Adult Health II Final Exam

S - The Marketplace to Buy and Sell your Study Material Adult Health II Final Exam Exam 1 Material 1. When counseling a couple in which the man has an autosomal recessive disorder and the woman has no gene for the disorder, the nurse uses punnett squares to show the couple the probability of their child having the disorder. Which statement by the nurse is accurate? A: “Each child would be a carrier of the disorder” 2) The sister of a pt diagnosed with BRCA gene- related to breast cancer asks the nurse “do you think I should be tested for this gene?” Which response by the nurse is most appropriate? A: “There are many things to consider” 3) A male pt with hemophilia (X-linked recessive) asks the nurse if his children will be hemophiliacs. The mother of the children does not carry the hemophilia gene. Which response by the nurse is accurate? A: “Your female children will be carriers” 4) When caring for a young adult pt who has abnormalities in the cytochrome P450 (CYP 450) gene, which action will the nurse include in the pt’s plan of care? A: Teach that some medications may not work effectively 5) Constance, an 81 year old pt with dehydration, explains to the nurse she does not understand how she became dehydrated. The nurse explains the following (choose): A: The loss of subcutaneous tissue, a reduced thirst drive, hormonal changes 6) A pt with a family history of CF asks for information about genetic testing. Which response is most appropriate? A: Refer the pt to a qualified genetic counselor 7) Which action will the nurse include in the plan of care for a pt who has thalassemia major? A: administer iron chelation therapy as needed 8) IV KCl 60 mEq is prescribed for treatment of a pt with severe hypokalemia. Which action should the nurse take? A: Infuse the KCl at a rate of 10 mEq/hr 9) A pt who was involved in a motor vehicle crash has had a tracheostomy placed to allow continued mechanical ventilation. How should the nurse interpret the following ABG’s: pH: 7.49, PaO2: 85 mmHg, PaCO2: 32 mm Hg, and HCO3: 25 mEq/L? A: resp. Alkalosis 10) A post op. Pt who had surgery for a perforated gastric ulcer has been receiving NG suctioning for 3 days. The pt has a serum sodium level of 127 mEq/L. Which prescribed therapy should the nurse question? A: Infuse 5% dextrose in water a 125 mL/hr 11) A pt receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the pt is receiving this infusion? A: Lung sounds 12) A pt who is lethargic and exhibits deep, rapid respirations has the following ABG results: pH: 7.32, PaO2: 88 mm Hg, PaCO2: 37 mm Hg, HCO3: 16 mEq/L. How should the nurse interpret these results? A: metabolic acidosis 13) A pt who has been receiving diuretic therapy is admitted to the ER with a serum potassium level of 3.0 mEq/L. The nurse should alert the healthcare provider immediately that the pt is on what medication? A: Digoxin (Lanoxin) 0.25 mg/day Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material 14) The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? A: Encourage fluid intake up to 4000 mL every day. 15) The nurse is caring for a pt who has CVAD. Which action by the nurse is appropriate? A: Use push-pause method to flush CVAD 16) A patient with renal failure who arrives for outpatient hemodialysis is unresponsive to questions and has decreased deep tendon reflexes. Family members report that the patient has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion. Which action should the nurse take first? A: Notify the patient's health care provider. 17) A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. The patient complains of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first? A: Give the patient the PRN IV morphine sulfate 4 mg. 18) A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most important for the nurse to report to the health care provider? A: The patient is experiencing laryngeal stridor. 19) Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete? A: Presence of the Chvostek's sign 20) A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse? A: Serum calcium is 18 mg/dL. 21) Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? A: Auscultate the patient's breath sounds. 22) A patient with chronic anemia comes in with increased fatigue, and occasional palpitations at rest-what are some labs you would expect? A: Hemoglobin 8.6 23) Food choice for a patient with iron-deficiency anemia A: omelette and whole wheat toast 24) A patient with pernicious anemia has a clear understanding of the teaching when they make what statement A: I could choose nasal spray rather than B12 injections 25) Nursing action for a patient with severe hemolytic anemia A: alternate rest and activity 26) Which statement by a patient taking oral ferrous sulfate indicates a need for further teaching? A: I will call the provider if my stools turn black 27) What is important in caring for a patient with sickle cell anemia crisis? A: Evaluate the effectiveness of opioid analgesics 28) What statement made by a patient indicates a good understanding of prevention of a sickle cell crisis? A: Risk for a crisis will decrease with an annual influenza vaccine Downloaded by: JawTestacademics | Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material 29) A patient has scleral jaundice and hemolytic anemia-what labs does the nurse need to check? A: bilirubin level 30) A patient is receiving IV heparin and warfarin for DVT and is diagnosed with HIT the platelet levels drop to 110,000. What action is appropriate? A:Discontinue heparin infusion 31) The nurse is caring for a pt who is in neutropenic precautions. The nurse understands that the following are important steps to protect someone in neutropenic precautions (choose) A: Enforce strict handwashing with all caregiver visitors, eliminate raw or unwashed foods, prohibit visitors who have been sick recently 32) A patient with AML asks the nurse if chemotherapy is worth undergoing. What is the nurses response? A: SE of chemo are difficult, but AML frequently goes into remission 33) A patient with pneumonia and respiratory acidosis is lethargic. What is the first action? A: start pt on oxygen 34) Ratio of balanced pH of carbonic acid to bicarbonate A: 1:20 35) A patient with heart failure has dyspnea and crackles. What are some other symptoms of fluid volume excess? A: increase in BP 36) A patient with a serum potassium of 5.9 would have what patterns on ECG? (choose) A: Peaked T wave, wide flat P wave 37) A patient that just had a blood transfusion is having back pain and difficult breathing 15 min after completion what is action? A: disconnect transfusion and administer normal saline 38) A nurse coming onto shift has several patient with neutropenia which should she assess first? A: Patient with a fever of 100.8 39) A patient that had traumatic bleeding begin 90 min ago would have what expected lab? A: a normal hemoglobin 40) SAA symptoms of stage IV-B Hodgkins lymphoma (choose) A: fever, night sweats, weight loss; involvement of multiple lymph 41) Nursing action to prepare patient for administration of potassium SAA (choose) A: Ensure to dilute potassium appropriately, monitor IV for infiltration and phlebitis 42) Symptoms of fluid volume deficit A: weight loss and poor skin turgor 43) Sex linked disorders appear more often in -than in -A: males/females 44) A change on a gene or a chromosome is a A: mutation 45) What compensatory mechanism occurs in respiratory acidosis A: retention of HCO3 by kidneys Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material 46) What would you administer to a patient with pernicious anemia? A: vitamin B12 injections 47) A patient with anemia has labs draw and she has an increased MCV-what type of anemia may the patient have? (choose) A: pernicious anemia and folic acid deficiency 48) A patient’s room has seizure pads placed in it. What type of electrolyte imbalance would you expect the patient to have? A: hyponatremia 49) A hypertonic solution will A: increase fluid transfer from cells to blood vessels 50) What will be included in a fluid balance assessment? (choose) A: skin turgor, IV intake, BP 51) A pt comes in with resp. Acidosis. The nurse knows the following ABG results likely belongs to the pt with: A: pH: 7.28, PaCO2: 55 mm Hg, HCO3: 24 mEq/L 52) Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? A: Auscultate the pt’s breath sounds Exam 2 Material • 61 year old w/ multiple risk factors CAD o Elevated low-density lipoprotein (LDL) level • Pt info that confirms chronic stable angina o Px that goes away after a Nitroglycerin tablet • Sublingual nitroglycerin (Nitrostat) which statement indicates effective teaching? o Call ambulance if I still have px after taking 3 nitro’s 5 mins apart • side effect of Lisinopril (Zestril) o Chronic cough • Appropriate nursing dx for a pt to nervous to get washed up alone 3 days after an MI o Anxiety related to change in health status • Effectiveness of pre-op teaching w/ pt scheduled for CABG using internal mammary artery. Additional teaching when pt says? o I will have incisions in my legs where they will remove the skin • Pravastatin (Pravachol) & Niacin what is most important to communicate to provider? o Generalized muscle aches & pains • Assessment finishing most important w/ coronary artery bypass graft using the right radial artery graft? o Pallor & weakness of the right hand • Most important ECG change when pt has chest px o ST segment elevation • 52 year old male w/ chronic stable angina w/ an order for Metoprolol (Lopressor) questions the order if? o The pt has a history of asthma • Atypical symptoms of unstable angina (select all that apply) o Fatigue, indigestion, & anxiety • Difference between unstable angina, NSTEMI & STEMI...following characteristics (select all that apply) o ST elevation on the ECG & positive biomarkers such as troponin Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material • 68 year old w/ ascites w/ jugular venous distention (JVD) HOB elevated 45 degree. Finding indicates? o Increased right atrial pressure • Pt w/ chronic HF went to bed fine but woke up in the middle of the night feeling like I they were suffocating. Nurse documents this as: o Paroxysmal nocturnal dyspnea • Following an acute MI a 63 year old develops clinical manifestations of HF. Discharge teaching includes? o Angiotensin-converting enzyme (ACE) inhibitors • DIagnostic test most useful in determining whether a pt w/ acute SOB has HF? o B type natriuretic peptide • Captopril which statement by the pt indicates effective teaching? o I will call for help when I need to get up to use the bathroom • HF pt develops dyspnea, tachycardia, & lung crackles. When contacting the hcp which intervention does the nurse expect to be implemented? o Administer O2, furosemide, & morphine sulfate • heart transplant 1st year major cause of death o Acute rejection infection • Ejection fraction normal range? o 58% • A pt w/ pulmonary congestion, poor peripheral circulation, hepatomegaly, & an EF of 35%. What’s the client experiencing? o Mixed HF (failure of both left & right side) • Pt breathing rapidly & coughing up frothy, blood-tinged sputum. What’s this a sign of? o Pulmonary edema • CHF pt taking a diuretic & ACE inhibitor & low sodium diet gained 5 lbs in the past 3 days. What will be the nurses priority action? o Assess the pt for clinical manifestations of acute HF • Pt w/ hx of CHF has dyspnea & dry hacking cough. Which action should the nurse do 1st? o Auscultate breath sounds • What is a holter monitor used for? o Monitoring the ECG for an extended period of time • Torsemide possible adverse effects include (select all that apply) o Hypokalemia, arrhythmias & ototoxicity • Which question by the nurse identifies a risk factor for IE? o Have you had any dental work done recently?/ • How does the nurse assess for the presence of pulsus paradoxus? o Note the BP during both inspiration & expiration • Pt w/ IE a nurse should ask about a history of what? (select all that apply) o Prostethic valve & renal dialysis • Most important assessment for a pt w/ mitral valve stenosis? o Systolic murmur • Pt w/ IE & Small black streaks in the nail. What does the nurse identify these as? o Splinter hemorrhages • What info should a nurse report immediately for a pt w/ mitral valve regurgitation? o The pt has diffuse bilateral crackles • IE needs further teaching when they state? o I will be on home IV antibiotics for 7-10 days • Assessment finding most important to tell hcp when pt has IE o Sudden onset of right flank px • Hcp order for pt w/ IE & fever priority to implement o Collect blood cultures • Nursing intervention for a pt w/ aortic stenosis w/ acute pain r/t decreased coronary blood flow o Promote rest to decrease myocardial O2 demand • Mitral valve stenosis during diastole the nurse knows Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material o The pressure in the left atrium will be greater than the pressure in the left ventricle • Gold standard for aortic disorders o CT scan of Chest • 5 cm abdominal aortic aneurysm..pt teaching on pt risk factors o Uncontrolled HTN • Drugs used for peripheral artery disease o Statins • Legs cramp & hurt after walking a few mins & goes away when I stop. The nurse should? o Palpate for the presence of dorsalis pedis & posterior tibial pulses • Pt w/ chronic PAD needs further teaching when the pt says I will? o Use a heating pad on my feet @ night to increase the circulation • Plan of care after endovascular repair of an abdominal aortic aneurysm? o Monitor fluid intake & urine output • Hx of intermittent claudication. Pt statement that supports this? o My legs cramp when I walk more than a block • Teaching plan for a pt w/ PAD? o It’s very important that you stop smoking cigarettes • History of AAA has severe back px & absent pedal pulses. 1st action by nurse? o Check BP • Pt w/ repair of AAA has absent popliteal, posterior tibial, & dorsalis pedis pulses. Legs cool & mottled. 1st action by nurse? o Notify surgeon & anesthesiologist • Right calf venous thromboembolism (VTE) what requires immediate action by the nurse? o New onset of SOB • AAA w/ suspected spontaneous rupture..what findings on assessment? (select all that apply) o Diaphoresis, tachycardia & pallor • Stable aortic dissection w/o complication. Notify provider after which assessment finding? o BP of 162/98 • Surgery for an aortic aneurysm when it reaches what size? o 5.5 cm • Pt w/ PAD requires further teaching when they say? o I should rest my legs & avoid exercise as often as I can. Exam 3 Material: • Rhinoplasty teaching: indicate what teaching is considered successful o Elevate head for 48 hours to minimize swelling • Management of upper respiratory infection with acute sinusitis. What indicates the need of additional teaching? o Use nasal decongestant spray until congestion is gone. • When auscultating lungs you hear coarse crackles bilaterally, patient is unsuccessful coughing up secretions, what intervention should nurse do o Put on sterile gloves and use sterile catheter to suction • What is the first action with epistaxis o Apply squeezing pressure to the bridge of nose for 5-15 minutes • Patient has total laryngectomy and radial neck dissection in the first 24 hours what is the first priority nursing action o Keep patient in semi fowler’s position • Patients that should receive in inactivated flu vaccine o 76 year old in home residence o Pregnant 36 year old o 30 year old who takes corticosteroids for rheumatoid arthritis • Nurse assess what in the chest of a patient with pneumococcal pneumonia o Increased tactile fremitus • What indicates a good understanding of discharge instructions with a patient with pneumonia o Continue deep breathing and coughing exercise at home Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material • Patient taking Rifampin (Rifadin) for tuberculosis calls about orange urine and orange tears, nurses response would be o Orange urine and tears are normal • Older patient receiving standard multidrug for tuberculosis should call health care professional if o Yellow tinged sclera • Nurse and nursing student is taking care of a tuberculosis patient. The nurse corrects the student nurse if o The student nurse enters room with surgical face mask • Most concern with 1 hour after chest tube placement o 400 mL of blood in collection chamber • Patient comes in after automobile accident and has tracheal deviation to the LEFT and absent breath sounds on the RIGHT the nurses 1st intervention is o Right side chest tube insertion • Patient with right side chest tube after thoracotomy continue bubbling in suction chamber o Nurse should continue to monitor collection device • Patient is admitted with bacterial pneumonia and sepsis. What is the 1st order o Obtain blood cultures from 2 different sites • Patient comes into emergency department with open stab wound with sucking air to left chest, the first intervention of the nurse o Tape non porous dressing on 3 sides over wound • Sprained ankle discharge instructions o Use pillow to elevate ankle above the heart • Patient is wearing a body jacket brace for spinal fracture o Ask the patient about abdominal discomfort • Long term arm plaster cast for fracture immobilization until cast is completely dry the nurse should o Handle the cast using fingertips • ORIF of lower leg continues to have severe pain in 15 after IV morphine. Pulses are barely palpable, foot cool to touch o Notify health care professional (R/T being compartment syndrome) • After 3 day hospitalization with right femur fracture patient suddenly feels short of breath and tachypnea and states, “I feel like I am going to die” first intervention o Apply O2 • Most important communication to share with health care professional with casts o Capillary refill delayed • What requires immediate report with lumbar compression fracture o Patient becomes incontinent of urine and stool (cauda equina) • Patient discharge instruction after 1 week IV antibiotic therapy for acute osteomyelitis in right leg o How to monitor for long term IV antibiotic cath • Patient just had laminectomy and discectomy reposition with o Placing a pillow between patients legs and turning entire body as a unit • 54 year old, menopausal with family history of osteoporosis is discharges with osteopenia following densitometry testing o Calcium loss from bones can be slowed by increase calcium intake and weight bearing exercise • Menu choice with patient with osteoporosis o Oatmeal with skim milk and fruit yogurt • Alendronate (flomax) and patient with osteoporosis o Assist patient to sit up at bedside • 54 year old, exercise to prevent development of osteoporosis o Walking o Weight lifting o Hiking • DXA scan, T score indication of osteoporosis Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material o -2.8 • Patient using ibuprofen to treat osteoarthritis, require change if o Dark colored stools • Patient with lupus (SLE) most important to inform health care professional o Increase in creatinine • Hydroxychloroquine (plaquenil) to treat rheumatoid arthritis advice patient about what adverse effect o Blurred vision • Most important to communicate to health care professional for patient taking methotrexate to treat rheumatoid arthritis o WBC is low • 28 year old patient with fibromyalgia states meaning they have a good understanding of effective self management o I need to stop drinking so much coffee and soda • Look up swan neck deformities picture • Assessment with patient with fibromyalgia nurse should expect patient to report o Sleep disturbances o Multiple tender points o Widespread bilateral musculoskeletal pain • Significant difference between RA and OA: following are specific to RA and NOT OA o MCP joint involvement o Symptoms occur symmetrically o No inflammation • SLE (lupus) leading cause of death o Renal failure • Not a risk factor of osteoarthritis o Diabetes o (age, obesity, and ACL injury all are risk factors) • Enlarged DIP joint o Heberden’s nodes • Women develop osteoporosis because o Lower calcium intake o Less bone mass o Bone resorption earlier and more rapid after menopause o Pregnancy o Breastfeeding o Longevity • Bone degradation related to osteoporosis common in o Spine, hips, and wrists • Patient came to the emergency room after automobile accident with left tension pneumothorax o Absent lung sounds on left with tracheal deviation to right • Suction chamber o 20 cm water • What is the nursing intervention when chest tube becomes disconnected o Place the distal end in tube of sterile water • Primary risk factor for lung cancer o Smoking • Hospital acquired pneumonia o More than 48 hours after admission • Patient undergoing tuberculosis should o Avoid alcohol • Patient has trach and on ventilator, for ventilation to be successful, the cuff of trach must be o Inflated Exam 4 Material Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material • Instruction regarding prevention of future UTIs o Empty bladder • Finding by nurse to determine benign prostate hyperplasia/ pyelonephritis o CVA tenderness • Preventing recurrence of renal calculi o Drink 2000 to 3000 ml • Healthcare associated infection of urinary tract. o Avoid unnecessary urinary catheterization • Assessment data reported with lower urinary tract infection. o Burning on urination • Risk factors to screen for UTI. o Diabetes, Kidney disease, frequent antibiotic use • Which information is most important for nurse to report to HCP for bladder infection o Intermittent hematuria • Aside from giving opioid medication, the nurse anticipates to give what with a male with kidney stone? o Flomax (Tamsulosin) • Bacterial UTI, allergies to sulfa drugs and penicillins. o Nitrofurantoin and Cipro • Kayexalate o Assess bowel sounds • More teaching on progressive CKD o Salt substitutes should be used instead of regular salt • Injury after an industrial accident and developed acute kidney injury. o Serum potassium level of 6.5meq • Patient with BHP admitted with acute urinary retention and elevated BUN and creatinine levels o Insert a catheter • Patient with AKI has peaked T waves, first action. o Check medical record for most recent potassium level • During hemodialysis, patient complains of nausea and vomiting. o Check blood pressure • Postrenal causes of kidney injury. o Prostate enlargement and ureteral calculi • Patient with AKI. patient has begun to make about 2 liters of urine daily for the past 2 days. patient is at risk for? o Hyponatremia and Dehydration • Prominent cause of CKD is? o Diabetes • During treatment for CKD, patient develops a thromboembolism o Erythropoietin • Teachings with a newly diagnosed hyperthyroidism patient. o Antithyroid medications may take several months for full effect. • Plan of care for a patient with hyperthyroidism who has exophthalmos. o Tape eyelids • Most important to make during initiation of thyroid replacement with Synthroid (levothyroxine). o Apical pulse rate • Hyperthyroidism secondary to pituitary tumor, what lab values? o Elevated TSH and elevated T3 and T4 • Assessment finding for diagnosis of cushing's syndrome. o Buffalo hump and moon face • Therapies effective for a patient with acute adrenal insufficiency. o Increasing serum sodium levels • Addisonian crisis. o I had a flu earlier this week, so I couldn't take hydrocortisone • Adrenalectomy Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material o Monitor fluids and electrolytes • Taking prednisone 40 mg daily most important to report? o Patient stopped taking medication 2 days ago • The table with Addison's disease o Infuse 5% dextrose and 0.9% saline • Teaching about migraine headache. o I will lie down some place dark and quiet when headaches begin • Assessment of a patient with cluster headache o Unilateral eye pain • Tonic clonic seizure o Assist patient in a turning on their side without limiting movement • Multiple sclerosis taking mitoxantrone (novantrone) risk. o Cardiotoxicity and infertility • Stooped posture, shuffling gait. o EEG testing • Patient complains of bilateral headache o Acetaminophen • Sumatriptan (imitrex) o Recent acute myocardial infarction • Continuous tonic-clonic seizures for over 5 minutes o Administer lorazepam 4 mg IV • Sinemet for parkinson's o Cogwheel rigidity of limbs • Cluster headache o Start prescribed PRN O2 at 6 ml/min • Status epilepticus o Side rail pads, oxygen mask, suction tubing • Trigeminal neuralgia o Triggers leading to facial discomfort • Pain from trigeminal neuralgia o Teach proper oral care • Autonomic dysreflexia o Assist in planning a prescribed bowel program • Left spinal cord lesion at level T7 o Assessment of the patient for increased leg pain • T2 spinal cord transection injury o Function of both arms should be retained • C5 spinal cord injury o Assessment of respiratory rate and effort • C7 spinal cord injury o Push upward on the epigastric area as patient coughs • Meningococcal meningitis o Staf f have entered the patient's room without a mask • Nuchal rigidity o Brudzinski's sign • Meningitis in teenagers o Immunize adolescents and college freshmen • Autonomic dysreflexia in serious condition o Diaphoresis above injury level o Bradycardia o Bladder distension o Blurred vision • Leading cause of death with spinal cord injury. o Pulmonary embolism Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material Distribution of this document is illegal Want to earn $103 per month?