Exam 1: NSG3280/ NSG 3280 (NEW 2026/ 2027 Update) Pathophysiology for Nurses I Review | Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen

Exam 1: NSG3280/ NSG 3280 (NEW 2026/ 2027 Update) Pathophysiology for Nurses I Review | Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen Q. When entering a client's room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. Which of the following actions should the nurse take when preparing the sterile field? A. Keep the sterile field at least 6 ft away from the client's bedside. B. Instruct the client to refrain from coughing and sneezing during the dressing change. C. Place a mask on the client to limit the spread of micro-organisms into the surgical wound. D. Keep a box of facial tissues nearby for the client to use during the dressing change. ANSWER C Q. A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first? A. The flap closest to the body B. The right side flap C. The left side flap D. The flap farthest from the body ANSWER D Q. A nurse is wearing sterile gloves in preparation for performing a sterile procedure. Which of the following objects can the nurse touch without breaching sterile technique? (Select all that apply.) A. A bottle containing sterile solution B. The edge of the sterile drape at the base of the field C. The inner wrapping of an item on the sterile field D. An irrigation syringe on the sterile field E. One gloved hand with the other gloved hand ANSWER C, D, E Q. A nurse is reviewing hand hygiene techniques with a group of assistive personnel. Which of the following instructions should the nurse include when discussing handwashing? (Select all that apply.) A. Apply 3 to 5 mL of liquid soap to dry hands B. Wash the hands with soap and water for at least 15 seconds C. Rinse the hands with hot water D. Use a clean paper towel to turn off hand faucets E. Allow the hands to air dry after washing ANSWER B, D Q. A nurse has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should the nurse recognize as contaminating the sterile field? (Select all that apply.) A. The provider drops a sterile instrument onto the near side of the sterile field B. The nurse moistens a cotton ball with sterile normal saline and places it on the sterile field C. The procedure is delayed 1 hr because the provider receives an emergency call D. The nurse turns to speak to someone who enters through the door behind the nurse E. The client's hand brushes along the outer edge of the sterile field ANSWER B, C, D Q. A nurse is caring for a client diagnosed with severe acute respiratory syndrome (SARS). The nurse is aware that health care professionals are required to report communicable and infectious diseases. Which of the following illustrate the rationale for reporting? (Select all that apply.) A. Planning and evaluating control and prevention strategies B. Determining public health priorities C. Ensuring proper medical treatment D. Identifying endemic disease E. Monitoring for common-source outbreaks ANSWER A, B, C, E Q. The nurse is caring for a client who presents with linear clusters of fluid-containing vesicles with some crustings. The nurse should identify the client has manifestations of which of the following conditions? A. Allergic reaction B. Ringworm C. Systemic lupus erythematosus D. Herpes zoster ANSWER D Q. A nurse is caring for a client who reports a severe sore throat, pain when swallowing, and swollen lymph nodes. The client is experiencing which of the following stages of infection? A. Prodromal B. Incubation C. Convalescence D. Illness ANSWER D Q. A nurse educator is reviewing with a newly hired nurse the difference in manifestations of a localized versus a systemic infection. The nurse indicates understanding when she states that which of the following are manifestations of a systemic infection? (Select all that apply.) A. Fever B. Malaise C. Edema D. Pain or tenderness E. Increase in pulse and respiratory rate ANSWER A, B, E Q. A nurse is contributing to the plan of care for a client who is being admitted to the facility with a suspected diagnosis of pertussis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Place the client in a room that has negative air pressure of a least six exchanges per hour B. Wear a mask when providing care within 3 ft of the client C. Place a surgical mask on the client if transportation to another department is unavoidable D. Use sterile gloves when handling soiled linens E. Wear a gown when performing care that might result in contamination from secretions ANSWER B, C, E Q. A nurse is caring for a client who fell at a nursing home. The client is oriented to person, place, and time and can follow directions. Which of the following actions should the nurse take to decrease the risk of another fall? (Select all that apply.) A. Place a belt restraint on the client when he is sitting on the bedside commode B. Keep the bed in its lowest position with all side rails up C. Make sure the clients call light is within reach D. Provide nonskid footwear E. Complete a fall-risk assessment ANSWER C, D, E Q. A nurse manager is reviewing with nurses on the unit that care of a client who has had a seizure. Which of the following statements by a nurse requires further instruction? A. "I will place the client on his side." B. "I will go to the nurses' station for assistance." C. "I will administer his medications." D. "I will prepare to insert an airway." ANSWER B Q. A nurse observes smoke coming from under the door of the staff's lounge. Which of the following actions is the nurse's priority? A. Extinguish the fire B. Activate the fire alarm C. Move clients who are nearby D. Close all open doors on the unit ANSWER C Q. A nurse is caring for a client who has a history of falls. Which of the following actions is the nurse's priority? A. Complete a fall-risk assessment B. Educate the client and family about falls C. Eliminate safety hazards from the client's environment D. Make sure the client uses assistive aides in his possession ANSWER A Q. A charge nurse is assigning rooms for the clients to be admitted to the unit. To prevent falls, which of the following clients should the nurse assign to the room closest to the nurses' station? A. A middle adult who is postoperative following a laparoscopic cholecystectomy B. A middle adult who requires telemetry for a possible myocardial infarction C. A young adult who is postoperative following and open reduction internal fixation of the ankle D. An older adult who is postoperative following a below-the-knee amputation ANSWER D Q. A nurse is providing discharge instructions to a client who has a prescription for oxygen use at home. Which of the following information should the nurse include about home oxygen safety? (Select all that apply.) A. Family members who smoke must be at least 10 ft from the client when oxygen is in use B. Nail polish should not be used near a client who is receiving oxygen C. A "No Smoking" sign should be placed on the front door D. Cotton bedding and clothing should be replaced with items made from wool E. A fire extinguisher should be made readily available in the home ANSWER B, C, E Q. A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The nurse educator evaluates the teaching as effective when the newly licensed nurse states the client who has a heat stroke will have which of the following? A. Hypotension B. Bradycardia C. Clammy skin D. Bradypnea ANSWER A Q. A nurse educator is conducting a parenting class for new parents of infants. Which of the following statements made by a participant indicates understanding of the instructions? A. "I will set my water heater at 130 degrees Fahrenheit." B. "Once my baby can sit up, he should be safe in the bathtub." C. "I will place my baby on his stomach to sleep." D. "Once my infant starts to push up, I will remove the mobile from over the crib." ANSWER B Q. A home health nurse is discussing the dangers of carbon monoxide poisoning with a client. Which of the following information should the nurse include in her counseling? A. Carbon monoxide has a distinct odor B. Water heaters should be inspected every 5 years C. The lungs are damaged from carbon monoxide inhalation D. Carbon monoxide binds with hemoglobin in the body ANSWER D Q. A home health nurse is discussing the dangers of food poisoning with a client. Which of the following information should the nurse include in her counseling? (Select all that apply.) A. Most food poisoning is caused by a virus B. Immunocompromised individuals are at risk for complications from food poisoning C. Clients who are at risk should eat or drink only pasteurized dairy products D. Healthy individuals usually recover from the illness in a few weeks E. Handling raw and fresh food separately can prevent food poisoning ANSWER B, C, E Q. A nurse is caring for a client who is receiving enteral tube feedings due to dysphagia. Which of the following bed positions should the nurse use for safe care of this client? A. Supine B. Semi-Fowler's C. Semi-prone D. Trendelenburg ANSWER B Q. A nurse is caring for a client who is sitting in a chair and asks to return to bed. Which of the following actions is the nurse's priority at this time? A. Obtain a walker for the client to use to transfer back to bed B. Call for additional staff to assist with the transfer C. Use a transfer gait belt and assist the client back to bed D. Determine the client's ability to help with the transfer ANSWER D A nurse is completing discharge instructions for a client who has COPD. The nurse should identify that the client understands the orthopneic position when she states that she will do which of the following when she has difficulty breathing at night? A. Lie on her back with her head and shoulders on a pillow. B. Lie flat on her stomach with her head to one side C. Sit on the side of her bead and rest her arms over pillows on top of her bedside table D. Lie on her side with her weight on her hip and shoulder with her arm flexed in front of her C A nurse manager is reviewing guidelines for preventing injury with staff nurses. Which of the following instructions should the manager include? (Select all that apply.) A. Request assistance when repositioning the client B. Avoid twisting your spine or bending at the waist C. Keep your knees slightly lower than your hips when sitting for a long time D. Use smooth movements when lifting and moving clients E. Take a break from repetitive movements every 2 to 3 hr to flex and stretch your joints and muscles A, B, D A nurse educator is reviewing proper body mechanics during employee orientation. Which of the following statements should the nurse identify as an indication that an attendee understands the teaching? (Select all that apply.) A. "My line of gravity should fall outside my base of support." B. "The lower my center of gravity, the more stability I have." C. "To broaden my base of support, I should spread my feet apart." D. "When lifting an object, I should hold it as close to my body as possible." E. "When pulling an object, I should move my front foot forward." B, C, D A nurse is caring for multiple clients during a mass casualty event. Which of the following clients is the priority? A. A client who received crush injuries to the chest and abdomen and is expected to die B. A client who has a 4-inch laceration to the head C. A client who has a partial-thickness and full-thickness burns to his face, neck, and chest D. A patient who has a fractured fibula and tibia C A nurse educator is discussing the facility protocol in the event of a tornado with the staff. Which of the following should the nurse include in the instructions? (Select all that apply.) A. Open door to client rooms B. Place blankets over clients who are confined to beds C. Move beds away from windows D. Draw shades and close drapes E. Instruct ambulatory clients in the hallways to return to their rooms B, C, D An occupational health nurse is caring for an employee who was exposed to an unknown dry chemical, resulting in a chemical burn. Which of the following interventions should the nurse include in the plan of care? A. Irrigate the affected area with running water B. Wash the affected area with antibacterial soap C. Brush the chemical off the skin and clothing D. Leave the clothing in place until emergency personnel arrive C A security officer is reviewing actions to take in the event of a bomb threat by phone to a group of nurses. Which of following statements by a nurse indicates understanding of proper procedure? A. "I will get the caller off the phone as soon as possible to alert the staff." B. "I will begin evacuating clients using elevators." C. "I will not ask any questions and just let the caller talk." D. "I will listen for background noises." D A nurse on a medical-surgical unit is informed that a mass casualty event occurred in the community an that it is necessary to discharge stable clients to make beds available for injury victims. Which of the following clients should the nurse recommend for discharge? (Select all that apply.) A. A client who is dehydrated and receiving IV fluid and electrolytes B. A client who has a nasogastric tube to treat small bowel obstruction C. A client who is scheduled for an elective surgery D. A client who has chronic hypertension and blood pressure 135/85 mm Hg E. A client who has acute appendicitis and is scheduled for an appendectomy C, D A nurse is introducing herself to a client as the first step of a comprehensive physical examination. Which of the following strategies should the nurse use with this client? (Select all that apply.) A. Address the client with the appropriate title and her last name B. Use a mix of open- and closed-ended questions C. Reduce environmental noise D. Have the client complete a printed history form E. Perform a general survey before the examination B, C, E A nurse in a provider's office is documenting his findings following an examination he performed for a client new to the practice. Which of the following parameters should he include as a part of the general survey? (Select all that apply.) A. Posture B. Skin lesions C. Speech D. Allergies E. Immunization status A, B, C A nurse is collecting data for a client's comprehensive physical examination. After the nurse inspects the client's abdomen, which of the following skill of the physical examination process should she perform next? A. Olfaction B. Auscultation C. Palpation D. Percussion B A nurse is performing a comprehensive physical examination of an older adult client. Which of the following interventions should the nurse use in consideration of the client's age? (Select all that apply.) A. Collect the data in one continuous session B. Plan to allow plenty of time for position changes C. Make sure the client has any essential sensory aids in place D. Tell the client to take her time answering questions E. Invite the client to use the bathroom before beginning the examination B, C, D, E A nurse in a family practice clinic is performing a physical examination of an adult client. Which part of her hands should she use during palpation for optimal assessment of skin temperature? A. Palmar surface B. Fingertips C. Dorsal surface D. Base of the fingers C A nurse is caring for an 82-year-old client in the emergency department who has an oral body temperature of 38.3 degrees Celsius (101 degrees Fahrenheit). pulse rate 114/min, and respiratory rate 22/min. He is restless and his skin is warm. Which of the following interventions should the nurse take? (Select all that apply.) A. Obtain culture specimens before initiating antimicrobials B. Restrict the client's oral fluid intake C. Encourage the client to rest and limit activity D. Allow the client to shiver to dispel excess heat E. Assist the client with oral hygiene frequently A, C, E A nurse is instructing an assistive personnel about caring for a client who has a low platelet count as a result of chemotherapy. Which of the following instructions is the priority measuring vital signs for this client? A. "Do not measure the client's temperature rectally." B. "Count the client's radial pulse for 30 seconds and multiply it by 2." C. "Do not let the client know you are counting her respirations." D. "Let the client rest for 5 minutes before you measure her blood pressure." A A nurse is instructing a group of nursing students in measuring a client's respiratory rate. Which of the following guidelines should the nurse include? (Select all that apply.) A. Place the client in semi-Fowler's position B. Have the client rest an arm across the abdomen C. Observe on full respiratory cycle before counting the rate D. Count the rate for 30 sec if it is irregular E. Count and report any sighs the client demonstrates A, B, C A nurse who is admitting a client who has a fractured femur obtains a blood pressure reading of 140/94 mm Hg. The client denies any history of hypertension. Which of the following actions should the nurse take first? A. Request a prescription for any hypertensive medication B. Ask the client is she is having pain C. Request a prescription fro antianxiety medication D. Return in 30 min to recheck the client's blood pressure B A nurse is performing an admission on a client. The nurse determines the client's radial pulse rate is 68/min and the simultaneous apical pulse rate is 84/min. What is the client's pulse deficit? 16/min A nurse in a provider's office is preparing to test a client's cranial nerve function. Which of the following directions should she include when testing cranial nerve V? (Select all that apply.) A. "Close your eyes." B. "Tell me what you can taste." C. "Clench your teeth." D. "Raise your eyebrows." E. "Tell me when you feel a touch." C, E A nurse is assessing a client's thyroid gland as a part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Palpating the thyroid in the lower half of the neck B. Visualizing the thyroid on inspection of the neck C. Hearing a bruit when auscultating the thyroid D. Feeling the thyroid ascend as the client swallows E. Finding symmetric extension off the trachea on both sides of the midline A, D, E A nurse is assessing an adult client's internal ear canals with an otoscope as a part of a head and neck examination. Which of the following actions should the nurse take? (Select all that apply.) A. Pull the auricle down and back B. Insert the speculum slightly down and forward C. Insert the speculum 2 to 2.5 cm (0.8 to 1 in) D. Make sure the speculum does not touch the ear canal E. Use the light to visualize the tympanic membrane in a cone shape B, C, E A nurse is caring for a client who asks what her Snellen eye test results mean. The client's visual acuity is 20/30. Which of the following responses should the nurse make? A. "Your eyes see at 20 feet what visually unimpaired eyes see at 30 feet." B. "Your right eye can see the chart clearly at 20 feet, and your left eye can see the chart clearly at 30 feet." C. "Your eyes see at 30 feet what visually unimpaired eyes see at 20 feet." D. "Your left eye can see the chart clearly at 20 feet, and your right eye can see the chart clearly at 30 feet. A A nurse is performing a head and neck examination for an older client. Which of the following age-related findings should the nurse expect? (Select all that apply.) A. Reddened gums B. Lowered vocal pitch C. Tooth loss D. Glare intolerance E. Thickened eardrums D, E A nurse in a provider's office is preparing to perform a breast examination for an older adult client who is postmenopausal. Which of the following findings should the nurse expect? (Select all that apply.) A. Smaller nipples B. Less adipose tissue C. Nipple discharge D. More pendulous E. Nipple inversion A, D, E A nurse in a provider's office is preparing to auscultate and percuss a client's thorax as a part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Rhonchi B. Crackles C. Resonance D. Tactile fremitus E. Bronchovesicular sounds C, E During an abdominal examination, a nurse in a provider's office determines that a client has abdominal distention. The protrusion is at midline, the skin over the area is taut, and the nurse notes no involvement of the flanks. Which of the following possible causes of distention should the nurse suspect? A. Fat B. Fluid C. Flatus D. Hernias C During a cardiovascular examination, a nurse in a provider's office places the diaphragm of the stethoscope on the left midclavicular line at the fifth intercostal space. Which of the following heart sounds is the nurse attempting to auscultate? (Select all that apply.) A. Ventricular gallop B. Closure of the mitral valve C. Closure of the pulmonic valve D. Closure of the tricuspid valve E. Murmur B, D A nurse in a provider's office is preparing to auscultate and percuss a client's abdomen as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Tympany B. High-pitched clicks C. Borborygmi D. Friction rubs E. Bruits A, B A nurse in a provider's office is preparing to assess a client's skin as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Capillary refill less than 2 seconds B. 1+ pitting edema in both feet C. Pale nail beds in both hand D. Thick skin on the soles of the feet E. Numerous light brown macules on the face A, D, E A nurse is assessing an older adult client who has significant tenting of the skin over his forearm. Which of the following factors should the nurse consider as a cause for this finding? (Select all that apply.) A. Thin, parchment-like skin B. Loss of adipose tissue C. Dehydration D. Diminished skin elasticity E. Excessive wrinkling B, C, D A nurse is assessing postoperative circulation of the lower extremities for a client who had knee surgery. The nurse should include which of the following? (Select all that apply.) A. Range of motion B. Skin color C. Edema D. Skin lesions E. Skin temperature B, C, E A nurse is performing skin assessments on a group of clients. Which of the following lesions should the nurse identify as vesicles? (Select all that apply.) A. Acne B. Warts C. Psoriasis D. Herpes simplex E. Varicella D, E A nurse is performing an integumentary assessment for a group of clients. Which of the following findings should the nurse recognize as requiring immediate intervention? A. Pallor B. Cyanosis C. Jaundice D. Erythema B A nurse in a provider's office is preparing to assess a young adult male client's musculoskeletal system as a part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Concave thoracic spine posteriorly B. Exaggerated lumbar curvature C. Concave lumbar spine posteriorly D. Exaggerated thoracic curvature E. Muscles slightly larger on his dominant side C, E A nurse is assessing a client's neurosensory system. To evaluate stereognosis, the nurse should ask the client to close his eyes and identify which of the following items? A. A word she whispers 30 cm from his ear B. A number she traces on the palm of his hand C. The vibration of a tuning fork she places on his foot D. A familiar object she places in his hand D A nurse is caring for a client who reports pain with internal rotation of her right shoulder. The nurse should identify that this discomfort can affect the client's ability to perform which of the following activities? A. Mopping her floors B. Brushing the back of her hair C. Fastening her bra behind her back D. Reaching into a cabinet above her sink C A nurse is performing a neurosensory examination for a client. Which of the following assessments should the nurse perform to test the client's balance? (Select all that apply.) A. Romberg test B. Heel-to-toe walk C. Snellen test D. Spinal accessory function E. Rosenbaum test A, B A nurse is collecting data from an older adult client as part of a neurosensory examination. Which of the following findings should the nurse expect as changes associated with aging? (Select all that apply.) A. Slower light touch sensitivity B. Some vision and hearing decline C. Slower fine finger movement D. Some short-term memory decline E. Slower superficial pain sensation B, C, D A nurse is performing mouth care for a client who is unconscious. Which of the following actions should the nurse take? A. Turn the client's head to the side B. Place two fingers in the client's mouth to open C. Brush the client's teeth once per day D. Inject a mouth rinse into the center of the client's mouth A A nurse is instructing a client who has diabetes mellitus about foot care. Which of the following guidelines should the nurse include? (Select all that apply.) A. Inspect feet daily B. Use moisturizing lotion on the feet C. Wash the feet with warm water and let them air dry D. Use over-the-counter products to treat abrasions E. Wear cotton socks A, B, E A nurse is planning care for a client who develops dyspnea and feels tired after completing her morning care. Which of the following actions should the nurse include in the client's plan of care? A. Schedule rest periods during morning care B. Discontinue morning care for 2 days C. Perform all care as quickly as possible D. Ask a family member to come in to bathe the client A A nurse is beginning a complete bed bath for a client. After removing the client's gown and placing a bath blanket over him, which of the following areas should the nurse wash first? A. Face B. Feet C. Chest D. Arms A A nurse is preparing to perform denture care for a client. Which of the following actions should the nurse plan to take? A. Pull down and out at the back of the upper denture to remove B. Brush the dentures with a toothbrush and denture cleanser C. Rinse the dentures with hot water after cleaning them D. Place the dentures in a clean, dry storage container after cleaning them B A nurse in a provider's office is caring for a client that states that, for the past week, she has felt tired during the day and cant sleep at night. Which of the following responses should the nurse ask when collecting data about the client's difficulty sleeping? (Select all that apply.) A. "Does your lack of sleep interfere with your ability to function during the day?" B. "Do you feel confused in the late afternoon?" C. "Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day?" D. "Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep?" E. "Tell me about any personal stress you are experiencing." A, C, D, E A nurse is talking with a client about ways to help him sleep and rest. Which of the following recommendations should the nurse give to the client to promote sleep and rest? (Select all that apply.) A. Practice muscle relaxation techniques B. Exercise each morning C. Take an afternoon nap D. Alter the sleep environment for comfort E. Limit fluid intake at least 2 hr before bedtime A, B, D, E A nurse is caring for an older adult client who has been following the facilities routine and bathing in the morning. However, at home, she always takes a warm bath before bedtime. Now she is having difficulty sleeping at night. Which of the following actions should the nurse take first? A. Rub the client's back for 15 min before bedtime B. Offer the client warm milk and crackers at 2100 C. Allow the client to take a bath in the evening D. Ask the provider for sleeping medication C A nurse is preparing a presentation at a local community center about sleep and hygiene. When explaining rapid eye movement (REM) sleep, which of the following characteristics should the nurse include? (Select all that apply.) A. REM sleep provides cognitive restoration B. REM sleep lasts about 90 min C. It is difficult to awaken a person in REM sleep D. Sleepwalking occurs during REM E. Vivid dreams are common during REM sleep A, C, E A nurse is instructing a client who has a new diagnosis of narcolepsy about measures that might help with self-management. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I'll add plenty of carbohydrates to my meals." B. "I'll take a short nap whenever I feel a little sleepy." C. "I'll make sure I stay warm when I am at my desk at work." D. "It's okay to drink alcohol as long as I limit it to one drink per day." B A nurse is caring for a client who is at high risk for aspiration. Which of the following actions should the nurse take? A. Give the client thin liquids B. Instruct the client to tuck when swallowing C. Have the client use a straw D. Encourage the client to lie down and rest after meals B A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following nutrients provides the body with the most energy? A. Fat B. Protein C. Glycogen D. Carbohydrates D A nurse is caring for a client who requires a low-residue diet. The nurse should expect to see which of the following foods on the client's meal tray? A. Cooked barley B. Pureed broccoli C. Vanilla custard D. Lentil soup C A nurse is caring for a client who weighs 80 kg (176 lb) and is 1.6 m (5 ft 3 in) tall. Calculate her body mass index (BMI) and determine whether this client's BMI indicates that she is of healthy weight, overweight, or obese. 31; Obese A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include? (Select all that apply.) A. Older adults are more prone to dehydration than younger adults are B. Older adults need the same amount of most vitamins and minerals as younger adults do C. Many older men and women need calcium supplements D. Older adults need more calories than they did when they were younger E. Older adults should consume a diet low in carbohydrates A, B, C A nurse is caring for a client who has been sitting in a chair for 1 hr. Which of the following complications is the greatest risk for the client? A. Decreased subcutaneous fat B. Muscle atrophy C. Pressure ulcer D. Fecal impaction C A nurse is caring for a client who is postoperative. Which of the following interventions should the nurse take to reduce risk of thrombus development? (Select all that apply.) A. Instruct the client not to perform the Valsalva maneuver B. Apply elastic stockings C. Review laboratory values for total protein level D. Place pillows under the client's knees and lower extremities E. Assist the client to change position often B, E A nurse is planning care for a client who is on bed rest. Which of the following interventions should the nurse plan to implement? A. Encourage the client to perform antiembolic exercises every 2 hr B. Instruct the client to cough and deep breathe every 4 hr C. Restrict the client's fluid intake D. Reposition the client every 4 hr A The nurse is evaluating teaching on a client who has a new prescription for a sequential compression device. Which of the following client statements should indicate to the nurse the client understands the teaching? A. "This device will keep me from getting sores on my skin." B. "This thing will keep the blood pumping through my leg." C. "With this thing on, my leg muscles won't get weak." D. "This device is going to keep my joints in good shape." B A nurse is instructing a client, who has an injury of the left lower extremity, about the use of a cane. Which of following instructions should the nurse include? (Select all that apply.) A. Hold the cane on the right side B. Keep two points of support on the floor C. Place the cane 38 cm (15 in) in front of the feet before advancing D. After advancing the cane, move the weaker leg forward E. Advance the stronger leg so that it aligns evenly with the cane A, B, D SubQ needle length 1/2"-5/8" SubQ gauge 26-30 SubQ angle 45-90 degrees SubQ volume 1 mL at most IM needle length (deltoid) 1"-2" (5/8"-1") IM gauge (deltoid) 21-23 (23-25) IM angle 90 degrees IM volume (deltoid) 3 mL (1 mL) at most Intradermal needle length 1/2" Intradermal gauge 26-28 Intradermal angle 5-15 degrees SubQ sites Upper arm Abdomen Sub-scapular Anterior thigh Flanks IM sites Dorsogluteal Ventral gluteal Rectus femoris Vastus lateralis Deltoid IM considerations aspiration z track Isotonic solution same osmolarity as blood plasma expands body and fluid without causing a fluid shift from one compartment to another Hypertonic a solution of higher osmotic pressure pulls fluid from the cells causing them to shrink Hypotonic a solution of lower osmotic pressure moves fluid into cells causing them to enlarge Isotonic solutions D5W 0.9 NS LR Hypertonic solutions D10W D5NS D5.45NS D5LR Hypotonic solutions 0.45 NS 0.33 NS IV - small length 1" IV - small gauge 22 IV - medium length 1 1/4" IV - medium gauge 20 IV - large length 1.88" IV - large gauge 14 IV tubing change 72 hours (3 days) IV solution change 24 hours (1 day) idiopathic unknown cause Eitology cause of disease iatrogenic result of an unintended or unwanted medical treatment Pathogenesis development of disease from initial stimulation Symptoms are subjective characteristics of a disease that only the patient can feel incubation period/ Latent interval between initial infection and first signs and symptoms prodomal phase time of mild signs or symptoms indicating onset of disease Manifest Phase the disease reaches its full intensity, and signs and symptoms attain their greatest severity convalescence gradual recovery after an illness Signs Observed and objective manifestations Symptoms Subjective feelings from patient syndrome S/S that has not been identified exacerbation a sudden increase in severity of disease or signs or symptoms Remission improvement or absence of signs of disease subclinical Stage of a disease or disorder not severe enough to produce symptoms that can be detected or diagnosed. sequela subsequent pathologic condition resulting from an acute illness endemic disease local region or native disease epidemic disease disease acquired by many hosts in a given area in a short time pandemic disease worldwide epidemic secondary prevention Efforts to limit the effects of an injury or illness that you cannot completely prevent. Colonoscopies, treating for obesity, high BP but being treated for it, primary prevention Efforts to prevent an injury or illness from ever occurring. Vaccinations tertiary prevention actions taken to contain damage once a disease or disability has progressed beyond its early stages. Therapies Homeostasis A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level Allostasis process by which the body achieves stability through physiological change GAS stages of stress -alarm -resistance -exhaustion alarm stage of GAS organism recognizes stress, begins to respond. Fight or flight and sympathetic nervous system engages epinephrine and norepinephrine resistance stage of GAS second stage; body functions normalize while responding to the stressor. The body attempts to cope with the stressor normalization/resolution of glucocorticoid secretion, fight or flight, and secretions and epinephrine and norepinephrine. Exhaustion stage of GAS third stage; if the client reaches this stage, body functions are no longer able to maintain an adaptive response to the stressor increased glucocorticoid secretions followed by dysregulation ALLOSTATIC OVERLOAD Epinephrine Enhances myocardialcontractility, increases heartrate, and increases cardiacoutput ▪Causes bronchodilation ▪ Increases the release ofglucose from the liver(glycogenolysis) andelevates blood glucoselevels Norepinephrine ▪ Constricts blood vessels andraises blood pressure ▪ Reduces gastric secretions ▪Increases night and farvision (pupil dilation) Cortisol ▪ Primary glucocorticoid ▪ Affects protein metabolism ▪ Promotes appetite ▪ Has anti-inflammatoryeffects ▪ Too much cortisol over timecan lead to pro-inflammatory effects Aldosterone ▪ Primary mineralocorticoid ▪ Promotes reabsorption ofsodium and water ▪ Increases blood pressure endorphins and enkephalins •Endogenous opioids (body's natural pain relievers) •Raise pain threshold •Produce sedation and euphoria immune cytokines •Secreted by macrophages during stress response •Enhance immune system response •Prolonged stress can suppress immune functioning. sex hormones • Affect stress responses, thus influencing allostasis • May help explain gender responses during stress • Examples estrogen, testosterone, and dehydroepiandrosterone (DHEA) Adaptation biopsychosocial process of adjusting physiology, morphology, and behavior in response to new or altered circumstances, internal and external in origin, in the physical and social environment Adaptation and resilience have been ________ with allostasis Intertwined Maladaptation ineffective, inadequate, or inappropriate change in response to new or altered circumstances Ways allostatic loads can accumulate (1) repeated exposures to multiple stressors, (2) inability to habituate or adapt to the stressor, (3) unnecessarily prolonged stress response or stress response that continues after the stressor is removed, and (4) inadequate response to the stressor that causes other stress response mediators to attempt to compensate. Homeostasis, the steady-state that previously existed, cannot be attained Elevated cortisol levels are connected with depressive illnesses and immune suppression Aldosterone does not raise glucose levels while stress induced hydronic swelling cellular swelling due to accumulation of water first manifestation of most forms of reversible cell injury results from malfunction of sodium-potassium pump with accumulation of sodium ions within the cell Na does not leave cell, causing water to flow into cell Characteristics of hydronic swelling large, pale cytoplasm dilated endoplasmic reticulum Swollen mitochondria Intracellular accumulation Excess accumulation of substances in cells which leads to cell injury b/c of toxicity, immune response, taking up excessive space needed for functioning. (anything from excess lipids, carbs, proteins, inorganic pigments, inorganic particles) liver is common place atrophy cells shrink and reduce their differentiated function in response to normal and injurious factors Prednisone Elderly Disuse hypertrophy increase in cell mass accompanied by an augmented functional capacity in response to physiologic and pathophysiologic demands increased cellular protein content Hyperplasia increase in number of cells Metaplasia replacement of one cell type with another **adaptation to persistent injury**, with a replacement of a cell type that is better suited Columnar cells go to squamous cells in exposed to cigarette smoke. But CAN be reversed Common in lungs Dysplasia disorganized appearance of cells because of abnormal variations in size, shape, and arrangement Probably cancerous PRENEOPLASTIC necrosis Usually occurs as a consequence of ischemia (Hypoxia) or toxic injury inflammatory response Cell death Coagulative most common type of necrosis: Process that begins with ischemia and ends with degradation of plasma membrane INTERRUPTED BLOOD SUPPLY Reperfusion injury to cells involves formation of free radicals liquefactive necrosis occurs with dissolution of dead cells, liquification of lysosomal enzymes, and formation of abscess or cyst from dissolved dead tissue Fat necrosis Death of adipose tissue Usually the result of trauma or pancreatitis Appears as a chalky white area of tissue caseous necrosis Characteristic of lung damage secondary to tuberculosis Resembles clumpy cheese *TB* Gangrenous necrosis Cellular death in a large area of tissue results from interruption of a blood supply to a particular part of the body frost bite amputation Necrotic death of brain tissue usually produces _____ necrosis. Liquefaction The cellular response indicative of injury because of faulty metabolism is intracellular accumulations Does hypothermia cause an increase or decrease in blood viscosity? Increase Which cellular component is most susceptible to radiation injury? DNA Carbon monoxide injures cells by reducing oxygen level on hemoglobin Apoptosis response to injury that does not directly kill the cell **does not cause inflammation** large number of cells are continually undergoing programmed cell death as tissues remodel Nutritional Injury poor intake, altered absorption, impaired distribution, inefficient cellular uptake of essential nutrients Infectious and immunologic injury -Bacteria and viruses can injure cells in a variety of ways depending on its virulence -Added injury may occur indirectly by triggering body's immune response - Ischemia is the most common cause of cell injury and injures cells faster than hypoxia alone chemical injury Toxic chemicals or poisons can cause cellular injury both indirectly and by becoming metabolized into reactive chemicals by the body cellular aging progressive decline in proliferative and reparative capacity of cells exposure to environmental factors somatic death death of the organism as a whole rigor mortis release of lytic enzymes in body tissues` Which type of diabetes's is affected by glycogenolysis and gluconeogensis? Type 1 Type two diabetes is caused by the build up of glucose and then beta cells don't produce enough insulin, so they will keep producing which will cause hypoglycemia becoming resistant to insulin and extra glucose because it is not binding to receptors and then it will become hyperglycemic and now insulin and glucose cannot bind to cells What is the pathology of type 1 diabetes Pancreas beta cells get killed by monocyte, macrophages, and T-lymphocytes can be tested with early antibodies Exercise when blood glucose levels are greater than ______ is safe if ketosis is not present 250 What does glucagon inhibit in the pancreas simple form of glucose breakdown to make ATP and glycogen formation What lab value is a good diagnostic tool for diagnosing/preventing diabetes? Triglycerides Neurotransmitters have a role in hyperglycemia. when food is in your mouth, insulin will start to be produced Why do hypovolemia and glycosuria have an influence in diabetes If there is too much glucose in the blood, the kidneys will not be able to filter all of it out, causing glucose in urine You end up urinating much more when you are experiencing pre-diabetic/diabetic symptoms, causing you to lose water (hypovolemia) metabolic syndrome A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes. Highest population at risk for metabolic syndrome People who live a sedentary lifestyle Native americans and hispanics visceral abdominal fat accumulation What anti-diabetic medication can pregnant women take? Glyburide because it does not cross the placenta barrier Why do pregnant women need more insulin? Because the infant is producing just as much glucose as the mom, which more insulin is needed to counter act it Does a type 2 diabetic need more or less insulin? Less insulin Type 1 require constant insulin because they produce zero insulin Type 2 diabetics will take oral meds until their bodies start to stop reacting to those What BMI is indicative of diabetes Above 25 What do catecholamines do to glucose levels? Raise it Epi and norepinephrine is released, causing insulin to not bind to glucose How does stress affect glucose levels? Stress releases cortisol, which promotes the creation of glucose and will fight against insulin Glycogenolysis breakdown of glycogen to glucose GLUT 1 Major glucose transporter at the blood brain barrier GLUT 2 Primary glucose transporter in the liver and is present install quantities in the pancreatic B cells GLUT-3 Glucose transport molecules foe pancreatic B cells GLUT-4 Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation GLUT 1 & 3 transporters Insulin independed GLUT-4 insulin dependent incretin effect Both hormones stimulate the production of insulin in the presence of glucose, promote proliferation and beta bells, and inhibit apoptosis Fed state glucose levels higher Fasting state glucose levels lower How does exercise influence insulin levels? Insulin levels will drop, glucagon and catecholamine levels initially rise and increase the production of free fatty acids How does stress effect blood glucose levels stress can trigger the flight to high response, which will rise catecholamines and cortisol levels with therefore interacts to ensure continuous supplies of glucose to help feed the body's energy needs What is the first line of treatment for type 2 diabetes? Diet and exercise Screening for type 2 diabetes every three years starting at the age of 45 metabolic syndrome A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes. Pre-diabetic A1C levels 5.7-6.4% Diabetic A1C 6.4% or higher Gestational diabetes Happens in response to insulin resistance secondary to the weight gain that occurs during pregnancy Especially pregnant women deliver a baby over 9 pounds How does glucagon function? When alpha cells are excreted as a response to glucose levels dropping, the liver will start to breakdown glucagon into glucose into the blood stream Loss of fluid volume seen in DKA Hypovolemia Glucose may be oxidized for the energy needs of the cell Glycolysis Insulin helps glucose ____________ Go into the cells, giving them energy Portion of the pancreas that secretes insulin beta cells Production of glucose from amino acids and other substrates gluconeogenesis Insulin binding to its receptor on target cells results in increased facilitated cellular diffusion of glucose Diabetic neuropathy is thought to result from decreased myoinositol transport Approximately how many people in the US have diabetes 34.2 million In DKA, respiratory compensation may occur through a process of respiratory alkolosis What dominates the fasting state glucagon Neural regulation controlled by this nervous system sympathetic nervous system During exercise, blood sugar will drops During stress, blood sugar will increase because of corticosteroids When cells create waste, which organ will most commonly be affected? Liver If there is an accumulation of waste in cells and water follows them, what happens? Cells will swell Pathophysiology includes all of the follow elements except Clinical management Understanding the epidemiology of a disease will help with prevention Examples of factors influencing epidemiology patterns include all of the following except political view What is a clinical sign of a disease cough The development of heart failure from untreated hypertension would be an example of a/an Sequela Evidence based treatments are based on the results of sound clinical research In which of Selye's stages of stress response would a patient be if he or she were experiencing gastrointestinal bleeding secondary to peptic ulcer disease? Exhaustion 1. Several hormones are released during stress and serve to increase blood glucose levels. These include all of the following except testosterone 1. Indicators that a person who is experiencing stress has achieved resistance include heart rate has returned to baseline What promotes the creation of glucose from amino acids? Cortisol 1. The lipid bilayer can form spontaneously in aqueous solution because. a. The lipid bilayer structure allows the water molecules to be less ordered. 1. The Gs-protein-coupled receptor pathway activates ________________ to Increase production of cyclic adenosine monophosphate (cAMP). Adenylyl cyclase 1. cyclic nucleotides, including C AMP and cyclic guanosine monophosphate (cGMP), are degraded by enzymes called Phosphodiesterase 1. Nitric oxide stimulates guanylyl cyclase to produce Cyclic GMP 1. Which of the following tissues has a limited capacity for replacement of damaged cells? Nervous tissue 1. Hydropic swelling is a sign of cellular injury associated with Na+ K+ pump dysfunction Glandular tissue normally responds to increased functional demand? hyperplasia