PRN1178/ PRN 1178 Exam 2 (New 2026/ 2027 Update) Client-Centered Care II Review| Qs & As| 100% Correct| A Grade - Rasmussen

PRN1178/ PRN 1178 Exam 2 (New 2026/ 2027 Update) Client-Centered Care II Review| Qs & As| 100% Correct| A Grade - Rasmussen Q. What is Acid-Base balance? ANSWER The maintenance of hydrogen ion concentration in the blood and tissue fluids so that body can function properly. Necessary for homeostasis. Q. Normal pH range? What is considered Acidic? What is considered alkalotic? ANSWER 7.35-7.45 (Below 7.35 = Acidity) (Above 7.45= Alkaline) Q. What body systems regulate acid-base balance? ANSWER Buffers, Kidneys, and Lungs Q. Respiratory Acidosis Common Causes? ANSWER Acute Airway Obstruction, COPD, Asthma, Pulmonary Edema, Opiate Overdose, Pneumonia, Atelectasis Q. How might a patient present with respiratory acidosis? ANSWER Hypoventilation/hypoxia, Rapid Shallow Respirations, Decreased BP with vasodilation, Dyspnea, Headache, Hyperkalemia, Dysrhythmias, Drowsiness, Dizziness, Disorientation, Muscle Weakness, Hyperreflexia, Q. Prevention Strategies Acid-Base Imbalances? ANSWER Healthy diet, exercise, limit alcohol consumption, Drink 6-8 cups of water per day, maintain healthy weight, refrain from smoking, manage stree Q. Common Causes of Respiratory Alkalosis ANSWER Hyperventilation (anxiety, fear), Mechanical Ventilation, High Fever/Sepsis, Prolonged Sunctioning, Pain, Alcohol Withdrawal. Q. Common Causes of Metabolic Acidosis ANSWER Diarrhea, Renal Failure, Diabetic Ketoacidosis, Hyperkalemia, Alcoholism Q. Compensating Mechanisms for Metabolic Acidosis ANSWER Kussmaul Respirations Q. Common Causes of Metabolic Alkalosis ANSWER Vomitting, Excessive Gastric Suctioning, Hypokalemia, Excess use of Antacids, Steroid Therapy, Potent Diuretic Use Q. What are ABG's? ANSWER Arterial Blood Gases pH 7.35-7.45 7.34 acid 7.45 base PaCO2 35-45mmHg 45 acid 35 base HCO3 22-26mEq/L 22 acid 26 base O2 sat PaO2 Q. pH normal range ANSWER 7.35-7.45 Below 7.35 means Q. PaCO2 normal range. What do imbalances mean? ANSWER 35-45 mm Hg. Below 35 means alkalotic, above 45 means acidiosis. Q. HCO3 normal range ANSWER 22-26 mEq/L. Below 22 means acidosis, about 26 means alkalotic Q. RO ME ANSWER Respiratory Opposite Metabolic Equal When pH and Respiratory are Opposite directions, this is a respiratory problem, when pH and Metabolic are in the same direction its a metabolic issue. Q. Anatomy of the Gastrointestinal Tract ANSWER -The GI tract begins with the mouth and continues to the esophagus, the stomach, the small intestine, and the large intestine, and ends at the anus. -The GI tract is approximately 9 m (30 feet) long. -The small intestine consists of the duodenum, jejunum, and ileum. -The large intestine consists of the cecum, colon (ascending, transverse, descending, and sigmoid), and rectum. -Accessory organs of the GI tract include the teeth, salivary glands, gallbladder, liver, and pancreas. Q. What is the name of food as it travels the GI system? ANSWER Chyme is partially digected, semiliquid food. Q. Functions of the GI system ANSWER ingestion, digestion, absorption, elimination Q. Patient Care for Dysphagia ANSWER Dysphagia means difficulty swallowing. Patient has risk of choking and apiration. Safety First: Limit Risk for Aspiration, Detemine Risk, Thickened Liquids, Soft Diet, NPO if necessary. Q. Oral Cancer Risk Factors ANSWER Tobacco Use, Smokeless Tobacco Use, Heavy Alcohol Use, Oral Infection with Human Papillomavirus Q. Oral Cancer - Nursing Management ANSWER Maintaining and Monitoring Airway, Respiratory Status, Oxygenation, Elevate Head, Cold Packs, Wound Care Q. Esophageal Cancer Risk Factors ANSWER Cigarette Smoking, Excessive Alcohol Use Q. Nursing Management for Esophageal Cancer ANSWER Limit Risk for Aspiration (Airway), adequate nutrition intake, Control Pain Q. Hiatal hernia nursing management ANSWER Prevent Pain and Reflux: Avoid Spicy, Irritating Foods, Encourage Weight Reduction, Sit Upright for at least 2 hours after eating, Lifting should be avoided, Elevate head of bed Q. Risk Factors for GERD ANSWER Large Meals, Obesity, Hiatal Hernia, Sleep Apnea Q. Diagnostic Tests for GERD ANSWER EGD (esophagogastroduodendoscopy), Barium Esophagram Q. Nursing Management For Gerd ANSWER Limit Spicy Foods, highly seasoned foods, acidic foods and fluids. Weight Loss. Admin of medications as prescribed by doctor, stop smoking, limit alcohol use, elevate head of bed Q. Medications used for treatment of GERD ANSWER Proton Pump Inhibitors (omeprazole, lansoprazole), H2 - Receptor Antagnosits (famotidine, cimetidine), Antacids, Prokinetic Drugs Q. Barrett Esophagus Causes ANSWER Caused by GERD Q. Barrett Esophagus Lifestyle Changes ANSWER Management of GERD - limiting spicy, highly acidic and seasoned foods and liquids, weight loss, managing diet, exercise, stop smoking, limit alcohol use Q. gastroenteritis nursing management ANSWER NPO until vomitting has stopped, electrolyte liquids when tolerated, BRAT diet Q. Gastiritis Risk Factors ANSWER Excessive Alcohol Use, Long-Term Ibuprofen Use, Corticosteroid Use, Infection w. H. pylori bacteria, Smoking, Pernicious Anemia, Q. Gastritis Complications ANSWER Upper GI Hemorrhage Q. Peptic Ulcer Causes ANSWER H. Pylori, Daily NSAID Use Q. Peptic Ulcer Complications ANSWER GI bleed leading to Hypovalemic Shock, N&V - coffee ground like gastric juices, restlessness, thirst, decreased BP, Tachycardia, Q. Gastric Cancer Risk Factors ANSWER H. Pylori infection, consuming smoked foods, penicious anemia, achlorhydria (absence of hydrochloric acid) Nasogastric Tube Care Q. Gastrostomy Tube Feeding Process and Care ANSWER Placed into the abdominal wall endoscopically. Assess the insertion site for signs of infection or excoriation. Inspect the insertion site and change the dressing once a day. Be certain the the tube is intact and that the mark on the tube is at the skin surface before starting or adding to the feeding. If not, stop the feeding and notify the healthcare provider. Rotate the external bolster to reach all areas of the skin for cleaning, if the tube cannot be moved, report this to the provider because the retention disk may have become embedded in the tissue. GI Tract is made up of what The mouth, pharynx, esophagus, stomach, small and large intestines, rectum, and anus. Accessory organs of the GI The liver, gallbladder, and pancreas Functions of the upper GI Chewing, swallowing, and breaking down food particles. Risk factors for oral cancer Cigarette smoking, tobacco use, pipe smoking, excessive alcohol use, infection with HPV, and genetic predisposition Signs and symptoms of oral cancer Lesions on the tongue or mucosa, sores or discoloration of the lips or mouth that don't heal treatment of oral cancer radiation, chemotherapy, surgery that may require the creation of a tracheostomy Nursing care of a patient with oral cancer Involves monitoring respiratory status, nutritional support, and comfort measures Esophageal cancer/ gastric cancer risk factors Smoking, excessive alcohol use cause of esophageal cancer Barrett esophagus Barrett esophagus Precancerous condition due to longstanding GERD, the constant irritation of the esophagus by stomach fluids can cause cells to become malignant. Signs and symptoms of esophageal cancer dysphagia, hoarseness, persistent cough, halitosis, regurgitation of foods, and weight loss. Treatment of esophageal cancer Endoscopic therapies and surgeries. Esophagectomy is less commonly done due to complication rate respiratory acidosis A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. respiratory alkalosis Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. metabolic acidosis decreased pH in blood and body tissues as a result of an upset in metabolism metabolic alkalosis elevation of HCO3- usually caused by an excessive loss of metabolic acids respiratory acidosis Causes: shallow, slow respirations- HYPOventilation; respiratory congestion or obstruction. Can be due to COPD, severe pneumonia, or excessive sedation; respiratory muscle weakness. Signs and symptoms of respiratory acidosis Hypoventilation, dyspnea, anxiety, and confusion ABG values for respiratory acidosis pH less than 7.35, PaCO2 greater than 45 causes of metabolic acidosis shock, DKA, lactic acidosis, renal failure, diarrhea, and starvation signs and symptoms of metabolic acidosis Kussmaul respirations; headache; confusion; malaise ABG values for metabolic acidosis low pH, HCO3 less than 22 Causes of respiratory alkalosis HYPERventilation caused by anxiety or pain, mechanical ventilation Signs and symptoms of respiratory alkalosis Hyperventilation; confusion; Lightheadedness ABG values for respiratory alkalosis ph greater than 7.45, paCO2 less than 35 metabolic alkalosis causes vomiting; prolonged gastric suction; hypokalemia; medications: diuretics, antacids or bicarbonate, mineralocorticoids signs and symptoms of metabolic alkalosis Hypoventilation; confusion; numbness/tingling; decreased LOC ABG values for metabolic alkalosis pH greater than 7.45, HCO3 greater than 26 Normal pH 7.35-7.45 Normal PaO2 levels 80-100 mmHg Normal PaCO2 levels 35-45 mmHg Normal HCO3 levels 22-26 A common cause of liver toxicity is? Taking extra strength acetaminophen at doses of 4500 mg per day Measures used to teach patients to prevent gastrointestinal ulcers include? Limiting the amount of routine alcohol consumption. You are planning care for several patients who had diagnostic testing. Which patient will require the most time for post procedural care? Patient who had a liver biopsy You are preparing a patient for a liver biopsy. Which nursing intervention should be included? Attending to patient's fears and anxiety, checking for a signed consent form the procedure, checking coagulation studies for bleeding problems, noting any allergy to local anesthetics. An 82 year old patient is undergoing bowel preparation for a diagnostic procedure. What are potential complications of the bowel prep? Dehydration, muscle cramps, and hypotension A decreased secretion of intrinsic factor is a physiologic change associated with the aging process; therefore, you suspect decreased intrinsic factor should assess for which behavior? Fatigue and activity intolerance. A lack of intrinsic factor may cause pernicious anemia, which can manifest as fatigue and activity intolerance. Which laboratory values would you use to assess liver function? ALT, ammonia, INR You emphasize the importance of eating natural sources of fiber to a patient who has frequent constipation. which patient statement indicates effective health teaching? "I will eat more fruits and vegetables" A 30-year-old woman is admitted with complaints of severe nausea and vomiting over the past 2 days. On admission she is hypotensive and extremely weak. what is the priority problem? deficient fluid volume A nurse is discussing healthy lifestyle measures with a group of older adults during a senior seminar. What instructions should you include as accurate information? Consume sufficient fiber, eat a normal, well-balanced diet, and exercise regularly An older adult woman of Puerto Rican descent is admitted for persistent anorexia and dehydration. There are no apparent underlying organic causes for loss of appetite. Which interventions would be culturally appropriate? Determine food preferences, encourage family visits, and provide small amounts of food and fluid frequently. When working with an obese patient who wants to lose weight, which statement would indicate that the teaching has been understood? "a program such as weight watchers will help me cut calories and keep on track" When screening for the presence of risk factors for oral and pharyngeal cancers, which questions would you ask? How much alcohol do you consume? Have you had any oral lesions? Do you have family members who have cancer? Do you smoke? You reinforce diet recommendations to a patient with GERD. Which patient statement indicates a need for further teaching? "I need to wait 30 minutes after eating before laying down" Patient should be waiting at least 3 hours before laying down A patient who has GERD for many years is diagnosed with Barrett esophagus. Etiologic factors for Barrett esophagus include? Long term gastroesophageal reflux causing mucosal irritation A nurse is taking care of a patient who had a modified radical neck dissection surgery. The patients spouse asks "why do you have to apply cold packs and elevate his head?" Which response is most appropriate? "These interventions reduce neck swelling" A nurse is reviewing signs and symptoms of esophageal cancer with people who are at risk. Which statement indicates that the participants have understood the information? "A feeling of fullness in the throat is an early sign" A patient reports a history of gastric ulcer. Which sign or symptom indicates the need for a priority action of health care provider notification? Vomit that looks like coffee grounds While a nurse is obtaining a clinical history, a patient with a known history of peptic ulcers suddenly complains of severe upper abdominal pain of increasing intensity that spreads to the shoulders. The abdomen has boardlike rigidity. Which signs/ symptoms signal worsening condition related to the peptic ulcer? Increased pulse, belching and flatulence A patient is receiving continuous enteral feedings. Which intervention will address the most serious problem associated with the feeding therapy? Raise the head of the bed You are supervising a nursing student during the care of a patient with a gastrostomy tube. You should intervene if the student: Changes the tubing and bag every 4 hours. Should be changed every 24 hours. A family member tells you, "dad seems to be having some trouble swallowing lately." What is your priority action? Observe during "practice swallows" The older adult is at greater risk for dehydration than the middle-aged adult is because? Older adults have a diminished sense of thirst, and compensatory mechanisms work less efficiently An 82-year old male patient is admitted with vomiting and diarrhea. On assessment, you note that he is apprehensive and his skin is cool, dry, and pale. His pulse is rapid, and his blood pressure is lower than normal. These symptoms are indicative of? Dehydration Your male patient has been ill with pneumonia and was admitted yesterday to start IV antibiotic therapy. He has a history of heart failure adn is taking digitalis and fuosemide. He has not been eating well the past 3 days because he was feeling so bad. The primary care provider ordered fluids and daily lab work yesterday. The patient seems more confused this morning and is very weak. His urine output has fallen. To determine what is causing these symptoms, you would first? Check the morning electrolyte levels. A patient with heart failure has lost 4.6 pounds. This represents a fluid loss of approximately? 2 Liters Patients who are undergoing diuretic therapy to decrease excess bod fluid tend to lose potassium. If too much potassium is lost, the patient will have which electrolyte and acid-base imbalance? Hypokalemia, and metabolic alkalosis. One of the best methods to assess whether peripheral edema is increasing or decreasing is to? Measure the circumference of the affected extremity in the same location each day. Daily fluid intake i the adult must be at least how many mL/ day to maintain homeostatsis? 1500 mL Whenever a water imbalance exists, there will be an accompanying imbalance of what? Sodium imbalance An increase in hydrogen ions results in? Acidosis, which is evidenced by a decrease in pH Acidosis depresses which system? nervous system, causing headache, lethargy, weakness, and confusion. Can progress to coma and death. A decrease in hydrogen ions results in? Alkalosis, evidenced by an increase in pH Alkalosis causes irritability of which system? nervous system, causing restlessness, muscle twitching, and tingling/ numbness of the fingers. Can also progress to tetany, seizures, and coma What should nurses monitor when a patient is receiving a diuretic regularly? Skin turgor, daily weight, and electrolyte status Which patients can be considered at high risk for fluid and electrolyte imbalance? A 45-year-old woman with thyroid crisis, A 35-year-old trauma victim on a ventilatory, a 30-year-old complaining of persistent diarrhea. An older adult man is admitted for severe disorientation, confusion, and general weakness. His souse reports that he is not able to tolerate any food or fluids and has had several episodes of vomiting and diarrhea. Which imbalances is the patient most likely experiencing? Hypokalemia, and hyponatremia In planning care for a patient with cogestive heart failure, you choose the problem statement: fluid volume overload due to altered cardiac output. The problem statement woul dmost likely be supported by which sign or symptom? Fine crackles in the lung sounds. A patient who has congestive heart failure has a fluid excess with a weight gain of 1.5 pounds since yesterday and edematous ankles. Which providers order has the highest priority? Administer furosemide 40mg po once daily The new patient on the floor has been diagnosed with gastroenteritis. What would be the most critical level to assess? Potassium You appropriately elicit a sign of hypocalcemia by? tapping the face about 1 inch from the ear. What would be the most accurate way to assess for dehydration in an older adult patient? urine output Inflammation of the tongue is called? glossitis Nutritional therapy for gallbladder disorders include? low fat intake Crohns disease is a type of? inflammatory bowel disease The term used to describe difficulty swallowing is? Dysphagia Dietary changes that help reduce the incidence of constipation includes? Increasing fluid intake A major difficulty in treating hepatitis is? The person usually has a poor appetite Nutrition therapy for patients with irritable bowel syndrome include? Eliminating food allergens and intolerances Inflammation of pockets of tissue in the lining of the mucous membrane of the colon is referred to as? Diverticulitis The bacteria associated with peptic ulcer disease is? Helicobacter pylori An intolerance to gluten is associated with? celiac disease A characteristic of cystic fibrosis is? pancreatic insufficiency Dietary care of a patient with GERD includes Lower intake of fat Compared with healthy children, children with cystic fibrosis need? More kilocalories Dryness of the mouth form lack of normal secretions is called? Xerostomia An example of a meal that may cause an increase in symptoms for a patient with peptic ulcer disease is? Chicken curry Achalasia failure of the lower esophagus sphincter (LES) muscle to relax What are common contributors to chronic GERD? impaired esophageal peristalsis, prolonged LES relaxation, and hiatal hernias What medication class is the mainstay of pharmacologic treatment for GERD? Proton pump inhibitors (PPI's) If PPI's are unsuccessful, patients can get the surgical procedure done that restores the LES function and esophageal peristalsis Laparoscopic fundoplication hiatal hernia protrusion of a part of the stomach upward through the opening in the diaphragm Patients with hiatal hernias are advised to? Eat small amounts of food at a time, avoid lying down after meals, and sleep with the head of the bed elevated. The frequent use of what helps to control the symptoms of heartburn? Antacids Ulcers are common in where? Duodenal bulb because the gastric contents emptying are the most concentrated. Most common causes of peptic ulcer disease are? H. pylori infection and long term use of NSAIDs. General symptoms of PUD increased gastric muscle tone, painful contractions when the stomach is empty. *Hemorrhage may be one of the first symptoms. Low plasma protein levels, anemia, and weight loss Diagnosis of PUD is determined from? radiographs and gastroscopy 4 basic goals for the treatment of PUD alleviate or minimize the symptoms, promote healing, prevent recurrences by eliminating the cause, and prevent comlications. 4 types of drugs for the management of PUD Antibiotics, which address the H. pylori infection (Amoxicillin) Antacids, which neutralize the acid (Mylanta, Maalox) Hydrochloric acid secretion controllers *Histamine H2-receptor antagonists which reduce the hydrochloric acid production and secretions (cimetidine, -tidine medications) *Proton pump inhibitors which reduce the acid production by inhibiting the hydrogen ion (Prazole medications) Mucosal protectors, which deactivate pepsin and produce a gel-like substance to cover the ulcer and protect it (bismuth, subsalicylate, sucralfate) Nutrition intervention for patients with PUD Eat a well-balanced healthy diet Avoid acid stimulation- dont eat large quantities at meals, avoid eating immediately before going to bed. Spicy foods, chocolate, caffeine, prevent healing Stop smoking.