Mental Health
When caring for an 87-year-old patient, the nurse needs to understand that which of the following most directly influences the patient's current self-concept:
A: Attitude and behaviors of relatives providing care
B: Caring behaviors of the nurse and health care team
C: Level of education, economic status, and living conditions
D: Adjustment to role change, loss of loved ones, and physical energy
D: Adjustment to role change, loss of loved ones, and physical energy
D: Adjustment to role change, loss of loved ones, and physical energy
A client who is started on metformin and glyburide would have initially presented with which symptoms?
a. Polydipsia, polyuria, and weight loss
b. weight gain, tiredness, & bradycardia
c. irritability, diaphoresis, and tachycardia
d. diarrhea, abdominal pain, and weight loss
a."a. Polydipsia, polyuria, and weight loss“ Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly ordered medications.
Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism.
Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia.
Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss."
The answers are C, D, E, and F. Remember, the risk factors for developing TB and to remember them I said remember the mnemonic “TB Risk”. It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5….all these are risk factors.
The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action is performed by the client, indicates a need for further teaching?
1.withdraws the NPH insulin first
2.withdraws the regular insulin first
3.injects air into NPH insulin vial first
4.injects an amount of air equal to the desired dose of insulin into each vial.
a.When preparing a mixture of short acting insulin such as regular insulin with another insulin preparation, the short acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short acting insulin with insulin of another type.
b.Which syringe in your kit is used to administer insulin? How is it different than the other syringes?
A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed?
The answer is A. Marcolides are used to treat gram-positive bacterial infections and are used in patients with penicillin allergies. Penicillin G is a penicillin antibiotic and would not be used because of the patient's allergy. In addition, usually if a patient is allergic to penicillin there is an increased chance they are allergic to cephalosporin....therefore it would not be used as well.
The nurse asks the patient, "How do you feel about yourself?"
The nurse is assessing the patient's:
A: Identity.
B: Self-esteem.
C: Body image.
D: Role performance.
B: Self-esteem.
A client with diabetes mellitus has a glycosylated hemoglobin A1C level of 9%. On the basis of this test result, the nurse plans to teach the client about the need for which measure?
1. Avoiding infection
2. Taking in adequate fluids
3. Preventing and recognizing hypoglycemia
4. Preventing and recognizing hyperglycemia
4.Rationale- In the test result for glycosylated hemoglobin A1C 7% or less indicates good control, 7% to 8% indicates fair control, and 8% or higher indicates poor control. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. Thus the test is useful in identifying clients who have periods of hyperglycemia that are undetected in other ways. Elevations indicate continued need for teaching related to the prevention of hyperglycemic episodes.
The answers are A, B, and E. These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.
Glimepiride (Amaryl) is prescribed for a client with DM. The nurse instructs the client to avoid consuming which food while taking this medication?
1.alcohol
2.organ meats
3.whole-grain cereals
4.carbonated beverages
a.When this medication is combined with alcohol, a disulfiram-like reaction may occur. This syndrome includes Flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication.
Advise clients not to drink alcohol while on this medication.
b.Drug classification? Other medications in this classification?
A patient is being discharged home on Doxycyline for treatment of pneumonia. Which statement by the patient indicates they understood your education material?
he answer is A. Doxycycline increases the skin's sensitivity to the sun, so the patient should wear sunscreen when outdoors. Also, the patient should not take this medication with antacids or milk products because this affects the absorption of the medication. Options B and C are incorrect statements.
Name that drug class!
When developing an appropriate outcome for a 15-year-old girl, the nurse considers that a primary developmental task of adolescence is to:
A: Form a sense of identity.
B: Create intimate relationships.
C: Separate from parents and live independently.
D: Achieve positive self-esteem through experimentation.
A: Form a sense of identity.
The fifth stage of Erik Erikson's theory of psychosocial development is identity vs. role confusion, and it occurs during adolescence, from about 12-18 years.
When can airborne infection isolation for a patient with pulmonary tuberculosis (TB) be discontinued?
1. Once isoniazid drug therapy has been initiated
2. After three consecutive acid-fast bacillus (AFB) smears are negative
3. After effective instruction on the use of a high-efficiency particulate air (HEPA) mask
4. When two consecutive negative x-ray results are confirmed
2. After three consecutive acid-fast bacillus (AFB) smears are negative
Airborne infection isolation is indicated for the patient with pulmonary or laryngeal TB until the patient is noninfectious (defined as effective drug therapy, clinical improvement, and three negative AFB smears). Therapy must be deemed effective. Teaching the patient to properly use the HEPA mask isn't a criterion for terminating isolation. Chest x-rays are not criteria to terminate isolation.
**Can you name the types of isolation AND an example of a disease that would require that isolation?**
An RN receives the change-of-shift report about these clients. Which client does the nurse assess first?
A. 30-year-old admitted 2 hours ago with malnutrition that is associated with malabsorption syndrome
B. 45-year-old who had gastric bypass surgery and is reporting severe incisional pain
C. 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL
D. 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min
ANSWER- D Aspiration is a major complication in clients receiving tube feedings, especially in clients with an altered level of consciousness. This client needs respiratory assessment and interventions immediately.
The client has been vomiting and has weak, flabby muscles. The client's pulse is irregular. The nurse would correctly suspect what type of imbalance?
a. Hypokalemia
b. Hyperkalemia
c. Hopocalcemia
d. Hypercalcemia
Hypokalemia
wWhich of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
a. Sulfonylureas
b. Meglitinides
c. Biguanides
d. Alpha-glucosidase inhibitors
c. Biguanides
Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver.
Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
Name examples of B,C and D?
An appropriate nursing diagnosis for an individual who experiences confusion in the mental picture of his physical appearance is:
A: Acute confusion.
B: Disturbed body image.
C: Chronic low self-esteem.
D: Situational low self-esteem.
B: Disturbed body image.
You’re teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education?*
The answers are B, D, E, F, and G. Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).
A 72 year-old male patient who is diagnosed with bilateral lower lobe pneumonia is admitted to your unit. The patient has a history of systolic heart failure and arthritis. On assessment, you note the patient has a respiratory rate of 21, oxygen saturation 93% on 2L nasal cannula, is alert & oriented, and has a productive cough with green/yellowish sputum. Which of the following nursing interventions will you provide to this patient based on your assessment findings and the patient's diagnosis? Select-all-that-apply:
The answers are B, D, and E. You would not keep the head-of-bed less than 30 degrees because this impedes breathing and increases the risk of aspiration. Also, since the patient has systolic heart failure you would NOT encourage 3L of fluids per day because the patient would not tolerate the extra fluid. However, in normal situations (if a patient does not have heart failure etc.) you would want to encourage fluids to keep secretions thin.
Your patient shares the following:
1) Urge to urinate but only small amount of urine produced
2) Pain and burning sensation in bladder
3) Fever
4) Blood in urine
This is a sign or symptom of?
Urinary tract infection
A client has a prescription to take guaifenesin (Mucinex). The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action?
a) Watch for irritability as a side effect.
b) Take the tablet with a full glass of water.
c) Take an extra dose if the cough is accompanied by fever.
d) Crush the sustained-release tablet if immediate relief is needed.
b) Take the tablet with a full glass of water.
Rationale: Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations should not be broken open, crushed, or chewed.
Based on knowledge of Erikson's stages of growth and development, the nurse plans her nursing care with the knowledge that old age is primarily focused on:
A: Intimacy versus Isolation.
B: Autonomy versus Shame and Doubt.
C: Generativity versus Self-Absorption.
D: Ego Integrity versus Despair.
D: Ego Integrity versus Despair.
This stage begins at approximately age 65 and ends at death. At the integrity versus despair stage, the key conflict centers on questioning whether or not the individual has led a meaningful, satisfying life.
You note your patient’s sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding?*
Answer: D Rifampin
A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia?
The answer is C. The key words to let you know this is hospital-acquired pneumonia and NOT community-acquired is that the patient was admitted with a gunshot wound AND has been hospitalized for 48 hours. If the patient presents with signs and symptoms of pneumonia 48-72 hours after admission it is classified as hospital-acquired. This is not ventilator acquired because the patient is not on mechanical ventilation and there is nothing in the scenario that leads us to think it is aspiration pneumonia
You are studying with a fellow student the difference between respiratory alkalosis and respiratory acidosis. Below are signs or symptoms of which?
Lethargy, Light-headedness, Dizziness, Confusion, Tachycardia, Increase sensitivity to digitalis preparations, Dysrhythmias(related to hypokalemia from compensation), Nausea, Vomiting, Epigastric pain, Tetany, Panic, Anxiety, Numbness/tingling of extremities(hypocalcemia), Hyperreflexia, Seizures, Blurred vision, Rapid/shallow breath, Hyperventilation(lungs are unable to compensate when there is a respiratory problem)
Respiratory Alkalosis Signs and Symptoms
lient is prescribed the decongestant oxymetazoline (Afrin) nasal spray. What should the nurse teach the client?
a. Take this drug at bedtime as a sleep aid.
b. Directly spray away from the nasal septum and gently sniff.
c. This drug may be used in maintenance treatment for asthma.
d. Limit the drug to 5 days of use to prevent rebound nasal congestion.
d. Limit the drug to 5 days of use to prevent rebound nasal congestion.
**Rebound congestion develops when you use nasal sprays containing phenylephrine and oxymetazoline for too long. Rebound congestion is tough to treat and can take up to 1 year to go away. You can avoid rebound congestion by stopping decongestant nasal sprays after 3 to 5 days. **