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81 Cards in this Set

  • Front
  • Back
An example of a mu agonist opioid that is frequently used in the treatment of pain is:
A. Dilaudid.
B. butyrophenone.
C. haloperidol.
D. benzodiazepine.
A. Dilaudid
When opioids bind with receptors in the gastrointestinal tract, intestinal motility:
A. decreases and gastric emptying increases.
B. increases and gastric emptying decreases.
C. decreases and gastric emptying is delayed.
D. increases and gastric emptying is delayed.
C. decreases and gastric emptying is delayed.
What medication is frequently used for anxiety in the palliative care setting?
A. Dilaudid
B. Haloperidol
C. Benzodiazepine
D. Butyrophenone
C. Benzodiazepine
A client receiving morphine for bone pain may find a lower dose of morphine is possible when what is added to the regimen?
A. Oxycodone
B. Dilaudid
C. MS Contin
D. Nonsteroidal anti-inflammatory drugs
D. Nonsteroidal anti-inflammatory drugs
Clients who experience discomfort of smooth muscle spasms are best treated with:
A. anticholinergic medication.
B. cholinergic medication.
C. nonsteroidal, anti-inflammatory drugs.
D. analgesics.
A. anticholinergic medication.
What medications are frequently used for anxiety in the palliative care setting?
A. Benzodiazepine
B. Haloperidol
C. Butyrophenone
D. All of these may be used
D. All of these may be used
What is widely used for the relief of dyspnea?
A. Benzodiazepine
B. Haloperidol
C. Butyrophenone
D. Morphine
D. Morphine
Disease processes commonly associated with dyspnea include which of the following?
A. Acute and chronic pulmonary disorders
B. Heart failure
C. Neuromuscular disorders
D. All of the above are correct.
D. All of the above are correct
When diagnosing delirium, what is the most commonly used assessment instrument for identifying cognitive changes?
A. Mini-Mental State Examination
B. Diagnostic and Statistical Manual of Mental Disorders
C. Journal of the American Medical Association
D. American Journal of Nursing
A. Mini-Mental State Examination
What are the clinical manifestations of cachexia-anorexia?
A. Muscle loss, impaired immunity, and glucose intolerance
B. Vitamin deficiency and loss of body fat
C. Fluid retention and fatigue
D. All of the above are correct.
D. All of the above are correct.
Which of the following is an example of/are examples of complicated grieving?
A. Chronic grief
B. Delayed grief
C. Exaggerated grief
D. Both a and b
E. All are examples of complicated grieving.
E. All are examples of complicated grieving.
Clients with metastatic bone disease often require the combination of an opioid and a __________ __________ __________.
nonsteroidal anti-inflammatory drug
__________ medications offer the benefit of more convenient dosing schedules.
Controlled-release
__________ __________ is defined as weight loss, wasting, or loss of appetite.
Cachexia-anorexia syndrome
Palliative care literature does not support the use of __________ __________ for relief of dyspnea.
oxygen therapy
__________ __________ and __________ can be effective analgesics in the management of neurologic pain syndromes.
Tricyclic antidepressants; anticonvulsants
Clients on an acute Medicare-certified rehabilitation unit may have a discharge diagnosis of all the following except:
A. stroke.
B. amputation.
C. burns.
D. myocardial infarction.
D. myocardial infarction.
Which of the following is a rehabilitation service setting?
A. Outpatient
B. Home
C. Inpatient
D. All of the above are service settings.
D. All of the above are service settings.
Because rehabilitation focuses on the unique needs of the client, it is said to be:
A. client-centered.
B. service setting focused.
C. goal-oriented.
D. wellness-oriented.
A. client-centered.
When using the FIM assessment tool, each area is assessed by using:
A. an 18-point scale, ranging from total dependence to total independence.
B. a 7-point scale, ranging from total dependence to total independence.
C. a team approach.
D. Medicare guidelines and principles.
B. a 7-point scale, ranging from total dependence to total independence.
Which of the following can be found on the rehabilitation team?
A. A social worker
B. A dietitian
C. A hospital administrator
D. Both a and b
D. Both a and b
What does cultural competence in rehabilitation include?
A. Cultural awareness
B. Cultural skills
C. Cultural desire
D. All of the above are correct.
D. All of the above are correct.
The rehabilitation process can be affected by all of the following except:
A. the attitudes of the client.
B. community resources.
C. financial resources.
D. All of the above are correct.
D. All of the above are correct.
8. __________ is an interdisciplinary specialty that supports a dynamic process of helping an individual to achieve a life that is independent and self-fulfilling.
Rehabilitation
A common assessment tool used in clinical practice to determine an individual’s level of functional ability is the __________ __________ __________ __________.
Functional Independence Measures (FIM)
For empowerment to be a realistic concept and nurses to have the power to decide and control their scope of practice, which is the most important quality?

A. Knowledge of the issues.

B. Authority to make decisions.

C. Accountability for those decisions.

D. Responsibility for those decisions.
A. Knowledge of the issues.
Which of these is the mechanism for achieving professional practice through greater participation in decision making?

A. Job satisfaction.

B. Collective bargaining.

C. Collective action.

D. Work place advocacy.
D. Work place advocacy.
3. Which is the only collective bargaining unit that is made up of nurses who are working to help other nurses?

A. N-STAT (Nurses Strategic Action Team).

B. UAN (United American Nurses).

C. NLN (National League for Nursing).

D. PAC (Political Action Committee).
B. UAN (United American Nurses).
1. What is the major cause of acute pancreatitis in the United States?
A. Geographic location
B. Nutrition
C. Alcohol abuse
D. Age
B. Nutrition
2. Where does pain normally begin with a client with acute pancreatitis?
A. Upper epigastrium
B. Mid-epigastrium
C. Lower epigastrium
D. Lower colon
B. Mid-epigastrium
Severe hemorrhagic pancreatitis may produce what two distinctive manifestations?
A. Bluish discoloration of the left flank and periumbilical area
B. Reddish discoloration of the left flank and periumbilical area
C. Bluish discoloration of the right flank and periumbilical area
D. Reddish discoloration of the right flank and periumbilical area
A. Bluish discoloration of the left flank and periumbilical area
When do clients with gallstone-associated pancreatitis typically experience pain?
A. Before a meal
B. After ingesting a large meal
C. During a meal
D. After drinking large amounts of liquids
B. After ingesting a large meal
What medical management procedure is used to reduce pain in clients with pancreatitis?
A. Morphine
B. Opioid analgesics
C. Meperidine
D. Both b and c
D. Both b and c
Which of the following is not a major goal of surgical intervention for chronic pancreatitis?
A. Denervation procedure
B. Ductal drainage procedure
C. Pancreatic enzyme replacement
D. Ampullar procedure
C. Pancreatic enzyme replacement
All of the following are disorders of gallstones except:
A. hypertension.
B. congenital malformations.
C. infection.
D. tumors.
A. hypertension.
What are the two most common conditions of biliary tract disorder?
A. Gallstones and associated pancreatitis
B. Gallstones and associated cholecystitis
C. Gallstones and associated cholelithiasis
D. Gallstones and associated cholangitis
B. Gallstones and associated cholecystitis
Which of the following is a factor involved in gallstone formation?
A. Bile is supersaturated with cholesterol or calcium.
B. Solute must precipitate from solution to solid crystals.
C. Crystals must come together and fuse to form stones.
D. All of the above are correct.
D. All of the above are correct.
What is the treatment of choice for symptomatic gallbladder disease?
A. Laser therapy
B. Surgery
C. Laparoscopic cholecystectomy
D. All of the above are correct.
C. Laparoscopic cholecystectomy
Based on the information listed above, what data would be considered risk factors for gallbladder disease?
A. Race, gender, and number of pregnancies
B. Age, hormone replacement, and weight
C. Hypertension, gender, and race
D. Hysterectomy, number of pregnancies, and weight
B. Age, hormone replacement, and weight
16. Ms. D is scheduled for a cholecystectomy and common bile duct exploration. In completing preoperative teaching, the nurse would include which of the following explanations?
A. Information about a midabdomen vertical incision
B. Information on extracorporeal shock wave therapy to break up the gallstones
C. A description of a T-tube
D. Information about taking insulin postoperatively
C. A description of a T-tube
Ms. D is scheduled for a cholecystectomy and common bile duct exploration. If Ms. D had an elevated bilirubin level, the most likely explanation would be a stone blocking the
A. common bile duct.
Ms. D is scheduled for a cholecystectomy and common bile duct exploration. Preoperatively, the physician will more likely order meperidine (Demerol) than morphine to treat Ms. D's pain because:
A. Demerol is a stronger opioid.
B. morphine has more respiratory effects.
C. morphine can increase spasms of the sphincter of Oddi.
D. only Demerol can be given intravenously.
C. morphine can increase spasms of the sphincter of Oddi.
Postoperatively, if Ms. D were to have a T-tube, nursing care plans would include which of the following?
A. Hang the drainage bag below the bed.
B. Report the first day's output of 500 ml to the physician.
C. Irrigate the T-tube every 4 hours.
D. Record the volume and color of the drainage every 8 hours.
D. Record the volume and color of the drainage every 8 hours.
A client is admitted for severe pain in the right upper quadrant of the abdomen radiating to the back and right shoulder. Which of the following admitting orders should the nurse question?
1. Morphine 2 - 6 mg IVP on admit for relief of pain
2. NPO
3. Ultrasound of the gallbladder
4. CBC, serum bilirubin, amylase, and lipase
1. Morphine 2 - 6 mg IVP on admit for relief of pain

Morphine is more likely to cause spasms of the sphincter of Oddi than meperidine, the drug of choice for acute pain of cholelithiasis. The client should be NPO during acute pain. Elevated serum bilirubin may indicate obstructed bile flow, an elevated WBC may indicate infection and inflammation, and serum amylase and lipase are monitored to identify possible pancreatitis related to common duct obstruction. Ultrasound of the gallbladder can accurately diagnose cholelithiasis.
Implementation; Physiological Integrity; Application
In establishing a plan of care for a client returning from surgery post cholecystectomy with a T-tube, which of the following actions does the nurse plan for maintenance of the T-tube?
1. Maintain the T-tube at the level of the surgical wound
2. Teach client how to clamp the tube
3. Monitor the T-tube drainage for color and consistency and record results
4. Maintain the client in supine position for 24 hours postoperatively
3. Monitor the T-tube drainage for color and consistency and record results
A community health nurse is planning a teaching session on the prevention of the spread of hepatitis. In planning the teaching program, the nurse knows that which of the following is transmitted by the fecal-oral route via contaminated food, water, shellfish, and direct contact with an infected person?
1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis Delta
1. Hepatitis A

Hepatitis A is transmitted by the fecal-oral route via contaminated food, water, shellfish, and direct contact with an infected person. Hepatitis B, Hepatitis C, and Hepatitis Delta are transmitted through contact with infected blood and body fluids.
Planning; Health Promotion and Maintenance; Analysis
A nurse sustains a needle stick after a deep intramuscular injection to a client with known Hepatitis B. After washing and flushing the injury site, which of the following is the most appropriate action? [Hint]
1. If the nurse has been vaccinated for Hepatitis B, no further action is necessary.
2. If the nurse has been vaccinated for Hepatitis B, determine by serum lab if the nurse has immunity to the virus.
3. Administer the Hepatitis B immune globulin (HBIG) immediately after exposure, even if the nurse has been vaccinated in the past.
4. Administer the Hepatitis A immune globulin (IG) and the Hepatitis B immune globulin (HBIG).
2. If the nurse has been vaccinated for Hepatitis B, determine by serum lab if the nurse has immunity to the virus.

Postexposure prophylaxis is recommended for people exposed to the Hepatitis B virus. However, if the individual has been vaccinated for Hepatitis B, serum levels will indicate immunity to the virus. Immunity should not be assumed. Hepatitis B immune globulin (HBIG) is given to provide short-term immunity, and the Hepatitis B vaccine may be given concurrently.
Implementation; Safe, Effective Care Environment; Application
A nurse, planning dietary and fluid management for a client with alcohol-induced cirrhosis and elevated serum ammonia levels, recognizes that which of the following is the most appropriate to include in the plan? [Hint]
1. Sodium restriction of 2.5g /day
2. Fluid restriction of 1000 mL/day
3. Restrict foods high in magnesium
4. Protein restriction of 75 to 100 grams per day
4. Protein restriction of 75 to 100 grams per day

Though dietary needs change as hepatic function fluctuates, sodium is generally restricted to 2 g or less/per day to reduce ascites and generalized edema. Fluids are generally limited to 1500 mL/day. Magnesium deficiency often accompanies alcohol-induced cirrhosis, necessitating magnesium replacement. When serum ammonia levels are high, protein is restricted to 75 to 100 g per day. When serum ammonia levels stabilize, protein intake is allowed as tolerated.
Planning; Physiological Integrity; Application
A client with a long history of alcohol-induced cirrhosis is brought to the emergency room via ambulance, after the client's wife called 911 to report her husband was vomiting up large amounts of blood. The client is diagnosed with bleeding esophageal varicies. The emergency room physician plans to insert a Sengstaken-Blakemore nasogastric tube for balloon tamponade. The emergency room nurse should anticipate and prepare for which of the following before the insertion of the nasogastric tube?
1. Upper endoscopy
2. Gastric lavage
3. Endotracheal intubation
4. Variceal ligation
3. Endotracheal intubation

Prior to insertion of the nasogastric tube, the client is intubated endotracheally to support the airway and reduce the risk of aspiration. An upper endoscopy, gastric lavage, or variceal ligation would not be performed until the client is hemodynamically stable.
Bleeding esophageal varicies are life-threatening and restoration of hemodynamic stability is the first priority.
Implementation; Physiological Integrity; Application
The nurse is preparing a client with ascites for an abdominal paracentesis. Which of the following indicates that the client is not properly prepared for the physician to begin the procedure?
1. The client is in a sitting position.
2. The client has not voided in 2 hours.
3. Vital signs were obtained 15 minutes ago.
4. The client has signed an informed consent.
2. The client has not voided in 2 hours.

The preparation of a client for abdominal paracentesis includes positioning in a sitting position, either in a chair on the side of the bed. Baseline vital signs are obtained, and since this is an invasive procedure, informed consent is also obtained. The client should void immediately prior to the paracentesis to avoid bladder puncture.
Evaluation; Physiological Integrity; Application
The nurse is evaluating the laboratory values of a client with cirrhosis. The abnormal laboratory results include total bilirubin 4.6mg/dL; serum ammonia 95 mm/dL, platelets 68,000/mm3 and RBC 4.2 million/mm3. Based on the laboratory reports, the nurse recognizes that the client is at most risk for which of the following?
1. Seizures
2. Anemia
3. Infection
4. Abnormal bleeding
4. Abnormal bleeding

The normal total bilirubin is 0.1 to 1.0 mg/dL, normal ammonia is 35 to 65 mm/dL, and normal RBC is 4.6 to 5.9 million/mm3. Normal platelet count is 150,000/mm3. The value of 68,000 places the client at high risk for abnormal bleeding or hemorrhage.
Assessment; Physiological Integrity; Analysis
A client admitted with acute pancreatitis complains of severe epigastric and abdominal pain accompanied by nausea and vomiting. Upon physical assessment, the nurse notes mild jaundice. When establishing nursing diagnoses for this client, which of the following represents the priority nursing diagnosis?
1. Pain: related to obstruction of pancreatic ducts and inflammation
2. Imbalanced Nutrition: Less Than Body Requirements
3. Risk for Fluid Volume Deficit
4. Self-Care Deficit
1. Pain: related to obstruction of pancreatic ducts and inflammation

Control of pain is a priority for the client with acute pancreatitis. Analgesics should be administered on a regular schedule. Management of nutrition, maintaining fluid volume balance, and promoting self-care are all appropriate interventions for the client, and can be better achieved with pain control.
Analysis; Physiological Integrity; Application
Which of the following results are expected for a client with chronic pancreatitis receiving pancreatic enzyme supplements?
1. A decrease in abdominal distention
2. A reduction in fatty, frothy, foul-smelling stools
3. An increase in appetite
4. A decrease in pain
2. A reduction in fatty, frothy, foul-smelling stools

Clients with chronic pancreatitis are prescribed pancreatic enzyme supplements to reduce fatty, frothy, foul-smelling stools (steatorrhea) which are caused by a decrease in pancreatic enzyme secretions. The supplements do not reduce abdominal distention or pain, nor do they increase appetite.
Assessment; Physiological Integrity; Analysis
What is the normal Amylase Level?



A. 50-150 u/L

B. 500-5000 u/L

C. 5-10 u/L

D. 0.5-1 u/L
A. 50-150 u/L
What are possible reasons for the AST (Aspartate Amino Transferase) to be elevated in relation to the liver or pancreas?
Cirrhosis, Acute Hepatitis, Hepatic Necrosis, Cancer (Primary or Metastatic), Acute Pancreatitis

AST is an enzyme present in tissues of high metabolic activity

Released into the circulation following injury or death of cells. Will rise in 12 hrs and remain high for about 5 days after severe cell damage. Amount of rise is directly related to the number of damaged cells & amount of time r/t injury and time of test.
The normal lipase level is?



A. 400-600 U/L

B. 40-240 U/L

C. 4-24 U/L

D. 0.4-2.4 U/L
C. 4-24 U/L
Which is a better indicator in later stages of Pancreatitis, Lipase or Amylase and Why?
Amylase levels begin to rise in 3-6 hours after onset of pain in acute pancreatitis and return to normal in 2-4 days. Lipase elevates 24-36 hours after onset of illness and persists for 7-14 days or until the pancreatitis resolves.
Why is the Albumin level often decreased with liver disease?
Albumin is a protein that is formed in the liver. Decreased levels occur due to liver damage.
Alkaline Phosphatase, Normal Value (20-70 U/L), is a laboratory test often performed on clients with liver disease.

What is the importance of performing this test?
Alkaline Phosphatase is an enzyme originating mainly in the bone, liver & placenta. It is used as a tumor marker & index of liver & bone disease. In liver disease, the blood levels rise when excretion of the enzyme is impaired as a result of obstruction of the biliary tract. Examples: Obstructive Jaundice, Cirrhosis, Cancer, Hepatitis, & Pancreatitis.
What is the antidote for Acetaminophen overdose and how soon does it need to be given?
N-Acetylcysteine (Mucomyst) is given to help prevent liver damage following acetaminophen overdose. It should be

given within 8 hours of ingestion for optimal effect.
8. The leading reason for liver transplantation in the U.S. is which?

A. Cirrhosis

B. Hepatitis A

C. Hepatitis B

D. Hepatitis C
D. Hepatitis C- related hepatic failure
???????
9. The primary method of spread of Hepatitis C Virus (HCV) is which?

A. Organ Transplantation

B. Intravenous Drug Use

C. Sexual Contact

D. Perinatal Transmission
B. Intravenous Drug Use

IV drug use accounts for about 60% of HCV transmissions in the U.S.
10. Which laboratory test would reveal liver cell damage in a client with Hepatitis C (HCV)?

A. Serum Myoglobin

B. Blood Urea Nitrogen (BUN)

C. Conjugated (Direct) Bilirubin

D. Serum Alanine Aminotransferase (ALT)
D. Serum Alanine Aminotransferase (ALT)

ALT elevation indicates liver cell damage. It is an enzyme that is present in high concentrations in the liver.
Which places the healthcare worker at greatest risk for acquiring hepatitis C?

A. Recapping a used needle

B. Administering blood products

C. Performing peritoneal dialysis

D. Not wearing gloves while bathing a client
A. Recapping a used needle
Cullen’s sign (often seen in pancreatitis) is a gray-blue discoloration

A. Around the umbilicus

B. Of the flank

C. Of the stool

D. Indicating pancreatic interstitial edema
A. Around the umbilicus
Sclerotherapy is used to treat

A. Ascites

B. Hypertension

C. Esophageal Varices

D. Liver Abscess
C. Esophageal Varices
Turner’s sign (bruising in the flanks) may be seen with pancreatitis. It is caused by

A. Accumulation of Ascites

B. Alcohol ingestion

C. Hypocalcemia

D. Retroperitoneal Bleeding
D. Retroperitoneal Bleeding
A client is admitted to a medical-surgical unit after six hours in the emergency room. He request that his AM care be delayed to allow him to rest. The nurse complies with his request. This is an example of which type of management philosophy?
Continuous quality improvement
Total quality management
Six sigma
Quality management
Total quality management

Total Quality Management is customer-focused.
A family member slips on the wet floor and hits her head. You understand that completion of an incident report is necessary for which hospital process?
Risk management
Outcome management
Quality management
Peer review
Risk management

Risk management deals with all incidents of error in the hospital.
A client experiences difficulty breathing after the change of shift. The nurse on duty discovers that the IVFs were infusing at a rate 10 times the calculated normal. After notifying the physician, what should be the next step in the client's care?
Notify family
Discipline the previous nurse
Complete an incident report
Obtain legal consult
Complete an incident report

Completion of an incident report is necessary after notification of the physician.
A client experiences an air emboli, resulting in a stroke, during an IV start. This can be classified as which type of risk?
Patient dissatisfaction
Medical-legal incident
Medication error
Diagnostic procedure
Diagnostic procedure

Any incident occurring during a procedure is known as a diagnostic procedure risk.
A client complains every morning about the night shift nursing staff. His call light is not answered promptly regarding his elimination needs. No one shares his concerns with the manager, and he falls while trying to walk to the bathroom. This is a common reason to file a complaint. This common reason is a result of which of the following?
Breakdown in communication
Lack of staff
Lack of concern
Breakdown in management
Breakdown in communication

Communication with the staff allows a better understanding of safety concerns.
In order to best reduce the potential for risk, the development of which type of atmosphere is needed?
Nurse-focused
Physician-focused
Family-focused
Patient-focused
Patient-focused

The patients will believe that their best interest is at heart.
What is the focus of a continuous quality improvement program?
Family
Client
Nurse
Physician
Client

Continuous quality improvement is client-focused.
Monitoring the number of times a medication is given utilizing the "five rights" is an example of which portion of the Six Sigma program?
Measure
Management
Quantitative
Goal
Goal

The goal of Six Sigma is monitoring
A client experiences a major incident. The time frame for reporting the incident would be:
24 hours.
36 hours.
48 hours.
72 hours.
24 hours.

The incident report needs to be submitted within 24 hours of the incident, which is one of the steps in reporting.
A client is admitted to a medical-surgical unit after six hours in the emergency room. He request that his AM care be delayed to allow him to rest. The nurse complies with his request. This is an example of which type of management philosophy?
Continuous quality improvement
Total quality management
Six sigma
Quality management
Total quality management

Total Quality Management is customer-focused.
Implementation: Safe, Effective Care Environment: Analysis
A family member slips on the wet floor and hits her head. You understand that completion of an incident report is necessary for which hospital process?
Risk management
Outcome management
Quality management
Peer review
Risk management

Risk management deals with all incidents of error in the hospital.
Evaluation: Safe, Effective Care Environment: Analysis
A client experiences difficulty breathing after the change of shift. The nurse on duty discovers that the IVFs were infusing at a rate 10 times the calculated normal. After notifying the physician, what should be the next step in the client's care?
Notify family
Discipline the previous nurse
Complete an incident report
Obtain legal consult
Complete an incident report

Completion of an incident report is necessary after notification of the physician.
Diagnosis: Safe, Effective Care Environment: Application
A client complains every morning about the night shift nursing staff. His call light is not answered promptly regarding his elimination needs. No one shares his concerns with the manager, and he falls while trying to walk to the bathroom. This is a common reason to file a complaint. This common reason is a result of which of the following?
Breakdown in communication
Lack of staff
Lack of concern
Breakdown in management
Breakdown in communication

Communication with the staff allows a better understanding of safety concerns.
Assessment: Safe, Effective Care Environment: Application
In order to best reduce the potential for risk, the development of which type of atmosphere is needed?
Nurse-focused
Physician-focused
Family-focused
Patient-focused
Patient-focused

The patients will believe that their best interest is at heart.
Planning: Safe, Effective Care Environment: Analysis