Pernicious anemia, PUD, gastritis, hep
A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? A.Acute asthma B.Chronic bronchitis C.Pneumonia D.Spontaneous pneumothorax
A spontaneous pneumothorax occurs when the client's lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.
which serum test indicates increase in presence of cholestasis, blocked bile ducts
ALP
what serum test detects liver injury or damage and heptatocellular necrosis?
ALT (Serum Glutamic-Pyruvic Transaminase)
what serum test detects bile duct blockage and is used to monitor treatment for liver disorders.
AST
Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find: A.A flushed face B.Dyspnea and pain C.Decreased temperature D.Severe cough and no pain
Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clients become short of breath, have a high temperature, and usually experience severe pain but do not have a severe cough (4). The shortness of breath is a result of decreased oxygen-carbon dioxide exchange at the alveolar level.
The nurse implements which of the following for the client who is starting a Schilling test? a.Administering methylcellulose (Citrucel) b.Starting a 24- to 48 hour urine specimen collection c.Maintaining NPO status d.Starting a 72 hour stool specimen collection
B Urinary vitamin B12 levels are measured after the ingestion of radioactive vitamin B12. A 24-to 48- hour urine specimen is collected after administration of an oral dose of radioactively tagged vitamin B12 and an injection of non-radioactive vitamin B12. In a healthy state of absorption, excess vitamin B12 is excreted in the urine; in a malabsorption state or when the intrinsic factor is missing, vitamin B12 is excreted in the feces. Citrucel is a bulk-forming agent. Laxatives interfere with the absorption of vitamin B12. The client is NPO 8 to 12 hours before the test but is not NPO during the test. A stool collection is not part of the Schilling test. If stool contaminates the urine collection, the results will be altered.
A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? a. Assess for potential abuse b. Check for diminished sensations c. Document the findings d. Clean and dress the area
B. Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain. The burn could be related to abuse, but this conclusion would require more supporting data. The findings should be documented, but the nurse would want to address the client's sensations first. The decision of how to treat the burn should be determined by the physician.
The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? a. Schilling's test, elevated b. Intrinsic factor, absent c. Sedimentation rate, 16 mm/hour d. RBCs 5.0 million
B. The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.
Basilar crackles are present in a client's lungs on auscultation. The nurse knows that these are discrete, non continuous sounds that are: A.Caused by the sudden opening of alveoli B.Usually more prominent during expiration C.Produced by airflow across passages narrowed by secretions D.Found primarily in the pleura.
Basilar crackles are usually heard during inspiration and are caused by sudden opening of the alveoli.
Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified? A.Serosanguineous drainage from the puncture site B.Increased temperature and blood pressure C.Increased pulse and pallor D.Hypotension and hypothermia
C Increased pulse and pallor are symptoms associated with shock. A compromised venous return may occur if there is a mediastinal shift as a result of excessive fluid removal. Usually no more than 1 L of fluid is removed at one time to prevent this from occurring
Tests for Hep C
ELISA test- initial screening for HCV antibodies RIBA HCV PCR RNA- confirms active virus and load OraQuick HCV antibody test- quick diagnosis
A member of the clinic housekeeping staff experiences a needlestick by a contaminated needle. Which of the following should be administered by the healthcare provider to provide the patient with passive immunity against the hepatitis B virus? Please choose from one of the following options. Interferon Hepatitis B immune globulin (HBIG) Antiviral medication Hepatitis B vaccine
Hep B vaccine
how do we confirm if hep A is found?
If (antibodies) anti-HAV is found
A person with hepatitis has ______ than normal PT and PTT levels
Longer- causing hemostasis
Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: .a sedentary lifestyle and smoking. a history of hemorrhoids and smoking alcohol abuse and a history of acute renal failure alcohol abuse and smoking
Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: call the physician place saline-soaked sterile dressings on the wound take a blood pressure and pulse pull the dehiscence closed
The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.
The most reliable index to determine the respiratory status of a client is to: A.Observe the chest rising and falling B.Observe the skin and mucous membrane color. C.Listen and feel the air movement D.Determine the presence of a femoral pulse
To check for breathing, the nurse places her ear and cheek next to the client's mouth and nose to listen and feel for air movement. The chest rising and falling (1) is not conclusive of a patent airway. Observing skin color (2) is not an accurate assessment of respiratory status, nor is checking the femoral pulse.
A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: place the client in a private room wear a mask when handling the client's bedpan wash the hands after touching the client wear a gown when providing personal care for the client
To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: yellow sclera light amber urine circumoral pallor black, tarry stools
Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
A patient with a diagnosis of lung cancer is receiving chemotherapy and reports nausea and loss of appetite resulting in decreased food intake. What should the healthcare provider recommend to promote adequate nutrition? Advise the patient to: Please choose from one of the following options. Eat small meals throughout the day. Eat only when feeling hungry. Eat only favorite foods to increase appetite. Eat large meals but less frequently throughout the day.
a
Which of the following blood components is decreased in anemia? a.Erythrocytes b.Granulocytes c.Leukocytes d.Platelets
a Anemia is defined as a decreased number of erythrocytes (red blood cells). Leukopenia is a decreased number of leukocytes (white blood cells). Thrombocytopenia is a decreased number of platelets. Lastly, granulocytopenia is a decreased number of granulocytes (a type of white blood cells)
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Endoscopy Upper GI series Hemoglobin (Hb) levels and hematocrit (HCT) Arteriography
a Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren't always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.
A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? Notify the physician Reposition the tube Irrigate the tube Increase the suction level
a. An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
The healthcare provider is caring for a postoperative patient who has undergone a lobectomy. The plan of care will include positioning the patient: Please choose from one of the following options. Supine in high Fowler's position. Laying on the non-operative side. Laying on the operative side. Supine with the head of the bed flat.
b
When caring for a patient receiving intravenous chemotherapy for lung cancer, the healthcare provider will plan to administer the prescribed antiemetic to the patient: Please choose from one of the following options. One half hour after the infusion has started. Before starting the infusion. When the patient complains of nausea. One hour after the infusion is complete.
b
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? a."The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." b."The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." c."The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." d."The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."
b Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of RBCs in this condition.
orange/yellow pigment waste product produced by breakdown of heme which is a component of hemoglobin.
bilirubin
how do we confirm HBV?
by a presence of Hep B Anti-HBsAg IgM
The primary purpose of the Schilling test is to measure the client's ability to: a.Store vitamin B12 b.Digest vitamin B12 c.Absorb vitamin B12 d.Produce vitamin B12
c. Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.
The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? a.Whole grains b.Green leafy vegetables c.Meats and dairy products d.Broccoli and Brussels sprouts
c. Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin c)
Acute liver failure secondary to viral hepatitis that can ultimately lead to accelerated liver failure and death unless a liver transplant is available
fulminant hep
Indicator of HDV infection
identification of intrahepatic delta antigen or rise in Anti HDV(hepatitis D virus antibodies)
how do we indicate if a person has been vaccinated against HBV
if they have a positive HBsAg
the presence of igG antibodies indicate what?
previous infection of HAV and provides permanent immunity
indicator of HEV infection
reserved for travelers or if hep E is present but virus cannot be detected. Only Hep E antibodies are found w/ people infected with HEV
