Exam 1 Content
Which of the following are normal aspects of aging?
A. Shortness of breath
B. Chest Pain
C. Tenting of skin on the back of the hand
D. Hearing loss
E. Decreased attention span
A, C, E- For tenting, it can be normal on the back of the hand but would be abnormal if on the sternum
A. CT scan without contrast
B. Xray
C. PET scan
D. Stress test
C. PET scan (not specific for Alzheimer's, but best diagnostic test to see changes in the brain; Can help to rule out other tissues that could be mimicking Alzheimer's)
Which of the following would be a proper interventions for the prevention of diabetic foot ulcers? Select all that apply.
A. Smoking cessation
B. Managing blood glucose levels
C. Wearing shoe inserts
D. Podiatrist appointments for toenail cutting
E. Assessing feet at every health care visit
A, B, C, D, E (all are proper interventions for reducing risk of diabetic foot ulcers)
Which of the following are modifiable risk factors for stroke?
A. Elevated cholesterol
B. Diabetes
C. Obesity
D. Smoking
E. Atrial Fibrillation
A, B, C, D, E- All are modifiable risk factors for stroke
Classification of anemia is based on the cause. What are the 3 primary causes of anemia? Select all that apply.
A. Destruction of erythrocytes
B. Loss of erythrocytes
C. B12 deficiency
D. Problems with production of erythrocytes
A, B, D (B12 deficiency is covered in problems with production)
You are caring for Mrs. T, an 84-year-old female diagnosed with Alzheimer's two years ago who moved into your long-term care facility 3 months prior. Recently, you notice she has not been sleeping or eating well and is more easily agitated. During your interview with Mrs. T, she answers "I don't know" to almost all of your questions. What do you suspect is going on with Mrs. T?
A. Delirium
B. Depression
C. Grief
D. Dementia
B. Depression- S/S of depression include insomnia, poor appetite/weight loss, agitation, anhedonia, low self-esteem, "I don't know" answers, and suicide attempts
You are speaking with the daughter of your 72 year old patient who was just admitted to the ED after getting lost while driving on her way home from work. The daughter mentions she has noticed some minor differences in her mother's cognition lately, particularly difficulty recalling names of people. You would expect this client to be in which stage of Alzheimer's?
A. Stage 2 (Very mild changes)
B. Stage 3 (Mild cognitive decline)
C. Stage 4 (Moderate cognitive decline)
D. Stage 5 (Moderately severe cognitive decline)
B. Stage 3 (Mild cognitive decline)- This stage is characterized by changes in thinking and reasoning, getting lost while driving, and difficulty recalling names and words. It is also the stage where others begin to notice changes.
A. Mild weight loss is expected with this type of medication.
B. Hypoglycemia is not a risk with taking this medication.
C. This medication works by stimulating the pancreas to secrete more insulin.
D. This medication can decrease the effectiveness of oral contraceptives.
D. This medication can decrease the effectiveness of oral contraceptives.-Pioglitazone is a Thiazolidinediones. We would expect weight GAIN with this medication, hypoglycemia IS a side effect, and the MOA is sensitizing body tissue to insulin, stimulating insulin receptor sites to lower blood glucose, and improve action of insulin (NOT stimulating pancreas to secrete insulin- that's Metformin); SE is decreasing oral contraceptive effectiveness
A nurse is caring for a client who is post-op from a carotid endarterectomy. Which of the following interventions is most important for the nurse to implement?
A. Neuro checks Q2H
B. Measuring neck circumference
C. Controlling blood pressure
D. Keeping the patient in supine position 2 hours post-op
B. Measuring neck circumference- Assesses for bleeding in the neck which poses a major risk to the airway; Neuro checks and controlling BP are also important interventions but the bleeding in the airway is our biggest concern; Idk if D is true I just made it up
A nurse is evaluating her client for possible anemia. Which s/s would she expect to see if the client is experiencing anemia?
A. Facial flushing and increased temperature
B. High blood pressure and rapid heart rate
C. Fatigue and dizziness
D. Muscle spasms and myoclonus
C. Fatigue and dizziness- Classic CNS symptoms; Skin will be pale, cool, or yellow not flushed and warm; HR will be elevated by BP will be low; Muscles will be weak not spasming
Which of the following members of the health care team would the nurse consult would the nurse consult regarding discharge planning?
A. Physician
B. Occupational therapy
C. Case Management
D. Physical Therapy
C. Case management- All of these specialities would most likely be involved when a client is pending discharge, but case management specifically plays a major role in this aspect of care.
A. This medication can slow progression of cognitive impairment caused by your Alzheimer's, but is unable to cure it.
B. This medication can help ease feelings of agitation and aggression.
C. Be sure to take this medication on an empty stomach 30 minutes after you wake up.
D. Do not take this medication with gingko biloba due to increased risk of CNS side effects.
A. This medication can slow progression of cognitive impairment caused by your Alzheimer's, but is unable to cure it. (Cholinesterase inhibitors help to improve cognitive impairment. No medications exist to cure Alzheimer's, but are utilized to slow progression of symptoms.)
The nurse is educating her patient who was newly diagnosed with Type II diabetes about precautions to take when exercising. Which of the following would the nurse include in the teaching? Select all that apply.
A. Immediately stop exercise if your heart rate exceeds 180 bpm.
B. Do not exercise if blood sugar is >250.
C. Eat a 15 g carbohydrate snack prior to exercise.
D. Check urine for ketones before exercise.
B, C, D- Exercise contraindicated in diabetics with BS >250 and ketones in the urine (can cause the body to release hormones that actually further increase glucose levels); 15g carb snack helps prevent hypoglycemia with exercise
A client presents to the ED complaining of left sided weakness, slurred speech, a headache rated 10/10, and has vomited 3x since admission. While taking vitals, the nurse obtains a blood pressure of 190/101. What is the nurse's priority action regarding this blood pressure?
A. Do nothing at first because increased blood pressure can help improve perfusion to brain tissue.
B. Switch the cuff size and retake the pressure.
C. Report findings to the provider and request an order for an antihypertensive.
D. Initiate seizure precautions.
C. Report findings to the provider and request an order for an antihypertensive.- The client is having symptoms indicative of a hemorrhagic stroke, therefore we would NOT let the blood pressure rise (ONLY do that for ischemic to hopefully improve blood flow); Seizure precautions are also important to implement during a hemorrhagic stroke, but have no correlation with the BP reading.
A client newly diagnosed with iron deficiency anemia is being discharged with a new prescription for ferrous sulfate. Which statement should the nurse include in her teaching?
A. Take this medication with a meal.
B. Take this medication with orange juice.
C. May take an extended release version to only take 1 pill/day.
D. Stools may be clay colored.
B. Take this medication with orange juice.- Vitamin C increases absorption of iron (although it also increases GI SE); Should be taken on an empty stomach, Cannot be extended release, and stools will be dark and tarry (not clay colored)
A nurse discovers her declining Alzheimer's patient has recently become incontinent. The nurse recognizes that this patient is experiencing which type of incontinence?
A. Stress incontinence
B. Urge incontinence
C. Functional incontinence
D. Overflow incontinence
C. Functional incontinence- Functional incontinence is associated with an inability to toilet due to physical impairment, cognitive impairment, psychological unwillingness, and environmental factors. Alzheimer's could be a contributing factor to physical impairment, cognitive impairment, or a psychological unwillingness.
A 55 year old man is brought to the ED by his wife. She states he has been acting very abnormal over the past few days, has been having trouble with motor function, and experienced a seizure in the car on the way to the hospital. Based on this description, the nurse would suspect which condition to be causing the symptoms?
A. Delirium
B. Huntington's disease
C. Frontotemporal dementia
D. Creutzfeldt-Jakob Disease (CJD)
D. Creutzfeldt-Jakob Disease (CJD)- CJD has a rapid onset and rapid progression. S/S include psychotic behavior, heightened emotional lability, memory impairment, loss of muscular function, muscle spasms, seizures, and visual disturbances.
A nurse is assessing her client for macrovascular complications of Type II diabetes. Which of the following would be an appropriate question for the nurse to ask?
A. Have you been having any difficulties with your vision recently?
B. Have you experienced any numbness or tingling in your legs?
C. Do you have any difficulties with urination?
D. Have you been extremely thirsty or hungry lately?
B. Have you experienced any numbness or tingling in your legs?- This is a symptom of Peripheral Vascular Disease, a macrovascular complication of uncontrolled diabetes. MI, Stroke, and PVD are macrovascular complications. The vision & urination question address possible microvascular complications. The last one was just b/c I couldn't think of anything else lmao.
A nursing student is explaining to her professor proper nursing interventions for stroke patients. The professor would be alerted the student requires further education when she says...
A. "The patient must be placed in High Fowler's position with their chin at a 90 degree angle to the floor while eating to prevent risk of aspiration."
B. "It is important to allow the client to make as many choices for their care as possible."
C. "Any flaccid limbs should be propped on a pillow and monitored frequently."
D. "A urinary catheter is often inserted temporarily until continence is regained."
D. "A urinary catheter is often inserted temporarily until continence is regained." Incontinence alone is not an indication for a urinary catheter, better intervention would be bladder training to treat the incontinence. (Does depend on the client and the severity of their symptoms- this is in general)
A nurse is bringing back a client from the waiting room to the ED. The client's chief complaints include diarrhea, confusion, tingling in the fingers and toes, and fatigue. Upon walking into the room, the client hits their elbow off of the bedside table. Even before assessing the client, the nurse would suspect that this client could be experiencing...
A. Megaloblastic anemia
B. Iron deficiency anemia
C. An ischemic stroke
D. Diabetic neuropathy
A. Megaloblastic Anemia- S/S of megaloblastic anemia include fatigue, low BP, glossitis, diarrhea, pale skin/mucous membranes, confusion, parathesias, and loss of proprioception (i.e., smacking the arm off of the table)
A nurse has just removed her patient's indwelling catheter. Which example shows proper documentation?
A. Catheter removed 1200. Due to void 0800.
B. Catheter removed 1200. Due to void 0600.
C. Catheter removed at 1200. Due to void 0700.
D. Catheter removed at 1200. Due to void 0900.
A. Catheter removed 1200. Due to void 0800.- Patient must void in less than 8 hours after catheter removal. If not, bladder scans and another catheter may be necessary
Name the 5 A's of Alzheimer's and a short description of each.
Aphasia- impaired communication
Agnosia- loss of comprehension of auditory/visual sensations
Apraxia- inability to perform voluntary movements
Amnesia- loss of memory
Anomia- inability to name things
Which of the following laboratory findings would you expect to see in a patient diagnosed with Hyperglycemic Hyperosmolar Syndrome (HHS)? Select all that apply.
A. BUN 32 mg/dL
B. Sodium 155 mEq/L
C. Potassium 6.0 mEq/L
D. Cr 1.5 mg/dL
E. Magnesium 3.0 mEq/L
A, B, C, E- HHS causes all electrolytes levels to increase as fluid is lost; BUN will be elevated WITHOUT an elevation in Creatinine (indicative of dehydration as opposed to a kidney injury)
A. HR 96, A-Fib
B. BP 198/88
C. R sided weakness
D. Dysarthria
E. INR 2.8
F. Lung sounds clear bilaterally
G. Headache 6/10
C, D, G- Remember with ischemic strokes we want the BP to rise initially, need more information about the HR/A-fib and the INR of 2.8 (could be normal if on Coumadin- may need to intervene if tPA to be given)
A. A 36-year-old female who is vegan
B. A 57-year-old male alcoholic
C. A 8-year-old male with Type 1 DM
D. A 28-year-old pregnant female
B. A 57-year-old male alcoholic- Chronic alcoholism can cause a folic acid deficiency and problems with absorption (i.e. why we would need to give an injection as opposed to PO supplement); Folic acid deficiency contributor to megaloblastic anemia along with B12; All the others I just made up idk