MED SURG test 2
A peripheral DXA (pDXA) scan assess BMD of the ______, ________, or ________.
heal, forearm, finger. - used for large-scale screening -Used in community health fairs - skill nursing facilities - women's health centers.
kyphotic posture: widened gait, shift in center of gravity related to aging
teach proper body mechanics; instruct pt to sit in supportive chairs with arms
decreased bone density related to aging
teach safety tips to prevent falls; reinforce need to exercise, especially weight bearing exercises
Skin manifestations of Paget's disease
- Flushed warm skin
serum phosphorus
3.0-4.5 ml/dL
creatine kinase (CK-MM)
30-170 units/L
Which statement by a patient with DM indicates an understanding of the principles of self-care?
"I plan to get my spouse to exercise with me to keep me company."
A client for whom skeletal traction is planned asks for an explanation regarding the purpose of this type of traction. Which is the nurse's best response?
"It aids in realigning the bone."
According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM?
2-hour glucose tolerance blood glucose = 210 mg/dL
Along with exercise, what is the recommended calorie reduction for a patient with diabetes who must lose weight?
250-500 calories/day
Which individual is at greatest risk for developing type 2 DM?
56-year-old Hispanic woman
bone scan
A radionuclide test in which radioactive material is injected for viewing the entire skeleton. Detects tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression fractures, and unexplained bone pain. Detects hairline fractures.
A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy
ANS: D Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the client's willingness and ability to follow the regimen. The other assessment findings are not as critical.
From which injection site is insulin absorbed most rapidly?
Abdomen
An adult client's susceptibility to osteoporosis is caused by which aspect of his or her history?
Active smoking
Stress Ulcers
Acute gastric mucosal lesions occurring after an acute medical crisis or trauma.
In which situations does the nurse teach a patient to perform urine ketone testing? (Select all that apply.)
Acute illness or stress When symptoms of DKA are present When a diabetic patient is in a weight-loss program
A patient with diabetes has signs and symptoms of hypoglycemia. The patient has a blood glucose of 56 mg/dL, is not alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do next?
Administer D50 IV push
While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurse's first action?
Administer oxygen via nasal cannula.
A client with a new fracture reports pain in the site of the fracture. An opioid pain medication was administered 20 minutes ago. Which is the nurse's best intervention? (Select all that apply.)
Administration of additional opioids Elevation of the extremity Application of ice
The nurse is using a common scale to grade a client's muscle strength. The client is able to complete range to motion (ROM) with gravity eliminated. Which grade does the nurse document in this client's record? A. 0 B. 1 C. 2. D. 3
C. 2
Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective?
Alpha-glucosidase inhibitors, which include miglitol (Glyset)
Alkaline Reflux Gastropathy
Also known as bile reflux gastropathy. It is a complication of gastric surgery in which pylorus is bypassed or removed.
Which infection control measures must the nurse teach a patient who will be performing SMBG? (Select all that apply.)
Always wash hands before monitoring glucose Regular cleaning of the meter is critical Do not reuse lancets Do not share blood glucose monitoring equipment
Chronic Gastritis
Appears as a patchy, diffuse (spread out) inflammation of the mucosal lining of the stomach. As the disease progresses, the walls and lining of the stomach thin and atrophy.
Rapid-Acting Insulin:
Aspart, Glulisine, Lispro Onset: 15 mins Peak: 30mins-3 hours Duration: 3-5 hours
When providing care for a client who has had a débridement for osteomyelitis, which intervention is most important for the nurse to implement?
Assess circulation in the distal extremities
A patient has been diagnosed with DM. Which aspects does the nurse consider in formulating the teaching plan for this patient? (Select all that apply.)
Assessing visual impairment regarding insulin labels and markings on syringes Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe Assessing patient motivation to learn and comprehend instructions Assessing the patient's ability to read printed material
serum testing
CBC, PT, electrolytes, billiruben urine test
After muscle injury, which lab will elevate?
CK will rise 2 to 4 hours after injury.
Benign Bone tumors
Benign (noncancerous) bone tumors are often asymptomatic and may be discovered on routine x-ray examination or as the cause of pathologic fractures. The major classifications include chondrogenic tumors (from cartilage), osteogenic tumors (from bone), and fibrogenic tumors (from fibrous tissue and found most often in children). Most common benign bone tumor is the osteochondroma. The femur and the tibia are most often involved. The chondroma, or endochondroma, is a lesion of mature hyaline cartilage affecting primarily the hands and the feet. The ribs, sternum, spine, and long bones may also. Chondromas are slow growing and often cause pathologic fractures after minor injury. They are found in people of all ages and genders. The origin of the giant cell tumor remains uncertain. This lesion is aggressive and can be extensive and may involve surrounding soft tissue. Although classified as benign, giant cell tumors can metastasize (spread) to the lung.
What glucose level range does the American Association of Clinical Endocrinologists recommend for a critically ill patient?
Between 140 and 180 mg/dL
Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established?
Biguanides, which include metformin (Glucophage)
In what other situation can bone loss occur/
Bone loss can also occurs when people spend prolonged time in a gravity-free or weightless environment (e.g., astronauts).
Which statement about dietary concepts for a patient with diabetes is true?
Carbohydrate counting is emphasized when adjusting dietary intake of nutrients.
A patient with type 1 DM is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do?
Carry all necessary diabetes supplies in a clearly identified pack aboard the plane.
Gastroesophageal Reflux Disease (GERD): Etiology
Caused by an incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder.
hyperphosphatemia
bone fractures in healing stage; bone tumors; acromeglay
osteomyelitis
bone infection
Synarthrodial joint
completely immovable (cranium)
While caring for a client who has chronic osteomyelitis and wound drainage, which intervention is most important for the nurse to implement?
Cover the wound with a dressing
A client has a fractured humerus. Which dietary choice indicates that the client understands the nutrition needed to assist in healing the fracture?
Low-fat milk, vitamin C supplements, and roast beef
A patient comes to the emergency department (ED) reporting rapid onset of epigastric pain with nausea and vomiting. The patient says the pain is worse than any heartburn he has had, and that he has not had an appetite for the past day. What does the nurse suspect this patient has? A. Peritonitis B. H. pylori infection C. Duodenal ulcer D. Acute gastritis
D. Acute gastritis
Melena
Dark, sticky feces, as evidence of blood in the stool.
A patient with type 2 DM often has which laboratory value?
Elevated triglycerides
muscle atrophy, decreased strength related to aging
teach isometric exercises
A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic with an erythrocyte sedimentation rate (ESR) that has increased from 15 to 25 mm/hr. Which is the nurse's best action?
Evaluate temperature and vital signs.
EMG
Evaluates diffuse or localized muscle weakness. Diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders. Stop muscle relaxants before test.
3 rating for muscle strength
Fair: can complete ROM against gravity
The critical care nurse is caring for an older patient admitted with HHS. What is the first priority in caring for this patient?
Fluid replacement to increase blood volume
Esophageal Diverticula
Food Can catch in little sac -Don't eat things with tiny seeds -dysphagia, regurgitation, nocturnal cough, and halitosis (bad breath) -Risk for esophageal varacies=risk for hemorage if broken during coughing fit
intrinsic factor
•makes the absorption of vitamin B12 happen •absence of insurance factor causes pernicious anemia
Which insulins are considered to have a rapid onset of action? (Select all that apply.) a. Novolin 70/30
Glulisine Aspart Lispro
Gastric Cancer
Infection with H. Pylori is the largest risk factor for gastric cancer. Patients with pernicious anemia, gastric polyps, chronic atrophic gastritis and achlorhydria are 2 to 3 times more likely to develop gastric cancer.
__________________ and ____________________ patients who are not exposed to sunlight may be at a higher risk.
Institutionalized and homebound
Which statement about insulin is true?
Insulin's effectiveness depends on the individual patient's absorption of the drug.
Which statements about type 1 DM are accurate?
It is an autoimmune disorder Age of onset is typically younger than 30 Etiology can be attributed to viral infections
Which statement is true about insulin?
It is necessary for glucose transport across cell membranes.
A client diagnosed with primary bone sarcoma of the leg is scheduled for tumor removal. The client expresses fear of loss of function. Which is the nurse's best response?
It is normal to feel this way
Why is glucose vital to the body's cells?
It is used by cells to produce energy.
The nurse has educated a client on Paget's disease. Which statement by the client indicates good understanding of causative factors?
It may have a genetic disposition
Which statements about type 2 DM are accurate? (Select all that apply.)
It peaks at about the age of 50. Most people with type 2 DM are obese People with type 2 DM have insulin resistance It can be treated with oral anti diabetic medications and insulin
Long-Acting Insulin:
Lantus Onset: 2-4 hours Peak: None Duration: 24 hours
A client has a fractured tibia and is asking the nurse about external fixation. What are some advantages for the use of external fixation for the immobilization of fractures?
Leads to minimal blood loss Allows for early ambulation Promotes healing
Which factors differentiate DKA from HHS? (Select all that apply.)
Level of hyperglycemia Amount of ketones produced
In developing an individualized meal plan for a patient with diabetes, which goals will be focal points of the plan? (Select all that apply.)
Maintaining blood glucose levels at or as close to the normal range as possible Patient food preferences Patient cultural preferences Limiting food choices only when guided by scientific evidence
Which are modifiable risk factors for type 2 DM? (Select all that apply.)
Maintaining ideal body weight Maintaining adequate physical activity
Which class of antidiabetic medication should be given 1-30 minutes before meals?
Meglitinides, which include nateglinide - (Starlix)
The nurse is caring for a client with a pelvic fracture. Which is the nurse's priority action to prevent complications?
Monitor blood pressure frequently.
Peptic Ulcer
Mucosal lesion of the stomach or duodenum.
Which diabetic complication is associated with neuropathy?
Muscle weakness
The nurse is caring for a client 3 days after a below-knee amputation. Which is a priority intervention?
Muscle-strengthening exercises
Intermediate-Acting Insulin
NPH Onset: 1-4 hours Peak: 4-14 hours Duration: 10-24 hours
When preparing to care for a client with a family history of Paget's disease, it is most important for the nurse to include education in which area?
Need for genetic testing
The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect?
Nephropathy
Microvascular Complications of DM
Nephropathy Neuropathy Retinopathy
What type of exercise does the nurse recommend for the patient with diabetic retinopathy?
Non-weight-bearing activities such as swimming
Early treatment of DKA and HHNS includes IV administration of which fluid?
Normal saline
when do when begin to lose bone?
after 30yrs of age.
The nurse is caring for a client with a fractured fibula. Which assessment prompts immediate action by the nurse?
Numbness and tingling in the extremity
Delayed Gastric Emptying
Often present after gastric surgery and usually resolves after 1 week.
The nurse is caring for several clients with fractures. Which client does the nurse consider at highest risk for developing deep vein thrombosis?
Older man who smokes and has a fractured pelvis
Proton Pump Inhibitors (PPI)
Omeprozole, Pantoprozole. Used to suppress gastric secretions.
Drug Therapy for DM 2
PO Drugs for Initial Treatment -Started at lowest dose and increase every 1-2 weeks until desired level is reached -Second agent (with different mechanism) is added if one agent is not enough -Third agent may be added -Insulin therapy is indicated if drug therapy is not suffice
The nurse is caring for a client with a lesion in the area of the tibia that is swollen and tender. Which client problem is the highest priority for nursing care?
Pain management related to physical injury.
The nurse assesses a client with a below-knee amputation. Which assessment of the skin flap requires immediate action?
Pale and cool to the touch
circ check
Palpation of pulses in extremities below the level of injury and assessment of sensation, movement, color, temp, and pain in the injured part. If pulse is not palpable, use a Doppler to find them.
For which patient should the health care provider avoid prescribing rosiglitazone (Avandia)?
Patient with symptomatic heart failure
The nurse is caring for an older adult client with multiple fractures. How does the nurse manage pain in this client?
Patient-controlled analgesia (PCA) pump with morphine
A client's susceptibility to osteomalacia is related to which risk factor?
Phosphate level of 1.0 mg/dl
2 rating for muscle strength
Poor: can complete ROM with gravity eliminated
The nurse is teaching a client who has left leg weakness to walk with a cane. Which gait training technique is correct?
Place the cane in the client's right hand and move the cane forward, followed by moving the left leg one step forward.
patient history
age, gender and culture • older patients are more at risk for stomach cancer • younger patients are more at risk for inflammatory bowel disease • question patient about GI disorders or abdominal surgeries • ask about prescription medications being taken how much and when they are taken and why they are prescribed
A patient with diabetes presents to the emergency department (ED) with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all of the time." How does the nurse document this subjective find- ing?
Polydipsia and polyuria
BMD decreases most rapidly in __________________ as serum estrogen levels diminish. Trabecular, or cancellous (spongy), bone is lost first, followed by loss of cortical (compact) bone.
Postmenopausal women
Which electrolyte is most affected by hyperglycemia?
Potassium
A deficiency in _______ may aslo reduce bone density.Because 50% of serum calcium is __________bound_________ is needed to use calcium.
Protein
Excessive ________ may increase calcium loss in the urine.
Protein intake example: people who are on high-protein, low-carbohydrate diets, like the Atkins diet.
The diabetic patient experiences early morning hyperglycemia (Somogyi effect) as a result of the counterregulatory response to hypoglycemia. What treatment does the nurse expect for this condition? (Select all that apply.)
Provide an evening snack to ensure adequate dietary intake. Evaluate insulin dosage and exercise program.
abdominal examination usually begins
RUQ LUQ LLQ RLQ make sure to document which quadrant or region
A client who has been diagnosed with osteomyelitis is beginning antibiotic therapy. Which information does the nurse include in the client's teaching plan?
Receiving antibiotic treatment at home from the home health nurse
What is the recommended protocol for patients with type 2 DM who must lose weight?
Reduce calorie intake moderately and increase exercise.
What type of insulin is used in the emergency treatment of DKA and hyperglycemic- hyperosmolar nonketotic syndrome (HHNS)?
Regular
Peptic Ulcer Disease (PUD)
Results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin.
Which statement about insulin administration is correct?
Rotating injection sites improves absorption and prevents lipohypertrophy.
A patient will be using an external insulin pump. What does the nurse tell the patient about the pump?
SMBG levels should be done three or more times a day.
Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action?
Second-generation sulfonylureas, which include glipizide (Glucotrol)
Glucagon is used primarily to treat the patient with which disorder?
Severe hypoglycemia
The older adult with DM asks the nurse for advice about beginning an exercise program. What is the nurse's best response? (Select all that apply.)
Start low-intensity activities in short sessions Be sure to include warm-up and cool-down periods Changes in activity should be gradual
The nurse is caring for a client after arthroscopy surgery. Which intervention is a postoperative priority for this client?
Straight leg raises with the involved leg
Cardiac muscle
Striated involuntary muscle controlled by the ANS.
Osteoporosis is diagnosed in a person who has a
T-score at or lower than −2.5.
0 rating for muscle strength
Zero: no evidence of muscle contractility
Health promotion and maintenance: Osteomalacia
Teach: increase vit. D intake , sun exposure, and drug supplements. -eat food high in Vit. D ex. milk and fortified foods. - Cheese and yogurt rarely contain vit. D and rish in cal. - at least 5min daily of sun exposure for Vit. D. - pt that don't eat dairy can have Soy and rice milk, tofu, and soy products fortified with vitamin D. -Other foods rich in the vitamin are eggs, swordfish, chicken, and liver, as well as enriched cereals and bread products. - take vit. D supplements.
CT
Test of choice for injuries of the bone.
myelography
Test that injects contrast medium into the subarachnoid space of the spine by spinal puncture. Post test, keep pt with head of bed elevated 30-50 degrees.
what bones are at risk for fracture with osteoporosis?
The spine, hip, and wrist.
A client with a nasogastric (NG) tube in place to help treat a gastric ulcer develops severe epigastric pain, and the nurse notes a rigid, boardlike abdomen. The nurse notifies the provider of this condition. Which subsequent action is correct? Check for placement of the NG tube. Irrigate the NG tube with saline solution. Maintain nasogastric suction. Withdraw the NG tube immediately.
This client is exhibiting signs of perforation. The nurse should maintain NG tube suction only to drain gastric secretions and prevent further peritoneal spillage. Unless there is reason to suspect incorrect placement, checking the placement of the tube is not the next action. The NG tube should not be irrigated in this instance, and it should not be withdrawn unless respiratory changes occur.
The mother of a 16-year-old client diagnosed with Ewing's sarcoma expresses concern that her son seems to be angry at everyone in the family. How does the nurse respond?
This is a normal stage in the grieving process
1 rating for muscle strength
Trace: no joint motion and slight evidence of muscle contractility
Which client assessment data are correlated with a diagnosis of chronic gastritis? Hematemesis Gastric hemorrhage Frequent use of corticosteroids Treatment with radiation therapy
Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Gastric hemorrhage is a symptom of acute gastritis. Corticosteroid use and hematemesis are also more likely to be signs of acute gastritis.
Which assessment finding relates most directly to a diagnosis of chronic osteomyelitis?
Ulceration of the skin
The nurse reviews the health history of a client with acute osteomyelitis. Which findings might have contributed to the diagnosis? (Select all that apply.)
Urinary tract infection Hemodialysis Gastrointestinal infection
After the administration of each dose of zoledronic acid (Zometa), it is most important for the nurse to determine which finding?
Urine output
The RN has assigned a client with severe osteoporosis to an LPN. Which information about the care of the client is most important for the RN to provide the LPN?
Use a lift sheet to reposition the client.
ultrasonography
Used to view soft tissue disorders, masses, traumatic joint injuries, osteomyelitis, and surgical hardware placement.
Gastric Ulcers
Usually develop in the antrum of the stomach near acid-secreting mucosa. Patient may be malnourished. Pain occurs 30 to 60 minutes after a meal. It is worsened by ingestion of food. Hematemesis is more common.
Pernicious Anemia
Vitamin B12 deficiency. Patients with chronic gastritis may require B12 for prevention or treatment of pernicious anemia.
The major treatment for Osteomalacia is
Vitamin Din active form egrocalfierol
The nurse is assessing a client with a body cast. Which assessment finding indicates a complication that must be reported to the health care provider?
Vomiting after meals
Hematemesis
Vomiting blood
Which exercise does the nurse recommend to a client at risk for osteoporosis?
Walking 30 minutes three times weekly
myopathy
a problem in muscle tissue
The nurse is teaching a patient with dumping syndrome about diet. Which statement by the patient indicates that teaching has been effective? a. I will use sugar-free gelatin with caution b. I will avoid rice in my diet c. meat in my diet consist of a total ounces a day d. I will limit fluids with my meals to 8 ounces
a. I will use sugar-free gelatin with caution
The nurse is caring for several patients with gastric and duodenal ulcers. Which differential features of gastric ulcers compared to duodenal ulcers does the nurse identify? (select all that apply) a. normal secretion or hypo-secretion b. relieved by ingestion of food c. hematemesis more common than melena d. no gastritis present e. most often, the patient has type O blood
a. normal secretion or hypo-secretion c. hematemesis more common than melena
The gastric ulcer patient's abdomen is rigid, tender and painful. He prefers lying in a knee-chest (fetal) position. What is the nurses priority action at this time? a. notify the health care provider b. administer an opioid pain mediation c. reposition the patient supine d. measure the abdominal circumference
a. notify the health care provider
Drug therapy for peptic ulcer disease is implemented for which purposes? (select all that apply) a. pain relief b. rebuild the mucosal lining of the stomach c. eliminate H. pylori infection d. Heal ulcerations e. prevent recurrence
a. pain relief c. eliminate H. pylori infection d. Heal ulcerations e. prevent recurrence
Which statement about general principles of diet therapy for patients with dumping syndrome is true? a. patients with dumping syndrome should have liquids only between meals b. patients with dumping syndrome should be encouraged to eat a diet high in roughage c.patients with dumping syndrome should eat a high-carbohydrate diet d. The diet for a patient with dumping syndrome must be low in fat and protein
a. patients with dumping syndrome should have liquids only between meals
Osteopenia is present when the T-score is
at −1 and above −2.5.
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? a. "Change positions slowly when you get out of bed." b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." c. "If you miss a dose of this drug, you can double the next dose." d. "Discontinue the medication if you develop a urinary infection."
b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)."
A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine
b. Presence of protein in the urine
A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg
b. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg
short bones
bear little or no weight (phalanges)
long bones
bear weight (femur)
when does the Bone mineral density (BMD) peak?
between 25 and 30yrs of age.
in osteoporosis the likely area of spinal fractures are?
between T8 and L3
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Document the finding in the client's chart. b. Assess tactile sensation in the client's hands. c. Examine the client's feet for signs of injury. d. Notify the health care provider.
c. Examine the client's feet for signs of injury.
A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a. Serum potassium level has increased. b. Blood osmolarity has decreased. c. Glasgow Coma Scale score is unchanged. d. Urine remains negative for ketone bodies.
c. Glasgow Coma Scale score is unchanged.
stole cytotoxic assay and stool culture to detect
colostrum difficile cytotoxic is consider the most reliable because it is a high sensitivity the most common test to detect c.difficile is the enzyme linked to immunosorbent assay (elisa) toxin a + b available in 2 to 6 hours
The patient with a gastric ulcer suddenly develops sharp epigastric pain that spreads over the entire abdomen. What complication has the patient most likely developed? a. Hemorrhage b. gastric erosion c. perforation d. gastric cancer
c. perforation (hole in GI system, is medical emergency, where bacteria, bile, stomach acid, partially digested food, stool enter abdominal cavity, causes severe stomach pain, fever and vomiting)
What is the cause of late dumping syndrome? a. Rapid emptying of food into the the small intestine b. shift of fluids into the gut leading to abdominal distention c. release of an excessive amount of insulin d. rapid entry of high-protein foods into the jejunum
c. release of an excessive amount of insulin
Drinking large amounts of ____________________ each day (over 40oz) are at high risk for calcium loss and subsequent Osteoporosis.
carbonated beverages
irregular bones
carpal bones and inner ear bones
A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond? a. "Drinking any wine or alcohol will increase your insulin requirements." b. "Because of poor kidney function, people with diabetes should avoid alcohol." c. "You should not drink alcohol because it will make you hungry and overeat." d. "One glass of wine is okay with a meal and is counted as two fat exchanges."
d. "One glass of wine is okay with a meal and is counted as two fat exchanges."
When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How should the nurse respond? a. "I can give your injections to you while you are here in the hospital." b. "Everyone gets used to giving themselves injections. It really does not hurt." c. "Your disease will not be managed properly if you refuse to administer the shots." d. "Tell me what it is about the injections that are concerning you."`
d. "Tell me what it is about the injections that are concerning you."`
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury? a. "Examine your feet using a mirror every day." b. "Rotate your insulin injection sites every week." c. "Check your blood glucose level before each meal." d. "Use a bath thermometer to test the water temperature."
d. "Use a bath thermometer to test the water temperature."
A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage)
d. Metformin (Glucophage)
Which peptic ulcer disease drug is useful to protect patients against NSAID-induced (nonsteroidal inflammatory drug) ulcers? a. magnesium hydroxide (Maalox) b. Omperazole (Prilosec) c. Esmoperazole (Nexium) d. Misoprostol (Cytotec)
d. Misoprostol (Cytotec)
A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg
d. Serum osmolarity: 375 mOsm/kg
An older adult patient is admitted with an upper GI bleed. Which finding does the nurse expect to assess in the patient? A. decreased pulse b. increased hemoglobin and hematocrit c. acute confusion d. increased blood pressure
d. increased blood pressure
gastrointestinal changes associated with aging
decrease gastric hydrochloric acid can lead to decrease absorption of essential minerals like iron
stomach changes as you get older
decrease hydrochloric acid levels lead to decrease absorption of iron and B12 proliferation of bacteria. atrophic gastritis occurs as a consequence of bacterial growth encourage Bland foods high in vitamins and iron can excess for pain
osteopenia
decreased bone density (bone loss)
assess skin for
discoloration or rashes, itching , jaundice, increased bruising, increased tendency to bleed
slowed movement related to aging
don't rush pt; be patient
hammertoe
dorsiflexion of any MTP joint with plantar flexion of the proximal interphalangeal joint next to it. Corrected with wires or screws for fixation.
what is the most common diagnostic screening to used for measuring bone mineral density and how does it work ?
dual x-ray absorptiometry (DXA, or DEXA). - spine and hip most often assessed when central DXA (cDXA) scan is performed. - Dr. recommends when to have baseline scan in their 40's. Note: it is the best tool currently available for a definite diagnosis for osteoporosis. - Pt. stays dressed only removes any metallic objects. -result displayed on computer graph & a T-score calculated. - no follow up care. - must consult result with primary HCP.
distal
extremities
action alert
if a bulging pulsating mass present during assessment of the abdomen do not touch the area the patient may have an abdominal aortic aneurysm. notify Health care provider
sequence of examining abdomen
inspection, auscultation, percussion, palpation
Untreated hyperglycemia results in which condition?
metabolic acidosis
proximal
near trunk of body
5 rating for muscle strength
normal: ROM unimpaired against gravity with full resistance
hypophosphatemia
osteomalacia
hypocalcemia
osteoporosis; osteomalacia
functions of the GI tract
secretion digestion absorption motility and elimination
Scoliosis
vertebrae rotate and begin to compress. Spinal column has lateral curve. 50 degrees is unstable, 60 degrees considered cardiopulmonary compromise
priority after a bone biopsy
watch for bleeding from puncture site and for tenderness, redness, or warmth that could indicate infection
person most likely to get osteoporosis
white, thin women
Which statement about sexual intercourse for patients with diabetes is true?
Impotence is associated with DM in male patients.
A client has been recently diagnosed with gastric cancer. What signs and symptoms suggest that the cancer is at an advanced stage? Select all that apply. Indigestion Nausea and vomiting Retrosternal pain Feeling of fullness Enlarged lymph nodes Iron deficiency anemia
In advanced gastric cancer, nausea and vomiting is often present and the lymph nodes may be enlarged. Vomiting may occur due to excessive dilation or thickening of the stomach wall, or may be due to pyloric obstruction. Lymph node enlargement is due to metastasis. Iron deficiency anemia is also a sign of advanced gastric cancer that may be due to the reduction of iron or vitamin B12 absorption. Indigestion, retrosternal pain, and a feeling of fullness are symptoms of early gastric cancer.
Which statements about sensory alteration in patients with diabetes are accurate? (Select all that apply.)
Loss of pain, pressure, and temperature sensation in the foot increases risk for injury Sensory neuropathy causes loss of normal sweating and skin temperature regulation It can be delayed by keeping blood glucose level as close to normal as possible
The nurse is performing a health history on a client who is newly diagnosed with peptic ulcer disease (PUD). Which condition in the client's history prompts the nurse to question the client further? Cardiovascular disease Hyperlipidemia Osteoarthritis Urinary tract infections
Nonsteroidal anti-inflammatory drugs are a major cause of PUD and are often used by clients who have arthritis; a report of osteoarthritis should prompt the nurse to explore types of treatments the client is using. Cardiovascular disease, hyperlipidemia, and urinary tract infections do not predispose clients to PUD.
Gastric Lavage
Not performed commonly today. Requires the insertion of a large-bore NGT with instillation of a room-temperature solution in volumes of 200 to 300 ml. The solution and blood are repeatedly withdrawn manually until returns are clear or light pink and without clots.
Osteoporosis is?
a chronic metabolic disease in which bone loss causes decreased density and possible fracture.
The nurse is teaching a client with peptic ulcer disease about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."
A. Nizatidine is most effective if administered once daily.
neuropathy
a problem in nerve tissue
Ganglion
round, benign cyst, often found on a wrist or foot joint or tendon. painless on palpation, may disappear and reappear. Can be aspirated with needle or removed with incision.
Osteomyelitis is categorized as exogenous
in which infectious organisms enter from outside the body as in an open fracture.
amphiarthrodial joint
slightly movable (pelvis)
Type 1 DM
•Pancreatic beta-cell destruction, therefore no insulin •Occur at any age but usually younger than 30 •Usually non-obese •Abrupt onset, thirst, hunger, increase urine output, weight loss
four divisions of large intestine
•ascending, transfers, descending, sigmoid colon •functions are movement of absorption and elimination
A client asks why a plaster cast is not applied to the fractured clavicle. Which is the nurse's best response?
"A splint or a bandage is sufficient to keep the bones in alignment."
The male diabetic patient asks the nurse for advice about alcohol consumption. What is the nurse's best response?
"Avoid more than two drinks a day and have them with or shortly after meals."
Which instruction is most important for the RN to provide to the nursing assistant assigned to care for a client with primary osteoporosis?
"Clean up clutter in the room."
What is Diabetes Mellitus
"For all types of diabetes mellitus (DM), the main feature is chronic hyperglycemia (high blood glucose level) resulting from problems with glucose regulation that include reduced insulin secretion or reduced insulin action The body doesn't make enough insulin or the body becomes resistant to insulin
A patient with acute gastritis is receiving treatment to block and buffer gastritis acid secretions to relieve pain. Which drug does the nurse identify as an antisecretory agent (protonpump) inhibitor? A. Sucralfate (Carafate) B. Ranitidine (Zantac) C. Mylanta D. Omperazole (Prilosec)
D. Omperazole (Prilosec)
A patient with DM has signs and symptoms of hypoglycemia. The patient is alert and oriented with a blood glucose of 56 mg/dL. What does the nurse do next?
Give 8 oz of skim milk and then a carbohydrate and protein snack.
Which laboratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 months?
Glycosylated hemoglobin (HbA1c)
Which are characteristics of regular insulin? (Select all that apply.)
When mixing types of insulin, this insulin is always drawn up first This insulin should be given 30 minutes before meals
fat embolism
Yellow marrow that becomes dislodged and enters the blood stream. Life threatening complication.
After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education? a. "If I develop an infection, I should stop taking my corticosteroid." b. "If I have pain over the transplant site, I will call the surgeon immediately." c. "I should avoid people who are ill or who have an infection." d. "I should take my cyclosporine exactly the way I was taught."
a. "If I develop an infection, I should stop taking my corticosteroid."
family history and genetic risk
ask about family history of GI disorders familial adenomatous polyposis (FAP) is inherited that predisposes the patient to colon cancer
steatorrhea
fat in the feces; frothy, foul-smelling fecal matter seinen malabsorption
A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient most at risk for developing?
hypoglycemia
auscultation
normal bowel sounds are high-pitched irregular gurgles every 5 to 15 seconds with a normal frequency range of 5 to 30 per minute characterized as normal hypoactive or hyperactive best way to ask if peristalisis is if the patient has passed gas within 8 hours or stool within 12 to 24 hours
how do osteoporosis and osteopenia (low bone mass) occur?
occur when osteoclastic (bone resorption) activity is greater than osteoblastic (bone building) activity. The result is a decreased bone mineral density (BMD).
Back pain accompanied by tenderness and voluntary restriction of spinal movement suggests_______________________ —the most common type of osteoporotic fracture.
one or more compression vertebral fractures
Paget's disease of the bone
osteitis deformans, is a chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) and re-formed (osteoblastic activity). The result is bone that is structurally disorganized, causing bones to be weak with increased risk for bowing of long bones and fractures. Familial/Sporadic
Type 1 Diabetes
• Beta-cell destruction leading to absolute insulin deficiency • Autoimmune • Idiopathic
Type 2 Diabetes
• Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance
Type 2 DM
•Dysfunctional pancreatic beta-cell, makes little insulin •In the 50's but may occur earlier in life •60-80% obese •Thirst, fatigue, blurred vision, vascular or neural complications
Which instruction does the nurse include in the discharge teaching plan of a client who has osteoporosis?
"Avoid using scatter rugs."
A client has a fracture and is being treated with skeletal traction. Which assessment causes the nurse to take immediate action? a. The client's blood pressure is 130/86 mm Hg. b. The traction weights are resting on the floor. c. Slight oozing of clear fluid is noted at the pin site. d. Capillary refill of the extremity is less than 3 seconds.
B
The nurse is performing a medical history and physical assessment for a client. Which assessment findings lead the nurse to conclude that the client is at risk for development of osteoporosis? (
Client is a white woman with a body mass index (BMI) of 19.4. Client fractured her wrist badly in a fall last year. Client drinks at least four cans of diet cola every day. Client has smoked two packs of cigarettes a day for 40 years.
Which nursing intervention is most effective in preventing transfer of an organism from the wound of a client with osteomyelitis to other clients?
Contact precautions
A client is seen at the clinic with the medical diagnosis of osteomalacia. When taking the client's history, what does the nurse assess for?
Dietary intake of vitamin D
The home care nurse is visiting a client with diabetes who has a new cast on the arm. On assessment, the nurse finds the client's fingers to be pale, cool, and slightly swollen. Which is the nurse's first intervention?
Elevate the arm above the level of the heart
A client newly diagnosed with Ewing's sarcoma is most likely to exhibit which laboratory finding?
Elevated alkaline phosphate (ALP)
In a patient with hyperglycemia, the respiratory center is triggered in an attempt to excrete more carbon dioxide and acid, thus causing a rapid and deep respiratory pattern. What is the term for this respiratory pattern?
Kussmaul respiration
Which oral agent may cause lactic acidosis?
Metformin
The client is being assessed for rotator cuff injury. Which physical assessment finding is consistent with this type of injury?
The client is unable to initiate or maintain abduction of the affected arm at the shoulder
A Woman who experience a __________ has 4 times greater risk for a second fracture.
Hip fracture
right upper quadrant contains
most of the liver, gallbladder, duodenum, head of pancreas, hepatic flexure of the colon, part of the ascending and transverse colon
elevation of creatine kinase
muscle trauma; progressive muscular dystrophy; effects of electromyography
Chronic Complications of DM Macrovascular
-Coronary heart disease -Cerebrovascular disease -Peripheral vascular disease
Which complications of DM are considered emergencies? (Select all that apply.)
DKA Hypoglycemia HHS
The nurse is preparing to teach a diabetic patient how to select appropriate shoes. Which points must be included in the teaching plan? (Select all that apply.)
"It is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist." "The heels of the shoes should be less than 2 inches high." "Avoid tight-fitting shoes, which can cause tissue damage to your feet." "You should get at least two pairs of shoes so you can change them at midday and in the evening."
A 25-year-old female patient with type 1 DM tells the nurse, "I have two kidneys and I'm still young. I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's best response?
"Keeping your blood sugar under control now can help to prevent damage to both kidneys."
The nurse is caring for a patient with DM. The patient's urine is positive for ketones. What does the nurse instruct the patient with regard to exercise?
"When urine ketones are present, you should not exercise."
A client who had a wrist cast applied 3 days ago calls from home, reporting that the cast is loose enough to slide off. How does the nurse respond?
"You need a new cast now that the swelling is decreased."
Osteomyelitis is categorized as endogenous (hematogenous)
-in which organisms are carried by the bloodstream from other areas of infection. - Acute hematogenous infection results from bacteremia, underlying disease, or nonpenetrating trauma. Urinary tract infections, particularly in older men, tend to spread to the lower vertebrae. Long-term IV catheters can be a source. Patients undergoing long-term hemodialysis and IV drug users also. Salmonella infections of the GI tract may spread. Patients with sickle cell disease and other hemoglobinopathies often have multiple episodes of salmonellosis.
Dietary protein intake is recommended at ______ grams per kilograms of body weight.
0.8 grams
A 65-year-old female client has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the client? A. Antalgic gait B. Midswing gait C. Narrow-based stance D. No lurch in gait
A. Antalgic gait
Gastroesophageal Reflux Disease (GERD): Esophageal assessment
1.Heartburn (Pyroris) 2.Epigastric pain 3.Dyspepsia (Indigestion) 4.Nausea; regurgitation 5.Pain and difficulty with swallowing (Odynophagia) 6.Hypersalivation (Water brash in response)
A client recently had an amputation of the right hand. Which statement by the client, who was right-handed, indicates that he or she is coping effectively? A. "I can learn to write with my left hand." B. "I'll need help with all of my personal care." C. "Clothing will cover my missing hand." D. "People will look at me differently."
A. "I can learn to write with my left hand."
alkaline phosphatase (ALP)
30-120 units/L (slightly increased in older adults)
A patient with diabetic ketoacidosis is on an insulin drip of 50 units of regular insulin in 250 mL of normal saline. The current blood glucose level is 549 mg/dL. According to insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump?
40 mL/hr
Which diabetic patient is at greatest risk for diabetic foot ulcer formation?
75-year-old African-American male with history of cardiovascular disease
serum calcium
9.0-10.5 mg/dL
psychosocial assessment
ask about recent stressors if patient is diagnosed with cancer they may experience phases of the grieving process will become depressed angry or in denial
Achalasia
aspiration precautions -reduced esophageal peristalsis -PEG tube in severe cases -Anticholinergic meds can cause -Esophageal Cancer -Stroke can cause
decreased ROM related to aging
assess pts ability to perform ADLs and mobility
smoking and chewing tobacco
smoking has a greater risk factor for GI cancer and chewing tobacco was a major cause of oral cancer
Other manifestations of Paget's disease
• Apathy, lethargy, fatigue • Hyperparathyroidism • Gout • Urinary or renal stones • Heart failure from fluid overload
Which types of ulcers are included peptic ulcer disease? (Select all that apply) A. Esophageal ulcers B. Gastric ulcers C. Pressure ulcers D. Duodenal ulcers E. Stress ulcers
B. Gastric ulcers D. Duodenal ulcers E. Stress ulcers
Diet for DM
-Carbs: 45% of daily calories from carbs -Protein: 15-20% -Fat: 20-35% -130g carbohydrate/day -Increase fiber intake 25g -Carb from: fruit, vegetable, whole grains, legumes and low-fat milk products -Cholesterol less than 200mg/day -Have 2 or more fatty fish serving per week
Foot Care
-Cleanse and inspects the feet daily -Wears properly fitting shoes -Avoid walking in bare feet -Trim toenails properly -Reports non-healing breaks in the skin
The nurse plans to use which tool to measure joint range of motion (ROM)? A. Doppler device B. Goniometer C. Reflex hammer D. Tonometer
B. Goniometer
the nurse is providing discharge teaching to a patient about self-monitoring of blood glucose (SMBG). What information does the nurse include? (Select all that apply.)
wash hands before using the meter Do a retest if the results seem unusual Do not share the meter
An older woman is admitted after falling down the stairs. Which assessment findings require immediate intervention? (Select all that apply.)
Blood pressure, 80/50 mm Hg Potassium, 6.0 mEq/L Dark brown urine
Cultural considerations: Osteoporosis
-occurs most often in older, lean-built Euro-American -Asian women, particularly those who do not exercise regularly. -African Americans are at risk for decreased vitamin D, which is needed for adequate calcium absorption in the small intestines.
lordosis
Commonly found in adults who have abdominal obesity.
Which are signs and symptoms of mild hypoglycemia? (Select all that apply.)
Headache Weakness Irritability
Gastritis
Inflammation of gastric mucosa (stomach lining)
H2-Receptor Antagonists
Pepcid, Axid. Used to block gastric secretions.
Neurovascular checks 7 Ps.
-pain: that cannot be controlled -pressure, -paresis or paralysis (weakness or inability to move), - paresthesia (abnormal, tingling sensation) -pallor -pulselessness. - If any of these findings occur, report them immediately to the surgeon.
____________an example of secondary disease, occurs when a limb is immobilized related to a fracture, injury, or paralysis. Immobility for longer than 8 to 12 weeks can result in this type of osteoporosis.
Regional Osteoporosis
Which client is at highest risk for the development of plantar fasciitis?
Young adult runner
A client is suspected of having muscular dystrophy (MD). Which laboratory test result does the nurse anticipate with this disease? A. Decreased serum creatine kinase (CK) level B. Moderately elevated aspartate aminotransferase (AST) C. Decreased alkaline phosphatase (ALP) D. Decreased skeletal muscle creatine kinase (CK-MM) level
B. Moderately elevated aspartate aminotransferase (AST)
phases of paget's disease: Active, mixed and Inactive
-the first phase (the active phase), a rapid increase in osteoclasts (cells that break down bone) causes massive bone destruction and deformity. The osteoclasts of pagetic bone are large and multinuclear, unlike the osteoclasts of normal bone tissue. -In the mixed phase, the osteoblasts (bone-forming cells) react to compensate in forming new bone. The result is bone that is vascular, structurally weak, and deformed. Common areas of involvement are the vertebrae, femur, skull, clavicle, humerus, and pelvis. -When the osteoblastic activity exceeds the osteoclastic activity, the inactive phase occurs. The newly formed bone becomes sclerotic and very hard.
Gastroesophageal Reflux Disease (GERD): Nonpharmacologic Interventions
*Patient Teaching*: -Avoid factors that decrease lower esophageal sphincter pressure or cause esophageal irritation -Low-fat, high-fiber diet -Weight loss -Avoid eating and drinking 2 hours before bedtime, and wearing tight clothes -Elevate the head of the bed on 6- to 8-inch blocks. right side-lying position, CPAP if obese -Avoid the use of anticholinergics, (delay stomach emptying), NSAID's (contain acetylsalicylic acid), oral contraceptives, sedatives, NSAIDs (e.g., ibuprofen), nitrates, and calcium channel blockers.
Regulation of glucose Pancreas: Islets of Langerhans
+Alpha Cell: Secrete glucagon (a hormone that trigger release of glucose) +Beta Cell: Produce (pro)insulin and amylin
Regulation of glucose Liver: Proinsulin
+Proinsulin stored by Beta Cell, liver transform into active insulin by removal C-peptide chain + Insulin allow cells to take up, use and store carbohydrate/fat/protein
Hiatal hernias
-Also called diaphragmatic hernias, -Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest.
Absence of insulin Energy from Fat
-Fats break down Release Free Fatty Acids Conversion to Ketone Bodies for Energy -Ketones = Metabolic Acidosis or Ketoacidosis -Kussmaul Respiration: Blow off CO2 and Acid
Hiatal hernias Open Surgery: Post-Op Nursing Interventions
-Incentive spirometry and deep breathing -Adequate PAIN control with analgesics is essential for postoperative deep breathing and coughing. -Prevent atelectasis and pneumonia. -Conventional: large-bore (diameter) nasogastric (NG) tube to prevent the fundoplication from becoming too tight around the esophagus. NG drainage should be dark brown with old blood, normal yellowish green w/in 8 hrs. Monitor patency, Hydration/ I&O -Begin clear fluids when peristalsis is re-established or in an effort to stimulate peristalsis. -Supervise the first oral feedings (dysphagia common) -Gas bloat syndrome, in which patients are unable to voluntarily eructate (belch).
Drug therapy : osteoporosis
-used when the BMD T-score for the hip is below −2.0 with no other risk factors or when the T-score is below −1.5 with one or more risk factors or previous fractures. -calcium and vitamin D3 supplements, bisphosphonates, or estrogen agonist/antagonists (formerly called selective estrogen receptor modulators) or a combination. -Estrogen and combination hormone therapy are not used solely for osteoporosis prevention or management because they can increase other health risks such as breast cancer and myocardial infarction.
The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1½ to 3 hours after a meal, usually at night. B. Pain is worsened by the ingestion of food. C. The client has a malnourished appearance. D. The client is a man older than 50 years.
A A key symptom of duodenal ulcers is that pain usually awakens the client between 1:00 a.m. and 2:00 a.m., occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.
A client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Starting a large-bore IV B. Administering IV pain medication C. Preparing equipment for intubation D. Monitoring the client's anxiety level
A A large-bore IV should be placed as requested, so that blood products can be administered. IV pain medication is not a recommended treatment for gastrointestinal bleeding. Intubation is not a recommended treatment for bleeding related to PUD. The mental status of the client should be monitored, but it is not necessary to monitor the anxiety level of the client
A client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? A. Schedule of the client's follow-up examinations and x-ray assessments B. Information on family members' progress in learning how to perform dressing changes C. Copy of the diet plan prepared for the client by the hospital dietitian D. Detailed account of what occurred during the client's surgical procedure
A Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly. It may take family members a long time to become proficient at tasks such as dressing changes. Although the case manager should be aware of the diet, family members will likely be preparing the client's daily diet, and they should be provided with this information. It is not necessary for the case manager to have details of the client's surgical procedure unless a significant event has occurred during the procedure.
skeletal muscle
A striated voluntary muscle controlled by the CNS and PNS. The main function is movement of the body and it's parts.
The nursing student caring for a patient with a duodent ulcer is about to administer a proton pump inhibitor (PPI). Which statement about this medication is true? A. These drugs should not be used for a prolonged period of time because they may contribute to osteoprosis-related fractures B. PPI's may not be given via feeding tube C. These drugs help prevent stress-induced ucers D. PPI's work by coating the stomach with a protective barrier
A. These drugs should not be used for a prolonged period of time because they may contribute to osteoprosis-related fractures
Which are pathologic changes associated with acute gastritis? (select all that apply) A. Vascular congestion B. Severe mucosal damage and ruptured vessels C. Edema D. Acute inflammatory cell infiltration E. Increased cell production in the superficial epithelium of the stomach lining
A. Vascular congestion B. Severe mucosal damage and ruptured vessels C. Edema D. Acute inflammatory cell infiltration
A patient has been receiving insulin in the abdomen for 3 days. On day 4, where does the nurse give the insulin injection?
Abdomen, but in an area different from the previous day's injection
Achlorhydria
Absence of secretion of hydrochloric acid.
Diabetic Ketoacidosis
Absolute (or near-absolute) insulin deficiency, resulting in: -Severe hyperglycemia -Ketone body production (ketosis) -Metabolic Acidosis -Cause: Inadequate insulin dose -Glucose: >300mg/dL -Positive for Ketones -Develops over hours to 1-2 days -Most common in Type 1 DM, but seen in Type 2 DM
A client has left-sided weakness. Which action by the client indicates that additional teaching about proper cane use is needed?
Advancing the cane while the right leg moves forward
Assessing Risk Factors for Primary Osteoporosis
Assess for: • Older age in both genders and all races • Parental history of osteoporosis, especially mother • History of low-trauma fracture after age 50 years • Low body weight, thin build • Chronic low calcium and/or vitamin D intake • Estrogen or androgen deficiency • Current smoking (active or passive) • High alcohol intake (3 or more drinks a day) • Lack of physical exercise or prolonged immobility
post-op arthroscopy
Assess neurovascular status of affected limb every hour. Monitor distal pulses, warmth, color, cap refill, pain, movement, and sensation. Ice for 24 hrs and extremity is elevated for 12-24 hrs.
A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention?
Assess pedal pulses.
The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? A. Apply antiembolism stockings. B. Place a nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.
B To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. hiccupssm stockings will need to be applied, monitoring output is important, and famotidine (Pepcid) will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis.
A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."
B Although licorice and slippery elm may be helpful in managing PUD, the client should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The client should not use over-the-counter medications without first discussing it with his or her provider.
Gastroesophageal Reflux Disease (GERD): Pathophysiology
Backflow of gastric and duodenal contents into the esophagus.
IV zoledronic acid (Reclast) and IV pamidronate (Aredia). For management of osteoporosis, Reclast is needed only once a year and Aredia is given every 3 to 6 months
Both drugs have been linked to a complication called jaw osteonecrosis (also known as avascular necrosis, or bone death) in which infection and necrosis of the mandible or maxilla occur. - teach pt. to have oral assessment before use of medication.
The patient with diabetes has a foot that is warm, swollen, and painful. Walking causes the arch of the foot to collapse and gives the food a "rocker bottom" shape. Which foot de- formity does the nurse recognize?
Charcot foot
The nurse finds a client vomiting coffee-ground emesis. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication
C Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the client's change in mental status, which is hypovolemia.
The nurse and the dietitian are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is best for this client? A. Chicken salad on whole wheat bread B. Liver and onions C. Chicken and rice D. Cobb salad with buttermilk ranch dressing
C Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products. The client with dumping syndrome should not be allowed to have mayonnaise, onions, or buttermilk ranch dressing; the dressing is made from milk products. The client can have whole wheat bread only in very limited amounts.
Which client does the nurse assess more carefully for risk of developing primary osteoporosis?
Client who drinks 6 cups of coffee per day
The nurse is caring for clients with above-knee amputations. Which client does the nurse treat first?
Client with regional pain syndrome
The nurse assesses that a client experiences regular epigastric discomfort that usually goes away after eating. Which initial nursing action is correct? Contact the provider to report these symptoms. Order a low-fat, bland diet to prevent discomfort. Request an order for an H2-receptor antagonist. Teach the client to avoid nonsteroidal antiinflammatory drugs and aspirin.
Clients with epigastric discomfort that usually abates after eating may have chronic gastritis and should be evaluated for this disease. The nurse should report these symptoms to the provider. Ordering a low-fat diet, requesting an order for an H2-receptor antagonist, and teaching the client to avoid NSAIDs and aspirin are all correct actions only after a diagnosis of gastritis has been made.
MRI
Commonly used to diagnose musculoskeletal disorders. Find out if pt has anything metal, is pregnant, or has chronic kidney disease. No metformin 24 hrs before or 48 hrs after is contrast is used.
What is the basic principle of meal planning for a patient with type 1 DM?
Considering the effects and peak action times of the patient's insulin
A patient with type 1 DM is taking a mixture NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning dose of insulin?
Contact the health care provider for an order regarding the insulin
A diabetic patient is scheduled to have a blood glucose test the next morning. What does the nurse tell the patient to do before coming in for the test?
Eat the usual diet but have nothing after midnight
Which are symptoms of early dumping syndrome (condition that can develop after surgery to remove all or part of your stomach or after surgery to bypass your stomach to help you lose weight. Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly)? (select all that apply) a. tachycardia b.confusion c. desire to lie down d. syncope e. occurs 30 minutes after eating
a. tachycardia c. desire to lie down d. syncope e. occurs 30 minutes after eating
When glucagon is administered, what does it do?
Frees glucose from hepatic stores of glycogen
4 rating for muscle strength
Good: can complete ROM against gravity with some resistance
After a 2-hour glucose challenge, which result demonstrates impaired glucose tolerance?
Greater than 140 mg/dL
In determining if a patient is hypoglycemic, the nurse looks for which characteristics in ad- dition to checking the patient's blood glucose? (Select all that apply.)
Hunger Irritability Palpitations Profuse perspiration
Absence of Insulin
Hyperglycemia -Fluid and electrolyte imbalance -Polyuria Polydipsia Polyphagia
A client is prescribed alendronate (Fosamax). Which statement indicates that the client understands teaching about this drug?
I should take this drug with a full glass of water
A client who has had an above-knee amputation of the right leg reports pain in the right foot. Which priority medication does the nurse administer?
IV calcitonin
The nurse is performing an assessment on a client admitted with a fractured left humerus. When the client moves the extremity, the nurse notes the presence of a grating sound. Which is the nurse's best intervention?
Immobilize the arm.
A 47-year-old patient with a history of type 2 DM and emphysema who reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The patient is placed on the regular oral antidiabetic agents, sliding-scale insulin, and antibiotic medications. On day 2 of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do?
Increase
Acute Gastritis
Inflammation of the gastric mucosa or submucosa after exposure to local irritants or other causes. Early manifestation is a thickened, reddened mucous membrane with prominent rugae (folds).
Intensive therapy with good glucose control results in delays in which diabetic complications? (Select all that apply.)
Macrovascular Cardiovascular disease Retinopathy Nephropathy Neuropathy
Male considerations : osteoporosis
Men also develop osteoporosis after the age of 50 years because their testosterone levels decrease. Testosterone is the major sex hormone that builds bone tissue. Men are often underdiagnosed, even when they become older adults.
Which cultures tend to have a higher incidence of DM? (Select all that apply.)
Mexican America African American American Indian
Which are considered the early signs of diabetic nephropathy? (Select all that apply.)
Microalbuminuria Elevated serum uric acid
The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl) Misoprostol (Cytotec)
Misoprostol is a prostaglandin analogue that protects against NSAID-induced ulcers. Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have peptic ulcer disease (PUD). Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions, but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection.
A client has been diagnosed with carpal tunnel syndrome. Which intervention does the nurse question in the treatment of this injury?
Morphine 30 mg to be taken orally every 4 ho
Sliding Hiatial Hernias
Most common • Heartburn • Regurgitation • Chest pain • Dysphagia • Belching
Duodenal Ulcers
Most often occur in the upper portion of the duodenum. Patient is usually well nourished. Pain occurs 1.5 to 3 hours after a meal. Pain will often wake patient in middle of night. Pain is relieved by ingestion of food. Melena is common.
The nurse is rounding on assigned orthopedic clients. The client with which type of fracture requires immediate interventions to prevent infection?
Open fracture of the tibia
The nurse is caring for a client with a fractured femur. Which factor in the client's history may impede healing of the fracture?
Paget's disease
SMBG levels is most important in which patients? (Select all that apply.)
Patients taking multiple daily insulin injections Patients with hypoglycemic unawareness Patients using a portable infusion device for insulin administration Patients with acute illnesses Pregnant patients
bone cancer
Osteosarcoma, or osteogenic sarcoma, is the most common type of primary malignant bone tumor. More than 50% of cases occur in the distal femur, followed by the proximal tibia and humerus. Tumor is relatively large, causing acute pain and swelling. The involved area is usually warm because the blood flow. Center of the tumor is sclerotic from increased osteoblastic activity. The periphery is soft, extending through the bone cortex in the classic sunburst appearance associated with the neoplasm. An inward spread into the medullary canal is also common. Osteosarcoma typically metastasizes (spreads). Ewing's sarcoma is not as common as other tumors, it is the most malignant. It causes pain and swelling. In addition, systemic manifestations, particularly low-grade fever, leukocytosis, and anemia, characterize the lesions. The pelvis and the lower extremity are most often affected. Death results from metastasis to the lungs and other bones. Usually occurs in children and young adults in their 20s. Men are affected more often. Patient with chondrosarcoma experiences dull pain and swelling for a long period. The tumor typically affects the pelvis and proximal femur. Arising from cartilaginous tissue, destroys bone and often calcifies. Occurs in middle-aged and older people, with predominance in men. From fibrous tissue, fibrosarcomas can be divided into subtypes, of which malignant fibrous histiocytoma (MFH) is the most malignant. Usually the clinical presentation of MFH is gradual, without specific symptoms. Local tenderness, with or without a palpable mass, occurs in the long bones of the lower extremity. As with other bone cancers, the lesion can metastasize to the lungs. Primary tumors of the prostate, breast, kidney, thyroid, and lung are called bone-seeking cancers. The vertebrae, pelvis, femur, and ribs are the bone sites commonly affected. Simply stated, primary tumor cells, or seeds, are carried to bone through the bloodstream. Fragility fractures caused by metastatic bone are a major concern.
The nurse is assisting with an esophagogastroduodenoscopy (EGD) procedure on a client who has symptoms of gastritis. The provider collects tissue samples and will test for H. pylori infection using which diagnostic test? Cytologic examination IgG or IgM testing pH measurement Rapid urease testing
Rapid urease testing may be done on tissue samples collected during an EGD to detect H. pylori infection. Cytologic examination is used to detect cancer cells. IgG or IgM H. pylori antibody tests are blood tests to diagnose infection. pH measurement is used to evaluate acid in the upper gastrointestinal tract.
Dumping Syndrome
Refers to a group of vasomotor symptoms that occur after eating. This syndrome is believed to occur as a result of the rapid emptying of food contents into the small intestine, which shifts fluid into the gut, causing abdominal distention. Typically occurs within 30 minutes of eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations and the desire to lie down.
Short-Acting Insulin
Regular Human Insulin Onset: 30 mins Peak: 2-5.5 hours Duration: 5-12 hours
Hiatal hernias: Preoperative Care
Reinforce the surgeon's instructions and prepare the patient for what to expect after: -Instruct patients who are overweight to lose weight before surgery -Advise to quit or significantly reduce smoking
The patient with type 2 diabetes is prescribed sitagliptin (Januvia) for glucose regulation. Which key changes does the nurse teach a patient to report to the health care provider immediately? (Select all that apply.)
Report any signs of jaundice Report any blue-grey discoloration of the abdomen Report any sudden onset of abdominal pain
Nutrition therapy: Osteoporosis
Teach patients: - about the adequate amounts of protein, magnesium, vitamin K, and trace minerals. - Increase Calcium and vitamin D intake. -avoid excessive alcohol and caffeine. -Patient who has a fracture, adequate intake of protein, vitamin C, and iron is important to promote bone healing. - lactose intolerant can choose a variety of soy and rice products that are fortified. -Calcium and vitamin D are added to many fruit juices, bread, and cereal products Note THE PROMOTION OF A SINGLE NUTRIENT WILL NOT PREVENT OR TREAT OSTEOPOROSIS. - develop a nutritional plan that is most beneficial in maintaining bone health (fruits, vegetables, low-fat dairy, protein sources, increased fiber, and moderation in alcohol and caffeine.)
A diabetic patient is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 7 am. At 10:30 am, the patient reports feeling uneasy, shaky, and has a headache. Which is the probable explanation for this?
The regular insulin's action is peaking, and there is an insufficient blood glucose level.
A female client who is a carrier of the gene for Duchenne's muscular dystrophy asks whether any of her daughters will have this disease. Which is the nurse's best response?
Your daughter can not get the disease
A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension
a. Deep and fast respirations c. Tachycardia e. Orthostatic hypotension
A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a. "Maintain tight glycemic control and prevent hyperglycemia." b. "Restrict your fluid intake to no more than 2 liters a day." c. "Prevent hypoglycemia by eating a bedtime snack." d. "Limit your intake of protein to prevent ketoacidosis."
a. "Maintain tight glycemic control and prevent hyperglycemia."
After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The lower abdomen is the best location because it is closest to the pancreas." b. "I can reach my thigh the best, so I will use the different areas of my thighs." c. "By rotating the sites in one area, my chance of having a reaction is decreased." d. "Changing injection sites from the thigh to the arm will change absorption rates."
a. "The lower abdomen is the best location because it is closest to the pancreas."
A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, "Can I ask my niece to prefill my syringes and then store them for later use when I need them?" How should the nurse respond? a. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up." b. "Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light." c. "Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes." d. "No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container."
a. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up."
A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? a. "Your risk of diabetes is higher than the general population, but it may not occur." b. "No genetic risk is associated with the development of type 1 diabetes mellitus." c. "The risk for becoming a diabetic is 50% because of how it is inherited." d. "Female children do not inherit diabetes mellitus, but male children will."
a. "Your risk of diabetes is higher than the general population, but it may not occur."
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? a. Administer 1 mg of intramuscular glucagon. b. Encourage the client to drink orange juice. c. Insert a new intravenous access line. d. Administer 25 mL dextrose 50% (D50) IV push.
a. Administer 1 mg of intramuscular glucagon.
A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: • Insulin glargine: 12 units daily at 1800 • Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the client's medication administration record, which action should the nurse take? a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin. c. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together. d. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together.
a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.
An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102° F (38.9° C) d. Severe orthostatic hypotension
a. Increased rate and depth of respiration
The student nurse is performing a gastric lavage on a patient with an active upper GI bleed. Which action by the student requires intervention by the supervising nurse? a. Using an ice-cold solution to perform lavage of the stomach b. instilling the lavage solution in volumes of 200 to 300 mL c. continuing the lavage until the solution returned is clear or light pink without clots d. positioning the patient on his left side during the procedure
a. Using an ice-cold solution to perform lavage of the stomach
The nurse is caring for a patient who under-went gastric resection. On assessment, the shiny, and appears "beefy." What does the nurse suspect has occurred? a. Vitamin B12 deficiency b. anemia c. hypovolemia d. inadequate nutrition
a. Vitamin B12 deficiency
The nurse is providing discharge teaching for a patient after gastrectomy. Which teaching points will the nurse include to help the patient minimize dumping syndrome? (select all that apply) a. eat small frequent meals b. drink an 8 ounce glass of water with each meal c. eliminate alcohol and caffeine from you diet d. lie flat for a short time after eating e. take B12 injections as prescribed by your health care provider.
a. eat small frequent meals c. eliminate alcohol and caffeine from you diet d. lie flat for a short time after eating e. take B12 injections as prescribed by your health care provider.
When performing an assessment on a patient with an active upper GI bleed, which conditions does the nurse identify as common causes of upper GI bleeding? (select all that apply) a. esophageal cancer b. esophageal varices c. gastroesophageal reflux disease d. dudoenal ulcer e. gastritis f. gastric cancer
a. esophageal cancer b. esophageal varices d. dudoenal ulcer e. gastritis f. gastric cancer
A patient with peptic ulcer disease is receiving Maalox (antiulcer, neutralize gastric acid follow dssolution in gastric contents, inactivates pepsin). Which actions does the nurse take when administering this medication? (select all that apply) a. give medication 2 hours after the patient's meal b. do not give other drugs within 1-2 hours of antacids c. assess the patient for a history of renal disease before giving Maalox e. observe the patient for the side effect of constipation
a. give medication 2 hours after the patient's meal b. do not give other drugs within 1-2 hours of antacids c. assess the patient for a history of renal disease before giving Maalox
Which strategies does the nurse expect to implement in the management of dumping sydnrome? (select all that apply) a. provide more frequent smaller meals b. provide a high-carbohydrate diet c. eliminate liquids ingested with meals d. increase protein and fat in the diet e. Administer acarbose to decrease carbohydrate absorption
a. provide more frequent smaller meals c. eliminate liquids ingested with meals d. increase protein and fat in the diet e. Administer acarbose to decrease carbohydrate absorption
midline of abdomen contains
abdominal aorta, uterus is enlarged, bladder if distended
A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How should the nurse respond? a. "You need to start with multiple injections until you become more proficient at self-injection." b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." c. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." d. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."
b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns."
A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? a. "Wash your hands after completing each test." b. "Do not share your monitoring equipment." c. "Blot excess blood from the strip with a cotton ball." d. "Use gloves when monitoring your blood glucose."
b. "Do not share your monitoring equipment."
A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching? a. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." b. "Monitor your blood glucose levels at least every 4 hours while sick." c. "If vomiting, do not use insulin or take your oral antidiabetic agent." d. "Try to continue your prescribed exercise regimen even if you are sick."
b. "Monitor your blood glucose levels at least every 4 hours while sick."
A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL • Postprandial blood glucose: 200 mg/dL • Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance
b. Good control of blood glucose
The nurse has provided instruction for a patient prescribed sucralfate (Carafate) to treat a gastric ulcer. Which statement by the patient indicates that teaching has been effective? a. this drug will stop the secretion of acid in my stomach b. I will take this drug on an empty stomach c. I will not be able to take ranitidine (Zantac) with this drug d. The main side effect of this drug that I can expect is diarrhea
b. I will take this drug on an empty stomach
A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories
b. Proteins
A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a. Assess for pain or burning with urination. b. Review the client's liver function study results. c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood.
b. Review the client's liver function study results.
Esophageal Trauma
blunt injuries, chemical burns, surgery or endoscopy (rare), or the stress of continuous severe vomiting
After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I should increase my intake of vegetables with higher amounts of dietary fiber." b. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." d. "My intake of water is not restricted by my treatment plan or medication regimen."
c. "I should decrease my intake of protein and eliminate carbohydrates from my diet."
Which drug would the health care provider prescribe to treat H. pylori infection? a. Ranitidine (Zantac) b. Omperazole (Prilosec) c. Clarithromycin (Biaxin) d. Pantoprazole (Protonix)
c. Clarithromycin (Biaxin)
A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take? a. Encourage the client to use an incentive spirometer. b. Increase the client's intravenous fluid flow rate. c. Consult the provider to test for ketoacidosis. d. Perform meticulous pulmonary hygiene care.
c. Consult the provider to test for ketoacidosis.
right lower quadrant contains
cecum, appendix, right utreter, right ovary and fallopian tube, right spermatic cord
The nurse notes that the skin around the client's skeletal traction pin site is swollen, red, and crusty, with dried drainage. Which is the nurse's priority intervention?
culture the drainage
A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education? a. "Test your urine daily for ketones." b. "Use only buffered insulin in your pump." c. "Store the insulin in the freezer until you need it." d. "Change the needle every 3 days."
d. "Change the needle every 3 days."
After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. "At my age, I should continue seeing the ophthalmologist as I usually do." b. "I will see the eye doctor when I have a vision problem and yearly after age 40." c. "My vision will change quickly. I should see the ophthalmologist twice a year." d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."
d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."
The patient with DM had a pancreas transplant and takes daily doses of cyclosporine (Neoral). For which key lab assessment does the nurse monitor?
serum creatinine
The nurse is caring for a client with an external fixator in place on the leg. What does the nurse assess for first?
signs of infection
After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I have so many complications; exercising is not recommended." b. "I will exercise more frequently because I have so many complications." c. "I used to run for exercise; I will start training for a marathon." d. "I should look into swimming or water aerobics to get my exercise."
d. "I should look into swimming or water aerobics to get my exercise."
After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? a. "I'll take this medicine during each of my meals." b. "I must take this medicine in the morning when I wake." c. "I will take this medicine before I go to bed." d. "I will take this medicine immediately before I eat."
d. "I will take this medicine immediately before I eat."
A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs? a. "Limit your fluid intake to 2 liters a day." b. "Animal organ meat is high in insulin." c. "Limit your carbohydrate intake to 80 grams a day." d. "Walk at a moderate pace for 1 mile daily."
d. "Walk at a moderate pace for 1 mile daily."
A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 29-year-old Caucasian b. A 32-year-old African-American c. A 44-year-old Asian d. A 48-year-old American Indian
d. A 48-year-old American Indian
A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of oxygen via face mask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin
d. Administration of intravenous insulin
Which statement about the use of antacids (neutralize gastric acids) in the treatment of gastric ulcers is true? a. Antacids should be administered with these meals b. Patients should take calcium carbonate (Tums) if they still have pain after taking their usual antacid c. The patient should take antacid on an empty stomach d. Avoid using antacids with phyentoin (Dilantin)
d. Avoid using antacids with phyentoin (Dilantin)
muscular dystrophy
slow or rapid progression of muscle weakness or loss. confirmed with muscle biopsy. cause of death usually respiratory failure. Decreased life span. Keep patient comfortable as possible.
Dupuytren's contracture
slow, progressive thickening of palmar fascia, results in flexion contracture of 4th and 5th fingers. Partial or selective fasciectomy is used to repair. Post op splint.
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? a. Apply ice to the site to reduce inflammation. b. Consult the provider for a new administration route. c. Assess the client for other signs of cellulitis. d. Instruct the client to rotate sites for insulin injection.
d. Instruct the client to rotate sites for insulin injection.
A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum chloride level of 98 mmol/L b. Serum calcium level of 8.8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L
d. Serum potassium level of 2.5 mmol/L
interventions of scoliosis treatment
surgery if greater than 50 degrees. Assess respiratory status and encourage deep breathing. patient has chest tube for 72 hrs. NG for 24. Keep body in align, use log roll. Patient can work in 3-6 wks.
Bruits
swishing sound over the abdominal aorta usually indicates the presence of an aneurysm do not palpate or percuss notify doctor
diarthrodial (synovial) joint
freely movable (elbow or knee)
Hallux valgus with bunion
great toe drifts laterally at the first metatarsophalangeal joint. occurs due to poor footwear. May need custom made shoes.
In Osteoporosis Fractures are also common where else in the body?
in the distal end of the radius (wrist) and the upper third of the femur (hip). Observe for signs and symptoms of fractures, such as swelling and malalignment.
Osteomyelitis is categorized as contiguous
in which bone infection results from skin infection of adjacent tissues. -Poor dental hygiene and periodontal (gum) infection can be causative factors in contiguous osteomyelitis in facial bones. Minimal nonpenetrating trauma can cause hemorrhages or small-vessel occlusions, leading to bone necrosis. Many infections are caused by Staphylococcus aureus.
borborygmus
increase bowel sounds especially loud gurgling sounds Result from increase motility of bowel usually heard with patients with diarrhea or gastroenteritis or complete intestinal obstruction
A client has an arm cast and reports that it feels really tight and the fingers are puffy. What is the nurse's best response?
"Please come to the clinic today to have your arm checked by the health care provider."
The nurse is caring for an older adult client who had leg amputation surgery the previous day. During the admission assessment, the client tells the nurse, "I don't want to live with only one leg, so I should have died during the surgery." Which is the nurse's best response?
"Remember that you are still the same person inside, with a missing body part."
A patient asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's best response?
"Rotation within one site is preferred to avoid changes in insulin absorption."
What can we teach patients to prevent osteoporosis?
- Build strong bones as a young person. - pt. who don't eat dairy to eat dark green leafy veggies. - read food labels for Calcium content - Explain important of sun exposure & adequate vit. D in diet. - vit.D3 supplaments - Limit carbonated beverages - exercise build bone tissue especially weight bearing exercises (walking). - high risk avoid activities that cause jarring (horse back riding and jogging) to prevent vertebral compression.
alendronate (Fosamax)
- Prevents bone loss and increasing bone density. teach: take on empty stomach, first thing in the moring with a full galss of water. - Take 30min before food, drink, or other drugs. - remain upright, sitting or standing for 30- 60min after admin and before eating. - Take liquid (75mL) & follow w/2oz of water. - IF CHEST DISCOMFORT OCCURS, DIFFICULTLY SWALLOWING, ESOPHAGITIS, ESOPHAGEAL ULCER AND GASTRIC ULCER CAN RESULT FROM THERAPY. DISCONTINUE DRUG AND REPORT TO HCP.
Assessment finding for Ostemalacia
- any history of chronic diseases of the GI tract including inflammatory bowel disease, gastric or intestinal bypass surgery. - history of renal or liver dysfunction may lead to insufficient vit. D metabolism. - drugs such as phenytoin (Dilantin) or Fluouride preparation may interfere with metabolism of Vit. D. -may occur at same time as osteoporosis. - early stages: muscle weakness and bone pain maybe mistaken for arthritis. proximal muscle weakness in shoulder and pelvic girdle area. - muscle weakness in lower extremities may cause waddling and unsteady gait. -if hypocal present, muscle cramps. - spine, ribs, pelvis, & lower extremities. - long bone bowing or spinal deformity similar to osteoporosis. - extreme case narrowing of pelvis makes childbirth difficult. - The classic diagnostic finding specific to the disease, however, is the presence of radiolucent bands (Looser's lines or zones). Looser's zones represent stress fractures that have not mineralized. They often appear symmetrically in the medial area of the femoral neck, ribs, and pelvis and may progress to complete fractures with minimal trauma. Bone biopsy of these areas may be needed for complete diagnosis. DXA scan may assist
Other intervention: Paget's disease
- application of heat and gentle massage. - Non impact exercise. - strenghthing and weight bearing. - ROM and gentle stretching . - relaxation tech. for pain - diet rich in calcium and Vit. D
Medicare reimbursed for BMD testing every 2yrs in people ages 65yrs and older who:
- are estrogen deficient - have vertebral abnormalities - receive longer-term steroid therapy.
Calcium & activated Vit. D (D3): Osteoporosis
- calcium carbonate (Os-Cal) is one of the most cost effective supplements formulas. - calcium citrate OTC as Citracal recommended for pt. with GI upset when taking calcium supplement. - Take supplements with food and 6 to 8oz of water. - divide daily dose with at least 1/3 of dose taken in the evening. - Take calcium supplements that also contain a small amount of activated Vit. D ex. ( Os-cal Ultra). - Vitamin D3 supplementation - Drink plenty of fluid to prevent caculi & regular labs for Ca and Vit. D.
Physical Assessment/Clinical Manifestations: Osteoporosis
- classic "dowager's hump," or kyphosis of the dorsal spine - pt. gotten shorter 2 to 3in. - back pain after lifting, bending or stooping. - pain worse w/activity relieved by rest. -pain may be sharp acute onset. - lower thoracic and lumbar vertebra discomfort w/palpation.
Monoclonal Antibodies: Osteoporosis
- denosumab (Prolia, Xgeva), a monoclonal antibody that has been approved for treatment of osteoporosis when other drugs are not effective. -drug binds to a protein that is essential for the formation, function, and survival of osteoclasts and is given subcutaneously twice a year. -By preventing the protein from activating its receptor, the drug decreases bone loss and increases bone mass and strength. -The most common SE is back pain, high cholesterol, urinary tract infection, and muscle pain. - can cause a decrease in serum calcium levels. -pt. who already have a low cal level shouldn't take med. . -can cause fractures, especially of the femur, and jaw osteonecrosis.
Lifestyle changes: Osteoporosis
- exercise to prevent and manage osteoporosis. - Pt. at risk for vertebra fractures, strengthening exercise of abd. and back muscles. -encourage active (ROM) exercises. - swimming provides overall muscle exercise. - General weight-bearing exercise. - walk for 30min 3 to 5 times a week. - avoid tobacco. - limit alcohol intake
Surgical Management: osteomyelitis
- for patients with chronic osteomyelitis. A sequestrectomy may be performed to débride the necrotic bone and allow revascularization of tissue. The excision of dead and infected bone often results in a sizable cavity, or bone defect. Bone grafts to repair bone defects are also widely used. If bone is extensively resected, reconstruction with microvascular bone transfers may be done. This procedure is reserved for larger skeletal defects. The most common donor sites are the patient's fibula and iliac crest. The bone graft may have an attached muscle or skin flap. Important difference is that neurovascular (NV) assessments must be done frequently because the patient experiences increased swelling after the surgical procedure. Elevate the affected extremity to increase venous return and thus control swelling. Assess and document the patient's NV status. Bony defect is small, a muscle flap may be the only surgery required. Local muscle flaps are used in the treatment of chronic osteomyelitis when soft tissue does not fill the dead space, or cavity, that results from bone débridement. The flap provides wound coverage and enhances blood flow to promote healing. A split-thickness skin graft is often applied several days after the muscle flap. As a last resort, the affected limb may need to be amputated.
Diagnostic assessment: Paget's Disease of the bone
- in serum alkaline phosphatase (ALP) and urinary hydroxyproline levels are the primary laboratory findings indicating possible Paget's. -The ALP isoenzyme testing can further break ALP into three fractions—liver, bone, and intestinal. Elevated bone isoenzymes can help in a more definitive diagnosis. -The 24-hour urinary hydroxyproline level reflects bone collagen turnover and indicates the degree of disease severity. Higher the hydroxyproline, the more severe. - cal levels in blood &urine may be low, normal, or elevated. The immobilized patient is more likely to have an increase in calcium levels. -elevated uric acid because nucleic acid from overactive bone metabolism. X-rays Reveal characteristic changes including the presence of osteolytic lesions and enlarged bones with radiolucent, or punched-out, appearance. Decrease in joint space may be seen with arthritic changes. Malalignment deformities, fractures, and secondary arthritic changes may be present. -Radionuclide bone scan may be most sensitive in detecting Paget's disease. A radiolabeled bisphosphonate is injected IV and shows pagetic bone in areas of high bone turnover activity. This test can determine the extent of Paget's disease in the skeleton. CT and MRI are useful in the detection of cancerous tumors, changes in the skull, and spinal cord or nerve compression
Osteomalacia
- loss of bone related to a vitamin D deficiency. It causes softening of the bone resulting from inadequate deposits of calcium and phosphorus in the bone matrix. -adult equivalent of rickets, or vitamin D deficiency, in children. Primary disease related to lack of sunlight exposure or dietary intake, vitamin D deficiency caused by various health problems may result in osteomalacia. -Malabsorption of vitamin D from the small bowel is a common complication of partial or total gastrectomy and bypass or resection surgery. - Disease of the small bowel may cause decreased vitamin and mineral absorption. -Liver and pancreatic disorders disrupt vitamin D metabolism and decrease its production. Chronic kidney disease (CKD) interferes with the synthesis of calcitriol, the most active vitamin metabolite. -can also be caused by bone tumors. Phosphate depletion (hypophosphatemia) lead to osteomalacia because they stimulate movement from bone and prevent calcium uptake in the bone. -also an adverse effect of long-term therapy with certain drugs such as antiepileptic drugs (AEDs) and barbiturates.
Drug therapy: Paget's disease
- mild to moderate pain ( NSAIDS, asprin, Ibuprofen). - bisphosphonate if wide spread and cal is twice than normal range. - Oral bisphosphonates are a first-line treatment choice for Paget's disease when alkaline phosphatase levels are at least twice the normal serum level. Alendronate (Fosamax), risedronate (Actonel), etidronate (Didronel), or tiludronate (Skelid) is given. if oral not effective pamidronate (Aredia) or zoledronic acid (reclast) is admin. IV. - 1500mg of cal daily in divided dose. - 800 international unit of Vit. D3 at least 2wks after zoledronic acid infusion. - densoumab (prolia) subq. 2x/yr. -Calcitonin subq.
Estrogen Agonist/Antagonists: Osteoporosis
- mimic estrogen in some parts of the body while blocking its effects elsewhere. -Raloxifene (Evista) the only approved drug in its classs. - Used to prevent and treat osteoporosis in postmenopausal women. - Increases BMD, reduces bone resorption, reduces incidence of osteoporotic vertebral fractures. - don't give to women with history of thromboembolism.
who is at risk for osteomalacia ?
- ppl with inadequate exposure to sunlight, not enough intake of vit. D fortified foods. - older adults - pt. on vegan diets - poor nutritional intake (homeless) - drug and or alcohol abuse.
Gastroesophageal Reflux Disease (GERD): Drug Therapy
-*Antacids* (for occasional episodes): elevating the pH level of the gastric contents= deactivating pepsin -*Histamine receptor antagonists* famotidine (Pepcid), ranitidine (Zantac): reduce acid secretion, improve symptoms, and promote healing of inflamed esophageal tissue. Available OTC -*PPI's* omeprazole (Prilosec), rabeprazole (AcipHex), pantoprazole (Protonix), and esomeprazole (Nexium),: reduce gastric acid secretion (long-acting inhibition for severe cases)
Hiatal hernias: Nonsurgical Interventions
-*Medications*: Antacids and a proton-pump inhibitor such as lansoprazole (Prevacid), omeprazole (Prilosec), or esomeprazole (Nexium)--controls reflux and its symptoms -*Nutrition and lifestyle*: similar to GERD
Gastroesophageal Reflux Disease (GERD): Noninvasive diagnostic procedures
-Barium swallow -Upper endoscopy -pH exam, Ambulatory,24-48 hrs (most accurate) *Definitive diagnostic test does not exist*
Hiatal hernias: Diagnostic Tests
-Barium swallow study with fluoroscopy (easily see rolling) -Esophagogastroduodenoscopy (EGD (sliding)
Esophageal Tumors: Pathophysiology
-Can be benign, most are malignant (cancerous) -Majority arise from the epithelium. -Squamous cell carcinomas located in the upper two thirds of the esophagus -Adenocarcinomas (glands) are more commonly found in the distal third and the gastroesophageal junction (most common type of esophageal cancer) -Grow rapidly because there is no serosal layer to limit their extension. -Mucosa is richly supplied with lymph tissue, there is early spread of tumors to lymph nodes. -More than half metastasize
Osteomyelitis
-Infection in bone, known as osteomyelitis. Inflammation produces an increased vascular leak and edema. Once inflammation is established, the vessels in the area become thrombosed and release exudate (pus) into bony tissue. Ischemia of bone tissue follows and results in necrotic bone. This area of necrotic bone separates from surrounding bone tissue, and sequestrum is formed. The presence of sequestrum prevents bone healing and causes superimposed infection, often in the form of bone abscess. The cycle repeats itself. - categorized as exogenous, endogenous (hemtogenous) and contiguous. - two major types Acute and Chronic.
Hiatal hernias: Laparoscopic Nissen fundoplication (LNF)
-Minimally invasive surgery commonly used -Cut noncompliant sphincter (myotome) -Complications occur less frequently compared with the more traditional open surgical approach -Usually 4 small incisions
Fasting Blood Glucose Test
-No food for at least 8 hours -Normal: <100mg/dL -Abnormal: >126mg/dL on at least two occasion
Glycolated Hemoglobin (A1C) Test
-No preparation, shows glucose control over the last 3 months -Normal: 4%-6% -Abnormal: 6.5% and 8% indicate poor DM control
Hiatial Hernia Surgery: Community-Based Care
-Open surgery: require activity restrictions during the 3- to 6-week postoperative recovery period -Laparoscopic surgery: normal activity in 3-7 days -Stool softeners or bulk laxatives for first postoperative weeks -Avoid straining and prevent constipation. -Inspect the healing incision daily and to notify HCP if swelling, redness, tenderness, discharge, or fever occurs. -Avoid contact with people with a respiratory INFECTION, contact the HCP if symptoms develop. -Coughing can cause the incision or the fundoplication to dehisce ("break open"). -Avoid smoking
key fetures of Acute Osteomyelitis
-Penetrating trauma leads to acute osteomyelitis by direct inoculation • Fever; temperature usually above 101° F (38.3° C) • Swelling around the affected area • Erythema of the affected area • Tenderness of the affected area • Bone pain that is constant, localized, and pulsating; intensifies with movement
Planning: Expected Outcomes
-Performs treatment regimen as prescribed -Follows recommended diet -Monitor blood glucose using correct testing procedure -Meets recommended activity levels -Uses drugs as prescribed -Maintains optimum weight -Problem solves about barrier to management -Foot care
Esophageal Tumors: Risk Factors
-Primary: Smoking and Obesity -malnutrition, untreated GERD ( Barrett's esophagus) , and excessive alcohol intake -Squamous cell carcinoma linked to high levels of nitrosamines (which are found in pickled and fermented foods) and nitrate. as well as chronic deficiency of fresh fruits and vegetables
Nonsurgical management of Osteomyelitis
-Provider starts antimicrobial (e.g., antibiotic) therapy ASAP. -Presence of copious wound drainage, Contact Precautions are used. -Teach family or caregivers in the home setting how to admin. antimicrobials if they are continued after hospital discharge. -Prolonged therapy for more than 3 months may be needed for chronic osteomyelitis. - After discontinuation of IV drugs, oral therapy may be needed for weeks or months. - teach pt. and family to finish treatment even if signs of improvement are present. -The wound may be irrigated, either continuously or intermittently, with one or more antibiotic solutions. A medical technique in which beads made of bone cement are impregnated with an antibiotic and packed into the wound can provide direct contact of the antibiotic with the offending organism. -pain meds. - treatment to increase perfusion hyperbaric oxygen (HBO) therapy.
Hiatal hernias: Operative Procedures
-Reinforcement of the lower esophageal sphincter (LES) by fundoplication -Wrapping a portion of the stomach fundus around the distal esophagus to anchor it and reinforce the LES
Hyperglycemic Hyperosmolar State
-Severe relative insulin deficiency, resulting in: -Profound hyperglycemia -Hyperosmolality (from urinary free water losses) -No significant ketone production or acidosis -Cause: Poor fluid intake -Glucose: >600mg/dL -Negative for Ketones -Develops over days to weeks -Typically presents in Type 2 diabetes or previously unrecognized diabetes
Hiatal hernias: trans-thoracic surgical approach
-Teach the patient about chest tubes -Complications are more common and potentially serious. -Primary focus of care after is the prevention of respiratory complications. -support the incision during coughing
Glucose Tolerance Test
-Used for Gestational DM -75g anhydrous glucose dissolved in water -Normal: <140mg/dL -Abnormal: >200mg/d
After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best? a. "Bacteria can often cause ulcers." b. "This operation often causes ulcers." c. "The medication keeps your blood pH low." d. "It prevents stress-related ulcers."
ANS: D After surgery, anti-ulcer medications such as pantoprazole are often given to prevent stress-related ulcers. The other responses are incorrect.
What statement about type A gastritis is most accurate? It has an autosomal recessive pattern of inheritance. It is associated with pernicious anemia. It is most often caused by H. pylori infection. It can occur due to exposure to benzene or lead.
A genetic link to type A gastritis has been found in the relatives of those who have pernicious anemia. The gene has an autosomal dominant pattern of inheritance. Type B gastritis is most often caused by H. pylori infection. Atrophic gastritis may occur due to exposure to toxins such as benzene or lead.
An older female client is diagnosed with gastric cancer. Which statement made by the client's family demonstrates a correct understanding of the disorder? A. "This may be related to her recurring ulcer disease." B. "This is probably curable with surgery." C. "Gastric cancer has a strong genetic component." D. "Thank goodness she won't have to undergo surgery."
A Infection with Helicobacter pylori is the largest risk factor for gastric cancer because it carries the cytotoxin-associated antigen A (CagA) gene. Clients with chronic ulcers are probably infected with this organism. Surgery is not curative; most gastric cancers do not present with symptoms until late in the disease and have a high fatality rate. There is no strong genetic predisposition to gastric cancer. Surgery is part of the treatment.
A client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your provider told you about participating in hospice?" C. "I can speak to your provider about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."
A Telling the client that pain control is a major component of hospice care correctly describes the services provided by hospice and its staff members, and reassures the client about their expertise in pain management. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's concerns. The nurse does not need to speak to the provider because pain control is an integral part of hospice services. It is inappropriate to tell a terminally ill client in need of pain control that he or she may become too dependent on pain medication.
smooth muscle
A non-striated, involuntary muscle responsible for contractions of organs and blood vessels and is controlled by the ANS
The nurse is teaching a patient about health promotion and maintence to prevent gastritis. Which information does the nurse include? (select all that apply) A. A balanced diet can help prevent gastritis B. To prevent gastritis, you should limit your intake of salt C. If you stop smoking, there is less of a chance that you will develop gastritis D. Yoga has been found to be effective in preventing gastritis E. Although regular exericise is good for you it has not been found to have an effect on the prevention of gastritis
A. A balanced diet can help prevent gastritis C. If you stop smoking, there is less of a chance that you will develop gastritis D. Yoga has been found to be effective in preventing gastritis
Question #2 The healthcare provider is teaching a group of students about the characteristics of type 1 diabetes mellitus. Which of the following describe the underlying cause of the disease?
A. Atrophy of pancreatic alpha cells *B. Destruction of pancreatic beta cells* C. Cellular resistance to insulin D. Increased hepatic glycogenesis
Which type of gastric ulcer does the nurse expect may occur when caring for a patient with extensive burns? A. Curlings ulcer B. Cushing's ulcer C. Stress ulcer D. Ischemic ulcer
A. Curlings ulcer
Which diagnostic test is the gold standard for diagnosing gastritis? A. Esophagogastrodudenscopy (EGD) B. Computed tomography (CT) scan C. Upper gastrointestinal (GI) series D. Cholangiogram
A. Esophagogastrodudenscopy (EGD)
The nurse has placed a nasogastric (NG) tube in a client with upper gastrointestinal (GI) bleeding to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? A. "Saline goes down the tube to help clean out your stomach." B. "Medication goes down the tube to help clean out your stomach." C. "The provider requested the tube to be placed just in case it was needed." D. "We'll start feeding you through it once your stomach is cleaned out."
A. Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots.
Which of the following chronic complications is associated with diabetes?
A. Leg ulcers, cerebral ischemic events, and pulmonary infarcts *B. Retinopathy, neuropathy, and coronary artery disease * C. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia's D. Dizziness, dyspnea on exertion, and coronary artery disease
A diabetic older adult client who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the health care provider will request which medication? A. Levofloxacin (Levaquin) B. Enoxaparin (Lovenox) C. Oxycodone (Roxicodone) D. Prednisone (Deltasone)
A. Levofloxacin (Levaquin)
When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor will be the priority for client teaching? A. Low calcium intake B. Postmenopausal status C. Positive family history D. Previous use of steroids
A. Low calcium intake
A patient with chronic gastritis is being admitted. Which sign/ symptom does the nurse identify as being associated with this patient's condition? A. Pernicious anemia B. Gastric hemorrhage C. Hematemesis D. Dyspepsia
A. Pernicious anemia
Which are possible complications of chronic gastritis? (select all that apply) A. Pernicious anemia B. thickening of the stomach lining C. Gastric cancer D. Decreased gastric acid secretion E. Peptic ulcer disease
A. Pernicious anemia C. Gastric cancer D. ac secretion E. Peptic ulcer disease
A client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider B. Asking the provider for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes
A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority?
A. Send blood to the laboratory for blood analysis B. Administer oxygen per nasal cannula *C. Administer 50% dextrose IV per protocol *' D. Administer the prescribed insulin
Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on? A. The need for ambulatory devices B. Medication that the client is currently taking C. Nutritional intake of the client before admission D. Current list of the client's medical conditions
A. The need for ambulatory devices
The nurse working during the day shift on the medical unit has just received report. Which client does the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy
A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best? a. "Your feet have less blood flow, so healing is slower." b. "The bones in your feet are hard to operate on." c. "The surrounding bones and tissue are damaged." d. "Your feet bear weight so they never really heal."
ANS: A The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging the healing time after surgery. The other explanations are not correct.
A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications. 1. Inspect bottles for expiration dates. 2. Gently roll the bottle of NPH between the hands. 3. Wash your hands. 4. Inject air into the regular insulin. 5. Withdraw the NPH insulin. 6. Withdraw the regular insulin. 7. Inject air into the NPH bottle. 8. Clean rubber stoppers with an alcohol swab.
ANS: 3, 1, 2, 8, 7, 4, 6, 5 After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first.
A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? a. "After the operation I can eat anything I want." b. "I will have to eat smaller, more frequent meals." c. "I will take stool softeners for several weeks." d. "This surgery may not totally control my symptoms."
ANS: A Nutritional and lifestyle changes need to continue after surgery as the procedure does not offer a lifetime cure. The other statements show good understanding.
A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the client's neck. What action by the nurse takes priority? a. Assess the client's oxygenation. b. Facilitate a STAT chest x-ray. c. Prepare for immediate surgery. d. Start two large-bore IVs.
ANS: A The priorities of care are airway, breathing, and circulation. The priority option is to assess oxygenation. This occurs before diagnostic or therapeutic procedures. The client needs two large-bore IVs as a trauma client, but oxygenation comes first.
To promote comfort after a colonoscopy, in what position does the nurse place the client? a. Left lateral b. Prone c. Right lateral d. Supine
ANS: A After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.
A client had a total knee replacement this morning and has a continuous passive motion (CPM) machine. What activity related to the CPM does the RN delegate to the unlicensed assistive personnel? a. Placing controls out of the reach of confused clients b. Assessing the client's response to the CPM c. Teaching the client's family the rationale for the CPM d. Assessing neurovascular status of the leg in the CPM
ANS: A All activities are appropriate for the client with a CPM, but the nurse can delegate only the task of keeping controls out of reach of the confused client. All other activities would need to be performed by the RN.
The nurse is working with a client who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the client. What finding by the nurse indicates goals for this client problem are being met? a. Attends meetings of a book club b. Has a positive outlook on life c. Takes medication as directed d. Uses assistive devices to protect joints
ANS: A All of the activities are appropriate for a client with RA. Clients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this client problem are being met. DIF: Evaluating/Synthesis REF: 312 KEY: Rheumatoid arthritis| autoimmune disorder| coping| psychosocial response MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Psychosocial Integrity
A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching? a. Acetaminophen (Tylenol) b. Cyclobenzaprine hydrochloride (Flexeril) c. Hyaluronate (Hyalgan) d. Ibuprofen (Motrin)
ANS: A All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hyaluronate is a synthetic joint fluid implant. Ibuprofen is a nonsteroidal anti-inflammatory drug. DIF: Remembering/Knowledge REF: 293 KEY: Osteoarthritis| acetaminophen| pharmacologic pain management| patient teaching MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A client is distressed at body changes related to kyphosis. What response by the nurse is best? a. Ask the client to explain more about these feelings. b. Explain that these changes are irreversible. c. Offer to help select clothes to hide the deformity. d. Tell the client safety is more important than looks.
ANS: A Assessment is the first step of the nursing process, and the nurse should begin by getting as much information about the client's feelings as possible. Explaining that the changes are irreversible discounts the client's feelings. Depending on the extent of the deformity, clothing will not hide it. While safety is more objectively important than looks, the client is worried about looks and the nurse needs to address this issue.
A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best? a. Consult with the provider about an x-ray. b. Encourage the client to use ibuprofen (Motrin). c. Have the client perform hip range of motion. d. Place the client in a rigid cervical collar.
ANS: A Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of osteoporotic fracture. The nurse should consult the provider about an x-ray. Motrin may be indicated but not until there is a diagnosis. Range of motion of the hips is not related, although limited spinal range of motion may be found with a vertebral compression fracture. Since the defect is in the thoracic spine, a cervical collar is not needed.
A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best? a. Assess medication records for steroid use. b. Facilitate a consultation with physical therapy. c. Measure the range of motion in both hips. d. Notify the health care provider immediately.
ANS: A Chronic steroid use is seen in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted. DIF: Applying/Application REF: 315 KEY: Systemic lupus erythematosus| autoimmune disorders| nursing assessment| pain| steroids MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is caring for a client who has dysphagia caused by systemic sclerosis. What is the best intervention for the nurse to implement for this client? a. Encourage frequent, high-protein, easy to swallow foods. b. Teach the client to lie flat after meals to prevent reflux. c. Thicken liquids to a nectar or honey consistency. d. Have the client hyperextend his or her neck while swallowing.
ANS: A Clients with dysphagia frequently have esophageal motility problems, and swallowing becomes difficult. This, combined with malabsorption, leads to a malnourished client. Frequent small meals consisting of high-protein and easy to swallow foods are best. Clients should eat only in an upright position to reduce choking. Thickening liquids may help, but this does not address the malnutrition. Hyperextending the neck may help, but specific techniques should be determined by a swallowing study.
A client with rheumatoid arthritis had abdominal surgery and has returned to the postoperative nursing unit. The client is unable to use the incentive spirometer correctly, demonstrating limited lung volume and fatiguing easily. What action by the nurse takes priority? a. Notify the physician immediately. b. Have respiratory therapy re-instruct the client. c. Assess for pain and medicate if necessary. d. Let the client rest for a few hours.
ANS: A Clients with rheumatoid arthritis can have cervical spine involvement resulting in subluxation. This may lead to decreased respiratory function and can be life threatening. This client was recently intubated for an operation and so is at higher risk for this problem. The nurse should notify the physician immediately and continue assessing the client.
An older client has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best? a. "Changes in your liver cause drugs to be metabolized differently." b. "Perhaps you don't need as high a dose of the drug as before." c. "Stomach muscles atrophy with age and you digest more slowly." d. "Your body probably can't tolerate as much medication anymore."
ANS: A Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels. The other options do not accurately explain this age-related change.
A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints. After a knee replacement, the health care provider has prescribed morphine sulfate for postoperative pain relief. The client also requests the celecoxib in addition to the morphine. What action by the nurse is best? a. Consult with the health care provider about administering both drugs to the client. b. Inform the client that the celecoxib will be started when he or she goes home. c. Teach the client that, since morphine is stronger, celecoxib is not needed. d. Tell the client he or she should not take both drugs at the same time.
ANS: A Despite getting an opioid analgesic for postoperative pain, the nurse should be aware that the client may be on other medications for arthritis in other joints. The nonsteroidal anti-inflammatory drug celecoxib will also help with the postoperative pain. The nurse should consult the provider about continuing the celecoxib while the client is in the hospital. The other responses are not warranted, as the client should be restarted on this medication postoperatively. DIF: Applying/Application REF: 293 KEY: Postoperative nursing| nonsteroidal anti-inflammatory drugs (NSAIDs)| musculoskeletal disorders MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
large intestine changes related to aging
peristalsis decreases and nerve impulses are dulled leading to constipation and impaction encourage high fiber diet and 1500 ml of fluid intake daily and as much activity as tolerated
An older adult client is scheduled for knee replacement surgery. Which statement by the client indicates a need for further preoperative instruction? a. "I need to keep my leg positioned away from my body." b. "I may have a continuous passive motion machine for a few days." c. "I may need more pain medicine than I did with my hip replacement." d. "I probably can get back to work within 2 to 3 weeks."
ANS: A Dislocation is not a problem with knee replacement surgery, so the client does not need to keep his or her leg abducted. The other statements indicate accurate understanding of the instructions.
A client with a history of rheumatoid arthritis will be starting drug therapy with etanercept (Enbrel). What is most important for the nurse to teach the client? a. The correct technique for subcutaneous injections b. How to self-monitor blood glucose levels c. How to set up and prime the IV tubing d. How to calculate the dosage based on symptoms
ANS: A Enbrel is a parenteral medication that is given by subcutaneous injection. The client and/or the family will need to be taught how to give a subcutaneous injection correctly. Blood glucose levels should not be affected by this medication. The medication is not administered IV. Drug dosages are not changed and recalculated by the client.
A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate? a. Giving subcutaneous injections b. Having a chest x-ray once a year c. Taking the medication with food d. Using heat on the injection site
ANS: A Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept. DIF: Understanding/Comprehension REF: 310 KEY: Rheumatoid arthritis| autoimmune disease| biologic response modifiers| client education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance
A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best? a. Ask the client about fear of falling. b. Instruct the client to increase calcium. c. Suggest other exercises the client can do. d. Tell the client to try weight lifting.
ANS: A Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.
What information does the nurse teach a women's group about osteoporosis? a. "For 5 years after menopause you lose 2% of bone mass yearly." b. "Men actually have higher rates of the disease but are underdiagnosed." c. "There is no way to prevent or slow osteoporosis after menopause." d. "Women and men have an equal chance of getting osteoporosis."
ANS: A For the first 5 years after menopause, women lose about 2% of their bone mass each year. Men have a slower loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after menopause.
The client's chart indicates genu varum. What does the nurse understand this to mean? a. Bow-legged b. Fluid accumulation c. Knock-kneed d. Spinal curvature
ANS: A Genu varum is a bow-legged deformity. A fluid accumulation is an effusion. Genu valgum is knock-kneed. A spinal curvature could be kyphosis or lordosis.
A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the client practices good self-care when the client makes which statement? a. "I always wear long sleeves, pants, and a hat when outdoors." b. "I try not to use cosmetics that contain any type of sunblock." c. "Since I tend to sweat a lot, I use a lot of baby powder." d. "Since I can't be exposed to the sun, I have been using a tanning bed."
ANS: A Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, avoiding drying agents such as powder, and avoiding tanning beds. DIF: Evaluating/Synthesis REF: 316 KEY: Systemic lupus erythematosus| nursing evaluation| self-care| patient teaching| integumentary system MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance
A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked to assess the client for Heberden's nodules. What assessment technique is correct? a. Inspect the client's distal finger joints. b. Palpate the client's abdomen for tenderness. c. Palpate the client's upper body lymph nodes. d. Perform range of motion on the client's wrists.
ANS: A Herberden's nodules are seen in osteoarthritis and are bony nodules at the distal interphalangeal joints. To assess for this finding, the nurse inspects the client's distal fingertips. These nodules are not found in the abdomen, lymph nodes, or wrists. DIF: Applying/Application REF: 292 KEY: Musculoskeletal system| musculoskeletal assessment| nursing assessment| osteoarthritis MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Health Promotion and Maintenance
The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate? a. "Drink 1 to 2 liters of water each day." b. "Have 10 to 12 ounces of juice a day." c. "Liver is a good source of iron." d. "Never eat hard cheeses or sardines."
ANS: A Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring. Citrus juice is high in ash, which can help prevent the formation of stones, but the value of this recommendation is not clear. Clients with gout should not eat organ meats or fish with bones, such as sardines. DIF: Understanding/Comprehension REF: 320 KEY: Gout| musculoskeletal system| patient education| nutrition MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further? a. Creatinine: 3.9 mg/dL b. Platelet count: 210,000/mm3 c. Red blood cell count: 5.2/mm3 d. White blood cell count: 4400/mm3
ANS: A Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal. DIF: Applying/Application REF: 314 KEY: Systemic lupus erythematosus| autoimmune disease| renal system MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
Morton's Neuroma
plantar digital neuritis, small tumor grows in a digital nerve of the foot. Pain causes acute burning sensation. Surgical removal of neuroma.
The nurse is caring for a client who has had hip replacement surgery 2 days before. The client reports severe pain at the surgical site despite having received 2 Vicodin (acetaminophen and hydrocodone) tablets 2 hours previously. The client is requesting IV pain medication. What is the nurse's primary intervention? a. Assess the surgical site for signs of infection. b. Administer 2 more Vicodin tablets. c. Apply a large ice bag to the operative site. d. Reassure the client that the Vicodin will work soon.
ANS: A Most clients do not need IV pain medication after the first day. If the client seems to be having unusual pain, the nurse should first assess the client for other problems, such as a joint infection. If findings are normal, applying ice to the hip will help to reduce swelling and pain. It is not time for another dose of Vicodin, because it has only been 2 hours. The nurse would not contact the surgeon unless all pain methods tried did not work. The Vicodin should have worked within 2 hours, so the nurse should not tell the client that the Vicodin will work shortly.
The nurse is teaching a community health class about health promotion techniques. Which statement by a student indicates a strategy to help prevent the development of osteoarthritis? a. "I will keep my BMI under 24." b. "I will switch to low-tar cigarettes." c. "I will start jogging twice a week." d. "I will have a family tree done."
ANS: A Obesity increases the stress on weight-bearing joints and contributes to the development of degenerative joint disease. Smoking does not decrease risk for osteoarthritis. Jogging increases the risk because of increased wear and tear on the joints. There is a genetic link to osteoarthritis; creating a family tree might help the client discover if there is any familial link but will not help prevent the disorder.
A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started "acting up," especially both hips and knees. What action by the nurse is best? a. Assess the client for the presence of subcutaneous nodules or Baker's cysts. b. Inspect the client's feet and hands for podagra and tophi on fingers and toes. c. Prepare to teach the client about an acetaminophen (Tylenol) regimen. d. Reassure the client that the problems will fade as the weather changes again.
ANS: A Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Baker's cysts. Podagra and tophi are seen in gout. Acetaminophen is not used for rheumatoid arthritis. Telling the client that the symptoms will fade with weather changes is not accurate. DIF: Applying/Application REF: 306 KEY: Rheumatoid arthritis| autoimmune disorders| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best? a. Ask the client about shellfish allergies. b. Document this information on the chart. c. Ensure that the client has a ride home. d. Instruct the client on bowel preparation.
ANS: A PTC uses iodinated dye, so the client should be asked about seafood allergies, specifically to shellfish. Documentation should occur, but this is not the priority. The client will need a ride home afterward if the procedure is done on an outpatient basis. There is no bowel preparation for PTC.
The nurse is caring for a client who is 1 day post total hip replacement. The nurse is instructing the client about how to perform quadriceps-setting exercises correctly. Which direction does the nurse provide to the client? a. "Straighten your legs and push the back of your knees into the mattress." b. "Straighten your legs and bring each leg separately off the mattress 6 inches." c. "Raise each leg 10 inches off the bed, keep it straight, and make ankle circles." d. "Bend each knee, and rapidly point your toes downward and then upward."
ANS: A Quadriceps-setting exercises are done by straightening the leg as much as possible by attempting to push the back of the knees into the mattress. The other exercises may be performed by the client as tolerated, but these items do not describe quadriceps-setting exercises.
A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best? a. Ensure the client gets 15 minutes of sun exposure daily. b. Give the client daily vitamin D injections. c. Hide vitamin D supplements in favorite foods. d. Plan to serve foods naturally high in vitamin D.
ANS: A Sunlight is a good source of vitamin D, and the nursing staff can ensure some sun exposure each day. Vitamin D is not given by injection. Hiding the supplement in food is unethical. Very few foods are naturally high in vitamin D, but some are supplemented.
A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? a. "It's a good thing I love orange and cherry gelatin." b. "My spouse will be here to drive me home." c. "I should refrigerate the GoLYTELY before use." d. "I will buy a case of Gatorade before the prep."
ANS: A The client should be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show a good understanding of the preparation for the procedure.
A client is getting out of bed into the chair for the first time after an uncemented hip replacement. What action by the nurse is most important? a. Have adequate help to transfer the client. b. Provide socks so the client can slide easier. c. Tell the client full weight bearing is allowed. d. Use a footstool to elevate the client's leg.
ANS: A The client with an uncemented hip will be on toe-touch only right after surgery. The nurse should ensure there is adequate help to transfer the client while preventing falls. Slippery socks will encourage a fall. Elevating the leg greater than 90 degrees is not allowed. DIF: Applying/Application REF: 299 KEY: Joint replacement| safety| falls| musculoskeletal system MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the client's foods. d. Make the client NPO.
ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.
P Q R S T
precipitating or palliative quality or quantity region radiation severity scale timing
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs? a. Assess the client's coping skills and support systems. b. Explain that the surgery leads to a longer life expectancy. c. Refer the client to the social worker or hospital chaplain. d. Reinforce physical therapy to aid with ambulating normally.
ANS: A The first step in the nursing process is assessment. The nurse should assess coping skills and possible support systems that will be helpful in this client's treatment. Explaining that a limb salvage procedure will extend life does not address the client's psychosocial needs. Referrals may be necessary, but the nurse should assess first. Reinforcing physical therapy is also helpful but again does not address the psychosocial needs of the client.
The school nurse removes a tick embedded in a student's scalp by the hairline. Which follow-up instruction is the nurse sure to provide to the mother? a. "Call your pediatrician right away if a fever or a red rash develops at the bite." b. "If your child does not have symptoms within 2 weeks, you can relax." c. "Call your pediatrician tomorrow to get antibiotics to prevent Lyme disease." d. "Keep the site clean, but you don't have to worry about further problems."
ANS: A The mother should be instructed to monitor for early symptoms of Lyme disease (fever, rash at the site, other flulike symptoms) following a tick bite. Symptoms can appear for up to 30 days after the bite. Antibiotics are not prescribed as a preventive measure. Because Lyme disease can cause serious complications, the mother needs to monitor the child's condition carefully.
A client has been diagnosed with rheumatoid arthritis. The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community. The elder is expected to attend social events and make community decisions. Stress seems to exacerbate the condition. What action by the nurse is best? a. Assess the client's culture more thoroughly. b. Discuss options for performing duties. c. See if the client will call a community meeting. d. Suggest the client give up the role of elder.
ANS: A The nurse needs a more thorough understanding of the client's culture, including the meaning of illness and the ramifications of the elder not being able to perform traditional duties. This must be done prior to offering any possible solutions. If the nurse does not understand the consequences of what is suggested, the client may simply be unwilling to listen or participate in problem solving. The other options may be reasonable depending on the outcome of a better cultural understanding. DIF: Applying/Application REF: 313 KEY: Rheumatoid arthritis| autoimmune disorders| coping| culture| patient-centered care| diversity MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity
A client with chronic gout takes probenecid (Benemid) and comes to the clinic reporting frequent severe headaches and a new gout flare. The client is frustrated because the gout had been under good control. Which question by the nurse is most helpful? a. "What do you take for your headaches?" b. "Do you know what triggers your gout?" c. "Have you been following your diet?" d. "Did you switch from wine to beer lately?"
ANS: A The nurse needs to assess what has changed for this client. The new onset of headaches should prompt the nurse to question the client about pain medications because aspirin inactivates probenecid. Gout can have triggers, but the client probably knows them by now if it has been well controlled. Nutritional therapy for gout remains controversial. Excessive alcohol can trigger an episode, but beer does not contribute any more than wine.
A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and cool, with 1+/4+ pedal pulses. What action by the nurse is best? a. Assess the neurovascular status of the right leg. b. Document the findings in the client's chart. c. Elevate the left leg on at least two pillows. d. Notify the provider of the findings immediately.
ANS: A The nurse should compare findings of the two legs as these findings may be normal for the client. If a difference is observed, the nurse notifies the provider. Documentation should occur after the nurse has all the data. Elevating the left leg will not improve perfusion if there is a problem.
The nurse is caring for a postoperative client on the medical-surgical unit following a total left hip replacement the previous day. During the assessment, the nurse notes that the client's left leg is cool, with weak pedal pulses. What is the nurse's first action? a. Assess circulatory status of the right leg. b. Notify the surgeon immediately. c. Measure leg circumference at the calf. d. Check for bilateral Homans' signs.
ANS: A The symptoms may represent impaired circulation or may be normal for this client. Before the surgeon is notified, the status of the nonoperative leg should be assessed and assessment findings on both legs compared with the client's baseline. Homans' sign (pain in the calf on dorsiflexion of the foot) is not always indicative of a deep vein thrombosis and should not be evaluated until other assessments are made. Measuring calf circumference would provide additional data related to deep vein thrombosis.
A client is in the internal medicine clinic reporting bone pain. The client's alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate? a. Assess the client for leg bowing. b. Facilitate an oncology workup. c. Instruct the client on fluid restrictions. d. Teach the client about ibuprofen (Motrin).
ANS: A This client has manifestations of Paget's disease. The nurse should assess for other manifestations such as bowing of the legs. Other care measures can be instituted once the client has a confirmed diagnosis.
The nurse on the postoperative inpatient unit assesses a client after a total hip replacement. The client's surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is best? a. Assess neurovascular status in both legs. b. Elevate the affected leg and apply ice. c. Prepare to administer pain medication. d. Try to place the affected leg in abduction.
ANS: A This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess the client. DIF: Applying/Application REF: 297 KEY: Nursing assessment| joint replacement| musculoskeletal system MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
Two hours after limb salvage surgery for a client with left leg bone sarcoma, the nurse notes that the toes of the left foot are more edematous, are cooler to the touch, and have a slower capillary refill. Which action does the nurse take first?
Check the splint for proper placement.
A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best? a. Arrange a home safety evaluation. b. Ensure the client has a walker at home. c. Help the client look into assisted living. d. Refer the client to Meals on Wheels.
ANS: A This client has several risk factors that place him or her at a high risk for falling. The nurse should consult social work or home health care to conduct a home safety evaluation. The other options may or may not be needed based upon the client's condition at discharge.
A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include? a. "Avoid large crowds or people who are ill." b. "Stay upright for 1 hour after taking this drug." c. "This drug may cause your hair to fall out." d. "You may double the dose if pain is severe."
ANS: A This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab. DIF: Applying/Application REF: 321 KEY: Psoriatic arthritis| autoimmune disorders| patient education| biologic response modifiers MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A hospitalized client's strength of the upper extremities is rated at 3. What does the nurse understand about this client's ability to perform activities of daily living (ADLs)? a. The client is able to perform ADLs but not lift some items. b. No difficulties are expected with ADLs. c. The client is unable to perform ADLs alone. d. The client would need near-total assistance with ADLs.
ANS: A This rating indicates fair muscle strength with full range of motion against gravity but not resistance. The client could complete ADLs independently unless they required lifting objects.
A school nurse is conducting scoliosis screening. In screening the client, what technique is most appropriate? a. Bending forward from the hips b. Sitting upright with arms outstretched c. Walking across the room and back d. Walking with both eyes closed
ANS: A To assess for scoliosis, a spinal deformity, the student should bend forward at the hips. Standing behind the student, the nurse looks for a lateral curve in the spine. The other actions are not correct.
What action by the perioperative nursing staff is most important to prevent surgical wound infection in a client having a total joint replacement? a. Administer preoperative antibiotic as ordered. b. Assess the client's white blood cell count. c. Instruct the client to shower the night before. d. Monitor the client's temperature postoperatively.
ANS: A To prevent surgical wound infection, antibiotics are given preoperatively within an hour of surgery. Simply taking a shower will not help prevent infection unless the client is told to use special antimicrobial soap. The other options are processes to monitor for infection, not prevent it. DIF: Applying/Application REF: 296 KEY: Joint replacement| Surgical Care Improvement Project (SCIP)| wound infection| antibiotics MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
A client who has had total hip replacement surgery asks the nurse when she will be able to use a regular-height toilet seat again. What is the nurse's best response? a. "As soon as you are able to walk without a limp." b. "As soon as the staples are removed from the incision." c. "When you are off pain medication and warfarin (Coumadin)." d. "When you can hold your leg 6 inches off the bed for 5 full minutes."
ANS: A When the client is able to walk without a limp, the artificial joint is seated sturdily enough in place that it will not be dislocated or dislodged by overflexing it. At that time, the client will no longer need assistive devices or ambulatory aids. With staples removed, holding the leg off the bed and taking Coumadin do not affect readiness to bend the hip enough to use a regular toilet seat.
A nurse is caring for a client with systemic sclerosis. The client's facial skin is very taut, limiting the client's ability to open the mouth. After consulting with a registered dietitian for appropriate nutrition, what other consultation should the nurse facilitate? a. Dentist b. Massage therapist c. Occupational therapy d. Physical therapy
ANS: A With limited ability to open the mouth, dental hygiene may be lacking. The nurse should encourage the client to see a dentist. The other referrals are not related to the mouth. DIF: Applying/Application REF: 317 KEY: Systemic sclerosis| autoimmune disorder| oral care| collaboration MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
A nurse is providing community education about preventing traumatic musculoskeletal injuries related to car crashes. Which group does the nurse target as the priority for this education? a. High school football team b. High school homeroom class c. Middle-aged men d. Older adult women
ANS: A Young men are at highest risk for musculoskeletal injury due to trauma, especially due to motor vehicle crashes. The high school football team, with its roster of young males, is the priority group.
A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis
ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.
The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a. "I just joined a gym, so I hope that helps me lose weight." b. "I sure hate to give up my coffee, but I guess I have to." c. "I will eat three small meals and three small snacks a day." d. "Sitting upright and not lying down after meals will help." e. "Smoking a pipe is not a problem and I don't have to stop."
ANS: A, B, C, D Lifestyle modifications can help control GERD and include losing weight if needed; avoiding chocolate, caffeine, and carbonated beverages; eating frequent small meals or snacks; and remaining upright after meals. Tobacco is a risk factor for GERD and should be avoided in all forms.
A client has been discharged to an inpatient rehabilitation center after an esophagogastrectomy. What menu selections by the client at the rehabilitation center indicate a good understanding of dietary instructions? (Select all that apply.) a. Boost™ supplement b. Greek yogurt c. Scrambled eggs d. Whole milk shake e. Whole wheat toast
ANS: A, B, C, D Malnutrition is a serious problem after this procedure. The client needs high-protein, high-calorie foods that are easy to chew and swallow. The Boost supplement, Greek yogurt, scrambled eggs, and whole milk shake are all good choices. The whole wheat bread, while heart healthy, is not a good choice as it is dry and not easy to chew and swallow.
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections
ANS: A, B, C, D Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.
The nurse working in the gastrointestinal clinic sees clients who are anemic. What are common causes for which the nurse assesses in these clients? (Select all that apply.) a. Colon cancer b. Diverticulitis c. Inflammatory bowel disease d. Peptic ulcer disease e. Pernicious anemia
ANS: A, B, C, D In adults, the most common cause of anemia is GI bleeding. This is commonly associated with colon cancer, diverticulitis, inflammatory bowel disease, and peptic ulcer disease. Pernicious anemia is not associated with GI bleeding.
The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. Helicobacter pylori infection d. Iron deficiency anemia e. Pernicious anemia
ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.
A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse instructs the client and family about the signs of potential complications, which include what problems? (Select all that apply.) a. Cholangitis b. Pancreatitis c. Perforation d. Renal lithiasis e. Sepsis
ANS: A, B, C, E Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.
The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: A, B, C, E Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.
The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.) a. Decreased hydrochloric acid production b. Diminished sensation that can lead to constipation c. Fat not digested as well in older adults d. Increased peristalsis in the large intestine e. Pancreatic vessels become calcified
ANS: A, B, C, E Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.
The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assisting with position changes and getting out of bed b. Keeping the head of the bed elevated to at least 30 degrees c. Reminding the client to use the spirometer every 4 hours d. Taking and recording vital signs per hospital protocol e. Titrating oxygen based on the client's oxygen saturations
ANS: A, B, D The UAP can assist with mobility, keep the head of the bed elevated, and take and record vital signs. The client needs to use the spirometer every 1 to 2 hours. The nurse titrates oxygen.
A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a. Registered dietitian b. Clinical pharmacist c. Occupational therapist d. Health care provider e. Speech-language pathologist
ANS: A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.
A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort
ANS: A, B, D Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence. DIF: Applying/Application REF: 311 KEY: Rheumatoid arthritis| autoimmune disorders| activities of daily living| musculoskeletal system| functional ability MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort
A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.) a. Assess the daily serum calcium level. b. Consult the provider about a loop diuretic. c. Institute seizure precautions for the client. d. Instruct the client to call for help out of bed. e. Place the client on a 1500-mL fluid restriction.
ANS: A, B, D The client is exhibiting manifestations of possible hypercalcemia. This disorder is treated with increased fluids and loop diuretics. The nurse should assess the calcium level, consult with the provider, and instruct the client to call for help getting out of bed due to possible fractures and weakness. The client does not need seizure precautions or fluid restrictions.
A home health care nurse is visiting a client discharged home after a hip replacement. The client is still on partial weight bearing and using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.) a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. c. Step into the bathtub with the affected leg first. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower.
ANS: A, B, D, E Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight bearing, so he or she cannot step into the bathtub leading with the operative side. Stepping into a bathtub may also require the client to bend the hip more than the allowed 90 degrees. DIF: Applying/Application REF: 301 KEY: Joint replacement| osteoarthritis| home safety| assistive devices MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply.) a. Electromyography b. Muscle biopsy c. Nerve conduction studies d. Serum aldolase e. Serum creatinine kinase
ANS: A, B, D, E Diagnostic testing for muscular dystrophy includes electromyography, muscle biopsy, serum aldolase and creatinine kinase levels. Nerve conduction is not related to this disorder.
A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.) a. Alcohol b. Caffeine c. Fat d. Carbonated beverages e. Vitamin D
ANS: A, B, D, E Dietary components that affect the development of osteoporosis include alcohol, caffeine, high phosphorus intake, carbonated beverages, and vitamin D. Tobacco is also a contributing lifestyle factor. Fat intake does not contribute to osteoporosis.
A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. "Avoid acetaminophen in over-the-counter medications." b. "It may take several weeks to become effective on pain." c. "Pregnancy and breast-feeding are not affected by MTX." d. "Stay away from large crowds and people who are ill." e. "You may find that folic acid, a B vitamin, reduces side effects."
ANS: A, B, D, E MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug. DIF: Applying/Application REF: 308 KEY: Rheumatoid arthritis| autoimmune disease| patient education| disease-modifying antirheumatic drugs (DMARDs)| acetaminophen MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood? (Select all that apply.) a. Ask a second nurse to double-check the blood. b. Prime the IV tubing with normal saline. c. Prime the IV tubing with dextrose in water. d. Take and record a set of vital signs. e. Teach the client about reaction manifestations.
ANS: A, B, D, E Prior to starting a blood transfusion, the nurse asks another nurse to double-check the blood (and client identity), primes the IV tubing with normal saline, takes and records a baseline set of vital signs, and teaches the client about manifestations to report. The IV tubing is not primed with dextrose in water.
When assessing gait, what features does the nurse inspect? (Select all that apply.) a. Balance b. Ease of stride c. Goniometer readings d. Length of stride e. Steadiness
ANS: A, B, D, E To assess gait, look at balance, ease and length of stride, and steadiness. Goniometer readings assess flexion and extension or joint range of motion.
The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.) a. Dry, scaly skin rash - Systemic lupus erythematosus (SLE) b. Esophageal dysmotility - Systemic sclerosis c. Excess uric acid excretion - Gout d. Footdrop and paresthesias - Osteoarthritis e. Vasculitis causing organ damage - Rheumatoid arthritis
ANS: A, B, E A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis. DIF: Remembering/Knowledge REF: 305, 314, 317 KEY: Autoimmune disorders MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition? (Select all that apply.) a. Administer vitamin B12 injections. b. Ask the provider about folic acid replacement. c. Educate the client on enteral feedings. d. Obtain consent for total parenteral nutrition. e. Provide iron supplements for the client.
ANS: A, B, E After gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse should provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.
A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown bag. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.
ANS: A, B, E When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.
A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Do not walk around barefoot." b. "Soak your feet in a tub each evening." c. "Trim toenails straight across with a nail clipper." d. "Treat any blisters or sores with Epsom salts." e. "Wash your feet every other day."
ANS: A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.
The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.) a. Draining sinus tracts b. High fevers c. Presence of foot ulcers d. Swelling and redness e. Tenderness or pain
ANS: A, C Draining sinus tracts and foot ulcers are seen in chronic osteomyelitis. High fever, swelling, and redness are more often seen in acute osteomyelitis. Pain or tenderness can be in either case.
The nurse is aware of the 2014 American Cancer Society Screening Guidelines for colon cancer, which include which testing modalities for people over the age of 50? (Select all that apply.) a. Colonoscopy every 10 years b. Colonoscopy every 5 years c. Computed tomography (CT) colonography every 5 years d. Double-contrast barium enema every 10 years e. Flexible sigmoidoscopy every 10 years
ANS: A, C The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.
A nursing student studying the musculoskeletal system learns about important related hormones. What information does the student learn? (Select all that apply.) a. A lack of vitamin D can lead to rickets. b. Calcitonin increases serum calcium levels. c. Estrogens stimulate osteoblastic activity. d. Parathyroid hormone stimulates osteoclastic activity. e. Thyroxine stimulates estrogen release.
ANS: A, C, D Vitamin D is needed to absorb calcium and phosphorus. A deficiency of vitamin D can lead to rickets. Estrogen stimulates osteoblastic activity. Parathyroid hormone stimulates osteoclastic activity. Calcitonin decreases serum calcium levels when they get too high. Thyroxine increases the rate of protein synthesis in all tissue types.
A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce
ANS: A, C, D, E Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided.
A student nurse learns about changes that occur to the musculoskeletal system due to aging. Which changes does this include? (Select all that apply.) a. Bone changes lead to potential safety risks. b. Increased bone density leads to stiffness. c. Osteoarthritis occurs due to cartilage degeneration. d. Osteoporosis is a universal occurrence. e. Some muscle tissue atrophy occurs with aging.
ANS: A, C, E Many age-related changes occur in the musculoskeletal system, including decreased bone density, degeneration of cartilage, and some degree of muscle tissue atrophy. Osteoporosis, while common, is not universal. Bone density decreases with age, not increases.
An older client returning to the postoperative nursing unit after a hip replacement is disoriented and restless. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply an abduction pillow to the client's legs. b. Assess the skin under the abduction pillow straps. c. Place pillows under the heels to keep them off the bed. d. Monitor cognition to determine when the client can get up. e. Take and record vital signs per unit/facility policy.
ANS: A, C, E The UAP can apply an abduction pillow, elevate the heels on a pillow, and take/record vital signs. Assessing skin is the nurse's responsibility, although if the UAP notices abnormalities, he or she should report them. Determining when the client is able to get out of bed is also a nursing responsibility. DIF: Applying/Application REF: 297 KEY: Joint replacement| delegation| abduction pillow| unlicensed assistive personnel (UAP)| nursing assessment MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.) a. Adherence to the antibiotic regimen b. Correct intramuscular injection technique c. Eating high-protein and high-carbohydrate foods d. Keeping daily follow-up appointments e. Proper use of the intravenous equipment
ANS: A, C, E The client going home with chronic osteomyelitis will need long-term antibiotic therapy—first intravenous, then oral. The client needs education on how to properly administer IV antibiotics, care for the IV line, adhere to the regimen, and eat a healthy diet to encourage wound healing. The antibiotics are not given by IM injection. The client does not need daily follow-up.
A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli
ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.
A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male b. Female with a 30-pound weight gain during pregnancy c. Male with a history of pancreatic trauma d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds
ANS: A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.
A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met? a. Choosing foods that are easy to swallow b. Lungs clear after meals and snacks c. Properly performing swallowing exercises d. Weight unchanged after 2 weeks
ANS: B All these assessment findings are positive for this client. However, this client is at high risk for aspiration. Clear lungs after eating indicates no aspiration has occurred. Choosing easy-to-swallow foods, performing swallowing checks, and having an unchanged weight do not assess aspiration, and therefore do not indicate that the priority goal has been met.
A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best? a. Arrange an intensive care unit tour. b. Assess the client's psychosocial status. c. Document the teaching and response. d. Have the client begin nutritional supplements.
ANS: B Clients facing this long, difficult procedure are often anxious and fearful. The nurse should now assess the client's psychosocial status and provide the care and teaching required based on this assessment. An intensive care unit tour may help decrease stress but is too limited in scope to be the best response. Documentation should be thorough, but the nurse needs to do more than document. The client should begin nutritional supplements prior to the operation, but again this response is too limited in scope.
A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client? a. Enteral tube feeding b. Esophageal dilation c. Nissen fundoplication d. Photodynamic therapy
ANS: B Esophageal dilation can provide immediate relief of esophageal strictures that impair swallowing. Enteral tube feeding is a method of providing nutrition when dysphagia is severe, but esophageal dilation would be attempted before this measure is taken. Nissen fundoplication is performed for severe gastroesophageal reflux disease. Photodynamic therapy is performed for esophageal cancer.
A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective? a. "I can only take this medicine at night." b. "I should take this on a full stomach." c. "This drug decreases stomach acid." d. "This should be taken 1 hour before meals."
ANS: B Gaviscon should be taken with food in the stomach. It can be taken with meals at any time. Its mechanism of action is not to decrease stomach acid.
A client has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first? a. Notify the surgeon. b. Put on a pair of gloves. c. Reinsert the NG tube. d. Take a set of vital signs.
ANS: B To avoid exposure to blood and body fluids, the nurse first puts on a pair of gloves. Taking vital signs and notifying the surgeon are also appropriate, but the nurse must protect himself or herself first. The surgeon will reinsert the NG tube either at the bedside or in surgery if the client needs to go back to the operating room.
increased bone prominence related to aging
prevent pressure on bone prominences
A client has a bone density score of -2.8. What action by the nurse is best? a. Asking the client to complete a food diary b. Planning to teach about bisphosphonates c. Scheduling another scan in 2 years d. Scheduling another scan in 6 months
ANS: B A T-score from a bone density scan at or lower than -2.5 indicates osteoporosis. The nurse should plan to teach about medications used to treat this disease. One class of such medications is bisphosphonates. A food diary is helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will not prevent the disease. Simply scheduling another scan will not help treat the disease either.
A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client who reports jaw pain when eating b. Client with a red, hot, swollen right wrist c. Client who has a puffy-looking area behind the knee d. Client with a worse joint deformity since the last visit
ANS: B All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first. DIF: Applying/Application REF: 305 KEY: Rheumatoid arthritis| nursing assessment| autoimmune disorder MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the client's blood glucose readings have been elevated. What question by the nurse is most appropriate? a. "Are you compliant with following the diabetic diet?" b. "Have you been taking glucosamine supplements?" c. "How much exercise do you really get each week?" d. "You're still taking your diabetic medication, right?"
ANS: B All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them. "Compliant" is a word associated with negative images, and the client may deny being "noncompliant." Asking how much exercise the client "really" gets is accusatory. Asking if the client takes his or her medications "right?" is patronizing. DIF: Applying/Application REF: 295 KEY: Osteoarthritis| nursing assessment| supplements MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.
ANS: B All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.
A client is undergoing computed tomography (CT) of a joint. What action by the nurse is most important before the test? a. Administer sedation as prescribed. b. Assess for seafood or iodine allergy. c. Ensure that the client has no metal on the body. d. Provide preprocedure pain medication.
ANS: B Because CT uses iodine-based contrast material, the nurse assesses the client for allergies to iodine or seafood (which often contains iodine). The other actions are not needed.
41. The nurse is caring for an older adult client who will be discharged home to live with an adult daughter. The client will be given prescriptions for four new medications for rheumatoid arthritis. How does the nurse ensure that the client will be able to take the medications correctly at home? a. Monitor the client self-administering medications while in the hospital. b. Include the client's daughter when teaching the client about the medications. c. Provide the client with pamphlets and information about all the medications. d. Make a chart showing which medications the client should take at different times.
ANS: B Because the client will be living with the daughter, she should be included in the teaching plan about the medications. Providing pamphlets or charts about the medications does not ensure that the client knows how to take them correctly at home. Self-administering medications may or may not be permitted by hospital policy and might be helpful, but including the daughter would be the best option.
The student nurse studying the gastrointestinal system understands that chyme refers to what? a. Hormones that reduce gastric acidity b. Liquefied food ready for digestion c. Nutrients after being absorbed d. Secretions that help digest food
ANS: B Before being digested, food must be broken down into a liquid form. This liquid is called chyme. Secretin is the hormone that inhibits acid production and decreases gastric motility. Absorption is carried out as the nutrients produced by digestion move from the lumen of the GI tract into the body's circulatory system for uptake by individual cells. The secretions that help digest food include hydrochloric acid, bile, and digestive enzymes.
A client is receiving warfarin (Coumadin) daily following total hip replacement surgery. Which laboratory value requires intervention by the nurse? a. Potassium (K+), 4.2 mEq/L b. International normalized ratio (INR), 5.1 c. Prothrombin time (PT), 13.4 seconds d. Hemoglobin (Hg), 16 g/dL
ANS: B Blood levels of Coumadin will be monitored by checking daily PT and INR (in some places, only INR). The INR is critically high. The K+ is normal and is not monitored for Coumadin therapy. The PT is used in some facilities to monitor Coumadin therapy. Hemoglobin would be important to assess because a side effect of Coumadin is bleeding, and a dropping hemoglobin level would indicate that bleeding was occurring. PT and hemoglobin are within the normal range.
flat bones
protect vital organs (scapula)
A client had a total knee replacement earlier in the day and has a continuous femoral nerve blockade (CFNB). When entering the room to assess the client, the nurse notes that the television volume is quite loud. The client explains that it is hard to hear with "all the ringing in my ears." What action by the nurse takes priority? a. Perform a neurovascular assessment on the operative extremity. b. Call another nurse to notify the anesthesiologist immediately. c. Take a full set of vital signs and discontinue the CFNB. d. Pad the siderails and instituting other seizure precautions.
ANS: B CFNB can enter the systemic circulation, causing tinnitus, nervousness, slurred speech, bradycardia, hypotension, bradypnea, and seizures. Because the client is exhibiting signs the CFNB has entered his or her circulation, the client is at risk for seizures and critical alterations in vital signs. The nurse should stay with the client and should continue to assess him or her while another nurse notifies the surgeon or the anesthesiologist
A client is admitted for a total hip replacement. Past medical history includes diabetes mellitus type 2, a heart attack 5 years ago, and allergies to sulfa drugs. The client currently takes insulin on a sliding scale and celecoxib (Celebrex). Before administering the client's medications, which action by the nurse is most appropriate? a. Take the client's blood pressure in both arms. b. Call the physician to clarify the orders. c. Schedule a preoperative electrocardiogram. d. Review the client's laboratory values.
ANS: B Celebrex is a cyclooxygenase (COX)-2 inhibitor. These drugs are thought to cause serious adverse reactions such as myocardial infarction and renal problems. This client already has coronary artery disease and a past myocardial infarction, so the nurse should discuss the order with the physician before giving the medication. Reviewing laboratory results could indicate renal impairment, but taking the client's blood pressure and scheduling an electrocardiogram (ECG) would not take priority over discussion with the physician
A client who has been taking antibiotics reports severe, watery diarrhea. About which test does the nurse teach the client? a. Colonoscopy b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B c. Ova and parasites d. Stool culture
ANS: B Clients taking antibiotics are at risk for Clostridium difficile infection. The most common test for this disorder is a stool sample for ELISA toxin A+B. Colonoscopy, ova and parasites, and stool culture are not warranted at this time.
A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)? a. Lavaging the tube with ice water b. Performing frequent oral care c. Re-positioning the tube every 4 hours d. Taking and recording vital signs
ANS: B Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Re-positioning the tube, if needed, is also done by the nurse. The UAP can take vital signs, but this is not a comfort measure.
A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate? a. "Drink at least 8 ounces of water with it." b. "Make appointments to come get your shot." c. "Sit upright for 30 to 60 minutes after taking it." d. "Take the drug on an empty stomach."
ANS: B Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces of water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60 minutes after taking this medication, nor does the client need to take the drug on an empty stomach.
A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic treatment does the nurse apply? a. Heating pad b. Ice packs c. Splints d. Wax dip
ANS: B Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting helps preserve joint function. A wax dip is used to provide warmth to the joint which is more appropriate for chronic pain and stiffness. DIF: Remembering/Knowledge REF: 311 KEY: Rheumatoid arthritis| autoimmune disorders| ice| pain MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort
The nurse is instructing a client about the management of systemic sclerosis. Which statement indicates that the client requires additional teaching? a. "I will let my doctor know right away if I develop a fever." b. "Ice packs will help relieve the aching pain in my hips and knees." c. "I will wear mittens when I am in the freezer section of the grocery store." d. "I will apply a rich moisturizer to my skin every morning after my shower."
ANS: B Ice packs should not be used by clients with systemic sclerosis because the cold can trigger symptoms of Raynaud's phenomenon. The client should wear mittens whenever his or her hands are exposed to cold temperatures, and moisturizer should be applied daily. The client should notify the doctor if a fever develops.
The nurse is working with a client who will be taking 20 mg of prednisone daily for rheumatoid arthritis. Which precautions does the nurse give the client about taking this medication? a. "Take this medication at bedtime because it will make you sleepy." b. "Take calcium and vitamin D supplements daily." c. "Eat a high-fiber diet with lots of lean meats." d. "Wash your face twice a day with an antibacterial soap."
ANS: B Long-term steroid use is associated with many complications, including diabetes, infection, and osteoporosis, among others. The client should be instructed to take calcium and vitamin D supplements to help prevent osteoporosis. Prednisone does not cause constipation, so increased fiber would not be helpful. Prednisone should be taken in the morning because it may interfere with sleep if taken at bedtime. Washing the face with antibacterial soap may cause skin dryness and breakdown.
A client who has had bilateral total knee replacements is prescribed enoxaparin sodium (Lovenox) injections twice daily for the next 3 weeks. The client asks the nurse why she has to have the medication. What is the nurse's best response? a. "To prevent swelling within your new knee joints." b. "To prevent the formation of blood clots in your legs." c. "To prevent arthritis from developing in your new knee joints." d. "To prevent an infection from developing in your new knee joints."
ANS: B Lovenox is an anticoagulant that will help prevent formation of postoperative deep vein thrombosis (DVT). Lovenox does not decrease or prevent swelling, it does not prevent arthritis, and it is not an antibiotic.
The nurse is working in a primary care clinic and sees a young male client. The client is athletic and is well over 6 feet tall, with size 14 shoes. What diagnostic test does the nurse facilitate for the client? a. Coagulation studies b. Echocardiography c. Electromyelography d. Genetic testing
ANS: B Marfan syndrome is seen in athletic clients who are very tall and have large hands and feet. Echocardiography should be done for clients who may have Marfan syndrome to monitor for mitral valve prolapse and aortic aneurysm. Marfan disease has a genetic component, and genetic testing may be done, but the priority is monitoring the client for cardiac complications.
A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? a. Document the findings in the chart. b. Request an electrocardiogram (ECG). c. Facilitate a serum potassium test. d. Place the client on bedrest.
ANS: B Pyloric stenosis can lead to hypokalemia, which is manifested by muscle weakness. The nurse first obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias. A potassium level is also warranted, as is placing the client on bedrest for safety. Documentation should be thorough, but none of these actions takes priority over the ECG.
A female client with rheumatoid arthritis has taken Rheumatrex (methotrexate) for the past year to control her symptoms. The client comes to the clinic and tells the nurse that a home pregnancy test was positive. What is the nurse's best response? a. "You need to schedule a prenatal appointment with your obstetrician right away." b. "Stop taking Rheumatrex immediately. I'll tell the physician you are pregnant." c. "Continue taking the Rheumatrex, and increase the dose if you have a flare." d. "See a genetic counselor to determine whether your baby will have rheumatoid arthritis."
ANS: B Rheumatrex is highly teratogenic and should not be taken during pregnancy. A prenatal appointment should be made right away, but the first priority is to stop taking methotrexate. Genetic counseling is not appropriate because the counselor will not be able to determine whether the baby will develop rheumatoid arthritis.
A client with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation. The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family. What action by the nurse is best? a. Explain to the client that SLE is an unpredictable disease. b. Help the client create backup plans to minimize disruption. c. Offer to talk to the family and educate them about SLE. d. Tell the client to remain compliant with treatment plans
ANS: B SLE is an unpredictable disease and acute exacerbations can occur without warning, creating chaos in the family. Helping the client make backup plans for this event not only will decrease the disruption but will give the client a sense of having more control. Explaining facts about the disease is helpful as well but does not engage the client in problem solving. The family may need education, but again this does not help the client to problem-solve. Remaining compliant may help decrease exacerbations, but is not as powerful an intervention as helping the client plan for such events. DIF: Applying/Application REF: 316 KEY: Systemic lupus erythematosus| autoimmune disorders| coping| psychosocial response MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity
The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ? a. Kidneys b. Liver c. Spleen d. Stomach
ANS: B Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.
The nurse is working in a clinic when a young male client presents with reports of pain with urination. The client wants testing for sexually transmitted diseases (STDs). The nurse notes that the client's eyes are red and inflamed. What question by the nurse is most important? a. "Do you have more than one sexual partner?" b. "Do you have any new joint pain?" c. "What eyedrops have you used for your red eyes?" d. "Are you allergic to any antibiotics?"
ANS: B The client has two symptoms of Reiter's syndrome (urethritis and conjunctivitis). The nurse should ask about joint pain because this is the third classic manifestation of this disease. All other questions are appropriate, but before treatment is started, the client needs an accurate diagnosis.
A client presents with painful, inflamed fingers with small, hard, yellow nodules that have a sandy yellow drainage. Which medication does the nurse prepare to administer to the client? a. Colchicine (Colasalide) b. Allopurinol (Zyloprim) c. Methotrexate (Rheumatrex) d. Aspirin
ANS: B The client is presenting with symptoms of chronic gout, and allopurinol would be the drug of choice to reduce uric acid levels. Colchicine is used to treat acute gout attacks. Methotrexate and aspirin are not used to treat chronic gout.
The nurse is working with a client who has severe rheumatoid arthritis in her hands. The client states that she is frustrated at mealtime because it is difficult for her to manage cups and silverware. What is the nurse's best response? a. "I'll have the nursing assistants set up your meal trays while you are in the hospital." b. "Let's see if the occupational therapist can provide you with some utensils that are easier for you to use." c. "I'll arrange for a home nursing assistant to help you with your meals after you are discharged from the hospital." d. "Let's see if the physical therapist can suggest some muscle strengthening exercises for you."
ANS: B The client wishes to be more independent at mealtimes; adaptive eating utensils from the occupational therapist will help her meet this goal. Muscle-strengthening exercises will not be as effective for the client's mealtime needs. The client wishes to remain as independent as possible, so a home nursing assistant should not be suggested.
A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is best? a. Allow the client cool liquids only. b. Assess the client's gag reflex. c. Remind the client to remain NPO. d. Tell the client to wait 4 hours.
ANS: B The local anesthetic used during this procedure will depress the client's gag reflex. After the procedure, the nurse should ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the client's readiness for them.
A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a. "Do you have family or friends for support?" b. "I'd like to know what you are feeling now." c. "Well, we knew this would probably happen." d. "Would you like me to refer you to hospice?"
ANS: B The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and "yes-or-no" questions are not therapeutic. Stating that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.
An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the family's wishes. d. Tell the family that such secrets cannot be kept.
ANS: B The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking "why" questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to follow the family's wishes or keep their confidence will not help move this family from their position and will set up an adversarial relationship.
A client is scheduled to have a hip replacement. Preoperatively, the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery. What action by the preoperative nurse is most important? a. Administer preoperative medications as prescribed. b. Ensure that a consent for transfusion is on the chart. c. Explain to the client how anemia affects healing. d. Teach the client about foods high in protein and iron.
ANS: B The preoperative nurse should ensure that all valid consents are on the chart, including one for blood transfusions if this may be needed. Administering preoperative medications is important for all preoperative clients and is not specific to this client. Teaching in the preoperative area should focus on immediate concerns. DIF: Applying/Application REF: 296 KEY: Joint replacement| informed consent| blood transfusions| preoperative nursing MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best? a. "Slippery elm has no benefit for this problem." b. "Slippery elm is often used for this disorder." c. "There is no evidence that this will work." d. "You should not take any herbal remedies."
ANS: B There are several complementary and alternative medicine regimens that are used for gastritis and peptic ulcer disease. Most have been tested on animals but not humans. Slippery elm is a common supplement used for this disorder.
The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.
ANS: B This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.
An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm3, red blood cell count: 3.2/mm3, hemoglobin: 9 g/dL, hematocrit: 32%. What intervention by the nurse is most appropriate? a. Instruct the client to avoid large crowds. b. Prepare to administer epoetin alfa (Epogen). c. Teach the client about foods high in iron. d. Tell the client that all laboratory results are normal.
ANS: B This client is anemic, which needs correction prior to surgery. While eating iron-rich foods is helpful, to increase the client's red blood cells, hemoglobin, and hematocrit within 2 months, epoetin alfa is needed. This colony-stimulating factor will encourage the production of red cells. The client's white blood cell count is normal, so avoiding infection is not the priority. DIF: Applying/Application REF: 296 KEY: Joint replacement| anemia| colony-stimulating factors| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority? a. Allow the client to rest in a position of comfort. b. Assess the client's cardiac and respiratory systems. c. Assist the client with ambulating and position changes. d. Position the client on one side propped with pillows.
ANS: B This degree of curvature of the spine affects cardiac and respiratory function. The nurse's priority is to assess those systems. Positioning is up to the client. The client may or may not need assistance with movement.
A client is having a myelography. What action by the nurse is most important? a. Assess serum aspartate aminotransferase (AST) levels. b. Ensure that informed consent is on the chart. c. Position the client flat after the procedure. d. Reinforce the dressing if it becomes saturated.
ANS: B This diagnostic procedure is invasive and requires informed consent. The AST does not need to be assessed prior to the procedure. The client is positioned with the head of the bed elevated after the test to keep the contrast material out of the brain. The dressing should not become saturated; if it does, the nurse calls the provider.
A client presents to the emergency department reporting severe abdominal pain. On assessment, the nurse finds a bulging, pulsating mass in the abdomen. What action by the nurse is the priority? a. Auscultate for bowel sounds. b. Notify the provider immediately. c. Order an abdominal flat-plate x-ray. d. Palpate the mass and measure its size.
ANS: B This observation could indicate an abdominal aortic aneurysm, which could be life threatening and should never be palpated. The nurse notifies the provider at once. An x-ray may be indicated. Auscultation is part of assessment, but the nurse's priority action is to notify the provider.
cartilage degeneration related to aging
provide moist heat, such as shower or warm, moist compresses
A client with Paget's disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Administering ibuprofen (Motrin) b. Applying a heating pad c. Providing a massage d. Referring the client to a support group e. Using a bed cradle to lift sheets off the feet
ANS: B, C Comfort measures for Paget's disease include heat and massage. Administering medications and referrals are done by the nurse. A bed cradle is not necessary.
The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.) a. It affects single joints only. b. Antibodies lead to inflammation. c. It consists of an autoimmune process. d. Morning stiffness is rare. e. Permanent damage is inevitable.
ANS: B, C RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Clients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment. DIF: Remembering/Knowledge REF: 304 KEY: Rheumatoid arthritis| musculoskeletal system| autoimmune disorder MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
An older client's serum calcium level is 8.7 mg/dL. What possible etiologies does the nurse consider for this result? (Select all that apply.) a. Good dietary intake of calcium and vitamin D b. Normal age-related decrease in serum calcium c. Possible occurrence of osteoporosis or osteomalacia d. Potential for metastatic cancer or Paget's disease e. Recent bone fracture in a healing stage
ANS: B, C This slightly low calcium level could be an age-related decrease in serum calcium or could indicate a metabolic bone disease such as osteoporosis or osteomalacia. A good dietary intake would be expected to produce normal values. Metastatic cancer, Paget's disease, or healing bone fractures will elevate calcium.
The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations? (Select all that apply.) a. Aphasia b. Dysphagia c. Eructation d. Halitosis e. Weight gain
ANS: B, C, D Common signs of esophageal disorders include dysphagia, eructation, halitosis, and weight loss. Aphasia is difficulty with speech, commonly seen after stroke.
A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.) a. Allopurinol (Zyloprim) - Acute gout b. Colchicine (Colcrys) - Acute gout c. Febuxostat (Uloric) - Chronic gout d. Indomethacin (Indocin) - Acute gout e. Probenecid (Benemid) - Chronic gout
ANS: B, C, D, E Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout. DIF: Remembering/Knowledge REF: 320 KEY: Gout| pain| pharmacologic pain management MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse working in the rheumatology clinic assesses clients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? (Select all that apply.) a. Anorexia b. Felty's syndrome c. Joint deformity d. Low-grade fever e. Weight loss
ANS: B, C, E Late manifestations of RA include Felty's syndrome, joint deformity, weight loss, organ involvement, osteoporosis, extreme fatigue, and anemia, among others. Anorexia and low-grade fever are both seen early in the course of the disease. DIF: Remembering/Knowledge REF: 305 KEY: Rheumatoid arthritis| nursing assessment| musculoskeletal system| autoimmune disorders MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to what organ dysfunctions? (Select all that apply.) a. Alanine aminotransferase: biliary system b. Ammonia: liver c. Amylase: liver d. Lipase: pancreas e. Urine urobilinogen: stomach
ANS: B, D Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.
The nurse is teaching a client with rheumatoid arthritis (RA) about joint protection principles. What information does the nurse include? (Select all that apply.) a. Use smaller joints to rest the larger ones. b. Hold objects with two hands, not one. c. Sit most often in a reclining chair. d. Use assistive-adaptive devices. e. Bend at your knees to lift objects.
ANS: B, D, E Clients with RA should use large joints to protect smaller ones, should hold objects with two hands instead of one, should sit in chairs with straight backs, should not bend at the waist but rather bend the knees while keeping the back straight, and should use assistive-adaptive devices wherever possible.
A client is 1 day postoperative after having Zenker's diverticula removed. The client has a nasogastric (NG) tube to suction, and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate? a. Document the findings as normal. b. Irrigate the NG tube with sterile saline. c. Notify the surgeon about this finding. d. Remove and reinsert the NG tube.
ANS: C NG tubes placed during surgery should not be irrigated or moved unless prescribed by the surgeon. The nurse should notify the surgeon about this finding. Documentation is important, but this finding is not normal.
A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)
ANS: C Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.
A client has a nasogastric (NG) tube. What action by the nursing student requires the registered nurse to intervene? a. Checking tube placement every 4 to 8 hours b. Monitoring and documenting drainage from the NG tube c. Pinning the tube to the gown so the client cannot turn the head d. Providing oral care every 4 to 8 hours
ANS: C The client should be able to turn his or her head to prevent pulling the tube out with movement. The other actions are appropriate.
A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first? a. Client who underwent diverticula removal with a pulse of 106/min b. Client who had esophageal dilation and is attempting first postprocedure oral intake c. Client who had an esophagectomy with a respiratory rate of 32/min d. Client who underwent hernia repair, reporting incisional pain of 7/10
ANS: C The client who had an esophagectomy has a respiratory rate of 32/min, which is an early sign of sepsis; this client needs to be assessed first. The client who underwent diverticula removal has a pulse that is out of the normal range (106/min), but not terribly so. The client reporting pain needs pain medication, but the client with the elevated respiratory rate needs investigation first. The nurse should see the client who had esophageal dilation prior to and during the first attempt at oral feedings, but this can wait until the other clients are cared for.
The following data relate to an older client who is 2 hours postoperative after an esophagogastrostomy: Physical Assessment Vital Signs Physician Orders Skin dry Urine output 20 mL/hr NG tube patent with 100 mL brown drainage/hr Restless Pulse: 128 beats/min Blood pressure: 88/50 mm Hg Respiratory rate: 20 on ventilator Cardiac output: 2.1 L/min Oxygen saturation: 99% Normal saline at 75 mL/hr Morphine sulfate 2 mg IV push every 1 hr PRN pain Intake and output every hour Vital signs every hour Vancomycin (Vancocin) 1 g IV every 8 hr What action by the nurse is best? a. Administer the prescribed pain medication. b. Consult the surgeon about a different antibiotic. c. Consult the surgeon about increased IV fluids. d. Have respiratory therapy reduce the respiratory rate.
ANS: C This client's vital signs, cardiac output, dry skin, and urine output indicate hypovolemia or possible hypotension resulting from pressure placed on the posterior heart during surgery. The client needs more fluids, so the nurse should consult with the surgeon about increasing the fluid intake. The client may be restless as a result of the hypotension and may not need pain medication at this time. There is no reason to request a different antibiotic. The respiratory rate does not need to be adjusted.
The nurse is caring for a client who had right total knee replacement surgery 3 days ago. During the assessment, the nurse notes that the client's right lower leg is twice the size of the left. What is the nurse's priority intervention? a. Elevate the client's right leg. b. Apply antiembolism stockings. c. Assess the client's respiratory status. d. Check the client's pedal pulses.
ANS: C A common complication after total knee replacement (TKR) is the formation of a thrombus below the surgical site. This complication can lead to a pulmonary embolus and can be life threatening. Before notifying the surgeon or the emergency team, assess the client's pulmonary status to determine whether he or she has any manifestations of an embolus. The client's leg may be elevated and pedal pulses palpated, but respiratory assessment must be done first. TED hose should not be applied to a leg with suspected deep vein thrombosis (DVT).
A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a. Assess the client for iodine or shellfish allergies. b. Educate the client on the side effects of sedation. c. Inform the client a second scan may be needed. d. Teach the client about bowel preparation for the scan.
ANS: C A second scan may be performed in 1 to 2 days to see if interventions have worked. The nuclear medicine scan does not use iodine-containing contrast dye or sedation. There is no required bowel preparation.
A client returns to the medical-surgical unit after a total hip replacement with a large wedge-shaped pillow between his legs. The client's daughter asks the nurse why the pillow is in place. What is the nurse's best response? a. "It will help prevent bedsores from developing." b. "It will help prevent nerve damage and foot drop." c. "It will keep the new hip from becoming dislocated." d. "It will prevent climbing out of bed if he becomes confused."
ANS: C Adduction of the operative leg beyond the midline could dislocate the new hip. The wedge pillow will help prevent this from happening. The wedge will not prevent bedsores from developing because it does not prevent pressure. The pillow will not prevent foot drop, because it is placed between the legs. The pillow is not a restraining device, and it will not prevent the client from climbing out of bed.
A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is best? a. Ask the client to call back if this happens again today. b. Instruct the client to go to the emergency department. c. Remind the client that a small amount of bleeding is possible. d. Tell the client to come in to the clinic this afternoon.
ANS: C After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse should remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.
A hospitalized client is being treated for Ewing's sarcoma. What action by the nurse is most important? a. Assessing and treating the client for pain as needed b. Educating the client on the disease and its treatment c. Handling and disposing of chemotherapeutic agents per policy d. Providing emotional support for the client and family
ANS: C All actions are appropriate for this client. However, for safety, the nurse should place priority on proper handling and disposal of chemotherapeutic agents.
A nurse answers a client's call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.
ANS: C All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid contamination with blood or body fluids.
The nurse has taught a client with lupus about skin protection in the clinic. Later, the nurse sees the client at an outdoor music festival. Which observation by the nurse indicates that the client requires further instruction? a. Client is wearing a thin, long-sleeved shirt. b. Client is wearing a hat with a full brim. c. Client is discussing her new perm. d. Client is seen applying sunscreen twice.
ANS: C Alopecia is common; the client should use gentle shampoo and avoid any harsh chemical treatments, such as a permanent wave. The other observations show good skin protection practices by the client.
A client has a continuous passive motion (CPM) device after a total knee replacement. What action does the nurse delegate to the unlicensed assistive personnel (UAP) after the affected leg is placed in the machine while the client is in bed? a. Assess the distal circulation in 30 minutes. b. Change the settings based on range of motion. c. Raise the lower siderail on the affected side. d. Remind the client to do quad-setting exercises.
ANS: C Because the client's leg is strapped into the CPM, if it falls off the bed due to movement, the client's leg (and new joint) can be injured. The nurse should instruct the UAP to raise the siderail to prevent this from occurring. Assessment is a nursing responsibility. Only the surgeon, physical therapist, or specially trained technician adjusts the CPM settings. Quad-setting exercises are not related to the CPM machine. DIF: Applying/Application REF: 301 KEY: Joint replacement| delegation| continuous passive motion machine| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
A client has a metastatic bone tumor. What action by the nurse takes priority? a. Administer pain medication as prescribed. b. Elevate the extremity and apply moist heat. c. Handle the affected extremity with caution. d. Place the client on protective precautions.
ANS: C Bones invaded by tumors are very fragile and fracture easily. For client safety, the nurse handles the affected extremity with great care. Pain medication should be given to control pain. Elevation and heat may or may not be helpful. Protective precautions are not needed for this client.
32. Which statement by a client indicates that additional teaching is needed in the management of fibromyalgia? a. "I will switch to decaffeinated coffee in the mornings." b. "Water aerobics classes will be a good form of exercise." c. "Limiting my physical activity will reduce my fatigue." d. "I will take my sertraline (Zoloft) right before I go to bed."
ANS: C Clients with fibromyalgia should be encouraged to exercise regularly, particularly performing activities that are low impact. Sleep disturbances are common in fibromyalgia, and anything that interferes with sleep, such as caffeine, should be avoided. Zoloft can cause drowsiness and should be taken daily at bedtime.
foods and meds to avoid for fecal occult blood test
raw fruits and vegetables and red meat vitamin c-rich Foods juices and tablets anticoagulants such as Warfarin and NSAIDs should be discontinued for 7 days before testing
The home care nurse is making a follow-up visit to a client who had total hip replacement surgery 2 weeks ago. Which client statement indicates a need for clarification regarding postoperative routine? a. "My daughter helps me put on my elastic TED (thromboembolic deterrent) hose every day." b. "I take 200 mg of Motrin (ibuprofen) at bedtime so that I can sleep." c. "Now that my hip doesn't hurt, I can cross my legs like a lady again." d. "Each day, I try to increase my walking time by at least 10 minutes."
ANS: C Crossing the legs beyond midline can dislocate the new hip joint and should be avoided at all times. The other statements demonstrate correct behavior and understanding.
A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed. What response by the nurse is best? a. "A little sedation will help you get some rest." b. "Depression often accompanies fibromyalgia." c. "This drug works in the brain to decrease pain." d. "You will have more energy after taking this drug."
ANS: C Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine, which reduces the pain from fibromyalgia. The other answers are inaccurate. DIF: Understanding/Comprehension REF: 322 KEY: Fibromyalgia| antidepressants| pain| pharmacologic pain management MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride (Versed). The client's respiratory rate is 8 breaths/min. What action by the nurse is best? a. Administer naloxone (Narcan). b. Call the Rapid Response Team. c. Provide physical stimulation. d. Ventilate with a bag-valve-mask.
ANS: C For an EGD, clients are given mild sedation but should still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse's first action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for Versed. The Rapid Response Team is not needed at this point. The client does not need manual ventilation.
The nurse knows that hematopoiesis occurs in what part of the musculoskeletal system? a. Cancellous tissue b. Collagen matrix c. Red marrow d. Yellow marrow
ANS: C Hematopoiesis occurs in the red marrow, which is part of the cancellous tissues containing both types of bone marrow.
The nurse is caring for a pregnant client who is taking Humira (adalimumab) to control symptoms of rheumatoid arthritis. The client mentions the pain and inconvenience of the subcutaneous injections and asks, "While I'm pregnant, can I take this drug by mouth instead?" What is the nurse's best response? a. "I will ask the physician to write a prescription for you today." b. "Humira takes much longer to work when it is given orally." c. "Humira can be given only by subcutaneous injection." d. "You can switch from Humira to oral leflunomide (Arava)."
ANS: C Humira is given by subcutaneous injection only. Arava causes birth defects; clients taking it must be on strict birth control and must inform their health care providers if pregnancy occurs.
The nurse is teaching a client how to reduce the pain that she often experiences with fibromyalgia. Which statement does the nurse include in the teaching? a. "Wear gloves outdoors in cooler temperatures." b. "Avoid exercising when your muscles are sore." c. "Make sure that you get enough sleep every night." d. "Stay out of the sun as much as possible."
ANS: C In many clients, the pain of fibromyalgia occurs as a direct response to sleep deprivation. Encouraging the client to get sufficient sleep every night can drastically reduce the amount of pain experienced. Wearing gloves will not decrease the pain of fibromyalgia, but it may help a disease such as Raynaud's phenomenon. Weight-bearing activities should not increase pain in a client with fibromyalgia. Similarly, sun exposure has not been identified as a causative pain factor.
An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first? a. Administer acetaminophen (Tylenol). b. Educate the client on amputation. c. Place the client on contact isolation. d. Refer the client to the wound care nurse.
ANS: C In the presence of a heavily draining wound, the nurse should place the client on contact isolation. If the client has discomfort, acetaminophen can be used, but this client has not reported pain and is afebrile. The client may or may not need an amputation in the future. The wound care nurse may be consulted, but not as the first action.
The school nurse is working with a group of high school students who will be going on a field trip to a nature center. Which student is at highest risk for a tick bite? a. Male student with a beard and a baseball cap b. Female student with long hair pulled back in a ponytail c. Male student wearing a long-sleeved shirt and shorts d. Female student who is wearing scented hand lotion
ANS: C Long pants should be worn and tucked into socks or boots to help prevent tick bites. Facial hair, hats, ponytails, and scented body products do not increase the risk for tick bites.
A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate? a. "Aspirin must be avoided." b. "Do not worry about black stools." c. "Report diarrhea to your provider." d. "Take 1 hour before meals."
ANS: C Maalox can cause hypermagnesemia, which causes diarrhea, so the client should be taught to report this to the provider. Aspirin is avoided with bismuth sulfate (Pepto-Bismol). Black stools can be caused by Pepto-Bismol. Maalox should be taken after meals.
For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age
ANS: C Misoprostol can cause abortion, so pregnant women should not take this drug. The other clients have no contraindications to taking misoprostol.
The nurse provides discharge teaching for a client to prevent a new attack of gout. Which statement by the client indicates that additional teaching is required? a. "I will keep a food and symptom diary for a few weeks." b. "If I get a headache, I will take Tylenol instead of aspirin." c. "I hate to start limiting my fluid intake so much!" d. "Citrus juices and milk may keep me from having kidney stones."
ANS: C Nutritional therapy for gout is controversial; however, clients do need to increase their fluid intake to prevent kidney stones. Certain foods may precipitate an acute attack, so clients should learn to determine which foods trigger their gout. Aspirin is well known to trigger gout attacks. Increasing the intake of alkaline ash foods such as citrus juices and milk might prevent the formation of kidney stones.
A nurse is working with a community group promoting healthy aging. What recommendation is best to help prevent osteoarthritis (OA)? a. Avoid contact sports. b. Get plenty of calcium. c. Lose weight if needed. d. Engage in weight-bearing exercise
ANS: C Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or reduce symptoms once it occurs. Arthritis can be caused by contact sports, but this is less common than obesity. Calcium and weight-bearing exercise are both important for osteoporosis. DIF: Understanding/Comprehension REF: 294 KEY: Client teaching| health promotion| osteoarthritis| weight loss MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance
A client with diagnosed osteoarthritis comes to the clinic reporting a low-grade fever, fatigue, and bilateral joint pain. What action by the nurse is most appropriate? a. Assess the client for a systemic infection. b. Discuss increasing the dose of anti-arthritis drugs. c. Prepare the client for a laboratory draw for rheumatoid factor. d. Teach the client joint protection activities.
ANS: C Osteoarthritis is generally a unilateral disease. The manifestations that this client exhibits are more consistent with rheumatoid arthritis, so the nurse will prepare the client for a blood draw. The nurse may need to teach joint protection measures, but an accurate diagnosis is most important.
The nurse working in the orthopedic clinic knows that a client with which factor has an absolute contraindication for having a total joint replacement? a. Needs multiple dental fillings b. Over age 85 c. Severe osteoporosis d. Urinary tract infection
ANS: C Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted. The client who needs fillings should have them done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract infection can be treated prior to surgery. DIF: Remembering/Knowledge REF: 295 KEY: Osteoarthritis| osteoporosis| joint replacement| surgical procedures MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? a. "Let's ask the provider about increasing your pain pills." b. "Hold ice bags against your hands before quilting." c. "Try a paraffin wax dip 20 minutes before you quilt." d. "You need to stop quilting before it destroys your fingers."
ANS: C Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure. Increasing pain pills will not help with movement. Ice has limited use unless the client has a "hot" or exacerbated joint. The client wants to finish her project, so the nurse should not negate its importance by telling the client it is destroying her joints. DIF: Applying/Application REF: 311 KEY: Rheumatoid arthritis| autoimmune disorders| nonpharmacologic pain management| heat MSC: Integrated Process: Caring NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort
The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor
ANS: C Sucralfate is a mucosal barrier fortifier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.
The nurse is caring for a client who has a history of severe rheumatoid arthritis. The client becomes combative and abusive to the staff when she is unable to perform personal care independently. What is the best statement the nurse can make to the client at this time? a. "I will have to restrain your hands if you cannot keep them to yourself." b. "I will ask your doctor for a psychiatrist to talk to you about anger management." c. "You seem frustrated. Would you like to try to dress again in a few minutes?" d. "Would you like me to get an order for medication to help you settle down?"
ANS: C The client is acting out her frustration over her chronic illness and loss of use of her hands. The nurse should acknowledge this frustration. Allowing the client to make decisions regarding care will help the client regain some sense of control and will help improve self-esteem. Requesting sedation, suggesting psychiatric therapy, or threatening use of restraints is not appropriate, because the client is expressing frustration over the situation.
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first? a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago b. Client taking ibandronate (Boniva) who cannot remember when the last dose was c. Client taking raloxifene (Evista) who reports unilateral calf swelling d. Client taking risedronate (Actonel) who reports occasional dyspepsia
ANS: C The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on risedronate may need to change medications.
A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.) a. Cut down on tobacco product use. b. Limit alcohol to two drinks a day. c. Strengthening exercises are important. d. Take recommended calcium and vitamin D. e. Walk 30 minutes at least 3 times a week.
ANS: C, D, E Lifestyle changes can be made to decrease the occurrence of osteoporosis and include strengthening and weight-bearing exercises and getting the recommended amounts of both calcium and vitamin D. Tobacco should be totally avoided. Women should not have more than one drink per day.
The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.) a. Antianxiety agents b. Antibiotics c. Barbiturates d. Corticosteroids e. Loop diuretics
ANS: C, D, E Several classes of drugs can cause secondary osteoporosis, including barbiturates, corticosteroids, and loop diuretics. Antianxiety agents and antibiotics are not associated with the formation of osteoporosis.
The nurse is caring for an older adult client who has fallen and fractured her hip. The client will have hip replacement surgery followed by extensive rehabilitation. The client confides in the nurse, "I feel like I don't have any control over anything anymore now that I am old." What is the nurse's best response? a. "I'll make sure that the physical and occupational therapists see you after surgery to help get your strength back." b. "It's normal to feel this way, but hopefully you will be back on your feet after a stay in rehab." c. "It's important to control what you can right now, like making out your menu every day and working with the therapists." d. "I sense that you are feeling depressed about the situation. I will ask the doctor to prescribe an antidepressant for you."
ANS: C The nurse should support the client's self-esteem and increase feelings of competency by encouraging activities that assist in maintaining some degree of control, such as participation in decision making and performance of tasks that he or she can manage. The nurse should provide immediate control options for the client, rather than waiting until after rehabilitation. The client's desire for control does not indicate depression, so an antidepressant is not indicated. Therapy referrals are appropriate but do not address the client's desire for control.
A client is scheduled for a bone biopsy. What action by the nurse takes priority? a. Administering the preoperative medications b. Answering any questions about the procedure c. Ensuring that informed consent is on the chart d. Showing the client's family where to wait
ANS: C The priority is to ensure that informed consent is on the chart. The preoperative medications should not be administered until the nurse is confident the procedure will occur and the client has already signed the consent, if the medications include anxiolytics or sedatives or opioids. The provider should answer questions about the procedure. The nurse does show the family where to wait, but this is not the priority and could be delegated.
A nurse is discharging a client after a total hip replacement. What statement by the client indicates good potential for self-management? a. "I can bend down to pick something up." b. "I no longer need to do my exercises." c. "I will not sit with my legs crossed." d. "I won't wash my incision to keep it dry."
ANS: C There are many precautions clients need to take after hip replacement surgery, including not bending more than 90 degrees at the hips, continuing prescribed exercises, not crossing the legs, and washing the incision daily and patting it dry. DIF: Evaluating/Synthesis REF: 298 KEY: Joint replacement| discharge planning/teaching| nursing evaluation MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance
A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.
ANS: C This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.
A nurse is caring for four clients. After the hand-off report, which client does the nurse see first? a. Client with osteoporosis and a white blood cell count of 27,000/mm3 b. Client with osteoporosis and a bone fracture who requests pain medication c. Post-microvascular bone transfer client whose distal leg is cool and pale d. Client with suspected bone tumor who just returned from having a spinal CT
ANS: C This client is the priority because the assessment findings indicate a critical lack of perfusion. A high white blood cell count is an expected finding for the client with osteoporosis. The client requesting pain medication should be seen second. The client who just returned from a CT scan is stable and needs no specific postprocedure care.
After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the client's pulses are 2+/4+ bilaterally; the skin is pale pink, warm, and dry; and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse perform next? a. Document the findings and monitor as prescribed. b. Increase the frequency of monitoring the client. c. Notify the surgeon or anesthesia provider immediately. d. Palpate the client's bladder or perform a bladder scan.
ANS: C With the femoral nerve block, the client should still be able to dorsiflex and plantarflex the affected foot. Since this client has an abnormal finding, the nurse should notify either the surgeon or the anesthesia provider immediately. Documentation is the last priority. Increasing the frequency of assessment may be a good idea, but first the nurse must notify the appropriate person. Palpating the bladder is not related. DIF: Applying/Application REF: 302 KEY: Postoperative nursing| joint replacement| nursing assessment| musculoskeletal system MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting
ANS: C, D Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.
A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? a. Document the findings in the chart. b. Notify the surgeon immediately. c. Reassess the drainage in 1 hour. d. Take a full set of vital signs.
ANS: D The drainage in the NG tube should initially be brown with old blood. The presence of bright red blood indicates bleeding. The nurse should take a set of vital signs to assess for shock and then notify the surgeon. Documentation should occur but is not the first thing the nurse should do. The nurse should not wait an additional hour to reassess.
The nurse is assessing four clients with musculoskeletal disorders. The nurse should assess the client with which laboratory result first? a. Serum alkaline phosphatase (ALP): 108 units/L b. Serum aspartate aminotransferase (AST): 26 units/L c. Serum calcium: 10.2 mg/dL d. Serum phosphorus: 2 mg/dL
ANS: D A normal serum phosphorus level is 3 to 4.5 mg/dL; a level of 2 mg/dL is low, and this client should be assessed first. The values for serum ALP, AST, and calcium are all within normal ranges.
A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a. Albumin: 2.1 g/dL b. Hematocrit: 28% c. Hemoglobin: 8.1 mg/dL d. International normalized ratio (INR): 4.2
ANS: D An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albumin is low and is an expected finding. The hematocrit and hemoglobin are also low, but this is expected in gastric cancer.
A nurse is discharging a client to a short-term rehabilitation center after a joint replacement. Which action by the nurse is most important? a. Administering pain medication before transport b. Answering any last-minute questions by the client c. Ensuring the family has directions to the facility d. Providing a verbal hand-off report to the facility
ANS: D As required by The Joint Commission and other accrediting agencies, a hand-off report must be given to the new provider to prevent error. The other options are valid responses but do not take priority. DIF: Applying/Application REF: 304 KEY: Hand-off communication| communication| The Joint Commission MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option? a. Client with diabetes who has a serum creatinine of 0.8 mg/dL b. Client who recently fell and has vertebral compression fractures c. Hypertensive client who takes calcium channel blockers d. Client with a spinal cord injury who cannot tolerate sitting up
ANS: D Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.
A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that one arm feels like "pins and needles" and that the neck is very painful since returning from surgery. What action by the nurse is best? a. Assist the client to change positions. b. Document the findings in the client's chart. c. Encourage range of motion of the neck. d. Notify the provider immediately.
ANS: D Clients with RA can have cervical joint involvement. This can lead to an emergent situation in which the phrenic nerve is compressed, causing respiratory insufficiency. The client can also suffer a permanent spinal cord injury. The nurse needs to notify the provider immediately. Changing positions and doing range of motion may actually worsen the situation. The nurse should document findings after notifying the provider. DIF: Applying/Application REF: 306 KEY: Rheumatoid arthritis| autoimmune disorder| musculoskeletal system| communication| critical rescue MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
A nurse is caring for a client who has had rheumatoid arthritis (RA) for 5 years. Which laboratory value requires the most immediate intervention by the nurse? a. White blood cell count (WBC), 3800/mm3 b. Hemoglobin (Hg), 10.6 g/dL c. Blood urea nitrogen (BUN), 16 mg/dL d. Creatinine, 3.2 mg/dL
ANS: D Clients with RA usually have pancytopenia, or a decrease in all cell types. WBC and hemoglobin are low, consistent with this condition. BUN is normal. Creatinine is very high; this indicates renal disease. This client may have renal consequences of his or her RA, which should be investigated.
The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP). What action by the UAP warrants intervention by the nurse? a. Checking to see if the machine is working b. Keeping controls in a secure place on the bed c. Placing padding in the machine per request d. Storing the CPM machine under the bed after removal
ANS: D For infection control (and to avoid tripping on it), the CPM machine is never placed on the floor. The other actions are appropriate. DIF: Applying/Application REF: 302 KEY: Joint replacement| continuous passive motion machine| infection control| delegation MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
A nurse is examining a client reporting right upper quadrant (RUQ) abdominal pain. What technique should the nurse use to assess this client's abdomen? a. Auscultate after palpating. b. Avoid any palpation. c. Palpate the RUQ first. d. Palpate the RUQ last.
ANS: D If pain is present in a certain area of the abdomen, that area should be palpated last to keep the client from tensing up, which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.
A client is suspected to have rheumatoid arthritis. Which manifestations does the nurse assess this client carefully for? a. Crepitus when the client moves the shoulders b. Numbness and tingling in the client's fingers c. Client has cool feet, with weak pedal pulses d. Low-grade fever, fatigue, anorexia with weight loss
ANS: D Low-grade fever is common with rheumatoid arthritis because of the inflammatory response. Fatigue, anorexia, and weight loss are also common symptoms. Impaired neurologic status, popping sounds with range of motion (ROM), and poor circulation are not common symptoms of rheumatoid arthritis.
An older client has returned to the surgical unit after a total hip replacement. The client is confused and restless. What intervention by the nurse is most important to prevent injury? a. Administer mild sedation. b. Keep all four siderails up. c. Restrain the client's hands. d. Use an abduction pillow.
ANS: D Older clients often have trouble metabolizing anesthetics and pain medication, leading to confusion or restlessness postoperatively. To prevent the hip from dislocating, the nurse should use an abduction pillow since the client cannot follow directions at this time. Sedation may worsen the client's mental status and should be avoided. Using all four siderails may be considered a restraint. Hand restraints are not necessary in this situation. DIF: Applying/Application REF: 297 KEY: Joint replacement| abduction pillow| musculoskeletal system| older adult MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
A nurse is caring for a client after joint replacement surgery. What action by the nurse is most important to prevent wound infection? a. Assess the client's white blood cell count. b. Culture any drainage from the wound. c. Monitor the client's temperature every 4 hours. d. Use aseptic technique for dressing changes.
ANS: D Preventing surgical wound infection is a primary responsibility of the nurse, who must use aseptic technique to change dressings or empty drains. The other actions do not prevent infection but can lead to early detection of an infection that is already present. DIF: Applying/Application REF: 297 KEY: Joint replacement| infection control| wound infection| dressings MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjögren's syndrome? a. Abdominal assessment b. Oxygen saturation c. Renal function studies d. Visual acuity
ANS: D Sjögren's syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur. The other assessments are not related to RA and Sjögren's syndrome. DIF: Applying/Application REF: 306 KEY: Rheumatoid arthritis| nursing assessment| musculoskeletal system| visual disturbances| autoimmune disorder| sensory system MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
The nurse is instructing a client about management of discoid lupus erythematosus (DLE). Which statement indicates that the client requires additional teaching? a. "I will be sure to apply sunscreen whenever I am outside." b. "I will apply small amounts of the steroid cream to my face twice a day." c. "I will take Plaquenil (hydroxychloroquine sulfate) with breakfast each morning." d. "Steroids weaken the immune system, so I will wash my hands frequently."
ANS: D Steroid creams used for the treatment of discoid lupus will not weaken the immune system because they should be applied in small amounts to affected areas. The client will be more sensitive to sun exposure while using the steroid cream, so sunscreen should be used whenever the client goes outside. The client should use only small amounts of the cream on her face. Plaquenil should be taken with meals or a glass of milk.
The nurse is teaching a client who has osteoarthritis ways to slow progression of the disease. Which statement indicates that the client understands the nurse's instruction? a. "I will eat more vegetables and less meat." b. "I will avoid exercising to minimize wear on my joints." c. "I will take calcium with vitamin D every day." d. "I will start swimming twice a week."
ANS: D Swimming is an excellent form of exercise for clients with arthritis because it involves minimal weight bearing and stress on the joints from gravity. Eating more vegetables will not decrease the progression of osteoarthritis. Taking calcium with vitamin D will decrease the risk of osteoporosis, not osteoarthritis. Gentle exercise is important to help slow progression of the disease.
A client is admitted with a large draining wound on the leg. What action does the nurse take first? a. Administer ordered antibiotics. b. Insert an intravenous line. c. Give pain medications if needed. d. Obtain cultures of the leg wound.
ANS: D The nurse first obtains wound cultures prior to administering broad-spectrum antibiotics. The nurse would need to start the IV prior to giving the antibiotics as they will most likely be parenteral. Pain should be treated but that is not the priority.
A client presents to the family practice clinic reporting a week of watery, somewhat bloody diarrhea. The nurse assists the client to obtain a stool sample. What action by the nurse is most important? a. Ask the client about recent exposure to illness. b. Assess the client's stool for obvious food particles. c. Include the date and time on the specimen container. d. Put on gloves prior to collecting the sample.
ANS: D To avoid possible exposure to infectious agents, the nurse dons gloves prior to handling any bodily secretions. Recent exposure to illness is not related to collecting a stool sample. The nurse can visually inspect the stool for food particles, but it still needs analysis in the laboratory. The container should be dated and timed, but safety for the staff and other clients comes first.
The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client taking celecoxib (Celebrex) and ranitidine (Zantac) b. Client taking etanercept (Enbrel) with a red injection site c. Client with a blood glucose of 190 mg/dL who is taking steroids d. Client with a fever and cough who is taking tofacitinib (Xeljanz)
ANS: D Tofacitinib carries a Food and Drug Administration black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis. Ranitidine is often taken with celecoxib, which can cause gastrointestinal distress. Redness and itchy rashes are frequently seen with etanercept injections. Steroids are known to raise blood glucose levels. DIF: Applying/Application REF: 311 KEY: Rheumatoid arthritis| autoimmune disorders| nursing assessment| biologic response modifiers MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
A client has an ingrown toenail. About what self-management measure does the nurse teach the client? a. Long-term antibiotic use b. Shoe padding c. Toenail trimming d. Warm moist soaks
ANS: D Treatment of an ingrown toenail includes a podiatrist clipping away the ingrown part of the nail, warm moist soaks, and antibiotic ointment if needed. Antibiotics are not used long-term. Padding the shoes will not treat or prevent ingrown toenails. Clients should not attempt to trim ingrown nails themselves.
A client has a possible connective tissue disease and the nurse is reviewing the client's laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.) a. Elevated antinuclear antibody (ANA) - Normal value; no connective tissue disease b. Elevated sedimentation rate - Rheumatoid arthritis c. Lowered albumin - Indicative only of nutritional deficit d. Positive human leukocyte antigen B27 (HLA-B27) - Reiter's syndrome or ankylosing spondylitis e. Positive rheumatoid factor - Possible kidney disease
ANS: D, E The HLA-B27 is diagnostic for Reiter's syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia. An elevated ANA is indicative of inflammatory CTDs, although a small minority of healthy adults also have this finding. An elevated sedimentation rate indicates inflammation, whether from an infection, an injury, or an autoimmune CTD. Lowered albumin is seen in nutritional deficiencies but also in chronic infection or inflammation. DIF: Remembering/Knowledge REF: 307 KEY: Autoimmune disorders| laboratory values MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
arthogram
An X-ray study of a joint after contrast medium (air or solution) is injected. Determines bone chips, torn ligaments, or other loose bodies within the joint.
The nurse is teaching a patient with diabetes about proper foot care. Which instructions does the nurse include? (Select all that apply.)
Apply moisturizing cream to the feet after bathing, but not between the toes. Do not go barefoot. Inspect the feet daily.
bunionectomy
removal of the bony overgrowth and bursa and realignment. one foot at a time. 6-12 weeks recovery
A client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"
B Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. It is not known to be a direct cause of the disease. Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease process in and of itself. Asking the client what the doctor has said is an evasive response on the part of the nurse and does not help answer the client's question.
A client with peptic ulcer disease asks the nurse whether a maternal history of gastric cancer will cause the client to develop gastric cancer. What is the nurse's best response? A. "Yes, it is known that a family history of gastric cancer will cause someone to develop gastric cancer." B. "If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." C. "Have you spoken to your health care provider about your concerns?" D. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."
B Genetic counseling will help the client determine whether he or she is at exceptionally high risk to develop gastric cancer. The client cannot know for certain whether family history places him or her at exceptionally high risk to develop gastric cancer unless specific testing is done. Asking the client what the provider has said is an evasive answer by the nurse and does not help answer the client's question. Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.
The nurse is teaching a client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? A. "I will need to avoid sweetened fruit juice beverages." B. "I can eat ice cream in moderation." C. "I cannot drink alcohol at all." D. "It is okay to have a serving of sugar-free pudding."
B Milk products such as ice cream must be eliminated from the diet of the client with dumping syndrome. The client with dumping syndrome can no longer consume sweetened drinks. Alcohol must be eliminated from the diet. The client can eat sugar-free pudding, custard, and gelatin with caution.
The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and then daily. D. Insert a nasogastric tube and connect to low intermittent suction.
B The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia. A type and crossmatch, administration of pantoprazole, and insertion of a nasogastric tube must all be done, but the nurse's immediate concern is correcting the client's hypovolemia.
Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast? A. Arthroscopy B. Computed tomography (CT) C. Electromyography (EMG) D. Tomography
B. Computed tomography (CT)
Care of the older adult may be affected by which physiologic change in the musculoskeletal system? A. Regeneration of cartilage B. Decreased range of motion (ROM) C. Increased bone density D. Narrower gait
B. Decreased range of motion (ROM)
When teaching a patient about pernicious anemia, which statement does the nurse include? A. Patients with pernicious anemia are not able to digest fats B. Pernicious anemia results in a deficiency of vitamin B12 C. all patients with gastrointestinal bleeding will eventually develop pernicious anemia D. Oral iron supplements are an effective treatment for pernicious anemia
B. Pernicious anemia results in a deficiency of vitamin B12
Which statements about gastritis are accurate? (select all that apply) A. The diagnosis of gastritis is made solely on clinical symptoms B. The onset on infection with Helicobacter pylori can result in acute gastritis C. Long-term use of acetaminophen (Tylenol) is a high risk factor for acute gastritis D. Atrophic gastritis is a form of chronic gastritis that is seen most in older adults E. Type B chronic gastritis affects the glands in the antrum, but may affect all of the stomach
B. The onset on infection with Helicobacter pylori can result in acute gastritis D. Atrophic gastritis is a form of chronic gastritis that is seen most in older adults E. Type B chronic gastritis affects the glands in the antrum, but may affect all of the stomach
The nurse is teaching a patient about ranitidine (Zantac) prescribed for gastritis. Which statement by the patient indicates effective teaching by the nurse? A. The drug will heal the areas of stomach that are sore B. This drug will block the secretions of my stomach C. Zantac will coat the inside of my stomach to protect it from acid D. This pill kills the bacterial infection I have in my stomach
B. This drug will block the secretions of my stomach
The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider? A. Knee pain at a level of 9 (0-to-10 scale) B. Warm, red, and swollen knee C. Allergy to shellfish and iodine D. Previous surgery on the other knee
B. Warm, red, and swollen knee
The nurse is assessing a client with Paget's disease. Which assessment finding leads the nurse to notify the health care provider immediately?
Base of the skull is enlarged with changes in vital signs.
A client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client? A. "It is normal to feel depressed at times about your condition. You have my support." B. "You could exercise more often to build up your strength and endurance." C. "How do you feel about the pain in your spine? I am here if you want to talk." D. "What does your family say to you? Try talking to them."
C. "How do you feel about the pain in your spine? I am here if you want to talk."
The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "I should avoid alcohol and tobacco." D. "I should eat small meals about six times a day."
C. "I should avoid alcohol and tobacco."
Which client information is most essential for the nurse to report to the health care provider before a client with knee pain undergoes magnetic resonance imaging (MRI)? A. Daily use of aspirin B. Swollen and tender knee C. Presence of a permanent pacemaker D. History of claustrophobia
C. Presence of a permanent pacemaker
When phosphorsu intake is high what mineral is lost more rapidly?
Calcium
What affects bone growth and metabolism?
Calcium, Phosphorus, Calcitonin, Vitamin D, Parathyroid hormone (PTH), Growth hormone, Glucocorticoids, Estrogen and androgens, Thyroxine, Insulin
arthroscopy
Can be a diagnostic test or surgical procedure. Tube is inserted into the joint for visualization of ligaments, menisci, and articular surfaces of the joint. Pt must be able to move joint. Informed consent.
Hypoglycemia
Cause: Too much insulin or excessive exercise Occurrence: Blood Glucose below 70mg/dL S/S: Sweating, irritability, tremors, anxiety, tachycardia, hunger Dangerous Low Levels: Confusion, paralysis, seizure and coma Tx Mild Hypoglycemia: ½ cup of fruit juice, ½ cup of regular soft drink, 6-10 hard candies, 4 cubes of sugar, 4 teaspoon of sugar, 1 tablespoon of honey/syrup Moderate Hypoglycemia: 15-30g of rapidly absorbed carbohydrate & low-fat milk or cheese 10 mins after Severe Hypoglycemia: 1mg glucagon IM or SubQ, second dose if still unconscious
Which descriptors are typical of type 2 diabetes mellitus (DM)?
Cells have decreased ability to respond to insulin Most patients diagnosed with are obese adults
A client who had a long-leg cast applied last week reports to the clinic nurse, "I can't seem to catch my breath and I feel a bit lightheaded." Which is the priority action of the nurse?
Check the client's pulse oximetry and arrange emergency transfer to the hospital.
A nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system? A. "Volkmann's canals connect osteoblasts and osteoclasts." B. "In the deepest layer of the periosteum is the cortex, which consists of dense, compact bone tissue." C. "The matrix of the bone is where deposits of calcium and magnesium are present." D. "Hematopoiesis occurs in the red marrow, which is where blood cells are produced."
D. "Hematopoiesis occurs in the red marrow, which is where blood cells are produced."
Which type of nonsteroidal antiinflammatory (NSAID) drug is less likely to cause mucosal damage to the stomach? A. Ibuprofen B. Asprin C. Acetaminophen D. Celecoxib
D. Celecoxib
The nurse is conducting a musculoskeletal history in an older adult client who requires a caregiver to perform all activities of daily living (ADLs). Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns? A. Level 0 B. Level II C. Level III D. Level IV
D. Level IV
The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg
D A decrease in blood pressure is the most indicative sign of bleeding. A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding.
A client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? A. Explain to the client the importance of drinking the enteral supplements prescribed. B. Ask the client's family to try to persuade the client to drink the supplements. C. Inform the client that a nasogastric tube may be necessary if he or she fails to comply. D. Ask the client if a change in flavor would make the supplement more palatable.
D Asking the client if a change in flavor would help shows that the nurse is attempting to determine why the client is not drinking the supplements. Many clients don't like certain supplement flavors. The nurse should not assume that the client does not understand the importance of drinking the supplements or that the client requires persuasion to drink the supplements. The problem may be entirely different. Telling the client that a nasogastric tube may be necessary could be construed as threatening the client.
A client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test? A. "It will be important to lie still in a reclined position for 20 minutes." B. "Do not eat or drink for 8 hours before the test." C. "You can have the MRI if you have an internal pacemaker." D. "All jewelry and clothing with zippers or metal fasteners must be removed."
D. "All jewelry and clothing with zippers or metal fasteners must be removed."
The ambulatory surgery postanesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first? A. Young adult client who has been in the PACU for 30 minutes after left knee arthroscopy under local anesthesia B. Adult client who had a synovial biopsy of the right knee under local anesthesia and has been in the PACU for 20 minutes C. Adult client who has multiple right knee incisions for repair of torn cartilage and arrived in the PACU an hour ago D. Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia
D. Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia
The charge nurse in the hospital-based day surgery center is making client assignments for the staff. Which client is most appropriate to assign to a nurse who has floated from the general surgical unit? A. Young adult who has just been admitted for surgery after sustaining an ankle fracture B. Adult who needs teaching about quadriceps-setting exercises after knee arthroscopy C. Middle-aged adult who will require a pneumatic tourniquet applied before knee surgery D. Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia
D. Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia
The nurse is reviewing the medication history for a client scheduled for a left total hip replacement. The nurse plans to contact the health care provider if the client is taking which medication? A. Acetaminophen (Tylenol) for pain relief B. Bupropion (Wellbutrin) for smoking cessation C. Magnesium hydroxide (Milk of Magnesia) to treat heartburn D. Prednisone (Deltasone) to treat asthma
D. Prednisone (Deltasone) to treat asthma
The nurse is teaching a patient being discharged home about taking prescribed medications that include sucralfate (Carafate). Which statement by the patient indicates teaching has been effective? A. The main side effect sucrlafate is diarrhea B. I will take sucralfate with meals C. I will take sucralfate along with the antacid medication I take D. Sucraflate works to heal my ulcer
D. Sucraflate works to heal my ulcer
Which client assessment information is correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C.Hematemesis and anorexia D. Treatment with radiation therapy
D. Treatment with radiation therapy all other options are acute
The nurse is caring for a patient who vomited coffee ground blood. Where does the nurse suspect the patient is bleeding? a. colon b. rectum c. small intestine d. upper GI system
D. upper GI system
The nurse is caring for a diabetic patient in the ED. The patient's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. What complication does the nurse suspect?
DKA
The relationship of osteoporosis to nutrition is well established:
Excessive caffeine in the diet can cause calcium loss in the urine. A diet lacking enough calcium and vitamin D stimulates the parathyroid gland to produce parathyroid hormone (PTH). Malabsorption of nutrients in the GI tract also contributes to low serum calcium levels.
A client asks the nurse how an infection such as H. pylori can cause gastric ulcers. What does the nurse tell the client about this organism? It causes direct damage to the gastric mucosa. It produces an enzyme that alters the pH of the gastric environment. It reduces the function of the pyloric sphincter, causing reflux. It secretes acid that reduces the integrity of the mucosal barrier
H. pylori secretes urease, which produces ammonia, causing the gastric environment to become alkaline. This causes the release of hydrogen ions and increased acid, which causes mucosal damage. The organism does not damage the mucosa directly or secrete acid. It does not affect pyloric sphincter function.
The nurse is caring for a client with rheumatoid arthritis. For which condition does the nurse assess most carefully?
Hallux valgus
plantar fasciitis treatment
rest, ice, stretching exercises, strapping of the foot to maintain arch support, shoes with good support and orthotics. NSAIDs or steroids.
A client with a duodenal ulcer receives an order for pantoprazole (Protonix) tablets. The client has a small-bore nasogastric (NG) tube. Which action by the nurse is appropriate? Contact the provider to discuss giving omeprazole or lansoprazole instead. Crush the tablet and dissolve in solution to give through the NG tube. Dissolve the tablet in orange juice and administer through a large-bore NG tube. Request an order for an intravenous proton-pump inhibitor medication.
Pantoprazole should not be crushed before administration, since it is designed to dissolve after passing through the stomach. Omeprazole and lansoprazole may be dissolved and given through any size NG tube. If oral medications cannot be used, an intravenous medication may be ordered.
The nurse is caring for a client with peptic ulcer disease (PUD). What signs and symptoms in the client suggest a surgical emergency? Select all that apply. Black, tarry stool Vomiting of bright red or coffee-ground blood Sudden, sharp pain in the mid epigastrium Tender, rigid, board-like abdomen Assuming the knee-chest position
Perforation of a peptic ulcer is a life-threatening surgical emergency. Perforation causes a sudden, sharp pain in the mid epigastric region. The client becomes apprehensive and the abdomen becomes tender, rigid, and board-like. To decrease the tension of the abdominal muscles, the client usually assumes a knee-chest position. Black, tarry stool or melena and vomiting blood (hematemesis) are common symptoms of PUD, but they do not indicate a surgical emergency.
Bishophonates alendronate ( Fosamax) Risedronate (Actonel) Ibandronate (Boniva) Zoledronic Acid ( Reclast, Zometa)
Preventing bone loss and increasing bone density alendronate ( Fosamax) Risedronate (Actonel) Ibandronate (Boniva) Zoledronic Acid ( Reclast, Zometa)
_____________________________ is more common and occurs in postmenopausal women and in men(decreasing levels of testosterone [which builds bone] and altered ability to absorb calcium) in their 70s and 80s.
Primary Osteroporosis
female considerations: Osteoporosis
Primary osteoporosis most often occurs in women after menopause as a result of decreased estrogen levels. Women lose about 2% of their bone mass every year in the first 5 years after natural or surgical (ovary removal) menopause. Obese women can store estrogen in their tissues for use as necessary to maintain a normal level of serum calcium.
Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Document instructions for a client with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a client who has arrived from the postanesthesia care unit (PACU) after a laparoscopic gastrectomy.
Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.
A client has severe Paget's disease. Which factor has the highest priority when the nurse intervenes in the care of this client?
Relief of pain
_____________________________ may result from other: hyperparathyroidism; long-term drug therapy, such as with corticosteroids; or prolonged immobility, such as that seen with spinal cord injury.
Secondary Osteoporosis
Antidiabetic PO Drugs
•Insulin Secretogogues •Sulfonylurea Agents •Meglitinide Analogs •Biguanides •Insulin Sensitizers •Alpha-Glucosidate Inhibitors •Incretin Mimetics •DPP-4 Inhibitors •Amylin Analogs •Sodium-Glucose Co-transport Inhibitors
The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a need for further teaching? "I need to avoid drinking coffee in the morning when I get to work." "I will not need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day."
The client should not eat six small meals daily as no evidence supports the theory that eating six meals daily promotes healing of the ulcer. This practice may actually stimulate gastric acid secretion. The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia.
A patient with type 2 DM, usually controlled with a second-generation sulfonylurea, develops a urinary tract infection. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse relay to the patient?
The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears.
Which is the priority nursing action for the client with a stress ulcer? Evaluating heart rate and blood pressure Maintaining a calm, stress-free environment Monitoring and treating gastric pain Preventing nausea and vomiting
The main manifestation of acute stress ulcers is bleeding caused by gastric erosion. The nurse should monitor for signs of bleeding, including heart rate and blood pressure. Stress ulcers are triggered by acute medical crises, trauma, and anxiety, but monitoring for bleeding is more important. Monitoring and treating pain, and preventing nausea and vomiting are not priority actions.
A patient will be using an external insulin pump. What does the nurse tell the patient about the pump?
The needle must be changed every two to three days.
hypercalcemia
metastatic cancers of the bone; paget's disease' bone fractures in healing stage
elevation of ALP
metastatic cancers of the bone; paget's disease; osteomalacia
A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.
a. Administer another half-cup of orange juice.
A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take? a. Document the finding in the client's chart. b. Administer a bolus of regular insulin IV. c. Call the surgeon to cancel the procedure. d. Draw blood gases to assess the metabolic state.
a. Document the finding in the client's chart.
left lower quadrant contains
part of the descending colon, sigmoid colon, left ureter, left ovary and fallopian tube, left spermatic cord
A patient develops an active upper GI bleed. Which are the priority actions the nurse takes for caring for this patient? (select al that apply) a. provide oxygen b. start 1 and 2 large-bore IV lines c. Prepare to infuse 0.9% normal saline solution d. monitor serum electrolytes e. prepare for nasogastric tube insertion
a. provide oxygen b. start 1 and 2 large-bore IV lines c. Prepare to infuse 0.9% normal saline solution e. prepare for nasogastric tube insertion
Peak bone mass is achieved by
about 30 years of age.
problems that affect nutrition
anorexia, dysphagia, dyspepsia • patient socioeconomic status
herbal preparations such as ayuvedic affect
appetite absorption and elimination
A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has depression and is taking this drug. Do you think I'm depressed?" How should the nurse respond? a. "Many people with long-term diabetes become depressed after a while." b. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?" c. "This antidepressant also has anti-inflammatory properties for diabetic pain." d. "No. Many medications can be used for several different disorders."
b. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?"
A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond? a. "Following the drug regimen more closely would have prevented this." b. "One acute rejection episode does not mean that you will lose the new organs." c. "Dialysis is a viable treatment option for you and may save your life." d. "Since you are on the national registry, you can receive a second transplantation."
b. "One acute rejection episode does not mean that you will lose the new organs."
After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I need to have an annual appointment even if my glucose levels are in good control." b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." c. "I can still develop complications even though I do not have to take insulin at this time." d. "If I have surgery or get very ill, I may have to receive insulin injections for a short time."
b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick."
A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? a. "Glucose is the only fuel used by the body to produce the energy that it needs." b. "Your brain needs a constant supply of glucose because it cannot store it." c. "Without a minimum level of glucose, your body does not make red blood cells." d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."
b. "Your brain needs a constant supply of glucose because it cannot store it."
A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? a. 0800 b. 1600 c. 2000 d. 2300
b. 1600.
The nurse correlates which laboratory value with inadequate functioning of a transplanted pancreas? a. Total white blood cell count 5000/mm3 b. 50% decrease in urine amylase level c. Blood urea nitrogen 30 mg/dL d. Elevated bilirubin level
b. 50% decrease in urine amylase level
change in bowel movement information from patient
pattern, color and consistency of feces, occurrence of diarrhea or constipation, effective action taken to relieve diarrhea or constipation, presence of Frank blood or tarry stool, presence of adominal distention or gas
large amount of NSAIDs can lead to
peptic ulcer disease and GI bleeding
Plantar fasciitis
inflammation of the plantar fascia, located in the area of the arch of the foot. Middle aged, older adults, athletes, & obesity. Worse with weight bearing.
secretin
is a hormone that inhibits further acid production in decreases gastric motility
esophagogastroduodenoscopy(EGD)
is a visual examination of the esophagus stomach and duodenum have patient remain NPO for 6 to 8 hours before after test take Vital Signs every 30 minutes until sedation begins to wear off NPO until gag reflex returns usually in 30 to 60 minutes have someone drop patient home teach patient sore throat or hoarse voice May persist for several days after the test throat lozenge can be used
Peripheral quantitative ultrasound (pQUS)
is an effective and low-cost peripheral screening tool that can detect osteoporosis and predict risk for hip fracture. The heel, tibia, and patella are most commonly tested. The procedure requires no special preparation, is quick, and has no radiation exposure or specific follow-up care.
Who is at risk for paget's disease
is seen more frequently in people ages 50 years and older and in those of European heritage. Risk increases 80 years old and older. Men are affected twice as often.
left upper quadrant contains
left left lobe of liver, stomach, spleen, body and tell the pancreas, splenic flexure of colon, part of transverse and descending colon
inspection of abdomen
make sure the patients bladder is empty STAAR assessment on right side overall asymmetry of ab presence of discoloration or scarring AB distension bulging flanks taut and glistening skin
Musculoskeletal manifestation of Paget's disease
• Bone and joint pain (may be in a single bone) that is aching, poorly described, and aggravated by walking • Low back and sciatic nerve pain • Bowing of long bones (legs and arms) - flexion contracture in hip joint. • Loss of normal spinal curvature • Enlarged, soft, thick skull. • Pathologic fractures • Osteogenic sarcoma (bone cancer)
Factors Contributing to Decreased Lower Esophageal Sphincter Pressure
• Caffeinated beverages, such as coffee, tea, and cola • Chocolate • Citrus fruits • Tomatoes and tomato products • Smoking and use of other tobacco products • Calcium channel blockers • Nitrates • Peppermint, spearmint • Alcohol • Anticholinergic drugs • High levels of estrogen and progesterone • Nasogastric tube placement
causes of secondary osteoporosis related to drugs (chronic use)
• Corticosteroids • Anti-epileptic drugs (AEDs) (e.g., phenytoin) • Barbiturates (e.g., phenobarbital) • Ethanol (alcohol) • Drugs that induce hypogonadism (decreased levels of sex hormones) • High levels of thyroid hormone • Cytotoxic agents • Immunosuppressants • Loop diuretics • Aluminum-based antacids
Causes of secondary Osteoporosis (Disease/Conditions)
• Diabetes mellitus • Hyperthyroidism • Hyperparathyroidism • Cushing's syndrome • Growth hormone deficiency • Metabolic acidosis • Female hypogonadism • Paget's disease • Osteogenesis imperfecta • Rheumatoid arthritis • Prolonged immobilization • Bone cancer • Cirrhosis • HIV/AIDS • Chronic airway limitation
Rolling hernias/ Paraesophageal hernias
• Feeling of fullness after eating • Breathlessness after eating • Feeling of suffocation • Chest pain that mimics angina • Worsening of manifestations in a recumbent position
Key features of Chronic Osteomyelitis
• Foot ulcer(s) (most commonly) • Sinus tract formation • Localized pain • Drainage from the affected area
Priority Concepts of diabetes
• GLUCOSE REGULATION • TISSUE INTEGRITY • SENSORY PERCEPTION • PERFUSION • INFECTION • PAIN • NUTRITION
Esophageal Cancer: Nonsurgical Interventions
• Nutrition therapy: prevent weight loss secondary to dysphagia) • Swallowing therapy (monitor S/S of aspiration) • Chemotherapy (only moderately effective alone) • Radiation therapy: palliation of symptoms by shrinking the tumor) • Chemoradiation (best chance of cure) • Targeted therapies: drugs interfere w/ cancer cell growth • Photodynamic therapy: Light activates the Photofrin, destroying only cancer cells • Esophageal dilation: temporary but immediate relief of dysphagia, sometimes with stents • Endoscopic therapies: laser therapy or electrocoagulation (pallative measure)
Esophageal Tumors: Symptoms
• Persistent and progressive dysphagia (most common feature) • Feeling of food sticking in the throat • Odynophagia (painful swallowing) • Severe, persistent chest or abdominal pain or discomfort • Regurgitation • Chronic cough with increasing secretions • Hoarseness • Anorexia • Nausea and vomiting • Weight loss (often more than 20 pounds) • Changes in bowel habits (diarrhea, constipation, bleeding)
Postoperative Instruction: Laparoscopic Nissen Fundoplication (LNF) or Paraesophageal Repair via Laparoscope
• Stay on a soft diet for about a week, -avoid carbonated beverages, tough foods, and raw vegetables that are difficult to swallow. • Remain on anti-reflux medications as prescribed for at least a month. • Do not drive for a week after surgery; do not drive if taking opioid pain medication. • Walk every day, but do not do any heavy lifting. • Remove small dressings 2 days after surgery, and shower; do not remove Steri-Strips until 10 days after surgery. • Wash incisions with soap and water, rinse well, and pat dry; report any redness or drainage from the incisions to your surgeon. • Report fever above 101° F (38.3° C), nausea, vomiting, or uncontrollable bloating or pain. For patients older than 65 years, report elevations above 100° F (37.8° C). • Schedule an appointment for follow-up with your surgeon in 3 to 4 weeks.
Acute Complications of DM
•Diabetic Ketoacidosis (DKA): Lack of insulin and ketosis •Hyperglycemic-hyperosmolar state (HHS): Insulin deficiency and profound dehydration •Hypoglycemia: Too much insulin or too little glucose
Exercise for DM
•Exercise helps with reduce insulin requirement and also help increase insulin sensitivity •Moderate weight loss •150 minutes per week or minimum 30 mins/day, 4 times/week
Treatment Goals for DKA & HHS
•Improve circulatory volume and tissue perfusion •Gradually reduce serum glucose and plasma osmolarity •Correction of electrolyte imbalance •For DKA, steady resolution of ketosis •Identify and prompt treatment of co-morbid precipitating cause
Risk Factors for Type 2 DM
•Waist Circumference: 40+ inches for men or 35+ inches for women •Fasting Blood Glucose: 100mg/dL+ •A1C: 5.5%-6% (6.5% = DM 2) •Blood Pressure: 130mmHg+ diastolic and/or 85mmHg+ for diastolic •Cholesterol Triglyceride: 150mg/dL+ HDL: 40mg/dL or less for men or 50mg/dL or less for women
large intestine
•functions are movement, absorption, and elimination • main function is elimination • absorbs water and electrolytes to reduce fluid volume of chyme
small intestine
•three main functions are movement, digestion, and absorption •its main function is absorption •intestinal enzymes Aid in the digestion of proteins carbohydrates and lipids