test 4

A client's stroke volume (SV) is 85mL/beat and the heart rate (HR) is 71 beats per minute (bpm). What is the client's cardiac output (CO) rounded to the nearest liter?

6 Liters (L) Explanation: CO = SV × HR 85mL = 0.085 L CO = 0.085 × 71 = 6.035 = 6 L

Which two areas are the most likely locations for a gastric ulcer to develop? Select all that apply. A) Lesser curvature B) Greater curvature C) Distal to the pylorus D) Proximal to the pylorus

A, D) Gastric ulcers often are found on the lesser curvature (not the greater curvature) and the area immediately proximal (not distal) to the pylorus.

A client has an excoriated skin area with purulent drainage. Which diagnostic test does the nurse anticipate being ordered? A) Skin biopsy B) Culture C) Wood's lamp D) Patch test

Answer: B Explanation: Cultures to identify infections may be conducted on tissue samples, on drainage and exudates from lesions, and on serum. Skin biopsies are used to differentiate a benign skin lesion from a skin cancer. A Wood's lamp is used to identify infections through immunofluorescent studies. Patch tests are used to determine allergies.

An older adult client is diagnosed with cardiomyopathy and a cardiac dysrhythmia. What would the nurse expect to be prescribed for this client? A) Beta blocker B) Digoxin C) Nitrate medications D) Fluids

A) Treatment for cardiomyopathy includes calcium channel blockers, beta blockers, and antiarrhythmics. Digoxin should be avoided because it increases the force of contractions. Nitrates should be avoided because they increase blood pressure. The client should be on a sodium and fluid restriction and not be encouraged to drink fluids.

1) The client enters the outpatient clinic and states to the triage nurse, "I think I have the flu. I'm so tired, I have no appetite, and everything hurts." The triage nurse assesses the client and finds a butterfly rash over the bridge of the nose and on the cheeks. Based on this data, which diagnosis should the nurse anticipate? A) Systemic lupus erythematosus B) Fibromyalgia C) Lyme disease D) Gout

Answer: A Explanation: A "butterfly rash" that covers the bridge of the nose and the cheeks is a characteristic manifestation of systemic lupus erythematosus (SLE). Although fibromyalgia, Lyme disease, and gout all share some symptoms with SLE (e.g., joint pain and/or fatigue), they are not associated with a rash over the nose and cheeks.

What is the most common clinical manifestation of coronary artery disease? A) Chest pain B) Dyspnea C) Irritability D) Tachycardia

Answer: A Explanation: Coronary artery disease is often asymptomatic. When clinical manifestations do occur, the most common indications are angina and myocardial infarction. Angina, acute coronary syndrome, and acute myocardial infarction are all characterized by the presence of chest pain of various intensities. Although dyspnea, irritability, and tachycardia may also be present in some clients, chest pain is the classical manifestation of coronary artery disease.

For a client with coronary artery disease, what can the nurse recommend to the client to help decrease cardiac workload and sympathetic nervous system stimulation? A) Physical rest B) Psychological rest C) Fluid intake D) Fluid restriction

Answer: A Explanation: For the client with coronary artery disease, physical rest helps decrease cardiac workload and sympathetic nervous system stimulation, promoting comfort. Information and emotional support help decrease anxiety and promote psychological rest. Although fluid overload may increase cardiac workload, the nurse should not restrict fluids unless prescribed by the physician.

The nurse is providing care to a female client who is diagnosed with coronary artery disease. The client states to the nurse, "I don't know how this happened." Which response by the nurse is the most appropriate? A) "Women who take oral contraceptives are more likely to develop this disease." B) "Women who have children later in life often develop this disease" C) "Women with a history of sexually transmitted infections are more likely to develop this disease." D) "Women who conceive through the use of in-vitro fertilization are more likely to develop this disease."

Answer: A Explanation: Risk factors for coronary artery disease that are unique to women include premature menopause, oral contraceptive use, and hormone replacement therapy (HRT). Having children later in life, a history of sexually transmitted infections, and the use of in-vitro fertilization do not increase the risk of coronary artery disease for women.

The nurse is caring for a client who has had a myocardial infarction. The client states, "I have been smoking for 35 years, what good will quitting do?" Which response is best? A) "Your risk of continued coronary artery disease will decrease by half when you stop." B) "Quitting will enhance the effects of your medications." C) "Your medications will not work if you smoke." D) "Quitting will ensure you don't develop any complications."

Answer: A Explanation: Smoking cessation reduces the risk for coronary heart disease by 50% no matter how long the person has smoked. It will reduce the possibility of lung cancer, decrease complications, and possibly enhance medication effects, but the primary focus for this client is the effect on coronary artery disease.

A nurse is teaching a client about the different types of angina. Which client statement indicate the need for follow up teaching? A) "Stable angina is the most common form of angina." B) "Prinzmetal angina is atypical angina that occurs with strenuous exercise." C) "Unstable angina occurs with increasing frequency, severity, and duration." D) "Clients with unstable angina are at risk for a heart attack."

Answer: B Explanation: Angina results from ischemia and can be a one-time event or a chronic condition. There are three types of angina: stable, unstable, and Prinzmetal. Stable angina is the most common form of angina and is relieved with rest and nitrate medications. Unstable angina occurs with increasing frequency, severity, and duration. Clients with unstable angina are at risk for a heart attack, or myocardial infarction. Prinzmetal angina is atypical angina that is unrelated to activity.

The nurse is instructing an older adult client about atorvastatin (Lipitor) to treat elevated cholesterol. Which side effects should the nurse advise the client to report to the healthcare provider? A) Headaches and nausea B) Muscle pain and weakness C) Bruising and excessive bleeding D) Shortness of breath and coughing

Answer: B Explanation: Clients taking statins, such as atorvastatin (Lipitor), should promptly report muscle pain, tenderness, or weakness; skin rash, hives, or changes in skin color; and abdominal pain, nausea, or vomiting. Headaches, bruising or bleeding, and shortness of breath or coughing are not common side effects that need to be reported to the physician.

The nurse is documenting assessment findings on a client with angina. Which term should the nurse use to describe chest pain that occurs at night and is unrelated to activity? A) Nonanginal pain B) Prinzmetal angina C) Unstable angina D) Stable angina

Answer: B Explanation: Prinzmetal (variant) angina is unrelated to activity and often occurs at night. Stable angina is induced by exercise and is relieved by rest or nitroglycerin. Unstable angina occurs with increasing frequency, severity, and duration. The pain is unpredictable. The client has been diagnosed with angina, and, therefore, the chest pain the client is experiencing is likely angina, not non-anginal pain.

A community health nurse is providing education to a group of adults regarding myocardial infarction (MI). When discussing ways to prevent the number of MI-related deaths, which statement by the nurse is inappropriate? A) "It is important to learn how to perform cardiopulmonary resuscitation (CPR)." B) "Be sure to take a baby aspirin every day to help prevent an MI." C) "Increase your knowledge of the manifestations of MI." D) "Seek immediate medical attention when you suspect an MI."

Answer: B Explanation: When educating clients regarding ways to decrease the number of MI-related deaths, the nurse will stress the importance of prevention. Learning about the manifestations of MI, as well as learning CPR, is appropriate. Clients should be taught to seek immediate medical attention when they suspect an MI. However, instructing all clients to take a baby aspirin every day to help prevent an MI is inappropriate, as not all clients should take this medication.

A client recovering from an acute myocardial infarction is prescribed aspirin. Which teaching points should the nurse include regarding this prescription? Select all that apply. A) Report any itching after seven days of taking. B) Check with your healthcare provider before taking herbal remedies. C) Take at a different time of day than warfarin. D) Report bleeding or bruising to the healthcare provider. E) Do not skip any scheduled appointments to have blood drawn for labs.

Answer: B, D Explanation: Itching is not a common side effect of aspirin therapy. Herbal remedies such as evening primrose oil, garlic, gingko biloba, or grapeseed extract can increase the effect of the aspirin. Aspirin and Coumadin are not to be taken concurrently. Bleeding and bruising can occur and should be reported to the healthcare provider. Aspirin inhibits platelet aggregation and clot formation. No lab appointments will be made just for aspirin therapy.

The nurse is providing care to a client who has experienced several episodes of angina. Which agent does the nurse anticipate being ordered to reduce the intensity and frequency of an angina episode? A) The client will experience relief of chest pain with therapeutic lifestyle changes. B) The client will experience relief of chest pain with statin therapy. C) The client will experience relief of chest pain with nitrate therapy. D) The client will experience relief of chest pain with anticoagulant therapy.

Answer: C Explanation: A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode. Therapeutic lifestyle changes are significant if the client is to maintain a healthy heart. Statins are used to decrease cholesterol levels. Anticoagulant therapy is used to prevent additional thrombi from forming post-myocardial infarction.

The nurse is teaching a client about the associated health risks of cocaine use. Which statement should the nurse use to describe how cocaine can cause myocardial infarction (MI)? A) Cocaine significantly increases the serum triglyceride level, leading to the development of an atheroma. B) Cocaine alters the body's clotting mechanisms, leading to thrombus formation. C) Cocaine increases sympathetic nervous system stimulation, increasing blood pressure and vasoconstriction. D) Cocaine alters electrolyte balance, leading to arrhythmias.

Answer: C Explanation: Acute MI may develop as a result of cocaine intoxication. Cocaine increases sympathetic nervous system activity by both increasing the release of catecholamines from central and peripheral stores and interfering with the reuptake of catecholamines. This increased catecholamine concentration stimulates the heart rate and increases its contractility, increases the automaticity of cardiac tissues and the risk of dysrhythmias, and causes vasoconstriction and hypertension. The other answers do not occur with cocaine intoxication.

The nurse is preparing preoperative teaching for a client scheduled for a ventricular assist device (VAD). Which should the nurse include in these instructions? A) Need to stay on bedrest for a week or more B) Cardiac pain postoperatively is to be expected C) Risk for postoperative infection D) Expect to be ambulating the evening of surgery

Answer: C Explanation: Clients with VAD are at considerable risk for infection; strict aseptic technique is used with all invasive catheters and dressing changes. The client may or may not be on bedrest for a week or more after the surgery. Cardiac pain postoperatively is not to be expected and could indicate a myocardial infarction. The client, however, will most likely not be ambulating the evening of the surgery.

A client with angina is experiencing acute chest pain. The client rates the pain as a 7 out of 10. The client's vital signs include P 119, R 24, BP 98/63, T 99.1°F, and SpO2 89%. Which actions would the nurse implement at this time? Select all that apply. A) Administer antianxiety medication as prescribed. B) Coach in nonpharmacologic pain management techniques. C) Implement bedrest. D) Administer morphine sulfate 2 mg intravenous push as prescribed. E) Administer oxygen at 2 liters/minute via nasal cannula as prescribed.

Answer: C, D, E Explanation: Interventions for the client experiencing acute chest pain include keeping the client on bedrest, administering morphine sulfate as prescribed, and administering oxygen as prescribed. Antianxiety medications are not effective in acute chest pain. Nonpharmacologic pain management techniques are not appropriate for an episode of acute chest pain.

The nurse is caring for a 76-year-old client with a history of angina. What atypical age-related warning sign of a myocardial infarction should the nurse need to include in client teaching? A) Cool, clammy skin B) Chest pain C) Tachycardia D) Abdominal pain

Answer: D Explanation: Older adults commonly have atypical symptoms of myocardial infarction, such as difficulty breathing, confusion, fainting, dizziness, abdominal pain, or cough. Cool, clammy skin; chest pain; and tachycardia are all symptoms of myocardial infarction that are more common in younger individuals but less common in older individuals.

A nurse recommends a gluten-free diet to a client recently diagnosed with celiac disease. The client says that she wants to become pregnant and asks how a gluten-free diet might aid in that. What is not a benefit for this client of a gluten-free diet? A) A gluten-free diet may lower the risk of infertility. B) A gluten-free diet may lower the risk of miscarriage. C) A gluten-free diet may increase the probability that the child's birth weight will be healthy. D) A gluten-free diet may improve fetal bone development.

D) Calcium is critical for fetal bone development, and pregnant women should consume around 1000 mg of calcium per day, but this is a separate issue from maintaining a gluten-free diet. Studies suggest that negative outcomes in mothers and their children are often the result of undiagnosed celiac disease. Adherence to a strict gluten-free diet after diagnosis may improve outcomes for clients with celiac-related infertility, miscarriage, and stillbirth. Birth weights of children born to mothers with celiac disease who follow a gluten-free diet may also be higher than those of mothers who do not.

The nurse is caring for a client with severe inflammation. Which assessment findings would indicate a systemic reaction to inflammation? Select all that apply. A) Erythema B) Edema C) Pain D) Tachypnea E) Tachycardia

Answer: D, E Explanation: Systemic manifestations of infection include elevated or abnormally low temperature, tachycardia, tachypnea, and leukocytosis. Erythema, warmth, pain, edema, and functional impairment all indicate a local reaction.

Which of the following drugs used in the treatment of peptic ulcer disease (PUD) works by both binding to proteins in the ulcer base and stimulating the secretion of mucus? A) Sucralfate B) Omeprazole C) Misoprostol D) Bismuth

A) All of the medications listed can be used to treat PUD, but they work in different ways. Sucralfate binds to proteins in the ulcer base, forming a protective barrier against acid, bile, and pepsin. Sucralfate also stimulates the secretion of mucus, bicarbonate, and prostaglandin. Omeprazole is a proton-pump inhibitor (PPI). Bismuth compounds stimulate mucosal bicarbonate and prostaglandin production to promote ulcer healing and suppress Helicobacter pylori. Misoprostol promotes ulcer healing by stimulating mucus and bicarbonate secretions and inhibiting acid secretion.

An adult burn patient is receiving fluid resuscitation of warm, lactated Ringer's solution during the first 24 hours following injury. The client's hourly urine output is being monitored to determine whether the resuscitation is adequate. The most recent reading is 1.10 mL/kg/hr. The nurse understands that this amount of urine output is A) slightly higher than the normal range. B) slightly lower than the normal range. C) within the normal range. D) extremely low.

A) In adult patients with burn injuries who are receiving fluid resuscitation, urine production of 0.5-1 mL/kg/hr is considered normal. Therefore, the nurse would understand that this patient's output is slightly high.

The healthcare provider prescribes misoprostol (Cytotec) for a female client for the treatment of peptic ulcer disease. What should the nurse ask the client prior to administration of this medication? A) "Is there any chance that you are pregnant?" B) "Are you currently sexually active?" C) "Are your menstrual cycles irregular?" D) "Do you plan on becoming pregnant in the next few months?"

A) Misoprostol (Cytotec) is contraindicated during pregnancy; in fact, it is sometimes used to terminate pregnancies. There is no contraindication for misoprostol (Cytotec) in a client with irregular menstrual cycles. Misoprostol (Cytotec) is safe as long as the client is not pregnant. Asking if client is sexually active could be appropriate, but the nurse would also ask if the client is using birth control.

The nurse is providing care to a client diagnosed with celiac disease who experiences frequent diarrhea. Based on this data, the nurse anticipates the client may also experience which associated problems? Select all that apply. A) Skin breakdown B) Fluid and electrolyte imbalance C) Hair loss D) Lifestyle issues E) Sexual dysfunction

A, B, D) Clients with diarrhea may have perianal skin irritation and skin breakdown. Diarrhea disturbs the fluid and electrolyte balance and can disrupt normal life activities. There is no known direct connection between diarrhea and hair loss or sexual dysfunction

The nurse is providing care to a pediatric client diagnosed with celiac disease. Which outcomes can be anticipated when the appropriate steps for managing celiac disease have been implemented? Select all that apply. A) The client is free of abdominal discomfort including bloating, gas, indigestion, nausea, and vomiting. B) The client is able to maintain normal or routine bowel habits. C) The client has diarrhea fewer than 3 days weekly. D) The client is able to maintain adequate nutritional status. E) The client is able to make appropriate menu choices prior to discharge.

A, B, D, E) When the client with celiac disease is placed on a gluten-free diet, treatment generally is successful, as long as the client avoids gluten totally. Symptoms such as diarrhea and abdominal discomfort should be eliminated and nutritional status should improve.

A school-age child, recently diagnosed with celiac disease, is underweight, vitamin deficient, and anemic and experiences frequent diarrhea. In addition to removing gluten from his diet, what other recommendations will the nurse provide for this child and family? Select all that apply. A) Fat restriction B) A high-carbohydrate diet C) Vitamin supplements D) High-calorie diet E) High-protein diet

A, C, D, E) A child with celiac disease who is underweight, vitamin-deficient, anemic, and experiencing diarrhea will require a low-fat, high-calorie, high-protein diet. Vitamin supplements are also likely required given that this child is vitamin deficient. In celiac disease, gastrointestinal dysfunction may cause carbohydrates to be incompletely digested, leading to malabsorption and intolerance.

Parents of a child diagnosed with celiac disease have requested guidance on how to implement an appropriate diet. In addition to a list of foods to include and exclude, which interventions by the nurse are appropriate? Select all that apply. A) Obtaining a dietary prescription B) Implementing a recommended exercise program C) Training on how to read food labels D) Providing a referral to support groups E) Encouraging the use of a gluten-free cookbook

A, C, D, E) Education that should be provided to the child and their family include obtaining a dietary prescription that will enable them to deduct the cost of special ingredients and commercially prepared products as a medical expense; education on how to read a food label; providing referrals to a support group; and encouraging the use of a gluten-free cookbook. Exercise is not considered an intervention that is specifically aimed at treating celiac disease.

The nurse is planning care for a client in the acute stage of a burn injury. Which aspects of care should the nurse identify as a priority? Select all that apply. A) Nutrition B) Psychosocial support C) Pain management D) Fluid resuscitation E) Wound care

A, C, E) Nursing care for the client during the acute stage of burn injuries will include wound care, nutritional therapy, and pain management. Fluid resuscitation occurs during the emergency phase of burn care. Psychosocial support will be needed once the client has stabilized.

A school nurse is providing care to a number of school-age children diagnosed with celiac disease. Which interventions are appropriate for the nurse to implement with this group of students? Select all that apply. A) Teaching about gluten-free food choices B) Emphasizing low-calorie food selections C) Implementing a school-based prevention program to eliminate the disease process D) Labeling gluten-free choices in the school lunch program E) Demonstrating coping strategies for living with celiac disease

A, D, E) Appropriate interventions for the school nurse to implement include teaching the children with celiac disease about gluten-free food choices. The nurse would also implement the labeling of gluten-free food choices in the school lunch program to aid the children in choosing foods to eat while at school. School-age clients may also benefit from learning about coping strategies. Food selections should be high in calories and protein. Celiac disease cannot be prevented.

A client presents with delayed wound healing. During the physical assessment, which nutrient deficiency does the nurse anticipate based on the data? A) Protein B) Digestive enzymes C) Insulin D) Carbohydrates

Answer: A Explanation: A deficiency of protein may delay wound healing. Digestive enzymes aid in the digestion of nutrients. Insulin allows glucose to be used by the cells. Carbohydrates are a source of energy.

The nurse is caring for a client who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the client's lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which of the following is a priority nursing diagnosis for this client? A) Risk for Infection B) Ineffective Health Maintenance C) Ineffective Individual Coping D) Risk for Impaired Skin Integrity

Answer: A Explanation: All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection.

A patient with an allergy to latex develops contact dermatitis following an examination during which the nurse wore latex gloves. Which best describes the associated pathophysiology? A) An immune response that leads to issues with tissue integrity B) Impaired tissue integrity that leads to an immune response C) Impaired tissue integrity that leads to an infection D) Decreased perfusion that leads to issues with tissue integrity

Answer: A Explanation: Allergic reactions are an example of an immune response that leads to issues with tissue integrity. Impaired tissue integrity, such as a cut, can lead to an immune response, but that is not the case in this scenario. If left untreated or exposed to bacteria or other infectious agents, the dermatitis could lead to an infection, but there is no evidence of that in this scenario. Decreased perfusion can lead to tissue damage or death, but not dermatitis.

A postoperative client is transferred to the medical-surgical unit from the intensive care unit (ICU). The client asks the assigned nurse why unlicensed assistive personnel (UAP) help with range-of-motion exercises. Which is the best response by the nurse? A) "Your condition has improved, so I delegated that part of your care to the UAP." B) "You do not need me to ambulate you." C) "The charge nurse made the decision to have the UAP assist you when walking." D) "I assigned all of your care to the UAP."

Answer: A Explanation: An assignment of care is made to a qualified individual (the RN), who then may delegate parts of that care to a UAP. The nurse would not assign care to the UAP, but rather, delegate certain tasks to the UAP. Saying that the client does not need the nurse is not the best approach; it is better to explain that the client has improved to the point where the UAP can assist with certain tasks. The UAP may be delegated tasks by a nurse assigned to care for the client. The charge nurse does not make the assessment to delegate to the UAP; the RN assigned to the care of the client is the decision maker.

The nurse is providing care to a client who experiences chronic inflammation due to arthritis. For which collaborative intervention should the nurse plan when providing care to this client? A) Administering anti-inflammatory medications B) Administering diuretics C) Administering frequent doses of opioid medications D) Administering antibiotics

Answer: A Explanation: Anti-inflammatory medication will reduce the pain and inflammation caused by arthritis. Opioid medication is not usually indicated to treat a chronic inflammatory process. Antibiotics would be ordered for an infection, not for chronic inflammation. Finally, diuretics are not used to treat the inflammatory process.

A nurse is working in a skilled nursing facility and is performing an assessment on an older adult client. The nurse notes that the client has hypopigmentation of the skin on both hands. The nurse should recognize that this condition is related to which age-related skin change? A) Hyperplasia of melanocytes B) Decreased perfusion of the dermis C) Increased permeability of the epidermal layer D) Hyperplasia of capillaries

Answer: A Explanation: Hypopigmentation, also known as age spots, is a common finding on the back of the hands of an older adult. Hypopigmentation is caused by hyperplasia of melanocytes. The other findings are incorrect

The nurse instructs an older adult client with arthritis on the side effects of nonsteroidal anti-inflammatory drug (NSAID) therapy. Which client statement would indicate that this teaching has been effective? A) "I will report any abnormal bruising." B) "Caffeine decreases the effectiveness of the medication." C) "I cannot take other medications while using NSAIDs." D) "If I notice a change in my mood after starting NSAID therapy, I will call the prescriber."

Answer: A Explanation: Older adult clients are at risk for increased bleeding with NSAID therapy. Thus, the client should be taught to report any abnormal bruising, which may indicate bleeding. Older adult clients often take several medications, and refraining from taking them with NSAIDs is an unrealistic outcome. Mood changes are not a side effect of NSAID therapy. Also, there is no reason for avoiding use of caffeine while using an NSAID.

A nurse educator is teaching a group of student nurses about newborn skin and factors that relate to this concept. Which statement will the educator include in the teaching session? A) "The newborn's skin is about 40% to 60% thinner than an adult's skin at birth." B) "The newborn's skin contains less water than an adult's and has tightly attached cells." C) "The newborn's thicker skin decreases absorption of harmful chemical substances and topical medications." D) "The newborn's skin has a greater percentage of underlying subcutaneous fat compared to adults."

Answer: A Explanation: The newborn's skin is about 40% to 60% thinner than an adult's, which makes the newborn's skin more susceptible to absorption of harmful chemical substances and topical medications. The newborn's skin contains more water than an adult's and has loosely attached cells. The newborn's skin has less subcutaneous fat compared to adults.

The nurse delegated to an unlicensed assistive personnel (UAP) the task of assisting a client with a simple dressing change. The client was formerly able to do the procedure, but because of painful arthritis is now unable to perform the redressing. The UAP has done this procedure before. Which must the nurse emphasize to the UAP? A) Report to the nurse immediately anything unusual, such as bleeding or infection. B) The nurse should demonstrate the steps of the procedure. C) Make the client do most of the procedure and report the expected output. D) The UAP should do health teaching while performing the procedure.

Answer: A Explanation: The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's ability. The nurse established the particular parameters outside of which immediate notification is requested. If in pain, the client should not have to do any of the procedure. If the UAP has done the procedure before, the nurse should not need to demonstrate it. Health teaching is outside of the scope of practice for the UAP.

The nurse is working on a medical-surgical unit that is short staffed due to a callout. The manager of the unit was unable to replace the nurse, so the extra clients were assigned to the remaining nurses. The manager was able to get the help of unlicensed assistive personnel (UAP) from the house pool to help on the unit. Which action by the nurses would ensure effective care for the client? A) Delegate vital signs and weights to the UAP. B) Explain to the manager that care may be compromised if another nurse does not work the shift. C) Tell the clients their care will be sparse. D) Assign care of invasive lines to the UAP.

Answer: A Explanation: The nurses would delegate to the UAP tasks such as taking and recording vital signs and weights to ensure that all clients receive appropriate care. UAPs are not assigned care, they are delegated tasks, and nurses should never delegate the task of care of invasive lines to the UAP. The goal for the unit is to meet the needs of the clients; complaining to the manager will not accomplish this. Telling the clients their care will be sparse is inappropriate.

The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which statement on the part of the client indicates an appropriate understanding of the plan of care? A) "I will take birth control pills while I am taking cytotoxic medications." B) "I do not need to contact the doctor if I develop a fever or rash." C) "I plan to go to a concert this weekend so that I get out of the house." D) "I can take aspirin as indicated for pain."

Answer: A Explanation: Treatment for SLE may include cytotoxic drugs. Because these drugs can cause birth defects, women who take them should be advised to avoid pregnancy by using contraceptives. Clients with SLE should also be taught to avoid crowds, because they are potential sources of infection. Aspirin can cause bleeding, so it should be taken only with extreme care. Also, clients with SLE should contact their primary care provider whenever signs of infection occur, because it means their immune system is compromised. Page Ref: 550

A nursing supervisor has been told to ensure that the hospital's new electronic records system is properly implemented on the nursing unit. Which actions by the supervisor are the best use of exercising the managerial role? Select all that apply. A) Creating a "buddy" system that pairs staff members who are more technologically comfortable with staff members who may require more assistance with the new system B) Providing regular training sessions in the new system C) Informing staff that the new system is optional D) Establishing a regular spot check of each staff member's effective use of the system E) Continuing to use paper records until the staff is completely comfortable with the new system

Answer: A, B, D Explanation: The manager's role includes choosing the means by which to achieve goals, assigning and coordinating tasks and developing and motivating staff, and evaluating outcomes and providing feedback. The manager should not undermine the organizational goals and objectives.

Which clients are at the highest risk of being admitted to the emergency department with severe nausea and vomiting? Select all that apply. A) A 47-year-old with a 3-hour history of chest pressure B) A 61-year-old reporting sudden onset of vertigo C) A 72-year-old with an asthma exacerbation D) A 23-year-old who sustained a head injury in a fall E) A 19-year-old who is 6 weeks pregnant

Answer: A, B, D, E Explanation: The vomiting center in the medulla of the brain may be affected by the vestibular system of the ear, acute myocardial infarction, pregnancy, and increased intracranial pressure. An asthma exacerbation is least likely to cause severe nausea and vomiting.

A nurse is caring for a client with systemic lupus erythematosus (SLE) who is prescribed immunosuppressive therapy. When providing teaching for this client, which statements are appropriate for the nurse to include? Select all that apply. A) "Avoid large crowds and situations that increase your exposure to infection." B) "Report any cough or difficulty breathing to the physician if you are taking cyclophosphamide." C) "Use aspirin instead of acetaminophen if you develop a fever." D) "Heavy menstrual bleeding may occur during therapy." E) "Be sure to drink plenty of liquids."

Answer: A, B, E Explanation: Clients who are on immunosuppressant therapy for SLE should be advised to avoid large crowds and situations that increase their exposure to infection; to report difficulty breathing or a cough; and to maintain adequate oral hydration. The client should report a fever if it develops, but aspirin should not be used, as this may increase the risk for bleeding. Also, women may have an absence of menstruation, not heavy bleeding, during therapy.

A female client with systemic lupus erythematosus (SLE) is being treated with immunosuppressant drugs and corticosteroids. When providing teaching to this client, which of the following points are appropriate for the nurse to include? Select all that apply. A) Avoid large crowds. B) Don't get a flu shot. C) Use contraception to prevent pregnancy. D) Refrain from taking aspirin products. E) Report any signs of infection to the healthcare provider.

Answer: A, C, D, E Explanation: Crowds may increase exposure to infection, which is potentially dangerous for clients who are taking immunosuppressants. Annual influenza vaccination is recommended, although clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects, so contraception is important. Aspirin products may increase the risk of bleeding, which would further impair immune function. Chills, fever, sore throat, fatigue, or malaise should be reported so related infections can be treated as quickly as possible.

A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry, stating, "I am afraid I will be disfigured because of all of these lesions." Which interventions should the nurse plan to teach this client to minimize the risk of skin infections associated with SLE? Select all that apply. A) Use sunscreen with an SPF of 15 or greater. B) Remain indoors on sunny days. C) Avoid swimming in a pool or the ocean. D) Avoid sun exposure between 10:

Answer: A, D Explanation: Clients with SLE can live a normal life, but they should take a few extra precautions to minimize the risk of skin lesions. For example, because there is a relationship between sun exposure and infection, the client should be taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days as long as the above precautions are taken. When indoors, the client should try to avoid fluorescent lighting, as exacerbations of SLE have been reported following exposure.

A client is scheduled for a diagnostic test to determine digestion status. Which test does not require fasting or other preparation? A) Barium swallow B) Amylase C) Endoscopy D) Lipid panel

Answer: B Explanation: A) An amylase test does not require any special preparation. A barium swallow, an endoscopy, and a lipid panel require fasting.

An experienced delegator is mentoring a newly appointed nurse in the hospital. The new nurse states, "I am hesitant to delegate tasks to unlicensed assistive personnel (UAP) because I am afraid they will not be done correctly." Which response by the experienced delegator is appropriate? A) Tell her not to delegate any tasks unless she is completely confident. B) Tell her to clearly identify the task and expectations and then to monitor the delegate's progress. C) Tell her that delegation often results in a decrease in job satisfaction. D) Tell her that her job responsibility requires that she do everything herself.

Answer: B Explanation: Although this is a typical concern of inexperienced and insecure delegators, following the delegation guidelines can increase her confidence in the process. The key to retaining control is to clearly identify the task and expectations and then to monitor the delegate's progress and provide feedback. If one is able to delegate some routine tasks to others, then job satisfaction should increase because of increased opportunities. An appropriate environment supports delegation.

A nurse is providing instruction to the parents of a pediatric client who is experiencing inflammation due to respiratory infection. Which of the following points would be most appropriate for the nurse to include as part of this teaching? A) "Try to keep your child in a supine position to promote more effective oxygenation." B) "Adequate fluid intake is even more important for children with inflammation than for adults with inflammation." C) "If your child seems to be gasping for air, encourage him to tuck his chin against his chest." D) "Rapid heartbeat is an early sign of dehydration and low blood volume in children."

Answer: B Explanation: As compared to adults, children have a larger tongue relative to the oral cavity, decreased airway muscle tone, a shorter epiglottis, a more anteriorly positioned larynx, a shorter and narrower trachea, and prominent adenoid and lymphoid tissue. These factors increase a child's risk of airway obstruction, especially when the child is supine and/or the neck is hyperflexed. Hence, these positions should be avoided. Also because of children's small size, absolute volumes of fluid loss represent a larger proportion of total body fluid. For this reason, adequate fluid intake is especially important for pediatric clients with inflammation. Finally, whereas adults typically respond to dehydration and hypovolemia with a compensatory increase in heart rate, tachycardia is frequently a late symptom of hypovolemia in children.

Which of the following manifestations is not associated with systemic lupus erythematosus (SLE)? A) Symmetric polyarthritis B) Excess hair growth C) Thrombocytopenia D) Pleural effusions

Answer: B Explanation: Common manifestations of SLE include symmetric polyarthritis, thrombocytopenia, and pleural effusions. Alopecia (hair loss) is also associated with SLE; excess hair growth is not.

A nurse is caring for a client diagnosed with discoid lupus erythematosus. The nurse is collaborating with this client to set goals for the nursing plan of care. Based on the information given here, which of the following would be an appropriate goal for this client? A) Learn strategies to cope with death and the dying process. B) Remain compliant with a sun protection plan. C) Gain weight to within 10 pounds of normal for height. D) Report pain no higher than 4 on a scale of 0 to 10.

Answer: B Explanation: Discoid lupus erythematosus is an autoimmune disorder of the skin, so clients must protect their skin against the sun to avoid exacerbations. The other goals are not appropriate because discoid lupus erythematosus is not fatal, is not related to weight, and is rarely painful unless complications arise.

The nurse is providing instructions to a client who has been prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which information is highest priority for the nurse to explain to the client about this medication? A) "Take your medication on an empty stomach." B) "Drink at least 8-10 glasses of water a day while taking this medication." C) "Constipation is common with your medication, so include roughage in your diet." D) "Take your medication with food."

Answer: B Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) are nephrotoxic; maintaining adequate hydration when taking these medications is important because it will help prevent kidney damage. Taking NSAIDs with food is recommended because doing so will decrease gastrointestinal (GI) irritation, but preventing kidney damage is more of a priority. Constipation is not an issue with NSAIDs.

Which of the following hormonal changes would most likely result in an exacerbation of systemic lupus erythematosus (SLE)? A) Increase in testosterone levels B) Increase in estrogen levels C) Increase in overall androgen levels D) Increase in serotonin levels

Answer: B Explanation: Sex hormones are thought to influence the development of SLE. In particular, increased estrogen levels and reduced androgen levels are shown to enhance antibody responses and have an adverse effect in clients with SLE. Testosterone is an androgen, so increased testosterone levels likely would not exacerbate SLE. Serotonin is a neurotransmitter and is typically not considered a hormone, and it does not play a direct role in the exacerbation of SLE.

What impact might corticosteroids have on tissue integrity? A) It may increase sensitivity to sunlight, leading to sunburns. B) It may cause thinning of the skin, making skin more easily injured. C) It may make skin appear shiny and lose its hair distribution. D) It may cause the skin to become overly dry.

Answer: B Explanation: Some medications, such as corticosteroids, cause thinning of the skin, making it much more easily damaged. Antibiotics, chemotherapy drugs, and some psychotherapeutic drugs increase sensitivity to sunlight and can predispose the individual to sunburns. Impaired peripheral arterial circulation in the lower extremities may produce skin that appears shiny and has lost its hair distribution. Excessive cleansing can cause the skin to become overly dry.

The nurse is preparing a presentation to a group of adolescent clients regarding proper nutrition. Which of the following teachings is appropriate for this group? A) The high metabolism of the typical adolescent lowers nutritional requirements. B) It is normal for adolescents to consume a lot of calories, but their diet should still be balanced. C) Roughly half of an adolescent's daily caloric intake should come from fats. D) The taste preferences of adolescents typically correlate to the nutritional value of what they eat.

Answer: B Explanation: The high metabolism of the typical adolescent raises nutritional requirements. The adolescent growth spurt is accompanied by rapid gains in height and weight. Bodily demands for calories and nutrients increase dramatically during this time. Adolescent girls require about 2200 calories per day, and adolescent boys require about 2800 calories per day. Roughly 50% of calories should come from complex carbohydrates, 30% from fats, and 20% from proteins. Taste preferences are one of the contributing factors to adolescents exceeding fat intake requirements and not getting enough other nutrients or vitamins, minerals, and fiber.

A client is admitted to the hospital with airway edema, bronchoconstriction, and increased mucus production after being exposed to an allergen. Which nursing interventions are appropriate to address this inflammation to the client's respiratory system? Select all that apply. A) Turn and reposition every 2 hours. B) Monitor oxygen saturation. C) Administer oxygen as prescribed. D) Restrict fluids. E) Monitor lung sounds.

Answer: B, C, E Explanation: Turning and repositioning every 2 hours would be appropriate to maintain tissue integrity but not to address respiratory inflammation. In contrast, monitoring oxygen saturation, administering oxygen, and monitoring lung sounds would all be appropriate care for a client who is experiencing inflammation of the respiratory system. Restricting fluids could cause respiratory secretions to thicken and hinder the client's ability to maintain a clear airway. Fluids should be encouraged. Page Ref: 673

What statement made by the client would indicate understanding of discharge teaching for self-care after hospitalization for acute pancreatitis? A) "I will avoid onions, caffeine, and spices." B) "I will take the antibiotics for 2 weeks." C) "I will avoid alcoholic beverages." D) "I will get immunized prior to my vacation."

Answer: C Explanation: Alcohol increases the risk of pancreatitis. Antibiotics are used to prevent pyloric stenosis. Onions, caffeine, and spices increase the risk of GERD. Immunizations can prevent specific types of hepatitis.

The nurse is caring for a client who has extensive deep tissue damage. The nurse notes that the client is also vegan. Which dietary information should the nurse teach this client to enhance the healing process? A) "A low-fat, high-carbohydrate, low-protein diet is best for healing." B) "A high-fat, low-carbohydrate diet is best for healing." C) "A high-carbohydrate, high-protein diet is best for healing." D) "A diet high in protein and vitamin D is best for healing."

Answer: C Explanation: Carbohydrates are important to meet the energy demands of healing, and protein is needed for cell growth. This client needs to be taught to eat proteins that provide the essential amino acids that can be lacking in a vegan diet. Fats are needed in moderation for the development of cell membranes. Vitamins necessary to promote healing are C, K, A, and the B-complex vitamins.

The charge nurse observes that a fellow charge nurse on the unit seems impaired and unable to perform client care. Which action by the charge nurse is most appropriate in this situation? A) Notifying security B) Calling the unit's nurse manager C) Discussing the situation with the nursing supervisor D) Confronting the other nurse directly

Answer: C Explanation: Discussing the situation with the nursing supervisor is the appropriate decision because the supervisor is the next highest link in the chain of command. As such, the supervisor is responsible for making the appropriate decision about how to deal with the potentially impaired charge nurse. Confronting the other nurse would not be appropriate given that the nurse seems impaired. Although the nurse manager will need to be notified, the charge nurse must first notify the nursing supervisor so he or she can determine how to proceed. Security may need to be notified eventually, but again, that decision would be made by the nursing supervisor.

The nurse presses a finger into swollen skin tissue on a client's feet and ankles and notes that it creates an indentation. The nurse should correctly document a finding of which alteration in skin integrity? A) Poor turgor B) Ascites C) Peripheral edema D) Hypothermia

Answer: C Explanation: Excess fluid trapped in bodily tissue, such as the feet and ankles, creates edema. To assess for the amount of edema, the nurse presses a finger into the edematous area to create an indentation. The amount of indentation indicates the level of edema. Ascites is abdominal swelling. Skin turgor is the skin's elasticity and is assessed by gently pinching the skin over the sternum or collarbone. Skin temperature is assessed through palpation.

A nurse is caring for a client with systemic lupus erythematosus (SLE) who is taking hydroxychloroquine (Plaquenil). When providing care for this client, the nurse should monitor for which adverse effect associated with this medication? A) Pulmonary fibrosis B) Cushingoid effects C) Retinal toxicity D) Renal toxicity

Answer: C Explanation: Hydroxychloroquine (Plaquenil) is an antimalarial drug that is also used to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness. Cushingoid effects are a concern with corticosteroid therapy. Pulmonary fibrosis is a potential adverse effect of cyclophosphamide, not Plaquenil. Renal toxicity is not the primary concern with Plaquenil.

The warmth and redness that accompany inflammation result from which of the following steps in the inflammatory process? A) Exudate production B) Cellular regeneration C) Hyperemia D) Margination of leukocytes

Answer: C Explanation: Immediately after injury or infection, the damaged tissues release histamines, kinins, and prostaglandins. These substances serve as chemical mediators to dilate blood vessels, causing more blood to flow to the injured area. This increase in blood supply is called hyperemia and is responsible for the characteristic signs of redness and heat that accompany inflammation. Margination refers to the process by which leukocytes aggregate along the inner surface of blood vessels in an injured area. Exudate production occurs later in the inflammatory process and involves the release of fluid, dead cells, and cellular products from the injured area. Cellular regeneration occurs during the last stage of the inflammatory process and does not cause redness or warmth.

What does the nurse anticipate finding in a client with impetigo? A) An infection in the hair follicles B) Loss of skin color in blotches or sections C) An itchy rash with clusters of fluid-filled vesicles D) A fungal infection in the skinfolds

Answer: C Explanation: Impetigo is a superficial skin infection common on the face, arms, and legs of children that presents as an itchy rash with clusters of fluid-filled vesicles that rupture easily. Ruptured vesicles develop a honey-colored crust over the lesions. Folliculitis is an infection of hair follicles. Vitiligo is a loss of skin color in blotches or sections that occur when the cells that produce melanin die or stop functioning. Candidiasis is a fungal infection commonly known as thrush and found in skinfolds.

The nurse is providing care to a client who is experiencing skin inflammation and pruritus. Which of the following medications does the nurse anticipate will be prescribed for this client? Select all that apply. A) Erythromycin B) Bacitracin C) Gentamycin D) Desoximetasone E) Desonide

Answer: D, E Explanation: Erythromycin is an antibacterial that interferes with bacterial DNA and protein synthesis, causing cell death. Bacitracin and gentamycin are antibiotics that interfere with bacterial replication and synthesis and are used to treat infections. Desoximetasone and desonide are topical corticosteroids that relieve inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Which intervention would best improve diet adherence of an older male immigrant recently diagnosed with gastroesophageal reflux disorder (GERD)? A) Scheduling low-fat meal deliveries to the home B) Providing printed diet information in his native language C) Interviewing the client to assess his current diet D) Giving a list of foods to avoid to the client's wife

Answer: C Explanation: Interviewing the client to assess his current diet will provide information on which to base a collaborative nutrition plan. Scheduling low-fat meal delivery to the home, giving printed diet information in his native language, and giving a list of foods to avoid to the client's wife are not appropriate until the nurse has information on which to base an individualized culturally sensitive teaching plan.

The nurse is caring for a 6-month-old infant with pyloric stenosis. Which of the following statements regarding this client's digestive system is false? A) The client has voluntary control over swallowing. B) Enzymes from the client's pancreas are sufficient to aid in digestion. C) The client has a complete set of primary teeth. D) The client's tongue is larger than an adult's in comparison to the nasal and oral passages.

Answer: C Explanation: Most children have a complete set of primary teeth by 3-6 years of age. At 6 months, the first teeth begin to erupt. An infant develops voluntary control over swallowing by 6 weeks. Enzymes are sufficient to aid in digestion by 4-6 months, so an infant at 6 months should have sufficient enzymes for digestion. The infant's tongue is larger than that of a child or adult in comparison to the nasal and oral passages.

The nurse is teaching the family of a school-age client diagnosed with inflammatory bowel disease regarding the administration of prednisone at home. At which time should the nurse instruct the parents to provide this medication to the client? A) 1 hour before meals B) At bedtime C) With meals D) Between meals

Answer: C Explanation: Prednisone, a corticosteroid, can cause gastric irritation. It should be administered with meals to reduce this irritation. It should not be given on an empty stomach.

A client asks the nurse whether there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which response by the nurse is the most appropriate? A) "Conditions that cause hypotension often worsen SLE." B) "GI upset is often associated with SLE exacerbation." C) "Pregnancy is often associated with a worsening of SLE." D) "Fever is a known trigger for SLE exacerbation."

Answer: C Explanation: Pregnancy can be associated with an exacerbation of SLE due to the associated rise in estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

The nurse is providing care for several clients on a medical-surgical unit. The nurse anticipates that the client with which condition may require surgery? A) Hepatitis B) Pancreatitis C) Pyloric stenosis D) Malabsorption disorder

Answer: C Explanation: Pyloric stenosis ultimately requires surgery to split the pyloric muscle to allow passage of food and fluid. Hepatitis, pancreatitis, and malabsorption disorders are medically treated.

13) Why is kidney damage often observed in clients with systemic lupus erythematosus (SLE)? A) SLE involves unusually high levels of circulating antigens. Because the kidneys play a critical role in filtering these antigens from the blood, they are under excess stress in clients with SLE. B) SLE is commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Because these medications carry a high risk of nephrotoxicity, their use often leads to kidney damage in clients with SLE. C) SLE involves deposition of immune complexes in the body's connective tissues. Because connective tissue makes up a significant portion of the kidneys, these organs are a frequent site of damage in SLE. D) SLE involves unusually high levels of circulating antibodies. Because the kidneys play a critical role in filtering these antibodies from the blood, they are under excess stress in clients with SLE.

Answer: C Explanation: SLE involves deposition of antigen-antibody complexes, also known as immune complexes, in the body's connective tissues. Because connective tissues makes up a large portion of the kidneys, these organs are frequently damaged in SLE. Note that the kidneys do not filter either antigens or antibodies from the blood. Also, even though NSAIDs are commonly used in the treatment of SLE and may exert nephrotoxic effects, use of NSAIDs is not the primary reason why kidney damage is often observed in clients with SLE.

The nurse observes flakes of greasy white dandruff in a client's hair. The nurse should correctly identify this as which type of secondary lesion? A) Nodule B) Macule C) Scales D) Crusts

Answer: C Explanation: Scales are flakes of greasy, keratinized skin tissue that vary in color from white, to gray, to silver. An example of this type of skin lesion is dandruff. Macules and nodules are primary skin lesions. A crust is an area of dry blood, serum, or pus left on the skin surface when vesicles or pustules break.

A nurse is conducting a skin assessment of a patient. Upon palpating skin temperature, the nurse notes the skin is warm and red. This is an abnormal sign that may be indicative of A) decreased hydration. B) decreased blood flow to the skin. C) inflammation and elevated body temperature. D) hypothyroidism.

Answer: C Explanation: Warm, red skin indicates inflammation and elevated body temperature. Decreased skin temperature is indicative of decreased blood flow to the skin. Excessively dry skin is indicative of hypothyroidism. Poor skin turgor is indicative of decreased hydration.

The nurse in a rheumatology clinic is managing care for clients who receive nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of their disease processes. Which of the following are the primary laboratory tests the nurse should assess prior to initiation of NSAID therapy? Select all that apply. A) Serum amylase B) Electrolytes C) Creatinine clearance D) Complete blood count (CBC) E) Liver function tests

Answer: C, D, E Explanation: It is important to assess the client's creatinine clearance to determine kidney function prior to initiation of NSAID therapy. It is also important to assess the client's liver function tests and complete blood count (CBC) prior to beginning NSAID therapy. There is no need to assess the client's electrolytes or serum amylase, because neither of these levels are affected by NSAIDs.

The nurse is caring for a client who has experienced a sports-related injury to the knee. During the morning assessment, which signs of inflammation should the nurse anticipate? Select all that apply. A) Pitting edema B) Pallor C) Swelling D) Warmth E) Pain

Answer: C, D, E Explanation: Swelling, warmth, and pain are all signs of inflammation. Pallor is not a sign of inflammation; redness is. Pitting edema is not a sign of inflammation.

A nurse is overseeing a group of students who are completing a clinical rotation on a medical-surgical unit. The students are providing direct client care with the assistance of the nurse. The nurse who is overseeing the students is functioning in which capacity? A) Clinical nurse specialist B) Nurse practitioner C) Nurse entrepreneur D) Nurse educator

Answer: D Explanation: Nurse educators are responsible for classroom and often clinical teaching—as is happening in this scenario. A clinical nurse specialist has an advanced degree or expertise and is considered to be an expert in a specialized area of practice. He or she provides direct client care, educates others, consults, conducts research, and manages care. A nurse practitioner has an advanced education, is a graduate of a nurse practitioner program, and usually deals with nonemergency acute or chronic illness and provides primary ambulatory care. A nurse entrepreneur usually has an advanced degree, manages a health-related business, and may be involved in education, consultation, or research.

The nurse is planning care for an adolescent client who has systemic lupus erythematosus (SLE). Which action by the client indicates the implemented plan of care is appropriate? A) Refusing to attend school B) Refraining from attending social functions C) Discussing skin changes with the healthcare provider D) Discussing skin changes with a good friend

Answer: D Explanation: Peer interaction is important to teens. Being able to discuss the physical changes related to SLE with a friend indicates acceptance of the change in body image. Refusing to go to school or attend social functions indicates nonacceptance of the changes to body image. Discussing changes only with healthcare personnel does not indicate the teen has adjusted to the body image changes.

A nurse is providing health education at several neighborhood community centers. The nurse adjusts the teaching plan based on the demographic characteristics of the clients that each center serves. For which of the following community centers should the nurse plan on providing information about signs and symptoms of systemic lupus erythematosus (SLE)? A) A community center that primarily serves young female children B) A community center that primarily serves young males of African American descent C) A community center that primarily serves Caucasian women D) A community center that primarily serves females of Asian descent

Answer: D Explanation: SLE is more common among women than men, and it most often affects women of childbearing age. Furthermore, SLE is more common in African Americans, Hispanics, Native Americans, Native Hawaiians, and Asians than it is in Caucasians.

A middle-age adult client states to the nurse, "I do not want to have brown spots on my skin like my parents did as they got older." Which instruction by the nurse is appropriate? A) Spend at least 15 minutes each day in the sun. B) Increase the intake of calcium. C) Increase the intake of dietary fat. D) Avoid the sun or use a sunscreen to reduce skin damage.

Answer: D Explanation: Small areas of hyperpigmentation, or liver spots, occur as an age-related skin change because of hyperplasia of melanocytes in sun-exposed areas. The nurse should instruct the client to avoid the sun or use a sunscreen to reduce skin damage. The nurse should not instruct the client to spend at least 15 minutes each day in the sun. The intake of dietary fat or calcium will not affect the development of liver spots.

The nurse is considering nutritional support for a client experiencing severe side effects of chemotherapy. Which independent and collaborative interventions will best limit the adverse digestive and nutritional effects of chemotherapy? A) Encourage client to drink 350 mL of clear liquids within 1 hour prior to meals. B) Position the client flat during intermittent enteral nutrition feedings. C) Verify that enteral nutrition and total parenteral nutrition (TPN) are never used concurrently. D) Teach the client relaxation techniques in addition to offering IV ondansetron.

Answer: D Explanation: The American Society of Clinical Oncologists suggests that individuals with cancer who are experiencing nausea and vomiting try distraction, relaxation, positive imagery, and acupuncture. The NCCIH also suggests relaxation techniques for those with chemotherapy-induced nausea and vomiting. Ondansetron is a serotonin receptor agonist used commonly as an antiemetic. Clients should be positioned with the HOB elevated 30 degrees during enteral nutrition feedings. Enteral nutrition and TPN are used concurrently. Nausea is worsened by drinking fluid within 1 hour of meals.

The nurse is assigned to a 4-month-old infant with vomiting and diarrhea who is brought to the pediatric clinic. The infant's vital signs are temperature: 37°C, apical HR: 130, R: 40/min. The abdominal assessment reveals a soft, concave abdomen, 10 gurgles auscultated in 1 minute in all four quadrants, and tympani to percussion. Which collaborative care action does the nurse anticipate? A) Check the surgical call schedule and reserve an operating suite. B) Place the infant NPO for a barium swallow. C) Prepare a milk-based infant formula to replace fluids. D) Complete a thorough digestion assessment interview with the mother.

Answer: D Explanation: The assessment data for this pediatric client indicates a nonemergent alteration in digestion that requires additional interview information from the mother. Nothing in the assessment indicates a surgical emergency. A barium swallow is not indicated for diarrhea. Milk-based formulas would be avoided until symptoms subside.

The nurse delegates vital signs and daily weights of assigned clients to the unlicensed assistive personnel (UAP) on duty. Which is the reason for the nurse to assess each client throughout the shift? A) The UAP cannot report to the next shift. B) The UAP is not trustworthy. C) The nurse maintains the authority to care for the clients. D) The nurse remains accountable for the clients' care.

Answer: D Explanation: The nurse remains accountable for the care of clients during delegation to the UAP. The UAP may be untrustworthy, but the reason the nurse checks on the clients is because the accountability belongs to the nurse. The nurse could take a report from the UAP and report that to the next shift. The nurse transfers the authority for the delegated care to the UAP.

In the presence of inflammation, a client's erythrocyte sedimentation rate (ESR) A) decreases due to the decreased proportion of fibrinogen in the blood. B) decreases due to the increased proportion of fibrinogen in the blood. C) increases due to the decreased proportion of fibrinogen in the blood. D) increases due to the increased proportion of fibrinogen in the blood.

Answer: D Explanation: When an inflammatory process is active, the increased proportion of fibrinogen in a client's blood causes the red blood cells to stick to one another and settle faster. This, in turn, results in a higher ESR reading.

The nurse is providing care to a pediatric client who was admitted to the pediatric intensive care unit (PICU) with a partial-thickness thermal burn. When planning care for this client, which should the nurse consider regarding this type of burn? A) Partial-thickness burns are deeper than superficial burns but still involve the epidermis only. B) A superficial partial-thickness burn extends from the skin's surface into the papillary layer of the dermis. C) A deep partial-thickness burn is often bright red and has a moist, glistening appearance with blister formation. D) A superficial partial-thickness burn is less painful than a deep partial-thickness burn.

B) A superficial partial-thickness burn extends from the skin's surface into the papillary layer of the dermis. Partial-thickness burns are deeper than superficial burns, extending from the epidermis into the dermis layer as well. A superficial partial-thickness burn is often bright red and has a moist, glistening appearance with blister formation. A deep partial-thickness burn is less painful than a superficial partial-thickness burn because sensation is decreased at the site.

The nurse is instructing a client on lifestyle changes to promote a healthy cardiovascular system. Which of the following should be included in this teaching session? Select all that apply. A) Limit exercise to 15 minutes a day B) Reduce saturated fats in the diet C) Avoid cigarette smoking D) Wear elastic hose E) Limit fluid intake

B) Interventions that help promote a healthy cardiovascular system are to avoid cigarette smoking and reduce saturated fats in the diet. Clients should exercise for at least 30 minutes most days of the week to maintain a healthy cardiovascular system. Wearing elastic hose and limiting fluid intake are not known to contribute to a healthy cardiovascular system.

The nurse is caring for a client who receives H2-receptor antagonists for the treatment of peptic ulcer disease. Based on the nursing diagnosis Risk for Bleeding, which assessment finding should the nurse report immediately to the healthcare provider? A) The client reports pain after 24 hours of treatment. B) The client reports episodes of melena. C) The client reports that he is constipated. D) The client reports that he took Tums antacids with his H2-receptor antagonist.

B) Melena could indicate GI bleeding and should be reported to the physician immediately. The client may still experience pain for several days with this type of medication. Taking Tums antacids with an H2-receptor antagonist will cause deceased absorption of the H2-receptor antagonist, but this does not need to be reported to the healthcare provider; rather, the nurse should educate the client. Constipation is a common side effect that does not need to be immediately reported to the healthcare provider.

The nurse is caring for a client who is scheduled to receive metoprolol (Lopressor). What should the nurse teach the client about this medication? A) Expect a rapid heart rate. B) Change positions slowly. C) Reduce protein intake. D) Increase fluids.

B) Metoprolol is a beta blocker. The client should be instructed to use care when ambulating and to change positions slowly because this medication causes orthostatic hypotension. This medication does not cause a rapid heart rate. Protein restriction is not indicated with this medication. The client should not be instructed to increase fluids.

The nurse is concerned that a client with an alteration in perfusion is at risk for inadequate oxygenation. What should the nurse consider when planning for this client's potential health problem? A) Encouraging ambulation every 30 minutes B) Instructing on deep breathing C) Administering medications appropriate to increase heart rate D) Positioning to increase blood return

B) The client is at risk for inadequate oxygenation. The nurse should consider teaching the client the importance of deep breathing to increase the amount of oxygen in the body tissues. Encouraging ambulation every 30 minutes would negatively impact oxygenation. Periods of rest should occur between activities, and no activity should be too strenuous. The client with oxygenation issues will have tachycardia. The nurse should consider medications that would reduce instead of increase the heart rate. The client should be in the high-Fowler position to improve oxygenation. Positions to increase blood flow to the heart include Trendelenburg, which would negatively impact oxygenation.

A client who sustained burns to both lower extremities reports feeling frustrated by not being able to provide self-care. Which nursing diagnosis would be appropriate for the client at this time? A) Ineffective Coping B) Powerlessness C) Anxiety D) Situational Low Self-Esteem

B) The client is expressing frustration over not being able to provide self-care. The nursing diagnosis most appropriate for the client at this time would be Powerlessness. There is not enough information to determine whether the client is or is not experiencing situational low self-esteem, ineffective coping, or anxiety.

An older adult client with severe burns over more than half of the body has an indwelling catheter. When evaluating the client's intake and output, which of the following should be taken into consideration? A) The amount of urine will be elevated due to the amount of intravenous fluids administered during the initial phases of treatment. B) The amount of urine will be reduced in the first 24 to 48 hours and will then increase. C) The amount of urine will be reduced during the first 8 hours of the burn injury and will then increase as diuresis begins. D) The amount of urine output will be greatest in the first 24 hours after the burn injury.

B) The client will have an initial reduction in urinary output. Fluid is reduced in the initial phases as the body manages the insult caused by the injury and fluids are drawn into the interstitial spaces. After the shock period passes, the client will enter a period of diuresis. Diuresis begins between 24 and 36 hours after the burn injury.

The nurse is planning to provide care to extended family members spanning three generations who are being treated for burn injuries after a fire. Based on an understanding of lifespan factors, the nurse should anticipate that which of the following is true? A) The 38-year-old pregnant mother is more likely to require an allograft than the other members of the family. B) The 82-year-old grandmother is more likely to have burns to a greater percentage of her total body surface area (TBSA) than younger family members. C) The 14-year-old son is less likely to experience edema associated with his injuries than older members of the family. D) The 6-year-old daughter is more likely to go into burn shock than the other members of the family.

B) The older adult population is more likely to suffer burns to a greater percentage of their TBSA than other age groups, largely because their skin is so much thinner and therefore more delicate than that of younger individuals. The other assumptions cannot be made based on patient age alone and depend on the depth and extent of the burns, which is information that is unavailable at this time.

The nurse is preparing to conduct a cardiac assessment for a pediatric client. Which location will the nurse use when auscultating the apical pulse? A) At the fifth intercostal space B) At the left nipple C) At the right nipple D) At the eighth intercostal space

B) When assessing a pediatric client, it may be more beneficial to auscultate the apical pulse in the area of the left nipple at the fourth intercostal space. The other answer options are not appropriate.

Why is steatorrhea a common manifestation of Zollinger-Ellison syndrome? A) The high levels of hydrochloric acid associated with Zollinger-Ellison syndrome lead to impaired protein digestion. B) The high levels of hydrochloric acid associated with Zollinger-Ellison syndrome lead to impaired fat digestion. C) The large colonies of Helicobacter pylori (H. pylori) associated with Zollinger-Ellison syndrome lead to impaired protein digestion. D) The large colonies of H. pylori associated with Zollinger-Ellison syndrome lead to impaired fat digestion.

B) Zollinger-Ellison syndrome is a form of PUD caused by a gastrinoma, or gastrin-secreting tumor. Gastrin is a hormone that stimulates the secretion of pepsin and hydrochloric acid. The high levels of hydrochloric acid entering the duodenum overwhelm the protective buffering mechanism; the result is diarrhea and steatorrhea from impaired fat digestion and absorption.

A home healthcare nurse is providing care to an older adult client who lives alone and has limited financial resources. The client has a history of celiac disease. When planning care for this client, which nursing diagnoses are appropriate? Select all that apply. A) Risk for Constipation B) Imbalanced Nutrition: Less than Body Requirements C) Risk for Imbalanced Fluid Volume D) Diarrhea E) Chronic Pain

B, C, D, E) Client with celiac disease often have nutritional imbalance, including anemia and vitamin deficiencies; impaired absorption of fluids and electrolyte, which leads to diarrhea and fluid imbalance; and pain related to abdominal bloating and cramping. Constipation is not a normal manifestation of celiac disease.

A nurse working at a burn center is caring for a client with an electrical burn. According to the American Burn Association, how would this burn be classified? A) Minor B) Moderate C) Major D) Significant

C) According to the American Burn Association, all electrical burns are classified as major. Significant is not a classification according to the American Burn Association, and all other choices are incorrect.

A client is being treated with blood transfusions for a large peptic ulcer in the duodenum. Which information in the client's history should the nurse suspect as a potential cause of this health problem? A) Allergies to penicillin and morphine sulfate B) History of chronic atrial fibrillation C) Daily medications include naproxen sodium and aspirin D) History of recent cataract extraction with lens implant

C) Clients who are taking high doses of nonsteroidal anti-inflammatory agents (NSAIDs) such as naproxen sodium and aspirin are predisposed to developing large ulcers that do not cause pain. The first symptom the client often experiences is a significant bleeding episode. Concurrent use of NSAIDs and aspirin should therefore be avoided. Allergies to penicillin and morphine sulfate, history of atrial fibrillation, and recent eye surgery are not relevant to the client's bleeding incident.

The nurse provides discharge teaching for a client with peptic ulcer disease (PUD). Which client statement indicates that teaching has been effective? A) "I will drink more milk and limit spicy foods." B) "I will take ibuprofen (Motrin) for my headaches." C) "I will limit my intake of coffee." D) "I will join a gym and increase my exercise."

C) Diet is usually not a major factor in the development of peptic ulcers, so eating or avoiding specific foods is not currently encouraged for the treatment of PUD. Caffeine, however, is a risk factor for PUD, so limiting caffeinated products such as coffee would be beneficial. There is no correlation between exercise and the management of PUD. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin should be avoided because they are a primary cause of PUD.

The nurse is caring for a client admitted to the hospital with lower extremity edema and shortness of breath. Which electrocardiogram finding indicates the client is at risk for an alteration in perfusion? A) P wave smooth and round B) Absent U wave C) PR interval 0.30 seconds D) ST segment isoelectric

C) The PR interval is normally 0.12-0.20 seconds. Intervals greater than 0.20 seconds indicate a delay in conduction from the SA node to the ventricles. A P wave should be smooth and round. The U wave is not normally seen. The ST segment should be isoelectric.

A burn patient is currently in the acute stage. When did this stage begin, and when will it end? A) It began with the onset of the burn injury and will end with fluid resuscitation. B) It began with wound closure and will end when the patient's health is fully restored. C) It began with the start of diuresis and will end with the closure of the burn wound. D) It began with the onset of the burn injury and will end with the closure of the burn wound.

C) The acute stage begins with the start of diuresis and ends with the closure of the burn wound, either by natural healing or by use of skin grafts. The emergent/resuscitative stage begins with the onset of the burn injury and ends with successful fluid resuscitation. The rehabilitative stage begins with wound closure and ends when the patient returns to the highest level of health restoration, which may take years.

Blood pressure is influenced by all except which factor? A) Pumping action of the heart B) Peripheral vascular resistance C) Heart rate D) Blood volume

C) The factors that determine blood pressure include the pumping action of the heart, peripheral vascular resistance, and blood volume and viscosity. Heart rate by itself does not determine blood pressure.

Which statements are correct regarding the various layers of the heart? Select all that apply. A) The endocardium covers the entire heart and great vessels. B) The endocardium is the muscular layer of the heart that contracts during each heartbeat. C) The outermost layer of the heart is the epicardium. D) The myocardium consists of myofibril cells. E) The myocardium has four layers.

C) The heart wall consists of three layers of tissue: the epicardium, the myocardium, and the endocardium. The epicardium covers the entire heart and great vessels, and then folds over to form the parietal layer lining the pericardium and adheres to the heart surface. The myocardium, the middle layer of the heart wall, consists of specialized cardiac muscle cells (myofibrils). The endocardium, which is the innermost layer, is a thin membrane composed of three layers. The myocardium is the muscular layer of the heart that contracts during each heartbeat. The outermost layer of the heart is the epicardium.

An older adult African American client with a history of celiac disease presents with abdominal cramps, pain, and diarrhea. The client denies the use of alcohol, but states, "My favorite foods are steak, cheese, and ice cream." Based on this data, which condition does the nurse suspect? A) Acute pancreatitis B) Appendicitis C) Lactase deficiency D) Food poisoning

C) The most common risk factor for pancreatitis is alcohol abuse. Appendicitis usually involves loss of appetite and nausea and/or vomiting soon after abdominal pain begins. Lactose intolerance is more common in Native Americans, Asians, Hispanics, and African Americans and in those with a history of celiac disease. Food poisoning generally causes some nausea and vomiting.

The nurse is auscultating heart sounds for a pregnant client in the third trimester of pregnancy. The client wants to know why her doctor told her she had an extra heart sound at the last visit. Which response by the nurse is appropriate? A) "You will need to have an echocardiogram to determine the reason for the extra sound." B) "You are likely experiencing heart failure due to the extra fluid that accumulates during this time in pregnancy." C) "You have what is known as a ventricular gallop, and it can be a normal finding during this trimester of pregnancy." D) "You have what is known as atrial gallop, and this is cause for concern."

C) Two other heart sounds may be present in some healthy individuals. The third heart sound (S3) may be heard in children, in young adults, or in pregnant females during the third trimester. It is heard after S2 and is termed a ventricular gallop. When the atrioventricular (AV) valves open, blood flow into the ventricles may cause vibrations. These vibrations create the S3 sound during diastole. There is no need for an echocardiogram. While the S3 sound can be associated with heart failure, this is not the case during pregnancy. S4, also known as an atrial gallop, can also be present in health individuals.

A nurse is educating a client with peptic ulcer disease (PUD) about Helicobacter pylori (H. pylori) and its role in PUD. Which statements by the nurse are appropriate to include in the teaching session? Select all that apply. A) "H. pylori produces enzymes that improve the efficacy of mucous gel in protecting the gastric mucosa." B) "H. pylori infection is found in about 25% of individuals with PUD." C) "Your inflammatory response to H. pylori contributes to gastric cell damage." D) "H. pylori infection increases production of gastric acids." E) "H. pylori infection is spread by droplets in the air."

C, D) H. pylori infection, found in about 70% of individuals who have PUD, is unique in colonizing the stomach. It is spread individual to individual (oral-oral or fecal-oral) and contributes to ulcer formation in several ways. The bacteria produce enzymes that reduce the efficacy of mucous gel in protecting the gastric mucosa. In addition, the host's inflammatory response to H. pylori contributes to gastric epithelial cell damage without producing immunity to the infection. H. pylori infection also increases the production of gastric acids.

The nurse is caring for a client who is to receive mechanical debridement of burn wounds. Which methods should the nurse anticipate using to complete this treatment? Select all that apply. A) Homograft B) Application of a topical agent to dissolve necrotic tissue C) Irrigation of the burn wounds D) Application of wet-to-dry gauze dressings E) Hydrotherapy

C, D, E) Mechanical debridement is done by applying and removing wet-to-dry gauze dressings, using hydrotherapy, or using irrigation. Applying a topical agent to dissolve necrotic tissue is an example of enzymatic debridement. The application of a homograft is a type of dressing and not a type of debridement.

The nurse is planning a teaching session regarding peptic ulcers for the residents of an assisted-living complex. Which concepts about peptic ulcer disease should the nurse include in the presentation to the residents? Select all that apply. A) A colonoscopy is the most common test used to diagnose the presence of a gastric ulcer. B) Gastric ulcers are more common than duodenal ulcers. C) Many peptic ulcers are infected with Helicobacter pylori (H. pylori) and are treated with antibiotics. D) The first sign of a peptic ulcer may be serious gastrointestinal bleeding. E) An individual with a peptic ulcer will most likely experience pain when the stomach is empty.

C, D, E) The client with a peptic ulcer may be largely asymptomatic until there is an episode of gastrointestinal bleeding. Duodenal ulcers are more common than gastric ulcers. The individual who has a peptic ulcer will most likely have abdominal pain when the stomach is empty. Tests used to diagnose a gastric ulcer include endoscopy and H. pylori testing. Peptic ulcers that are infected with H. pylori will often be treated with antibiotics.

Which data supports the nurse's concern that a client is at a high risk for a burn injury? Select all that apply. A) Part-time employment at a convenience store B) Diagnosis of hypertension C) Age 71 years D) Uses public transportation for grocery shopping E) Currently smokes one pack of cigarettes per day

C, E) Older clients are more vulnerable to fire and burn injury because of decreased visual acuity, depth perception, sense of smell, and hearing, and because of impaired mobility. Alterations in cognition, such as dementia, are also risk factors. Smoking is another risk factor. All of these factors increase the risk of accidentally starting a fire and diminish the ability to survive it. Hypertension does not increase the client's risk for experiencing a burn injury. Part-time employment and use of public transportation do not increase the client's risk of experiencing a burn injury.

The nurse is evaluating the adequacy of the burn-injured client's nutritional intake. Which laboratory value is the best indicator of nutritional status? A) Creatine phosphokinase (CPK) B) Blood urea nitrogen (BUN) levels C) Hemoglobin D) Albumin level

D) Albumin level is used to indicate protein synthesis and nutritional status. Creatine phosphokinase is used to identify the presence of muscle injuries. BUN levels are used to evaluate kidney function. Hemoglobin levels will fluctuate with the stages of the burn injury, dependent on the fluid status.

A client is evaluated after suffering severe burns to the torso and upper extremities. The nurse notes edema at the burned areas. Which of the following best describes the underlying cause of this manifestation? A) Decreased osmotic pressure in the burned tissue B) Reduced microvascular permeability at the site of the burned area C) Increased potassium in the intracellular compartment D) Inability of the damaged capillaries to maintain fluids in the cell walls

D) Burn shock occurs during the first 24-36 hours after the injury. During this period, there is a shifting of fluid volume that is the direct result of lost cell wall integrity at the injury site and in the capillary bed. There is an increase in microvascular permeability at the burn site. The osmotic pressure is also increased, causing fluid accumulation. Potassium ions leave the intracellular compartment, putting patients at risk for cardiac dysrhythmia due to hypokalemia.

An adult burn patient is brought in to the intensive care unit (ICU) for treatment. Prior to sustaining the injury, the client was considered underweight for her height. The nurse understands that this may have important implications for the client because A) she will have lower fluid resuscitation calculations than patients of normal weight. B) she will be at greater risk for developing cardiac or renal insufficiencies. C) she will require more supportive care than patients who are normal weight. D) she will lose as much as 20% of her preburn weight during rehabilitation.

D) During the acute and rehabilitative phases of the burn injury, the patient loses as much as 20% of preburn weight. This has significant implications for all patients, especially those who are underweight at the time of injury. Fluid resuscitation calculations are based on the time of injury, not body weight. Patients with a past medical history of cardiac or renal problems are at an increased risk for cardiac and renal insufficiency regardless of weight. Children and older adults require more supportive care than other client populations because of differences in their skin and healing, not because of their body weight.

How should the nurse position a client who is returned to the burn unit following a graft procedure to the leg? A) Place the client flat with the affected extremity abducted. B) Elevate the head of bed 30 degrees C) Maintain the head of bed flat D) Elevate the affected extremity

D) Elevating the affected extremity will reduce edema and promote perfusion. Elevating the head of bed, leaving the head of bed flat, and abducting the extremity will not increase healing or improve the client's long-range prognosis.

The nurse is planning a teaching session for older community members about the risks for peptic ulcer disease (PUD) in this age group. Which of the following pieces of information should the nurse include when teaching this group? A) PUD causes less bleeding in older clients than in younger clients. B) Older clients experience more severe abdominal pain than younger clients with PUD. C) Older clients should undergo colonoscopy when diagnosed with PUD. D) PUD is likely exacerbated by the bacterium Helicobacter pylori (H. pylori).

D) H. pylori infection is a major factor in the development of ulcers, and prevalence increases with the age of the client. Seventy to 90% of persons with gastric ulcers and 90 to 100% of clients with duodenal ulcers are found to have this infection. Older clients tend to experience more bleeding and often have less pain than younger clients with PUD. Bleeding may be the initial symptom experienced by older clients. Clients with peptic ulcers should have upper GI endoscopy performed to diagnose the problem with visualization and biopsy, not colonoscopy.

Which of the following statements best describes the role of gluten in celiac disease? A) It acts as a toxin damaging the villi of the small intestine. B) It acts as an immunological body to destroy pathogens. C) It acts as a virus to cause disease. D) It acts as a foreign substance that provokes an immune response.

D) In celiac disease, gluten is a foreign substance that provokes an immune response. The immune response prompts an inflammatory response in the small bowel, which in turn leads to a loss of villi and microvilli; the immune response causes this to happen, not gluten. Gluten doesn't act as an antibody as part of the immunological response of the body; it provokes that response. It doesn't act as a viral pathogen to cause disease but as an antigen.

A client with Helicobacter pylori asks the nurse why bismuth (Pepto-Bismol) has been prescribed along with oral antibiotics for treatment. What should the nurse explain about the use of Pepto-Bismol for treatment of this health problem? Select all that apply. A) "It helps prevent the side effects of antibiotics." B) "It increases stomach acid to help kill bacteria." C) "It helps relieve ulcer-related constipation." D) "It is effective with inhibiting bacterial growth." E) "It stimulates the production of substances that promote ulcer healing."

D, E) Bismuth compounds (Pepto-Bismol) are added to the antibiotic regimen to inhibit bacterial growth. Bismuth compounds also stimulate mucosal bicarbonate and prostaglandin production to promote ulcer healing. Bismuth does not prevent all side effects of antibiotics, nor does it increase stomach acid. Bismuth is used to relieve diarrhea, not constipation.

The nurse is caring for an older adult. Which age-related changes should the nurse identify as increasing the risk of dry skin? Select all that apply. A) Reduction in elastin B) Depleted moisture in epidermal cells C) Decreased size of sebaceous glands D) Thinner subcutaneous skin layer E) Poor nutrition

The nurse is caring for an older adult. Which age-related changes should the nurse identify as increasing the risk of dry skin? Select all that apply. A) Reduction in elastin B) Depleted moisture in epidermal cells C) Decreased size of sebaceous glands D) Thinner subcutaneous skin layer E) Poor nutrition