth, it is old and should be discarded." 2. I must keep this medication in its original dark, glass bottle." 3. "I can take one tablet every five minutes up to 3 doses for chest pain." 4. "I know that I must put this tablet under my tongue for it to work." 5. "My medication should be renewed yearly."

2. I must keep this medication in its original dark, glass bottle." 3. "I can take one tablet every five minutes up to 3 doses for chest pain." 4. "I know that I must put this tablet under my tongue for it to work." This question is asking you to identify correct statements made by the client about sublingual nitroglycerin. Sublingual nitroglycerin can be given either as a tablet or spray. Nitroglycerin causes venous vasodilation which results in venous pooling which decreases venous return...preload. Nitroglycerin causes arterial vasodilation which decreases resistance in the arteries so it decreases afterload. Now, this is a good thing because this result will cause decreased preload and afterload, which will also decrease the workload and oxygen demands on the heart. Nitro also causes dilation because of what arteries? Coronary arteries, which will increase blood flow to the actual heart muscle, the myocardium. Because if i can increase blood flow to the actual heart muscle then, blood is going to carry more what?-oxygen. A client can take one every five minutes up to 3 doses. "Clients should be instructed to contact the Emergency management system (EMS) if pain is unrelieved or increases after 1 tablet of sublingual or spray. "Is it ok to swallow your nitro?' NO. Nitro should be kept in a dark, glass bottle. Do not mix medications in the bottle with nitroglycerin and do not open the bottle frequently. Keep it dry. Keep it cool. It may not burn or fizz in the client's mouth. And the client will get a what? Headache. Now, how often should nitroglycerin be renewed? An average of every three to five months. Two years for the spray. After the nitroglycerin, what do you expect the blood pressure to do? (Drop) 1. Incorrect: Nitroglycerin may or may not burn or fizz in the client's mouth. It is normal. 5. Incorrect. Nitroglycerin should be renewed on average every three to five months. Two years for the spray.

As a member of the emergency preparedness team at the hospital, which action should the nurse encourage the team to implement? SATA 1. Develop a response for each potential disaster. 2. Provide education to employees on the response plan. 3. Practice the response plan on a regular basis 4. Evaluate the hospital's level of preparedness 5. Coordinate with neighboring hospitals regarding different emergency response plans.

2. Provide education to employees on the response plan. 3. Practice the response plan on a regular basis 4. Evaluate the hospital's level of preparedness 5. Coordinate with neighboring hospitals regarding different emergency response plans. Developing a single response plan, educating individuals to the specifics of the response plan, and practicing the plan and evaluating the facility's level of preparedness are effective means of implementing emergency preparedness. Consideration must be given to the proximity of chemical plants, nuclear facilities, schools, and areas where large groups gather. The basic principle of emergency preparedness are the same for all types of disasters. Only the response interventions vary to address the specific needs of the situation. So, one good response plan should be developed rather than multiple plans. This will ensure adequate understanding of the plan and decrease confusion of roles that could occur with multiple plans. Does every hospital in an area need to prepare for a chemical disaster if there is no chemical plant near? (no) Remember, education, practice, and evaluation are key to a good response plan. 1. Incorrect: One good response plan should be developed rather than multiple plans.

The nurse is planning to educate a client who has a diagnosis of right sided heart failure, what information should the nurse include? SATA 1. Blood backs up in the left upper chamber of the heart 2. Your feet, legs, and ankles will likely swell because blood is backing up in your veins. 3. Activity will increase your heart rate. 4. You might find that you go to the bathroom more often at night. 5. Weigh yourself daily to monitor for rapid weight gain.

2. Your feet, legs, and ankles will likely swell because blood is backing up in your veins. 3. Activity will increase your heart rate. 4. You might find that you go to the bathroom more often at night. 5. Weigh yourself daily to monitor for rapid weight gain. Vascular congestion is evident by swelling of the lower extremities. Ascites may increase pressure on the stomach and intestines causing GI upset with nausea and anorexia. The heart rate increases in an attempt to increase cardiac output. Bedrest induces diuresis. The fluid leaves the extremities and goes back into the vascular space where the kidneys get rid of the excess fluid. Daily weights are important to monitor fluid retention. A rapid weight gain is fluid, not fat. The right side of the heart wants blood to go forward to the lungs for oxygenation. If the right side of the heart is weakened, blood cannot go forward to the lung, it will start going backward to the venous system. There is a decrease in cardiac output and decreased oxygenation of tissues. This causes edema in the extremities, distended neck veins, enlarged organs such as the liver. Lack of oxygen can lead to fatigue, and depression. Edema of the organs can cause GI upset such as nausea, and anorexia. Fluid in the peripheral tissue is being mobilized and excreted at rest so increased urination occurs at night. The client awakens during the night to urinate. The heart rate will increase in an effort to keep blood moving in a forward direction. Do you remember what causes pure right sided heart failure or "cor pulmonale"? It started out as a lung problem like COPD, or pulmonary embolus. 1. Incorrect: The blook backs up into the right atrium and venous circulation

The nurse is caring for a client with acute renal failure. The morning assessment findings indicate the client has become confused and irritable. Which finding is MOST likely responsible for the change in behavior? 1. Hyperkalemia 2. Hypernatremia 3. Elevated blood urea nitrogen (BUN) 4. Limited fluid intake

3. Elevated blood urea nitrogen (BUN) A client with acute renal failure will have an increased (BUN). Significant elevation in BUN may result in nausea vomiting, lethargy, fatigue, impaired though processes, and headache. 1. Incorrect: Hyperkalemia can result from acute renal failure. Symptoms of hyperkalemia do not include confusion and irritability. Hyperkalemia may cause muscle weakness, muscle twitching, and flaccid paralysis. 2. Incorrect: Clients with renal failure retain fluid and are at risk for dilutional hyponatremia. Increased or decreased sodium levels can cause confusion, but this client is not at risk for hypernatremia. 4. Incorrect: Clients in acute renal failure should have limited fluid intake. This will not lead to confusion.