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MS |! 2 |! Exam |! 2 |! with |! precise |! answers
A |! client |! presents |! to |! the |! ED |! with |! upper |! gastrointestinal |! bleeding |! and |! is |! in |! moderate |! distress. |! In |! planning |! care, |! what |! is |! the |! priority |! nursing |! action |! for |! this |! client? |! - |! Correct |! answer |! ✔Assessment |! of |! vital |! signs The |! pernicious |! anemia |! that |! may |! accompany |! gastritis |! is |! due |! to |! which |! of |! the |! following? |! - |! Correct |! answer |! ✔A |! lack |! of |! intrinsic |! factor |! normally |! produced |! by |! acid-secreting |! cells |! of |! the |! gastric |! mucosa. -Acid |! secreting |! cells |! are |! lost |! or |! nonfunctioning. The |! nurse |! performs |! a |! detailed |! assessment |! of |! the |! abdomen |! of |! a |! patient |! with |! a |! possible |! bowel |! obstruction, |! knowing |! that |! a |! manifestation |! of |! an |! obstruction |! in |! the |! small |! intestines |! is... |! - |! Correct |! answer |! ✔1. |! Projectile |! vomiting
- |! Persistent, |! colicky |! abdominal |! pain
- |! Increased, |! tinkling |! bowel |! sounds |! above |! the |! blockage. The |! nurse |! anticipates |! a |! patient |! will |! need |! an |! esophagastroduodenoscopy |! (EGD). |! Select |! all |! the |! actions |! that |! are |! appropriate |! in |! this |! patients |! care. |! - |! Correct |! answer |! ✔1. |! Signed |! informed |! consent
- |! Teaching |! related |! to |! conscious |! sedation
- |! Full |! set |! of |! vitals |! before |! the |! procedure
- |! Keep |! the |! patient |! NPO |! until |! gag |! reflex |! returns |! post-procedure.
A |! patient |! with |! chronic |! gastritis |! associated |! with |! the |! presence |! of |! H. |! pylori |! is |! treated |! with |! triple-drug |! therapy. |! The |! nurse |! explains |! to |! the |! patient |! that |! the |! drugs |! commonly |! included |! in |! this |! regimen |! include |! - |! Correct |! answer |! ✔1. |! Amoxicillin |! (Amoxil)
- |! Clarithromycin |! (Biaxin)
- |! Omeprazole |! (Prilosec) The |! nurse |! is |! caring |! for |! a |! client |! with |! acute |! pancreatitis |! and |! is |! monitoring |! the |! client |! for |! paralytic |! ileus. |! Which |! assessment |! data |! should |! alert |! the |! nurse |! to |! this |! occurrence? |! - |! Correct |! answer |! ✔Inability |! to |! pass |! flatus In |! caring |! for |! a |! client |! with |! cholelithiasis |! and |! a |! possible |! biliary |! obstruction, |! what |! clinical |! findings |! would |! you |! expect? |! - |! Correct |! answer |! ✔1. |! Clay |! colored |! or |! light |! colored |! bowel |! movements. |!
- |! Abdominal |! pain
- |! Jaundice The |! nurse |! is |! assessing |! a |! client |! who |! is |! experiencing |! an |! acute |! episode |! of |! cholecystitis. |! Where |! should |! the |! nurse |! anticipate |! the |! location |! of |! the |! pain? |! - |! Correct |! answer |! ✔Right |! upper |! quadrant, |! radiating |! to |! the |! right |! scapula |! and |! shoulder. Which |! of |! the |! following |! would |! be |! the |! most |! important |! for |! a |! nurse |! to |! teach |! a |! client |! who |! is |! hospitalized |! with |! acute |! pancreatitis |! prior |! to |! discharge? |! - |! Correct |! answer |! ✔Avoidance |! of |! alcohol |! use |! for |! up |! to |! a |! year. |! -alcohol |! can |! precipitate |! future |! flares |! or |! turn |! it |! into |! chronic |! pancreatitis.
blood |! from |! the |! nasogastric |! tube. |! You |! interpret |! these |! findings |! as |! - |! Correct |! answer |! ✔This |! decrease |! in |! hemoglobin |! and |! hematocrit |! was |! caused |! by |! hemodilution |! from |! fluid |! replacement |! therapy. The |! nurse |! should |! teach |! the |! client |! who |! is |! receiving |! warfarin |! sodium |! that: |! - |! Correct |! answer |! ✔International |! Normalized |! Ratio |! (INR) |! is |! used |! to |! assess |! effectiveness. The |! nurse |! is |! changing |! the |! subclavian |! dressing |! of |! a |! client. |! When |! assessing |! the |! catheter |! insertion |! site, |! the |! nurse |! notes |! the |! presence |! of |! yellow |! drainage |! from |! around |! the |! sutures |! that |! are |! anchoring |! the |! catheter. |! What |! should |! the |! nurse |! obtain |! before |! cleaning |! the |! site? |! - |! Correct |! answer |! ✔Swab |! and |! culture |! of |! the |! exudate |! to |! send |! to |! the |! lab. A |! patient |! with |! SIADH |! has |! a |! serum |! sodium |! level |! of |! 129. |! The |! nurse |! is |! concerned |! about |! potential |! complication |! form |! this |! laboratory |! finding |! and |! implements |! safety |! measures. |! What |! would |! be |! the |! priority? |! - |! Correct |! answer |! ✔Pad |! the |! side |! rails |! in |! case |! of |! seizures. Select |! all |! the |! statements |! that |! apply |! to |! the |! proper |! administration |! of |! total |! parenteral |! nutrition |! - |! Correct |! answer |! ✔1. |! Can |! hang |! for |! only |! 24 |! hours
- |! Required |! glucose |! monitoring |! every |! 6 |! hours |! and |! PRN
- |! Label |! should |! contain |! all |! nutrients |! as |! well |! as |! date, |! time, |! and |! expiration |! date.
The |! nurse |! places |! a |! priority |! on |! which |! of |! these |! interventions |! to |! care |! for |! a |! client |! with |! an |! NG |! tube. |! - |! Correct |! answer |! ✔1. |! Frequent |! oral |! care |! for |! dry |! oral |! mucosa. |!
- |! Use |! of |! low |! intermittent |! suctioning. |!
- |! Frequent |! assessment |! of |! bowel |! sounds. Signs |! of |! compensation |! for |! metabolic |! acidosis |! include |! - |! Correct |! answer |! ✔Deep |! rapid |! respirations The |! physician |! orders |! dopamine |! at |! 4mcg/kg/min |! for |! a |! 210lb |! patient. |! Supplied |! 400mg |! in |! 250ml |! of |! D5W. |! Calculate |! the |! COS |! and |! IR |! - |! Correct |! answer |! ✔COS: |! 400,000 |! mcg/250 |! ml= |! 1600 |! mcg/ml IR: |! (4mcg |! X |! 94.45 |! kg |! X |! 60 |! min) |! / |! 1600mcg/ml |! = |! 14 |! ml/hr In |! preparing |! a |! client |! for |! a |! colonoscopy, |! the |! nurse |! should |! explain |! that: |! - |! Correct |! answer |! ✔1. |! A |! signed |! informed |! consent |! in |! necessary
- |! Sedation |! may |! be |! used |! during |! the |! procedure
- |! Bowel |! cleansing |! is |! necessary |! for |! preparation Signs |! and |! symptoms |! of |! a |! bowel |! perforation |! might |! include: |! - |! Correct |! answer |! ✔1. |! Free |! air |! under |! the |! diaphragm |! on |! Xray
- |! A |! sudden |! change |! in |! pain |! and |! new |! pain |! in |! the |! shoulder
- |! Changes |! in |! vital |! signs |! including |! elevated |! temp.
A |! client |! is |! diagnosis |! of |! diabetic |! ketoacidosis |! (DKA) |! is |! being |! treated |! in |! the |! ED. |! Which |! findings |! would |! the |! nurse |! expect |! to |! note |! as |! confirming |! this |! diagnosis? |! - |! Correct |! answer |! ✔1. |! Deep, |! rapid |! breathing
- |! Elevated |! blood |! glucose |! levels
- |! Low |! plasma |! bicarbonate |! level A |! client |! is |! admitted |! to |! a |! hospital |! with |! a |! diagnosis |! of |! DKA. |! The |! initial |! blood |! glucose |! level |! was |! 950mg/dL. |! A |! continuous |! intravenous |! infusion |! of |! short |! acting |! insulin |! is |! initiated |! along |! with |! intravenous |! rehydration |! with |! normal |! saline. |! The |! serum |! glucose |! level |! is |! now |! 240mg/dl. |! The |! nurse |! would |! next |! prepare |! to |! administer |! which |! item? |! - |! Correct |! answer |! ✔Intravenous |! fluids |! containing |! dextrose |! - |! used |! to |! avoid |! tanking |! them |! into |! hypoglycemia. The |! nurse |! is |! caring |! for |! a |! client |! admitted |! to |! the |! ED |! with |! DKA. |! In |! the |! acute |! phase, |! the |! nurse |! plans |! for |! which |! priority |! intervention? |! - |! Correct |! answer |! ✔Administer |! short-duration |! insulin |! intravenously. The |! nurse |! teaches |! a |! client |! with |! diabetes |! mellitus |! about |! differentiating |! between |! hypoglycemia |! and |! ketoacidosis. |! The |! client |! demonstrate |! an |! understanding |! of |! the |! teaching |! by |! stating |! that |! a |! form |! of |! glucose |! should |! be |! taken |! if |! which |! symptoms |! develop? |! - |! Correct |! answer |! ✔1. |! Shakiness
- |! Palpitations
- |! Light |! headedness Levothyroxine |! (Synthroid) |! is |! prescribed |! for |! a |! client |! diagnosed |! with |! hypothyroidism. |! Upon |! review |! of |! the |! clients |! record, |! the |! nurse |! notes |! that |! the
|! client |! is |! taking |! warfarin. |! Which |! modification |! to |! the |! plan |! of |! care |! should |! the |! nurse |! review |! with |! the |! clients |! health |! care |! provider? |! - |! Correct |! answer |! ✔A |! decreased |! dosage |! of |! warfarin |! sodium. A |! client |! arrives |! at |! the |! clinic |! complaining |! of |! fatigue, |! lack |! of |! energy, |! constipation, |! and |! depression. |! Hypothyroidism |! is |! diagnosed, |! and |! levothyroxine |! is |! prescribed. |! What |! is |! an |! expected |! outcome |! of |! the |! medication? |! - |! Correct |! answer |! ✔Achieve |! normal |! thyroid |! hormone |! levels. The |! nurse |! should |! include |! which |! interventions |! in |! the |! plan |! of |! care |! for |! a |! client |! with |! hypothyroidism? |! Select |! all |! that |! apply |! - |! Correct |! answer |! ✔1. |! Instruct |! the |! client |! about |! thyroid |! replacement |! therapy. |!
- |! Encourage |! the |! client |! to |! eat |! foods |! high |! in |! fiber |! and |! lots |! of |! fluids. |!
- |! Instruct |! the |! client |! to |! contact |! the |! HCP |! if |! episodes |! of |! chest |! pain |! occur. |! -Cold |! intolerance |! so |! need |! a |! warmer |! environment. A |! client |! is |! admitted |! to |! an |! ED, |! and |! a |! diagnosis |! of |! myxedema |! coma |! is |! made. |! Which |! action |! would |! the |! nurse |! prepare |! to |! carry |! out |! initially? |! - |! Correct |! answer |! ✔Maintain |! a |! patent |! airway The |! nurse |! is |! preparing |! a |! client |! with |! a |! new |! diagnosis |! of |! hypothyroidism |! for |! discharge. |! The |! nurse |! determines |! that |! the |! client |! understand |! discharge |! instructions |! if |! the |! client |! states |! that |! which |! symptoms |! are |! associated |! with |! the |! diagnosis? |! - |! Correct |! answer |! ✔1. |! Feeling |! cold
- |! Loss |! of |! body |! hair
- |! Persistent |! lethargy
- |! Puffiness |! of |! the |! face
HHS: |! >
Cause |! of |! HHS |! - |! Correct |! answer |! ✔Infection, |! corticoids, |! phenytoin, |! thiazides Signs |! of |! HHS |! - |! Correct |! answer |! ✔Severe |! dehydration, |! hyperglycemic |! signs, |! more |! mental |! status |! changes Are |! there |! ketones |! or |! lipolysis |! in |! HHS? |! - |! Correct |! answer |! ✔No! |! No |! lipolysis= |! no |! ketones Treatment |! for |! DKA |! and |! HHS |! - |! Correct |! answer |! ✔-risk |! for |! fluid |! volume |! deficit |! -manage |! airway -fluid |! replacement |! + |! insulin |! therapy |! -when |! glucose |! @ |! 250-> |! change |! to |! D5W |! w/ |! .45% |! NS |! with |! glucose |! because |! we |! don't |! want |! to |! deplete |! them. |! -potassium |! labs -regular |! insulin |! = |! continuous |! -patient |! teaching: |! know |! signs |! of |! hypoglycemia. -if |! stressed: |! still |! take |! insulin |! (even |! if |! not |! eating |! because |! their |! body |! needs |! insulin |! because |! of |! the |! increased |! stress) Acidosis |! Treatment |! - |! Correct |! answer |! ✔-Assess |! LOC |! and |! respiration's |! -give |! sodium |! bicarbonate |! if |! ph |! is |! <7.
-corrected |! bug |! fluids |! and |! insulin What |! is |! the |! level |! for |! hypoglycemia, |! signs, |! and |! treatment |! - |! Correct |! answer |! ✔<60. Sweaty, |! pallor, |! dilated |! pupils If |! on |! BB: |! signs |! might |! not |! show |! up Tx: |! give |! 15g |! of |! carbs, |! D5W, |! oral |! glucose -should |! improve |! rapidly |! when |! they |! get |! glucose Diabetes |! insipidus |! is |! what |! type |! of |! problem |! - |! Correct |! answer |! ✔Pituitary |! problem What |! is |! DI |! and |! the |! two |! types? |! - |! Correct |! answer |! ✔Inadequate |! ADH |! Neurogenic: |! lack |! of |! ADH |! (trauma/tumor) Nephrogenic: |! insensitivity |! to |! ADH |! (genetic) Signs |! of |! DI |! - |! Correct |! answer |! ✔Mental |! status |! changes, |! dehydration, |! POLYURIA, |! low |! urine |! osmolality, |! diluted |! urine Symptoms |! of |! DI |! - |! Correct |! answer |! ✔Increased |! serum |! osmolality, |! increased |! serum |! sodium |! and |! potassium |! (less |! volume |! to |! dilute) -dehydration |! can |! lead |! to |! seizures, |! coma, |! and |! or |! death Nursing |! diagnosis |! for |! DI |! - |! Correct |! answer |! ✔Fluid |! deficit, |! priority |! is |! fluid |! replacement
-declomycin |! (demeclocyline)= |! block |! affect |! of |! ADH |! on |! renal. |! (Increases |! urine |! output) -Lithium= |! not |! for |! confusion, |! blocks |! renal |! response |! -hypertonic |! solution= |! slow |! over |! time |! -supplement |! with |! sodium |! and |! potassium |! -weigh |! DAILY- |! especially |! with |! fluid |! problems -avoid |! opioids |! (can |! increase |! salt) —don't |! have |! to |! restrict |! Na |! or |! K Why |! are |! patients |! with |! pancreatitis |! NPO? |! - |! Correct |! answer |! ✔You |! don't |! want |! to |! stimulate |! the |! pancreas Goal |! of |! pancreatitis |! - |! Correct |! answer |! ✔Rest, |! NPO, |! decrease |! stimulation, |! pain |! control Characteristics |! and |! causes |! of |! pancreatitis |! - |! Correct |! answer |! ✔Inflammation |!
- |! auto |! digestion |! Alcohol |! abuse |! + |! cholecystitis Signs |! of |! pancreatitis |! - |! Correct |! answer |! ✔Left |! upper |! quadrant |! pain |! not |! relieved |! by |! vomiting |! Hypocalcemia= |! tetany |! (shaky, |! spasms) How |! to |! relieve |! pancreatitis |! pain |! - |! Correct |! answer |! ✔Cough |! and |! deep |! breathe
Labs |! for |! pancreatitis |! - |! Correct |! answer |! ✔Amylase |! and |! lipase |! INCREASED Information |! for |! acute |! abdominal |! pain |! - |! Correct |! answer |! ✔NPO ALWAYS |! do |! vitals |! first Can |! be |! many |! different |! problems |! so |! do |! full |! history |! second -could |! be |! bleeding, |! pregnant, |! etc What |! is |! Cushing's |! Disease |! and |! what |! is |! the |! main |! cause? |! - |! Correct |! answer |! ✔Excess |! corticosteroids |! (glucocorticosteroids) Main |! cause: |! exogenous- |! excess |! administration What |! is |! ACTH |! and |! what |! does |! it |! stimulate? |! - |! Correct |! answer |! ✔Adrenocorticotropic |! hormone, |! stimulates |! adrenal |! gland, |! from |! anterior |! pituitary. Signs |! of |! Cushing's |! Disease |! - |! Correct |! answer |! ✔Thinning |! of |! hair, |! buffalo |! hump, |! moon |! face, |! fat |! pads, |! slowed |! healing, |! striae, |! thin |! skin -If |! you |! fix |! problem |! or |! stop |! medication |! administration |! these |! signs |! will |! go |! away, |! they |! are |! not |! life |! long. Symptoms |! of |! Cushing's |! Disease |! - |! Correct |! answer |! ✔Hypertension |! (sodium |! and |! water |! retention), |! hypokalemia |! (alkalosis), |! hyperglycemia.
Hyperkalemia Weight |! loss, |! fatigue, |! bronze |! skin What |! is |! Addisonian |! crisis? |! - |! Correct |! answer |! ✔Insufficient |! adrenocortical |! hormones- |! sudden |! drop Caused |! by: |! Stress, |! sudden |! withdrawal |! of |! meds, |! surgery |! -Shock= |! priority Treat |! with: |! Fluid |! replacement |! + |! steroids Treatment |! for |! Addison's |! Disease |! - |! Correct |! answer |! ✔Steroids |! - |! prednisone |! and |! hydrocortisone |! (immunosuppressant) Teaching |! points |! for |! Addison's |! Disease |! - |! Correct |! answer |! ✔Report |! stressful |! events |! to |! titrate |! med |! dosage Dont |! stop |! meds |! suddenly |! - |! greater |! than |! a |! week Risk |! for |! infection Monitor |! blood |! glucose Side |! Effects: |! Same |! as |! Cushing's Risk |! for |! osteoporosis |! = |! vitamin |! D |! and |! Calcium Take |! meds |! in |! morning |! (2/3) |! and |! (1/3) |! in |! late |! afternoon What |! is |! Hyperthyroidism |! (Graves |! Disease) |! including |! the |! pathophysiology |! behind |! it |! - |! Correct |! answer |! ✔Exophthalmos: |! protruding |! eyes Everything |! increased
Patho: |! Antibodies |! attach |! to |! TSH |! receptors |! and |! stimulate |! thyroid |! to |! release |! T3 |! and |! T4. |! Leads |! to |! excess |! release. Signs |! and |! Symptoms |! of |! Graves |! Disease |! (hyperthyroidism) |! - |! Correct |! answer |! ✔Increased |! metabolism -Weight |! loss |! and |! muscle |! wasting -Rapid |! pulse -increased |! appetite -Dyspnea |! and |! insomnia -Increased |! bowel -Increased |! respirations |! -Fine/thin |! nails |! and |! clubbing -Intolerance |! to |! heat, |! elevated |! basal |! temp -Hypertension What |! is |! Hypothyroidism |! (Hashimoto's) |! along |! with |! signs |! and |! symptoms |! - |! Correct |! answer |! ✔Patho: |! deficiency |! in |! thyroid |! hormones Decreased |! metabolism -weight |! gain, |! slowed |! movements, |! lethargy -decreased |! appetite, |! constipation -thick |! nails -intolerance |! to |! cold -decreased |! HR |! and |! force
|! -carpal |! spasms, |! tetany |! = |! give |! calcium GI |! bleeding- |! what |! to |! do |! first |! and |! risk |! factors |! - |! Correct |! answer |! ✔Perform |! vitals |! first |! to |! assess |! for |! shock. -Shock= |! decreased |! BP |! and |! tachycardia Risk |! factors: -Inappropriate |! NSAID |! use -previous |! bleed -alcohol |! use -older |! adults What |! is |! Hematemesis |! and |! what |! to |! do |! if |! this |! occurs |! - |! Correct |! answer |! ✔Coffee |! ground |! throw |! up -Do |! an |! endoscopy |! to |! see |! where |! the |! bleed |! is -Been |! in |! there |! a |! while |! and |! is |! being |! digested |! that |! is |! why |! its |! black |! and |! coffee |! texture What |! is |! melena? |! - |! Correct |! answer |! ✔Black |! stools -Iron |! supplements |! may |! cause |! this -Indicative |! of |! upper |! GI |! bleed What |! is |! occult |! bleeding |! and |! what |! test |! confirms |! this? |! - |! Correct |! answer |! ✔Small |! amounts |! of |! blood -cant |! see, |! need |! to |! do |! occult |! blood |! test
|! Guaiac |! Test Diagnostics |! and |! Treatment |! for |! GI |! bleeding |! and |! Complications |! - |! Correct |! answer |! ✔Upper |! GI |! bleed: |! Endoscopy Lower |! GI |! bleed: |! Colonoscopy |! Treat: |! Endoscopic |! hemostasis |! therapy -stops |! vessels |! - |! cauterize |! to |! stop |! bleeding -H2 |! blockers |! and |! meds Complications: |! Shock |! and |! hemorrhage Symptoms |! of |! Upper |! GI |! obstruction |! - |! Correct |! answer |! ✔Colicky |! pain tinkly |! sounds severe |! vomiting |! (vomiting |! relieves |! pain) Symptoms |! of |! Lower |! GI |! obstruction |! - |! Correct |! answer |! ✔Abdominal |! distention |! May |! not |! have |! vomiting Description |! of |! mechanical |! obstruction |! - |! Correct |! answer |! ✔Common, |! physical |! most |! are |! in |! small |! bowel Description |! of |! nonmechanical |! obstruction |! - |! Correct |! answer |! ✔Paralytic |! ileus |! (bowel |! not |! working), |! vascular, |! neurogenic
