Download NUR 242 Exam 3: Study Guide Unit 7 & 8:NUR 242 Exam 3 Study Guide Unit 7 & 8 and more Exams Nursing in PDF only on Docsity!
NUR 242 Exam 3 Study Guide Unit 7 & 8
The patient is in the ICU for 3 days and then transferred back to the pulmonary stepdown unit. She is still slightly short of breath with exertion. Her O2 saturation is 99% on oxygen at 2 L per nasal cannula. She denies any shortness of breath when resting during the assessment. The provider plans to discharge the patient on home oxygen in the morning. What should the nurse include in this patient's discharge teaching? (- ANS: Make sure that the patient understands any new medication regimen. She should be instructed to call 911 for any severe respiratory distress. Because she is being discharged with home oxygen, home health services should be arranged. A patient with COPD presents for a routine follow up. The patient smokes 1 PPD. Which statement by the patient causes the nurse to suspect an increase in dyspnea? A. "I bought a new pillow so I could prop myself up at night to sleep." B. "I have a productive cough in the morning." C. "I have gained weight since I was here last." D. "The patient is well groomed and is sitting in a tripod position." (- ANS: A Patients with COPD, who smoke, may have a productive morning cough. Weight loss often occurs when dyspnea is increased due to the increased metabolic demand. A tripod or orthopneic position is common with COPD and when combined with a disheveled appearance
may indicate an increase in dyspnea. Buying a new pillow indicates that the patient must sleep propped up because breathing is worse while lying down. They may not recognize the increased dyspnea and they try to compensate by using multiple pillows in order to rest. The nurse is assessing a patient with a chest tube following a pneumonectomy. Which assessment finding requires intervention? A. Bandage around the posterior tube is loose. B. 2 cm of water is in the second chest tube chamber. C. The water in the water seal chamber rises and falls with inhalation/exhalation. D. Bubbling present in the water seal chamber when the patient coughs. (- ANS: A After lung surgery, two tubes, anterior and posterior, are used. Dressings around the wound should not be loose. The wounds should be covered with airtight dressings. A home health patient with a history of asthma is having shortness of breath. The nurse discovers that the peak flowmeter indicates a peak expiratory flow (PEF) reading that is in the red zone. What is the priority nursing action? A. Call 911 immediately. B. Take the patient's vital signs.
confirmed, it is very important to address these problems. The patient is experiencing tachypnea. After consulting with the provider, the following orders are received: Full liquid diabetic diet IV fluids 1000 mL .9 NS at 60 mL/hr Oxygen at 2 L per nasal cannula Blood cultures × 3 and urinalysis Tylenol grain × every 4 hour for temperature above 101º F Cefazolin (Ancef) 1 g IVP every 8 hour Which of the provider's orders should the nurse implement first? A. IV fluids 1000 mL .9 NS at 60 mL/hr B. Oxygen at 2 L per nasal cannula C. Blood cultures and urinalysis D. Cefazolin (Ancef) 1 g IVP every 8 hour (- ANS: B All of the provider's orders are very important. However, the most important one is oxygen therapy. Hypoxia is often seen with pneumonia, so it is very important that supplemental oxygen is started as soon as possible. IV fluids should be started to enhance pulmonary toileting, and the laboratory should be notified to draw the needed blood cultures. UAP can obtain the specimen for urinalysis. The blood cultures and the UA should be obtained before the IVP Ancef is administered.
The nurse understands that which of the following is the most common symptom of pneumonia in the older adult patient? A. Fever B. Cough C. Confusion D. Weakness (- ANS: C The older adult with pneumonia often has weakness, fatigue, lethargy, confusion, and poor appetite. Fever and cough may be absent, but hypoxemia is usually present. The most common manifestation of pneumonia in the older adult patient is confusion from hypoxia rather than fever or cough. Which assessment finding for an older adult patient does the nurse ascribe to the natural aging process? A. Tightening of the vocal cords B. A decrease in residual volume C. A decrease in the anteroposterior diameter D. A decrease in respiratory muscle strength (- ANS: D
A. Cough B Dyspnea C. Chest pain D. Sputum production (- ANS: A Cough is a main sign of lung disease. Dyspnea (difficulty in breathing or breathlessness) is a subjective perception and varies among patients. A patient's feeling of dyspnea may not be consistent with the severity of the presenting problem. Sputum production may be associated with coughing and indicate an acute or chronic lung condition. Chest pain can occur with other health problems, as well as with lung problems. A patient in the ED has been experiencing upper abdominal pain after meals for the past 2 months. She also notices that when she takes a nap or sleeps at night, she has pain. Eating seems to decrease pain. She has been taking OTC antacids with some relief. Which assessment factor puts the patient at risk for peptic ulcer disease? A. Weight loss of 35 pounds B. Use of NSAIDs to control arthritis pain C. GERD 4 years ago D. Use of prednisone (Deltasone) for inflammation (- ANS: B
Peptic ulcer development is associated primarily with NSAID use and bacterial infections with H. pylori. Which diagnostic results support the diagnosis of peptic ulcer disease? (Select all that apply.) A. Low hemoglobin B. Low WBC level C. Low hematocrit D. Positive for H. Pylori bacteria E. Low potassium of 3.4 mEq/L. (- ANS: A, C, D Low HCT and Hgb often occur related to bleeding. The presence of infection with H. pylori is the second most common factor associated with the development of PUD. The patient would have a high, not low, WBC count. The potassium level is not a diagnostic factor for PUD. An EGD confirms that the patient has PUD. Three hours later, the patient is admitted to the medical unit for workup and further testing. On admission the patient reports midline epigastric tenderness and indigestion (dyspepsia). The patient is prescribed triple therapy. Which drugs will the nurse expect to be prescribed for the patient at this time? A. Proton pump inhibitor and two antibiotics B. Histamine antagonist, antacid, and proton pump inhibitor
A 64-year-old patient with a history of arthritis and hypertension is admitted with progressive epigastric cramping, dyspepsia, nausea, and dark sticky stools for 2 days. Which order should the nurse question? A. IV fluids, normal saline at 125 ml/hr B. Guaiac stool sample ´ 2 C. Naproxen (Naprosyn) 500 mg twice daily D. Stool sample for bacterial testing (- Answer: C Rationale: Long-term NSAID use creates a high risk for acute gastritis. Naproxen is an NSAID that may be used to treat arthritis. Other risk factors for acute gastritis include alcohol, caffeine, and corticosteroids. IV fluids may or may not be needed to replace any fluids or blood lost from the patient's gastritis. Stool guaiac is nonspecific but may be ordered to confirm blood in the stool, and a stool sample may be used to test for the presence of Helicobacter pylori infection. However, it is not as accurate as blood or breath tests. What is the nursing priority in the management of a patient with an active upper GI bleed? A. Obtain vital signs. B. Apply oxygen by nasal cannula. C. Type and crossmatch the patient for blood products. D. Notify the physician. (- Answer: A
Rationale: Vital signs are needed to evaluate the severity of the patient's bleed and hypovolemic status. Oxygen will assist with delivery of oxygen to the tissues and a type and crossmatch, although important, is not the immediate priority. Assessment data such as the patient's vital signs are needed before contacting the physician. A patient has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor the patient's laboratory results for evidence of which condition? A. Hypernatremia B. Hypercalcemia C. Hyperglycemia D. Hyperkalemia (- Answer: C Rationale: Long-term adverse effects that commonly occur with steroid therapy include hyperglycemia, osteoporosis, peptic ulcer disease, and increased risk for infection The nurse is caring for a patient with a long history of osteoarthritis. Which risk factors will the nurse teach the patient that may contribute to development of gastroesophageal reflux disease (GERD)? A. Weight of 130 lbs
nursing function, as well as education for signs and symptoms of infection if the patient has a rolling hiatal hernia. A patient in the ED has been experiencing upper abdominal pain after meals for the past several months. She reports pain after napping or sleeping at night. She has been taking OTC antacids with some relief. The nurse understands that which assessment finding places the patient at risk for peptic ulcer disease? A. GERD 4 years ago B. Weight loss of 35 lbs C. Use of NSAIDs to control arthritis pain D. Recent discontinuation of prednisone (Deltasone) (- ANS: C Peptic ulcer development is associated primarily with nonsteroidal anti- inflammatory drug (NSAID) use and bacterial infections with Helicobacter pylori. Which diagnostic results does the nurse recognize that support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.) A. Low hemoglobin (Hgb) B. Low white blood cell (WBC) level C. Low hematocrit (Hct) D. Positive for H. pylori bacteria
E. Low potassium of 3.4 mEq/L (- ANS: A, C, D Low Hct and Hgb often occur related to bleeding. Presence of infection with H. pylori is the second most common factor associated with development of PUD. The patient would have a high, not low, WBC count. Potassium level is not a diagnostic factor for PUD. An EGD, Esophagogastroduodenoscopy. confirms that the patient has PUD. Three hours later, the patient is admitted to the medical unit for workup and further testing. On admission the patient reports midline epigastric tenderness and indigestion (dyspepsia). The patient is prescribed triple therapy. Which drugs does the nurse prepare to administer? A. Proton pump inhibitor (PPI) and two antibiotics B. Antibiotic and two PPIs C. Histamine antagonist, antacid, and PPI D. Antacid, PPI, and prostaglandin analogue (- ANS: A For H. pylori infections, a common drug regimen is triple therapy, which includes a PPI, such as lansoprazole (Prevacid), and two antibiotics, such as metronidazole (Flagyl) and clarithromycin (Biaxin). EGD, Esophagogastroduodenoscopy
Long-term NSAID use creates a high risk for acute gastritis. Naproxen is an NSAID that may be used to treat arthritis. Other risk factors for acute gastritis include alcohol, caffeine, and corticosteroids. IV fluids may or may not be needed to replace any fluids or blood lost from the patient's gastritis. Stool guaiac is nonspecific but may be ordered to confirm blood in the stool, and a stool sample may be used to test for the presence of H. pylori infection. However, it is not as accurate as blood or breath tests. What is the nursing priority in the management of a patient with a newly active upper GI bleed? A. Obtain vital signs. B. Notify the physician. C. Apply oxygen by nasal cannula. D. Type and cross match the patient for blood products. (- ANS: C Oxygen will assist with delivery of oxygen to the tissues. Vital signs are then needed to evaluate the severity of the patient's bleed and hypovolemic status, which can then be reported to the physician. A type and cross match, although important, can take place afterward. At the oncologist's office, the patient tells the nurse that he has been experiencing vomiting and diarrhea. He states that he is tired all the time and has lost about 15 pounds over the past month. What is the priority diagnostic test that the nurse anticipates?
A. Esophagogastroduodenoscopy (EGD) B. Colonoscopy C. Serum electrolytes D. Stool for fecal occult blood (- ANS: D The most common signs of colorectal cancer are rectal bleeding and anemia. What symptom does the nurse expect the patient with intussusception to exhibit? A. Decrease in pulse B. Singultus (hiccups) C. Frequent bloody stools D. Extremely elevated body temperature (- ANS: B Intussusception is a telescoping of the intestine within itself. Singultus (hiccups) is common with all types of intestinal obstruction. The vagus and phrenic nerves stimulate the hiccup reflex. Intestinal obstruction can increase the intraabdominal pressure, causing pressure on the phrenic nerve and the symptom of singultus (hiccups). A patient received one positive fecal occult blood test. Which response is most appropriate?
Severe UC presents with greater than 6 bloody stools daily and may include fever, tachycardia, anemia, abdominal pain, and an elevated C- reactive protein and/or erythrocyte sedimentation rate (ESR). The patient is admitted to the acute medical unit. Which medication would the nurse question? A. Ibuprofen (Motrin) B. Mesalamine (Asacol) C. Prednisone (Deltasone) D. Loperamide (Imodium) (- ANS: A Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID); NSAIDs increase the risk for bleeding. Later in the afternoon, the patient states that the abdominal pain is getting worse. Which nursing interventions are appropriate? (Select all that apply.) A. Providing sitz baths as needed B. Administering analgesics as ordered C. Teaching music therapy or guided imagery D. Evaluating the diet for foods that cause pain E. Providing antidiarrheal medications if ordered (- ANS: A, B, C
Sitz baths will help prevent skin excoriation or irritation. Complementary therapies used in conjunction with analgesics can be very helpful in controlling pain. Antidiarrheal medications may provide symptomatic relief. Evaluating offending foods would not address the patient's immediate symptoms of pain. The patient states, "I am afraid I'll never get to go out with my friends again because I can't be away from the toilet." Which is the appropriate nursing response? A."What makes you say that?" B."Your friends will understand." C."I wouldn't worry about it if I were you." D."It sounds like you are concerned about managing this disorder when you are out." (- ANS: D This response verbalizes the implied concern. Response A does not address the concern and requires the patient to give an answer that defends her feelings. Responses B and C minimize the patient's feelings and do not address her concerns. The patient is preparing for discharge. She asks what is the best way to keep her skin from breaking down. What is the appropriate teaching the nurse will provide? A."Add high-fiber or high-cellulose foods to your diet." B."Apply a pectin-based skin barrier after each bowel movement."
