Obesity
A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate?
A: Mechanical compression only
B: Prophylactic anticoagulation only
C: Mechanical compression and prophylactic anticoagulation
D: Early ambulation and prophylactic anticoagulation
E: Mechanical compression and early ambulation
C: Mechanical compression and prophylactic anticoagulation
Both mechanical compression (intermittent pneumatic compression devices) and prophylactic anticoagulation with low molecular weight heparin agents are prescribed in the client who is postoperative bariatric surgery. Early ambulation is encouraged; however, it is not the only intervention.
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
A: Dyspnea and fatigue
B: Ascites and orthopnea
C: Purpura and petechiae
D: Gynecomastia and testicular atrophy
C: Purpura and petechiae
A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions?
A: Frequent changes of positions
B: Placing the patient in the prone position
C: Perform chest physiotherapy
D: Suction the patient every 4 hours
A: Frequent changes of positions
Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?
A: 30-45 minutes
B: 10-15 minutes
C: 1-2 hours
D: 3 hours
B: 10-15 minutes
The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.
Patients with hyperthyroidism are characteristically:
A: Calm
B: Anorexic and apathetic
C: Emotionally unstable
D: Sensitive to heat
D: Sensitive to heat
Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.
A nurse is reviewing a client’s morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client
A: May be developing an infection
B: Has thrombocytopenia
C: Has leukemia
D: May be developing anemia
A: May be developing an infection
Less mature granulocytes have a single-lobed, elongated nucleus and are called band cells. Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. An increased number of band cells is sometimes called a left shift or shift to the left. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of white blood cells in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?
A: Take with dairy products
B: Take 1 hour before breakfast
C: Decrease intake of fruits and juices
D: Decrease intake of dietary fiber
B: Take 1 hour before breakfast
Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.
A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient’s iron stores?
A: Blood transfusions
B: Radiation
C: Chelation therapy
D: Phlebotomy
D: Phlebotomy
The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient’s iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.
A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response?
A: The fat is excreted in your urine
B: The fat is absorbed in your intestines
C: The fat remains undigested in your stomach
D: The fat is passed in your stools
D: The fat is passed in your stools
Orlistat (Xenical) prevents the absorption of 30% of fat, decreasing caloric intake. Undigested fat is passed in the stools. The undigested fat is not excreted in the urine, absorbed in the intestines, or left undigested in the stomach.
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?
A: Vomiting
B: Ringing in the ears
C: Asterixis
D: Watery diarrhea
D: Watery diarrhea
The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
A: Black, tarry stools
B: Light amber urine
C: Circumoral pallor
D: Yellow sclerae
D: Yellow sclerae
Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?
A: Obesity
B: Rare ketosis
C: Presence of islet cell antibodies
D: Requirement for oral hypoglycemic agents
C: Presence of islet cell antibodies
Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
A: Myxedema coma
B: Exophthalmos
C: Tibial myxedema
D: Thyroid storm
A: Myxedema coma
Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?
A: Rh (-) mother, Rh (-) child
B: Rh (+) mother, Rh (-) child
C: Rh (-) mother, Rh (+) child
D: Rh (+) mother, Rh (+) child
C: Rh (-) mother, Rh (+) child
A mother who is Rh negative and gives birth to an Rh positive child is at greatest risk for a febrile nonhemolytic reaction because exposure to an Rh-positive fetus raises antibody levels in the Rh negative mother. An Rh-negative mother can carry an Rh-negative child without being at greatest risk for a febrile nonhemolytic reaction; however, these mothers are often treated prophylactically. An Rh-positive mother may carry either an Rh-positive or Rh-negative child without increased risk.
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?
A: "I feel hot all of the time"
B: "I have a difficult time falling asleep"
C:" I have an increase in my appetite"
D: "I have difficulty breathing when walking 30 feet"
D: "I have difficulty breathing when walking 30 feet"
Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigue and able to sleep often with a decrease in appetite, not an increase.
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis?
A: Sickle cell disease
B: Polycythemia vera
C: Aplastic anemia
D: Pernicious anemia
B: Polycythemia vera
Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. Sickle cell disease and the anemias do not have the characteristics of erythrocytosis.
A client who is postoperative from bariatric surgery is diagnosed with bile reflux after reports of severe epigastric pain and vomiting of bilious material. What statements are true regarding this condition? Select all that apply.
A: Symptoms are usually relieved after vomiting
B: Symptoms are usually relieved after eating
C: Usually occurs after disruption of the pylorus
D: Usually occurs after alteration of pancreatic enzymes
E: Symptoms are usually relieved with pharmacological therapy
C: Usually occurs after disruption of the pylorus
E: Symptoms are usually relieved with pharmacological therapy
Bile reflux may occur with procedures that manipulate or remove the pylorus, which acts as a barrier to the reflux of duodenal contents. Reflux of bile can cause inflammation of the stomach (i.e., gastritis) or esophagus (i.e., esophagitis). Burning epigastric pain and vomiting of bilious material manifest this condition. Eating or vomiting does not relieve the symptoms. Bile reflux may be managed with proton pump inhibitors.
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
A: Vitamin A
B: Thiamine
C: Riboflavin
D: Vitamin K
A: Vitamin A
Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.
A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?
A: Increased serum calcium levels
B: Elevated urine amylase levels
C: Decreased liver enzymes
D: Decreased white blood cell count
B: Elevated urine amylase levels
Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.
Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?
A: 1 month
B: 3 months
C: 4 months
D: 6 months
B: 3 months
Glycosylated hemoglobin is a blood test that reflects average blood glucose concentrations over a period of 3 months.
Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following?
A: Hypothyroidism
B: Cretinism
C: Myxedema
D: Diabetes Insipidus
B: Cretinism
During fetal and neonatal development, undersecretion of thyroid hormone may cause cretinism (stunted growth and mental development). In adults, hyposecretion of thyroid hormone causes myxedema or hypothyroidism. Diabetes insipidus is caused by undersecretion of antidiuretic hormone (ADH/vasopressin).
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?
A: Respiratory rate of 10 breaths/minute
B: Crackles auscultated bilaterally
C: Oral temperature of 97F
D: Pain and tenderness in calf area
B: Crackles auscultated bilaterally
Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.
A client’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?
A: "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs"
B: "DIC occurs when the immune system attacks platelets and causes systemic bleeding"
C: "DIC is a complication of an autoimmune disease that attacks the body's own cells"
D: "DIC is caused when hemolytic processes destroy erythrocytes"
A: "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs"
The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).
The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?
A: Debilitating fatigue
B: Gradual muscle paralysis
C: Severe thrombocytopenia
D: Bone pain in the back of the ribs
D: Bone pain in the back of the ribs
Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.
A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population?
A: After surgery, your ability to conceive is decreased considerably
B: You should avoid pregnancy for at least 12 months after surgery
C: You should avoid pregnancy for at least 18 months after surgery
D: After surgery, contraceptives have much less efficacy
C: You should avoid pregnancy for at least 18 months after surgery
When teaching a female of childbearing age regarding precautions after bariatric surgery, the nurse should instruct the client to avoid pregnancy for at least 18 months after surgery. The ability to conceive after weight loss surgery may improve more often than worsen. Contraceptives are no less effective after surgery than before.
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?
A: You must have the second one in 2 weeks and the third in 1 month
B: You must have the second one in 1 month and the third in 6 months
C: You must have the second one in 6 months and the third in 1 year
D: You must have the second one in 1 year and the third the following year
B: You must have the second one in 1 month and the third in 6 months
Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.
Which foods should be avoided following acute gallbladder inflammation?
A: Coffee
B: Cooked fruits
C: Cheese
D: Mashed potatoes
C: Cheese
The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.
Which statement is correct regarding glargine insulin?
A: Its peak action occurs in 2-3 hours
B: It cannot be mixed with any other type of insulin
C: It is usually given 20-30 minutes before a meal
D: It's given twice daily
B: It cannot be mixed with any other type of insulin
Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate?
A: Administer a sedative as ordered
B: Administer IV calcium gluconate as ordered
C: Administer an oral calcium supplement as ordered
D: Start administering oxygen at 2L/min via nasal cannula
B: Administer IV calcium gluconate as ordered
When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?
A: The client is having an allergic reaction to the blood.
B: The client is experiencing vascular collapse.
C: The client is having a febrile non-hemolytic reaction.
D: Transfusion Associated Circulatory Overload
C: The client is having a febrile non-hemolytic reaction.
The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the client.
A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?
A: Sickle Cell anemia
B: Hemolytic anemia
C: Folic acid deficiency
D: Thalassemia
C: Folic acid deficiency
Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell–derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4–5 g/dL, the leukocyte count 2,000–3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse’s first action?
A: Assess renal function
B: Administer pain medication as ordered
C: Place heating pads on the client's back
D: Refer client to a chiropractor
A: Assess renal function
Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.
A client is diagnosed with dumping syndrome after bariatric surgery. Which findings on the nursing assessment correlate with this diagnosis? Select all that apply.
A: Hypertension
B: Sweating
C: Dizziness
D: Tachycardia
E: Fever
F: Constipation
B: Sweating
C: Dizziness
D: Tachycardia
Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that is common among clients who have had bariatric surgery. Symptoms of dumping syndrome include (but are not limited to): sweating, tachycardia, nausea, vomiting, dizziness, and diarrhea. Fever, hypertension and constipation are not symptoms of dumping syndrome.
A client is actively bleeding from esophageal varices. Which medication would the nurse mostexpect to be administered to this client?
A: Octreotide
B: Spironolactone
C: Propranolol
D: Vasopressin
E: Lactulose
A: Octreotide
In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.
A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the majorcauses of chronic pancreatitis?
A: Malnutrition and acute pacreatitis
B: Alcohol consumption and smoking
C: Caffeine consumption and acute pancreatitis
D: Acute hepatitis and alcohol consumption
B: Alcohol consumption and smoking
Alcohol consumption in Western societies is a major factor in the development of chronic pancreatitis, as is smoking. Because heavy drinkers usually smoke, it is difficult to separate the effects of the alcohol abuse and smoking. Malnutrition is a major cause of chronic pancreatitis worldwide, but alcohol consumption is more commonly the cause in Western societies. Caffeine consumption is not related to acute pancreatitis. Acute hepatitis does not usually lead to chronic pancreatitis unless complications develop.
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication?
A: Different types of insulin are not to be mixed in the same syringe
B: The intermediate acting insulin is withdrawn before the short acting insulin
C: The short acting insulin is withdrawn before the intermediate acting insulin
D: Rapid acting insulin is withdrawn before the intermediate acting insulin
C: The short acting insulin is withdrawn before the intermediate acting insulin
When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."
A nurse is reviewing a laboratory order for a client who is scheduled to be tested for a suspected endocrine disorder. The client was recently seen in the office for bronchitis, and you note that he is still taking cough medication. The nurse explains to the client that he will not be able to get his lab testing done today. Why has the testing been postponed?
A: The client is being tested for a thyroid disorder
B: The client is being tested for a parathyroid disorder
C: The client is being tested for an adrenal disorder
D: The client is being tested for a pituitary disorder
A: The client is being tested for a thyroid disorder
If a client has recently taken a drug that contains iodine (e.g., some cough medicines) or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate.
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?
A: Extreme leukocytosis
B: Sickle cell anemia
C: Renal transplantation
D: Essential thrombocytopenia
D: Essential thrombocytopenia
Platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia (temporary measure)or in a single-donor platelet transfusion.
Which client is most at risk for developing disseminated intravascular coagulation (DIC)?
A: A client admitted with suspected cocaine overdose
B: A client with an amniotic fluid embolism
C: A client with stage IV pressure ulcer
D: A client with heart failure and renal failure
B: A client with an amniotic fluid embolism
The client with the amniotic fluid embolism is at greatest risk for developing DIC. Other risk factors for developing DIC include trauma, cancer, shock, and sepsis. Possible cocaine overdose, a stage IV pressure ulcer, and heart failure and renal failure aren't risk factors for DIC.
The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV?
A: Weight gain
B: Peripheral edema
C: Pale body color
D: Splenomegaly
D: Splenomegaly
Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV
A nurse cares for clients with obesity and recognizes that clients with larger waist-to-hip ratios are at greater risk for obesity-related morbidity in comparison to others with smaller waist-to-hip ratios. What findings related to this does the nurse recognize as true? Select all that apply.
A: Individuals with larger waist-to-hip ratios are also referred to as pear-shaped.
B: Individuals with larger waist-to-hip ratios have android obesity.
C: Individuals with larger waist-to-hip ratios have gynoid obesity.
D: Individuals with larger waist-to-hip ratios are also referred to as apple-shaped.
E: Individuals with larger waist-to-hip ratios have larger visceral fat stores.
A: Individuals with larger waist-to-hip ratios are also referred to as pear-shaped.
B: Individuals with larger waist-to-hip ratios have android obesity.
E: Individuals with larger waist-to-hip ratios have larger visceral fat stores.
Larger waist-to-hip ratios lead to an "apple-shape" appearance and is referred to as android obesity. These individuals have larger abdominal or visceral fat stores than those individuals with smaller waist-to-hip ratios.
A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position?
A: On the left side
B: Trendelenburg position
C: On the right side
D: High-fowlers position
C: On the right side
Immediately after the biopsy, assist the client to turn on to the right side; place a pillow under the costal margin, and caution the client to remain in this position. In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the client on the left side is not indicated. Positioning the client in the Trendelenburg position may be indicated if the client is in shock, but it is not the position designed for the client after liver biopsy. The high Fowler position is not indicated for the client after liver biopsy.
A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply.
A: "The pancreas enlarges and atrophies with age."
B: "The pancreas develops fibrous material with age."
C: "The pancreas develops fatty deposits with age."
D: "The pancreas decreases secretion of enzymes with age."
E: "The pancreas decreases bicarbonate secretion with age."
B: "The pancreas develops fibrous material with age."
C: "The pancreas develops fatty deposits with age."
D: "The pancreas decreases secretion of enzymes with age."
E: "The pancreas decreases bicarbonate secretion with age."
Age-related changes to the pancreas include: the development of fibrous material and fatty deposits, as well as decreased secretion of both pancreatic enzymes and bicarbonate. The pancreas remains the same size as the client ages and atrophy is not a normal age-related finding.
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of:
A: Deficient knowledge (treatment regimen)
B: Ineffective coping
C: Impaired adjustment
D: Health seeking behaviors
A: Deficient knowledge (treatment regimen)
The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:
A: Sodium and potassium abnormalities
B: Chloride and magnesium abnormalities
C: Sodium and chloride abnormalities
D: Calcium and phosphorus abnormalities
A: Sodium and potassium abnormalities
In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.
When collecting health history on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.
A: Dietary intake
B: Medication use
C: Ethnicity
D: Herbal supplements
E: Skin color
A: Dietary intake
B: Medication use
C: Ethnicity
D: Herbal supplements
Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess. Assessing skin color is part of the physical assessment.
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse
A: Notifies the provider
B: Assigns the client to a private room
C: Places the client in isolation
D: Changes the water in the humidifier for oxygen therapy every 48 hours
B: Assigns the client to a private room
The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions need to be followed, such as allowing no visitors with infection. Water in oxygen humidifiers should be changed every 24 hours.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan?
A: “Consolidation therapy is administered to reduce the chance of leukemia recurrence.”
B: “Consolidation occurs as a side effect of chemotherapy.”
C: “Consolidation of the lungs is an expected effect of induction therapy.”
D: “Consolidation is the term used when a client does not tolerate chemotherapy.”
A: “Consolidation therapy is administered to reduce the chance of leukemia recurrence.”
Consolidation therapy is administered to eliminate residual leukemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.
A nurse provides medication teaching for a client with obesity who is prescribed Lorcaserin. Which statement will the nurse include in the teaching?
A: "Wear sunblock if you are outside for any length of time."
B: "Avoid driving heavy equipment."
C: "Do not take with calcium products like milk."
D: "Wash your hands after touching the medication."
B: "Avoid driving heavy equipment."
Lorcaserin (Belviq) may cause drowsiness and the client should be told not to operate heavy equipment. The other answer choices do not pertain to this medication and will not be used when teaching the client about the medication.
The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu?
A: Omelet with green peppers, onions, mushrooms, and cheese with milk
B: Pancakes with butter and honey, and orange juice
C: Ham and cheese sandwich, baked beans, potatoes, and coffee
D: Baked chicken with sweet potato french fries, cornbread, and tea
B: Pancakes with butter and honey, and orange juice
Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. The other choices are all higher in protein. The client’s ascites indicates that a low-sodium diet is needed, and the other choices are all high in sodium.
A client discharged after a laparoscopic cholecystectomy calls the surgeon’s office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client?
A: "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use."
B: "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation."
C: "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."
D: "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."
C: "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."
If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.
A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?
A: Administer prescribed dose of insulin
B: Begin fluid replacement
C: Administer bicarbonate to correct acidosis
D: Administer prescribed antiemetics
B: Begin fluid replacement
Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?
A: BUN level of 12mg/dL
B: Blood glucose level of 90 mg/dL
C: Serum sodium level of 134 mEq/L
D: Serum potassium level of 5.8 mEq/L
C:
D: Serum potassium level of 5.8 mEq/L
Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct?
A: Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required.
B: The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply.
C: The liver and spleen can resume production of blood cells through extramedullary hematopoiesis.
D: The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells.
C: The liver and spleen can resume production of blood cells through extramedullary hematopoiesis.
In adults with disease that destroy marrow or cause fibrosis or scarring, the liver and spleen can also resume production of blood cells through a process known as extramedullary hematopoiesis.
A teenaged client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be ordered for administration to control bleeding?
A: Albumin
B: Fresh frozen plasma
C: A colloid solution such as hetastarch
D: A crystalloid solution such as lactated ringer's
B: Fresh frozen plasma
Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hetastarch, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care?
A: "Treatment is simple and consists of single-drug therapy"
B: "Intrathecal chemotherapy is used primarily as preventive therapy"
C: "The goal of therapy is palliation"
D: "Side effects are rare with therapy"
B: "Intrathecal chemotherapy is used primarily as preventive therapy"
Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.