NURS4121: Exam Review
An IV hydrocortisone infusion is started before a client is taken to surgery for a bilateral adrenalectomy. Which rationale should the nurse explain to the client for the IV infusion?
-provide substances to respond to stress after removal of the adrenal gland
The nurse is planning care for a patient with diabetes insipidus (DI). Which intervention made by the nurse requires correction?
-restricting fluids at night
Which dietary selection made by the patient indicates understanding of previously taught dietary principles associated with having viral hepatitis?
-salad, sliced chicken, Jello -we want carbs, moderate protein, and fat content
The nurse is caring for a patient who is positive for hepatitis A. Which precautions would the nurse take?
-use gloves when removing the bedpan
A 50 y/o male was involved in an MVA. What is the priority action?
assess ABCs
Why does hypovolemic shock occur in burn patients?
burns cause a massive fluid shift due to capillary permeability
In the oliguric phase of AKI, what should the nurse assess for?
pulmonary edema - we are worried about HTN and fluid overload
What finding will the nurse expect when analyzing the cardiac rhythm for a patient with first degree atrioventricular (AV) block?
every P wave is conducted to the ventricles
A 42 y/o male has partial thickness, circumferential burns on his right arm, and superficial burns on his chest. What is a potential complication?
infection
The nurse is caring for a patient with the following arterial blood gas values: pH 7.37, PCO2 35 mmHg, HCO3 24. These findings indicate that the patient is experiencing what condition?
normal acid-base balance
What clinical finding would the nurse expect to identify when completing a nursing admission history and physical on a patient with suspected hyperthyroidism?
palpitations, tachycardia, and thickened skin
The nurse is taking care of a patient with cirrhosis of the liver and ascites. Which lunch is an appropriate choice for a patient with this disorder?
penne pasta, spinach, banana, and decaf iced tea - moderate to low fat and low sodium intake
Why would the nurse plan an AKI patient's care based on excess fluid volume?
pitting edema in lower limbs
A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 BPM. If the bradycardia is symptomatic, which of the following findings should the nurse expect the patient to exhibit?
-SOB
A patient has a diagnosis of acute myocardial infarction, and his cardiac rhythm is sinus bradycardia with six to eight premature ventricular contractions (PVCs) per minute. The pattern that the nurse recognizes as the most characteristic of PVCs is which of the following?
-a wide, distorted QRS complex
The nurse is caring for a patient with Addison's disease. Which dietary instruction would the nurse provide?
-add extra salt to food
The nurse is providing discharge instructions to a patient diagnosed with cirrhosis and varices. Which information would the nurse include in the teaching session?
-avoiding aspirin -avoid tylenol -avoid coughing, sneezing, and straining to have a BM
When assessing a patient with Graves disease, which clinical data would the nurse expect to find in the patient's history?
-diaphoresis
Which type of hepatitis develops into a chronic form of the disease?
-hepatitis B, C, D
Which symptom would the nurse monitor for in a patient with Addison's disease?
-hypoglycemia
A patient is admitted with a head injury and has large amounts of clear, colorless urine draining from the urinary catheter. Which physiological response is possibly causing the increased urine output?
-inadequate ADH secretion
A patient in the coronary care unit (CCU) develops ventricular fibrillation. Which action should the nurse take first?
-initiate CPR, then defibrillator, then life saving drugs
Which is a nursing responsibility during a 24-hour urine collection for a patient with the diagnosis of Addison's disease?
-keep the patient quiet and reduce stress to prevent cortisol, which could skew results
Which information about a patient's condition would the nurse consider when providing care to a patient who just received radioactive iodine for Grave's disease?
-mildly radioactive and should be treated with routine safety precautions
A health care team is caring for a patient with diabetes insipidus. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective patient care?
-monitoring urine output -administering oral rehydration medication
Which sign would the nurse expect to observe in a patient with small cell carcinoma of the lung who develops syndrome of inappropriate antidiuretic hormone (SIADH)?
-oliguria -seizures -vomiting
A patient with advanced cirrhosis with ascites is short of breath & has an increased respiratory rate. Which of the following actions should the nurse implement?
-place the client in Fowler's position to relieve pressure on the diaphragm
Which interventions would the nurse implement when caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
-provide frequent oral care -initiate fall risk precautions -monitor for and report neuro changes
Hepatitis A Case Study: A 30 y/o male has general fatigue, lack of appetite, headache, and a yellowish complexion. His symptoms became progressive over the past few days. One month ago he was in Mexico and ate a lot of seafood. Physical exam shows enlarged tender liver and jaundice. 1. What type of hepatitis does he have? 2. How did he get infected? 3. What is the treatment? 4. What is the priority for his care? 5. What teaching should the nurse give?
1. A 2. contaminated food 3. supportive treatment as long as symptoms don't worsen 4. know who he has been in contact with, what is symptoms are, nutrition education, adequate fluid, rest to decrease metabolic load, and assess other dysfunctions such as clotting factors 5. vaccine, nutrition, rest, health promotion teaching to prevent another incident
Cushing Syndrome Case Study: A 60 y/o man is having COPD exacerbations related to smoking. He has been on home O2 for years and began oral steroid therapy 10 months ago. Assessment: BP 180/94, striae over his trunk and thighs, full looking face, and truncal obesity with supraclavicular and posterior upper back fat with thin extremities. 1. What syndrome has he developed? 2. What is the most probable cause of this change? 3. What is his primary nursing management? 4. In case of memory alteration, what can the nurse do to promote medication adherence?
1. Cushing syndrome 2. oral steroids, too high dosage 3. decrease dosage, and teach about diagnosis and oral steroids 4. alarms, pill organizers, educate on the importance of medication
Hepatitis Case Study: A 35 y/o woman is in a hepatic coma. She denies alcohol use of more than 90 mL/day. Records show progressive weakness, weight loss, anorexia, jaundice, edema, ascites, and mental disorientation. She is stuporous and hypotensive on admission and is twitching. She is thin, malnourished, has ascites, and has edema on lower extremities. Her liver and spleen are palpable, jaundice and spider angiomas are present. There is evidence of bruising throughout the body. 1. What clinical manifestations of cirrhosis does she have? 2. Explain the results of her diagnostic findings. 3. What is the priority for her care? 4. What client and family teaching is essential?
1. alcoholic cirrhosis 2. poor liver function 3. prevent further liver damage, manage ascites with diuretics and sodium restrictions, keep an eye on neuro status, lactulose, and supportive care such as frequent repositioning 4. referral to social work, skin and wound healing
Hypothyroidism Case Study: A 38 y/o woman is complaining of overwhelming fatigue not relieve by rest. She attends school and is very sedentary. She is exhausted and has trouble with school. Her face is puffy, and her skin is dry and pale. She is dressed in too many layers for the warm weather. She also complains of general body aches with frequent muscle cramps and constipation. Vitals: BP 142/84, HR 52, RR 12, temp 36. 1. What are some possible causes of her symptoms? 2. What can the nurse tell her about treatment and follow up? 3. What teaching will the nurse provide?
1. depression, anemia, cardiac disease, electrolyte imbalances, dehydration, allergies 2. synthroid needs to be taken every day for the rest of her life 3. low calorie diet, synthroid takes a while to normalize levels, constipation may occur, and hyperthyroidism can occur if too much medication is taken
AFIB Case Study: A 45 y/o woman enters the ER with sudden onset of palpitations and SOB. ECG shows AFIB with a rapid ventricular response (HR is 168 BPM). She has no previous history of acute cardiac problems. An emergent cardioversion is planned because the person is young and has no cardiac history. 1. What are some teaching points before the procedure? 2. What treatments are available if the procedure is unsuccessful? 3. What risks does sustained atrial fibrillation pose, and how can this information be helpful in ensuring adherence to a treatment plan?
1. quick procedure, will be sedated, explain what a cardioversion is 2. calcium channel blockers and beta blockers 3. loss of atrial kick, thrombus formation, stroke
What would the nurse expect to see when assessing a patient with a primary brain tumour who has developed SIADH?
vomiting, increased weight, decreased serum sodium, and decreased LOC
A patient with AKI asks if they will need a kidney transplant. What should the nurse respond?
your condition can be reversed with proper treatment and usually won't destroy the kidney
