A client with diabetes mellitus is experiencing polyphagia. Which outcome statement is the priority for this client? A) Fluid and electrolyte balance. B) Prevention of water toxicity. C) Reduced glucose in the urine. D) Adequate cellular nourishment.

D) Adequate cellular nourishment. Diabetes mellitus Type 1 is characterized by hyperglycemia that precipitates glucosuria and polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Polyphagia is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose for energy, so the outcome statement should include stabilization of adequate cellular nutrition (D). (A, B, and C) relate to subsequent osmolar fluid shifts related to glucosuria, polyuria, and polydipsia. More test answers on https://studyhippo.com/med-surg-hesi-practice-questions/

The nurse is performing discharge teaching for a patient with Addison’s disease. It is MOST important for the nurse to instruct the patient about: a. signs and symptoms of infection b. fluid and electrolyte balance c. seizure precautions d. steroid replacement

d. steroid replacement steroid replacement is the most important information the client needs to know. More test answers on https://studyhippo.com/nclex-style-practice-questions-medsurg-diabetes/

Two hormones are closely involved in the regulation of the fluid and electrolyte balance of the body. Name them and explain their effects on their common target organ.

Aldosterone and ADH are both involved in fluid and electrolyte balance by acting on the kidney. Aldosterone causes the kidney to retain salt and thereby also retain water isoosmotically. ADH causes the body to retain water but does not affect salt retention, so high levels of ADH lowers blood osmolality. More test answers on https://studyhippo.com/14-04-anatomy-test/

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Fluid And Electrolyte Balance Nutrition

Test Answers on Bio Chapter 6 – Flashcards 80 terms

Jonathan Walsh

80 terms

Preview

Test Answers on Bio Chapter 6 – Flashcards

question

2. For the majority of exercisers, adding excess protein or amino acid supplements to an adequate diet will stimulate muscle building.

answer

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4. Amino acid supplements are easy to digest and can relieve the digestive system from overworking.

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5. When a person ingests a large dose of any single amino acid, absorption of others of its type may be limited.

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6. If needed, protein can help to maintain a steady blood glucose level and so meet the glucose needs of the brain.

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8. Without critical essential amino acids to perform their roles, many of the body's life-sustaining activities would come to a halt.

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9. Overconsumption of protein-rich foods offers no benefits and may pose health risks, particularly for weakened kidneys.

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10. Each amino acid has its own distinctive chemical side chain attached to the center carbon of the backbone.

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11. The body is able to make all of the 20 amino acids needed from fragments derived from carbohydrate and fat.

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13. Growing children are in negative nitrogen balance because they need more protein for adding blood, bone, and muscle cells.

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14. Legumes are a good source of protein, many B vitamins, iron, and other minerals, making them exceptionally nutritious foods.

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16. Vegetarians have significantly higher rates of hypertension than the general population.

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17. The growth of well-fed vegetarian children is similar to that of their meat-eating peers.

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1. Which of the following is found in protein but not in carbohydrate or fat? a. carbon b. hydrogen c. nitrogen d. oxygen

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C: Nitrogen

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2. Which of the following accounts for the differences among the various amino acids? a. the amine group b. the side chain c. the acid group d. a and b e. b and c

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B: The side chain

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3. The body normally makes tyrosine from the essential amino acid: a. phenylalanine. b. leucine. c. valine. d. lysine.

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A: phenylalanine

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4. A(n) _____ bond is formed between the amine group end of one amino acid and the acid group end of the next amino acid in a protein. a. peptide b. amino acid c. ionic d. sulfur

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A: Peptide

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5. Which of the following is a protein catalyst that facilitates chemical reactions? a. hormone b. antibody c. lipoprotein d. enzyme

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D: Enzyme

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6. How many amino acids are considered to be essential amino acids? a. 5 b. 7 c. 9 d. 13

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C: 9

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7. The sequences of amino acids that make up a protein molecule are specified by: a. age. b. sex. c. heredity. d. the diet.

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C: heredity

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8. All of the following cause denaturation of proteins except: a. bases. b. alcohol. c. heat. d. light. e. salts of heavy metals.

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D: light

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9. For athletes, the path to bigger muscles includes a. vigorous physical training. b. well-timed meals. c. excess protein consumption. d. a and b e. b and c

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D: A and B (Vigorous physical training AND well-timed meals)

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10. The role of enzymes in the small intestine in protein digestion is to split polypeptides into all except: a. proteins. b. amino acids. c. dipeptides. d. tripeptides.

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A: proteins

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12. When amino acids are absorbed by the cells of the small intestine: a. they are absorbed best in large doses of a single amino acid. b. they are absorbed without preference at all sites on the cells. c. all proteins must be broken into single amino acids before they can enter the body. d. they can be circulated in the bloodstream to other cells and linked together to create new proteins.

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D: they can be circulated in the bloodstream to other cells and linked together to create new proteins.

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13. The process of protein turnover includes: a. eating food sources of amino acids every day to grow new cells and replace worn-out ones. b. synthesizing intestinal cells, which can live for months. c. preserving all old amino acids in the body to be re-circulated. d. excreting old amino acids that are left from cell breakdown.

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A: eating food sources of amino acids every day to grow new cells and replace worn-out ones.

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14. Proteins attract water and hold it within blood vessels, preventing it from freely flowing into the spaces between the cells. This is an example of how protein is used for: a. supporting growth and maintenance. b. building enzymes, hormones, and other compounds. c. building antibodies. d. maintaining fluid and electrolyte balance.

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D: maintaining fluid and electrolyte balance.

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15. When amino acids are degraded for energy, their amine groups are stripped off and used elsewhere or incorporated by the liver into: a. bile. b. urea. c. glucose. d. urine.

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B: Urea

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16. If amino acids are oversupplied: a. the body stores them until they are needed. b. the body removes and excretes their amine groups. c. the body converts amino acid residues to glycogen or fat. d. a and b e. b and c

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E: b and c ( the body removes and excretes their amine groups AND the body converts amino acid residues to glycogen or fat.)

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17. Amino acids are "wasted" (not used to build protein or nitrogen-containing compounds) in the body whenever there is: a. not enough energy from carbohydrate and fat. b. too much protein. c. adequate high-quality protein. d. a and b e. b and c

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D: a and b ( not enough energy from carbohydrate and fat AND too much protein.)

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18. The DRI for protein depends on: a. height. b. activity level. c. body size. d. sex.

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C: body size

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19. All of the following are needed for the body to synthesize protein except: a. adequate carbohydrate and fat. b. an adequate total amount of protein. c. all essential amino acids in the proper amounts. d. amino acid supplements.

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D: amino acid supplements.

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20. The DRI Committee recommends _____ percent of total calories as the minimum amount of protein. a. 5 b. 10 c. 15 d. 20

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B: 10

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21. The DRI for protein for healthy adults is _____ gram(s) per pound of body weight. a. 0.5 b. 0.4 c. 1.0 d. 0.8

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B: 0.4

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22. In making recommendations for protein intake, the committee on DRI took into consideration that the protein in a normal diet would be: a. primarily from animal sources. b. primarily from plant sources. c. a combination of animal and plant sources. d. used with 100% efficiency by everyone.

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C: a combination of animal and plant sources.

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23. Negative nitrogen balance occurs in: a. a surgery patient. b. growing children. c. pregnant women. d. lactating women.

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A: a surgery patient.

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24. The strategy of combining two _____ plant protein sources permits the amino acids in one food to make up for those lacking in the other food. a. complementary b. complete c. high-tryptophan d. a and b e. b and c

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A: complementary

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25. Which of the following provides amino acids that are best absorbed by the body? a. legumes b. animal proteins c. grains d. vegetables

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B: animal proteins

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26. Of the following foods, which likely contains the most easily digestible protein? a. oats b. whole wheat c. potatoes d. tuna

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D: tuna

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28. What is the result of a dietary protein deficiency? a. increased synthesis of proteins b. decreased breakdown of body protein c. a weakened immune system d. enhanced nutrient absorption

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C: a weakened immune system

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29. Which statement about the role of protein in a weight-loss plan is accurate? a. Protein should contribute 65 percent or more of the calories. b. There is no evidence that protein helps control the appetite. c. It is the proper proportion of nutrients that brings about long-term weight loss. d. Meeting protein recommendations during weight loss is critical for preserving lean tissues.

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D: Meeting protein recommendations during weight loss is critical for preserving lean tissues.

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37. Humans need to eat protein-containing foods regularly because: a. we need essential amino acids that can only be provided by foods. b. our bodies cannot make any amino acids needed for proteins. c. the function of protein is to maintain our muscle strength. d. protein is broken down quickly during digestion and lost from the body.

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A: we need essential amino acids that can only be provided by foods.

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30. Which of the following is not associated with an excess of protein? a. enlarged livers in humans b. enlarged kidneys in animals c. worsening of existing kidney problems d. high-fat foods that contribute to obesity

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A: enlarged livers in humans

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31. Removing the grain protein gluten from the diet has been shown to: a. resolve digestive problems in people with celiac disease. b. help with weight loss in people trying to lose weight. c. reduce problems with insomnia. d. reduce cancer risk.

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A: resolve digestive problems in people with celiac disease.

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33. An overemphasis on protein-rich foods can lead to: a. a low intake of iron. b. a low intake of folate. c. a low intake of vitamin C. d. a and b e. b and c

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E: b and c ( a low intake of folate. AND a low intake of vitamin C.)

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34. The more animal protein you eat, the higher your intake of _____. a. vitamin B12 b. vitamin A c. folate d. vitamin C

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A: vitamin B12

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35. Which of the following food groups does not provide significant protein? a. fruits b. grains c. vegetables d. milk, yogurt, and cheese

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A: fruits

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36. The heavy use of soy products in place of meat can inhibit _____ absorption. a. calcium b. folate c. iron d. vitamin C

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C: iron

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38. The recycling system for amino acids in the body is primarily used to: a. provide fuel for the cells to spare glucose. b. convert nonessential amino acids into essential amino acids. c. provide the cells with materials to build body proteins. d. add protein to muscles when there is a shortage of energy from foods.

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C: provide the cells with materials to build body proteins.

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40. Why should eggs be cooked, rather than eaten raw? a. Raw egg proteins bind the mineral iron. b. Raw egg proteins speed up protein digestion. c. Raw egg proteins bind the B vitamin biotin. d. b and c e. a and c

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E: a and c ( Raw egg proteins bind the mineral iron AND Raw egg proteins bind the B vitamin biotin.)

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41. Why is milk used as a first-aid remedy for someone who has swallowed a heavy-metal poison? a. The poison acts on the protein in the milk rather than on the protein of the gastrointestinal tract. b. Milk will cause the person to vomit and expel the poison. c. Milk will provide calcium, which serves to render the poison harmless. d. a and b e. b and c

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A: The poison acts on the protein in the milk rather than on the protein of the gastrointestinal tract.

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43. Tim, who lost a large amount of weight during an illness, is thinking about taking amino acid supplements to help him regain muscle mass. What advice would you give him? a. Amino acid supplements are an excellent way to quickly provide energy to muscles for rebuilding. b. Taking amino acid supplements helps keep the digestive system from overworking while you recover from illness. c. Extra carbohydrate, but never extra protein, is needed for recovery. d. Whole protein is better handled by the digestive system and will better promote recovery.

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D: Whole protein is better handled by the digestive system and will better promote recovery.

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44. When comparing the digestion and absorption of proteins with fats it is important to know that: a. proteins are broken down into individual amino acids and absorbed by all intestinal cells at an equal rate. b. larger peptide molecules must be completely broken down into amino acids to be absorbed into the bloodstream from the intestine. c. cells in the small intestine preferentially absorb different types of amino acids, which causes competition by amino acids at the absorption sites. d. amino acids need a carrier in the bloodstream because they do not transport very well alone.

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C: cells in the small intestine preferentially absorb different types of amino acids, which causes competition by amino acids at the absorption sites.

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45. The process of protein turnover involves: a. the conversion of protein to glucose for energy in half of the protein we eat. b. the loss of amino acids by excretion through the kidneys when cells die. c. the use of amino acids that have been conserved from breakdown of old cells. d. the annual replacement of old cells with new protein that has entered the body in food.

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C: the use of amino acids that have been conserved from breakdown of old cells.

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47. A child suffering from protein deficiency develops edema. This is an example of protein's role in: a. supporting growth and maintenance. b. building enzymes and hormones. c. maintaining fluid and electrolyte balance. d. maintaining acid-base balance.

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C: maintaining fluid and electrolyte balance

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48. Certain proteins act as buffers in the blood. In this role they are responsible for: a. providing immunity from foreign substances that invade the body. b. making sure that sodium is transported outside the cells. c. ensuring that too much fluid in the cells doesn't cause edema. d. picking up and releasing hydrogens in the blood to balance its pH.

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D: picking up and releasing hydrogens in the blood to balance its pH.

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50. An athlete consumes large amounts of meat in an effort to build extra muscle tissue. This practice does not work because: a. the body has no place to store extra amino acids. b. the body will dismantle its tissue proteins in this situation. c. the body converts amino acid residues to fuel or stores them as fat. d. a and b e. a and c

answer

E: a and c ( the body has no place to store extra amino acids AND the body converts amino acid residues to fuel or stores them as fat.)

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51. In times of energy shortage from carbohydrates or fats in foods, the body uses protein in what way? a. decreases the breakdown of food proteins for energy and uses stored glycogen b. stores amino acids in the cells to be used later for energy c. removes the nitrogen portion and burns the remaining fragments for energy d. converts it to fat to provide more concentrated energy

answer

C: removes the nitrogen portion and burns the remaining fragments for energy

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52. A young man has said to you that he is eating much more protein in his diet than the recommendation but he feels he needs the extra amount just in case he wants to build more muscle mass in the near future. How would you respond to him? a. It should be fine because the cells will store the extra amino acids for future use. b. If he has excess calories in his diet, he may gain fat weight from converted protein. c. The extra protein will be used for fuel instead of the carbohydrate. d. The body won't digest the extra protein and it will be eliminated in feces.

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B: If he has excess calories in his diet, he may gain fat weight from converted protein.

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53. Which of the following statements is true? a. Athletes need slightly more protein than other healthy adults. b. Athletes should consume protein supplements to build muscle. c. Dieters should take protein supplements to spare body protein. d. a and b e. b and c

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A: Athletes need slightly more protein than other healthy adults.

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55. What is the DRI for protein for a 40-year-old male who is 6'4" tall and weighs 180 pounds? a. 144 grams b. 90 grams c. 72 grams d. 180 grams

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C: 72 grams(180*.4=72)

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56. A sedentary male college student aged 23 needs how much protein if he weighs 175 pounds? a. 140 grams/day b. 70 grams/day c. 88 grams/day d. 175 grams/day

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B: 70 grams/day>>>(175*.4=70)

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57. A 135-pound female athlete needs about how much protein? a. 81-108 grams/day b. 54-68 grams/day c. 68-81 grams/day d. 162-230 grams/day

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A: 81-108 grams/day(135*.6=81;135*.8=108)

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58. A 10-year-old boy is going through a growth spurt. Because he needs to build new muscle tissue, what should his nitrogen status be? a. positive nitrogen balance b. negative nitrogen balance c. nitrogen equilibrium d. nitrogen deficiency

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A: positive nitrogen balance

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59. Cells will do all of the following to create their own working proteins from available amino acids except: a. synthesize nonessential amino acids that are missing for the protein that is being made. b. obtain amino acids that are available in the cell's amino acid pool. c. slow down protein synthesis until enough of the limiting amino acid is available again. d. hold partially completed proteins until the diet provides the missing amino acids.

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D: hold partially completed proteins until the diet provides the missing amino acids.

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60. An adolescent girl has decided to adhere to a vegetarian diet and has selected a tossed green salad, whole-wheat crackers, and apple juice for lunch. What would you advise her about her complementary protein sources? a. She has made good choices of complementary protein foods. b. Adding garbanzo beans to her salad would provide the protein combination she needs. c. She has to include milk or cheese with her meal or there will not be enough protein. d. She should not be following a vegetarian diet because it is not nutritionally adequate.

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B: Adding garbanzo beans to her salad would provide the protein combination she needs.

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61. Examples of complementary protein combinations include all of the following except: a. pasta with tomato sauce. b. rice and black-eyed peas. c. whole-wheat cereal with almonds. d. peanut butter and jelly on whole-wheat bread.

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A: pasta with tomato sauce.

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63. What is one of the risks of consuming a diet high in protein? a. significant loss of iron from the body in urine b. development of kidney disease c. increased risk of heart disease with high intakes of fatty meats and whole milk d. increased risk of heart disease with high intakes of legumes and nuts

answer

C: increased risk of heart disease with high intakes of fatty meats and whole milk

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64. Your neighbor has placed herself on a gluten-free diet to help her lose weight. What advice would you give her? a. She should be successful because it is an excellent way to lose weight. b. It will help relieve any digestive symptoms she may have. c. Gluten-free weight-loss diets offer no advantages over other low-calorie diets. d. Gluten-free diets help prevent cancer.

answer

C: Gluten-free weight-loss diets offer no advantages over other low-calorie diets.

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Use Label for questions 66-70: 66. A vegetarian dish using textured vegetable proteins, such as this "chicken" patty, is an adequate substitute for meat because it: a. contains textured wheat protein, which is a high-quality protein. b. contains soy protein, which is a high-quality protein. c. provides a good source of carbohydrate. d. provides only limited amounts of fiber.

answer

D: provides only limited amounts of fiber.

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67. How will frequent consumption of this food item affect iron absorption in the body? a. increase iron absorption because soy has a high iron content b. decrease iron absorption because the textured wheat protein has a high iron content c. decrease iron absorption because soy inhibits iron absorption d. increase iron absorption because it is high in fiber

answer

C: decrease iron absorption because soy inhibits iron absorption

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68. How does the fat content of this product compare with that of an actual piece of chicken eaten with the skin? a. Both foods have exactly the same type of fat composition. b. This product is higher in cholesterol. c. This product is higher in total fat. d. This product is lower in saturated fat.

answer

D: This product is lower in saturated fat.

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69. This product: a. contains as much vitamin B12 as chicken. b. has been fortified with vitamin B6. c. contains no vitamin B12 because it is not an animal protein source. d. will provide adequate vitamin B12 when eaten with grains, fruits, and vegetables.

answer

C: contains no vitamin B12 because it is not an animal protein source.

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70. Using this food product as part of a vegetarian diet: a. will likely result in excessive weight gain from eating too many grain products. b. may reduce the risk of developing heart disease. c. may increase blood pressure through excessive soy intake. d. may increase the risk of colon cancer.

answer

B:may reduce the risk of developing heart disease.

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71. Your mother is considering changing her diet to include only non-meat proteins to reduce her risk of developing heart disease or cancer. What evidence is available to support her decision? a. vegetarian diets contain greater amounts of heart-protective omega-3 fatty acids b. plant-based diets are usually lower in saturated fat and higher in fiber, which reduces risk of heart disease c. substituting soy for meat proteins has resulted in a large decrease in heart disease risk d. lung cancer appears less frequently in people eating plant-based diets

answer

B: plant-based diets are usually lower in saturated fat and higher in fiber, which reduces risk of heart disease

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73. Compared to meat eaters, vegetarians tend to have: a. higher death rates from heart disease. b. healthier body weights. c. lower blood pressure. d. a and b e. b and c

answer

E: b and c ( healthier body weights. AND lower blood pressure.)

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75. Which statement is true of a vegan diet? a. Very young children may not consume enough plant sources of protein to build and maintain bone and muscle tissue. b. A vegan woman always has excellent stores of nutrients needed for pregnancy. c. Research shows that vegan diets promote normal growth in children. d. Vegan children's daily protein requirement is less than meat-eating children's.

answer

A: Very young children may not consume enough plant sources of protein to build and maintain bone and muscle tissue.

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********Added question: Your friend is a vegetarian who consumes large quantities of soy products in the place of meat. From a nutrition perspective, your friend is at risk of developing _____ deficiency. a. vitamin C b. iron c. folate d. calcium

answer

*******B: iron

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76. Poorly-planned vegetarian diets typically lack all of the following except: a. calcium. b. vitamin B12. c. zinc. d. folate.

answer

D: folate.

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78. Including which of the following foods in a vegan child's diet helps to ensure adequate growth and bone development? a. whole grains for zinc b. walnuts for omega-3 fatty acids c. raisins for calcium d. a and b e. a and c

answer

D: a and b ( whole grains for zinc AND walnuts for omega-3 fatty acids)

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79. The best way for a vegetarian to ensure adequate absorption of dietary iron is to: a. include leafy greens because the iron they contain is absorbed readily. b. avoid dried fruits because they interfere with iron absorption. c. include vitamin C-rich foods because they enhance absorption of iron. d. consume 3 times the amount of iron recommended for meat eaters.

answer

C: include vitamin C-rich foods because they enhance absorption of iron.

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80. To ensure adequate intakes of vitamin B12, vitamin D, and calcium, vegans need to: a. select fortified foods. b. use complete meal supplements. c. use supplements daily. d. a and b e. a and c

answer

E: a and c ( select fortified foods. AND use supplements daily.)

STUDY

Fluid And Electrolyte Balance Nutrition Peanut Butter And Jelly

Nutrition Ch6 – Flashcards 88 terms

Lesly Nixon

88 terms

Preview

Nutrition Ch6 – Flashcards

question

Vegetarians have significantly higher rates of hypertension than the general population.

answer

False

question

Most people in the U.S. would find it next to impossible not to meet their protein requirements.

answer

True

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Some foods are so high in acid that they are capable of making the acid in the stomach even stronger.

answer

False

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Sickle-cell disease is an example of an inherited mistake in the amino acid sequence.

answer

True

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Amino acid supplements are easy to digest and can relieve the digestive system from overworking.

answer

False

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When a person ingests a large dose of any single amino acid, absorption of others of its type may be limited.

answer

True

question

If needed, protein can help to maintain a steady blood glucose level and so serve the glucose need of the brain.

answer

True

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Starvation always incurs wasting of lean body tissue as well as loss of fat.

answer

True

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The growth of well-fed vegetarian children is similar to that of their meat-eating peers.

answer

True

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PEM is the world's most widespread form of malnutrition.

answer

True

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For the majority of exercisers, adding excess protein or amino acid supplements to an adequate diet will stimulate muscle building.

answer

False

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Sound nutrition authorities acknowledge that well-chosen vegetarian diets are consistent with good health and can meet nutrient needs.

answer

True

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Certain proteins act as buffers in the blood. In this role they are responsible for:

answer

picking up and releasing hydrogens in the blood to balance its pH.

question

Which of the following groups of the USDA Food Guide contribute(s) an abundance of high-quality protein?

answer

b and c

question

Our body has the need to eat protein-containing foods regularly because:

answer

we need essential amino acids that can only be provided by foods.

question

Which of the following provides amino acids that are best absorbed by the body?

answer

animal proteins

question

A person who lost a large amount of weight during an illness has been advised by a health food store employee that he should add amino acid supplements to his diet to help in weight gain. What would you tell this person?

answer

if he needs additional protein for recovery it should be as whole protein because the digestive system can handle that form better

question

The process of protein turnover involves:

answer

the use of amino acids that have been conserved from breakdown of old cells.

question

For athletes, the path to bigger muscles includes

answer

a and b

question

Which of the following is a health benefit of a vegetarian diet?

answer

vegetarians tend to have lower blood pressure than nonvegetarians

question

The DRI Committee recommends _____ percent of total calories as the minimum amount of protein.

answer

question

The genetic coding or expression that determines our DNA messaging for cells is:

answer

available in all cells but is idle in some cells and active in others.

question

When planning a vegetarian diet, the following recommendation should be adhered to:

answer

fruits and vegetables high in iron and calcium should be emphasized.

question

When amino acids are degraded for energy, their amine groups are stripped off and used elsewhere or incorporated by the liver into:

answer

urea

question

A young man has said to you that he is eating much more protein in his diet than the recommendation but he feels he needs the extra amount just in case he wants to build more muscle mass in the near future. How would you respond to him?

answer

if he has excess calories in his diet, he may gain fat weight from converted protein

question

Poorly-planned vegetarian diets typically lack all of the following except:

answer

folate

question

What is the DRI for protein for a 40-year-old male who is 6'4" tall and weighs 180 pounds?

answer

65 grams

question

What change in body function will occur in a child with marasmus?

answer

the digestive tract develops dysentery, which results in diarrhea and mineral loss

question

The sequences of amino acids that make up a protein molecule are specified by:

answer

heredity

question

Which of the following is found in protein but not in carbohydrate or fat?

answer

nitrogen

question

Negative nitrogen balance occurs in:

answer

a surgery patient

question

The best way for a vegetarian to ensure adequate absorption of iron in the diet is to:

answer

include vitamin C-rich foods because they enhance absorption of iron

question

The more animal protein you eat, the higher your intake of _____.

answer

vitamin B12

question

Compared to meat eaters, vegetarians tend to have:

answer

b and c

question

A 3-year-old child from a homeless family has been brought into the health clinic with a swollen belly, fluid buildup around her ankles, brittle hair, and irritability. Her mother has been feeding her mostly bread and dry cereal over the past several months. Providers suspect that she may have which form of PEM?

answer

kwashiorkor

question

The process of protein turnover includes:

answer

eating food sources of amino acids every day to grow new cells and replace worn-out ones.

question

When comparing the digestion and absorption of proteins with fats it is important to know that:

answer

cells in the small intestine preferentially absorb different types of amino acids, which causes competition by amino acids at the absorption sites.

question

How many amino acids are considered to be essential amino acids?

answer

question

Proteins use the process of active transport to move substances in or out of the cell by:

answer

opening passages in the membrane and escorting substances through the cell.

question

What is one of the risks of consuming a diet high in protein?

answer

a high-protein diet can raise homocysteine levels in the blood

question

The heavy use of soy products in place of meat can inhibit _____ absorption.

answer

iron

question

The recycling system for amino acids in the body is used to:

answer

provide the cells with materials to build body proteins.

question

The role of enzymes in the small intestine in protein digestion is to split proteins into all except:

answer

oligopeptides

question

A 135-pound woman needs how much protein?

answer

49 grams/day

question

In times of energy shortage from carbohydrates or fats in foods, the body uses protein in what way?

answer

it removes the nitrogen portion and burns the remaining fragments for energy

question

A child suffering from protein deficiency has edema. This is an example of protein's role in:

answer

maintaining fluid and electrolyte balance.

question

Which of the following accounts for the differences among the various amino acids?

answer

the side chain

question

Your mother is considering changing her diet to include only non-meat proteins to reduce her risk of developing heart disease or cancer. What evidence is available to support her decision?

answer

plant-based diets are usually lower in saturated fat and higher in fiber, which reduces risk of heart disease

question

When amino acids are absorbed by the cells of the small intestine:

answer

they can be circulated in the bloodstream to other cells and linked together to create new proteins.

question

The stomach lining is protected from the very strong acid of the stomach by:

answer

a coat of mucus

question

All of the following are needed for the body to synthesize protein except:

answer

amino acid supplements

question

The roles of enzymes formed by body proteins are important when foods are eaten because:

answer

an enzyme acts as a catalyst to speed up a reaction without being altered itself.

question

Cells will do all of the following to create their own working proteins from available amino acids except:

answer

hold partially completed proteins until the diet provides the missing amino acids.

question

A woman who is on a vegan diet has become pregnant. What would be a health concern for her?

answer

she may have difficulty gaining adequate weight during her pregnancy

question

The strategy of combining two incomplete plant protein sources so that the amino acids in one food make up for those lacking in the other food is called:

answer

mutual supplementation.

question

Proteins attract water and hold it within blood vessels, preventing it from freely flowing into the spaces between the cells. This is an example of how protein is used for:

answer

maintaining fluid and electrolyte balance.

question

A boy 10 years old is going through a growth spurt. Because he needs to build new muscle tissue, what should his nitrogen status be?

answer

positive nitrogen balance

question

The DRI for protein for healthy adults is _____ gram(s) per kilogram of body weight.

answer

0.8

question

Your friend states that she avoids acid foods like tomatoes and orange juice because they give her an acid stomach. How would you respond to this statement?

answer

b and c

question

Which of the following statements is/are true?

answer

Athletes need slightly more protein than other healthy adults.

question

An athlete consumes large amounts of meat in an effort to build extra muscle tissue. This practice does not work because:

answer

a and c

question

Which of the following cooking methods would you use to increase the digestibility of protein?

answer

stewing

question

The body normally makes tyrosine from the essential amino acid:

answer

phenylalanine

question

Your friend is a vegetarian who consumes large quantities of soy products in the place of meat. From a nutrition perspective, your friend is at risk of developing _____ deficiency.

answer

iron

question

Which statement is true of a vegan diet?

answer

very young children and the elderly may not consume enough plant sources of protein to build and maintain bone and muscle tissue

question

In making recommendations for protein intake, the committee on DRI took into consideration that the protein in a normal diet would be:

answer

a combination of animal and plant sources.

question

If amino acids are oversupplied:

answer

b and c

question

Why is milk used as a first-aid remedy for someone who has swallowed a heavy-metal poison?

answer

The poison acts on the protein in the milk rather than on the protein of the gastrointestinal tract

question

All of the following cause denaturation of proteins except:

answer

light

question

The calorie-deficiency disease resulting from chronic starvation is known most specifically as:

answer

marasmus

question

Which of the following is not a characteristic of children with kwashiorkor?

answer

They look like skin and bones.

question

Which of the following is not a characteristic of children with kwashiorkor?

answer

They look like skin and bones.

question

An adolescent girl has decided to adhere to a vegetarian diet and has selected a tossed green salad, whole-wheat crackers, and apple juice for lunch. What would you advise her about her complementary protein sources?

answer

adding garbanzo beans to her salad would provide the protein combination she needs

question

To ensure adequate intakes of vitamin B12, vitamin D, and calcium, vegans need to:

answer

a and c

question

Why should eggs be cooked, rather than eaten raw?

answer

a and c

question

The DRI for protein depends on:

answer

body size

question

A child with marasmus would exhibit all of the following symptoms except:

answer

edema

question

Of the following foods, which likely contains the most easily digestible protein?

answer

tuna

question

A young man who is a sedentary college student needs how much protein if he weighs 175 pounds?

answer

64 grams/day

question

An overemphasis on protein-rich foods can lead to:

answer

b and c

question

Which of the following is not associated with an excess of protein?

answer

enlarged livers in humans

question

Amino acids are wasted (not used to build protein or nitrogen-containing compounds) whenever there is:1. not enough energy from carbohydrate and fat.2. low-quality protein.3. too much protein.4. high-quality protein.

answer

1,2,and 3

question

Which of the following would have the highest protein DRI per unit of body weight?

answer

a 6-year-old-child

question

A(n) _____ bond is formed between the amine group end of one amino acid and the acid group end of the next amino acid in a protein.

answer

peptide

question

Children adhering to a vegan diet need to include which of the following foods to ensure adequate growth and bone development?

answer

a and b

question

Examples of complementary protein combinations include all of the following except:

answer

pasta with tomato sauce

question

Which of the following is a protein catalyst, which acts on other substances to change them chemically?

answer

enzyme

question

Which of the following food groups does not provide significant protein?

answer

fruits

STUDY

Anorexia Nervosa And Bulimia Anorexia Nervosa And Bulimia Nervosa Community Health Fluid And Electrolyte Balance Health Assessment Negative Symptoms Of Schizophrenia Nursing White Blood Cell Count

HESI Case Study Integument Assessment – Flashcards 24 terms

Kaiya Hebert

24 terms

Preview

HESI Case Study Integument Assessment – Flashcards

question

1. When assessing the skin of a client with bulimia, which data is important for the nurse to obtain? -Texture -Pigmentation -Turgor -Thickness

answer

Turgor

question

The nurse assesses that Mandi's skin turgor is slightly inelastic. 2. What additional finding validates the nurse's initial assessment regarding the client's fluid status? -Areas of skin bruising -Dry Mucus membranes -Shiny appearance of the forehead -Rapid Facial flushing

answer

- Dry Mucus Membranes

question

Because Mandi shows early signs of fluid volume deficit, the nurse provides her with a sports drink. While Mandi drinks the fluid, the nurse continues the assessment. Since entering the nurse's office, Mandi's face has become flushed, with flushing also noticeable bilaterally on her neck. 3. The nurse observes that Mandi's skin pigmentation is deeply tanned. To evaluate the client for pallor, what are should the nurse assess? -Cheeks and chin -Earlobes -Hair follicles -Conjuctivae

answer

Conjuctivae

question

The nurse sees no evidence of pallor. 4. What follow up assessment should the nurse perform after observing the facial flushing? -Ask about any feelings of anxiety -Observe the color of the sclerae -Measure the oxygen saturation -Check for loss of skin integrity

answer

Ask about any feels of anxiety

question

5. The nurse observes that there are numerous blackheads around Mandi's chin and nose. What action should the nurse take in response to this finding? -Note any pustules or nodules -Palpate the areas for tenderness -Ask about a history of eczema -measure for pitting edema

answer

Note any pustules or nodules

question

The nurse attempts to question Mandi about her vomiting. Mandi refuses to talk about the vomiting episodes that occurred earlier in the day, stating that she must have "eaten something bad" the night before for dinner. However, she seems open to talking about other things, so the nurse continues with the client interview, focusing on the appearance of her skin, hair, and nails. 6. Which question is most important for the nurse to ask the client? -"How often do you use a tanning booth?" -"Do you use a hair coloring product?" -"What do you use to cleanse your skin?" -"Do you tend to bite or chew your nails?"

answer

How often do you use a tanning booth?

question

The nurse examines a mole on Mandi's abdomen. The mole is oval, solid tan, and approximately 2mm in diameter. 7. The nurse questions Mandi about the observable moles on her skin. What question is most important to ask the client? -"Have any of your moles changed in size or appearance?" -"Do you have any moles on your abdomen or chest?" -"Do the moles on your arms make you feel self-conscious?" -"Have you ever tried to cover up your moles with make up?"

answer

Have any of your moles changed in size or appearance?

question

8. What additional observation is important in assessing the mole? -There is no inflammation around the mole -The mole is surrounded by freckles -The mole does not blanche when compressed -The border of the mole is smooth

answer

The border of the mole is smooth

question

9. Mandi also points out a small (1mm), smooth, slightly raised bright red dot on her abdomen and asks the nurse to examine the spot as well. How should the nurse proceed? -Offer assurance that this lesion is not an abnormal finding -Apply pressure over the lesion and observe for blanching -Advise the client to be examined by a healthcare provider -Determine if the client experience any trauma at the site

answer

Offer assurance that this lesion is not an abnormal finding

question

After completing the assessment of Mandi's skin lesions, the nurse takes Mandi's hand and examines her fingernails. 10. The nurse observes that the nail surface is slightly curved and the angle of the nail base is 160 degree. What action should the nurse take in response to this finding? -Use a pulse oximeter to measure the oxygen saturation -Ask the Client about any current or past use of cigarettes -Continue the assessment, noting the color of the nail surface -Assess for crepitus underneath and around the nail surface

answer

Continue the assessment, noting the color of the nail surface

question

11. While assessing the Client's nails, it is most important for the nurse to follow-up on which assessment finding? -Ragged cuticles -Firm nail base -Irregular nail edges -brittle nail surface

answer

-brittle nail surgace

question

Mandi has colored her hair solid black and uses an assortment of colored hair ties for accents. The nurse comments on Mandi's hair color and proceeds to assess her hair. 12. Which assessment is most important for the nurse to complete? -Ask the client how long she has colored her hair -Observe the texture and distribution of hair growth on the scalp -Check the client's hair for split ends -Note the pattern of hair growth around the client's forehead

answer

-Observe the texture and distribution of hair growth on the scalp

question

12. Mandi tells the nurse that her scalp itches sometimes. The nurse observes while flecks on the client's shoulders. What action should the nurse take first? -Instruct the client about dandruff treatments -Explain how to treat the hair and scalp for head lice. -Remind the client not to share hair brushes -Observe the client's hair shafts and scalp

answer

-Observe the client's hair shafts and scalp

question

14. The nurse observes the overall hair distribution on Mandi's face and arms. There is visible hair growth on her forearms. She has thin eyelashes and eyebrows, and otherwise fine, downy facial hair. What action should the nurse take in response to these observations? -Document the areas of alopecia as an indication of the client's poor nutrition -Move on to the next area of assessment since the findings are within normal limits -Note the absence of normal hair growth patterns on the client's face. -Ask the client if the excessive hair growth on her arms is of concern to her

answer

-Move on to the next area of assessment since the findings are within normal limits

question

While observing the mole and cherry angioma on Mandi's abdomen, the nurse also observed several areas of apparent skin injury on Mandi's lower abdomen. Because the nurse feels a trusting relationship has now been established, the nurse believes that Mandi may respond to further assessment related to the injured areas and asks Mandi to allow the nurse to observe her abdomen again. Mandi agrees. 15. The nurse observes several bruises of various colors across Mandi's lower abdomen. What concern should the nurse address? -Painful injury with hot and cold objects -Recent injury with different sized objects -Repeated injury over a period of time -Self-inflicted injury to obtain attention

answer

-repeated injury over a period of time

question

16. The nurse observes areas of petechiae surrounding some of the bruises. How should the nurse respond to this finding? -Document the location of the bruises and petechiae -Ask the client how these burns occurred -Palpate the areas for warmth and swelling -immediately measure and record the vital signs

answer

-Document the location of the bruises and petechiae

question

17. After expressing concern about the bruises on Mandi's abdomen, how should the nurse begin the abuse assessment? -Determine if the client is sexually active. -Ask the client if someone else caused the injuries -Encourage the client to describe her family structure -Advise the client of her right to legal counsel during the interview

answer

-Ask the client if someone else caused the injuries

question

18. To gather data related to the frequency of abuse by Mandi's boyfriend, what action should the nurse take first? -Determine if the client has ever tried to break up with her boyfriend and how she attempted to the end the relationship -Provide a calendar for the client to mark the dates when any violent and abusive behavior by her boyfriend occurred. -Instruct the client that there is no point in denying the pattern of abuse because of the varying colors of the bruises -Ask the client about her boyfriend's use of any illegal drugs or frequency of alcohol abuse since they have been dating

answer

-Provide a calendar for the client to mark the dates when any violent and abusive behavior by her boyfriend occurred.

question

While conversing with the nurse about her boyfriend, Mandi starts to scratch her neck, and says "On no, this happens sometimes when I get really stressed." 19. What finding should the nurse expected in response to Mandi's itching? -Hirsutism -Urticaria -Purpura -Pustules

answer

Urticaria

question

20. The nurse observes raised, pink wheals on Mandi's neck. How should the nurse respond to this observation? -Apply a warm compress directly over the wheals -Offer assurance that this is a temporary response -Ask if the client has been stung by an insect recently -Explain that antibiotics will need to be prescribed

answer

-Offer assurance that this is a temporary response

question

21. The nurse prepares to administer diphenhydramine (Benadryl) 12.5mg orally. The tablet is supplied in a 25mg doe. How many tablet(s) should the nurse give?_________ (enter numerical value only)

answer

0.5 or 1/2

question

The nurse teaches Mandi about Benadryl. Which information should the nurse included? (select all that apply.) -Blurred vision or loss of balance are potentially serious side effects of this medication -This medication may cause an increase in secretions and moisten mucous membranes. -This medication may cause drowsiness. -Benadryl blocks the effect of histamine response to reduce itching -Benadryl products contain aspirin, so observe for signs of bleeding

answer

-Blurred vision or loss of balance are potentially serious side effects of this medication -This medication may cause drowsiness. -Benadryl blocks the effect of histamine response to reduce itching

question

Before reporting the information obtained about the physical abuse that Mandi experienced, the nurse documents the findings. 23. Which strategy should the nurse use to document the extent of the physical injuries? -Include xrays in the client record -use the numeric braden scale -prepare a detailed injury map -complete the abuse assessment screen

answer

prepare a detailed injury map

question

How should the nurse document the information obtained when charting Mandi's abuse assessment? -Refrain from including information that might identify the alleged abuser. -Summarize the abusive events without directly quoting the client -Delete any expletives the client used when describing the abuser -Quote the client's responses to the questions as verbatim as possible

answer

Quote the client's responses to the questions as verbatim as possible

STUDY

Fluid And Electrolyte Balance Nursing Urology

Human Diseases Quiz 3 – Flashcards 69 terms

Rebecca Mallory

69 terms

Preview

Human Diseases Quiz 3 – Flashcards

question

How is urge incontinence different from stress incontinence?

answer

Urge incontinence is caused from an abnormal bladder contraction. Stress incontinence is caused from weak pelvic floor muscles.

question

Why is cystitis more common in females?

answer

Females have short, wide and adjacent to areas w/ resident flora

question

Patient has a malignant tumor of the bladder, what clinical manifest. is the initial symptom? a. fever b. frequency c. urinary retention d. painless hematuria

answer

d. painless hematuria

question

Hematuria

answer

blood in the urine

question

What is the glomerular filtration rate and what does it determine?

answer

Glomerular filtration rate is the speed of blood that moves through the glomerulus (cluster of capillaries). It determines the kidney function and the stage of kidney disease.

question

Glomerulonephritis

answer

question

Nephrotic Syndrome

answer

question

Acute Renal Failure

answer

question

Chronic Renal Failure

answer

question

What is the complication for a patient w/ a large renal calculi? a. chronic hypertension b. hydronephrosis c. polyuria d. dysuria

answer

b. hydronephrosis

question

Chronic hypertension

answer

question

Hydronephrosis

answer

abnormal dilation of the renal pelvis and the calyces of one or both kidneys

question

Polyuria

answer

question

Dysuria

answer

question

What prevention strategy will you teach the patient w/ risk for renal calculi? a. avoid dairy products and other sources of Calcium b. start taking antibiotics w/ the first sign of a stone c. Avoid aspirin and aspirin containing products d. Drink at least 3-4 liters of fluid a day

answer

d. drink at least 3-4 liters of fluid a day

question

Which assessment parameter most accurately determines fluid and sodium retention status in a patient w/ chronic kidney disease? a. capillary refill b. intake and output c. muscle strength d. weight and blood pressure

answer

d. weight and blood pressure

question

Which vitamin in insufficient when there is a chronic alteration in kidney function? a. Vitamin A b. Vitamin D c. Vitamin E d. Vitamin K

answer

b. vitamin D

question

Which of the following conditions is associated w/ over secretion of renin? a. hypertension b. renal calculi c. diabetes mellitus d. diabetes insipidus

answer

a. hypertension Rationale using RAAS; renin is secreted from the kidneys that is combined with angiotensinogen to create angiotensin I, ACE is added to create angiotensin II that acts on the pituitary gland- ADH (H2O absorption), adrenal gland- aldosterone(Na+, Cl- reabsorption, K+ excretion), arterioles (vasoconstriction) all which raise the blood pressure

question

Whish laboratory result for a patient w/ chronic renal failure will require rapid action by the nurse? a. Blood urea nitrogen of 54 mg/dL b. Serum potassium of 7.1 mEq/L c. Hemoglobin of 10.4 g/dL d. Serum pH 7.34

answer

b. serum potassium of 7.1 mEq/L (K+ deals with the heart)

question

Which results are normal in a urinalysis? a. protein small b. glucose negative c. leukocytes positive d. blood negative e. ketones negative

answer

b, d, and e there should be no protein or leukocytes in the urine

question

What is erythropoietin?

answer

A hormone the kidneys release in response to hypoxia. It stimulates the bone marrow to produce more red blood cells (if iron stores are adequate, then increase of red blood cells increases oxygen-carrying capacity)

question

Potassium

answer

Primary intracellular cation. Involved in: electrical conduction, acid-base balance, & metabolism. Shifts of K+ into intravascular space can be dangerous to the heart. Leaves little room for fluctuation, avg. 40-60 mEq

question

Sodium

answer

Most significant cation, extracellular. Primary func. is to control serum osmolarity & water balance. Regulated by kidneys & aldosterone (adrenal cortex to retain Na+ or discard Na+)

question

Bicarbonate

answer

question

Calcium

answer

99% found in bones & teeth, 1% ionized (unbound) in the blood; blood clotting, hormone secretion, receptor func, nerve transmission & muscular contraction. Inverse relationship w/ Phosphorus & synergistic relationship with Magnesium (needs Mg to func.) Avg. 800-1200 mg/day

question

Phosphorus

answer

Mostly found in bones & small amount in bloodstream. Inverse relationship w/ Ca+; bone & tooth mineralization, cellular metabolism, acid-base balance, & cell membrane formation. Average 1,000 mg/day

question

Magnesium

answer

Intracellular cation, stored in bone & muscle; helps maintain normal muscle & nerve func, regular cardiac rhythm, a healthy immune system, bone strength, blood glucose levels, & normal blood pressure. Avg 400 mg/day

question

Albumin

answer

Protein of the blood plasma, regulate the osmotic blood pressure; produced in the liver

question

Protein

answer

should not show up in the urine

question

BUN

answer

Blood Urea Nitrogen, test that measures nitrogen in blood from urea. Sees how well the kidneys are working

question

Creatinine

answer

Chemical waste from muscle metabolism, produced from creatine. Transported through bloodstream to kidneys and excreted; if largely increased can cause renal failure

question

Which of the following cancers of the female genitourinary tract is the most easily detected & cured? a. cancer of the vulva b. cancer of the cervix c. cancer of the ovary d. cancer of the endometrium

answer

b. cancer of the cervix

question

Ovarian cancer: a. is often asymptomatic until disease is far advanced b. is easily detected using the serum marker PSA c. is easily detected during a pelvic exam d. can be detected w/ the Pap smear

answer

a. is often asymptomatic until disease is far advanced PSA is for prostate cancer, isn't easily detected with pelvic exam or with Pap smear (no good screening for ovarian cancer, BRCA1 & 2 help predict the likelihood)

question

Reason that antibiotic therapy predisposes women to vulvovaginal candidiasis is that it: a. produces a decrease in immune function b. increases vaginal pH leading to yeast overgrowth c. decreases pH of vaginal secretions d. increases vaginal glycogen stores

answer

b. increases vaginal pH leading to yeast overgrowth becomes more alkaline- increases the risk for yeast infections

question

Which patient is most likely to have erectile dysfunction? A. middle-aged man who first had sexual intercourse at age 15 B. middle-aged man who has had diabetes mellitus for 25 yrs C. young man who had a myocardial infarction 2 yrs ago D. young man who is the president of a corporation/ large debt

answer

B. middle-aged man who has had diabetes mellitus for 25 years (decrease in blood circulation)

question

Without treatment, which infection may progress to damage the aorta, liver, & central nervous system? a. syphilis b. gonorrhea c. chlamydia d. trichomoniasis

answer

a. syphilis (can lead to death & affect the baby)

question

Which of the following types of vaginal discharge is characteristic of a trichomonas infection? a. mucopurulent b. thin & watery c. copious frothy green or yellow & foul smelling d. homogenous fishy smelling w/ pH above 4.5

answer

c. copious frothy green or yellow & foul smelling trichomonas infection- caused by a parasite

question

Which assessment finding in the patient indicates the highest risk of a malignant breast lesion? a. ill-defined painful rubbery lump in the outer breast quadrant b. 1-cm freely mobile rubbery mass discovered by the patient c. backache & breast fungal infection d. nipple discharge & dimpling

answer

d. nipple discharge & dimpling the rubbery lump is ill-defined but not painful and it can be mobile in early stages, but not at the highest risk then breast fungal infection (associated w/ lactation) is mastitis

question

Uterine prolapse, cystocele, & rectocele may all be the result of: a. repeated infections b. chronic constipation c. hormonal abnormalities d. pregnancy & childbirth

answer

d. pregnancy & childbirth cause lots of stress on the pelvic floor muscles, weakening them

question

Which of the following infections would increase risk for cancer development in the genital region? a. syphilis b. chancroid c. cytomegalovirus d. human papillomavirus

answer

d. human papillomavirus chancroid- venereal infection causing ulceration of the lymph nodes in the groin cytomegalovirus- part of the herpes viruses; can cause mental retardation & fetal death w/ maternal infections

question

Prostate cancer can be defined as: a. a rare malignancy b. slow-growing tumor often confined to the prostate c. most common among Caucasian men d. none of the above

answer

b. slow-growing tumor often confined to the prostate

question

Herpes

answer

Viral STI; infection that causes blisters on the genitals & in the reproductive tract, caused by herpes simplex virus (HSV) HSV1- above the waist, cold sores HSV2- (70%) occurs below the waist; transmissible through skin-to-skin contact, though increased risk when blisters are present (reoccurence of both types, more common in 2)

question

Condylomata acuminate

answer

Viral STI, genital warts; benign growths caused by HPV. Occur on external genital, vaginal wall, cervix, anus, thighs, lips, mouth, & throat. Lesions vary in appearance (cauliflower-like, rough, flat smooth, etc.) treat -preventative HPV vaccine, growth removal for aesthetic

question

Chlamydia

answer

Bacterial STI, intracellular parasite; neonatal conjunctivitis (eye infection- blindness), PID, epididymitis, prostatitis, infertility, & eptopic pregnancy S/S: dysuria, discharge (purulent), testicular tenderness/pain, rectal pain, & painful sexual intercourse. Treat- antibiotic azithromycin (zithromax), doxycycline, or erythromycin

question

Gonorrhea

answer

Bacterial STI, (the clap or the drip), aerobic bacterium w/ many drug-resistant strain. Attaches to the mucosa of the vag, mouth, or anus causing irritation & inflammation; complications like chlamydia & in other parts of the body- arthritis, dermatitis, & endocarditis. Manifest- dysuria, urinary frequency/urgency, discharge (white, yellow, or green), redness or edema at urinary meatus (in men), pharyngitis, white blisters that darken & disappear. Treat- antibiotics

question

Syphilis

answer

Bacterial STI, ulcerative infection spiral-shaped bacterium. Ulcerative lesions- chancres. Primary- one chancre forms, painless & goes away; bacteria goes dormant. Secondary- nonpruritic, brown-red rash, malaise, fever, & patchy hair loss; go away & dormant Latent/ Tertiary- final stage, spreads to brain, nervous system, heart, skin, & bones. Can cause blindness, paralysis, dementia, cardiovascular disease, & death. Treat- early on antibiotics like penicillin, etc. not effective in latent phase syphilis

question

Trichomoniasis

answer

Protozoan STI, the trick, a one-celled anaerobic organism. Parasite can burrow under the mucosal lining. Women- reside in vag & symptomatic when microbial imbalances occur, contracted through prolonged moisture exposure. Men usually have symptoms & resolve without treatment. Manifest- copious amounts of odorous, frothy, white or yellow-green discharge, irritates vag & vulva; itching, painful intercourse, & dysuria. Treat- antibiotic, metronidazole (Flagyl)

question

Prostate Cancer

answer

Most common cancer in men, usually confined to prostate. Prostate enlarges & impedes the urethra (difficulty urination & erectile disfunc), blood semen & hematuria Treat- prostatectomy or angiotestosterone drug therapy

question

Testicular Cancer

answer

Uncommon cancer, young (15-35 yr old men), slow growing or fast growing. Risk- history, infection, trauma, tobacco use, testicle abnormalities. Usually affects one testicle, metastasize to nearby lymph, lungs, liver, bone & brain. Manifest- hard, painless, palpable mass that does not transilluminate; discomfort, enlargement, & female-like breast). Highly curable; treat- orchiectomy, chemo/ radiation

question

Breast Cancer

answer

Most common malignancy in women, can occur in men; advancing age, early onset menstruation, history, genetics (BRCA1/2 genes), obesity, etc. Manifest- movable mass, hard, uneven edges, usually painless, change in nipple appearance (dimple, redness, or puckering), nipple drainage (bloody, clear-yellow/green or purulent) Treat- aggressive multimethod (chemo, radiation, surgery, & hormone therapy)

question

Cervical Cancer

answer

Pap smear can detect precancerous cells, which are 100% treatable. Usually caused by HPV, & asymptomatic when manifest- discharge (pale, watery, pink, brown, bloody, or foul smelling), abnormal vaginal bleeding, menorrhagia (abnormal heavy bleeding) Advanced cancer- anorexia, weight loss, fatigue, pelvic, back or leg pain, unilateral lower extremity edema, heavy bleeding, leaking urine or feces from vag, & bone fractures Treat- loop electrosurgical excision procedure, cryotherapy, laser therapy, adv- chemo, radiation, & surgery

question

Ovarian Cancer

answer

9th most common cancer in women, no reliable screening test, difficult to treat, & metastasize at time of diagnosis. Risks- genetic (BRCA1/2), advancing age, infertility, excessive estrogen exposure, obesity, & androgen hormone therapy Manifest- abdominal distention, pelvic pain, & eating disturbances, bowel pattern changes, GI discomfort, pair during intercourse, malaise, urine frequency, & menstruation changes. Treat- surgery, chemo, salpingo-oopho-rectomy (ovary & fallopian tube removal) & hysterectomy

question

Which of the four types of gastritis is the most common? a. chemical gastropathy b. multifocal atrophic c. autoimmune d. helicobacter pylori (H. pylori)

answer

d. helicobacter pylori

question

Chron's disease is characterized by: a. sharply demarcated granulomatous skip lesions of the bowel b. ulcerative lesions of the mucosal layer of the colon c. increased risk of colon cancer d. lack of systemic involvement

answer

a. sharply demarcated granulomatous skip lesions of the bowel

question

Which of the following patients is most at risk for developing hepatitis B: a. 54- yr old woman who takes acetaminophen (Tylenol) daily for headaches b. 24- yr old college student who has had several sexual partners c. 33- yr old business man who travels frequently d. 23- yr old college student that binge drinks

answer

b. 24- yr old college student who has had several sexual partners Tylenol is a risk if large amounts are consumed

question

Which of the following patients is at risk for intestinal obstruction? a. an elderly patient who is on bedrest bc post-operative abdominal surgery b. Jewish patient who smokes & consumes high amounts of caffeine c. an individual eating a low-fiber, high fat diet d. an adult diagnosed w/ cirrhosis of the liver

answer

a. an elderly patient who is on bedrest bc post-operative abdominal surgery abdominal surgery needs to be moving asap, & is often given meds that can cause intestinal obstruction

question

Decreased synthesis of which substance in the patient diagnosed w/ liver failure would be responsible for development of ascites? a. bile b. glucose c. albumin d. carbohydrates

answer

c. albumin -regulates fluid balance & is in the liver

question

Colorectal cancer w/ visible peristaltic wavers & auscultations, hear high-pitched bowel sounds match: a. patient's tumor has metastasized to the liver & biliary tract b. patient's tumor has caused a intussusception of the intestine c. patient's growing tumor has caused a partial bowel obstruction d. patient has developed toxic megacolon from the growing tumor

answer

c. patient's growing tumor has caused a partial bowel obstruction -showed by high pitched sounds intussusception- intestine folds into itself- telescope toxic megacolon- complication of IBD

question

What is the underlying pathology experienced by people w/ irritable bowel syndrome? a. impaired colonic reflexes resulting in decreased peristalsis b. excessive gastric secretions resulting in ulcer formation c. changes in mucous cell structure resulting in steatorrhea d. increased response to stretching & discomfort resulting in intestinal motility

answer

d. increased response to stretching & discomfort resulting in intestinal motility steatorrhea- abnormal amount of fat in feces

question

Acute right lower quadrant pain associated w/ rebound tenderness & systemic signs of inflammation are indicative of: a. gastritis b. peritonitis c. appendicitis d. cholecystitis

answer

c. appendicitis gastritis- inflammation of stomach's mucosal lining peritonitis- inflammation of peritoneum (lining of the abdominal wall & abdominal organs) cholecystitis- inflammation caused by calculi in biliary system

question

Patient admitted to healthcare facility w/ a diagnosis of a bleeding gastric ulcer, nurse expects stool to be: a. coffee-ground like b. clay-colored c. black & tarry d. bright red

answer

c. black & tarry - blood travels through GI tract & loses the color coffee-ground- blood in vomit clay-colored- biliary system problem (lack of bile salts)

question

Oral cancer can be defined as: a. painless, whitish thickening lesions b. can occur anywhere in the mouth c. alcohol & tobacco increase risk of oral cancer d. all of the above

answer

d. all of the above

question

Hepatitis A

answer

Type A- waterborne (fecal-oral), abrupt; fever, nausea & jaundice in children, mild severity Type B- perinatal (blood/skin), insidious; nausea & jaundice, moderate severity Type C- sexual (blood/skin), insidious; nausea, mild severity Type D- sexual (blood/skin), insidious; fever, nausea & jaundice, moderate-severe Type E- waterborne (fecal-oral), abrupt; fever, nausea & jaundice, severe

question

Pancreatitis

answer

inflammation of pancreas acute- medical emergency; upper abdominal pain radiates to back & worsens after eating, nausea/ vomiting, mild jaundice, low fever, blood pressure & pulse changes chronic- upper abdominal pain, indigestion, losing weight, streatorrhea, constipation, & flatulence Treat- no eating; intravenous nutrition (TPN), pancreatic enzyme supplements when diet is resumed, maintain hydration-intravenous, antibiotic if infected, pain management, etc.

question

Peptic ulcer

answer

Lesions affecting the the lining of the stomach or duodenum. Vary in severity based on depth of ulcer superficial erosion- complete penetration through wall

question

Cholelithiasis

answer

Gallstones (calculi in gallbladder), varying in sizes & shapes. More common in fair-skinned women. Risks- age, obesity, rapid weight loss, pregnancy, hormone replacement, some chronic diseases. Cholecystitis calculi cause inflammation or infection in biliary system, small asymptomatic, large -obstruct bile flow; gallbladder rupture, fistula formation, gangrene, hepatitis, pancreatitis, & carcinoma Manifest- abdominal pain, distension, nausea, clay-colored stool, fever, leukocytosis Treat- low-fat diet, meds to dissolve calculi, surgical removal

question

Gastric ulcer

answer

Ulcer in stomach lining- related to malignancy & NSAID use; pain worsens w/ eating

question

Duodenal ulcer

answer

Ulcer in duodenum- asociated w/ excess acid; epigastric pain relieved by food

question

Gastroesophageal reflux disease

answer

Chyme backs up into the esophagus, & occasionally bile. From: certain foods (chocolate, spicy or fatty, etc.), smoking, alcohol, obesity, pregnancy, meds, etc. Manifest- heartburn, epigastric pain (after meal), dysphagia, nausea (after eating), dry cough, "lump in throat" feeling, regurgitation of food, etc. Treat- avoid triggers, avoid NSAIDs, loose clothing, small frequent meals, reduce stress, losing weight, antacids, etc.

STUDY

Fluid And Electrolyte Balance Nursing Nursing-LPN

PrepU Chapter 37: Management of Patients With HIV Infection and AIDS – Flashcards 65 terms

David Dunn

65 terms

Preview

PrepU Chapter 37: Management of Patients With HIV Infection and AIDS – Flashcards

question

Which of the following is usually the most important consideration in decisions to initiate antiretroviral therapy?

answer

CD4 counts

question

Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as containing the genetic viral material?

answer

Ribonucleic acid (RNA)

question

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test?

answer

Western blot assay

question

A nurse is visiting the home of a client with AIDS who is experiencing HIV encephalopathy. When developing the plan of care for the client and his caregiver, the nurse identifies the nursing diagnosis of disturbed thought processes related to confusion and disorientation secondary to HIV encephalopathy. Which expected outcome would be most appropriate for the nurse to document on the client's plan of care?

answer

The client can state that he is at his home.

question

You are caring for a client who has a diagnosis of HIV. Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications?

answer

Side effects of drug therapy

question

Which of the following indicates that a client with HIV has developed AIDS?

answer

Herpes simplex ulcer persisting for 2 months

question

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often."What should the nurse consult with the physician regarding?

answer

Testing the client for the presence of HIV

question

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?

answer

Bank autologous blood

question

A new nursing graduate is working at the hospital in the medical-surgical unit. The preceptor observes the nurse emptying a patient's wound drain without gloves on. What important information should the preceptor share with the new graduate about standard precautions?

answer

Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens.

question

A patient is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the patient about for treatment?

answer

TMP-SMZ (Bactrim)

question

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?

answer

Risk for injury

question

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission?

answer

urine

question

The nurse is teaching a client with HIV how to use a male condom. The client demonstrates understanding of the information when he states which of the following? Select all that apply.

answer

-"I need to hold the condom by the tip to squeeze out the air before putting it on." -"I should unroll the condom all the way over my erect penis." -"I should avoid using baby oil or petroleum jelly with a condom."

question

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by ____.

answer

HIV-1 is more prevalent than HIV-2 subtypes

question

A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in?

answer

Primary infection

question

Which of the following options should the nurse encourage to replace fluid and electrolyte losses in a patient with AIDS?

answer

liquids

question

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses. As part of the presentation, the nurse is planning to describe the events that occur once HIV enters the host cell. Which of the following would the nurse describe as the first step?

answer

attachment

question

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply.

answer

- Semen - Breast milk -Blood -Vaginal secretions

question

The nurse is collecting objective data for a client with AIDS at the clinic. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does the nurse understand this finding indicates?

answer

Candidiasis

question

A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy?

answer

Keep the CD4 cell count above 350/mm3 and viral load undetectable.

question

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis?

answer

Stool specimen for ova and parasites

question

Which blood test confirms the presence of antibodies to HIV?

answer

Enzyme-linked immunosorbent assay (ELISA)

question

The nurse teaches the patient that lowering his or her viral load will have what effect?

answer

A longer survival time

question

Diagnosis of Kaposi's sarcoma (KS) is made by which of the following?

answer

Biopsy

question

A patient taking amprenavir (APV, Agenerase) complains of "getting fat." What is the nurse's best action?

answer

Teach the patient about medication side effects.

question

During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?

answer

Kaposi's sarcoma

question

A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when he schedules a return visit for viral load testing at which time?

answer

6 weeks

question

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?

answer

Antibodies to HIV are not present in his blood.

question

A client with AIDS is brought to the clinic by his family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

answer

AIDS dementia complex (ADC)

question

The client comes to the clinic to obtain the results from the test to determine if he is infected with HIV. The physician informs the client that he has a CD4 cell count of 300 cells/mm3 and a high viral load. What does the nurse anticipate the physician will discuss with the client?

answer

The initiation of antiretroviral therapy

question

Antiretroviral medications should be offered to individuals with T-cell counts of less than

answer

350 cell/mm

question

A client with AIDS is exhibiting shortness of breath, cough, and fever. The nurse most likely would suspect infection with which of the following?

answer

Pneumocystis jiroveci

question

HIV is harbored within which type of cell?

answer

Lymphocyte

question

A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about?

answer

Reverse transcriptase inhibitors

question

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise?

answer

Avoid residue, lactose, fat, and caffeine.

question

A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection?

answer

Trimethoprim-sulfamethoxazole (Bactrim, Septra)

question

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate?

answer

Kaposi's sarcoma

question

A client taking abacavir (ABC) has developed fever and rash. What is the priority nursing action?

answer

Call the health care provider to report.

question

The nurse receives a phone call at the clinic from the family of a patient with AIDS. They state that the patient started "acting funny" after complaining of headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?

answer

"The patient may have cryptococcal meningitis and will need to be evaluated by the physician."

question

The nurse is administering an injection to a client with AIDS and, when finished, attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse?

answer

Report the incident to the supervisor

question

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:

answer

Chronic diarrhea.

question

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay with positive results twice. What is the next step for the nurse to explain to the patient for confirmation of the diagnosis?

answer

Perform a Western blot test for confirmation of diagnosis.

question

A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse?

answer

"I understand your concern. The blood is screened very carefully for different viruses as well as HIV."

question

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find?

answer

Hypokalemia

question

A client suspected of having HIV has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?

answer

ELISA

question

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?

answer

"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."

question

A client with suspected HIV has had two positive enzyme-linked immunosorbent assay tests. What diagnostic test would be run next?

answer

Western Blot

question

Which assessment finding is not likely to cause noncompliance with antiretroviral treatment?

answer

past substance abuse

question

A patient receiving antiretroviral therapy is complaining of "not urinating enough." What is the nurse's best action?

answer

Assess BUN and creatinine.

question

A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV?

answer

Gynecologic problems

question

Postexposure prophylaxis (PEP) medications should be started within __________ after exposure, but no longer than __________, to offer any benefit. It must be taken for __________.

answer

1 hour; 72 hours; 4 weeks

question

A patient is on ART for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year?

answer

50 mm3 to 150 mm3

question

When do most perinatal HIV infections occur?

answer

After exposure during delivery

question

Which of the following has not been implicated as a factor for noncompliance with antiretroviral treatment?

answer

Past substance abuse

question

The term used to define the balance between the amount of HIV in the body and the immune response is

answer

viral set point.

question

Which of the following is an early manifestation of HIV encephalopathy?

answer

Headache

question

As part of HAART therapy, a client is prescribed a non-nucleoside reverse transcriptase inhibitor (NNRTI). Which of the following would be an example of a drug from this class? Select all that apply.

answer

- Delavirdine - Efavirenz

question

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient?

answer

Inform the patient that it would be beneficial to test for HIV.

question

The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care?

answer

Assist with chest physiotherapy every 2 to 4 hours.

question

The nursing instructor is talking about HIV/AIDS with their pre-nursing pathophysiology class. The instructor explains to the class that the virus that causes HIV/AIDS is called a retrovirus. What characteristics of this retrovirus would the instructor talk with the class about?

answer

HIV-1 and HIV-2 subtypes

question

There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS?

answer

Disclosure of the client's condition

question

When assisting the patient to interpret a negative HIV test result, what does the nurse tell the patient this result means?

answer

His body has not produced antibodies to the AIDS virus.

question

What test will the nurse assess to determine the patient's response to antiretroviral therapy?

answer

Viral load

question

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?

answer

CDC category A: HIV asymptomatic

question

The development of a positive HIV antibody test following initial infection generally occurs in which timeframe?

answer

4 weeks

STUDY

Fluid And Electrolyte Balance

Pharmacology Final Exam – Flashcards 165 terms

Viola Marenco

165 terms

Preview

Pharmacology Final Exam – Flashcards

question

Common side effects of medications for endocrine diseases include all of the following EXCEPT

answer

no changes in growth and cardiac function

question

Which of the following are true of somatropin?

answer

1, 2, 4, and 5

question

Which of the following are true of glucocorticoids and other steroids?

answer

1, 2, 3, 4, and 5

question

Signs and symptoms of hypoglycemia/insulin shock include all of the following EXCEPT

answer

Slow onset

question

Glucose absorption inhibitors

answer

all of the above

question

Which of the following statements is NOT true about adverse reactions to insulin?

answer

Insulin may cause allergic reactions in most patients

question

Hormones may be used for all of the following EXCEPT

answer

Visual Disturbances

question

Which of the following is true of thyroid hormones? 1. The three hormones secreted are thyroxine, triiodothyronine, and calcitonin. 2. Hyposecretion is cretinism in infants and children and myxedema in adults. 3. Hyposecretion may be the result of lack of iodine as well as radiation therapy and surgical removal of the thyroid. 4. Replacement therapy is lifelong. 5. Replacement therapy regimen should be taken in the mornings because of the hormone's side effect of insomnia.

answer

1, 2, 3, 4, and 5

question

Which of the following is NOT true of thiazolidinediones or glitazones?

answer

They do not delay the progression of the disease.

question

Which of the following are common symptoms of endocrine diseases? 1. skin, hair, and nail changes 2. mental deviations 3. changes in urinary output and edema 4. changes in energy levels, blood pressure, and possible heart irregularities 5. sexual irregularities

answer

1,2,3,4,5

question

Which of the following is NOT true of TSH?

answer

It decreases the uptake of iodine.

question

Sort the following insulin preparations from the shortest to the longest duration of action. 1. Lispro 2. Lantus 3. NPH 4. Regular

answer

1,4,3,2

question

Which of the following is NOT true of Lispro insulin?

answer

A person taking Lispro insulin may have more carbohydrates in the diet.

question

Calcitonin is secreted by the thyroid gland but is regulated by the parathyroid gland to ensure an adequate supply of calcium for neuromuscular and endocrine function.

answer

true

question

When a local ophthalmic anesthetic is used a patient may lose the blink reflex and pain associated with ophthalmic procedures.

answer

true

question

Eye infections should be treated with topical anti-inflammatory and antiinfective agents without doing a culture of the secretions.

answer

False

question

Drugs may be used to obtain mydriasis and miosis with ocular examinations and treatment of eye diseases.

answer

True

question

The side effects of miotics include

answer

a,b,c

question

Symptoms of ototoxicity include tinnitus, loss of balance, and vertigo.

answer

True

question

Otic antiinfective agents

answer

a,b,c

question

To safely store ophthalmic and otic medications, medications with the same name should be stored next to each other or in close proximity so that the allied health professional can be sure to use the correct medication.

answer

false

question

Which of the following statements is NOT true?

answer

Most medications used in the eye and ear have no side effects.

question

Local ophthalmic anesthetic agents are used for tonometry.

answer

True

question

When using ophthalmic anticholinergics, patients should wear dark glasses in sunshine and use dimmed lights but should have no problems with moving about after dark.

answer

False

question

Which of the following are true of keratolytic agents? 1. Keratolytic agents are used to promote the formation of the horny layer of skin. 2. Local side effects of keratolytic agents include burning and local irritation. 3. Keratolytic agents promote shedding of warts, calluses, and corns. 4. Keratolytic agents are used to treat dandruff, seborrheic dermatitis, acne, venereal warts, and psoriasis. 5. Systemic side effects of keratolytics include tinnitus, dizziness, ototoxicity, and headache.

answer

all except 1

question

Which of the following is NOT true about skin preparations?

answer

Emollients are always used to soothe and do not contain medications.

question

Occlusive dressings allow antifungals to remain in contact with the skin for a longer period of time, and these dressings increase the efficacy of the drug.

answer

false

question

Topical anesthetics are found in all of the following forms EXCEPT

answer

ophthalmic preparations

question

Which of the following is NOT true of medications used on the skin?

answer

Minoxidil is used for baldness, and it should be applied to the hair every 3 days.

question

With skin conditions, topical corticosteroids are less likely to cause systemic responses.

answer

True

question

Which of the following is NOT true of topical corticosteroids?

answer

They should be applied thickly so that the medication will stay in contact with the lesion for a longer period of time.

question

Which of the following statements is NOT true about treatment of burns?

answer

Sulfonamides should be placed on tissue before débridement to soften the area, but this treatment has no antibacterial effect.

question

Common symptoms of skin disorders include all of the following EXCEPT

answer

fever and eschar

question

Which of the following are true about the treatment of acne vulgaris? 1. Topical and systemic antibiotics are used to treat acne. 2. Many preparations for acne are available OTC, and some require a prescription. 3. Treatment of acne includes reduction of sebum and bacteria. 4. Side effects of medications for acne include dryness, scaling, and peeling of the skin; stinging and burning; itching; erythema; and skin tenderness. 5. Some medications for acne cause irritation followed by skin peeling.

answer

1, 2, 3, 4, and 5

question

Patient teaching regarding gout should include which of the following?

answer

All of the above

question

The use of colchicines is specific for gout

answer

True

question

Biphosphonates are used to prevent fractures

answer

True

question

Which of the following are found in the names of gold salts?

answer

question

Which is NOT true of salicylate NSAIDs?

answer

They are relatively safe and have the advantage over other medications of not causing gastrointestinal symptomatology

question

Centrally acting muscle relaxants include all of the following EXCEPT

answer

probenecid (Benemid)

question

Steroids are given to treat an exacerbation of rheumatoid disease.

answer

True

question

Central-acting and direct-acting muscle relaxants are the drugs of choice for muscle spasticity.

answer

True

question

Medications used for arthritis include

answer

All of the above

question

Which of the following are used to treat osteoporosis?

answer

A and C

question

Which of the following is true of opioid/synthetic opioid medications for diarrhea?

answer

All of the above statements are true.

question

Which of the following is NOT true of gastric pump inhibitors

answer

They are safe for treating ulcers before their confirmed diagnosis.

question

Which of the following is NOT true of H2-receptor antagonists that interact with histamine to inhibit gastric secretions?

answer

They should not be used for GERD.

question

Which of the following is necessary in patient teaching concerning laxative use

answer

All of the above are necessary.

question

Use the following to answer the following questions. 1. baking soda 2. Riopan 3. Amphojel 4. milk of magnesia 5. Tums 6. Gelusil 7. Alka Seltzer 8. Maalox 9. Rolaids 10. Gaviscon Which are calcium-based antacids?

answer

5 and 9

question

Which of the following are indications for laxative use?

answer

all except b

question

Which of the following is true of adsorbents used to treat diarrhea?

answer

All of the above statements are true.

question

Which of the following is NOT true of bowel evacuants?

answer

They are used for normal constipation.

question

Suppositories may cause rectal irritation.

answer

true

question

Which of the following is NOT true about taking medications for motion sickness?

answer

They should be taken when symptoms occur.

question

Xanthine derivatives such as theophylline are not always the drugs of choice for asthma because of the narrow therapeutic range.

answer

True

question

Which of the following is NOT a common side effect of medications for respiratory disorders?

answer

Fever and Rhinorrhea

question

Which of the following is NOT true of combination OTC products?

answer

If a patient has only a runny nose, a combination product is indicated

question

Cromolyn is for the prophylaxis of asthma.

answer

true

question

Which of the following is NOT true of medications to inhibit influenza?

answer

They are substitutes for the influenza vaccine.

question

Which of the following is NOT true of antitussives?

answer

All opioid antitussives require a prescription.

question

Medications for chronic pulmonary disease may be administered by

answer

a, b, and c

question

Which of the following is NOT a use for antihistamines?

answer

chest congestion

question

Which of the following is NOT true of mucokinetic agents?

answer

Hypotonic saline is used as a mucolytic agent.

question

Which of the following is NOT true of cromolyn sodium?

answer

It is more effective if used after the onset of allergic symptoms caused by histamines.

question

Which of the following is NOT a medication group used in treating hypertension?

answer

cardiac glycosides

question

Which of the following is NOT true of nitroglycerin?

answer

Sublingual nitroglycerin is a stable medication and is effective until the expiration date whether the bottle has been opened or not.

question

Which of the following are NOT symptoms of circulatory disorders?

answer

diuresis and homeostasis

question

Which of the following is NOT true of medications used as antidysrhythmics?

answer

All of the above statements are true.

question

Which of the following is NOT true of vasodilators?

answer

They increase heart rate and cardiac output.

question

Which of the following is NOT a type of medication used for coronary conditions?

answer

aminoglycosides

question

Which of the following is NOT true of HMG CoA reductase inhibitors?

answer

They may be discontinued when lipoprotein levels are lowered.

question

Antihypertensives cure hypertension.

answer

FALSE

question

Which of the following is NOT true regarding the treatment of cardiac dysrhythmias?

answer

ardiac dysrhythmias are cured by the medications that are used in treatment.

question

Nicotinic acid reduces LDL and VLDL levels and raises HDL levels but is limited by its side effects.

answer

true

question

Common foods that may irritate the urinary bladder include all of the following EXCEPT

answer

milk and milk products

question

Lower urinary tract infections are associated with all of the following symptoms EXCEPT

answer

headache

question

Which of the following is NOT true of urinary tract antiseptics?

answer

They are the first choice in treating UTIs.

question

Which of the following is NOT true of urinary tract antispasmodics?

answer

They are indicated for use in children under the age of 5 to relieve enuresis.

question

Which of the following is NOT true of sulfonamides?

answer

Those found on the market today are divided into short-acting, intermediate-acting, and long-acting drugs.

question

Drugs that are used to treat urinary tract infections include

answer

all of the above

question

DDVAP is a drug used in older adults who have enuresis.

answer

True

question

Which of the following are NOT common side effects of medications for urinary tract disorders?

answer

enuresis and incontinence

question

Drugs for enuresis reduce incontinence, frequency, and urgency due to spasms of the smooth muscles of the bladder.

answer

True

question

Which of the following is NOT true of medications used to treat overactive bladder and enuresis?

answer

All of the above statements are true.

question

Which of the following is NOT true of testosterone?

answer

It has no use in females.

question

Which of the following medication classes is NOT used to treat premenstrual syndrome?

answer

progesterone and calcium

question

Which of the following is NOT true of oral contraceptives?

answer

All oral contraceptives are combinations of estrogen and progestins.

question

Which of the following is true about treatment of benign prostatic hypertrophy?

answer

All of the above statements are true.

question

Adjusting the estrogen and progestin content of oral contraceptives will not change the side effects encountered with them.

answer

False

question

Which of the following is NOT true of progestins?

answer

Progesterone is an artificially produced progestin.

question

The side effects of testosterone replacement therapy include all of the following EXCEPT:

answer

a decrease in libido but never an increase

question

Which of the following does NOT apply to postcoital contraception?

answer

Emergency contraceptive pills (ECPs) are either estrogen pills or progestin pills, not combination medications.

question

Which of the following is NOT a common symptom of male reproductive tract diseases?

answer

genital lesions

question

Which of the following is NOT true regarding adrenergic antagonists used in treating BPH?

answer

They increase libido; therefore gaining compliance is easy.

question

Which of the following is NOT true of central nervous system stimulants?

answer

They may be prescribed over long periods of time for obesity.

question

Medications to treat migraine headache include all of the following EXCEPT

answer

all are used

question

Which of the following is/are NOT (a) side effect(s) of beta-blockers?

answer

mental awareness

question

Which of the following is NOT true of antiseizure medications?

answer

Patients taking antiseizure medications can adjust their doses as needed to stay seizure free without consulting a physician.

question

Medications to prevent migraine headache share all the following characteristics EXCEPT

answer

Both b and d are not true statements.

question

Medications known as adrenergic agents are catecholamines and noncatecholamines.

answer

True

question

Which of the following is NOT true of parasympatholytic medications?

answer

Parasympatholytic agents and anticholinergic medications are entirely different compounds that have similar actions.

question

Which of the following is NOT needed in patient teaching with analgesics?

answer

Medication may be stopped at any time owing to the dangers of physical dependence and habituation.

question

Common signs and symptoms of neurological disorders include all of the following EXCEPT

answer

diarrhea or constipation

question

Which of the following is true of medications for migraine headache?

answer

All of the above statements are true.

question

Antipsychotics are contraindicated in

answer

Children and the elderly

question

Which of the following is NOT a side effect of antipsychotic agents?

answer

all are side effects

question

Antianxiety medications are also called

answer

b and c

question

Common side effects of medications for mental disorders include all of the following EXCEPT

answer

hypertension and bradycardia

question

The major forms of psychosis include

answer

a and b

question

The medication(s) approved by the FDA for Alzheimer's disease is/are

answer

a,b,c

question

Mental health is concerned with which of the following aspects of a person? 1. physical health 2. cognitive health and affective being 3. behavioral and social health 4. the environment

answer

1,2,3,4

question

Antipsychotics are classified by

answer

all except c

question

Reasons for using medications in psychotherapy include

answer

all of the above

question

Low potency, intermediate potency, and high potency traditional antipsychotics all have an equal therapeutic effect.

answer

True

question

What is NOT a source of inhalants commonly used for euphoria and hallucinations?

answer

all of the above are sources of inhalants

question

Personal characteristics of drug misusers and abusers include all of the following EXCEPT

answer

feelings of self-worth

question

Which of the following are the most frequently abused chemical substances?

answer

caffeine

question

Which of the following is NOT a sign or symptom of drug abuse/misuse that should be recognized by allied health professionals?

answer

keeping medical appointments and maintaining good health practices

question

The half-life of cocaine is fairly long, leading to toxicity and the chance of acute intoxication.

answer

false

question

Which is NOT true of drugs used with alcoholism?

answer

Disulfiram should be given to a person who abuses alcohol whether the person desires to stop consuming alcohol or not.

question

Which of the following is NOT true of ethyl alcohol?

answer

It has no medicinal indications.

question

Which of the following is NOT true of marijuana?

answer

The potency of marijuana is always the same.

question

The side effects of smoking cessation include all of the following EXCEPT

answer

decreased appetite, nausea, and diarrhea

question

Which of the following is NOT a hallucinogen, psychedelic, or psychomimetic?

answer

marijuana

question

Which of the following statements are true concerning ophthalmic anti-inflammatory and antiinfective agents? 1. Most ophthalmic antiinfective/anti-inflammatory agents are effective on mucous membranes that have been injured or are inflamed. 2. To discourage drug-resistant strains of antiinfectives, antibiotics for ophthalmologic problems should be administered locally. 3. Any topical medication may be used in the eye. 4. With viral infections, both eyes may need to be treated. 5. In irrigating eyes, the head should be turned toward the affected side to prevent cross-contamination of the unaffected eye.

answer

1,2,4,5`

question

Which of the following statements is NOT true?

answer

Mydriatics are used to cause pupil constriction for diagnostic tests.

question

OTC ophthalmic medications are always safe for use by all people because the FDA has approved the use of these drugs.

answer

False

question

Agents that mimic the sympathetic nervous system bring about pupillary dilation, while cycloplegic agents cause paralysis of the ciliary muscles and prevent accommodation. These medications are used primarily for diagnostic testing.

answer

True

question

Medications used in the ear often contain more than one ingredient so that more than one symptom or condition is treated at one time.

answer

True

question

The rate of medication absorption through the skin depends on which of the following?

answer

all of the above

question

Which of the following are true of topical fungal preparations? 1. They may be used on hair, nails, or skin. 2. Most are used to treat Candida and tinea infections. 3. Most are available OTC as well as by prescription. 4. They should be used completely even if symptoms improve. 5. Therapy for fungal infections is long-term.

answer

1,2,3,4,5

question

Topical creams and ointments for pediculosis should be applied to the affected area and left on for 12 hours, and then the area should be thoroughly washed.

answer

True

question

Common side effects of musculoskeletal medications include

answer

All of the above

question

TNF inhibitors block the immune response to prevent inflammation of joints.

answer

True

question

The goal of arthritis therapy includes all of the following EXCEPT

answer

Curing the disease

question

Which of the following is an immunosuppresant agent and a DMARD?

answer

methotrexate

question

Anticholinesterase agents increase muscle tone.

answer

True

question

Which of the following is true concerning medications acting on gastrointestinal system tissues?

answer

All of the above statements are true except for d.

question

Which of the following is true of oral antiviral agents?

answer

All of the above statements are true.

question

Which of the following is NOT true of gastric pump inhibitors?

answer

They are safe for treating ulcers before their confirmed diagnosis.

question

Which of the following should not be given to persons with diabetes?

answer

phosphorated carbohydrate solution (Emetrol)

question

Which of the following is NOT true of histamine?

answer

It is not a problem with most upper respiratory inflammatory diseases.

question

Which of the following is NOT true of decongestants?

answer

They are very safe for persons who have diabetes mellitus.

question

Which of the following is NOT true of expectorants?

answer

They are not found as combination medications.

question

Which of the following is NOT a common side effect of circulatory medications?

answer

edema and shortness of breath

question

Antihypertensives receive the same response in all ethnic and cultural groups.

answer

false

question

Which of the following are routes of administration for nitroglycerin?

answer

all of the above

question

Which of the following is NOT true of hemorrheologic agents?

answer

All of the above statements are true.

question

Which of the following is NOT true of medications used to affect coagulation?

answer

Anticoagulants include vitamin K, heparin, and warfarin.

question

TMZ-SMZ is the abbreviation for trimethoprim-sulfonamide.

answer

false

question

Which of the following statements about fluid and electrolyte balance is NOT true?

answer

Infants and obese persons have less fluid in their bodies than normal adults.

question

DDVAP is an antidiuretic hormone.

answer

True

question

Which of the following is NOT true of testosterone replacement therapy?

answer

The treatment and dosage are the same for all males, regardless of the diagnosis.

question

Which of the following is NOT true about forms of contraception?

answer

All IUDs provide long-term contraception of 8 years and are intrauterine progesterone inserts.

question

Which of the following is true of sildenafil (Viagra)?

answer

All of the above statements are true.

question

Common side effects of medications for neurological conditions include all of the following EXCEPT

answer

muscle turgidity or spasticity

question

Beta-blockers are the drugs of choice in migraine headache prophylaxis

answer

True

question

Which of the following is NOT true about the use of CNS stimulants as anorexiants and for narcolepsy?

answer

They may be taken after 6:00 PM in persons desiring to lose weight and for narcolepsy without causing excessive stimulation.

question

Which of the following is NOT true of adrenergic agonists?

answer

They are not sympathomimetic medications and do not simulate the "fight-or-flight" response of the body.

question

Mental health is concerned with which of the following aspects of a person? 1. physical health 2. cognitive health and affective being 3. behavioral and social health 4. the environment

answer

1, 2, 3, and 4

question

Psychotherapeutic agents were first introduced in the ______. Before that time, psychotic patients were institutionalized.

answer

1950s

question

Antipsychotics are also called

answer

A and C

question

Antipsychotics include

answer

a, b, and c

question

Common signs and symptoms of mental disorders include all of the following EXCEPT

answer

proper work ethics and work skills

question

Which of the following is NOT true of abused central nervous system stimulants?

answer

There is an antidote for amphetamine and cocaine toxicity that stops the toxic effects with few side effects.

STUDY

Fluid And Electrolyte Balance Pharmacology

HSC3147_CMB-15Spring Final – Flashcards 180 terms

Sara Edwards

180 terms

Preview

HSC3147_CMB-15Spring Final – Flashcards

question

Common side effects of medications for endocrine diseases include all of the following *EXCEPT*

answer

no changes in growth and cardiac function

question

Which of the following are true of somatropin? 1. It is also known as growth hormone. 2. It is expensive to prescribe. 3. It should be used for any child who is of short stature. 4. It has a drug interaction with insulin. 5. Variations in its secretion may lead to acromegaly in adults and dwarfism in children.

answer

1, 2, 4, and 5

question

Which of the following are true of glucocorticoids and other steroids? 1. They are potent anti-inflammatory agents. 2. Their adverse effects include "moon face," "pot belly," and "buffalo hump." 3. They cause the kidney to retain sodium. 4. They may be administered orally, intramuscularly, intravenously, intraarticularly, and topically. 5. They have distinct methods of administration that include alternate-day therapy and declining dosages.

answer

1, 2, 3, 4, and 5

question

Signs and symptoms of hypoglycemia/insulin shock include all of the following *EXCEPT*

answer

slow onset

question

Glucose absorption inhibitors

answer

all of the above

question

Glitazones are a class of antihyperglycemics that are similar to other oral antidiabetic medications.

answer

false

question

Which of the following is *NOT* true of TSH?

answer

It decreases the uptake of iodine.

question

Insulin acts as a key to open body cells to glucose.

answer

true

question

Which of the following is true of insulin preparations?

answer

Both a and b are true.

question

Signs and symptoms of hypoglycemia/insulin shock include all of the following *EXCEPT*

answer

slow onset

question

All of the following are true about sulfonylureas *EXCEPT* they

answer

are insulin-like preparations

question

Hormones may be used for all of the following *EXCEPT*

answer

visual disturbances

question

Hyperglycemics

answer

all of the above

question

All of the following are true of Lantus insulin *EXCEPT* it

answer

is cloudy

question

Calcitonin salmon is safe for use because the drug has the same metabolic effects as human calcitonin.

answer

true

question

answer

1, 2, 4, and 5

question

Which of the following statements is *NOT* true?

answer

Mydriatics are used to cause pupil constriction for diagnostic tests.

question

OTC ophthalmic medications are always safe for use by all people because the FDA has approved the use of these drugs.

answer

false

question

answer

true

question

Medications used in the ear often contain more than one ingredient so that more than one symptom or condition is treated at one time.

answer

true

question

Which of the following statements is *NOT* true?

answer

Mydriatics are used to cause pupil constriction for diagnostic tests.

question

answer

false

question

Corticosteroids may cause increased ocular pressure, while ibuprofen may alter color vision and may cause blurred vision.

answer

true

question

Ear analgesics may be warmed mineral oil, sweet oil, or glycerin as well as medications with benzocaine.

answer

true

question

OTC ophthalmic medications are always safe for use by all people because the FDA has approved the use of these drugs.

answer

false

question

Which of the following statements is *NOT* true?

answer

Most medications used in the eye and ear have no side effects.

question

Otic antiinfective agents

answer

a, b, and c

question

Medications used in the ear often contain more than one ingredient so that more than one symptom or condition is treated at one time.

answer

true

question

Which of the following is *NOT* true of agents for glaucoma?

answer

Medications used topically in the eye do not have side effects.

question

Symptoms of ototoxicity include tinnitus, loss of balance, and vertigo.

answer

true

question

The rate of medication absorption through the skin depends on which of the following?

answer

all of the above

question

Which of the following is *NOT* true of topical corticosteroids?

answer

They should be applied thickly so that the medication will stay in contact with the lesion for a longer period of time.

question

answer

1, 2, 3, 4, and 5

question

Topical anesthetics are found in all of the following forms *EXCEPT*

answer

foams and shampoos

question

Topical creams and ointments for pediculosis should be applied to the affected area and left on for 12 hours, and then the area should be thoroughly washed.

answer

true

question

Topical creams and ointments for pediculosis should be applied to the affected area and left on for 12 hours, and then the area should be thoroughly washed.

answer

true

question

Oral contraceptives may be used to treat acne in females after menarche and those who have not responded to topical medications.

answer

true

question

Which of the following statements is *NOT* true about treatment of burns?

answer

Sulfonamides should be placed on tissue before débridement to soften the area, but this treatment has no antibacterial effect.

question

Common side effects of medications for skin disorders include all of the following *EXCEPT*

answer

loss of hair

question

Which of the following is *NOT* true of skin preparations?

answer

Persons with oily skin should bathe less frequently.

question

Topical preparations come in which of the following forms?

answer

all of the above

question

Most topical antiviral medications are applied only once a day.

answer

false

question

answer

1, 2, 3, 4, and 5

question

Which of the following is *NOT* true of topical corticosteroid medications?

answer

They should be spread on the affected area and beyond, and the area may be covered for greater absorption.

question

Topical anesthetics are found in all of the following forms *EXCEPT*

answer

foams and shampoos

question

Common side effects of musculoskeletal medications include

answer

all of the above

question

TNF inhibitors bock the immune response to prevent inflammation of joints.

answer

true

question

The goal of arthritis therapy includes all of the following *EXCEPT*

answer

curing the disease

question

Which of the following is an immunosuppressant agents and a DMARD?

answer

methotrexate

question

Anticholinesterase agents increase muscle tone.

answer

true

question

Patient teaching regarding gout should include which of the following?

answer

All of the above should be included.

question

TNF inhibitors, methotrexate, and DMARDs may be used concurrently.

answer

true

question

The use of colchicine is specific for gout.

answer

true

question

Anticholinesterase agents increase muscle tone.

answer

true

question

TNF inhibitors bock the immune response to prevent inflammation of joints.

answer

true

question

The goal of arthritis therapy includes all of the following *EXCEPT*

answer

curing the disease

question

Which of the following are found in the names of gold salts?

answer

"au"

question

Which of the following is an immunosuppressant agents and a DMARD?

answer

methotrexate

question

Common side effects of musculoskeletal medications include

answer

all of the above

question

Biphosphonates are used to prevent fractures.

answer

true

question

Which of the following is true concerning medications acting on gastrointestinal system tissues?

answer

All of the above statements are true except for d.

question

Which of the following is true of oral antiviral agents?

answer

All of the above statements are true.

question

Which of the following is *NOT* true of gastric pump inhibitors?

answer

They are safe for treating ulcers before their confirmed diagnosis.

question

Which of the following should not be given to persons with diabetes?

answer

phosphorated carbohydrate solution (Emetrol)

question

Which of the following are indications for laxative use?

answer

all except b

question

Which of the following is *NOT* true of bulk-forming laxatives?

answer

They interfere with food absorption.

question

Which of the following should not be given to persons with diabetes?

answer

phosphorated carbohydrate solution (Emetrol)

question

Which of the following is *NOT* true concerning medications for H. pylori?

answer

They always include an antacid.

question

Which of the following is *NOT* true about fluoride treatment?

answer

Fluoride tablets and solutions may be administered with meals and are better given with food because of the bad taste that follows administration.

question

Which of the following is true of lubricant laxatives?

answer

All of the above statements are true.

question

Which of the following is *NOT* true about antacids?

answer

They have no other indications except the treatment of gastric hyperacidity.

question

answer

5 and 9

question

Which of the following is true of opioid/synthetic opioid medications for diarrhea?

answer

All of the above statements are true.

question

Which of the following is *NOT* true of laxatives and cathartics?

answer

People need a bowel movement everyday and should take laxatives and cathartics to ensure this normal body function.

question

Which of the following are used in mouthrinses?

answer

all of the above

question

Cromolyn is for the prophylaxis of asthma.

answer

true

question

Which of the following is *NOT* true of histamine?

answer

It is not a problem with most upper respiratory inflammatory diseases.

question

Which of the following is *NOT* true of decongestants?

answer

They are very safe for persons who have diabetes mellitus.

question

Which of the following is *NOT* true of combination OTC products?

answer

If a patient has only a runny nose, a combination product is indicated.

question

Which of the following is *NOT* true of expectorants?

answer

They are not found as combination medications.

question

Which of the following is *NOT* true of decongestants?

answer

They are very safe for persons who have diabetes mellitus.

question

Cromolyn can be used long-term for the prophylaxis of asthma.

answer

true

question

Which of the following is *NOT* true of cromolyn sodium?

answer

It is more effective if used after the onset of allergic symptoms caused by histamines.

question

Which of the following is *NOT* a common side effect of medications for respiratory disorders?

answer

fever and rhinorrhea

question

Which of the following is *NOT* true of medications to inhibit influenza?

answer

They are substitutes for the influenza vaccine.

question

Which of the following are *NOT* common symptoms of respiratory tract disorders?

answer

nausea, vomiting, and anorexia

question

Which of the following is *NOT* true of histamine?

answer

It is not a problem with most upper respiratory inflammatory diseases.

question

Which of the following is *NOT* true of xanthine derivatives?

answer

They are still the drugs of choice for pulmonary diseases.

question

Which of the following is *NOT* true of treatment for COPD?

answer

Xanthine derivatives constrict smooth muscle, so sputum may be expectorated.

question

Which of the following is *NOT* a use for antihistamines?

answer

chest congestion

question

Which of the following is *NOT* a common side effect of circulatory medications?

answer

edema and shortness of breath

question

Antihypertensives receive the same response in all ethnic and cultural groups.

answer

false

question

Which of the following are routes of administration for nitroglycerin?

answer

all of the above

question

Which of the following is *NOT* true of hemorheologic agents?

answer

All of the above statements are true.

question

Which of the following is *NOT* true of medications used to affect coagulation?

answer

Anticoagulants include vitamin K, heparin, and warfarin.

question

Which of the following is *NOT* true of nitroglycerin?

answer

Sublingual nitroglycerin is a stable medication and is effective until the expiration date whether the bottle has been opened or not.

question

Which of the following is *NOT* true of hypertension and its treatment?

answer

Compliance with antihypertensive therapy is easily accomplished because the patient has headaches and lethargy that are reminders to take medications.

question

Which of the following is *NOT* true of topical hemostatics?

answer

The size and place of a wound have no bearing on which topical hemostatic agent is used.

question

Which of the following is *NOT* true about the treatment of hyperlipidemia?

answer

Medications are the first line of treatment for hyperlipidemia.

question

Which of the following is *NOT* true of antiplatelet medications?

answer

All of the above statements are true.

question

Which of the following is *NOT* true of drugs used for angina pectoris?

answer

Medications for angina should last only a short time—only the time necessary to stop the angina attack.

question

Antihypertensives receive the same response in all ethnic and cultural groups.

answer

false

question

Thiazide diuretics (diuretics that reduce blood volume) are the most frequently used class.

answer

true

question

Which of the following is *NOT* a medication group used in treating hypertension?

answer

cardiac glycosides

question

Which of the following is *NOT* true of vasodilators?

answer

They alleviate edema.

question

TMZ-SMZ is the abbreviation for trimethoprim-sulfonamide.

answer

false

question

Which of the following are *NOT* common side effects of medications for urinary tract disorders?

answer

enuresis and incontinence

question

Which of the following statements about fluid and electrolyte balance is *NOT* true?

answer

Infants and obese persons have less fluid in their bodies than normal adults.

question

Lower urinary tract infections are associated with all of the following symptoms *EXCEPT*

answer

headache

question

DDVAP acts in much the same manner as antidiuretic hormone.

answer

true

question

Lower urinary tract infections are associated with all of the following symptoms *EXCEPT*

answer

headache

question

Skin rashes may occur as a side effect of UTI medications.

answer

true

question

Which of the following is *NOT* true of urinary tract antiseptics?

answer

They are the first choice in treating UTIs.

question

Which of the following is *NOT* true of urinary tract analgesics?

answer

Pyridium will not stain clothing.

question

Drugs that are used to treat urinary tract infections include

answer

all of the above

question

Upper urinary tract infections are associated with all of the following symptoms *EXCEPT*

answer

burning and frequency of urination

question

DDAVP is an antidiuretic hormone.

answer

true

question

Which of the following is *NOT* true of sulfonamides?

answer

Those found on the market today are divided into short-acting, intermediate-acting, and long-acting drugs.

question

Which of the following is *NOT* true of medications used to treat overactive bladder and enuresis?

answer

All of the above statements are true.

question

Drugs for enuresis reduce incontinence, frequency, and urgency due to spasms of the smooth muscles of the bladder.

answer

true

question

Which of the following is *NOT* a symptom of sexually transmitted diseases?

answer

congenital malformations

question

Which of the following is *NOT* true of testosterone replacement therapy?

answer

The treatment and dosage are the same for all males, regardless of the diagnosis.

question

Which of the following is *NOT* true about forms of contraception?

answer

All IUDs provide long-term contraception of 8 years and are intrauterine progesterone inserts.

question

Which of the following medication classes is *NOT* used to treat premenstrual syndrome?

answer

progesterone and calcium

question

Which of the following is true of sildenafil (Viagra)?

answer

All of the above statements are true.

question

Which of the following is *NOT* true of medications used to treat endometriosis?

answer

Women taking danazol (Danocrine) may become pregnant any time during the treatment of endometriosis.

question

Which of the following is true about treatment of benign prostatic hypertrophy?

answer

All of the above statements are true.

question

Uses of estrogen include which of the following?

answer

all of the above

question

Combination oral contraceptives occur in which of the following formulas? 1. Monophasic: Daily doses of estrogen and progestin remain the same throughout the menstrual cycle. 2. Biphasic: Estrogen remains constant, but the progestin dose is increased during the second half of the cycle. 3. Triphasic: The menstrual cycle is divided into three phases, with the amount of progestin changed in each phase. 4. Estrophasic: The amount of progestin remains constant, and the estrogen dose is gradually increased throughout the cycle.

answer

1, 2, 3, and 4

question

Which of the following does *NOT* apply to spermicides and barrier devices as means of contraception?

answer

Spermicides come in gels, foams, creams, and ointments and may be bought OTC.

question

The side effects of testosterone replacement therapy include all of the following *EXCEPT*

answer

a decrease in libido but never an increase

question

Which of the following is *NOT* true of testosterone?

answer

It has no use in females.

question

Adjusting the estrogen and progestin content of oral contraceptives will not change the side effects encountered with them.

answer

false

question

Which of the following is *NOT* a symptom of sexually transmitted diseases?

answer

congenital malformations

question

Which of the following is *NOT* true of oral contraceptives?

answer

All oral contraceptives are combinations of estrogen and progestins.

question

Common side effects of medications for neurological conditions include all of the following *EXCEPT*

answer

muscle turgidity or spasticity

question

Beta-blockers are the drugs of choice in migraine headache prophylaxis.

answer

true

question

Which of the following is *NOT* needed in patient teaching with analgesics?

answer

Medication may be stopped at any time owing to the dangers of physical dependence and habituation.

question

Which of the following is *NOT* true about the use of CNS stimulants as anorexiants and for narcolepsy?

answer

They may be taken after 6:00 PM in persons desiring to lose weight and for narcolepsy without causing excessive stimulation.

question

Which of the following is *NOT* true of adrenergic agonists?

answer

They are not sympathomimetic medications and do not simulate the "fight-or-flight" response of the body.

question

Which of the following is *NOT* true of medications for spasticity?

answer

Most muscle relaxants are effective for spasticity.

question

Alcohol will have a synergistic effect with hypnotics and sedatives.

answer

true

question

Medications to treat migraine headache include all of the following *EXCEPT*

answer

all are used

question

Groups of drugs that are used to treat seizures include which of the following?

answer

a, b, and c

question

Which of the following statements is *NOT* true?

answer

Catecholamines are produced and stored in the brain to increase the stimulation of the autonomic nervous system.

question

Which of the following is *NOT* needed in patient teaching with analgesics?

answer

Medication may be stopped at any time owing to the dangers of physical dependence and habituation.

question

All of the following are true of drugs for parkinsonism *EXCEPT*

answer

They are effective in arresting the disease.

question

Which of the following is *NOT* true of parasympatholytic medications?

answer

Parasympatholytic agents and anticholinergic medications are entirely different compounds that have similar actions.

question

Which of the following is *NOT* true of local anesthetics?

answer

The onset of most local anesthetics is slow, and they last for prolonged periods of time.

question

Which of the following is *NOT* true of anesthetics?

answer

Allied health professionals in an ambulatory care setting have no responsibility in preparing a patient for general anesthesia; this is the responsibility of the surgeon and anesthetist.

question

Mental health is concerned with which of the following aspects of a person? 1. physical health 2. cognitive health and affective being 3. behavioral and social health 4. the environment

answer

1, 2, 3, and 4

question

Psychotherapeutic agents were first introduced in the ______. Before that time, psychotic patients were institutionalized.

answer

1950s

question

Antipsychotics are also called

answer

a and c

question

Antipsychotics include

answer

a, b, and c

question

Common signs and symptoms of mental disorders include all of the following *EXCEPT*

answer

proper work ethics and work skills

question

The medication(s) approved by the FDA for Alzheimer's disease is/are

answer

donepezil (Aricept)

question

Mental health is a lifelong process to form a sense of harmony and balance for the individual.

answer

true

question

A person who is in contact with reality but is fearful and has difficulty adjusting to surroundings is considered to have

answer

neurosis

question

The major forms of psychosis include

answer

a and b

question

Mental health is concerned with which of the following aspects of a person? 1. physical health 2. cognitive health and affective being 3. behavioral and social health 4. the environment

answer

1, 2, 3, and 4

question

Most drugs that are used to treat ADHD are

answer

b and c

question

Antipsychotics are contraindicated in

answer

a and b

question

Low potency, intermediate potency, and high potency traditional antipsychotics all have an equal therapeutic effect.

answer

true

question

Antidepressant medications include

answer

a, b, and c

question

Tricyclic antidepressants are generally not recommended for children under 12 years of age.

answer

true

question

The side effects of smoking cessation include all of the following *EXCEPT*

answer

decreased appetite, nausea, and diarrhea

question

Which is *NOT* true of drugs used with alcoholism?

answer

Disulfiram should be given to a person who abuses alcohol whether the person desires to stop consuming alcohol or not.

question

The half-life of cocaine is fairly long, leading to toxicity and the chance of acute intoxication.

answer

false

question

Which of the following is *NOT* true of abused central nervous system stimulants?

answer

There is an antidote for amphetamine and cocaine toxicity that stops the toxic effects with few side effects.

question

Which of the following is *NOT* a hallucinogen, psychedelic, or psychomimetic?

answer

marijuana

question

Which of the following is *NOT* true of hallucinogens, psychedelics, and psychomimetics?

answer

There is no medication to dissipate "bad trips" found with hallucinogens, psychedelics, and psychomimetics.

question

Which of the following is *NOT* related to withdrawal of opiates/opioids?

answer

When in a withdrawal program, the person exhibits few symptoms.

question

Which of the following are the most frequently abused substances?

answer

A and C are correct

question

Which of the following is *NOT* true of abused central nervous system stimulants?

answer

There is an antidote for amphetamine and cocaine toxicity that stops the toxic effects with few side effects.

question

Which of the following is *NOT* a hallucinogen, psychedelic, or psychomimetic?

answer

marijuana

question

The half-life of cocaine is fairly long, leading to toxicity and the chance of acute intoxication.

answer

false

question

Not all socioeconomic, ethnic, or cultural classes have problems with drug and substance abuse—just those persons at the opposite ends of the cultural spectrum.

answer

false

question

What is *NOT* a source of inhalants commonly used for euphoria and hallucinations?

answer

all of the above are sources of inhalants.

question

Which of the following medications do *NOT* interact with nicotine?

answer

all of the above interact with nicotine

question

Which of the following is *NOT* a side effect of abused and misused drugs?

answer

hypertension and bradycardia

STUDY

Fluid And Electrolyte Balance Pharmacology Sexually Transmitted Diseases

Pharmacology Final – Flashcards 155 terms

Briley Leonard

155 terms

Preview

Pharmacology Final – Flashcards

question

Topical preparations come in which of the following forms?

answer

all of the above

question

answer

all except 1

question

Which of the following statements is NOT true of prophylactic agents?

answer

Sunscreens have no effect on premature aging or in precancerous conditions, although these products do prevent cancer.

question

Topical creams and ointments for pediculosis should be applied to the affected area and left on for 12 hours, and then the area should be thoroughly washed.

answer

true

question

Which of the following is NOT true about skin preparations?

answer

Emollients are always used to soothe and do not contain medications.

question

answer

1-5

question

Which of the following is NOT true of medications used on the skin?

answer

Minoxidil is used for baldness, and it should be applied to the hair every 3 days.

question

The rate of medication absorption through the skin depends on which of the following?

answer

all of the above

question

Which of the following is NOT true of skin preparations?

answer

persons with oily skin should bathe less frequently

question

Which of the following is NOT true of topical corticosteroids?

answer

They should be applied thickly so that the medication will stay in contact with the lesion for a longer period of time.

question

Topical anesthetics are found in all of the following forms EXCEPT

answer

foams and shampoos

question

Common side effects of musculoskeletal medications include

answer

all of the above

question

TNF inhibitors bock the immune response to prevent inflammation of joints.

answer

true

question

The goal of arthritis therapy includes all of the following EXCEPT

answer

curing the disease

question

Which of the following is an immunosuppressant agents and a DMARD?

answer

methotrexate

question

Anticholinesterase agents increase muscle tone.

answer

true

question

Which of the following are used to treat osteoporosis?

answer

a & c

question

Centrally acting muscle relaxants include all of the following EXCEPT

answer

probenecid (Benemid)

question

Central-acting and direct-acting muscle relaxants are the drugs of choice for muscle spasticity.

answer

true

question

Which of the following is NOT true of alendronate?

answer

it may given without regard to vit D

question

The same nostril may be used for administration of nasal calcitonin salmon.

answer

false

question

TNF inhibitors, methotrexate, and DMARDs may be used concurrently.

answer

true

question

Patient teaching regarding gout should include which of the following?

answer

- all should be included

question

Which is NOT true of salicylate NSAIDs?

answer

They are both anti-inflammatory and analgesic agents.

question

Common side effects of musculoskeletal medications include

answer

all of the above

question

Which of the following is true concerning medications acting on gastrointestinal system tissues?

answer

all true except d

question

Which of the following is true of oral antiviral agents?

answer

all are true

question

Which of the following is NOT true of gastric pump inhibitors?

answer

They are safe for treating ulcers before their confirmed diagnosis

question

Which of the following should not be given to persons with diabetes?

answer

phosphorated carbohydrate solution (Emetrol)

question

Which of the following are indications for laxative use?

answer

all but b

question

Which of the following is NOT true of osmotic saline laxatives?

answer

They work in response to the amount of medication given, making water replacement insignificant.

question

Which of the following is NOT true of anorexiants?

answer

They can stand on their own to produce long-term weight loss

question

Which of the following is NOT true concerning medications for H. pylori?

answer

Two antibiotics are usually ordered to prevent drug resistance.

question

Which of the following is true of anti-inflammatory agents for the GI tract?

answer

all of the above are true

question

Which of the following is true of opioid/synthetic opioid medications for diarrhea?

answer

all are true

question

answer

question

Cromolyn is for the prophylaxis of asthma.

answer

true

question

Which of the following is NOT true of histamine?

answer

It is not a problem with most upper respiratory inflammatory diseases

question

Which of the following is NOT true of decongestants?

answer

They are very safe for persons who have diabetes mellitus

question

Which of the following is NOT true of combination OTC products?

answer

If a patient has only a runny nose, a combination product is indicated.

question

Which of the following is NOT true of expectorants?

answer

They are not found as combination medications

question

Which of the following is NOT true of antihistamines?

answer

They may be used chronically for several years because tolerance does not develop.

question

Cromolyn can be used long-term for the prophylaxis of asthma.

answer

true

question

Chlorpheniramine is the antihistamine of choice in the elderly.

answer

false

question

Which of the following is NOT true of mucokinetic agents?

answer

Hypotonic saline is used as a mucolytic agent.

question

Antitussives are especially effective for the productive cough.

answer

false

question

Medications for chronic pulmonary disease may be administered by

answer

a,b,c

question

Which of the following is NOT a use for antihistamines?

answer

chest congestion

question

Which of the following is NOT a common side effect of circulatory medications?

answer

edema and shortness of breathe

question

Antihypertensives receive the same response in all ethnic and cultural groups.

answer

false

question

Which of the following are routes of administration for nitroglycerin?

answer

all of the above

question

Which of the following is NOT true of hemorheologic agents?

answer

all of the above

question

Which of the following is NOT true of medications used to affect coagulation?

answer

Anticoagulants include vitamin K, heparin, and warfarin.

question

Which of the following is NOT true of cardiac glycosides?

answer

They decrease congestion in the heart by increasing the force that increases the amount of blood pumped from the heart.

question

Which of the following is NOT true about the treatment of hyperlipidemia?

answer

Medications are the first line of treatment for hyperlipidemia

question

Nicotinic acid reduces LDL and VLDL levels and raises HDL levels but is limited by its side effects.

answer

true

question

Which of the following is NOT a type of angina pectoris?

answer

-chronic

question

Which of the following is NOT true of HMG CoA reductase inhibitors?

answer

They may be discontinued when lipoprotein levels are lowered.

question

Which of the following is NOT a medication group used in treating hypertension?

answer

cardiac glycosides

question

Which of the following is NOT true of antiplatelet medications?

answer

all above are true

question

TMZ-SMZ is the abbreviation for trimethoprim-sulfonamide.

answer

false

question

Which of the following are NOT common side effects of medications for urinary tract disorders?

answer

enuresis and incontinence

question

Which of the following statements about fluid and electrolyte balance is NOT true?

answer

Infants and obese persons have less fluid in their bodies than normal adults.

question

Lower urinary tract infections are associated with all of the following symptoms EXCEPT

answer

headache

question

DDVAP acts in much the same manner as antidiuretic hormone.

answer

true

question

Skin rashes may occur as a side effect of UTI medications.

answer

true

question

DDAVP is a drug used in older adults who have enuresis.

answer

true

question

Common foods that may irritate the urinary bladder include all of the following EXCEPT

answer

milk products

question

Sulfonamides suppress the synthesis of folic acid.

answer

true

question

Which of the following is NOT true of urinary tract antiseptics?

answer

They are the first choice in treating UTIs.

question

Upper urinary tract infections are associated with all of the following symptoms EXCEPT

answer

burning and frequency of urination

question

Major electrolytes that need replacement include all of the following EXCEPT

answer

chlorides

question

Which of the following is NOT true of urinary tract analgesics?

answer

Pyridium will not stain clothing.

question

Which of the following are NOT common symptoms of urinary tract disorders?

answer

chest pain and nausea ** pg494

question

Which of the following is NOT a symptom of sexually transmitted diseases?

answer

congenital malformation

question

Which of the following is NOT true of testosterone replacement therapy?

answer

The treatment and dosage are the same for all males, regardless of the diagnosis.

question

Which of the following medication classes is NOT used to treat premenstrual syndrome?

answer

progesterone and calcium

question

Which of the following is true of sildenafil (Viagra)?

answer

All of the above statements are true.

question

Common side effects of medications for endocrine diseases include all of the following EXCEPT

answer

no changes in growth and cardiac function

question

answer

1, 2, 4, and 5

question

answer

1-5

question

Signs and symptoms of hypoglycemia/insulin shock include all of the following EXCEPT

answer

slow onset

question

Glucose absorption inhibitors

answer

all of the above

question

Sort the following types of insulin from the slowest to the longest onset of action. 1. Regular 2. Levemir 3. Lispro 4. NPH

answer

-1, 2, 3, 4 -3,4,2,1 -3,1,4,2 -4,3,2,1

question

answer

1-5

question

Signs and symptoms of hyperglycemia/diabetic coma include all of the following EXCEPT

answer

no thirst

question

Which of the following is a modified human derivative of insulin and is therefore less antigenic and the preferred insulin for use today?

answer

all of the above

question

Calcitonin is secreted by the thyroid gland but is regulated by the parathyroid gland to ensure an adequate supply of calcium for neuromuscular and endocrine function.

answer

true

question

Which of the following is NOT true of calcitonin salmon?

answer

There are no drug interactions with calcitonin salmon because it acts like human calcitonin.

question

Growth hormone stimulates almost all tissues and organs for growth.

answer

true

question

Hormones may be used for all of the following EXCEPT

answer

endocrine diagnostic testing**

question

Insulin preparations vary in

answer

all of the above

question

answer

1, 2, 4, and 5

question

Which of the following statements is NOT true?

answer

Mydriatics are used to cause pupil constriction for diagnostic tests.

question

OTC ophthalmic medications are always safe for use by all people because the FDA has approved the use of these drugs.

answer

false

question

answer

true

question

Medications used in the ear often contain more than one ingredient so that more than one symptom or condition is treated at one time.

answer

true

question

Drugs may be used to obtain mydriasis and miosis with ocular examinations and treatment of eye diseases.

answer

true

question

When a local ophthalmic anesthetic is used a patient may lose the blink reflex and pain associated with ophthalmic procedures.

answer

true

question

Medications used for systemic diseases have no ocular side effects.

answer

false

question

Cerumenolytics are used to harden watery wax in the ear.

answer

false

question

Which of the following is NOT true of agents for glaucoma?

answer

Medications used topically in the eye do not have side effects.

question

Eye infections should be treated with topical anti-inflammatory and antiinfective agents without doing a culture of the secretions.

answer

false

question

Local ophthalmic anesthetic agents are used for tonometry.

answer

true

question

Which of the following is NOT true concerning infertility and its treatment?

answer

all of the above are true

question

Which of the following is NOT a common symptom of female reproductive tract diseases?

answer

frequency and urgency of urination

question

Which of the following does NOT apply to spermicides and barrier devices as means of contraception?

answer

spermicides come in gels, foams, creams, and ointments and may be bought OTC*****

question

Which of the following medication classes is NOT used to treat premenstrual syndrome?

answer

progesterone and calcium

question

Uses of estrogen include which of the following?

answer

all of the above

question

Which of the following is NOT a common symptom of male reproductive tract diseases?

answer

all of the above

question

The side effects of testosterone replacement therapy include all of the following except

answer

a decrease in libido but never an increase

question

Which of the following does NOT apply to postcoital contraception?

answer

Emergency contraceptive pills (ECPs) are either estrogen pills or progestin pills, not combination medications.

question

Which of the following is NOT true of oral contraceptives?

answer

All oral contraceptives are combinations of estrogen and progestins.

question

Which of the following is NOT true of estrogens?

answer

They do not change the shape of the cornea and have no effect on the fitting of contact lenses

question

Which of the following is NOT a symptom of sexually transmitted diseases? Correct!

answer

congenital malformations

question

Which of the following is NOT true of testosterone replacement therapy?

answer

the treatment and dosage are the same for all males, regardless of the diagnosis.

question

Which of the following is NOT true about forms of contraception?

answer

All IUDs provide long-term contraception of 8 years and are intrauterine progesterone inserts.

question

Common side effects of medications for neurological conditions include all of the following EXCEPT

answer

muscle turgidity or spasticity

question

Beta-blockers are the drugs of choice in migraine headache prophylaxis.

answer

true

question

Which of the following is NOT needed in patient teaching with analgesics?

answer

Medication may be stopped at any time owing to the dangers of physical dependence and habituation.

question

Which of the following is NOT true about the use of CNS stimulants as anorexiants and for narcolepsy?

answer

They may be taken after 6:00 PM in persons desiring to lose weight and for narcolepsy without causing excessive stimulation.

question

Which of the following is NOT true of adrenergic agonists?

answer

They are not sympathomimetic medications and do not simulate the "fight-or-flight" response of the body.

question

Successful treatment of seizures requires individualization of the medication to the person.

answer

true

question

Which of the following is NOT true of parasympathomimetic medications?

answer

Cholinergic medications have few side effects and are considered safe for use in most patients.

question

Sedatives and hypnotics are entirely different pharmaceutical compounds.

answer

false

question

Which of the following is NOT true of endorphins and enkephalins?

answer

Endorphins are part of the blood-brain barrier

question

Medications known as adrenergic agents are catecholamines and noncatecholamines.

answer

true

question

Which of the following is NOT true of central nervous system stimulants?

answer

They may be prescribed over long periods of time for obesity.

question

Alcohol will have a synergistic effect with hypnotics and sedatives.

answer

true

question

Which of the following is NOT true of medications for spasticity?

answer

Most muscle relaxants are effective for spasticity

question

Mental health is concerned with which of the following aspects of a person? 1. physical health 2. cognitive health and affective being 3. behavioral and social health 4. the environment

answer

1-4

question

Psychotherapeutic agents were first introduced in the ______. Before that time, psychotic patients were institutionalized.

answer

1950s

question

Antipsychotics are also called

answer

a & c

question

Antipsychotics include

answer

a,b,c

question

Common signs and symptoms of mental disorders include all of the following EXCEPT

answer

proper work ethics and work skills

question

Which of the following is NOT a side effect of antipsychotic agents?

answer

all side effects

question

The most commonly prescribed medications for neurosis are benzodiazepines. Side effects include

answer

-sensitivity to sunlight -interactions with alcohol -a and c - a, b, and c

question

Common side effects of drugs for Alzheimer's disease are related to

answer

all but c

question

Tricyclic antidepressants are generally not recommended for children under 12 years of age.

answer

true

question

The major difference in the benzodiazepines is

answer

he duration of action

question

Antianxiety medications are also called

answer

-b and c

question

The dangers with monoamine oxidase inhibitors are

answer

-interactions with tyramine-containing foods

question

The side effects of smoking cessation include all of the following EXCEPT

answer

decreased appetite, nausea, and diarrhea

question

Which is NOT true of drugs used with alcoholism?

answer

Disulfiram should be given to a person who abuses alcohol whether the person desires to stop consuming alcohol or not.

question

The half-life of cocaine is fairly long, leading to toxicity and the chance of acute intoxication.

answer

false

question

Which of the following is NOT true of abused central nervous system stimulants?

answer

There is an antidote for amphetamine and cocaine toxicity that stops the toxic effects with few side effects.

question

Which of the following is NOT a hallucinogen, psychedelic, or psychomimetic?

answer

marijuana

question

Which of the following medications do NOT interact with nicotine?

answer

all of the above do

question

Which of the following is NOT true of nicotine?

answer

Peripheral blood vessels constrict, raising blood pressure in persons who start smoking.****

question

Personal characteristics of drug misusers and abusers include all of the following EXCEPT

answer

feeling of self-worth

question

Which of the following is NOT a side effect of abused and misused drugs?

answer

hypertension and bradycardia

question

Which of the following is NOT true of central nervous system depressants?

answer

Withdrawal from barbiturates and benzodiazepines should be done rapidly to prevent long-term withdrawal signs and symptoms.

question

Not all socioeconomic, ethnic, or cultural classes have problems with drug and substance abuse—just those persons at the opposite ends of the cultural spectrum.

answer

false

question

Which of the following is NOT true of ethyl alcohol?

answer

it has no med indications

question

Which of the following is NOT true of smoking cessation products?

answer

all above are true

STUDY

Blood In The Urine Emphasize The Importance Of Fluid And Electrolyte Balance

Patho Unit 7 – Flashcards 64 terms

Marvel Brown

64 terms

Preview

Patho Unit 7 – Flashcards

question

The clinical significance of BPH resides in its tendency to compress the ________ and cause partial/complete obstruction of urinary outflow, resulting in over-distention of the bladder.

answer

Urethra

question

Testicular __________ is a twisting of the spermatic cord that suspends the testis.

answer

torsion

question

Testicular torsion obstructs venos drainage, with resultant edema and hemorrhage and subsequent _______ obstruction. This is a medical emergency needing imediate attention.

answer

Arterial

question

____________ cancer is the second most frequently diagnosed cancer in men, and the highest rates in the world are found in the United States.

answer

Prostate

question

A weak urinary stream, postvoid dribbling, frequency of urination, and nocturia are classic symptoms of an enlarged prostate.

answer

True

question

In regards to polycystic ovary syndrome, elevated _________ _________ results in increased androgen productio and contributes to a vicious cycle of anovulation and multiple cyst formation. (Please spell out)

answer

Luteinizing hormone

question

Certain types of sexually transmitted human papillomaviruses are risk factors for a neoplasia, which can be a precursor lesion of invasive carcinoma.

answer

True

question

Polycystic ovary syndrome is a common ___________ disorder.

answer

Endocrine

question

Risk factors for ______ ______ include increasing age, family history and hormonal influences (late menopause).

answer

Breast cancer

question

Ovarian cancer has severe early symptoms and is most often diagnosed in its early stages.

answer

False

question

Symptoms that are believed to have a strong correlation to ______ _______ include increased abdominal size, dyspepsia, early satiety or bloating.

answer

Ovarian cancer

question

________ therapy is used to block the effects of estrogen on the growth of breast cancer cells.

answer

Hormone

question

________ represents an inflammation of the vagina that is characterized by vaginal discharge and burning, itching, redness and swelling of the vaginal tissues. Infections transmitted sexually are a common cause.

answer

Vaginitis

question

Cancer of the breast is the most common cancer in females.

answer

True

question

The incidence of _______ _______ is much lower in countries where women bear numerous children.

answer

Ovarian cancer

question

_______ lubricates the hair and skin, preventing evaporation of moisture and helps conserve body heat.

answer

Sebum

question

________ is an unpleasant sensation of itch leading to the desire to scratch.

answer

Puritius

question

________ are small fluid-filled blisters (often seen with Herpes).

answer

Vesicles

question

The ________ ______ are structures that become inflamed in acne.

answer

Sebaceous glands

question

_____________, or the sensation of itch, is a symptom common to many skin disorders.

answer

pruritus

question

Sebaceous glands, which release a lubricant for the skin and hair, are located over the entire skin surface except for the palms, soles, and sides of the feet.

answer

True

question

Skin cancers affect light-skinned persons more commonly than dark-skinned persons.

answer

True

question

Although ________ represents a small subset of skin cancers, it is the most deadly since it's a rapidly progressing, metastatic form of cancer.

answer

Melanoma

question

_______-_______ full-thickness burns involve the entire epidermis and dermis.

answer

Second degree

question

Varicella in adults is of similar significance and severity as in children.

answer

False

question

Allergic and hypersensitivity ___________ involved the inflammatory response to multiple agents. The disorders are usually characterized by edema.

answer

Dermatoses

question

The structure of the skin renders it susceptible to bacterial and fungal infections but resistant to viral infections.

answer

False

question

_________ instability begins almost immediately with injury to capillaries in the burned area and surrounding tissue. Patients often present with hypovolemic shock in the ER.

answer

Hemodynamic

question

This produces direct damage to the DNA and other nuclear proteins (in the skin) and produced free radicals: _______ radiation.

answer

Ultraviolet

question

Moderate to severe cases of ____ may be managed with systemic antibiotics.

answer

Acne

question

Dysplastic (pre-cancerous) _____ are usually larger than others. Their appearance is flat, slightly raised plaque with a pebbly surface.

answer

Nevi

question

This disease is usually manifested by raised, well-demarcated, erythematous plaques with adherent silvery scales:_________. Histologically it is characterized by increased epidermal turnover with marked epidermal thickening.

answer

Psoriasis

question

This common childhood disease is characterized by macules over various parts of the body, mild to extreme puritus and cold-like symptoms: _________.

answer

Varicella, Chickenpox

question

Malignant melanoma, which is a malignant tumor of melanocytes, is a rapidly progressive and metastatic form of skin cancer.

answer

True

question

PTH prevents serum calcium levels from falling below and serum ________ levels rising above normal physiologic concentrations.

answer

Phosphate

question

The process of bone formation and mineral metabolism is complex and involves the interplay among the actions of PTH, ____________, and vitamin D.

answer

calcitonin

question

The articulating areas of a joint are nourished indirectly by the ______ _____ rather than by blood vessels.

answer

Synovial fluid

question

The tendons and ligaments of the joint capsule are sensitive to position and movement, particularly stretching and twisting. Their _________ function reflexively to adjust the tension of the muscles that support the joint.

answer

Proprioceptors

question

Whereas PTH increases blood calcium levels, the hormone _______ lowers blood calcium levels.

answer

Calcitonin

question

________ involves reabsorption of the excess bony callus that develops in the marrow space and encircles the fracture site.

answer

Remodeling

question

_______________ represents an acute or chronic infection of the bone and is very difficult to treat and eradicate.

answer

Osteomyelitis

question

_________ formation is thought to be necessary for the initiation of cellular events essential to bone healing.

answer

Hematoma

question

______________ is an aggressive and highly malignant bone tumor with primary symptoms of deep localized pain with nighttime awakening and swelling in the affected bone.

answer

Osteosarcoma

question

The treatment of bone tumors includes surgery in combination with multi-agent ________, both before and after surgery.

answer

Chemotherapy

question

Legg-Calvé-Perthes disease is a childhood disorder that specifically involves the knee.

answer

False

question

__________ is an aggressive and highly malignant tumor of the bone.

answer

Osteosarcoma

question

All forms of scoliosis can be corrected with continued use of a brace.

answer

False

question

____________ osteomylitis originates with infectious organisms that reach bone through the bloodstream.

answer

Hematogenous

question

[X] __________ [Y] _______ fractures occur when normal stress is applied to bones that have been weakened by disease or tumors.

answer

Pathologic, stress

question

[X]_____-[Y]_____-[Z]_____ disease is an ideopathic osteoneocrotic disease of the proximal femoral epiphysis with later reabsorption.

answer

Legg, Calve, Perthes

question

Sclerosis, or formation of new bone and cysts, usually occurs at the joint margins, forming abnormal bony outgrowths called estophytes or spurs. This is charachteristic of _________.

answer

Osteoarthritis

question

_________ of joints (crepitus) and joint locking may occur when the joint is moved.

answer

Cracking

question

_______________ arthritis is a systemic inflammatory disease that attacks joints by producing a proliferative synovitis that leads to destruction of the articular cartilage and underlying bone.

answer

Rheumatoid

question

The pathogenesis of ___________ ________ can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture.

answer

Rheumatoid arthritis

question

_______ is a condition that is common to all metabolic bone diseases.

answer

Osteopenia

question

Regular exercise and adequate calcium and vitamin D intake are important factors in preventing ________. Calcitonin is also one of the drugs used in treatment.

answer

Osteoporosis

question

Often, the first manifestations of the disorder are those that accompany a skeletal-fracture, a _________ compression or fracture of the hip, pelvis, humerus or other bones

answer

Vertebral

question

_______________ is a skeletal disorder characterized by the loss of bone mass and deterioration of the architecture of cancellous bone with a subsequent increase in bone fragility and susceptibility to fractures.

answer

Osteoporosis

question

Arthalgias and arthritis are among the most common occurring early symptoms of [X]_______ [Y]______ [Z]________. Renal involvement occurs in about half to two-thirds of persons as well.

answer

Systemic, Lupus, Erythematosus

question

All persons affected with rheumatoid arthritis have the presence of the rheumatoid factor, an auto antibody that reacts with a fragment of immunoglobulin G to form immune complexes.

answer

False

question

Systemic lupus erythematosus is a chronic inflammatory disease that can affect virtually any organ system, including the musculoskeletal system.

answer

True

question

Rheumatic disorders have signs and symptoms that are limited to the skeletal system.

answer

False

question

Premature __________ is increasingly being seen in female athletes owing to an increased prevalence of eating disorders and amenorrhea.

answer

Osteoporosis

question

_______________ is a condition that is common to all metabolic bone diseases and is characterized by a reduction in bone mass greater than expected for age, race, or sex.

answer

Osteopenia

STUDY

Breast Fed Infants Fluid And Electrolyte Balance Nutrition

NURTRITION FINAL – Flashcards 116 terms

Rebecca Mallory

116 terms

Preview

NURTRITION FINAL – Flashcards

question

Anyone who eats a meal high in salt can temporarily increase his or her body's water content.

answer

true

question

After about 25 years of age, regardless of calcium intake, bones begin to lose density.

answer

false

question

A deficiency of sodium is not harmful.

answer

false

question

Low salt intakes have been linked with lower rates of stomach cancer.

answer

true

question

The bioavailability of calcium in calcium-fortified orange juice is comparable to that of milk.

answer

true

question

The body will signal thirst before dehydration occurs to prevent problems with fluid loss.

answer

false

question

Soft water contains sodium, which may aggravate hypertension.

answer

true

question

Some minerals act as buffers to help maintain body fluids at the correct pH to permit life's processes.

answer

true

question

The main source of iodine in the U.S. is plants grown in the middle part of the country.

answer

false (less iodine in the soil)

question

The primary role of fluoride is to prevent dental caries throughout life

answer

true, not a necessary nutrient

question

Women in their reproductive years are likely to carry more intra-abdominal fat than are women past menopause.

answer

false

question

Waist circumference indicates visceral fatness, and above a certain girth, disease risks rise.

answer

true

question

Eating certain foods can elevate the basal metabolic rate, and thus promote weight loss.

answer

false

question

For someone with at least one obese parent, the chance of becoming obese is estimated to be between 30 and 70 percent.

answer

true

question

Taller people need proportionately more energy than shorter people to balance their energy budgets.

answer

true

question

Physical inactivity alone does not cause obesity.

answer

false

question

The BMI is very valuable in helping muscular athletes determine their health risks.

answer

false

question

No single body composition or weight suits everyone; needs vary by gender, lifestyle, and stage of life.

answer

true

question

Leptin is a hormone produced by the body to stimulate the appetite and encourage eating.

answer

false

question

The set-point theory states that the body's regulatory controls will maintain body weight over time and resist efforts to lose weight by dieting.

answer

true

question

People who regularly engage in physical activity live longer on average than those who are physically inactive.

answer

true

question

By strengthening the muscles of the back and abdomen, resistance training can improve posture.

answer

true

question

Iron-deficiency anemia impairs physical performance because iron helps deliver the muscles' glucose.

answer

false

question

Active people do not need extra fluid in cold weather.

answer

false

question

Active people do not need extra fluid in cold weather.

answer

false

question

Muscle hypertrophy is an increase in size in response to use.

answer

true

question

The body is able to store unlimited amounts of glycogen in muscles.

answer

false

question

Taking vitamin or mineral supplements just before competition will help to improve performance.

answer

false

question

An athlete should weigh herself before and after her workout to determine how much fluid she should replace.

answer

true

question

What is the intensity level of a physical activity that causes some increase in breathing, is a perceived exertion of 5 or 6, and allows you to have a conversation while doing the activity?

answer

moderate

question

Chronic diseases are the only type of diseases that afflict people in developed countries.

answer

false

question

Degenerative conditions are also referred to as chronic diseases.

answer

true

question

Dietary supplements can trigger extra immune power to fend off dangerous infections in well-fed people.

answer

false

question

A deficiency or toxicity of even a single nutrient can weaken the body's defenses considerably.

answer

true

question

Just as a virus causes influenza, a risk factor causes a chronic disease.

answer

false

question

Thirty minutes of brisk walking on at least 5 days a week can improve the odds against heart disease.

answer

true

question

Metabolic syndrome, with its cluster of factors, raises the risk of CVD.

answer

true

question

Constituents in foods may be cancer causing, cancer promoting, or protective against cancer.

answer

true

question

Excess calories from carbohydrates, protein, and fat all raise cancer rates.

answer

true

question

Obesity is a risk factor for certain cancers such as colon, breast, endometrial, pancreas, and kidney cancer.

answer

true

question

All varieties of sushi are made from raw fish.

answer

false

question

Numerous health organizations have concluded that irradiation of food is safe and can improve food safety in the United States and the world.

answer

true

question

Properly irradiated food does not become radioactive.

answer

true

question

BHT protects fruits and vegetables from browning caused by exposure to oxygen.

answer

true

question

Food additives used in the U.S. are strictly controlled and pose little cause for concern.

answer

true

question

Current evidence indicates that moderate intakes of nonnutritive sweeteners pose no health risks.

answer

true

question

Incidental food additives sometimes find their way into foods, and adverse effects are common.

answer

false

question

Water-soluble vitamins are affected by canning.

answer

true

question

Raw produce does not pose a threat for foodborne illness because it is low in protein content.

answer

false

question

Salmonella bacteria from a hen may enter the egg she lays as well as contaminate its shell.

answer

true

question

A low-birthweight baby is nearly 40 times more likely to die in the first year of life than is a normal-weight baby.

answer

true

question

A low-birth weight baby is defined as one who weighs less than 5 1/2 pounds.

answer

true

question

During pregnancy, the recommended carbohydrate intake is less than 175 grams per day.

answer

false

question

Folate fortification has lowered the number of neural tube defects that occur each year.

answer

true

question

The DRI recommendation for calcium intake is higher for pregnant than non-pregnant women in the same age group.

answer

false

question

For normal-weight women, the ideal pattern of weight gain during the first trimester is one pound per week.

answer

false

question

Physical activity during pregnancy can improve fitness, facilitate labor, and reduce psychological stress.

answer

true

question

The energy nutrient composition of breast milk is much different from that of a healthful adult diet: it is much lower in protein but higher in fat.

answer

true

question

Alcohol crosses the placenta and is directly toxic to the fetus.

answer

true

question

An infant's basal metabolic rate is only half that of an adult, based on body weight.

answer

false

question

warning symptoms of botulism

answer

difficulty breathing difficulty swallowing double vision weak muscles

question

hazard anaylsis critical control point

answer

all food producers have a plan to limit contaminations of food

question

ideal conditions for bacteria

answer

nutrients, moisture, warmth (40-140 degree Fahrenheit)

question

four practices to defeat bacteria

answer

clean, separate, cook, chill

question

bovine spongiform encephalopathy

answer

disease in meats that causes fatal brain disorder

question

honey

answer

clostridium botulinum spores that affect infants

question

irridation

answer

application of ionizing radiation to foods to reduce insect infestation or microbial contamination or to slow the ripening or sprouting process

question

solanine

answer

greek toxin in potatoes

question

growth hormone

answer

increase lean tissue growth, milk production, reduce feed requirements

question

arsinic

answer

in pourtyl, rice, fish, offs, milk, drinking water

question

methylmercury

answer

poisoning in food that can cause blindness, deafness, and retardation

question

gras list

answer

for food additives

question

salt and sugar

answer

overused as additives to prevent bacterial growth by withdrawing water from food

question

nitrate

answer

additive in meats to preserve color and prevent acidity, safety issues in colon cancer

question

sulfite

answer

additive to preserve, severe allergies, not in raw foods, decrease thiamine in foods

question

aspartame

answer

link with insulin resistance, pku

question

monosodium gluamate

answer

used in restaurants, banned in infants bc brain cells, protective against cancer, msg system complex in those that are sensitive

question

fat replacers

answer

add Taste, texture, and cooking with fewer or no calories

question

olestera

answer

fat non nutritive that takes away vitamins so fortified with it

question

obese women are likely to suffer from gestational diabetes, hypertension, and complications during and infections after birth

answer

true

question

women requires ... carloeis using second trimester and extra ... calories during third

answer

340, 450

question

protein is higher ... dri for pregnant

answer

25 grams

question

folate amounts in pregnancy

answer

400-600 mpg so enough RBC

question

choline in pregnancy

answer

vital for structural integrity of cell membranes, synthesis of important NT, metabolism of lipids. needed to close neural tube and for development of brain and spinal cord. in eggs, milk, legumes, meats

question

build the skeleton during pregnancy

answer

vitamin d, calcium, phosphorus, magnesium

question

iron in pregnancy

answer

increase blood volume and provide for placental and fetal needs. increase abosportion and tease menurstration. should chose heme iron, additional iron sources, and enhance vitamin c to enhance absorption

question

zinc during pregnancy

answer

vital for protein synthesis and cell development.

question

wanted weight gain in pregnancy

answer

3.5 pounds in frist, 1 pound per week in others

question

smoking during pregnancy

answer

damage fetal dan, restrict blood supply, limit oxygen and removal of waste, slows growth reduce brain size, improper development skids low birthweight

question

listeriosis

answer

bad food poisoning in women thet can be deadly

question

preeclempsia

answer

HTN and protein in urine, can lead to mother and fetal death and seizures

question

lactacting

answer

spends 500 calories, eat an extra 330. drink lots of lid

question

breast milk provides all nutrients a healthy infant needs for six months except for

answer

vitamin d

question

great milk contains a generous proportion of essential fatty acids lanolin acid and linolenic acid as well asarachiodonic and ha.

answer

true

question

protein in breast milk

answer

alpha-lactalbumin

question

vitamin d in infants

answer

cause rickets deficiency. sunlight exposure

question

infant supplements

answer

viamon d, iron, and fluoride

question

coloustrum

answer

antibodies in breastmilk

question

iron in abbies

answer

4-6 months need from greater formulas. iron refortified cerairles, then protein foods likee meat and eggs, contribute iron but bioavailability poor. serve vitamin c to advance absorption

question

zinc in babies

answer

less in breast milk, rely on complementary foods like protein foods

question

look up minerals

answer

u fool

question

glucose and fiber needs of 1 year old

answer

falls in adult range because of size of brain

question

fat recommendations of children

answer

1-3 is 20-40, 4-18 is 25-35

question

vitamin d in children

answer

15 mpg, to maximize calcium absorption, ensure none growth

question

iron in children

answer

7-10 mg per day. lean meats, eggs, legumes, whole grains. deficiencies lead to behavior and inteleecultal dampening,

question

lead poisoning

answer

decreased bone and muscle growth, near damage, kidney malfunction, hearing impraitment, speech and language difficulty, developmental delay. absorbed more if lac iron, calcium, and zinc

question

Hunger results primarily from food poverty

answer

true

question

Federal programs to relieve hunger are crucial to many people, even if not fully successful in preventing hunger.

answer

true

question

SNAP debit cards cannot be used to purchase foods of low nutrient density such as chocolate doughnuts.

answer

false

question

Natural causes of famine have become more important in recent years than political or social causes.

answer

false

question

There is a strong, credible body of evidence documenting that the earth is warming and that this is largely due to human activities

answer

true

question

By 2050, one billion additional tons of grains will be needed to feed the world's population.

answer

true

question

Poverty is associated with a high human birth rate.

answer

true

question

Energy Star products rank in the top 1% for energy efficiency.

answer

false

question

Poverty drives people to restrict the number of children they have.

answer

false

question

In countries with high malnutrition rates, both personal and national economies decline as productivity ceases

answer

true

STUDY

Current Health Status Fluid And Electrolyte Balance Non Small Cell Lung Cancer Nursing Oncology Pharmacology Small Cell Lung Cancer

Pharm: Treatment of Cancer PrepU – Flashcards 30 terms

Patricia Harrah

30 terms

Preview

Pharm: Treatment of Cancer PrepU – Flashcards

question

Cytotoxic antineoplastic medications can produce several adverse effects that can affect the treatment used. In caring for patients undergoing chemotherapy, for which of the following should monitoring occur? (Select all that apply.)

answer

> Mucositis > Tetany

question

A nurse is administering an antineoplastic extravasation occurs. How can the nurse best prevent tissue damage caused by extravasation?

answer

Inspect the site frequently for redness or swelling

question

An adverse effect of tamoxifen therapy involves menopausal symptoms.

answer

True

question

The nurse may be asked to administer which medication to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?

answer

Allopurinol (Zyloprim)

question

A nurse is caring for a client who is undergoing chemotherapy. The client has experienced several episodes of vomiting. Which activity should the nurse perform as part of ongoing assessment for signs of dehydration and electrolyte imbalances?

answer

Measure all fluid intake and output

question

A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy?

answer

Take special care when shaving or brushing her teeth.

question

The nurse is caring for a client newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What would be the nurse's best response?

answer

"Your tumor originated from a single cell that is genetically different from other cells in the surrounding tissue."

question

A client asks the nurse what cancer cell growth is called. What would the nurse tell the client?

answer

proliferation

question

A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image?

answer

Suggest the use of a wig or cap.

question

A nurse is caring for a patient who is at risk for erythema during antineoplastic drug therapy. What should the nurse suggest to this patient?

answer

Wear loose protective clothing.

question

A patient undergoing antineoplastic drug therapy is administered an alkylating drug. The patient is also administered an aminoglycoside as an anti-infective agent. Which of the following interactions of the alkylating drug with the aminoglycoside should the nurse assess the patient for?

answer

Increased risk of nephrotoxicity

question

A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases?

answer

Non-Hodgkin's lymphoma

question

A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide for the treatment of leukemia?

answer

The patient's bone marrow function is significantly depressed.

question

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

answer

Prostate cancer

question

A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing:

answer

dyspnea

question

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are:

answer

cell cycle-specific.

question

A patient taking high doses of cyclophosphamide is exhibiting muscle cramps and confusion and reports headaches. The nurse assesses the laboratory tests and notices the sodium level is low. What does the nurse determine may be occurring with this patient?

answer

The patient is exhibiting signs of syndrome of inappropriate antidiuretic hormone caused by the high dose of cyclophosphamide.

question

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse?

answer

"Your hair will grow back, but the new hair may be a different color or texture."

question

Which agent would the nurse expect to be administered orally?

answer

Methotrexate

question

Anemia from chemotherapy treatment is the result of bone marrow suppression.

answer

True

question

A client is experiencing intense nausea while being treated with chemotherapeutics. What actions should the nurse perform? Select all that apply.

answer

> Ensure that the client has had a dietician consult > Administer antiemetics as prescribed > Provide the client with small, frequent meals

question

A female client is receiving L-asparaginase. She is at the end of her chemotherapeutic course and is concerned because her liver function tests are abnormal. What is an appropriate response by the nurse?

answer

"Liver impairment usually subsides when chemotherapy is complete."

question

A nurse is caring for a patient being treated with antineoplastic drugs. The patient is at risk for thrombocytopenia due to bone marrow suppression. What should the nurse monitor for in this patient?

answer

Bloody urine

question

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?

answer

Tamoxifen

question

A patient has been prescribed melphalan, an alkylating agent, for the treatment of an ovarian tumor. The patient wants to know the action of the drug in treating the tumor. Which of the following should the nurse inform the patient?

answer

Changes the cell to a more alkaline environment.

question

The client receiving a first infusion of paclitaxel reports chills and dyspnea. The oncology nurse assesses the client and observes facial flushing, wheezing, and extreme anxiety. What is the priority intervention by the nurse?

answer

Stop the infusion.

question

An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib?

answer

The patient has chronic heart failure resulting in significant peripheral edema.

question

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?

answer

Risk for Infection related to suppressed bone marrow function

question

Intravenous carmustine has been prescribed for a patient with cancer. The nurse should help relieve the discomfort of pain and burning during the infusion by

answer

slowing the infusion.

question

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to:

answer

drink a lot of water.

STUDY

Acute Urinary Retention Fluid And Electrolyte Balance Health Assessment Nursing Urology

Pathoma- Female GU (Vulva) – Flashcards 21 terms

Pedro Huang

21 terms

Preview

Pathoma- Female GU (Vulva) – Flashcards

question

vulva, vagina, and cervix

answer

three components of the female GU that comprise the lower GU tract

question

squamous cells

answer

type of epithelial cells that comprise the vulva

question

inflammation

answer

this immune response causes Bartholin's cysts

question

Bartholin's cyst

answer

typically presents as a unilateral, painful cystic lesion at the lower vestibule

question

reproductive age

answer

age during which Batholin's cysts are most common

question

6 and 11

answer

types of HPV that are considered low-risk and result in condyloma

question

koilocytes

answer

cells that exhibit a raisin-esque nucleus in response to HPV infection (high risk or low risk)

question

lichen sclerosis

answer

condition characterized by thinning of the epidermis and fibrosis of the dermis over the vulva. Vulvar skin is considered "parchment-like"

question

leukoplakia

answer

lichen sclerosis, lichen simplex chronicus, and vulvar carcinoma all have this common presentation

question

postmenopausal

answer

age group most at risk of lichen sclerosis

question

squamous cell carcinoma

answer

potential cancer that could result from long-standing lichen sclerosis

question

lichen simplex chronicus

answer

characterized by hyperplasia of the vulvar squamous epithelium. Vulvar skin is considered "leathery"

question

false

answer

true or false: lichen simplex chronicus is associated with increased risk of squamous cell carcinoma

question

HPV and lichen sclerosis

answer

two conditions that can result in rare vulvar carcinoma

question

16, 18, 31, and 33

answer

four high-risk HPV subtypes that are associated with dysplasia and progression to vulvar carcinoma

question

age

answer

demographic feature that differentiates women with vulvar carcinoma from HPV from women with vulvar carcinoma from lichen sclerosis

question

extramammary paget's disease

answer

condition characterized by malignant epithelial cells in the epidermis that represents carcinoma in-situ (no underlying carcinoma) that presents as erythematous, pruritic, and ulcerated vulvar skin

question

nipple

answer

this particular type of Paget's disease is associated with underlying carcinoma, but not in the vulvar region

question

PAS +, keratin +, and S-100 -

answer

three cell markers that would be indicative of extramammary paget's disease

question

PAS -, keratin -, and S-100 +

answer

three cell markers that would be indicative of melanoma of the vulvar

question

melanoma

answer

specific cancer that must be ruled-out when extrammary paget's disease is considered

STUDY

Fluid And Electrolyte Balance Indications For Use Nutrition Total Energy Expenditure

Medical Nutrition Therapy Final Exam – Flashcards 117 terms

Bernice Cooper

117 terms

Preview

Medical Nutrition Therapy Final Exam – Flashcards

question

Resting Energy Expenditure

answer

Also expressed as RMR and BMR, it is the energy required to maintain all body functions. A significant amount of energy is used to maintain metabolic activities. It is 60-75% of TEE.

question

Thermic Effect of Food

answer

The energy spent on the digestion, absorption and metabolism of food. It is 5-10% of TEE. This component is largely ignored in sick people.

question

What components are used to compute TEE?

answer

REE, Thermic effect of food, physical activity (15-30%), and illness or injury

question

What factors increase REE

answer

LBM, hormones (thyroid), pregnancy/lactation, environment/cold exposure, drugs/stimulants, stress, temperature/fever.

question

Direct Calorimetry

answer

Heat production parallels energy expenditure

question

Indirect Calorimetry

answer

Oxygen consumption parallels energy expenditure, clinical measure of TEE

question

Doubly labeled water

answer

Ingest water labelled with isotopes of oxygen and hydrogen; measures O2 and H disappearance from the body; Easier in free-living; Research studies as a measure of TEE.

question

Mifflin-St. Jeor Equation

answer

Energy expenditure estimation used more commonly for healthy and non-stressed individuals. Would need to multiply by a stress factor if used for sick individuals.

question

Sources of fluids in PN/EN pt

answer

Maintenance IV fluids; medications given via IV drip, Water flushes given with crushed medications; water flushes to keep tubes patent; water contained in EN or PN

question

Sources of fluid loss in pt

answer

chest tubes, percutaneous drains (biliary/pancreatic), wound drainage, ostomies/stool/urine, NG tube suction, excessive drooling, fistulas, increased insensible losses (burns, tracheostomies, fever, kinder beds)

question

Clinical or physical signs of nutritional deficiency

answer

Dehydration, edema, muscle wasting, decreased subcutaneous fat, clinical symptoms of vitamin/mineral deficiencies

question

When can you use Albumin, Pre-albumin, and transferrin to assess protein status?

answer

In stable patients, with good renal function. If pt is stress/inflammed the levels will not reflect protein status. TYN and UUN do not account for wound losses.

question

General Characteristics of EN

answer

Fed into GI track; Fed enterally; mimics the composition of normal diet in liquid form (polymeric, hydrolyzed)

question

General Characteristics of PN

answer

Fed outside GI tract; fed parenterally (intravenous, large or small veins, central or peripheral); concentrated monomeric formulas: glucose, free amino acids, lipids)

question

Oral Liquid Supplements

answer

Used when nutritional needs are not met by standard diet alone, often used to supplement a normal diet, commercially available, lactose and gluten free, high protein, high calorie nutrient dense foods and liquids.

question

Indications for EN support

answer

Cancer of the head and neck; radical surgery to the upper GI tract neck, oral pharynx, or upper respiratory track; esophageal cancer; dysphagia; gastroparesis; gastric outlet obstruction; mild malabsorptive disease (Crohn's disease, SBS, pancreatitis); inability to meet nutrient needs by intake alone (as with burn, trauma, sepsis and chemo pts); depressed mental status; neurological impairment; paralysis; P.O. intake less than cooler and protein needs (often d/t cancer and anorexia); correction of malnutrition d/t chronic disease.

question

Indications for EN support in children

answer

Congenital abnormalities of the mouth, esophagus, stomach or intestines; malabsorption as with cystic fibrosis, Crohn's, fat malabsorption; sucking and swallowing disorders (premature); brain injury; developmental delay; neuromuscular disorders; cerebral palsy; failure to thrive.

question

Indications and notes for NGT (nasogastric)

answer

Inadequate oral intake; high needs; Intubated/sedated; relatively functional GI tract; normally used short term

question

Indications and notes for nasoduodenal or nasojejunal

answer

Functional lower GI tract (proximal injury/surgery); inadequate gastric motility (high residuals); esophageal reflux. These routes require continuous drip feeding d/t bypassing gastric emptying

question

Indications and notes for gastrostomy

answer

Esophageal injury or obstruction; inability to swallow; anticipate EN needed for > 4 weeks. Long term usage. Caution: GERD and intractable vomiting

question

Indications and notes for Jejunostomy

answer

Obstruction/surgery proximal to jejunum; UGI stricture or fistula; inadequate gastric motility. Use long term transpyloric continuous drip

question

Continuous Drip EN

answer

Used in ICU settings; better tolerated in sick in-patient; less N, D, cramping, and bloating; may reduce risk of aspiration pneumonia; generally requires infusion pump (intestine); can by cycled in homecare puts with good tolerance to EN.

question

Bolus EN

answer

Gastric feeding (cannot be used post-pyloric); appropriate for long-term feedings; allows mobility for pt; allows mealtime feedings that mimics normal eating patterns; usually 50-500cc/feeding

question

Intermittent EN

answer

Given "drip" method; gravity garage or pump; feeding bag; may give same volume as bolus but over a longer time period; can be given nocturnally at increased rate to allow daytime mobility; used to transition to oral feedings; used for intestine feedings to increase mobility.

question

Indications for use of standard EN formula

answer

normal GI function with mild/moderate stress

question

Indications for use of high protein, high Kcal EN formula

answer

hypermetabolic, volume restrictions, high protein

question

Indications for use of elemental/partially hydrolyzed EN formula

answer

Malabsorption, bowel rest, pancreatitis

question

What does low residue mean?

answer

Only a small amount of the EN is getting to the colon.

question

Complications of EN

answer

Diarrhea, Constipation, Bloating, Nausea/vomiting, high residuals, aspiration, naso-pharyngeal irritation, clogged tube, hyperglycemia, hypoglycemia, dehydration, hypokalemia, hypophosphatemia

question

Complications of overfeeding on EN

answer

hyperglycemia, lipogenesis, fluid and fat gain vs LBM, immunosuppression (XS lipid and linoleic acid), excess CO2 production, increased minute ventilation.

question

Complications of underfeeding on EN

answer

loss of lean tissue, skin breakdown, poor wound healing, immundysfunction. Intake is often <75% of order

question

What is the most serious life-threatening complication of enteral therapy?

answer

Aspiration/Pneumonia

question

Benefits of EN

answer

Stimulates immune barrier function at GI; attenuates bacterial translocation; physiologic presentation of nutrients; maintains gut mucosal integrity; attenuates hypermetabolic response; simplifies fluid/electrolyte management; more "complete" nutrition that PN; provides iron, fiber, glutamine, phytochemicals that are not found in PN; less infectious complications; stimulates return of bowel function; less expensive.

question

MNT for flatulence

answer

Low fructose diet, reduce gas forming foods, increase physical activity

question

Causes of flatulence

answer

Swallowed air, distention, cramping, high fiber (raffinose), high fructose diets.

question

Constipation is defined as

answer

low stool caliber, hard stool, no BM for 3 days

question

Causes of constipation (systemic etiology)

answer

Side effect of medication (narcotics, NSAIDs); metabolic endocrine abnormalities, such as hypothyroidism, uremia (renal failure), hypercalcemia, systemic neuromuscular disease (ALS), spina bifida, Parkinson's disease, lack of exercise, bedridden hospitalized or LTC (any sedentary lifestyle); ignoring the urge to defecate; vascular disease of the large bowel; poor diet low in fiber; pregnancy

question

Causes of constipation (gastrointestinal etiology)

answer

cancer; diseases of the upper GIT; Diseases of the large bowl resulting in failure of propulsion along the colon (colonic inertia) and/or failure of passage through anorectal structures (outlet obstruction); IBS; anal fissures or hemorrhoids; laxative abuse; stimulants; patients of opioids.

question

Constipation: Nutrition-related contributing factors

answer

Low intake of fruits, vegetables and whole grains; consumption of the typical refined American diet; decreased fluid intake, water; increased consumption of caffeinated beverages; dairy products (milk and hard cheese); laxative abuse (senna, castor, phenylphthalenin)

question

Laxatives

answer

senna, castor, phenylphthalein

question

Constipation MNT

answer

High (non-soluble) fiber diet; increase intake of whole grain cereals; increase intake of f&v (raw or cooked w/ skins and hull), and legumes; increase water to 8 cups of water per day; OTC fiber supplements of fermentable fibers (psyllium, methylcellulose)

question

Types of diarrhea

answer

Osmotic, secretory, exudative, medication induced, malabsorptive

question

Osmotic diarrhea is caused by

answer

overconsumption of sugars (fructose, lactose intolerance)

question

Secretory diarrhea is caused by

answer

bacteria, viruses, toxins

question

Exudative diarrhea is caused by

answer

HFD, mucus, fluid, electrolytes, blood, plasma proteins, Crohn's, UC, radiation

question

What medications can cause diarrhea

answer

antibiotics (AAD)

question

Malabsorptive diarrhea is caused by

answer

decreased absorptive surface (celiac) or low bile or pancreatic enzymes (steatorrhea)

question

What electrolytes are lost with excess fluid loss

answer

sodium and potassium

question

What is the leading cause of nosocomial diarrhea

answer

Clostridium difficile

question

Clostridium difficile

answer

leading cause of nosocomial diarrhea; opportunistic proliferation of pathogenic organisms associated with antibiotic therapy and chronic use of PPIs; spore forming and spread via tube feedings from pt to pt. Causes colitis, secretory diarrhea, colon dilation (magacolon), peritonitis, can be fatal; diagnosed by still sample, tx w/ antibiotics

question

Diarrhea MNT

answer

Oral fluids/electrolytes (carbonated beverages, sports drinks-potassium, soups, vegetable juice, isotonic liquids); avoid-sugar alcohol, fructose, lactose; w/ servere acute vomiting use IV hydration; with chronic diarrhea check zinc status; do not need to with hold food.

question

BRAT Diet

answer

not evidence based to treat diarrhea, high CHO and fructose, bananas, rice, applesauce and toast.

question

Tropical spruce

answer

Infectious diarrhea d/t bacterial overgrowth d/t mucosa atrophied/inflamed d/t decreased absorption. Can result in multiple vitamin and mineral deficiencies (low HCl and IF)-folic acid, B12

question

Irritable bowel syndrome nutrion-related presenting features

answer

Alternating diarrhea and constipation, dyspepsia, bloating, distention, incomplete evacuation, mucus in stool, discomfort after eating. R/o lactose intolerance or other GI dx. IBS is a diagnosis of exclusion

question

IBS-MNT

answer

Soluble fiber (normalize transit time), eliminate offending foods, low FODMAP (?), individualized to pt d/t variability in food tolerances. Probiotics (bifidobacterium infantis)

question

What is not allowed on a low FODMAP diet

answer

fructose, lactose, oligosaccharides (fructans or galactans), polyols.

question

Small Intestine Bacterial Overgrowth (SIBO)

answer

Bacterial overgrowth from stasis in the intestine, obstruction, radiation enteritis, fistula, IBD, IBS, or removal of ileocecal valve, surgical repair. Bacterial will cause a loss of bile salt function resulting in steatorrhea, bacteria use B12 resulting in def.

question

SIBO Tx

answer

antibiotics for bacterial overgrowth, probiotics and probiotics to regain normal cultures. Limit refined CHO *increase whole grains, veggies and oligosaccharides. May use MCT, Low FODMAP, B12 supplement

question

Common tests for malabsorption

answer

Direct stool examination; fecal fat test; C-xylose absorption test; breath test; pancreatic exocrine deficiency; schilling test (B12 malabsorption, protein losing enteropathy); Intestinal biopsy looking for celiac, eosinophilic enteritis, giardiasis, Crohn's disease.

question

Primary lactose intolerance

answer

deficiency in lactase brought on by gradual decline in lactase production

question

Secondary lactose intolerance

answer

intestinal infection or destruction of mucosal cells, intractable diarrhea, Crohn's and gluten sensitive enteropathy

question

Tests used to diagnose lactose intolerance

answer

Breath Hydrogen test or lactose tolerance test

question

Lactose intolerance MNT

answer

decrease consumption of lactose containing foods/milk; lactase enzyme replacements and treated milk products added to diet; calcium and vitamin D supplements; Identify hidden sources of lactose (milk solids, whey, casein)

question

Nutritional concerns with steatorrhea

answer

loss of energy/wt loss; loss of fat soluble vitamins; loss of ca and mg; increased absorption of oxylate (urolithiasis)

question

MNT for steatorrhea

answer

low fat diet; MCT supplements; water forms of fat soluble vitamins

question

Etiologies of celiac disease

answer

genes (familial or HLA class II), immune (antigliadin Ab), gliadin intolerance, damaged mucosa (decrease absorptive surface)

question

Gold standard for diagnosis of celiac disease

answer

endoscopic tissue biopsy

question

MNT for celiac disease

answer

Gluten free diet

question

Dermatitis Herpetiformis

answer

Red, raised, small or large blisters that burn and itch intensely, not unique to celiac disease.

question

Ulcerative colitis

answer

is a mucosal disease of the large intestine, including the rectum

question

Crohn's disease

answer

may involve any part of the GIT; most in distal ileum and colon; segments of inflamed bowel.

question

Ulcerative Colitis nutrition-related presenting features

answer

Chronic diarrhea, frequent watery stools; up at night; bloody diarrhea; fever; anorexia; wt loss; low hgb, hct, albumin, and potassium; elevated ESR and CRP

question

Ulcerative Colitis - MNT

answer

oral fluids and electrolytes; low fiber, low residue (acute phases); may add soluble bulking agent to prevent constipation and diarrhea; monitor zn levels w/ chronic persistent diarrhea; monitor Hgb, HCT, f/u with Fe studies indicated with anemia, etiology is GI bleed depletes iron.

question

Crohn's Disease - MNT

answer

Crohn's disease can lead to severe malnutrition. May require complete bowel rest (PN or EN hydrolyzed/elemental, low fat formulas); nutrition must be individualized and monitored (electrolytes, fluid status, wt, growth in children, anemia, fat soluble vitamins, pre-albumin, CRP-inflammation, zinc). Tropic feeds. Similar to UC, low fiber; low residue. High protein, high calorie; may benefit from MCT, vitamin and mineral supplementation, lactose restriction prn.

question

Fistula

answer

Abnormal opening between organs. Caused by birth defects, trauma, inflammatory disease, malignant disease, enterocutaneous post surgery

question

Fistula MNT

answer

Restore fluid and electrolyte balance, PN may be necessary and depends on location of the fistula, enteral nutrition may be possible using predigested formulas, oral diets

question

Short bowel syndrome

answer

Loss of 70-75% of the small bowel (100-120 cm of small bowel w/o colon or 50 cm of small bowel with colon). Results in wt loss, diarrhea, decreased transit time, malabsorption, dehydration, loss of electrolytes, hypokalemia; steatorrhea; B12 def; loss of fat soluble vitamins; fatty acid mineral soaps with ca, zn, and mg.

question

SBS MNT

answer

1) PN, 2) slow introduction of EN, focus on glutamine, nucleotides, SCFAs first (tropic feeds); MCT for fat soluble vitamins; evaluate narcotics. Eventually the remaining bowel will increase its absorptive surface.

question

MNT for Ileostomy or Colostomy

answer

Nutrition needs very; avoid gas and odor forming foods; fluid and electrolyte needs; B12 supplement

question

Diverticulosis nutrition-related issues

answer

High refined carbohydrate, high fat low fiber "western" diet contributes to disease

question

Diverticulosis MNT

answer

High fiber, low fat. Special focus on soluble fibers

question

Soluble fiber supplements

answer

metamucil, fibercon, citrucel, psyllium

question

Colorectal Cancer Nutrition-related contributing factors

answer

High fat, low fiber, refined "western" diet; low ca and FA intake; high alcohol (beer) intake; high meat intake; obesity; tobacco.

question

Colorectal cancer nutrition-related protective factors

answer

whole grain, FA, ca, vit D, multivitamin, PA and NSAIDs

question

Screening for GI disease: What is the most important indicator

answer

unintentional wt loss

question

Screening for GI disease: "flags" in diet hx

answer

Changes in appetite; N, V, & D; chewing/swallowing problems; food intolerances; supplements; pre and probiotics; typical intake/ability to take fluids

question

Screening for GI disease: "flags" in lab values

answer

Vit B12, FA, Ferritin, vitamin D

question

Achalasia

answer

Failure of esophageal neurons, in ability to relax the LES, MNT- Liquids not tolerated

question

Odynophagia

answer

Painful swallowing, as with the canker sores as a result of oral and esophageal cancers. MNT-liquids better tolerated than solids

question

Nutrition-related presenting characteristics for dysphagia

answer

Pt c/o food sticking in throat; aspiration pneumonia; wt loss; PEM

question

Dysphagia MNT

answer

question

EGD

answer

Esophagogastroduodenoscopy, used to evaluate GERD

question

GERD

answer

Backward flow of the stomach or duodenal contents into the esophagus, result of competency of the LES

question

Esophagitis

answer

Inflammation, ulceration, erosions, scarring of the esophagus. D/t reflux, ingestion of corrosive agent, infection, intubation, radiation, eosinophilic infiltration, NSAIDs,

question

Barrett's Esophagus

answer

Precancerous condition; risk factors: prolonged GERD, mae gender, >50 yo, family hx

question

Hiatal hernia

answer

out-pouching of a portion of the stomach into the chest through esophageal hiatus of the diaphragm

question

Hiatal Hernia MNT

answer

wt reduction and decreasing meal size. May require surgery

question

GERD/Hiatal hernia nutrition-related presenting characteristics

answer

S exacerbated by fried foods, spicy foods, large meals, over-eating, alcohol, caffeine, and dietary indiscretion. pt c/o heart burn after large meals; chronic GERD may cause dysphagia, dental erosions

question

MNT for GERD

answer

Prevent pain and chemical irritation of esophageal mucosa (avoid acidic foods, alcohol, spiced foods); Prevent reflux (avoid foods that lower LES pressure i.e. high fat, greasy, alcohol, carminatives, chocolate. Avoid eating 2-4 hrs before bed; raise head of bed; avoid PA immediately following meals; avoid wearing tight fitting clothing; avoid overeating. Reduce Acidity of Gastric Contents (proton pump inhibitors, H2 receptor antagonist, antacids)

question

Omeprazole/prilosec

answer

Proton pump inhibitors, decrease Mg.

question

H2 receptor Antagonists

answer

cimetidine (Tagamet); Ranitidine (Zantac)

question

Antacids

answer

Magnesium and Aluminum hydroxide, calcium carbonate, magnesium phosphate

question

Ingesting too many magnesium based antacids can

answer

cause diarrhea and deplete phosphorus.

question

MNT for cancers of the oral cavity, pharynx and esophagus

answer

Modify texture and consistency of pets diets per recommendations of swallow study. Avoid acidic foods and alcohol to help with symptoms. Correct nutritional deficiencies, prevent further wt loss, utilize high protein, high calorie food choices, oral supplements and EN; f/u with nutritional plan. Tx of cancer may cause nutritional issues (decreased saliva production, tooth decay, swallowing difficulties, tooth extractions).

question

Esophagectomy MNT

answer

individualized NTRI plan and f/u, nutritional support (TF), slow progression to oral feedings. Monitor dumping syndrome, nutrient malabsorption, recommend liquid multivitamins and B12

question

What is required for normal RBC synthesis

answer

Functional bone marrow, EPO, protein, iron, B12, FA, Vit C, B6

question

What lab measures RBC size

answer

MCV

question

What lab measures RBC production

answer

Reticulocytes

question

Anemia

answer

decrease in the oxygen-carrying capacity of blood d/t decreased hemoglobin

question

Which anemias are affected by alcohol consumption

answer

Folic acid, B12, GI bleeding, Immune suppression, liver disease, impaired biosynthetic processes

question

What medications can result in anemia

answer

NSAIDS, Steroids, antacids, H2 blockers, anticoagulants, myelosuppressive drugs, vitamin antagonists

question

Microcytic Anemias

answer

IDA, ACD, Thalassemia, Sideroblastic

question

Causes of macrocytic anemia

answer

B12 and FA deficiencies, pernicious anemia, liver disease, hypothyroidism, drugs (FA and B12 antagonists, antivirals)

question

Normocytic anemias

answer

ACD/AI, pregnancy, bleeding, renal failure, cirrhosis, CLL, CML

question

What medications can result in anemia

answer

NSAIDS, Steriods, antacids, H2 blockers

question

What anemia patients my responds well to EPO tx

answer

pt with renal disease, rheumatoid arthritis, HIV, multiple myeloma

question

What anemias should not be tx with iron?

answer

blood loss, ACD/AI, thalassemia, sideroblastic, lead toxicity, sickle cell (?)

STUDY

Fluid And Electrolyte Balance Foundations Of Professional Nursing Normal Blood Glucose Nursing Surgery

Med Surg: Nutritional Needs – Flashcards 79 terms

David Dunn

79 terms

Preview

Med Surg: Nutritional Needs – Flashcards

question

What is TPN

answer

a method of providing all the nutrients that a client will need for a 24 hour period through an IV

question

What type of vein must TPN run through

answer

central

question

What type of vein can PPN run through

answer

peripheral

question

Why must TPN run through a central vein

answer

because it is a vesicant and running it through a large vein will allow it to be diluted

question

Where are the central lines located

answer

in the trunk of the body, subclavian, internal jugular, PICC

question

How is TPN administered

answer

on an infusion pump

question

What are the goals of TPN

answer

improve nutritional status establish a positive nitrogen balance maintain muscle mass promote weight maintenance/ gain enhance wound healing

question

Who decides what is in a TPN solution

answer

the entire health team based on labs, physical assesment, and underlying disease process

question

Why can traditional IV fluids not be used for TPN

answer

does not provide sufficient calories

question

How many calories are in D5W

answer

4 cal/g

question

What are the clinical indications for using TPN

answer

multiplicity of problems 10% loss of pre-illness body weight NPO NPO sevan days after surgery enternal nutrition not an option hyper-catabolic situation (hyperthyroidism, severe burns) major illness (cancer)

question

what is cacexia

answer

severve malnutrition

question

what is one sign of cacexia

answer

temporal wasting

question

What is TPN composed of

answer

amino acids-protein (wound healing) glucose or dextrose ( energy) fat (maintain body temp, increase caloric consumption) insulin

question

Where does the glucose in TPN come from

answer

beet pulp becuase it has a lower glycemic index which helps reduce the risk of hyperglycemia

question

What electrolytes are in TPN

answer

K+ (muscle function) 3.5-5.3 mEq Ca++ (bone growth and maintenance, muscle contraction, neuromuscular interaction) Mg ++ (muscle and neurological fxn) Na + (muscle contraction) Cl - and PO4 ( acid/ base balance, muscle fxn)

question

What trace elements are included in TPN

answer

micro-nutrients zinc (wound healing, collogen strength) copper (promote tissue profusion) selenium (muscle mass) iodinw fluoride cobalt nickle iron

question

Which vitamins are fat soluable

answer

ADEK

question

which vitamins are water soluable

answer

B complex and C

question

When is thiamine added to a TPN solution

answer

when there is suspected ETOH abuse or impaired liver fxn

question

What type of soultion is TPN

answer

hyperglycemic

question

What type of insulin can be added to TPN

answer

REGULAR

question

What is the #1 way to seeif TPN solution is beneficuual

answer

weight assesment

question

What should be assesed to determine need for TPN

answer

electrolyte status caloric intake protein loss (decreased skin tugor and muscle mass) - pre-albumin labs

question

Nursing Dx associated with the need for TPN

answer

imbalanced nutrition less than body requirements r/t inadequate oral intake of nutrients AMB muscle waisting, low albumin leves, decreases levels of pre-albumin, weight loss, and poor tissue healing

question

Examples of nursing goals while on TPN

answer

balanced nutrition gain 3lbs within a week labs within normal limits

question

What are some complications that can occur with TPN

answer

infection hyperglycemia hypoclycemia (shaking, sweating, irritablity) fluid volume overload air embolism

question

Nursing Dx for client who has infection in TPN lin

answer

Risk for overwhelming baterial infection

question

Signs/ symptoms of infection

answer

fever chills swelling and erythemia at catheter site purulent drainage tachycardia tachypnea change in LOC hypotention increased WBC septic shock

question

how to prevent CRBI

answer

strick aseptic tecnique change solution per hos. protocol change tubing q 12 hrs change dressign per hos. protocol bag and tubing should not hang longer than infusion time

question

What should be done if CRBI occurs

answer

pull cath and send to lab for culture admin abx as ordered

question

causes of hypergylcemia durring TPN therpay

answer

blood gluscose levels > 200mg/ dl too rapid infusion of TPN stress of illness

question

Sign and symptoms of hyoerglycemia

answer

excessive thirst, fatigue, polyuria, restlessness, confusion, weakness, diuresis, hyperglycemic coma

question

Nursing interventions to prevent hyperglycemia durring TPN

answer

assess BG as ordered sliding scale insulin maintain BG < 200 mg/dl

question

What would put a client at risk for hypoglycemia durring TPN therapy

answer

TPN being abruptly discontinue toomuch insulin via TPN or sliding scale

question

Signs and symptoms of hypoglycemia

answer

shaky, weak, diaphoretic, may be hungry, BG < 70 mg/dl

question

nursing implementations for prevent hypoglycemia

answer

monitor BG gradually decrease TPN flow rate always use infusion pump never stop TPN abruptly infuse D10W infusion or D50 IVP restart additional IV

question

Signs and symptoms of an air embolism

answer

resp distress, restlessness, chest pain, hypertension, weak pulse, tachycardia

question

what should be done if air embolism is suspected

answer

place pt in trendelenburg and place on left side

question

prevention of air embolism

answer

valsalva maneuver durring tube change prime tubing check connections

question

What does CRBI stand for

answer

catheter related bloodstream infection

question

signs and symptoms of fluid volume overload

answer

restlessness, resp distress, change in LOC, tachypnea, tachycardia, bounding pulse, increased BP, JVD, wet lung sounds, decreased 02 stats, excessive weight gain

question

fluid overload prevention

answer

use pump dont play catch up

question

what should be done is fluid volume overload is suspected

answer

don't leave pt sit bed up anticipate giving 2-4 lt o2 via cannula diruetics

question

rules regarding rate of TPN

answer

start low, go slow 50 ml/hr if rate is not writtin in order increase gradually over 24hr period until rate is reached

question

additional complications

answer

venous thrombus movement clot or thrombosus in cath electrolyte imbalance excessive weight gain increased lipid levels fatty liver (monitor trigycerides, glucose) refeeding syndrome

question

signs of refeeding syndrome

answer

acute decrease in K+, Mg++, PO4 hypoglycemia

question

who is at risk for refeeding syndrome

answer

severly malnurished pt beginning on TPN

question

TPN nursing interventions

answer

know facility protocols maticulously care for TPN site accurate I&Os daily weights

question

what is always the # intervention

answer

assesment

question

what is tube feeding

answer

enteral nutrition administration of nutritionally balanced liquefied food through tube inserted into stomach, duodenum, or jejunum

question

advantages of enteral feeding over TPN

answer

easily administered, safer, more physiologicallu effcient, less expensive

question

how is tube placement varified

answer

x-ray ausculation of air aspiration of stomach fluids ( pH around 5)

question

how often should placement be assesed

answer

q8hr

question

what are the advantages of using a dobb-hoff

answer

more flexible and comfortable less mucosal damage

question

indications for enteral feedings

answer

anorexia orofacial fractures head/ neck cancer burns nurtitional deficiencies neurological conditions phychiatric conditions chemotherapy radiation therapy

question

tube feeding delivery options

answer

continuous infusion by pump intermmittent by gravity intermittent bolus by syringe cyclic feeding by infusion pump

question

Nursing Dx with enteral feedings

answer

Risk for aspiration r/ t reflux

question

complcations related to nasogastric and nasointestinal tubes

answer

can become silodge by vomiting or coughing tube can end up in trachea increases resk for aspiration can become knotted/ kinked in GI tract

question

when would a gastrostomy or jejunostomy tube be used

answer

for long-term feedings when GI tract is intact and unobstructed

question

how are gastrostomy or jejunostomy tubes placed

answer

surgically, radiologically or endoscopically

question

what is a PEG tube

answer

Percutaneous Endoscopic Gastrostomy

question

how is a PEG tube placed

answer

via percutaneous endoscopy through esophagus into stomach andthen pulled through a stab wound made in abdominal wall

question

how should pt being positioned durring enteral feeding administration

answer

sitting or lying with HOB at 30-45 degrees HOB should remain elevated for 30 -60 minutes after intermittent delivery

question

what should be done to help keep tube patent

answer

by administering water before/ after each feeding, drug admin, and residual checks

question

when should placement be checked

answer

prior to intial feeding prior to irrigation prior to med admin prior to fluid admin q shift

question

what should be done before begining a feeding

answer

aspirate gastric contents and measure amount

question

when should a feeding be held and why

answer

if more than 150 ml is aspirated b/c it can be a sign of clinical intolerance

question

what is done with residual stomach contents

answer

put back through tube

question

what is the appropriate tempurature for formula and why

answer

room/ body temp prevents cramping and abdominal distension overall GI comfort

question

standard volume for intermittent feedings

answer

200 to 500 ml

question

what will help to decrease tube feeding diarrehea

answer

administration of "free water"

question

general nursing considerations with enteral feedings

answer

daily weights BMI skin turgor assess bowl sounds before feedings accurate I&Os initial glucose checks label with date and time feeding was started feeding infusions older than 8 hrs should be discarded tubing changed q 24 hr

question

nursing considerations with enteral feedings

answer

verify tube placement position pt safely correct formula aseptic technique admin feeding according to order maintain tube patency assess tube feeding residuals admin free water as ordered

question

enteral complications

answer

aspiration vomiting diarrhea constipation dehydration

question

when is a high protein formula contraindicated

answer

in pts with renal failure

question

aspiration prevention

answer

elevate HOB check residuals assess lung sounds and respiratory status

question

diarrhea prevention

answer

start feedings slow dilute initial feedings perineal care assess fluid and electrolyte status

question

gerontologic considerations

answer

fluid and electrolyte balanaces glucose intolerance decreased ablity to handle large volumes increased risk of aspiration

STUDY

Fluid And Electrolyte Balance Injuries Nursing

Adult 1- FINAL- ch. 59 Care of pts w/problems of the Biliary system & Pancreas – Flashcards 28 terms

Chad Lipe

28 terms

Preview

Adult 1- FINAL- ch. 59 Care of pts w/problems of the Biliary system & Pancreas – Flashcards

question

A patient is admitted to the patient care unit with obstructive jaundice. Which sign/ symptom does the nurse expect to find upon assessment of the patient?

answer

pruritus

question

the daughter of a patient with cholelithiasis has heard that there is a genetic disposition for cholelithiasis. The daughter asks the nurse about the risk factors. how does the nurse respond?

answer

Hormone replacement therapy has been associated with increased risk for cholecystitis.

question

which patient is at low risk for development of gallbladder disorders?

answer

Patient who is 20 years old and male.

question

the nurse on a medical surgical unit is caring for several patients with acute cholecystitis. Which task is best to delegate to the UAP?

answer

Obtain the patient's vital signs.

question

The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient has a heart rate of 118 a minute, is pale, diaphragmatic, and describes extreme fatigue. What is the nurse's priority action at this time?

answer

Notify the patient's healthcare provider.

question

The healthcare provider has assessed a patient's abdomen and found rebound tenderness on deep palpitation. What does the nurse recognize?

answer

Blumberg's sign.

question

a patient is scheduled for tests to verify the medical diagnosis of cholecystitis. For which diagnostic test does the nurse provide patient teaching?

answer

Ultrasonography of the right upper quadrant.

question

which type of drug is used to treat acute severe biliary pain?

answer

opioids, morphine.

question

The nurse is administering ketorolac, Toradol, to a 78-year-old patient for mild to moderate pain management. Which assessment finding indicates the patient is experiencing a side effect of this drug?

answer

Abdominal bloating and cramping.

question

The nurse is caring for an older adult patient with acute biliary pain. Which drug order does the nurse question?

answer

Meperidine, Demerol.

question

Which factor renders the patient the least likely to benefit from ESWL for the treatment of gallbladder stones?

answer

Height 5'10", 325 pounds

question

which statement about the care of a patient with a Jackson Pratt, JP, drain after a traditional cholecystectomy is true?

answer

serosanguineous draninage stained with bile is expected for 24 hours.

question

The female patient is to have her gallbladder removed by natural orifice transluminal endoscopic surgery. What does the nurse teach about the surgery?

answer

The surgeon will use a vaginal approach to remove your gallbladder.

question

After removal of the gallbladder, a patient experiences abdominal pain with vomiting for several weeks. What does the nurse recognize?

answer

Postcholecystectomy syndrome

question

patient with acute cholecystitis has a pacemaker. Which diagnostic test is contraindicated?

answer

Magnetic resonance cholangiopancreatography, MRCP

question

the nurse is evaluating electrolyte values for a patient with acute pancreatitis and notes that the serum calcium is 6.8 mEq/L. how does the nurse interpret this finding?

answer

A result of the body not been able to use bound calcium.

question

Disseminated intravascular coagulation, DIC, is a complication of pancreatitis. What pathophysiology leads to this complication?

answer

Consumption of clotting factors in micro thrombi formation.

question

the patient with acute pancreatitis experiences of abdominal pain. What is the best intervention to begin management of this pain?

answer

IV opioids by means of patient controlled analgesia, PCA.

question

the patient comes to the emergency department with severe abdominal pain and the mid-epigastric area. The patient states that the pain began suddenly, is continuous, radiates to his back, and it is worst when he lies flat on his back. What conditions is the nurse suspect?

answer

Acute pancreatitis.

question

Which diagnostic test is the most accurate in verifying a diagnosis of acute pancreatitis?

answer

Lipase.

question

A patient with acute pancreatitis is at risk for the development of paralytic, a dynamic, ileus. Which option provides the nurse with the best indication of bowel function?

answer

Asking the patient if he or she has passed flatus or had a stool.

question

which condition is most likely to be treated with antibiotics?

answer

Acute necrotizing pancreatitis.

question

The nurse has instructed a patient in the recovery phase of acute pancreatitis about diet therapy. Which statement by the patient indicates the teaching has been successful?

answer

I will avoid eating chocolate and drinking coffee.

question

The nursing student is caring for a patient with chronic pancreatitis who is receiving pancreatic enzyme replacement therapy. Which statement by the student indicates the need for further study concerning this therapy?

answer

If the patient has difficulty swallowing the enzyme preparation, I will crush it and mix it with foods.

question

The nurse detects an epigastric mass while assessing a patient with acute pancreatitis. The patient describes epigastric pain that radiates to his back. What does the nurse suspect?

answer

Pancreatic pseudocyst

question

what is the most common and serious complication after a Whipple procedure?

answer

Fistula development

question

the nurse is teaching a patient and family how to prevent exacerbations of chronic pancreatitis. which teaching point does the nurse include?

answer

Avoidance of alcohol and nicotine.

question

The patient is to continue pancreatic enzyme replacement therapy, PERT, after discharge. Which statement indicates that the patient understands teaching about this therapy?

answer

I will take the enzymes after I take my ranitidine, Zantac.

STUDY

End Stage Kidney Disease End Stage Renal Disease Fluid And Electrolyte Balance Nursing Specific Gravity Of Urine Surgery

Acute Renal Injury & CKD – NCLEX – Flashcards 26 terms

Jessica Forbes

26 terms

Preview

Acute Renal Injury & CKD – NCLEX – Flashcards

question

How do you determine that a patient's oliguria is associated with acute renal failure (ARF)? A. Specific gravity of urine at 3 different times is 1.010. B. The serum creatinine level is normal. C. The blood urea nitrogen (BUN) level is normal or below. D. Hypokalemia is identified.

answer

A. Specific gravity of urine at 3 different times is 1.010. A urinalysis may show casts, red blood cells (RBCs), white blood cells (WBCs), a specific gravity fixed at about 1.010, and urine osmolality at about 300 mOsm/kg.

question

When caring for a patient during the oliguric phase of acute kidney injury, what would be an appropriate nursing intervention? A. Weigh patient three times weekly B. Increase dietary sodium and potassium C. Provide a low-protein, high-carbohydrate diet D. Restrict fluids according to the previous day's fluid loss

answer

D. Restrict fluids according to the previous day's fluid loss Patients in the oliguric phase of acute kidney injury have fluid volume excess with potassium and sodium retention. They will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times per week.

question

Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia

answer

B. Hyperkalemia In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased due to decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

question

Which patient has the greatest risk for prerenal AKI? A. The patient is hypovolemic because of hemorrhage. B. The patient relates a history of chronic urinary tract obstruction. C. The patient has vascular changes related to coagulopathies. D. The patient is receiving antibiotics such as gentamicin.

answer

A. The patient is hypovolemic because of hemorrhage. Prerenal causes of AKI are factors external to the kidneys. These factors reduce systemic circulation, causing a reduction in renal blood flow, and they lead to decreased glomerular perfusion and filtration of the kidneys.

question

The patient admitted to the intensive care unit after a motor vehicle accident has been diagnosed with AKI. Which finding indicates the onset of oliguria resulting from AKI? A. Urine output less than 1000 mL for the past 24 hours B. Urine output less than 800 mL for the past 24 hours C. Urine output less than 600 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours

answer

D. Urine output less than 400 mL for the past 24 hours The most common initial manifestation of AKI is oliguria, a reduction to urine output to less than 400 mL/day.

question

The patient in the oliguric phase of AKI excreted 300 mL of urine in addition to 100 mL of other losses during the past 24 hours. With appropriate calculations, you determine that for the next 24 hours the patient's fluid allocation is A. 600 mL. B. 800 mL. C. 1000 mL. D. 1200 mL.

answer

C. 1000 mL. Fluid intake must be closely monitored during the oliguric phase. The rule for calculating the fluid restriction is to add all losses for the previous 24 hours to 600 mL for insensible losses.

question

Your plan for care of a patient with AKI includes which goal of dietary management? A. Provide sufficient calories while preventing nitrogen excess. B. Deliver adequate calories while restricting fat and protein intake. C. Replace protein intake with enough fat intake to sustain metabolism. D. Restrict fluids, increase potassium intake, and regulate sodium intake.

answer

A. Provide sufficient calories while preventing nitrogen excess. The challenge of nutrition management in AKI is to provide adequate calories to prevent catabolism despite the restrictions required to prevent electrolyte and fluid disorders and azotemia (accumulation of nitrogen and wastes in blood).

question

For the patient with AKI, which laboratory result would cause you the greatest concern? A. Potassium level of 5.9 mEq/L B. BUN level of 25 mg/dL C. Sodium level of 144 mEq/L D. pH of 7.5

answer

A. Potassium level of 5.9 mEq/L Hyperkalemia is one of the most serious complications in AKI because it can cause life-threatening cardiac dysrhythmias.

question

Important nursing interventions for the patient with AKI are (select all that apply) A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. D. increase intake of vitamin A and D. E. frequent mouth care.

answer

A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. E. frequent mouth care. You have an important role in managing fluid and electrolyte balance during the oliguric and diuretic phases of AKI. Observing and recording accurate intake and output are essential. Measure daily weights with the same scale at the same time each day to assess excessive gains or losses of body fluids. Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membrane.

question

What characterizes AKI (select all that apply)? A. Primary cause of death is infection. B. It usually affects older people. C. The disease course is potentially reversible. D. The most common cause is diabetic nephropathy. E. Cardiovascular disease is the most common cause of death.

answer

A. Primary cause of death is infection. C. The disease course is potentially reversible. AKI is potentially reversible. It has a high mortality rate, and the primary cause of death is infection; the primary cause of death for chronic kidney failure is cardiovascular disease. AKI commonly follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Although it can occur at any age, the older adult is more susceptible to AKI because the number of functioning nephrons decreases with age.

question

During the oliguric phase of AKI, you monitor the patient for (select all that apply) A. hypertension. B. electrocardiographic (ECG) changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity.

answer

A. hypertension. B. electrocardiographic (ECG) changes. D. pulmonary edema. You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended and have a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions. The patient is monitored for hyponatremia. Damaged tubules cannot conserve sodium, and the urinary excretion of sodium may increase, resulting in normal or below-normal levels of serum sodium. Monitoring may reveal ECG changes and hyperkalemia. Initially, clinical signs of hyperkalemia are apparent on electrocardiogram, which demonstrate peaked T waves, widening of the QRS complex, and ST-segment depression. Urinary specific gravity is fixed at about 1.010.

question

If a patient is in the diuretic phase of AKI, you must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia

answer

C. Hypokalemia and hyponatremia In the diuretic phase of AKI, the kidneys have recovered their ability to excrete wastes but not to concentrate the urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

question

You are preparing to administer a dose of PhosLo to a patient with chronic kidney disease (CKD). This medication should have a beneficial effect on which laboratory value? A. Sodium B. Potassium C. Magnesium D. Phosphorus

answer

D. Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen in CKD.

question

A patient is admitted to the hospital with CKD. You understand that this condition is characterized by A. Progressive irreversible destruction of the kidneys B. A rapid decrease in urinary output with an elevated BUN level C. Increasing creatinine clearance with a decrease in urinary output D. Prostration, somnolence, and confusion with coma and imminent death

answer

A. Progressive irreversible destruction of the kidneys CKD involves progressive, irreversible loss of kidney function.

question

Nurses need to educate patients at risk for CKD. Which individuals are considered to be at increased risk (select all that apply)? A. Older African Americans B. Individuals older than 60 years C. Those with a history of pancreatitis D. Those with a history of hypertension E. Those with a history of type 2 diabetes

answer

A. Older African Americans B. Individuals older than 60 years D. Those with a history of hypertension E. Those with a history of type 2 diabetes Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minorities (e.g., African American, Native American).

question

Patients with CKD have an increased incidence of cardiovascular disease related to (select all that apply) A. hypertension. B. vascular calcifications. C. a genetic predisposition. D. hyperinsulinemia causing dyslipidemia. E. increased high-density lipoproteins levels.

answer

A. hypertension. B. vascular calcifications. D. hyperinsulinemia causing dyslipidemia. Traditional cardiovascular risk factors, such as hypertension and elevated lipid levels, are common in CKD patients. Hyperinsulinemia stimulates hepatic production of triglycerides. Most patients with uremia develop dyslipidemia. Much of the cardiovascular disease may be related to nontraditional risk factors such as vascular calcification and arterial stiffness. Vascular calcification and arterial stiffness are major contributors to cardiovascular disease in CKD. Calcium deposits in the vascular medial layer are associated with stiffening of the blood vessels. The mechanisms involved are multifactorial and incompletely understood, but they include (1) vascular smooth muscle cells that change into a chondrocyte or osteoblast-like cell, (2) high total body calcium and phosphate levels due to abnormal bone metabolism, (3) impaired renal excretion, and (4) drug therapies to treat the bone disease (e.g., calcium phosphate binders).

question

Measures indicated in the conservative therapy of CKD include A. decreased fluid intake, carbohydrate intake, and protein intake. B. increased fluid intake; decreased carbohydrate intake and protein intake. C. decreased fluid intake and protein intake; increased carbohydrate intake. D. decreased fluid intake and carbohydrate intake; increased protein intake.

answer

C. decreased fluid intake and protein intake; increased carbohydrate intake. Water and any other fluids are not routinely restricted in the pre-end-stage renal disease (ESRD) stages. Patients on hemodialysis have a more restricted diet than patients receiving peritoneal dialysis. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. Generally, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains are no more than 1 to 3 kg between dialyses (interdialytic weight gain). For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is being studied. Historically, dietary counseling often encouraged restriction of protein for CKD patients. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, you should teach patients to avoid high-protein diets and supplements because they may overstress the diseased kidneys.

question

The advantage of continuous replacement therapy over hemodialysis is its ability to A. remove fluid without the use of a dialysate. B. remove fluid in less than 24 hours. C. allow the patient to receive the therapy at the work site. D. be administered through a peripheral line.

answer

A. remove fluid without the use of a dialysate. Several features of continuous replacement therapy are different from those of hemodialysis. Solute removal can occur by convection (no dialysate required) in addition to osmosis and diffusion. The process can take days or weeks. The patient cannot receive the therapy at work and a vascular access device is required.

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You are caring for a patient receiving continuous replacement therapy and notice that the filtrate is blood tinged. What is your priority action? A. Place the patient in Trendelenburg position. B. Initiate a peripheral intravenous line. C. Suspend treatment immediately. D. Administer vitamin K (Aquamephyton) per order.

answer

C. Suspend treatment immediately. The ultrafiltrate should be clear yellow, and specimens may be obtained for evaluation of serum chemistries. If the ultrafiltrate becomes bloody or blood tinged, a possible rupture in the filter membrane should be suspected, and treatment is suspended immediately to prevent blood loss and infection.

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A patient with a history of end-stage renal disease (ESRD) resulting from diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessment should you prioritize before, during, and after his treatment? A. Level of consciousness B. Blood pressure and fluid balance C. Temperature, heart rate, and blood pressure D. Assessment for signs and symptoms of infection

answer

B. Blood pressure and fluid balance Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of the procedure indicates a particular need to monitor blood pressure and fluid balance.

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Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) is of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B. "You will be allowed a more liberal protein diet after you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You must continue regular medical and nursing follow-up visits while performing CAPD."

answer

A. "It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and it is imperative to teach the patient methods to prevent it from occurring. Although the other teaching statements are accurate, they do not address the potential for mortality by peritonitis, making that nursing action the highest priority.

question

How should you assess the patency of a newly placed arteriovenous graft for dialysis? A. Irrigate the graft daily with low-dose heparin. B. Monitor for any increase in blood pressure in the affected arm. C. Listen with a stethoscope over the graft for presence of a bruit. D. Frequently monitor the pulses and neurovascular status distal to the graft.

answer

C. Listen with a stethoscope over the graft for presence of a bruit. A thrill can be felt by palpating the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein.

question

What are the main advantages of peritoneal dialysis compared to hemodialysis? A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. B. The diet is less restricted and dialysis can be performed at home. C. The dialysate is biocompatible and causes no long-term consequences. D. High glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss.

answer

B. The diet is less restricted and dialysis can be performed at home. Advantages of peritoneal dialysis include fewer dietary restrictions and home dialysis is possible.

question

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours earlier. What is an expected assessment finding for this patient during the early stage of recovery? A. Hypokalemia B. Hyponatremia C. Large urine output D. Leukocytosis with cloudy urine output

answer

C. Large urine output Patients frequently experience diuresis in the hours and days immediately after kidney transplantation. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

question

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, what do you tell the patient? A. Successful transplantation usually provides better quality of life than that offered by dialysis. B. If rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. C. The immunosuppressive therapy that is required after transplantation causes fatal malignancies in many patients. D. Hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection.

answer

A. Successful transplantation usually provides better quality of life than that offered by dialysis. Kidney transplantation is extremely successful, with 1-year graft survival rates of about 90% for deceased donor transplants and 95% for live donor transplants. An advantage of kidney transplantation compared with dialysis is that it reverses many of the pathophysiologic changes associated with renal failure when normal kidney function is restored. It also eliminates the dependence on dialysis and the accompanying dietary and lifestyle restrictions. Transplantation is also less expensive than dialysis after the first year.

question

A kidney transplant recipient complains of fever, chills, and dysuria over the past 2 days. What is the first action that you should take? A. Assess temperature and initiate a workup to rule out infection. B. Provide warm covers for the patient and give 1 gram of acetaminophen orally. C. Reassure the patient and let him know this is common after transplantation. D. Notify the nephrologist that the patient has developed symptoms of acute rejection.

answer

A. Assess temperature and initiate a workup to rule out infection. You must be astute in the observation and assessment of kidney transplant recipients, because prompt diagnosis and treatment of infections can improve patient outcomes. Fever, chills, and dysuria indicate a possible infection. The temperature should be assessed, and the patient should have diagnostic tests to identify or rule out an infection.

STUDY

Fluid And Electrolyte Balance Nursing Nursing-LPN Patient Self Determination Act

Rasmussen Nursing 1 – Test 2 – Flashcards 272 terms

Deloris Connelly

272 terms

Preview

Rasmussen Nursing 1 – Test 2 – Flashcards

question

Urge incontinence

answer

The involuntary loss of larger amounts of urine accompanied by a strong urge to void. It is often referred to as OVERACTIVE BLADDER.

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Stress incontinence

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An involuntary loss of small amounts of urine with increased intra-abdominal pressure. Activities that produce leakage of urine include exercise, laughing, sneezing, coughing, and lifting.

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Functional incontinence

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The untimely loss of urine when no urinary or neurological cause is involved. This type of incontinence occurs because of physical disability, immobility, pain, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.

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Mixed incontinence

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A combination of urge and stress incontinence.

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Transient incontinence

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Short-term incontinence that is expected to resolve spontaneously. Causes include UTI and medications, especially diuretics.

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Overflow incontinence

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The loss of urine in combination with a distended bladder. Causes of Overflow Incontinence include fecal impaction, neurological disorders, and enlarged prostate.

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Unconscious (reflex) incontinence

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Loss of urine when the person does not realize the bladder is full and has no urge to void. Central nervous system disorders and multi-system problems are common causes.

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Enuresis

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Bed-wetting. Unintentional passage of urine.

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Presentations of enuresis

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Wet sheets Wet clothes Room smells of urine

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Nursing interventions for enuresis

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Bladder training Estabish toileting schedule Monitor and increase fluid in AM, decrease in PM Teach Kegel exercises Teach incontinence diary Avoid caffeine and alcohol Provide incontinence care

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Urinary retention

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An inability to empty the bladder completely. Etiologies include obstruction (BPH), inflammation and swelling, neurological problems, medications (anesthesia & opiods), and anxiety. Treatments: Urinary catheterization.

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Nursing interventions for urinary retention

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Prevent UTI's Prevent backflow of urine Encourage fluids Perineal hygiene

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Urinary tract infection (UTI)

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An infection involving the kidneys, ureters, bladder, or urethra. Often caused by E.Coli. A UTI is labeled according to the region of infection. In general terms, reference is made to lower urinary tract (e.g., urethra, bladder, or prostate) and upper urinary tract infections (e.g., ureters or kidney).

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Symptoms of upper UTI

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-Fairly high fever (higher than 38.3° C [101° F]) -Shaking chills -Nausea -Vomiting -Flank pain

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Symptoms of lower UTI

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Dysuria Frequency Urgency Hesitancy Cloudy, foul smelling urine Hematuria Bladder spasms Lower abdominal pain Mild fever (less than 38.3° C [101° F]) Chills Not feeling well (malaise) OLDER ADULTS will appear confused, have a loss of appetite, (hypotension, tachycardia, tachypnea, and fever are symptoms of urpsepsis)

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Nursing interventions for UTI

answer

Promote fluid intake up to 3 liters daily Administer antibiotics as prescribed Encourage to urinate every 3-4 hours Encourage to shower daily Recommend warm sitz bath for comfort Avoid use of indwelling catheters Advise to urinate before and after sex Advise to drink cranberry juice to reduce risk

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Interstitial cystitis

answer

Presentations of I.C. include: Urgency Frequency Nocturia Dysuria Hematuria may be present All of these with no evidence of infection! Pain: Pain ranges from mild to severe. Pain is most prominent as the bladder fills between voiding. Suprapubic pain is a common finding, but a person may also feel pain in the bladder, the urethra, the area below the umbilicus, the lower back, or the area around the vagina. Men may also feel pain in the scrotum, testes, or penis. Pain can come and go or it can be constant. It can increase during sex, and some women find that it is worse when they are having their period.

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Pyelonephritis

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An infection of the UPPER urinary tract. It may involve the ureters, renal pelvis, and papillary tips of the collecting ducts. Unchecked, it can extend into the tubules of the nephron, creating a potential for renal failure. Filtration, re absorption and secretion are impaired.

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Symptoms of pyelonephritis

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-Bacteruria -Flank pain at the costovertebral angle (CVA) -Fever -Chills -Colicky abdominal pain -Nausea -Vomiting -Dysuria -Frequency -Nocturia

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Diagnostic tests for pyelonephritis

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Urinalysis and urine culture may be sufficient in mild, initial cases of pyelonephritis in an uncomplicated presentation. Computed tomography (CT) is the standard diagnostic tool for pyelonephritis unresponsive to 72 hours of antibiotic therapy. Ultrasound is used when CT scanning is contraindicated, such as in pregnancy or in pre-existing renal compromise.

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Nursing interventions for pyelonephritis

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Assess and monitor: Nutritional status I&O Fluid & Electrolytes BUN/Creatnine WBC's Temp Pain Increase fluid intake to at least 2L/day Administer acetaminophen for fever Administer opiods for pain Assist with hygiene

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Glomerulonephritis

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Inflammation of the glomerular capillaries. In patients with glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter urine. Eventually, the glomeruli become inflamed and scarred, and slowly lose their ability to remove waste and excess water from the blood to make urine. Immune complex disease - NOT AN INFECTION

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Symptoms of glomerulonephritis

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Anorexia Oliguria Brown, tea, or cola-colored urine Proteinuria Dysuria SOB Orthopnea Crackles S3 heart sound Periorbital edema Mild hypertension Changes in LOC Weight gain Flank pain --This cluster of symptoms—hematuria, edema, and hypertension—is known as nephritic syndrome. Approximately 95% of patients with post-streptococcal glomerulonephritis have at least two of these symptoms; 40% have all three.

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Diagnostics for glomerulonephritis

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-Laboratory tests include: -CBC -Electrolytes -BUN & creatinine (will be elevated) -GFR (will be decreased) -Urinalysis -Cultures of the throat and skin to rule out Streptococcus

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Nursing interventions for glomerulonephritis

answer

Administer antibiotics as prescribed Monitor blood pressure Monitor fluid and electrolytes Maintain low sodium diet (2g per day) Fluid restrictions (1L per day) Monitor I&O Possible loop diuretics with severe edema Possible ACE inhibitor or calcium channel blocker

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Nephrotic syndrome

answer

Not a single disease but a group of symptoms. Symptoms include heavy proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and normal renal function. Nephrotic syndrome can be primary or secondary. Primary nephrotic syndrome occurs as part of a recognized systemic disease. Nephrotic syndrome is often described as a disease of children and is relatively rare. It is 15 times more common in children than in adults.

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Manifestations of nephrotic syndrome

answer

Pitting edema (ankles & legs) Periorbital edema Pleural effusion or ascites Foamy urine Anorexia Irritability Fatigue Abdominal discomfort Diarrhea

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Renal calculi

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Kidney stones. Cause is unknown, but greater incidence in males. Most stones are calcium oxalate but can also be composed of calcium phosphate, uric acid, struvite, and cystine.

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Manifestations of renal calculi

answer

-Severe pain (renal colic). Pain intensifies as the stone moves through the ureter. Flank pain suggests the stone is located in the kidney or ureter. Flank pain that radiates to the abdomen, scrotum, testes, or vulva suggest the stone is in the ureter or bladder. -Frequency -Fever -Diaphoresis -Pallor -Nausea -Vomiting -Tachycardia, tachypnea, increased BP (pain) -Decreased BP (shock) -Hematuria -Oliguira/anuria occurs with stones that obstruct urinary flow. This is a medical emergency and needs to be treated to preserve kidney function.

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Nursing interventions for renal calculi

answer

-Increase fluid intake to 3L/day -Administer IV fluids, analgesics and antibiotics as prescribed -Strain all urine to check for passage of stone, and save to send to lab for analysis -Monitor pain, I&O, urinary pH

question

Acute renal failure

answer

Sudden loss of kidney function caused by failure of renal circulation or damage to the tubules or glomeruli. Usually reversible, with spontaneous recovery in a few days to weeks Ischemia is primary cause; it produces irreversible damage to tubules if continues for more than 2 hours.

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Nursing interventions for acute renal failure

answer

Monitor labs and dialysis Potassium restrictions Fluid reduction Accurate I&O Daily weights Check for edema and lung sounds Energy conservation

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Oliguria

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Urine output of less than 400 mL in 24 hours. For pediatric patients, oliguria is < 0.5-1.0 mL/kg per hour.

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Anuria

answer

The absence of urine, often associated with kidney failure or congestive heart failure. This term is used when urine output is less than 100 mL in 24 hours.

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Chronic renal failure

answer

A progressive and irreversible decline in renal function ranging from mild with nearly normal function to ESRD requiring renal replacement therapy. Characterized by a glomerular filtration rate (GFR) less than 20% of normal. Diabetes mellitus and hypertension are the two most common causes of CRF in the United States. The common underlying cause of progression to CRF is glomerulosclerosis. Regardless of the initial insult, glomerulosclerosis is the end result. As the level of glomerular function declines, need for intervention increases.

question

Clinical presentations of chronic renal failure

answer

1. Early: nausea, apathy, weakness, and fatigue; declining urine output 2. Late: possibly frequent vomiting, increasing weakness, lethargy, and confusion 3. Client may report "restless leg syndrome," paresthesia, and sensory loss 4. Personality changes, such as anxiety, irritability, and hallucinations; seizures and coma posible in late stages 5. Respirations may change to Kussmaul pattern, with deep coma following 6. Skin becomes pale and dry, with yellowish hue; metabolic wastes cause itching and uremic frost (crystallized deposits of urea on skin) 7. Urinalysis shows fixed specific gravity approximately 1.010, equivalent to plasma; abnormal proteins, blood cells, and casts are present. 8. Elevated creatinine and BUN and decreased creatinine clearance 9. Abnormal electrolyte values as noted above 10. Moderate anemia 11. Decreased platelets 12. Decreased renal size by ultrasonography 13. Positive renal biopsy if damage caused by cancer

question

Nursing management of chronic renal failure

answer

1. Provide diet low in protein (such as 60 grams protein) with supplemented amino acids; restrict fluids as ordered 2. Provide electrolyte replacement or restriction -Na+ restriction (such as 2 grams daily) -K+ restriction (such as 2 grams daily) -Replacement of bicarbonate stores to treat acidosis 3. Monitor and plan nursing care for hypertension and heart failure 4. Prepare client for dialysis or kidney transplant 5. Monitor I&O and vital signs 6. Monitor laboratory results: BUN and serum creatinine, pH, electrolytes, and CBC 7. Provide symptomatic relief for nausea and vomiting 8. Observe for signs of infection 9. Provide rest periods to combat fatigue, which is chronic in nature 10. Help client learn about and adjust to diagnosis; support coping strategies and work with client to develop realistic goals 11. Medication therapy: limited by kidneys' inability to excrete -Diuretics to reduce volume of extracellular fluid -ACE inhibitors to maintain normal BP -Electrolyte replacement -Phosphate binding agents, such as calcium carbonate -Kayexalate to reduce serum K+ levels

question

Uremia

answer

Excess urea and other nitrogenous waste products in blood.

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Diarrhea

answer

Increased frequency of bowel movements (more than 3 times a day) as well as liquid consistency and increased amount; accompanied by urgency, discomfort, and possibly incontinence.

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Fecal incontinence

answer

Involuntary elimination of feces, often caused by diarrhea.

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Nursing interventions for fecal incontinence

answer

Determine cause. Such as medications, infections, or impaction. Provide perineal care after each stool, and apply moisture barrier. Provider can prescribe anal bag or other bowel management system to collect stool and prevent it from coming in contact with the skin.

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Constipation

answer

A bowel pattern of difficult and infrequent evacuation of hard, dry feces. The number of bowel movements a patient has is individual, but if a patient has fewer than three bowel movements per week or must vigorously strain, the patient is considered to have constipation. It is due to sedentary lifestyle, poor diets (low in dietary fiber and fluid), frequent use of laxatives, pregnancy, and some medications.

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Fecal impaction

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The presence of a hardened fecal mass in the rectum. The impaction often blocks the passage of normal stool and sets up a vicious cycle of furthering hardening.

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Manifestations of fecal impaction

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Liquid stool may leak, seeping around the hardened mass, and the patient may report feelings of fullness, bloating, constipation, diminished appetite, and a change in bowel habits. You can detect fecal impaction by digital examination of the rectum.

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Bowel obstruction

answer

Significant mechanical impairment or complete arrest of the passage of contents through the intestine. Can be either mechanical (physical or structural) or functional. Most obstructions occur in the small intestine. Most commonly due to postoperative adhesions, fibrous bands within the peritoneum, which may compress the bowel and cause obstruction, or be a focus for a volvulus (a twisting of the bowel on itself that causes obstruction). Prior abdominal surgery or sepsis (e.g., pelvic inflammatory disease, appendicitis) may cause adhesions.

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Clinical presentation of bowel obstruction

answer

Colicky, mid-abdominal pain often over a period of days. Vomiting occurs early in the course, especially with proximal simple obstruction. A change in the character of the pain (continuous, increasing severity) suggests the development of more ominous ischemic complications. Pain lasting several days, with progressive distension, suggests a more distal obstruction. Patients may report reduced to absent flatus for days preceding presentation and distension. Auscultation typically reveals increased bowel sounds and high-pitched tinkling in early obstruction.

question

Nursing interventions for bowel obstruction

answer

Careful abdominal examination is necessary in suspected obstruction. Palpation should follow percussion, and severe pain is unusual, unless strangulation, ischemia or infarction, or perforation have occurred. In that case, there may be signs suggestive of peritonitis and acute abdomen, including guarding and rebound tenderness. A careful search for inguinal hernias, a rectal exam for masses, and analysis of stool for occult blood conclude the abdominal assessment. Strict bowel rest and careful attention to fluid replacement for loss as well as maintenance, with appropriate laboratory guided electrolyte supplementation (especially potassium), are indicated.

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Irritable bowel syndrome (IBS)

answer

A relatively common functional disorder characterized by abdominal pain and altered bowel habits in the absence of structural or biochemical explanations for the symptoms. The cause of IBS is unknown, although there may be a genetic propensity to the disorder. In addition, stress exacerbates the manifestations, as does a diet high in fat, irritating foods, alcohol, and smoking.

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Symptoms of IBS

answer

Recurrent abdominal pain or discomfort at least three days per month in the last three months associated with two or more of the following: 1. Improvement with defecation 2. Onset associated with a change in frequency of stool 3. Onset associated with a change in form (appearance) of stool

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Health promotion and disease prevention for IBS

answer

Avoid foods that trigger exacerbation, such as dairy, wheat, corn, fried foods, alcohol, spicy foods, and aspertame. Avoid alcoholic and caffeinated beverages, and other fluids containing fructose and sorbitol. Consume 2-3L/day from food and fluid sources Increase fiber intake (approx 30-40g/day)

question

Ulcerative colitis

answer

Edema and inflammation that begins in the rectum and can progress proximally, but is usually limited to sigmoid colon and rectum. Cause is unknown but may be related to stress, genetics, infection, dietary factors (low fiber intake), or antibody formation.

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Symptoms of ulcerative colitis

answer

Abdominal pain/cramping (LLQ) Anorexia Weight loss Fever Diarrhea Abdominal distention Abdominal tenderness & firmness High pitched bowel sounds Rectal bleeding

question

Nursing interventions for ulcerative colitis

answer

Rest is required to decrease intestinal activity. Diet therapy may include a low-residue, high-protein, high-calorie diet with vitamins and iron; in severe cases NPO to rest bowel; TPN will be ordered in severe cases. Assess dehydration, fluid and electrolytes.

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Appendicitis

answer

An inflammation of the appendix, which is a small finger-like appendage just below the ileocecal valve. Treatment: Appendectomy is the most common emergency abdominal surgery in the United States.

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Diverticulitis

answer

Inflamed sac-like pouches of mucosa through the muscular layer of the bowel that may occur anywhere along the GI tract. Can lead to bleeding (5%), abscess and fistula formation, perforation, and/or obstruction.

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Crohn's disease

answer

Chronic inflammatory bowel disorder with a relapsing and remitting course. Once remission is achieved, the main aim of the management of Crohn's disease is maintenance of that remission. Usually begins with a small inflammatory lesion of the intestinal mucosa. Eventually, the inflammation continues and progression through all layers of tissue is seen. Deeper ulcerations, fissures, and granulomatous lesions persist into the deeper layers of the bowel wall. As the disease progresses, the inflammation causes the bowel wall to thicken and become fibrotic, and a narrowing of the intestinal lumen occurs. Fistulas are common between loops of bowel, as are adhesions of the diseased bowel areas. The absorption of nutrients is impaired as the jejunum and ileum are affected.

question

Clinical presentations of Crohn's disease

answer

Typically, abdominal pain (RLQ) and tenderness accompanies the disorder. Often the pain is relieved temporarily with defecation. In addition, eating can initiate the abdominal discomfort, and patients may consequently limit their food intake. This lends them to have nutritional deficits, and weight loss, and experience malnutrition and even secondary conditions. Diarrhea is common and not necessarily positive for occult bleeding. There may be a palpable mass in the RLQ. Steatorrhea is also a common finding with the stool (pale appearance, presence of fat and mucous)

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Nursing interventions for Crohn's disease

answer

Provide prescribed diet: usually high-calorie, high-protein; involve client in making appropriate menu choices. Weigh daily, maintain calorie count, and monitor I&O. TPN may be ordered during periods of severe exacerbation to provide total bowel rest.

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Gastroenteritis

answer

An increase in the frequency and water content of stools and vomiting as a result of inflammation of the mucous membranes of the stomach and intestines, primarily affecting the small bowel. May be viral or bacterial in origin.

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Symptoms of gastroenteritis

answer

Onset of diarrhea w/ accompanying abdominal cramping or pain Nausea and vomiting Bloody, mucous, or watery, foul smelling stool Possible fever Dehydration Positive stool sample for bacteria

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Treatment for gastroenteritis

answer

Fluid replacement Diet therapy Drug therapy (antiemetics or anticholinergics) Antimicrobials are given if it is caused by an infecting organism susceptible to therapy

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Patient education for gastroenteritis

answer

Replace fluids Follow recommended diet Wash hands Do not share utensils Maintain clean bathroom

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Consequences of fecal or urinary incontinence

answer

Skin breakdown Changes in daily activities Changes in social relationships

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Elimination

answer

Excretion of waste from the body

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Bowel elimination

answer

Passage and dispelling of stool through the intestinal tract by means of intestinal smooth muscle contraction.

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Urinary elimination

answer

Passage of urine out of the urinary tract through the urinary sphincter and urethra.

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Populations at greatest risk for problems with bowel and urinary elimination

answer

Children Pregnant women Older adults

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Renal ultrasound (kidney scan)

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A renal ultrasound visualizes the parenchyma and associated structures, including the renal blood vessels, using sound waves to produce an image. The nurse's role during a renal ultrasound is to primarily make sure the patient has received the proper education and is prepared for the procedure guidelines for patient education.

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Patient education for renal ultrasound

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The nurse can assist and educate the patient undergoing a renal ultrasound by providing the following information: -You will be positioned in a supine position. Your flank will be exposed and appropriately draped. -Your abdomen will be lubricated with an acoustic gel. -You will be asked to take a deep breath and hold it. This is done so that various parts of the kidney can be visualized. -The technician will use a transducer to visualize various regions of the kidney and surrounding areas.

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Renal biopsy

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Removal of a piece of kidney tissue for microscopic evaluation. The least intrusive method to obtain samples of the renal cortex. Pre-procedure, the patient will be instructed not to eat or drink for four to six hours. The patient should be forewarned of the approximate two-hour period of bedrest required for transplant graft biopsy and the four to six hours of bedrest for native kidney (one's own kidney as opposed to a transplant graft) biopsy. Less bed rest is required for transplant biopsy due to less strain on the renal capsule with the graft located in a lower abdominal quadrant.

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Post-procedure patient education for renal biopsy

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Frequent vital signs and inspection of the biopsy site for hematoma. Typical frequency is every 15 minutes during the first hour. Then, gradually the interval is increased if no bleeding occurs. Monitor for any evidence of bleeding. Signs and symptoms include significant change in blood pressure, tachycardia, nausea or vomiting (often associated with hypotension), or a reduction in hematocrit. Anything more than minimal pain is a warning symptom and the patient should be thoroughly assessed. Ureteral colic could signal a clot occluding the ureter. Back pain may indicate a retroperitoneal or intrarenal bleed. Monitor the urine for hematuria or clots. Serial samples of urine are saved in urinalysis tubes, dated, timed, and placed in a rack for color comparison. Educate the patient to avoid heavy lifting for approximately of two weeks and to notify the health care provider of flank pain, light-headedness or dizziness, rapid pulse, dysuria, or hematuria.

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Cystoscopy

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Direct visualization of the urethra, bladder, and ureteral orifices by insertion of a scope. May be used to obtain biopsies and treat pathology of visualized areas.

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Nursing management for cystoscopy

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The patient must avoid food and fluids for four to eight hours prior to the procedure if receiving general anesthesia. Postprocedural care includes monitoring the patient for urinary obstruction secondary to swelling and hematuria related to biopsy or inadvertent injury to urinary structures. Light hematuria and pain during the first void may not be abnormal depending on the extensiveness of the procedure. The patient should be educated to notify the nurse for problems voiding, gross hematuria, excessive pain, fever or chills, and continued dysuria.

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Intravenous pyelogram (IVP)

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Evaluates renal function by analyzing flow of contrast over time. A radiopaque contrast agent is injected intravenously. This renders the urine radiopaque as the contract agent is excreted in the urine. Abnormalities of the lumen, calculi, and masses can be detected. It is imperative to check for dye allergies and to hydrate the patient for posttest dye excretion to avoid nephrotoxicity.

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KUB (Xray of kidneys, ureters, and bladder)

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The KUB shows kidney size, shape, and position and the presence of calculi. Hydronephrosis, cysts, and tumors may be visualized. Constipation can interfere with the viewing field.

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Colonoscopy

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Provides direct visualization of the rectum, colon, entire large intestine, and distal small bowel. A flexible scope is inserted through the rectum and advanced to the cecum. Useful in detecting lower GI disease. Positioning: LT side with knees to chest Anesthesia: Moderate sedation (Midazolam, fentanyl, and/or propofol)

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Nursing management for colonoscopy (Prep)

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-Bowel Prep (laxatives, such as bisacodyl and polyethyline glycol) -Polyethyline glycol isn't recommended for older adults as it can cause fluid and electrolyte imbalances -Polyethyline glycol can also inhibit the absorption of some medications. Review medications and consult with doctor. -Clear liquid diet, NPO after midnight -Patient must avoid medications such as aspirin, anticoagulants, and antiplatelets.

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Nursing management for colonoscpy (Post-procedure)

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-Notify provider of severe pain (possible perforation) -Monitor for rectal bleeding -Monitor vitals & respiratory status. Maintain open airway until patient is awake -Resume normal diet as prescribed -Encourage increased fluid intake -Instruct that there can be some flatulence due to air instillation during the procedure -Do not drive or use equipment for 12-18 hrs after

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Esophagogastroduodenoscopy (EGD)

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Insertion of endoscope through the mouth into the esophagus, stomach, and duodenum to identify or treat areas of bleeding, dilate an esophageal stricture, and diagnose gastric lesions or celiac disease. Position: LT side laying with head of bed elevated Anesthesia: Moderate sedation per IV access. Topical anesthetic to depress gag reflex, atropine to decrease secretions. Prep: NPO 6-8 hrs.

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Nursing management for EGD (Post-procedure)

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-Monitor vitals and respiratory status. Maintain open airway until patient is awake -Notify provider of any bleeding, abdominal or chest pain, and any evidence of infection -Withhold fluids until return of gag reflex -D/C IV therapy when patient tolerates oral fluids w/o nausea and vomiting -Do not drive or use equipment for 12-18 hrs after -Use throat lozenges if sore throat or hoarse voice persists following procedure

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Barium swallow (esophagraphy)

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A fluoroscopic visualization of the esophagus following the ingestion of barium sulfate. The results of barium studies can reveal congenital abnormalities; lesions; spasm; reflux, stricture, and obstruction; inflammation; ulceration; varices; and fistula.

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Patient prep for barium studies

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-Patient should not smoke for 24 hours prior to the procedure (smoking causes an increased production of gastric juices) -Placing the patient on NPO status after midnight -Administering a laxative the evening before and enemas the morning of the test -Educate patient that during the procedure (which will last approximately two hours), pictures will be taken at 30-minute intervals with the patient in different positions -Post-procedure barium will be expelled in the stool, making it milky white. Fluids are forced to help with the excretion of barium. If the barium is not completely excreted, it can cause intestinal obstruction. -Follow up two to three days post-procedure to ensure the patient has had a normal brown stool

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Barium enema

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A rectal infusion of barium sulfate. Is the roentgenographic study of the lower intestinal tract. The colon should be free of all fecal material to allow for maximum visualization

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Clinical management: Primary prevention

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Hydration Adequate dietary fiber Regular toileting practices Regular exercise Avoidance of environmental contamination

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Clinical management: Collaborative interventions

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Treatment strategies depend on the underlying condition The most common strategies include: Pharmacotherapy Incontinence management Invasive procedures and surgery

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Process of micturition (voiding of urine)

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Filling of bladder --> 200-450 mL of urine Activation of stretch receptors in bladder wall Signaling to the voiding reflex center Contraction of detrusor muscle Conscious relaxation of external urethral sphincter

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Lifespan considerations related to urination (infants)

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15-60 mL per kg Produce 8-10 wet diapers per day No voluntary control

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Lifespan considerations related to urination (children)

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Toilet training requires: -Mature neuromuscular system -Adequate communication skills Problems include: -Enuresis -Nocturnal enuresis

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Lifespan considerations related to urination (older adults)

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Kidney function decreases Urgency and frequency common Loss of bladder elasticity and muscle tone leads to: -Nocturia -Incomplete emptying

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Factors Affecting Urinary Elimination

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Personal Sociocultural Environmental Nutrition Hydration Activity level Medications Surgery and anesthesia

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Pathological conditions affecting urinary elimination

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Bladder/kidney infections Kidney stones Hypertrophy of the prostate (male) Mobility problems Decreased blood flow through glomeruli Neurological conditions Communication problems Alteration in cognition

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Nursing management for urinary incontinence

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Prevent skin breakdown Encourage/teach lifestyle modifications Implement bladder training Encourage client to perform Kegel's exercises Use anti-incontinence devices as needed Strategies to promote independent urination Pharmacological interventions Surgical interventions Parental teaching for enuresis

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Consequences: Urinary retention

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Cause: External sphincter does not open for release of urine or blockage of urethra -Leads to increased urine volume and bladder distention -Backflow to the upper urinary tract -Dilation of the ureters and renal pelvis -Pyelonephritis and renal atrophy

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Managing urinary retention

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Urinary Catheterization: Introduction of a sterile tube into the bladder -Straight catheter -Indwelling catheter: Foley -Suprapubic catheter

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Nursing care for urinary catheter

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Prevent urinary tract infection Prevent backflow of urine Encourage fluids Perineal hygiene

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Process of defecation

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Defecation: process of elimination of waste Feces: semisolid mass of fiber, undigested food, inorganic material, etc. -Fecal material reaches rectum -Stretch receptors initiate contraction of sigmoid colon/rectal muscles -Internal anal sphincter relaxes -Sensory impulses cause voluntary "bearing down" -External sphincter relaxes

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Factors affecting bowel elimination

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Developmental stage Personal factors Sociocultural factors Nutrition/hydration Medications Procedures Pregnancy Pathological conditions Bowel diversions -Ileostomy -Colostomy

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Nursing management of diarrhea

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-Monitor stools to quantify diarrhea -Assess and monitor for fluid imbalance -Monitor for alterations in perineal skin integrity -Proper dietary teaching *Clear liquid *Bananas, rice, applesauce, toast (BRAT) *Foods to avoid -Antidiarrheal medications ***Not recommended for acute diarrhea Lomotil, immodium -Teach clients about over-the-counter aids

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Nursing management of constipation

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-Increase intake of high-fiber foods -Increase fluid intake -Increase activity/exercise -Provide privacy -Help client to a position that facilitates defecation -Allow uninterrupted time -Offer laxatives when lifestyle changes are ineffective

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Nursing management of fecal impaction

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-Prevention is the best treatment -Determine presence: digital examination -Enemas *Oil retention to soften *Tap water or Fleet enemas to remove and cleanse -Manual/digital removal: dysimpacting -Establish bowel program to prevent recurrence

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Establishing a bowel training program

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-Plan program with the client -Increase fiber in diet gradually -Increase fluid intake to 8 glasses water per day -Establish a designated time for defecation -Provide privacy for the client -Treatment plan should be staged -Treatment may include stool softener -Modify the plan based on client results

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Nursing management of an ileostomy/colostomy

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-Stoma assessment and care -Strict attention to skin care/peristomal skin assessment -Monitor amount and type of effluent -Be attentive to client's psychosocial needs -Be professional; show acceptance -Attend to odor control -Address client participation in ostomy care ` -Client teaching for home care

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Colostomy

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Brings a portion of the colon through a surgical opening in the abdomen. The location of the colostomy determines the consistency of the feces eliminated, as well as the need to wear an ostomy appliance. The closer the colostomy is to the ascending colon and the ileocecal valve (between the small and large intestine), the more liquid and continuous the drainage will be. In contrast, a colostomy close to the sigmoid colon will produce solid feces.

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Double-barreled colostomy

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Has two separate stomas that externalize the bowel on both sides of the portion that has been removed. The proximal and distal loops are sutured together and both ends are brought out through the abdominal wall. The proximal stoma is the functioning end that drains fecal material. The distal stoma may drain mucus and is sometimes called a mucous fistula.

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Loop colostomy

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Usually performed as an emergency procedure and situated often in the right transverse colon. Consists of a segment of bowel brought out to the abdominal wall. The posterior wall of the bowel remains intact, but a plastic rod is wedged under the bowel to keep it from slipping back into the abdomen. The anterior wall is incised, and the mucosal surface is left visible and open to air. It, too, has a functioning proximal end and limited drainage from the distal end.

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Ileostomy

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Brings a portion of the ileum through a surgical opening in the abdomen, bypassing the large intestine entirely. Drainage at this level is liquid and continuous. The patient must wear an ostomy appliance at all times to collect the drainage.

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Pharmacotherapy for bowel elimination

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-Laxatives *Bulk-forming agents *Bowel stimulants *Lubricants *Saline laxatives -Stool softeners -Antibiotics -Antispasmodics -Analgesics

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Clinical judgement

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An interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's response. Related terms: Inference Interpretation Decision Clinical reasoning Critical thinking

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Attributes of clinical judgment

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Involves a holistic view of the patient situation. Is a process orientation (a circular process). Requires reasoning and the interpretation of data.

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Clinical judgment process - Noticing

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A nurse notices things about a patient in the context of the nurse's background and experience, context of environment, and knowing the patient. A nurse is looking for patterns that are consistent with previous experiences and uses that information to guide care.

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Clinical judgment process - Interpreting

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Interpreting is the process of assembling information to make sense of it. Types of reasoning patterns tend to vary with the experience of the nurse: -Novice nurses tend to rely on analytic reasoning. -Expert nurses draw from a variety of reasoning patterns; analytic, intuitive, and narrative.

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Clinical judgment process - Responding

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Responding is the implementation of actions and interventions, based on patient needs. Depending on the level of expertise, the nurse may or may not be able to judge the effectiveness of the intervention before initiating it.

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Clinical judgment process - Reflecting

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Reflecting is the process of thinking and learning from experiences. -Reflection-in-action happens in real time while care is occurring. -Reflection-on-action happens after the patient care occurs. Reflecting is critical for development of knowledge and improvement in reasoning.

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Ethics

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-The study or examination of morality through a variety of different approaches. -How you respond to an ethical situation is a reflection of the core values, beliefs, and character that make you the person who you are and, ultimately, the professional who you will become. -Systematic study of right and wrong conduct. -Formal process for making consistent moral decisions.

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Bioethics

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Ethical questions surrounding biological sciences and technology.

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Clinical ethics

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Decisions made at the bedside.

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Research ethics

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Conduct of research using humans and animals.

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Societal ethics

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Society provides a normative basis for ethical behavior with laws and regulations. Law is the minimum standard of behavior to which all members of society are held.

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Organizational ethics

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Formal and informal principles and values guide the behavior, decisions, and actions taken by members of an organization. Directs all aspects of an organization.

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Professional ethics

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Ethical standards and expectations of a particular profession Held to a higher standard because of privileged role in society Code of conduct Aimed at the highest ideals of practice

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Personal ethics

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Continuously intersect with other categories of ethics. Do not overlap perfectly; consequently, a potential for conflict exists. Sources of ethics are not static and change over time.

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Ethical theory

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Ethics of Duty -Is the right thing to do. Ethics of Consequence -Is the greatest good for the greatest number. Ethics of Character -Is based on life experiences and a willingness to reflect on our actions. Ethics of Relationship -Is the nature and obligation inherent in human relationships.

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Nursing ethics

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Ethical questions that arise out of nursing practice -What will your level of participation be in a given ethically challenging situation? -Can you support clients'decisions based on their ethical beliefs? -What are your feelings about the results of decisions made by others?

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Failure to act or respond in an ethically appropriate way has been linked to:

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Serious and potentially dangerous errors Personal stress Professional burnout

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Ethical decision making

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Health care decisions that present an ethical dilemma are not made by individuals alone. Health care organization's compliance officer and compliance committee are charged with the responsibility of ensuring that ethical standards are met. Institutions have reporting mechanisms for unethical behaviors.

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Ethical issues in nursing

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Protecting patients' rights and human dignity Not respecting informed consent treatment Providing care with risk to the health of the nurse Using or not using chemical or physical restraints Understaffing Prolonging the living and dying process with inappropriate measures Policies that could threaten the quality of care Working with unethical or impaired colleagues

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Morals

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Private, personal, or group standards of right and wrong Moral behavior; in accordance with custom; reflects personal moral beliefs

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Moral distress

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Occurs when the nurse is aware of the right and moral action to take in a given patient situation but is unable to carry out that action because of external constraints. Perceived constraints : -Physicians; nurse administrators; other nurses -The law; threat of lawsuit

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Moral outrage

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Belief that others are acting immorally. Similar to moral distress, except that in cases of moral outrage, nurses do not participate in the act. Therefore, they do not believe that they are responsible for doing wrong, but that they are powerless to prevent the wrongdoing. Powerlessness Cannot prevent a "wrong" Respond with "whistleblowing"

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Whistleblowing

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Identification of an unethical or illegal situation Can involve one person or an entire organization Reporting such an action to someone in authority Need accurate information Be aware of the consequences ANA working to protect whistleblowers

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Factors in moral decision making

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Values -Belief about the worth of something -Highly prized ideals, customs, conduct, goals -Freely chosen -Learned through observation and experience -Vary from person to person Attitudes -Feelings toward person, object, idea -Includes thinking and feeling component -What a person thinks Beliefs -Something that one accepts as true -Not always based on fact

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Consequentialism

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The rightness or wrongness of an action depends on the consequences of the act rather than on the act itself. Theories of this type are also called: Teleology- from the Greek word telos, meaning "end" or the study of ends (also called final causes) . Utilitarianism- the most familiar consequentialist theory, takes the position that the value of an action is determined by its usefulness. The principle of utility states that an act must result in the greatest good (positive benefit) for the greatest number of people.

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Deontology

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Unlike the utilitarian model, considers an action to be right or wrong regardless of its consequences.

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Formalism

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Defines morals based off of logic and reason which says that if something is defined as wrong or right, it is defined as wrong or right all the time.

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The categorical imperative

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One should act only if the action is based on a principle that is universal—or in other words, if you believe that everyone should act in the same way in a similar situation.

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Feminist ethics

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Based on the belief that traditional ethical models provide a mostly masculine perspective, and that they devalue the moral experience of women. Uses relationships and stories rather than universal principles. Addresses female perspective of issues.

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Ethics of care

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Nursing's responsibility to care in ethical situations. Using an ethics of care perspective, nurses include a responsibility to care as a part of their professional behavior. Some aspects of care include the ability and duty to appreciate, understand, and even share the patient's pain or condition.

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Professional guidelines for ethical decision making

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Nursing Codes of Ethics International Council of Nurses American Nurses Association Standards of Care Patient Care Partnership

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Autonomy

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Patients have the freedom to make decisions for themselves.

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Non-maleficence

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To do no harm, either intentional or unintentional

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Beneficence

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To act in the best interest of others; to benefit others

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Fidelity

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Duty to keeping commitments and promises

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Veracity

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To tell the truth, which has an added benefit of promoting trust between client and nurse.

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Justice

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Fair, equitable, and appropriate treatment; resources are distributed equally to all.

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Evidence based practice

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Knowledge bases for clinical decisions Definition: -Research evidence -Clinical expertise -Patient preference Sociopolitical forces in quality of care EBP is using the best research and proven assessments and treatments in our day-to-day clinical care and service delivery. Why it is important to patient care: The patient gets up-to-date care that has already been done in studies.

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Major features of EBP

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Interdisciplinary Evidence summary Translation to clinical practice guidelines Provider and organizational factors guide integration Evaluation

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ACE Star Model of Knowledge Transformation

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The core concept of the ACE Star Model is knowledge transformation; this is defined as the conversion of research findings from primary research results through a series of stages and forms to have an impact on health outcomes by way of evidence-based care. Each of the five points of the star focuses on a sequential cognitive activity. In the model the stages progress clockwise from discovery to evaluation.

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Star point 1: Discovery

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Primary research. It is the approach with which nurses are familiar, i.e., single reports of research studies.

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Star point 2: Evidence summary

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All primary research on a given clinical topic is gathered and summarized into a single statement about the state of the science.

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Star point 3: Translation

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Experts are called on to consider the evidence summary, fill in gaps, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs). Clinical practice guidelines are commonly produced and sponsored by a clinical specialty organization. The aim of translation is to provide a useful and relevant package of screened, summarized, and interpreted evidence to clinicians and patients in a form that suits the time, cost, and care standard.

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Star point 4: Integration

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Perhaps the most familiar stage of knowledge transformation in health care because of society's longstanding expectation that health care be based on the most current knowledge, thus requiring implementation of innovations. Once guidelines are produced, implementation plans are put into action to change the individual clinician practices, organizational practices, and environmental policies.

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Star point 5: Evaluation

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A broad array of endpoints and outcomes are evaluated. These include evaluation of the impact of EBP on patient health outcomes, provider and patient satisfaction, efficacy, efficiency, economic analysis, and the health status of a population. As new knowledge is transformed through the five stages, the final outcome is evidence-based quality improvement of health care.

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Steps in conducting a systematic review

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Formulate question Locate relevant studies Select and appraise studies Summarize and synthesize results Interpret findings Update regularly

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Laws

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Established to protect society Nursing practice guided by legal principles Purpose of laws: -Protect clients/society -Define scope of nursing practice -Identify minimum level of care to be provided

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Health care law

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The collection of laws that have a direct impact on the delivery of health care or on the relationships among those in the business of health care or between the providers and the recipients of health care.

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Legislation

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The process of introducing, adopting, changing, or repealing law.

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Regulation

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The process of putting laws into action through the establishment of rules.

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Litigation

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The process of seeking help through the courts to address a perceived wrong.

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Five traditional legal disciplines:

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Tort law Contract law Property law Constitutional law Criminal law **All legal disciplines have shaped health care law to some degree, but most health care laws are derived from constitutional law and tort law.

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Criminal law

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Federal or state government prosecutes Offense against society Can lead to a fine, imprisonment, or death -Misdemeanor **Minor crime; DUI -Felony **Homicide

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Civil law

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Allows for resolution of dispute between private parties May result in monetary compensation Plaintiff: person bringing suit Defendant: person being sued

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Types of civil law

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Contract law -Dealing with agreements between individuals Explicit or implicit Tort law -Dealing with duties and rights among individuals Involves claims for damages

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State board of nursing

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A state board of nursing holds the legal authority for nursing practice and regulates nursing practice through: Establishing the requirements to obtain a nursing license Issuing nursing licenses Determining the scope of practice Setting minimum education standards Managing disciplinary procedures

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Professional nursing practice

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Is regulated by the states; nurses must hold a state-issued license to practice nursing. Details of the practice of nursing are found in the scope of practice for each state. Practice can vary from state to state; for this reason, nurses should be familiar with the nursing practice act and scope of practice in the state in which they work.

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Quasi-Intentional Torts: Slander

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Oral defamatory statements

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Quasi-Intentional Torts: Defamation

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False communication to a third person

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Quasi-Intentional Torts: Libel

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Written defamatory statements

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Intentional Torts: Assault and battery

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Performing a procedure without consent.

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Intentional Torts: False imprisonment

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Restraining a client against her/his will

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Intentional Torts: Fraud

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Failing to provide essential information for informed consent

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Intentional Torts: Invasion of privacy

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Breach of confidentiality (HIPAA)

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Negligence

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Failure to perform as a reasonable, prudent person would Failure to follow standards of practice No intent to harm is present

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Malpractice

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Tort law or law of medical liability is the legal discipline for malpractice. Four elements must be satisfied: duty, breach, causation, and harm. Is a failure to "follow the standard of care" and is the direct cause of harm. The profession establishes the standard, making this a unique characteristic of medical malpractice.

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Common malpractice claims

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Failure to assess and diagnose Failure to plan Failure to implement a plan of care Failure to evaluate

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Minimizing malpractice risk

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Observe mandatory standards of care Use nursing process; follow professional standards Avoid medication and treatment errors Report and document accurately Obtain informed consent Attend to client safety Maintain client confidentiality Provide education and counseling Delegate, assign, and supervise properly Accept appropriate assignments Participate in continuing education Observe professional boundaries Observe mandatory reporting regulations Be aware of legal safeguards for nurses

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Employer/employee liability

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Vicarious liability Employer liable for the acts of its employee if the employee was acting as an agent of the employer and the actions resulted in injury within that scope of employment.

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Federal laws

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Bill of Rights Social Security Act of 1965 Consolidated Omnibus Budget Reconciliation Act Emergency Medical Treatment and Active Labor Act of 1986 American with Disabilities Act Patient Self-Determination Act of 1991 Health Insurance Portability and Accountability Act of 1996 Patient Protection and Affordable Care Act of 2010

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State laws

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Licensing of professionals—scope of practice -Credentialing -Discipline Licensing of health care institutions Laws relating to public health and disease prevention and control (mandatory reporting laws) -Communicable disease -Abuse Consent Advanced directives Physician-assisted suicide

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HIPAA

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The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996 to protect patients: ■ Protect health insurance benefits for workers who lose or change their jobs. ■ Protect coverage to persons with preexisting medical conditions. ■ Establish standards to protect the privacy of personal health information.

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Mandatory reporting laws

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The law in various states requires healthcare workers to report communicable diseases. You also have a duty to report physical, sexual, or emotional abuse or neglect of children, older adults, or the mentally ill, whether you suspect it or have actual evidence of it.

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Advanced directives

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Two common forms of advance directives are a living will or health care proxy (POA) -Living will outlines medical treatment client wishes to refuse (ex: intubation) if client unable to communicate wishes at that time -Health care proxy (also called durable power of attorney for health care) appoints someone (usually family or trusted friend) to make health care decisions if client unable to do so

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Safe and effective care environment - Surgery

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Differentiate among the various types and purposes of surgery. Examine individual patient factors for potential threats to safety, especially for older adults. Use appropriate patient identifiers when providing instruction, administering drugs, marking surgical sites, and performing any procedure. Verify that the patient has given informed consent for the surgical procedure and that the presurgical checklist is complete and accurate. Identify patient conditions or issues that need to be communicated to other members of the surgical and postoperative teams.

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Psychosocial integrity - Surgery

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Use effective communication when teaching patients and family members about what to expect during the surgical experience. Act as a patient advocate with regard to patients' rights, informed consent, and advance directives. Identify learning needs for the patient preparing for surgery.

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Physiological integrity - Surgery

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Use knowledge of physiology and behavioral principles to describe an accurate and complete preoperative assessment. Evaluate personal factors that increase the patient's risk for complications during and immediately after surgery. Evaluate laboratory values for changes that may affect the patient's response to drugs, anesthesia, and surgery. Explain the purposes and techniques commonly used for patient preoperative preparation. Apply anti-embolic stockings, sequential compression boots, or other devices to reduce or prevent vascular complications.

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Teamwork and collaboration

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Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care

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Pre-operative period

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Begins when patient is scheduled for surgery; ends at time of transfer to surgical suite Nurse functions as educator, advocate, promoter of health and safety

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Surgical settings

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Inpatient -Same day admission Outpatient -Same day surgery Ambulatory -Free standing centers -Physician offices -Ambulatory care centers

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Pre-op assessment includes:

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Current medications - complementary or alternative -herbs -OTC meds Medical history & Family history -Cardiovascular -Pulmonary Previous surgical procedures and anesthesia -Pain control -Management of nausea / vomiting Blood donation Discharge planning - support system

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Older adults: Changes of aging as surgical risk factors

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Decreased: -Cardiac output, peripheral circulation -Vital capacity, blood oxygenation -Blood flow to kidneys, glomerular filtration rate Increased: -Blood pressure -Risk for skin damage, infection -Sensory deficits -Deformities related to osteoporosis/arthritis

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Pre-op system assessment - Cardiovascular

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Affect the ability of the heart to work as an efficient pump. Coronary Artery Disease MI within 6 months before surgery Angina Hypertension Dysrhythmias

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Pre-op system assessment - Respiratory

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Decrease pulmonary function, increase the risk of respiratory infection, and may be exacerbated by general anesthesia. Chronic respiratory problems -Emphysema -Asthma -Bronchitis Smoking -Increases carboxyhemoglobin blood level and deceases oxygen delivery

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Pre-op system assessment - Renal/urinary

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Renal disease/impairment affects the patient's ability to excrete many medications, including anesthetic agents. It also affects the body's ability to regulate fluid and electrolytes.

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Pre-op system assessment - Neurological

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-Determine baseline LOC -Note presence of sensory or perceptual deficits -Assess range of motion and ability to perform activities of daily living

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Pre-op system assessment - Nutrition status

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Patients who are malnourished or obese are at risk for delayed wound healing, infection, and fatigue. Obese clients are also more prone to cardiovascular disorders and impaired pulmonary function.

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Prevention of cardiovascular complications

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-Be aware of patients at greater risk for DVT -Antiembolism stockings -Pneumatic compression devices -Leg exercises -Mobility

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Pre-op Labs

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Urinalysis Blood type and crossmatch CBC or hemoglobin level and hematocrit Clotting studies (PT, INR, aPTT) Electrolyte levels Serum creatinine level Pregnancy test

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Pre-op Diagnostics

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Chest x-ray - Assesses respiratory status and heart size ECG - Assesses preexisting cardiac disease or rhythm abnormalities

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Nursing Diagnoses - Surgery

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Knowledge deficit (surgical experience) related to unfamiliarity with surgical procedures and preparation. Anxiety related to new or unknown experiences, possibility pain, and possible surgical outcomes.

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Knowledge deficit: Goals & outcomes

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The patient will: Verbalize -in own words purpose and expected results of surgery -understanding of preoperative preparations Ask -questions when terms or procedure is not known Adhere -to NPO requirements Demonstrate -correct use of exercises and techniques to be used after surgery to prevent complications

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Knowledge deficit: Interventions

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*Preoperative teaching *Informed consent: -Surgeon obtains signed consent before sedation and/or surgery -Nurse clarifies facts and dispels myths about surgery -Nurse not responsible for providing detailed information about procedure!

question

Informed consent

answer

Patients may sign with "X" In emergency, telephone authorization is acceptable Special permits required for some procedures

question

NPSG's and informed consent

answer

Ensure correct site is selected and wrong site is avoided Licensed independent practitioner marks site, involving patient if possible "Time out" procedure adopted by most facilities

question

Self-determination

answer

Pt has the right to have or initiate: -Advance directives -Living wills -Durable power of attorney Mandated by the Patient Self-Determination Act Provide legal instructions to healthcare providers ***Surgery does not provide an exception to the patient's advance directives or living will.

question

Implementing dietary restrictions

answer

NPO - Patient not to ingest anything by mouth for 6 to 8 hours before surgery: -Decreases risk for aspiration -Give patients written/oral directions to stress adherence -Surgery can be canceled if instructions not followed

question

Administering regularly scheduled medications

answer

Consult with physician and anesthesia provider for instructions Drugs for certain conditions often allowed with a sip of water: -Cardiac disease -Respiratory disease -Seizures -Hypertension

question

Medications that may affect surgery, therefore are a risk

answer

-Antibiotics - may potentiate the action of anesthetic agents -Anticoagulants - increase risk for bleeding -Antidysrhythmics - may impair cardiac function during anesthesia -Antihypertensives - increase the risk for hypotension during surgery; may interact with anesthetic agents to cause bradycardia and impaired circulation -Aspirin - increase risk for bleeding -Corticosteroids - delay wound healing and increase risk for infection -Diuretics - alter fluid and electrolyte balance (especially potassium balance) -Opiods - increase the risk of respiratory depression -NSAID's - inhibit platelet aggregation, increasing the risk for bleeding -Tranquilizers - increase the risk of respiratory depression

question

Intestinal preparation

answer

Performed to prevent injury to colon; reduce number of intestinal bacteria -Enema or laxative

question

Skin preparation

answer

Skin is first line of defense - break in barrier can lead to infection 1st step in reducing surgical site infection -Can start 1-2 days before surgery with -Antiseptic solutions with shower Removal of hair -DO NOT SHAVE! Clip instead

question

Patient and family teaching

answer

Tubes -Urinary catheter -NG Drains -Penrose -JP -Hemovac Vascular access -PIV -Central Line

question

Prevention of respiratory complications

answer

Breathing exercises -Deep (diaphragmatic) -Expansion Incentive spirometry Coughing and splinting

question

Patients at risk for VTE

answer

Obese patients Age 40 or older History of cancer Decreased mobility or immobile Spinal cord injury Smoking History of VTE, PE, varicose veins, edema Oral contraceptives History of decreased cardiac output Hip fracture, total hip/knee surgery

question

Pre-operative chart review

answer

-Ensure all documentation, preoperative procedures, orders are complete -Check surgical consent form and others for completeness -Inform patient that area will be marked before procedure begins -Document allergies, height, and weight -Ensure all laboratory and diagnostic test results are in chart -Document/report any abnormal results -Report special needs and concerns

question

Pre-operative patient preparation

answer

Remove most clothing; provide gown Leave valuables with family member or lock up Tape rings in place if cannot be removed Ensure patient is wearing ID band Remove: -Dentures -Prosthetic devices -Hearing aids -Contact lenses -Fingernail polish -Artificial nails -Pierced jewelry

question

Pre-operative Medications

answer

Sedatives/Antihistamines - provide sedation and antiemetic effects -hydroxyzine (Vistaril) -diphenhydramine (Benadryl) Hypnotics - provide sedation and increase the duration of sleep -lorazepam (Ativan) -temazapam (Restoril) Anxiolytics - control anxiety, calming -midazolam (Versed) -diazepam (Valium) Opioid analgesics - provide pain relief and sedation; induce anesthesia -morphine (Duramorph) -fentanyl (Sublimaze) Anticholinergic agents - reduce oral and pulmonary secretions, prevent laryngospasms, prevent bradycardia -atropine (Atropisol) -scopolamine (Maldemar) H2 histamine blockers - reduce gastric acidity and reflux -ranitidine (Zantac) -cimetidine (Tagamet)

question

Members of the surgical team

answer

Sterile team: -Surgeon and surgical assistant or RNFA -Scrub nurse -Surgical technologist Clean team: -Anesthesia providers -Circulating nurse -ORTs/surgical technologists may be used in addition to nursing staff -Holding area nurse -Specialty nurses

question

Scrub nurse

answer

Sets up the sterile field Prepares the surgical instruments Assists with the sterile draping of the patient Anticipates and responds to the surgeon's needs Maintains the integrity of the sterile field

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Registered nurse first assistant (RNFA)

answer

An RN with additional education and training in surgical technique. The RNFA serves as an assistant to the surgeon to perform the surgical procedure, a role that has historically been filled by physicians.

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Anesthesiologist or a nurse anesthetist (CRNA)

answer

Induces amnesia, analgesia, and muscle relaxation or paralysis with anesthesia. Their role is to continuously monitor and evaluate the patient's responses to the anesthetic agent and the surgical procedure. CRNAs administer more than half of all anesthetics in the United States.

question

Circulating nurse

answer

An RN who applies the nursing process to coordinate all activities in the operating room. She is a client advocate who continuously monitors the client and the sterile field maintains a safe, comfortable environment; communicates with appropriate personnel outside the operating room; responds to emergencies; and, in some cases, administers sedation to the patient. An important aspect of the circulating nurse's role is to attend to the patient during the induction of anesthesia.

question

Time out

answer

The circulating nurse, in the role of patient advocate, is usually the team member who initiates the time out. A correctly performed time out includes verifying the correct: -patient -procedure -site -side (laterality) -surgeon -position As well as that proper equipment, instrumentation, and implants are available.

question

What to do if a doctor becomes hypoglycemic during a procedure?

answer

Nurse has the duty to report impaired practice.

question

Minimally invasive and robotic surgery (MIS)

answer

Now common practice Preferred technique for many surgery types, including: Cholecystectomy Joint surgery Cardiac surgery Splenectomy Spinal surgery Potential injury Mechanical trauma Thermal injury

question

Environment of the surgical team

answer

Preparation of surgical suite, team safety Layout Health and hygiene of surgical team Surgical attire Surgical scrub Remember!!! People are a source of bacteria in the surgical setting! Special health care standards, dress are needed Watch for nosocomial infections, identify source of pathogens

question

Surgical scrubbing

answer

Broad-spectrum, surgical antimicrobial solution Vigorous rubbing that creates friction used from fingertips to elbow Scrub continues for 3 to 5 min

question

Anesthesia

answer

Induced state of partial or total loss of sensation, occurring with or without loss of consciousness Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, achieve controlled level of unconsciousness (in some cases)

question

General anesthesia

answer

Reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of CNS Involves single or combination of agents Depresses CNS, resulting in analgesia, amnesia, and unconsciousness with loss of muscle tone and reflexes

question

Stages of general anesthesia

answer

Stage 1—Beginning of anesthesia; client is drowsy and dizzy; pain sensation is depressed Stage 2—Excitement stage; client has irregular breathing, involuntary motor movements; avoid stimulating client, which can trigger vomiting, holding the breath, and increased activity; ensure client safety by proper use of safety straps Stage 3—Stage of anesthesia appropriate for surgical procedures; client has skeletal muscle relaxation, constricted pupils, absence of eyelid reflex Stage 4—medullary depression; client is NEAR DEATH; pupils are fixed and dilated, respirations are weak, pulse is rapid and thready Emergence—recovery from anesthesia

question

Administration of general anesthesia

answer

Inhalation IV injection Balanced anesthesia Adjuncts to general anesthetic agents: -Hypnotics -Opioid analgesics -Neuromuscular blocking agents

question

Balanced anesthesia

answer

Combination of IV drugs and inhalation agents used to obtain specific effects Example: -thiopental for induction -nitrous oxide for amnesia -morphine for analgesia -pancuronium for muscle relaxation

question

Complications of general anesthesia

answer

Malignant hyperthermia Overdose Unrecognized hypoventilation Problems with specific anesthetic agents Intubation problems

question

Malignant hyperthermia

answer

Acute, life-threatening complication May be genetic Begins with skeletal muscle exposed to specific agent Causes increased metabolism, calcium levels in muscle cells Leads to acidosis, high temperatures, dysrhythmias

question

Clinical presentations of malignant hyperthermia

answer

-Tachycardia -Tachypnea -Skin initially appears flushed, then becomes mottled and cyanotic -Myoglobinuria -Rise in end tidal carbon dioxide -Rapid rise in body temperature -Respiratory and metabolic acidosis

question

Regional anesthesia

answer

Blocks multiple peripheral nerves in specific body region: Field Nerve Spinal Epidural

question

Regional - Local anesthetic

answer

Briefly disrupts sensory nerve impulse transmission from specific body area/region Delivered topically and by local infiltration Patient remains conscious, able to follow instructions Injected in a specific area for minor surgical procedures, such as lidocaine for suturing a small wound

question

Regional - Field block

answer

Injection of anesthetic around the operative field.

question

Regional - Nerve block

answer

Anesthetic agent is injected into and around a nerve or group of nerves, such as a pudendal block used to numb perineum for an episiotomy.

question

Regional - Spinal block

answer

Anesthesia is injected through a lumbar puncture into subarachnoid space, such as for hernia repairs or cesarean section deliveries Patient is conscious but has no sensation or movement of lower extremities up to a specific area.

question

Regional - Epidural block

answer

Anesthetic agent injected into epidural space to anesthetize larger areas, such as in vaginal childbirth; Patient is awake and aware of surroundings but feels no pain

question

Complications of regional and local anesthesia

answer

Anaphylaxis Incorrect delivery technique Systemic absorption Overdose Local complications

question

Treatment of complications of anesthesia

answer

Establish open airway Give oxygen Notify surgeon Fast-acting barbiturate is usual treatment Epinephrine for unexplained bradycardia

question

Moderate sedation

answer

IV delivery of sedative, hypnotic, opioid drugs to reduce level of consciousness Patient maintains patent airway, can respond to verbal commands Amnesia action is short

question

Potential for injury

answer

Interventions: Proper body position Prevent pressure ulcer formation Prevent obstruction of circulation, respiration, nerve conduction

question

Potential for infection

answer

Interventions include: Plastic adhesive drape Skin closures, sutures and staples, nonabsorbable sutures Insertion of drains Application of dressing Patient transfer from OR table to stretcher

question

Potential for hypoventilation

answer

Continuous monitoring of: -Breathing -Circulation -Cardiac rhythms -Blood pressure and heart rate Continuous presence of anesthesia provider

question

Potential for hypoxemia

answer

Highest incidence occurs on 2nd postoperative day Interventions: -Airway maintenance -Monitor (Spo2) -Semi-Fowler's position -Oxygen therapy, breathing exercises -Mobilization as soon as possible

question

Potential for wound infection and delayed healing

answer

Interventions: Nursing assessment of surgical area Dressings—first change usually done by surgeon Drains—provide exit route for air, blood, bile; help prevent deep infections, abscess formation during healing Drug therapy, irrigation to treat wound infection Débridement Surgical management required for wound opening

question

Post-operative period

answer

Begins with completion of surgery and transfer to PACU, ambulatory care unit, or ICU

question

PACU recovery room

answer

During this period, the client is at high risk for respiratory and cardiovascular compromise. As a precaution, the anesthetist and the circulating nurse accompany the client and attend to his needs during transport to the PACU. Ongoing evaluation and stabilization of patients to anticipate, prevent, manage complications after surgery The Joint Commission's NPSGs require circulating nurses and anesthesia providers give PACU nurses verbal hand-off reports including surgical procedure, anesthesia, drugs and IV fluids administered, and estimated blood loss

question

Functions of the PACU nurse

answer

Respiratory LOC, TPR, O2 Sat, BP Examine surgical area Discharge from PACU

question

What to do if patient is confused in the PACU

answer

Orient the patient. Let them know where they are, how they got there, the time, day, etc.

question

Post-op: Respiratory system assessment

answer

-Patent airway, adequate gas exchange -Note artificial airway when applicable -Rate, pattern, depth of breathing -Breath sounds -Accessory muscle use -Snoring and stridor -Respiratory depression or hypoxemia

question

Post-op: Cardiovascular assessment

answer

Vital signs every 15 mins until stable Heart sounds Cardiac monitoring Peripheral vascular assessment -Monitor for VTE

question

Post-op: Neurological assessment

answer

Cerebral functioning Motor and sensory assessment after epidural or spinal anesthesia

question

Post-op: Fluid, electrolyte & acid-base balance assessment

answer

I & O Hydration status IV fluids Vomitus Urine Wound drainage NG tube drainage Acid-base balance

question

Post-op: Renal/urinary system assessment

answer

Check for urine retention Consider other sources of output (e.g., sweat, vomitus, diarrhea stools) Report urine output of < 30 mL/hr

question

Post-op: Gastrointestinal assessment

answer

Postoperative nausea/vomiting common 30% of patients experience nausea or vomiting after general anesthesia Peristalsis may be delayed up to 24 hours Monitor for bowel sounds **Absent bowel sounds common due to meds that decrease peristalsis, not a big concern immediately after surgery

question

Post-op: Drug therapy to reduce nausea/vomiting

answer

Ondansetron (Zofran) Meclizine (Antivert, Dramamine)

question

Post-op: NG tube drainage

answer

Inserted during surgery to: Decompress and drain stomach Promote GI rest Allow lower GI tract to heal Provide enteral feeding route Monitor any gastric bleeding Prevent intestinal obstruction **Assess drained material every 8 hr

question

Post-op: Skin/incision assessment

answer

Normal wound healing **draining wound does not mean infected wound** Impaired wound healing - seen most often between 5th and 10th days after surgery -Dehiscence -Evisceration Marking post op drainage: How: Any drainage is on the dressing, the nurse circles the area and marks it with a time and date. Provides a gauge how much seepage is occurring. When to notify surgeon: When excessive bleeding or hematoma formation has occurred, the surgeon should be notified right away so that the wound site assessment can be performed.

question

Post-op: Management of nicotine withdrawal

answer

Transdermal nicotine patch

question

Gravity drains

answer

Gravity drains: -Penrose: Short-term drain to give fluids under the wound a channel to drain to the surface; prevents pressure on suture lines -T-tube: Drain directly through a tube from the surgical area

question

Closed-wound drainage systems

answer

Jackson-Pratt Hemovac: drainage collects in a collecting vessel by means of compression and re-expansion of the system.

question

Montgomery straps

answer

Used when frequent dressing changes are anticipated. They help prevent skin irritation from frequent tape removal.

question

Application of skin staples

answer

The stapler is lightly positioned over everted skin edges. It is not necessary to press the staple, or stapler anvil, into the skin to get a proper "bite" (just "kiss" the skin). Center the staples over the incision line, using the locating arrow or guideline, and place staples approximately ¼ inch apart.

question

Post-op: Discomfort/pain assessment

answer

Pain/discomfort is expected after surgery Physical and emotional signs of pain Consider type, extent, length of surgical procedure in assessing patient's discomfort, need for medication

question

Physical and emotional signs of acute pain

answer

Increased pulse and blood pressure Increased respiratory rate Profuse sweating Restlessness Confusion (older adults) Wincing, moaning, crying

question

Pain interventions

answer

Drug therapy Complementary & alternative therapies: -Positioning -Massage -Relaxation/diversion techniques

question

Post-op: Laboratory assessment

answer

Analysis of electrolytes CBC "Left-shift" (bandemia) Specimens for C&S ABGs Urine and renal laboratory tests Other (e.g., serum amylase, blood glucose)

question

Incentive spirometry

answer

Encourage incentive spirometer, deep breathing and coughing exercises every 2 hours while awake to prevent atelectasis and pneumonia.

question

Post-surgical patient education: Diet

answer

Drink at least 6 to 8 glasses of fluid daily unless otherwise ordered (water is beneficial) Adhere to any diet restrictions (provide individualized instruction according to diet) Eat well-balanced meals that are high in vitamin C and protein to aid wound healing

question

Post-surgical patient education: Activity

answer

Maintain activity restriction if ordered by surgeon Resume activities gradually (all clients) Avoid heavy lifting for 6 weeks after major surgery Avoid lifting more than 10 pounds or performing activities involving pushing or pulling with an abdominal incision Often may return to work in 6 to 8 weeks (depending on surgery and client status preoperatively)

question

Post-surgical patient education: Wound care

answer

Take care of incision and/or change dressing as taught (specific information is individualized to client and surgery; provide 1 to 2 days of dressing materials or according to hospital policy) Cover incision with plastic wrap before showering (if allowed) Sutures or staples are often removed in surgeon's office 7 to 14 days post operatively Steri-Strips will fall off by themselves (if used instead of sutures or if applied for support when sutures are removed before discharge) Keep wound clean, dry, and intact

STUDY

End Stage Renal Disease Fluid And Electrolyte Balance Nursing Short Bowel Syndrome Short Term Therapy

TPN – Flashcard 72 terms

Jill Lopez

72 terms

Preview

TPN – Flashcard

question

What is the primary purpose of TPN?

answer

- To meet the patient's nutritional needs - To allow growth of new body tissue (protein)

question

What materials are used to administer TPN?

answer

A central line, such as a tunneled triple lumen catheter or a single- or double-lumen peripherally inserted central (PICC) line

question

TPN contains complete nutrition, this includes...

answer

- Calories (in a high concentration [20% to 50%] of dextrose) - Lipids/essential fatty acids - Protein - Electrolytes - Vitamins - Trace elements.

question

TPN standard IV bolus therapy is typically less than or equal to _____ calories/day.

answer

700

question

Total parenteral nutrition (TPN) is a _______ , __ ______ solution.

answer

- Hypertonic - IV Bolus

question

What are some reasons for administering parenteral nutrition?

answer

- Client's GI tract does not function - Client cannot consume sufficient nutrients via GI tract

question

Partial Parenteral Nutrition (PPN) is: Hypertonic or Isotonic?

answer

Isotonic

question

Partial Parenteral Nutrition (PPN) is: Intended for long or short term use?

answer

Short-Term

question

Partial Parenteral Nutrition (PPN) is: Administered into a large or small peripheral vein?

answer

Large

question

Potential indications for TPN include any condition that: (name two)

answer

- Affects the ability to absorb nutrition. - Has a prolonged recovery. - Creates a hypermetabolic state. - Creates a chronic malnutrition.

question

There are two basic guidelines regarding when to initiate TPN. What are they?

answer

- A weight loss of 7% body weight and NPO for 5 days or more - A hypermetabolic state

question

A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12-hr shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained.

answer

A. CORRECT: The client is at risk for hyperglycemia during the administration of TPN and may require supplemental insulin. C. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection. D. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr.

question

A nurse is caring for a client who is receiving TPN solution. It has been 24 hr since the current bag of solution was hung, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag. B. Infuse the remaining solution at the current rate and then hang a new bag. C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag. D. Remove the current bag and hang a bag of lactated Ringer's solution.

answer

A. CORRECT: The current bag of TPN should not hang more than 24 hr due to the risk of infection.

question

What are the benefits to having a PICC line route for TPN? (name two)

answer

- Access to central vein - Can accommodate hypertonic fluids - Lower risk of phlebitis than PPN - Easier to insert than central line

question

PPN is appropriate for caloric needs that are no more than how many calories per day?

answer

2000 - 2500

question

TPN administration regime whereby nutrients are infused at night, but not during the day.

answer

Cyclic TPN

question

This kind of solution is one with a higher concentration of solutes outside the cell than inside the cell. It has a higher osmolality than the comparison solution.

answer

Hypertonic Hyp*e*rtonic *e*nters the vessel *I*sotonic stays where *I* put it Hyp*o*tonic goes *o*ut of the vessel

question

This kind of solution has a lower concentration of solutes outside the cell than inside the cell. It has a lower osmolality than the comparison solution.

answer

Hypotonic Hyp*o*tonic goes *o*ut of the vessel *I*sotonic stays where *I* put it Hyp*e*rtonic *e*nters the vessel

question

This kind of solution is one in which its effective osmole concentration is the same as the solute concentration of a cell. It has approximately the same osmolality of the comparison solution.

answer

Isotonic *I*sotonic stays where *I* put it Hyp*o*tonic goes *o*ut of the vessel Hyp*e*rtonic *e*nters the vessel

question

Parenteral nutrition is administered A. intramuscularly. B. into the stomach. C. into the small intestine. D. into the circulatory system.

answer

D. Into the circulatory system

question

The digestive tract is used as the route for nutrient delivery whenever possible to prevent: A. thrombosis and cardiac arrest. B. diarrhea and sepsis. C. hunger and constipation. D. GI atrophy and sepsis.

answer

D. GI atrophy and sepsis.

question

3. Medical conditions for which TPN may be indicated include: A. AIDS-related enteropathy. B. cardiovascular disease. C. acute pancreatitis D. bowel infarction E. all of the above. F. A, C and D only.

answer

F. A, C and D only.

question

True or False? With PPN, nutrients are supplied to the superior vena cava.

answer

False!

question

True or False? When nutrient needs are high and the patient must be on parenteral nutrition for a long period of time, TPN is the appropriate choice.

answer

True!

question

True or False? IV lipids are hypertonic.

answer

False!

question

True or False? The maximum kcalories tolerated with PPN is about 1000 kcal/day?

answer

False!

question

True or False? Up to about 90 g/day of protein can be supplied via PPN.

answer

True!

question

True or False? Protein, carbohydrates, and vitamin/minerals contribute to solution osmolarity.

answer

True!

question

The complication that can arise when a hypertonic solution is introduced to a small vein is: A. infarction. B. thrombosis. C. sepsis. D. dehydration.

answer

B. thrombosis.

question

The purpose(s) of lipid emulsion in PN therapy is/are to: A. Provide kcalories. B. provide essential fatty acids. C. provide essential amino acids. D. two of the above. E. all of the above.

answer

D. two of the above. - Provide kcalories. - provide essential fatty acids.

question

Contraindications for lipid emulsions include: A. Diabetes mellitus. B. Acute pancreatitis with hyperlipidemia. C. Severe egg allergy. D. Hyperlipidemia. E. B and D only. F. B, C and D only.

answer

F. B, C and D only.

question

True or False? The PN patient should receive lipid emulsions every day.

answer

False!

question

Why is the TPN infusion started slowly? A. To prevent fluid overload. B. So the body has time to adapt to the glucose load. C. So the body has time to adapt to the hypotonic solution. D. So the body has time to adapt to the protein load. E. A and B only. F. A, B and D only.

answer

E. A and B only.

question

True or False? With cyclic TPN, the patient receives the infusion 24 hours a day.

answer

False!

question

True or False? If, for some reason, the infusion must be stopped for a period of time, the rate should be increased upon commencement of the infusion to "catch up" so that the day's kcalorie and protein needs can be met.

answer

False!

question

What should the nurse observe for when a patient switches from continuous TPN to cyclic TPN?

answer

Signs of: Glucose Overload Fluid Imbalance

question

True or False? Cyclic TPN reduces the risk of hepatotoxicity and allows essential fatty acids to be released from body stores.

answer

True!

question

With TPN infusion initiation, _______ liter(s) of solution is/are infused the first day, then the infusion is increased by _______ liter(s) a day until the desired volume is reached. A. 1; 1. B. 1; 2. C. 2; 1 D. 0.5; 0.5

answer

A. 1; 1.

question

True or False? Pneumothorax is caused by a sudden cessation of TPN infusion.

answer

False!

question

True or False? In monitoring the TPN patient, fluid input/output should be recorded every day.

answer

True!

question

A weight gain of greater than _______ lb(s). per day indicates fluid retention. A. 0.5 B. 1.0 B. 1.5 D. 2.0

answer

A. 0.5

question

A potential complication associated with the sudden cessation of the TPN infusion is: A. rebound hypoglycemia B. pneumothorax C. kidney failure D. nutritional recovery syndrome

answer

A. rebound hypoglycemia

question

250 mL of a 10% lipid emulsion provides _______ kcalories. A. 250 kcals. B. 275 kcals. C. 500 kcals. D. 550 kcals.

answer

B. 275 kcals 10% solution = 1.1 kcal / mL 250 x 1.1 = 275

question

250 mL of a 20% lipid emulsion provides _______ kcalories. A. 250 kcals. B. 275 kcals. C. 500 kcals. D. 550 kcals.

answer

C. 500 kcals. 20% solution = 2 kcal / mL 250 x 2 = 500

question

What is the maximum lipid tolerance (in grams) for a patient who weighs 70 kg? A. 125 g B. 175 g C. 250 g D. 375 g

answer

B. 175 g Maximum fat-emulsion amount should not exceed a dose of 2.5g/kg/day and should be administered slowly over 12 hours 2.5 x 70 = 175

question

A nurse is caring for a cient who is receiving enteral tube feedings. The client requires 2000 cal / day to meet his caloric needs. The tube feeding prescribed provides 2 cal / mL. How many mL/hr should the nurse set the pump to administer the tube feeding within 24 hr? (round to nearest whole number)

answer

42 mL 2000 calories / 2 calories per mL = 1000 calories 1000 / 24 = 41.66

question

Excessive lipid administration may suppress which body system? A. Digestive B. Respiratory C. Immune D. Endocrine

answer

C. Immune

question

True or False? Lipids are often hung separately, or piggyback into EN?

answer

True!

question

Lipid solutions could be a potential source of Vitamin K. In which pharmacological therapy could that be contraindicated?

answer

Could pose a problem in the patient on anticoagulants.

question

You need at least ____% of kcals from lipids to prevent Essential Fatty Acid Deficiency.

answer

10%

question

To decrease the risk of overfeeding, an energy intake of how many kcals/kg/day are recommended in a non-obese patient?

answer

25 - 30

question

Is it okay to put additives into lipid solutions?

answer

No - do not mix!

question

The nurse is reviewing the laboratory test results for a 70-year-old patient with lung cancer. The patient was admitted with a diagnosis of malnutrition. Serum albumin level is 4.0 g/dl and prealbumin is 10 mg/dl. The nurse should draw which of the following conclusions? A. The albumin level is normal, and therefore the patient does not have protein malnutrition. B. The albumin level is increased, which is a common finding in patients with cancer who have malnutrition. C. Both the serum albumin and prealbumin levels are reduced, consistent with the admitting diagnosis of malnutrition. D. Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status.

answer

D. Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status. Serum albumin has a half-life of approximately 20 to 22 days; therefore the serum level may lag behind actual protein changes by more than 2 weeks and is therefore not a good indicator of acute changes in nutritional status. Prealbumin has a half-life of 2 days and is a better indicator of recent or current nutritional status.

question

The nurse is caring for a patient admitted to the hospital for asthma who weighs 186 lb (84.5 kg). During dietary counseling, the patient asks the nurse how much protein he should ingest each day. How many grams of protein does the nurse recommend should be included in the diet based on the patient's current weight? A. 24 B. 41 C. 68 D. 93

answer

C. 68 Correct The daily intake of protein should be between 0.8 and 1 g/kg of body weight. Thus this patient should take in between 68 and 84 g of protein per day in the diet. **From PPT notes: Protein should be provided at the rate of 1 to 1.5 g/kg/day depending on the patient's needs.**

question

A patient with dysphagia from a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the following interventions should the nurse integrate into this patient's care? A. Flush the tube with 30 ml of normal saline every 4 hours. B. Flush the tube before and after feedings if the patient's feedings are intermittent. C. Flush the PEG with 100 ml of sterile water before and after medication administration. D. To prevent fluid overload, avoid flushing when the patient is receiving continuous feeding.

answer

B. Flush the tube before and after feedings if the patient's feedings are intermittent. The nurse should flush feeding tubes with 30 ml of water (not normal saline) every 4 hours during continuous feeding or before and after intermittent feeding. Flushes of 100 ml are excessive and may cause fluid overload in the patient.

question

Which of the following methods should be used to confirm the placement of a patient's newly-inserted nasogastric (NG) feeding tube? A. X-ray B. Aspiration C. Air auscultation D. Measurement of external length

answer

A. X-ray It is imperative to ensure that an NG tube is situated in the GI tract rather than the patient's lungs. When an NG tube has been recently inserted, it is important to confirm this placement with an x-ray that will identify the tube's radiopaque tip.

question

The nurse recognizes that the majority of patients' caloric needs should come from which of the following sources? A. Fats B. Proteins C. Polysaccharides D. Monosaccharides

answer

C. Polysaccharides Polysaccharides are the complex carbohydrates that are contained in the breads and grains that form the base of the food pyramid. - Carbs should constitute between 45% and 65% of caloric needs - 20% to 35% from fats - 10% to 35% from proteins.

question

A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral nutrition (PN). Which of the following principles should guide the nurse's administration of the patient's nutrition? A. Administration of PN requires clean technique. B. Central PN requires rapid dilution in a large volume of blood. C. Peripheral PN delivery is preferred over the use of a central line. D. Only water-soluble medications may be added to the PN by the nurse.

answer

B. Central PN requires rapid dilution in a large volume of blood. Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is an excellent medium for microbial growth, aseptic technique is necessary during administration. Administration through a central line is preferred over the use of peripheral PN and no medications may be added to PN by the nurse.

question

Which of the following assessments is considered priority in the care of a patient who has recently begun receiving parenteral nutrition (PN)? A. Skin integrity and bowel sounds B. Electrolyte levels and daily weights C. Auscultation of the chest and tests of blood coagulability D. Peripheral vascular assessment and level of consciousness

answer

B. Electrolyte levels and daily weights The use of PN necessitates frequent and thorough assessments. Key focuses of these assessments include daily weights and close monitoring of electrolyte levels. Assessments of bowel sounds, integument, peripheral vascular system, LOC, chest sounds, and blood coagulation may be variously performed, but close monitoring of fluid and electrolyte balance supersedes these in importance.

question

Which needs to be tapered slowly, TPN or PPN?

answer

TPN

question

PPN does not need to be tapered off. Why?

answer

It uses more dilute solution with less dextrose.

question

TPN does need to be tapered off. Why?

answer

To prevent hypoglycemia

question

The nurse is responsible to ensure that PN solution is discontinued and replaced with a new solution if that bag is not empty after how long?

answer

24 hours

question

If fat emulsions are infused separately from PN solution, is it delivered rapidly or slowly?

answer

Slowly

question

How long should a fat emulsion infusion run for?

answer

Slowly over 12 hours

question

A nurse is planning care for a client who has a new prescription for TPN. Which of the following interventions should be included? (select all that apply) A. Obtain CBS 4xday B. Give meds through secondary port on TPN tubing C. Monitor VS three times during 12 hr shift D. Change TPN tubing every 24 hrs E. Ensure a daily aPTT is obtained

answer

A, C, D - Client is at risk of hyperglycemia - VS recommended to assess for fluid overload - Tubing in TPN should be changed every 24hrs.

question

A nurse is caring for a client who is receiving TPN solution. It has been 24hrs since the current bag of solution was hung, and 400 mL remains to infuse. Which of the following is the appropriate nursing action to take? A. Remove current bag, hang new one B. Infuse remaining solution at current rate and hang new bag C. Increase infusion rate so remaining solution is administered within the hour and hang a new bag D. Remove the current bag and hang a bag of lactated ringer's solution

answer

A. The current bag of TPN should not hang more than 24 hrs due to the risk of infection

question

Potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally).

answer

Refeeding Syndrome

question

What is the hallmark biochemical feature of refeeding syndrome?

answer

Hypophosphataemia

question

What lab values do you want to monitor in the patient who may have refeeding syndrome?

answer

- Phosphorous - Magnesium - Potassium - Glucose

question

Pt receiving IV Fat Emulsion therapy should have which levels monitored?

answer

Serum Triglycerides

question

Patients receiving PN

answer

...

STUDY

Fluid And Electrolyte Balance Fluid Volume Excess Nursing Nursing-LPN

HESI Patient Review Susan Wilson (2) – Flashcards 42 terms

Rae Jordan

42 terms

Preview

HESI Patient Review Susan Wilson (2) – Flashcards

question

Based on Susan's assessment data and history, you identify which of the following as a priority nursing diagnosis for Susan at this time?

answer

Deficient fluid volume related to inadequate intake of fluids.

question

With regard to rupture of membranes, which questions are important?

answer

A. "What time did your 'water break'?" C. "What was the color of the fluid?"

question

Based on your assessment, you determine that the fetus is in a/an ____ presentation

answer

Cephalic/vertex/occiput

question

Based on your assessment, you position the ultrasound transducer on Susan's abdomen at the:

answer

right lower quadrant

question

Fetal heart rate increases can be associated with a variety of factors. These include:

answer

the mother receiving the drug Brethine (terbutaline) The mother receiving the drug Yutopar (ritodrine) Maternal fever or infection Fetal anemia Also, Maternal Dehydration Maternal Hyperthyroidism

question

Susan has been monitored for 15 min. Which of the following actions on your part is indicated?

answer

Continue to monitor the fetal heart rate

question

To measure the frequency contractions you examine a 10-minute strip and:

answer

determine the time from the beginning of one contraction to the beginning of the next

question

You perform a vaginal exam to check for shortening and thinning of cervix. This is called

answer

effacement / effacing

question

You also determine that the fetus is at zero station....Your response is based on the knowledge that zero station means that:

answer

the baby's presenting part is at the level of the mother's ischial spines

question

zero station means that

answer

the baby's presenting part is at the level of the mother's ischial spines

question

Based on your assessment of Susan (3 cm dilated, 80% effaced, fetus at zero station) and your interpretation of her data, you determine that she is now in which stage of labor?

answer

Stage one (until cervix is fully dilated)

question

Susan decides to rest in bed. Which of the following positions are acceptable?

answer

right lateral left lateral

question

You remind Susan that it is important for her to try to urinate every two hours. The rationale for this is that a distended bladder can:

answer

interfere with fetal descent cause difficulty in voiding after delivery increase the pain associated with uterine contractions

question

In response to the order for Stradol (butorphanol tartrate), which of the following is indicated?

answer

Administer the Stradol as ordered

question

You determine that Susan is now in which phase of stage one labor?

answer

Active phase

question

A number of factors may affect the length of time a woman's labor will last. These include:

answer

maternal activity and position the parity of the mother fetal position and size

question

What is the best nursing action to take at this time?

answer

Suggest that John take a short break and have another family member coach Susan temporarily

question

You identify this as a/an________ deceleration

answer

Early

question

Early deceleration is caused by

answer

compression of the head

question

The anesthesiologist performs the epidural procedure and Susan begins to feel almost immediate relief from painful contractions. You know that a priority nursing intervention is to:

answer

frequently monitor Susan's blood pressure for hypotension

question

Because Susan had an epidural she has not exhibited some of the signs/behaviors that otherwise characterize the transition phase. These include:

answer

amnesia between contractions diaphoresis reluctance to be touched physical shaking

question

You examine a recent strip from the fetal monitor. The abnormal fetal heart rate pattern you observe is interpreted as a ___ deceleration

answer

late

question

In response to the occurrence of a late deceleration, which of the following actions should be carried out FIRST?

answer

Turn on left side

question

At this point, which of the following would be appropriate advice for Susan?

answer

Let me help you assume the knee-chest position if the urge to push is uncomfortable Don't push yet. Pant through contractions if you need to

question

Based on your assessment of this male neonate, you determine that his 1-minute Apgar score is

answer

question

As Susan and John admire their new son, you notice a sudden gush of blood from Susan's perineum and an apparent lengthening of the umbilical cord. You recognize that these signs indicate

answer

separation of the placenta

question

After the placenta has been expelled, Dr. Cooper asks you to start a Pitocin (oxytocin) drip, at a concentration of 10 units in 1000 mL Lactated Ringer's. You know that Pitocin (oxytocin) is administered at this time to:

answer

stimulate uterine contractions

question

Susan's pitocin drip is infusing with an infusion pump at a rate of 60 mL per hour ___ milliunit of drug is infusing per minute

answer

question

The correct term for the cone shape of a vaginally-delivered infant's head is

answer

molded

question

The newborn is prone to hypothermia because:

answer

Newborns have a large body surface to body weight ratio Blood vessels are close to the skin surface There is minimal subcutaneous fat

question

John asks "Why does he need to have a shot already?" Your explanation to John is based on the knowledge that:

answer

Vitamin K is needed to prevent bleeding problems in the early neonatal period Newborns are unable to synthesize vitamin K due to absence of intestinal flora at birth

question

apply erythromycin ophthalmic ointment to the newborn's eyes to:

answer

protect the infant from gonorrheal or chlamydial infection

question

Which of the following assessments would be considered normal at this time?

answer

Fundus is firm, at the midline, and two fingerbreadths below the umbilicus

question

At the next assessment, Susan's uterus is midline. The fundus feel boggy at one fingerbreadth below the umbilicus, what should you do first?

answer

Massage Susan's uterus

question

the vaginal discharge that occurs during the postpartum period (puerperium), which and consists of blood, tissue, and mucous, is called

answer

lochia

question

Which of the following is the expected progression of lochial changes during the puerperium?

answer

Rubra, serosa, alba

question

The term that describes the expected gradual reduction in size of the uterus after delivery as it contracts to return to normal size is

answer

involution

question

When John describes to you the advantages he sees in breastfeeding, you agree when he says:

answer

breastfed babies experience fewer respiratory illnesses than formula-fed babies breastfed babies are not likely to have allergies to their mother's breast milk breastfeeding is more economical

question

Which of the following statements would indicate that Susan understands correct information on breastfeeding?

answer

To break suction, I will insert my finger into the corner of Jason's mouth before removing him from the breast When Jason has a growth spurt, he will want to nurse more often which will increase my milk supply

question

After delivery, a declining level of estrogen allows for rising levels of the hormone responsible for milk production. You know that the hormone that stimulates milk production is

answer

prolactin

question

The hormone responsible for milk ejection is

answer

oxytocin

question

Susan expresses concern about engorged breasts. Some of her friends have told her that it's painful. You discuss engorgement with Susan and suggest:

answer

to help avoid engorgement, feed Jason at least every 2-3 hours around the clock to help avoid engorgement, make sure Jason is positioned for good milk transfer during feedings if engorgement occurs, express some milk prior to feedings to facilitate latching-on

STUDY

Fluid And Electrolyte Balance Nursing

Chapter 1: Concepts Basic to Perioperative Nursing – Flashcards 18 terms

Misty Porter

18 terms

Preview

Chapter 1: Concepts Basic to Perioperative Nursing – Flashcards

question

What is the nursing model created by the Association of periOperative Registererd Nurses (AORN) featuring domains that are in continuous interaction with the health system and encircling the focus of perioperative nursing practice—the patient?

answer

The Perioperative Patient-Focused Model.

question

What is the expanded perioperative role characterized by handling and cutting tissue, using instruments and medical devices, providing exposure and hemostasis, and suturing, all as components of assisting-at-surgery behaviors?

answer

The registered nurse first assistant (RNFA) is an example of an expanded perioperative nursing role.

question

The AORN publication, Standards of Perioperative Nursing, is an example of what kind of standard?

answer

The AORN Standards are an example of process-based standards.

question

What standards are based on and describe the application of the nursing process in perioperative nursing?

answer

They include the collection and analysis of data, identification of expected outcomes, planning and implementation of care, and evaluation of outcomes.

question

Institutional standards are usually directive about specific actions in specific circumstances within a facility or system. What type of standards typically provide generalized authoritative statements that can be implemented in all settings?

answer

National standards provide generalized authoritative statements that can be implemented in all settings.

question

List the types of advanced practice nurses who may practice in the perioperative environment.

answer

Nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs) are examples of nurses who may practice in the advanced role in the perioperative environment.

question

Define the phase of the nursing process concerned with the collection of relevant data about the patient.

answer

The assessment phase.

question

Define the phase of the nursing process that focuses on identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care.

answer

The nursing diagnosis phase.

question

What is the act of transferring the authority for a selected nursing task or tasks in a selected situation(s) to a competent person?

answer

Delegation.

question

What is the initiative that encompasses improvements in quality and effectiveness, based on ethical and economic perspectives?

answer

Performance improvement is the initiative that encompasses improvements in quality and effectiveness, based on ethical and economic perspectives.

question

Define the phase of the nursing process typically associated with describing the desired or favorable patient condition that can be achieved through nursing interventions.

answer

The outcome identification phase.

question

Define the phase of the nursing process characterized by preparation for what will or may happen and determining the priorities for care.

answer

The planning phase.

question

Define the phase of the nursing process characterized by performing the nursing care activities and interventions that were planned, and responding with critical thinking and orderly action.

answer

The implementation phase.

question

Define the phase of the nursing process that focuses on the patient's progress in attaining identified outcomes.

answer

The evaluation phase.

question

What is the specialty nursing language that provides a uniform and systematic method to collect and document the basic elements of perioperative nursing care?

answer

Perioperative Nursing Data Set (PNDS).

question

What certification is available to perioperative nurses that demonstrates proficiency in support of quality patient care and sets a standard of commitment to the profession of OR nursing?

answer

Certified Nurse, Operating Room (CNOR).

question

Describe the minimal level of education required for an advanced practice nurse.

answer

A Master's degree is required for advanced practice nursing.

question

What are some examples of emerging roles in the OR?

answer

Emerging roles include care coordinator, family liaison, robotics coordinator, and informatics specialist.

STUDY

Fluid And Electrolyte Balance National League For Nursing Nurse Practice Acts

Nursing Fundamentals ATC Farmer Exam 1 Davis Plus Questions – Flashcards 180 terms

Jessica Forbes

180 terms

Preview

Nursing Fundamentals ATC Farmer Exam 1 Davis Plus Questions – Flashcards

question

Which of the following are responsibilities of each state's board of nursing? Select All That Apply 1) Determining the salaries of nurses working in the state 2) Approving nursing education programs 3) Establishing criteria that allow a person to be licensed as a registered nurse 4) Hiring instructors for schools of nursing in the state 5) Developing rules and regulations for guidance to nurses 6) Enforcing the rules that govern nursing

answer

2) Approving nursing education programs 3) Establishing criteria that allow a person to be licensed as a registered nurse 5) Developing rules and regulations for guidance to nurses 6) Enforcing the rules that govern nursing

question

A friend recently graduated from high school and is planning to start a program to become a registered nurse, which will include 2 years of nursing classes plus many liberal arts and science classes. Whoch of the following educational routes is your friend taking to become a nurse? 1) Diploma program 2) Associate degree program 3) Baccalaureate degree program 4) Master's entry program

answer

2) Associate degree program

question

Which of the following trends in the United States is most likely to increase the demand for nurses and other healthcare professionals? 1) Increased access to health and medical information among healthcare consumers 2) Growing proportion of older adults 3) Collective bargaining 4) The women's movement

answer

2) Growing proportion of older adults

question

You work as a labor and delivery nurse in the birthing center of a large hospital. Your hospital follows a model of care in which during a single shift, you are assigned to provide all aspects of care for just one patient. This is an example of which model for nursing care? 1) Case method 2) Functional nursing 3) Team nursing 4) Primary nursing

answer

1) Case method

question

You are currently a registered nurse but would like to become an advanced practical nurse. In particular, you would like to work with patients with cardiovascular disease in the coronary care unit of a hospital. Which advanced practice nursing certification should you pursue? 1) Nurse practitioner 2) Certified registered nurse anesthetist 3) Clinical nurse specialist 4) Certified nurse midwife

answer

3) Clinical nurse specialist

question

In your career as a nurse, you have provided primary, secondary, and tertiary care to a wide variety of patients. Which of the following is an example of primary care? 1) Administering pneumonia immunizations to older adults in a community clinic 2) Administering an antibiotic to a child with strep throat in an ambulatory care center 3) Caring for a patient who is learning to walk again after a traumatic injury in a rehabilitation center 4) Providing in-home hospice care for a patient who is dying of brain cancer

answer

1) Administering pneumonia immunizations to older adults in a community clinic

question

You have received unexpected blood test results for a patient and would like to confirm that there were no errors in the processing of the specimen. Which of the following healthcare professionals should you contact to address this concern? 1) Nursing assistant 2) Physical therapist 3) Physician's assistant 4) Laboratory technologist

answer

4) Laboratory technologist

question

Which of the following is a recommendation for healthcare reform that the American Nurses Association (ANA) published in 2008? 1) Provide universal access to essential healthcare services for all citizens and residents 2) Privatize the entire healthcare system 3) Shift the priority from health promotion to illness care 4) Established a three-payer system for financing healthcare

answer

1) Provide universal access to essential healthcare services for all citizens and residents

question

You are providing care for a 20-year-old who is currently unemployed, has no health insurance, and is struggling financially. Which of the following would it be most appropriate to provide information on? 1) Medicare 2) Medicaid 3) CHIP 4) Individual private insurance

answer

2) Medicaid

question

The following each describes one of five of the stages in Benner's model of the process by which a nurse acquires clinical skills and judgement: novice, advanced beginner, competence, proficient, expert. Put the descriptions in the correct order according to the their corresponding stages. - Can handle patient load and prioritize situations - Can recognize problems in the absence of classic signs and symptoms - Has a more sophisticated use of rules; recognition of abnormal findings but not of significance - Is task oriented and focuses on "learning the rules" - Can see the "big picture," coordinate services, and forecast needs

answer

1) Has a more sophisticated use of rules; recognition of abnormal findings but not the significance 2) Can recognize problems in the absence of classic signs and symptoms 3) Can handle patient load and prioritize situations 4) Is task oriented and focuses on "learning the rules" 5) Can see the "big picture," coordinate services, and forecast needs

question

In the hospital where you work as a registered nurse, nursing tasks are specialized. You are responsible for performing ordered treatments, such as giving injections, taking blood draws, and taking vital signs. A licensed practical nurse distributes medications to patients. A nursing assistant gives bed baths and makes the beds. This is an example of which model of nursing care? 1) Case method 2) Functional nursing 3) Team nursing 4) Primary nursing

answer

2) Functional nursing

question

Which of the following were acknowledged by the American Nurses Association (ANA) in 2010 as key characteristics of registered nursing? Select All That Apply 1) Nursing practice is the same for every nurse 2) Nurses coordinate care by establishing partnerships 3) Care is central to the practice of the registered nurse 4) Registered nurses use a corporate process to plan and provide care to their healthcare consumers 5) A strong link exists between the work environment and the nurse's ability to achieve optimal outcomes 6) The profitability of the healthcare facility is central to the practice of the registered nurse

answer

2) Nurses coordinate care by establishing partnerships 3) Care is central to the practice of the registered nurse 5) A strong link exists between the work environment and the nurse's ability to achieve optimal outcomes

question

Your uncle, who is 56, recently has a heart attack and was in the hospital for emergency coronary bypass surgery. After his stay in the hospital, he was moved to a facility for inpatient, multidisciplinary care for 6 weeks to help him recover and regain function. In which type of care facility was your uncle most likely treated? 1) Ambulatory care center 2) Nursing home 3) Rehabilitation center 4) Assisted living facility

answer

3) Rehabilitation center

question

You are interested in joining a nursing organization that has as one of its primary goals the improvement of working conditions for nurses throughout the world. Which of the following organizations would be best for you to join? 1) American Nurses Association 2) National League for Nursing 3) International Council of Nursing 4) Sigma Theta Tau International

answer

3) International Council of Nursing

question

Which of the following are factors that has a strong influence on the evolution of professional nursing? Select All That Apply 1) Buddhism 2) Societal beliefs 3) Architecture 4) Christianity 5) The marketplace 6) The military

answer

2) Social beliefs 4) Christianity 6) The military

question

You perform a blood draw on a patient and afterward the patient says, "Nobody has ever done such a good job finding my vein and taking a blood sample. You really now what you're doing." What type of knowledge is the patient referring to in this situation? 1) Theoretical knowledge 2) Practical knowledge 3) Self-knowledge 4) Ethical knowledge

answer

2) Practical knowledge

question

What are the two components of "doing" in the full-spectrum nursing concepts? 1) Critical thinking and theoretical knowledge 2) Practical knowledge and the nursing process 3) Self-knowledge and ethical knowledge 4) Patient data and patient preferences and context

answer

2) Practical knowledge and the nursing process

question

Which of the following are examples of critical-thinking attitudes? Select All That Apply 1) Independent thinking 2) Intellectual curiosity 3) Intellectual empathy 4) Intellectual pride 5) Intellectual safety 6) Intellectual perseverance

answer

1) Independent thinking 2) Intellectual curiosity 3) Intellectual empathy 6) Intellectual perseverance

question

While caring for a 6-year-old boy who is adjusting to being in the hospital for the first time, you suggest to his father that he bring in the boy's special blanket and favorite stuffed animal to help ease the transition. Which component of caring are you demonstrating by this action? 1) Knowing 2) Being with 3) Doing for 4) Enabling

answer

4) Enabling

question

You are working with a patient who is in severe pain following a traumatic accident. The patient's religious beliefs prevent her from taking any kind of medication for pain. After experimenting with several different nonpharmacological methods of pain management, you discover that a combination of distractions works: the patient views a television program while receiving a shoulder massage, which is reasonably effective in providing her with relief from pain. Which of the following types of complex thinking is this best an example of? 1) Clinical reasoning 2) Diagnostic reasoning 3) Decision making 4) Problem-solving

answer

4) Problem-solving

question

What are the two components of "caring" in the full-spectrum nursing concepts? 1) Critical thinking and theoretical knowledge 2) Practical knowledge and the nursing process 3) Self-knowledge and ethical knowledge 4) Patient data and patient preferences and context

answer

3) Self-knowledge and ethical knowledge

question

Which of the following are examples of critical-thinking skills? Select All That Apply 1) Subjectively gathering information about a problem or issue 2) Recognizing the need for more information 3) Assuming the credibility and usefulness of sources of information 4) Recognizing gaps in one's knowledge 5) Speaking carefully 6) Separating relevant from irrelevant data

answer

2) Recognizing the need for more information 4) Recognizing gaps in one's knowledge 6) Separating relevant from irrelevant data

question

A hospital administrator calls and asks you to prioritize treatment of a patient who is related to the administrator. This request bothers you, and you decide to report it to your supervisor. Which type of nursing knowledge are you acting on in this situation? 1) Theoretical knowledge 2) Practical knowledge 3) Self-knowledge 4) Ethical knowledge

answer

4) Ethical knowledge

question

After assessing a client, you determine that the client has the following problem: imbalanced nutrition: less that body requirements. At which phase in the nursing process are you? 1) Assessment 2) Diagnosis 3) Planning 4) Implementation

answer

2) Diagnosis

question

Which of the following are components of the definition of critical thinking? Select All That Apply 1) Reasoned thinking 2) Openness to alternatives 3) Adherence to established guidelines 4) Ability to reflect 5) Loyalty to traditional approaches 6) Desire to seek the truth

answer

1) Reasoned thinking 2) Openness to alternatives 4) Ability to reflect 6) Desire to seek the truth

question

You are in the process of assessing a patient who is of another race and religion than yours. As you perform the assessment, you begin to wonder what factors—including the patient's race and religion—may be influencing your behavior in this situation. Which thinking process in the critical-thinking model are you demonstrating? 1) Contextual awareness 2) Inquiry 3) Considering alternatives 4) Reflecting skeptically and deciding what to do

answer

1) Contextual awareness

question

In the course of a day, you encounter many different types of patients. Which of the following patients would most require you to use the most complex critical thinking skills in your care of him or her? 1) An 18-year-old football player who has broken his leg 2) A 60-year-old school teacher who has strep throat 3) A 45-year-old attorney who has developed high blood pressure 4) An 80-year-old woman with diabetes who has broken her hip

answer

4) An 80-year-old woman with diabetes who has broken her hip

question

You have just finished a physical examination of an 8-year-old girl and discovered bruises on her body in places that make you suspect that she has been physically abused. Before you investigate that line of reasoning, however, you stop and think about all the other likely ways that a child her age could obtain bruises in those locations. Which thinking process in the critical-thinking model are you demonstrating? 1) Contextual awareness 2) Inquiry 3) Considering alternatives 4) Reflecting skeptically and deciding what to do

answer

3) Considering alternatives

question

Place the following six phases of the nursing process in correct order. - Evaluation - Planning outcomes - Implementation - Assessment - Planning Interventions - Diagnosis

answer

1) Assessment 2) Diagnosis 3) Planning Outcomes 4) Planning Interventions 5) Implementation 6) Evaluation

question

Which of the following is an example of a nurse who is using critical thinking? 1) Following the hospital's new policy to require a photo ID for all visitors to the birthing center 2) Questioning a medication order from a physician that doubles the patient's dosage when the patient exhibited no changes in a recent office visit 3) Recording the patient's vital signs once an hour, per the physician's request 4) Calculating the proper dosage of a child's oral medication based on established height/weight charts

answer

2) Questioning a medication order from a physician that doubles the patient's dosage when the patient exhibited no changed in a recent office visit

question

You are conducting an initial assessment of a new client. The client does not have time today for a comprehensive assessment, so you will be doing that at the client's next visit. Which of the following types of data should you collect as part of this assessment? Select All That Apply 1) Status of a healing laceration 2) Emotional status 3) Phone number 4) Blood pressure 5) Marital status 6) Occupation

answer

3) Phone number 5) Marital status 6) Occupation

question

A patient is in the examination room waiting to be assessed. You are the registered nurse assigned to assess the patient. You also have a nurse aide assisting you. Which aspects of the patient's assessment would be appropriate for you to delegate to the nurse aide? 1) Take the patient's temperature 2) Weigh the patient 3) Validate the data collected 4) Measure the patient's height 5) Conduct the patient interview 6) Complete the physical assessment

answer

1) Take the patient's temperature 2) Weigh the patient 4) Measure the patient's height

question

As you perform a detailed assessment of a 10-year-old client, the client asks, "Why are you taking so long to check me out?" What is your most appropriate response to this patient? 1) "I have to figure out what's wrong with you." 2) "I have to get enough information so that I can help you." 3) "I have to decide what kind of treatment to give you." 4) "I have to help you feel better."

answer

2) I have to get enough information so that I can help you."

question

During a physical examination, you gather much data on a client. Which of the following are data findings that you should validate? Select All That Apply. 1) A report of a height of 6 feet, 6 inches in a client who appears very tall 2) A blood pressure reading of 80/60 mm Hg in a client with hypertension who is not on medication 3) A heart rate of 40 beats/min in a moderately active 45-year-old 4) A denial of illicit drug use in conjunction with the observation of needle track marks on the client's arm 5) An oral temperature of 98.2*F 6) A total cholesterol score of 245

answer

2) A blood pressure reading of 8-/60 mm Hg in a client with hypertension who is not on medication 3) A heart rate of 40 beats/min in a moderately active 45-year-old 4) A denial of illicit drug use in conjunction with the observation of needle track marks on the client's arm

question

As you perform an assessment of a client, which of the following actions are required by The Joint Commission? Select All That Apply 1) Record findings of the assessment in writing or on a computer tablet 2) Delegate taking the patient's biometric measures to a nurse aide 3) Include evaluation of the client's physical, psychological, and social status in the assessment 4) Follow agency policy regarding when the client is to be reassessed 5) Assess the client for possible physical abuse 6) Assess the client for pain

answer

1) Record findings of the assessment in writing or on a computer tablet 3) Include evaluation of the client's physical, psychological, and social status in the assessment 4) Follow agency policy regarding when the client is to be reassessed 6) Assess the client for pain

question

Which phase of the nursing process uses the data gathered during assessment to identify the client's health problems and strengths? 1) Planning Interventions 2) Implementation 3) Diagnosis 4) Evaluation

answer

3) Diagnosis

question

You are assessing a child with sickle cell disease who is experiencing an acute pain crisis. You are concerned that the child's spleen may be enlarged, which is a serious complication of this disease. You don't see any signs of enlargement in the patient's abdomen but you know that the condition may still be present. You decide to examine the patient's abdomen by feel. Which of the following physical assessment techniques are you using? 1) Inspection 2) Palpation 3) Percussion 4) Auscultation

answer

2) Palpation

question

You are documenting the assessment data of a client. Which of the following is the most appropriate documentation? 1) Patient is angry over a long wait in the waiting room 2) Client is intoxicated 3) Child has bruises from being spanked 4) Patient has a cluster of three clear vesicles on the upper lip

answer

4) Patient has a cluster of three clear vesicles on the upper lip

question

As a new nurse, you are interviewing a 15-year-old client as part of a comprehensive assessment and come to the portion of the health history that relates to her sexual health. You are embarrassed to ask someone her age about her sex life and you fear what her reaction will be. Which of the following actions should you take? 1) Skip this section and assume that the client will mention any problem she has in this area 2) Ask a more experienced nurse to complete the interview 3) Ask to speak to the client's mother about this topic 4) Explain that you will keep all information confidential and then ask the necessary questions

answer

4) Explain that you will keep all information confidential and then ask the necessary questions

question

You are interviewing a client to obtain information about his health history. Because he appears nervous, you begin by using directive interviewing. Which of the following is an example of a question you might ask when using this type of interviewing? 1) "How has your weight loss program been going?" 2) "When was your last physical examination?" 3) "What signs or symptoms have you experienced related to your diabetes?" 4) "How would you describe your work environment?"

answer

2) "When was your last physical examination?"

question

In your interview with a new client, you learn that she drinks six beers a day. In which section of the nursing health history would you record this information? 1) Biographical data 2) Chief complaint 3) Family health history 4) Social history

answer

4) Social history

question

You are assessing the functional abilities of a client who is in hospice care and nearing the end of life. Which of the following special needs assessments would be most appropriate to use with this client? 1) Katz Index of Activities of Daily Living (ADL) scale 2) Lawton Instrumental Activities of Daily Living (IADL) scale 3) Karnofsky Performance scale 4) Wellness assessment

answer

3) Karnofsky Performance scale

question

You have just completed a client assessment and need to record the data you have gathered. Which of the following guidelines should you observe as you complete this task? Select All That Apply. 1) Wait at least 24 hours before recording 2) If recording on paper, write only with pencils 3) Write the patient's own words, when possible, in quotation marks 4) Record only the most important patient words 5) Record inferences, not cues 6) Use concrete, specific information rather than vague generalities

answer

3) Write the patient's own words, when possible, in quotation marks 4) Record only the most important patient words 6) use concrete, specific information rather than vague generalities

question

You are preparing for an interview with a client and deciding how to incorporate directive and nondirective interviewing techniques. Which of the following is a disadvantage of directive interviewing? 1) It may cause you to miss topics important to the patient 2) It is ineffective 3) It can produce much irrelevant data 4) It is not effective for clients who are anxious

answer

1) It may cause you to miss topics important to the patient

question

A patient arrives at the clinic where you work complaining of pain in her temples. She describes the pain as throbbing and intense. This is an example of which type of data? 1) Primary subjective 2) Primary objective 3) Secondary subjective 4) Secondary objective

answer

1) Primary subjective

question

As you are weighing a client and calculating her body mass index, you begin to think that a diagnosis of "Imbalanced nutrition: more than body requirements" would be appropriate for this client. Which of the following is true of this guess? 1) It illustrates that nursing diagnosis actually begins during assessment 2) It is an example of a nurse not properly following the nursing process 3) It is an example of the nurse making a medical diagnosis, which should not be done 4) It proves that the nursing process need not be followed

answer

1) It illustrates that nursing diagnosis actually begins during assessment.

question

You have written your diagnostic statements for a client. Which of the following criteria should you use to judge their quality? Select All That Apply 1) In choosing a NANDA-I label, do not rely on the label definition alone 2) Include both problem and etiology, with cause and effect stated correctly 3) Be sure that the etiology restates the problem 4) Use medical diagnosis and treatments as etiological factors 5) Write the statement concisely 6) Be sure the statement is descriptive and specific

answer

1) In choosing a NANDA-I label, do not rely on the label definition alone. 2) Include both problem and etiology, with cause and effect stated correctly. 5) Write the statement concisely. 6) Be sure the statement is descriptive and specific.

question

You are in the process of selecting a diagnostic label for a health problem of a client. Which of the following is the first step you should take in this process? 1) Narrow your search to the class or most likely labels 2) Identify the domain that seems to fit the cue cluster 3) Consult a nursing diagnosis handbook 4) Compare definitions and defining characteristics of the diagnostic labels to your cue cluster

answer

2) Identify the domain that seems to fit the cue cluster.

question

You are caring for a client who complains of having hard stool and of not having had a bowel movement in 3 or 4 days. You suspect that the client has constipation. Moreover, after seeing his intake and output measures, you believe that the constipation is caused by inadequate intake of fluids and fiber-rich foods. Which of the following would be an appropriate nursing diagnosis based on these findings? 1) Hard stool and bowel movement every 3 or 4 days r/t constipation AMB inadequate intake of fluids and fiber-rich foods 2) Inadequate intake of fluids and fiber-rich foods r/t constipation AMB painful, hard tool and bowel movement every 3 or 4 days 3) Constipation r/t inadequate intake of fluids and fiber-rich foods AMB painful, hard tool and bowel movement every 3 or 4 days 4) Hard stool and bowel movement every 3 or 4 days r/t inadequate intake of fluids and fiber-rich foods AMB constipation

answer

3) Constipation r/t inadequate intake of fluids and fiber-rich foods AMB painful, hard tool and bowel movement every 3 or 4 days

question

Which of the following is an example of an actual nursing diagnosis? 1) Risk for infection related to surgery 2) Impaired walking related to a diabetic ulcer 3) Possible risk for imbalanced nutrition: less than body requirements 4) Readiness for enhanced nutrition

answer

2) Impaired walking related to a diabetic ulcer

question

While caring for a patient in the hospital, you note ulcers on the patient's feet. You recall that the patient's laboratory test results indicated a high blood glucose level. Which of the following is an appropriate nursing diagnosis that you could make in this situation? 1) Advanced type 2 diabetes mellitus 2) Staphylococcus infection of the feet 3) Impaired tissue integrity 4) Potential complication of type 2 diabetes mellitus: hyperglycemia

answer

3) Impaired tissue integrity

question

You are reflecting critically on your diagnostic reasoning after formulating a nursing diagnosis. Which of the following questions should you ask yourself to evaluate your self-knowledge? Select All That Apply. 1) Is this diagnosis based on sound knowledge? 2) What biases and stereotypes may have influenced my interpretation of the data? 3) Did I rely too much on past experiences? 4) Do I feel reasonably sure I have interpreted the data correctly? 5) Did I rely too much on the client's medical diagnosis, the setting, or what others say about the client instead of on the data? 6) Am I qualified to make this diagnosis, or should I consult with a more experienced nurse or other member of the collaborative healthcare team?

answer

2) What biases and stereotypes may have influenced my interpretation of the data?3) Did I rely too much on past experiences? 6) Am I qualified to make this diagnosis, or should I consult with a more experienced nurse or other member of the collaborative healthcare team?

question

Which of the following is the first step in the process of analyzing and interpreting data? 1) Cluster cues 2) Identify data gaps 3) Identify significant data 4) Identify data inconsistencies

answer

3) Identify significant data

question

Which of the following is the best definition of health problem? 1) Any condition that requires intervention to promote wellness or to prevent or treat disease or illness 2) A statement of client health status that nurses can identify, prevent, or treat independently 3) A description of a disease, illness, or injury developed so that appropriate medical treatment can be given 4) A complication related to a disease that a nurse monitors to detect a change in status

answer

1) Any condition that requires intervention to promote wellness or to prevent or treat disease or illness

question

You are preparing to write a collaborative problem diagnosis. Which of the following elements is typically left out of a collaborative problem? 1) Complication 2) Disease 3) Etiology 4) The word potential

answer

3) Etiology

question

Which of the following is an example of a wellness nursing diagnosis? 1) Risk for infection related to surgery 2) Impaired walking related to a diabetic ulcer 3) Possible risk for imbalanced nutrition: less than body requirements 4) Readiness for enhanced nutrition

answer

4) Readiness for enhanced nutrition

question

You are working with a client in the hospital who has lost 5 pounds since being admitted. You recognize that this client is probably experiencing imbalanced nutrition: less than body requirements. Which of the following are likely etiologies related to this diagnosis? Select All That Apply. 1) Excessive fear of weight gain 2) Self-induced vomiting related to self-starvation 3) Diet high in fat 4) Inability to ingest food 5) Lack of physical activity 6) Depression

answer

1) Excessive fear of weight gain 2) Self-induced vomiting related to self-starvation 4) Inability to ingest food 6) Depression

question

Put the following steps of the diagnostic reasoning process in the correct order. - Verify problems with the patient. - Analyze and interpret data. - Record the diagnostic statements. - Draw conclusions about the patient's health status. - Prioritize the problems.

answer

1) Analyze and interpret data 2) Verify problems with the patient 3) Draw conclusions about the patient's health status 4) Record the diagnostic statements 5) Prioritize the problems

question

Which of the following is an accurate statement regarding the relationship of the nursing diagnosis to outcomes and interventions? 1) The problem suggests the goals. 2) The etiology suggests the problem. 3) The goals suggest the etiology. 4) The interventions suggest the etiology.

answer

1) The problem suggests the goals.

question

You are preparing to prioritize the health problems that you have identified for a patient. You have decided to prioritize them based on the problems that relate to the client's most basic human needs. Which theoretical framework are you using? 1) Problem urgency 2) Future consequences 3) Patient preference 4) Maslow's hierarchy

answer

4) Maslow's hierarchy

question

You are creating a comprehensive care plan for a patient. Which of the following are examples of appropriate information to include in this plan? Select All That Apply. 1) Assistance the patient will require with bathing 2) Prescriptions for an antibiotic and an analgesic 3) A detailed family health history 4) A nursing diagnosis of "Impaired mobility related to fractured toe" 5) Information on the patient's insurance plan 6) Special teaching on care of an ostomy pouch

answer

1) Assistance the patient will require with bathing 2) Prescriptions for an antibiotic and an analgesic 4) A nursing diagnosis of "Impaired mobility related to fractured toe" 6) Special teaching on care of an ostomy pouch

question

You are caring for a patient who is experiencing significant pain following surgery. You have been administering acetaminophen by mouth for the past 24 hours but can clearly see that the patient's pain level is high. You add a note to the patient's care plan and notify the patient's provider about the pain, recommending a change in medication. Which type of planning is this? 1) Initial, formal 2) Initial, informal 3) Ongoing, formal 4) Ongoing, informal

answer

3) Ongoing, formal

question

Your hospital has recently implemented a new electronic health record system that includes computer-generated care plans. Which of the following are advantages of computerized planning? Select All That Apply. 1) Increases the use of intuition 2) Ensures consideration of a variety of actions 3) Prevents overlooking common and important interventions4) Increases the use of insight 5) Reduces time spent on paperwork 6) Enhances nursing expertise

answer

2) Ensures consideration of a variety of actions 3) Prevents overlooking common and important interventions 5) Reduces time spent on paperwork

question

You are using the standardized Nursing Outcomes Classification (NOC) vocabulary to develop patient outcomes. In NOC vocabulary, the observable behaviors and states you can use to evaluate patient status are which of the following? 1) Indicators 2) Outcomes 3) Measurement scales 4) Outcome labels

answer

1) Indicators

question

You are formulating a goal for a patient who is experiencing a disturbed sleep pattern related to anxiety about finances. Which of the following would be specific and concrete performance criteria for such a goal? Select All That Apply. 1) Will return to a normal sleep pattern 2) Will sleep at least 8 hours each night 3) Will fall asleep within 1 hour of going to bed 4) Will get enough sleep at night 5) Will report feeling rested in the morning 6) Will sleep more

answer

2) Will sleep at least 8 hours each night 3) Will fall asleep within 1 hour of going to bed 5) Will report feeling rested in the morning

question

You are preparing to discharge a client and are deciding whether you need to create a comprehensive, formal discharge plan. Which of the following client characteristics or situations would tend to necessitate a formal discharge plan? Select All That Apply. 1) Mental illness 2) Medication continued at home 3) Complicated major surgery 4) Inadequate financial resources 5) A significant other to help provide care 6) Malnutrition

answer

1) Mental illness 3) Complicated major surgery 4) Inadequate financial resources 6) Malnutrition

question

You have given a client the following nursing diagnosis: Ineffective Airway Clearance related to ineffective cough secondary to incisional pain. Which of the following is an example of an essential patient goal related to this diagnosis? 1) Coughs forcefully/effectively 2) Rates pain as < 3 on a scale of 1 to 10 scale 3) Splints incision while coughing 4) Lungs clear to auscultation

answer

4) Lungs clear to auscultation

question

Below are the steps in the process for writing an individualized patient care plan. Put them in the correct order. - Transcribe medical orders to appropriate documents - Write activities of daily living and basic care needs in special sections of the Kardex, care plan, or computer - Make a working problem list - Develop individualized care plans for problems not addressed by standardized documents - Decide which problems can be managed with standardized care plans or critical pathways - Individualize the standardized plan as needed

answer

1) Individualize the standardized plan as needed 2) Write activities of daily living and basic care needs in special sections of the Kardex, care plan, or computer 3) Make a working problem list 4) Transcribe medical orders to appropriate documents 5) Decide which problems can be managed with standardized care plans or critical pathways 6) Develop individualized care plans for problems not addressed by standardized documents

question

You have diagnosed a patient with the following nursing diagnosis: Possible Constipation related to suspected inadequate intake of fiber and fluids. Which of the following is the appropriate patient goal to address this diagnosis? 1) Will have normal, formed bowel movement within 24 hours after receiving stool softener 2) Will have bowel function within normal limits for patient 3) There is no patient goal. 4) Reports increased intake of dietary fiber and fluids

answer

3) There is no patient goal.

question

You have given a client you are working with a nursing diagnosis of "Impaired Mobility related to atrophied muscles from confinement to bed." Which of the following states an appropriate long-term goal that addresses that problem? 1) Walk three steps using a walker 2) Walk down the hall and back unassisted 3) Perform exercises daily to strengthen legs 4) Client resists efforts at rehabilitating his legs

answer

2) Walk down the hall and back unassisted

question

In preparing a care plan for a patient, you decide to use a preprinted plan. The plan you choose groups patients according to diagnosis, describes the minimal standard of care required to meet the recommended length of stay, and specifies patient outcomes and broad interventions for each day and each hour. Which type of plan have you chosen? 1) Unit standards of care 2) Critical pathway 3) Standardized patient care plan 4) Integrated plans of care

answer

2) Critical pathway

question

A new nurse you are training asks why you have to write down the patient care plan. She tells you that at her last job, she didn't have to write anything down. Which of the following reasons would you tell her? Select All That Apply. 1) To ensure that care is complete 2) To help instill confidence in patients 3) To provide continuity of care 4) To promote efficient use of nursing efforts 5) To provide a guide for assessments and charting 6) To meet the requirements of accrediting agencies

answer

1) To ensure that care is complete 3) To provide continuity of care 4) To promote efficient use of nursing efforts 5) To provide a guide for assessments and charting 6) To meet the requirements of accrediting agencies

question

During your physical examination of a new client, you observe that she appears underweight and you make a mental note that she may require counseling related to disordered eating. Which type of planning is this? 1) Initial, formal 2) Initial, informal 3) Ongoing, formal 4) Ongoing, informal

answer

2) Initial, informal

question

You are formulating goals as part of creating an individualized care plan for a client. Which of the following is a goal or expected outcome, as opposed to just an outcome? 1) Constipation relieved 2) Pain level unchanged 3) Anxiety related to pending surgery 4) Allergic reaction to penicillin

answer

1) Constipation relieved

question

A patient is becoming discouraged because she is struggling to relearn how to brush her teeth after a stroke. You decide to have her first attempt to grasp her modified toothbrush handle and hold it up for 10 seconds. This is an example of which of the following? 1) Short-term goal 2) Long-term goal 3) Short-term outcome 4) Long-term outcome

answer

1) Short-term goal

question

Nursing interventions are actions based on clinical judgment and nursing knowledge that nurses perform to achieve client outcomes. Interventions are also referred to as which of the following? Select All That Apply. 1) Goals 2) Outcomes 3) Nursing actions 4) Measures 5) Strategies 6) Activities

answer

3) Nursing actions 4) Measures 5) Strategies 6) Activities

question

Put the following steps in the evidence-based practice process in correct order. - Formulating an answerable question about prevention, diagnosis, prognosis (likely outcome), and interventions - Evaluating or grading the quality of the evidence obtained - "Translating" the evidence into guidelines for practice - Integrating the guidelines and evidence with clinical expertise and the patient's preferences and characteristics - Compiling and analyzing the data to prepare a structured report of the review - Conducting a systematic review of published evidence (research) to find studies that shed light on the desired topic

answer

1) Formulating an answerable question about prevention, diagnosis, prognosis (likely outcome), and interventions 2) Evaluating or grading the quality of the evidence obtained 3) Integrating the guidelines and evidence with clinical expertise and the patient's preferences and characteristics. 4) Compiling and analyzing the data to prepare a structured report of the review 5) "Translating" the evidence into guidelines for practice 6) Conducting a systematic review of published evidence (research) to find studies that shed light on the desired topic

question

You are reflecting critically about a nursing order you have just composed for a client. You should make sure that the order is which of the following? Select All That Apply. 1) Complete, addressing all aspects of the problem 2) Generic, able to be used for a wide variety of clients 3) Clear, specific, and precise, avoiding vague language 4) Long and complex, including the details of all procedures 5) Technically complete, including all required components 6) Prioritized, indicating which orders must be implemented immediately

answer

1) Complete, addressing all aspects of the problem 3) Clear, specific, and precise, avoiding vague language 5) Technically complete, including all required components 6) Prioritized, indicating which orders must be implemented immediately

question

In caring for a patient who is confined to bed in the hospital for many weeks, you are seeking interventions to help prevent decubitus ulcers, or pressure sores. You decide to conduct a systematic review of published research to find studies that shed light on this topic. This action is an example primarily of which of the following? 1) Theory 2) Critical pathway 3) Evidence-based practice 4) Protocol

answer

3) Evidence-based practice

question

You are preparing to perform a blood draw on a client who is seated in a phlebotomy chair. The client appears pale and confesses that he "gets squeamish" at the sight of blood. Which of the following responses best illustrates the use of the critical-thinking skill of predicting to help generate an intervention in this situation? 1) With other clients who were squeamish, I have successfully distracted them by making small talk; maybe that will work for this client. 2) Because the client is squeamish, he may faint during the blood draw, so I should have him lie down. 3) I learned in a music therapy workshop that music can help calm anxious clients; perhaps I should play some soft music. 4) This client is experiencing a vasovagal response, in which the parasympathetic nervous system is triggered by a threat in the environment.

answer

2) Because the client is squeamish, he may faint during the blood draw, so I should have him lie down.

question

Below are the steps for selecting the best nursing intervention for each patient. Put them in the correct order. - Identify several interventions or actions - Review the nursing diagnosis - Choose the best interventions for the patient - Review the desired patient outcomes - Individualize standardized interventions

answer

1) Review the desired patient outcomes 2) Individualize standardized interventions 3) Identify several interventions or actions 4) Review the nursing diagnosis 5) Choose the best interventions for the patient

question

You are providing wellness teaching to a client who frequently experiences constipation. Which of the following interventions would be most appropriate in this situation? 1) Recommend an over-the-counter laxative 2) Administer a prescribed stool softener 3) Obtain more data to confirm or rule out constipation 4) Provide the patient with a daily fluid intake guide to promote optimal health

answer

4) Provide the patient with a daily fluid intake guide to promote optimal health

question

You are researching standardized intervention classification systems to find spiritual care interventions to use with your clients. Which of the following are some spiritual care interventions you might consider? Select All That Apply 1) Spiritual growth facilitation 2) Religious ritual enhancement 3) Decision-making support 4) Health screening 5) Spiritual support 6) Bereavement support

answer

1) Spiritual growth facilitation 2) Religious ritual enhancement 5) Spiritual support 6) Bereavement support

question

You are writing up a nursing order for a client. Which of the following components should you include in it? Select All That Apply. 1) Date 2) Subject 3) Prescribed medications 4) Action verbs 5) Times and limits 6) Signature

answer

1) Date 2) Subject 4) Action verbs 5) Times and limits 6) Signature

question

Which of the following is an example of an interdependent intervention? 1) Assisting the client in performing leg exercises and reporting results to the physical therapist 2) Administering a prescribed antibiotic 3) Collecting a stool sample per orders 4) Encouraging the client to increase fluid intake to prevent dehydration

answer

1) Assisting the client in performing leg exercises and reporting results to the physical therapist

question

While caring for a patient one day, you perform many interventions, both direct care and indirect care. Which of the following is an example of an indirect-care intervention? 1) Teaching a patient how to care for an incision site 2) Administering an injection 3) Listening to the patient explain fears related to death 4) Making a referral for the patient to see a speech pathologist

answer

4) Making a referral for the patient to see a speech pathologist

question

You are a home health nurse and are planning interventions for a client who is recovering from a stroke. You would like to use an intervention classification system that is especially designed to meet the needs of home health nursing. Which of the following systems should you choose? 1) North American Nursing Diagnosis Association—International (NANDA-I) 2) Nursing Interventions Classification (NIC) 3) Clinical Care Classification (CCC) 4) Omaha System

answer

3) Clinical Care Classification (CCC)

question

You are caring for a patient for whom you have given the actual nursing diagnosis of constipation. Based on the status of this problem, which of the following interventions should take priority? 1) Encourage the patient to drink more fluids 2) Administer a prescribed stool softener 3) Obtain more data to confirm or rule out the constipation 4) Provide the patient with a daily fluid intake guide to promote optimal health

answer

2) Administer a prescribed stool softener

question

You are counseling a client on potential lifestyle changes to optimize her health. Which of the following is an appropriate wellness intervention for the client? 1) "The client will spend at least 15 minutes per day meditating for the next week." 2) "I will walk at least 1 mile every day at lunch time with a coworker for the next month." 3) "The client will take all prescribed medications at the right time for the next 3 months." 4) "I will perform hand exercises daily to regain strength lost following carpal tunnel surgery."

answer

2) "I will walk at least 1 mile every day at lunch time with a coworker for the next month."

question

Throughout your day as a nurse, you make many interventions, both independent and dependent. Which of the following is an example of an independent intervention? 1) Administering a prescribed analgesic 2) Delegating the bathing of a patient to a nurse aide 3) Drawing blood for an ordered complete blood count 4) Starting IV therapy

answer

2) Delegating the bathing of a patient to a nurse aide

question

You are preparing to discharge a client and have concerns about his ability to adhere to the diabetic diet that you and the nutritionist have developed for him. Which of the following are effective ways to promote cooperation with the diet? Select That All Apply. 1) Assess the client's knowledge of diabetes. 2) Ask the client what concerns he has about going on the diet. 3) Provide teaching on what foods to avoid and what foods will help keep his blood glucose level steady. 4) Talk openly and regularly about adherence. 5) Be determined to change any of the client's attitudes that contribute to resistance to the diet. 6) Help the client set ambitious, challenging goals.

answer

1) Assess the client's knowledge of diabetes. 2) Ask the client what concerns he has about going on the diet. 3) Provide teaching on what foods to avoid and what foods will help keep his blood glucose level steady. 4) Talk openly and regularly about adherence.

question

You are critically reflecting on variables that could have affected the results of an intervention. Which of the following should you consider? Select All The Apply. 1) Client's ability and motivation to follow directions for treatment 2) Effectiveness of the same treatment in clients in other regions 3) Availability and support from family and significant others 4) Client's family history 5) Client's lack of experience, knowledge, or ability 6) Staffing in the institution

answer

1) Client's ability and motivation to follow directions for treatment 3) Availability and support from family and significant others 5) Client's lack of experience, knowledge, or ability 6) Staffing in the institution

question

Which of the following are key components of the implementation phase? Select All That Apply. 1) Diagnosing 2) Data gathering 3) Doing 4) Documenting 5) Decision making 6) Delegating

answer

3) Doing 4) Documenting 6) Delegating

question

You are evaluating a client's collaborative problem of Potential Complication of myocardial infarction: congestive heart failure (CHF). Which of the following should be your primary goal in such evaluation? 1) Client reports no pain. 2) Client's reassessment data are within normal range. 3) Client achieves activities of daily living. 4) Client does not have another heart attack.

answer

2) Client's reassessment data are within normal range.

question

As you are preparing to implement your nursing plan for applying dressings to a client who has sustained third-degree burns, you decide that it would be best to include times during each intervention that you will stop and check in with the client before continuing. This action is known as which of the following? 1) Checking your knowledge and abilities 2) Preparing supplies and equipment 3) Establishing feedback points 4) Preparing the patient

answer

3) Establishing feedback points

question

A scale is reliable if it does which of the following? 1) Functions for many years 2) Yields consistent results time after time 3) Is accurately measuring a person's mass or weight 4) Is achieving expected or accepted levels of performance

answer

2) Yields consistent results time after time

question

You are preparing to delegate several tasks to a licensed vocational nurse. Which of the following "rights" of delegation should you keep in mind as you do this? Select All That Apply. 1) Right task 2) Right circumstance 3) Right dosage 4) Right person 5) Right communication 6) Right supervision

answer

1) Right task 2) Right circumstance 4) Right person 5) Right communication 6) Right supervision

question

You are now entering the implementation phase of the nursing process with a client. Which of the following are actions that would be appropriate to take in the implementation phase? Select All That Apply. 1) Write up a nursing order for the client. 2) Reposition a pregnant patient to her side to prevent compression of the inferior vena cava vein. 3) Develop expected outcomes related to a patient's progress with feeding himself. 4) Document a patient's anaphylactic response to a medication. 5) Delegate the application of cold compresses to the patient's forehead to a nurse aide. 6) Interview the patient to obtain a detailed health history.

answer

2) Reposition a pregnant patient to her side to prevent compression of the inferior vena cava vein. 4) Document a patient's anaphylactic response to a medication. 5) Delegate the application of cold compresses to the patient's forehead to a nurse aide.

question

One of your patients needs to be transported via wheelchair to radiology for a chest x-ray. You have a nurse aide perform this task. This is an example of which of the following? 1) Assigning 2) Delegating 3) Collaborating 4) Coordinating

answer

2) Delegating

question

Which of the following is a program designed to promote excellence in nursing? 1) Quality assurance 2) Reliability 3) Validity 4) Collaboration

answer

1) Quality assurance

question

A client has been on cholesterol medication for 6 months now and recently had her cholesterol level checked. Although greatly improved, the cholesterol level is still above normal. The client will return in another 6 months to have her cholesterol checked again. Which type of evaluation is this? 1) Initial evaluation 2) Ongoing evaluation 3) Intermittent evaluation 4) Terminal evaluation

answer

3) Intermittent evaluation

question

After evaluating a care plan, you determine that some goals have been met but others have not. Which of the following would be the most appropriate actions to take at this point? Select All That Apply. 1) Discontinue the care plan. 2) Examine the entire plan. 3) Revise the care plan only in the areas of the unmet goals. 4) Review all steps of the nursing process. 5) Revise the entire plan. 6) Continue with the same plan but allow more time for goal achievement.

answer

3) Revise the care plan only in the areas of the unmet goals. 6) Continue with the same plan but allow more time for goal achievement.

question

You are performing an evaluation of the adequacy of your facility's radiography equipment to meet the imaging demands of patients. Which type of evaluation are you conducting? 1) Structure 2) Process 3) Outcomes 4) Reliability

answer

1) Structure

question

You are training a new nurse on the evaluation phase of the nursing process. The nurse asks why evaluation is important. Which of the following are correct rationales for evaluation that you should tell the nurse? Select All That Apply. 1) To identify incompetent nurses so that they may be terminated 2) To ensure positive outcomes for patients 3) To conserve scarce resources 4) To validate established nursing practices 5) To satisfy professional standards of practice 6) To help ensure nursing's survival

answer

2) To ensure positive outcomes for patients 3) To conserve scarce resources 5) To satisfy professional standards of practice 6) To help ensure nursing's survival

question

Below are the steps for evaluating patient progress. Put them in the correct order. - Record the evaluative statement - Judge goal achievement - Review outcomes - Collect reassessment data

answer

1) Record the evaluative statement 2) Judge goal achievement 3) Collect reassessment data 4) Review outcomes

question

Which of the following are the four essential concepts of a nursing theory? 1) Nurse, context, patient, and health 2) Caring, person, theory, and nursing 3) Health, setting, patient, and treatment 4) Person, environment, health, and nursing

answer

4) Person, environment, health, and nursing

question

You decide to conduct a qualitative study of asthma. Which of the following might be characteristics of such a study? Select All That Apply. 1) Goal of generalizing results to a similar population 2) Large numbers of subjects 3) Focus on the lived experience of a 12-year-old girl with asthma 4) Use of words and quotations from people interviewed 5) Controlled data collection 6) Purpose of sharing the experience of people in the study

answer

3) Focus on the lived experience of a 12-year-old girl with asthma 4) Use of words and quotations from people interviewed 6) Purpose of sharing the experience of people in the study

question

You decide to develop your own theory of nursing. You begin by taking it for granted that all nurses have an impulse to serve those who are in need. This idea is an example of which of the following? 1) Phenomenon 2) Assumption 3) Concept 4) Definition

answer

2) Assumption

question

Which of the following are true of theory? Select All That Apply. 1) A theory is a fact. 2) A theory is based on observations of facts. 3) A theory is a collection of random and unrelated ideas and concepts. 4) A theory helps us find meaning in our experiences. 5) A theory is a way of viewing reality. 6) A theory answers the question "Who am I?"

answer

2) A theory is based on observations of facts. 4) A theory helps us find meaning in our experiences. 5) A theory is a way of viewing reality.

question

You have located a dozen research articles that directly address your research question and are preparing to read them. What questions should you ask yourself during reading so that you can best analyze the value of each article? Select All That Apply. 1) What is the book, journal, or article about as a whole? 2) What is being said in detail, and how? 3) How many pages does the article contain? 4) Is the book, journal, or article "true" in whole or part? 5) How long will it take to read the article? 6) Is it of any significance?

answer

1) What is the book, journal, or article about as a whole? 2) What is being said in detail, and how? 4) Is the book, journal, or article "true" in whole or part? 6) Is it of any significance?

question

Which of the following accurately describe nursing research? Select All That Apply. 1) Requires a master's degree in nursing for one to participate in it 2) Is systematic 3) Is subjective 4) Involves analysis of phenomena 5) Encompasses all clinical practice areas 6) Provides evidence on which to base nursing care

answer

2) Is systematic 4) Involves analysis of phenomena 5) Encompasses all clinical practice areas 6) Provides evidence on which to base nursing care

question

You are interested in researching the unique role or function that nurses perform and the basic needs of patients that they address. You should investigate the theory of which of the following nursing theorists? 1) Florence Nightingale 2) Virginia Henderson 3) Hildegard Peplau 4) Nola Pender

answer

2) Virginia Henderson

question

You are formulating a searchable research question that considers the effectiveness of nonpharmacological methods of pain management with the use of analgesics. You are at the point now at which you are deciding which nonpharmacological methods to research. At which point in the acronym PICO is this question addressed? 1) P 2) I 3) C 4) O

answer

2) I

question

Below are six basic human needs that make up Maslow's Hierarchy of Needs. Put them in the correct order, from the most basic need to the least basic need. - Self-esteem needs - Self-actualization needs - Physiological needs - Safety and security needs - Transcendence of self - Love and belonging needs

answer

1) Safety and security needs 2) Transcendence of self 3) Self-esteem needs 4) Self-actualization needs 5) Love and belonging needs 6) Physiological needs

question

After consulting with many nursing colleagues, you are surprised at how many do not use research as the basis for their practice. Which of the following are common barriers to using research? Select All That Apply. 1) Negative attitudes toward research 2) Lack of research conducted in areas relevant to the field of nursing 3) Lack of knowledge of nursing research 4) Inadequate forums for disseminating research 5) Lack of support from the employing institution 6) Study findings that are not ready for the clinical environment

answer

1) Negative attitudes toward research 3) Lack of knowledge of nursing research 4) Inadequate forums for disseminating research 5) Lack of support from the employing institution 6) Study findings that are not ready for the clinical environment

question

After working in a new job at a hospital for several months, you observe that the method in place for administering patient medications seems inefficient. With the permission of your charge nurse, you implement a new approach to administration of medications, using it for 1 week and then reverting to the established method the following week. You follow this plan for a month and record the time it takes each shift to administer the regular medications. You find in the end that the hospital's approach was actually faster. What method of gaining knowledge did you employ in this case? 1) Authority and tradition 2) Scientific method 3) Logical reasoning 4) Trial and error plus common sense

answer

2) Scientific method

question

You are looking for a narrowly focused nursing construct that will specifically guide how you approach teaching patients self-care just before discharge from the hospital. Which of the following should you consider? 1) Grand theories 2) Clinical practice theories 3) Conceptual frameworks 4) Conceptual models

answer

2) Clinical practice theories

question

You are assisting a nurse researcher in conducting a research study on the sleep quality of inpatients in a large metropolitan hospital. Halfway through the study, one of your subjects informs you that he no longer wants to participate in the study. You recognize his right to leave the study and thank him for participating. Which right has this subject exercised? 1) Right to full disclosure 2) Right to self-determination 3) Right not to be harmed 4) Right to privacy

answer

2) Right to self-determination

question

Below are the phases of the research process. Put them in the correct order. - Select a research design - Analyze data - Collect data - Use the research findings - Select and define the problem

answer

1) Use the research findings 2) Collect data 3) Select a research design 4) Analyze data 5) Select and define the problem

question

During a late shift in the emergency room, you see a patient arrive limping and supported on either side by a friend. When you examine the patient's leg, you see that the ankle is swollen and red. The patient describes the pain as severe, especially when he puts any weight on the leg. You determine from these findings that the ankle is likely fractured. Which of the following processes did you use to arrive at this conclusion? 1) Deductive reasoning 2) Conceptual framework 3) Inductive reasoning 4) Conceptual model

answer

3) Inductive reasoning

question

You are teaching a group of older adults in a senior center on factors that increase their susceptibility to infection. Which of the following should you mention? Select All That Apply. 1) Living alone 2) Smoking cigarettes 3) Obesity 4) Immune-suppressing agents 5) Retirement 6) Urinary catheterization

answer

2) Smoking cigarettes 4) Immune-suppressing agents 6) Urinary catheterization

question

You are providing teaching to a client who frequently develops upper respiratory infections. Which of the following lifestyle practices should you encourage her to adopt to support her immune defenses? Select All That Apply. 1) Drink more water than usual when you have a fever. 2) Maintain a healthy intake of protein during illness. 3) Sleep at least 5 hours per day. 4) Wash your hands frequently. 5) Exercise moderately. 6) Laugh often.

answer

1) Drink more water than usual when you have a fever. 2) Maintain a healthy intake of protein during illness. 4) Wash your hands frequently. 5) Exercise moderately. 6) Laugh often.

question

You are caring for a client with tuberculosis. The pathogen associated with this disease is very small and remains infectious over long distances when suspended in the air. It is easily transmitted through ventilating systems. Which type of precautions should be used with a client with this disease? 1) Standard 2) Contact 3) Droplet 4) Airborne

answer

4) Airborne

question

You are providing training on infection control to healthcare workers at your hospital. Which of the following should you mention as primary defenses of the body against infectious disease? Select All That Apply. 1) Phagocytic white blood cells 2) Fever 3) The skin 4) B lymphocytes 5) Mucous membranes of the trachea 6) Acid in the stomach

answer

3) The skin 5) Mucous membranes of the trachea 6) Acid in the stomach

question

You are donning your personal protective equipment using sterile technique. Put the following steps in correct order. - Perform the surgical scrub. - Put on shoe covers, hair covers, and a mask. - Don gloves using the closed method. - Secure the waist tie on your gown. - Keep your hands within your field of vision at all times. - Don the gown, with assistance from a coworker.

answer

1) Put on shoe covers, hair covers, and a mask 2) Perform the surgical scrub 3) Don the gown, with assistance from a coworker. 4) Don gloves using the closed method 5)Secure the waist tie on your gown 6) Keep your hands within your field of vision at all times.

question

You are preparing to perform a physical examination of a healthy, young student athlete. Which type of precautions should be used with this client? 1) No precautions required 2) Standard 3) Contact 4) Droplet

answer

2) Standard

question

You are caring for a client who has developed methicillin-resistant Staphylococcus aureus (MRSA). Which of the following risk factors related to this infection should you most suspect in this client? 1) Employment in a preschool 2) Multiple sexual partners 3) Multiple stays in the intensive care unit 4) Smoking

answer

3) Multiple stays in the intensive care unit

question

Below are steps to take in the event of a biological epidemic. Put them in the correct order. - Institute the appropriate level of standard precautions. - Recognize an outbreak. - Prepare clients for a pandemic. - Notify the safety officer.

answer

1) Recognize an outbreak 2) Notify the safety officer 3) Institute the appropriate level of standard precautions 4) Prepare clients for a pandemic

question

As a nurse in the intensive care unit, you realize that you are at high risk of transmitting multidrug-resistant organisms (MDROs) to patients. Given what you know about how these organisms are usually transmitted, which of the following infection prevention measures is most important for you to implement? 1) Wearing a mask 2) Wearing a gown 3) Performing hand hygiene 4) Following airborne precautions

answer

3) Performing hand hygiene

question

Which of the following are examples of emerging infectious diseases? Select All That Apply. 1) Microorganisms in humans that extend their host range to begin infecting animals 2) Newly identified diseases caused by an unrecognized microorganism 3) Diseases occurring in new geographical areas 4) Microbes that evolve to become more virulent 5) Known diseases that dramatically decrease in incidence 6) Organisms that are deliberately altered for bioterrorism

answer

2) Newly identified diseases caused by an unrecognized microorganism 3) Diseases occurring in new geographical areas 4) Microbes that evolve to become more virulent