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267 Cards in this Set

  • Front
  • Back
An evaluation of a patient's life stresses might include which of the following tools?
Social Readjustment Rating Scale
What is considered an extrinsic health-influencing factor?
Women are more prone to ______ disease than are men.
The sequential acquisition of physical, mental, and social skills is called
the developmental process
Which variables would be important to explore with a patient who is taking an MAOI?
Dietary intake and preferences
Which patients might benefit the most from a highly structured environment with familiar objects?
An older adult with dementia of the Alzheimer's type.
What level of need would a highly structured environment best meet?
Safety and security
Which variables would be most likely to influence a patient's choice of medical treatments to prolong his life?
Culture and religion
An example of a situational variable that can influence a person's response to stress is
What organization publishes the DSM-IV?
American Psychiatric Association (APA)
A child with autism is sitting alone in a corner and rocking back and forth. The nurse knows that
social isolation is normal behavior for a child with autism.
Which would be most helpful for a patient with chronic alcoholism and a desire for accountability?
A twelve-step program and a sponsor.
Which of the following interventions may require the patient to sign an informed consent form?
Reiki therapy (an Eastern touch therapy in which the practitioner systematically uses light hand placement in one of 12 positions on the recipient's body to balance and direct healing energy to those sites)
A statement that attempts to explain the available evidence with relation to a given topic is called a
Thyroid hormone and cortisol are believed to play a role in which kind of disorders?
Depressive disorders
All of the following are diagnostic imaging techniques except: CAT scan, MRI, GTT, PET scan.
An exploration of family health history would be most important for a patient who is believed to have
Levels of which neurotransmitter may be decreased in patients with seasonal affective disorder?
A nurse who is trained in the technique of psychotherapy is drawing on the theory developed by
Sigmund Freud
A patient tells the nurse that he no longer wants to go to behavioral therapy because the therapist makes him remember painful events from his past. What theoretical understanding serves as the basis for the therapist's methods?
Repressed memories can unconsciously influence people in the present.
A patient tells the nurse that he can never succeed at anything because he feels inadequate. Which of the following conflicts may not have been resolved in this patient's past?
Initiative vs. guilt
Which defense mechanism is associated with the theory set forth by Henry Stack Sullivan?
Dissociation (A psychological separation of "splitting off"; an intrapsychic defensive process, which operates automatically and unconsciously. Through its operation, emotional significance and affect are separated and detached from an idea, situation, or object)
The four phases of Hildegard Peplau's theory of nursing include
Orientation, Identification, Exploitation (bargaining) and Resolution (termination).
A nurse who is interested in applying Caplan's theory to behavior management would focus on
Preventive strategies to help patients cope with anxiety.
Give a nursing diagnosis that is amenable to nursing intervention?
At risk for altered respiratory function
Which is the best example of a health promotion need?
Need to teach patient about ways to prevent diarrhea.
Which somatic symptom might the nurse expect to see in a patient who is experiencing a grief response?
Which test is helpful in assessing major depressive disorders accompanied by psychosis?
Dexamethasone suppression test (psychosis defined as a general term for a state of mind in which thinking becomes irrational and/or disturbed. It refers primarily to delusions, hallucinations, and other severe thought disturbances.)
A patient who is exhibiting destructive behavior might benefit most at the time of this behavior from
de-escalation techniques
Two major defining characteristics of dysthymic disorder are
guilt and depression
A patient tells the nurse that he no longer takes pleasure in hobbies that he once enjoyed. What specific behavior is he exhibiting?
Which psychological disorder is an affective response to life stress?
Bipolar disorder
A person with seratonin deficiency might benefit the most from which therapy?
Light therapy
Which statement by a mother with postpartum depression would most indicate cause for concern about the safety of the mother and the infant?
"I feel like no one can care for my baby as well as I can; the world is not a safe place."
What are three characteristics of a person with mania?
Loud speech, flight of ideas and impaired judgement
Which symptom might be present in a depressed patient?
Psychomotor retardation
A nurse who is caring for a patient with a cyclothymic affective disorder knows that cyclothymia differs from true bipolar disorder in which way?
Hypomania is a primary characteristic of cyclothymia
Low levels of what neurotransmitter characteristically accompanies aggression and anxiety?
Low levels of GABA
The fight-or-flight response is associated with which physiological symptom?
Increased gastric motility
Which symptom differentiates post-traumatic stress disorder from the other anxiety responses?
Flashbacks are common
What type of reassurance might patients who are experiencing a severe panic attack most need from the nurse?
Reassurance that they are not having a heart attack.
Paresthesia is most often associated with which of the following conditions?
Panic attack
Which intervention might be most helpful for patients with obsessive-compulsive disorder?
Allowing them to complete any ritualistic behaviors in which they are engaged and then gently directing them
A person who feels that his safety may be compromised and who is experiencing heart palpitations and a feeling of suffocation may have
A person who has developed alters may have done so for which reason?
As a means of dealing with anxiety.
The symptom most commonly associated with conversion disorder is
la belle indifference (Literally, "beautiful indifference." Seen in certain patients with conversion disorders who show an inappropriate lack of concern about their disabilities.)
The physician has ordered sulfasalazine (5-ASA) for a patient with ulcerative colitis. Which laboratory value might be affected by this medication?
Folate levels
The nurse would suspect that a patient was having a hallucination if he said that
He heard a voice telling him to injure himself.
Which would the nurse expect to be present in a patient with schizophrenia?
Elevated dopamine levels and enlarged ventricles.
What are the two negative symptoms of schizophrenia?
Alogia (poverty of speech) and avolition (general lack of desire, motivation and persistence)
A family member of a patient with schizophrenia asks the nurse what signs might indicate that the person is on the verge of a psychotic episode. What signs should the nurse discuss with the relative?
Difficulty concentrating and magical thinking
A patient with catatonia is repeating words and phrases that other people have said. What is the name of this symptom?
Which two symptoms can be associated with drug-induced delirium?
Irregular heart beat and depressed respirations
A fifty-six year old patient is experiencing short-term memory loss, personality changes, and difficulty finding words. The nurse suspects that the area of the patient's brain that might be affected is the
hippocampus (an area of the brain believed responsible for memory and personality)
All of the following are indicative of dementia of the Alzheimer's type (3)
senile plaques, neurofibrillary tangles and low levels of acetylcholine.
The Folstein Mini Mental Status Exam tests for all of the following (3)
word memory and recall, orientation to time and place and ability to calculate
A patient with Alzheimer's dementia is experiencing apraxia. Which trait does the patient exhibit?
Inability to tie his shoes (apraxia: inability to make a voluntary movement in spite of being able to demonstrate normal muscle function)
Name three behavioral characteristics of someone with Alzheimer's dementia
sundowning (unsettled behavior evident in the late afternoon or early evening), catastrophic reactions and depression
The type of dementia that can be treated with medication that may prevent additional pathalogical changes in the brain is
Multi-infarct dementia (A dementia caused by a series of small strokes that affect the brain, also called vascular dementia)
What medication is commonly used to prevent further pathological changes in the brains of patients with multi-infarct dementia?
Which diagnostic test might be ordered for a patient who is suspected of having AIDS dementia complex?
Spinal tap
A patient who is a heavy drinker is admitted to the hospital with sudden ptosis, nystagmus and a diagnosis of dementia. What might the nurse also expect to see?
Thiamine deficiency
Which nursing diagnosis would be most appropriate for a patient with Huntington's corea?
Body image disturbance (Huntington's disease is a genetic disorder of the nervous system, characterized by involuntary movements and progressive mental deterioration)
Which two symptoms are associated with Parkinson's disease?
Festination (walking with a series of quick, small, shuffling steps as if hurrying forward to keep balance) and nonintentional tremors
A patient with what psychological disorder would most benefit from antipsychotic therapy?
A patient is receiving Haldol. What needs to be monitored?
urinary output
A patient who is exhibiting negative symptoms of psychosis might benefit most from which medication?
If a patient is receiving Clozaril, which symptom should be immediately reported to the physician?
Fever of 100.5 degrees
Which two symptoms might the nurse expect to see in a patient who is on Thorazine?
Hypotension and somnolence
Extrapyramidal side effects are related to abnormal secretion of what neurotransmitter?
Which symptom is associated with medication-induced parkinsonism?
Bradykinesia (The slowing down and loss of spontaneous and voluntary movement)
A physician has ordered amantadine (Symmetrel) for a patient. What is the most likely reason?
To relieve constant finger tapping
Which two symptoms are associated with acute dystonia?
Torticollis (A contracted state of the neck muscles that produces a twisting of the neck and unnatural position of the head ) and oculogyric crisis (A fixed upward gaze that can occur as a side effect of certain antipsychotic drugs)
Which nursing intervention is most appropriate for a patient who is experiencing tardive dyskinesia?
Providing for safety
The AIMS is used to evaluate symptoms associated with
Extrapyramidal side effects (Abnormal Involuntary Movement Scale)
In addition to administering medications, what can the nurse do to help relieve extrapyramidal side effects?
Create a quiet, restful environment
What assessment criteria would be most helpful for the nurse to explore prior to giving antipsychotic medication to a patient?
History of seizure
Which action would be most appropriate to teach a nursing assistant who is caring for an elderly patient on Risperdal?
Dangling the patient's feet before standing up
A nurse who is administering high-dosage and high-potency medications that alter dopamine levels needs to be sure to assess the patient's
Temperature and blood pressure
Muscle spasms that occur with neuroleptic malignant syndrome are often treated with which two medications?
Dantrolene (Dantrium) and bromocriptine
One major category of medications used to treat anxiety disorders is
Which medication may be given if a patient with a behavioral disorder is prone to seizures?
Clonazepam (Klonopin)
A patient is taking cyproheptadine hydrochloride (Periactin) to treat depression. The nurse knows that the patient's depression is probably related to
Antidepressant therapy might be useful for these three conditions
Post-traumatic stress syndrome, dysthymic disorder and early Alzheimer's dementia
It is believed that antidepressants act by potentiating the action of what two neurotransmitters?
Norepinephrine and serotonin
Which class of drugs is not an antidepressant?
A patient with Alzheimer's dementia is taking Elavil. What two assessments would be important for the nurse to make?
Heart rate and blood pressure (Elavil is a tricyclic antidepressant)
Teaching for a patient who is taking tricyclic antidepressants might include
Information about alcohol-antidepressant interactions
A patient who is about to be discharged is given a prescription for phenelzine sulfate (Nardil). Patient teaching should include information about avoiding which of the following foods?
Aged cheese, chocolate, bananas and soy sauce
What sign might indicate that a patient is having an MAOI-tyramine interaction?
Severe headache in the occipital region
What medication might be given in the emergency room to a patient who is having an MAOI-tyramine interaction?
Phentolamine mesylate (Regitine)
Fluoxetine hydrochloride (Prozac) might be most beneficial for patients with
Seasonal affective disorder and compulsive eating disorders
A patient who is experiencing serotonin syndrome might have which of the following sets of symptoms?
Very high fever, hypertension and muscle rigidity
The nurse suspects that a patient who has been admitted to the ER may have taken an overdose of sedatives/hypnotics. What action might the physician initially order?
Gastric lavage with activated charcoal
A patient with bipolar disorder complains about being more thirsty than usual and having to urinate frequently. The nurse's response would reflect his understanding that
These symptoms are common side effects of lithium
Which medication may be used to treat a person with mania who fails to respond to lithium therapy?
Valproic acid (Depakene, Depakote)
What is the anticipated effect of carbamazepine (Tegretol)?
Higher seizure thresholds
A child is exhibiting repetitive motor movements, blinking, jerking of the arms, and clearing of the throat. He is also making abnormal verbalizations like repetitive grunting, humming or panting sounds. What two drugs might be the cause of this behavior?
Ritalin or Dexedrine overdose
Toxic effects of anticonvulsant medications can include these three
Hypertensive crisis if given with MAOIs, hair loss and hypersalivation.
Which levels should be monitored in a patient who is taking carbamazepine or valproic acid?
Liver enzymes
In the morning, a patient who is taking zolpidem tartrate (Ambien) tells the nurse that he is more tired than ever. What might be the rationale for this statement?
Deprivation of rapid eye movement (REM) sleep results in abnormal sleep patterns
Early withdrawl symptoms associated with sedatives/hypnotics include (2)
Restlessness and insomnia
The nurse who attempts to provide a calm environment for a patient with dementia is using
Mileu therapy
Positive reinforcement, aversion conditioning, desensitization, and modeling are included in what type of therapy?
Behavior modification
Dream analysis might be most beneficial for a patient with
Post-traumatic stress disorder
Which principle might the nurse explain to a patient who asks how biofeedback therapy works?
Some involuntary responses can be controlled.
Which is a true statement about alternative and complimentary therapies?
The mechanisms by which most work remain unknown
Elderly nursing home residents who are depressed might be helped by having a nurse
Encourage them to do a life review
Symptoms of Antabuse-alcohol interaction are caused by
The accumulation of acetaldehyde
Three symptoms of Antabuse-alcohol reaction are
Flushing and vertigo, throbbing headache and tachycardia, and blurred vision and diaphoresis
Which medication is usually given to treat addictions to illegal opiate drugs?
Methadone (Dolophine)
Which vitamin might be given to a patient with Alzheimer's dementia?
Vitamin E
A nurse who is assisting a physician with electroconvulsive therapy (ECT) knows that succinylcholine (Anectine) may be ordered. The purpose of this medication is to
Relax the muscles
When dealing with depressed patients, the nurse should be sure to ask about prior use of which substance?
St. John's Wort
The Community Mental Health Center Act of 1963 focused on
Deinstitutionalization of people with behavioral disorders
Which is a true statement about the endocrine glands?
They secrete directly into the bloodstream or lymph system
When is secretion of glucocorticoid hormones highest?
Secretion is usually highest in the morning
The primary action of epinephrine (adrenaline) and norepinephrine is to
Increase heart rate and metabolism
The endocrine gland primarily involved in calcium regulation is the
Adequate intestinal absorption of calcium is dependent on which substance?
Vitamin D
Which pituitary hormone aids in water absorption by the kidneys?
Vasopressin (ADH)
Which substance is a waste product of protein metabolism?
A patient is admitted to the hospital with a diagnosis of pheochromocytoma. This is related to hypersecretion of which two hormones?
Epinephrine and norepinephrine (Tumor of the adrenal gland which causes severe high blood pressure.)
Which two symptoms are associated with pheochromocytoma?
Hypertension and headache
Increased secretion of catecholamine hormones can precipitate which symptom?
Malignant hypertension
Increased urinary excretion of catecholamine metabolites can best be diagnosed with what?
Twenty-four-hour urine tests for vanillylmandelic acid
A patient with pheochromocytoma is having an angiogram. What is the probable reason for this test?
To determine the location of the tumor
Which should a patient avoid prior to diagnostic testing for catecholamines? (3)
Aspirin, cough medicine and coffee.
A patient with malignant hypertension might initially be treated with
Sodium nitroprusside (Nipride)
Postoperative monitoring of a patient who has had an adrenalectomy will include
Frequent blood pressure checks
When might a patient's need for exogneous corticosteroids increase?
During times of physical or emotional stress
Which might be a nursing diagnosis appropriate to a patient with Cushing's syndrome?
Disturbance in body image (Cushing's Syndrome is a disorder caused by excessive secretion of the adrenal gland hormone cortisol. The syndrome is characterized by accumulation of fat around the abdomen and the upper back)
Which set of diagnostic results might the nurse expect to see in a patient with Cushing's syndrome? (3)
Hyperglycemia, hypokalemia, and high 17-hydroxycorticosteroids
A patient admitted with a possible diagnosis of Addison's disease is experiencing weakness, nausea, dizziness and a BG of 75. What might be the rationale for the symptoms?
Low levels of circulating corticosteroid hormones (Addison's disease is marked by the atrophy or destruction of the adrenal cortex. Most cases of Addison's disease appear to involve an autoimmune process.)
A patient's diagnosis of Addison's disease is confirmed. What should be the primary focus of preventive discharge teaching?
Stress reduction and diet counseling
A patient with adrenocortical insufficiency has the following symptoms: severe dehydration, severe hypotension, tachycardia, cardiac dysrhythmias and rapid respirations. What laboratory values would the nurse expect to see?
Hypoglycemia and hyperkalemia (high amounts of potassium in the blood)
The nurse is assigning a room to a nursing home resident with Addison's disease. Who would be the best roommate for this resident?
A bed-bound resident with a fractured hip
A patient with adrenal insufficiency is weak and dizzy and appears to be confused. What might be an appropriate nursing intervention?
Check the patient's BG
Which medication would the nurse expect to give to a patient following hypophysectomy (surgical removal of the pituitary gland) to prevent complications from CSF (cerebrospinal fluid) leakage?
An antitussive (prevents or relieves coughs)
A patient is experiencing changes in mental status with headaches, seizures and altered levels of consciousness. Nursing assistants report low urine output. Laboratory values indicate hyponatremia, hypokalemia and urine with high specific gravity. What might the nurse suspect as the cause of these symptoms?
Cerebral edema as a result of fluid retention
A patient who was admitted with a fractured hip is experiencing increased thirst and polyuria. His urine is very dilute and has a specific gravity of 1.003. What might be the reason for these symptoms?
Hyposecretion of ADH
Which laboratory test might be ordered for the patient in the previous scenario?
Fluid deprivation test
A physician has ordered Pitressin tannate for a patient. It is important to ask the patient if he has any allergies to
The nurse is told to give desmopressin acetate to a patient. What understanding accompanies this medication?
It may be given intranasally
A patient with diabetes insipidus will be placed on which diet?
Low-protein (a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal.)
A patient with which glandular condition is most likely to be placed on antidepressant therapy?
Which set of symptoms is associated with elevated serum thyroxine levels? (3)
Heat intolerance, tachycardia and gradual weight loss
First define and then give three symptoms which are indicative of thyrotoxicosis?
thyrotoxicosis: pathologically excessive production of thyroid hormones. Symptoms are Lagophthalmos (abnormal condition in which an eye cannot close completely or failure of the eyelids to protect the eye), diplopia (double vision) and photophobia (Abnormal sensitivity to light)
The nurse listens over the patient's thyroid gland and hears a whistling sound. What is she hearing?
A bruit
Which two medications may be given to inhibit the production of T3 and T4?
Propylthiouracil (PTU, Propacet) and methimazole (Tapazole)
Lugol's solution or saturated solution of potassium iodine (SSKI) may be ordered if a patient is scheduled for thyroid surgery. What is the rationale for these medications?
To reduce the vascularity of the thyroid gland
Which instruction might the nurse include in discharge planning for a patient with hyperthyroidism who has not undergone surgery?
Elevate the head of the bed at night
Complications of radioactive iodine ablation (removal) may be corrected by
Synthroid therapy following treatment
Give three complications of thyroidectomy
Airway obstruction, tetany and thyroid storm (Thyroid storm may be the initial presentation of thyrotoxicosis in undiagnosed children. Common clinical presentation includes fever, tachycardia, neurologic abnormalities, and hypertension, followed by hypotension and shock.)
What symptom would the nurse consider to be related to hemorrhage following thyroidectomy?
Complaints of a feeling of fullness in the neck
Twitching and tingling in the extremeties following thyroidectomy is indicative of
Which might the nurse expect to see in a patient after he has undergone thyroidectomy and the facial nerve is tapped?
Twitching of the eye when the facial nerve is tapped
Which represents normal serum calcium levels?
8.5-10.5 mg/dL
Which would be the most important nursing intervention to prevent thyroid storm?
Frequent monitoring of blood pressure and temperature
Signs of early hypothyroidism include
Extreme fatigue and depression
Serum levels of which two are an early indicator of hypothyroidism?
Low serum T3 and T4
Teaching for nursing assistants who are caring for a frail elderly person with hyperparathyroidism would include
Care to prevent fractures when turning the patient in bed (Hyperparathyroidism is a condition in which the body produces excessive amounts of parathyroid hormone (PTH) disrupting the regulation of calcium. As a result, calcium is taken from the bones; blood levels of calcium rise; and increased amounts of calcium may be excreted in urine)
A patient with hyperparathyroidism should not be given which meal?
Macaroni and cheese and broccoli
A patient with chronic hypoparathyroidism might be encouraged to take which vitamin?
Vitamin D
Which meal would be appropriate for a patient with hypoparathyroidism?
Salmon salad, broccoli casserole and tea
A patient with hypoparathyroidism has an elevated phosphate level. What medication might be ordered to decrease gastrointestinal absorption of phosphate?
Aluminum hydroxide antacid (Amphojel)
One characteristic of the oliguric phase of acute renal failure is
Low hemoglobin
A medication that is sometimes given to stimulate production of red blood cells is
Epoetin alfa (Epo A)
The most appropriate treatment to reverse severe hyperkalemia is
Kayexalate enema
The most appropriate meal for a patient with acute renal failure would be
Tuna and macaroni casserole, green beans and skim milk
Maintaining what two things would be important to prevent complications from chronic renal failure?
Maintaining normal blood pressure and potassium levels
Which symptom of chronic renal failure is related to buildup of urate crystals in the joints?
Which three lab values would be monitored for a patient with chronic renal failure?
Elevated BUN, serum creatinine and potassium
Which three symptoms might the nurse expect to see in a patient with disequilibrium syndrome?
Nausea, muscle twitching and backache
If a patient who is on dialysis suddenly experiences chest pain and a drop in blood pressure, what should the nurse do?
Turn the patient to his left side and lower the head of the bed.
Which point would be important to teach to the family of a patient on peritoneal dialysis?
The importance of good hand washing (peritoneal dialysis is a method of dialysis for patients with kidney failure in which fluids are pumped into the abdomen resulting in the removal of wastes from the blood; peritoneal dialysis can be done in the home as opposed to hemodialysis which must be done at a hospital or clinic)
A patient with a transplanted kidney is taking cyclosporin and steroids. Which should the nurse stress during teaching?
Avoidance of people with colds
A patient with renal colic may experience pain in what location?
Thigh and genital area (renal colic is flank pain caused by obstruction to the flow of urine, often caused by kidney or uretal stones)
Which diagnostic test might be appropriate for a patient who is suspected of having urolithiasis?
Intravenous pyelogram (a series of x-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein) and (urolithiasis is kidney stones, also called renal calculi and nephrolithiasis)
Which might be a primary nursing diagnosis for a person with renal colic?
Alteration in comfort
If a patient is passing uric acid stones, what type of diet is recommended?
Alkaline-ash diet
A patient with oxalate stones should avoid which foods? Define oxalate stones.
Tea, chocolate, spinach, strawberries and nuts (A salt of oxalic acid found in kidney stones of patients suffering from hyperoxaluria, a genetic disease that causes deposits of calcium oxalates in the urinary organs)
Which treatment for kidney stones involves immersing the patient in water?
Extracorporeal shock wave lithotripsy (uses highly focused impulses projected from outside the body to pulverize kidney stones)
A patient with acute glomerulonephritis might have the following three symptoms
Oliguria (reduced, scant urine output), dark or tea-colored urine and pruritus (itching)
Questioning a patient with acute glomerulonephritis might reveal a history of
Beta-hemolytic streptococcus
What would be an important nursing intervention for a person with acute glomerulonephritis?
Encouraging the patient to remain on bed rest
A patient with a diagnosis of glomerulonephritis with fluid retention might have which elevated laboratory value?
The major clinical finding in a child with nephrotic syndrome will be
Pitting edema (nephrotic syndrome is a condition characterized by high levels of protein in the urine, low levels of protein in the blood, tissue swelling, and high cholesterol)
Which might be a nursing diagnosis related to nephrotic syndrome?
Alteration in urine output
An overweight patient has been treating herself with over-the-counter and herbal remedies like milk of magnesia and garlic. Which might be an appropriate nursing diagnosis?
At risk for fluid and electrolyte imbalance
A patient with excessive amounts of ketones in the blood would also be expected to have
Metabolic acidosis and low serum pH
The wife of a patient with Alzheimer's dementia asks the nurse why all the health magazines that she has read promote vitamin E. What is the rationale underlying the nurse's response to the woman?
Vitamin E may help counter free radical production
Supplements of which vitamin would be important for a patient with oxalate stone formation and a prolonged clotting time?
Vitamin K
What is a primary function of the gallbladder?
Storage and concentration of bile
From where is insulin secreted?
Beta cells in the pancreas
Metabolism of what substance produces ketones?
What type of transport represents the normal mechanism of insulin and glucose interaction?
Active transport
A patient is suspected of having cholecystitis. What question might be most helpful for confirming the diagnosis?
Questioning the patient about his recent dietary intake (cholecystitis is inflammation of the gall bladder)
Where would the nurse expect biliary colic to occur?
Upper right abdominal quadrant and right flank
What might be an appropriate nursing intervention for a patient with obstruction of the common bile duct?
Skin care to help alleviate pruritus
In a patient with cholecystitis, the nurse might expect to see elevation of which lab value?
Elevated white blood cell count
Prior to intravenous cholangiogram or oral cholecystography, what question would be most important for the nurse to ask?
Asking the patient about any allergies (a cholangiogram is an X-ray study of the bile ducts performed with contrast injected into the ducts) (a cholecystography is x-ray that shows the flow of contrast fluid through the intestines into the gallbladder)
Which type of medication is generally used to relieve gallbladder spasms?
If a patient is taking ursodiol (Actigall) or chenodiol (Chenix), what teaching might the nurse provide at discharge?
Signs and symptoms of ulcer development
Which food would be contraindicated for a patient who is taking urosodiol or chenodiol?
Egg sandwich with mayonnaise
If clotting time is prolonged in a patient with gallbladder disease, what vitamin will usually be given?
Vitamin K
Which treatment is used for severe depression?
Electroconvulsive therapy
In which position will the patient be most comfortable following a laparoscopic cholecystectomy?
Sims (A position in which the patient lies on one side with the under arm behind the back and the upper thigh flexed. Also called lateral recumbent position)
Which drainage tube will the nurse clamp prior to and following meals for patients who have had gallbladder surgery?
T-tube (a tube placed in the bile duct that allows bile to drain into a bag outside the body)
Which three nursing or medical interventions are commonly used following abdominal gallbladder surgery?
Heparin, TED stockings and early ambulation
Discharge teaching for a patient who has undergone cholecystectomy includes providing information about signs of biliary obstruction. Three of these signs might include
Pruritus, dark urine and clay-colored stools
Three risk factors for acute pancreatitis include
Chronic alcohol abuse, gallstones and use of thiazide diuretics
The pain associated with acute pancreatitis can best be explained as resulting from
Increased secretion of trypsin (an enzyme of pancreatic origin; catalyzes the hydrolysis of proteins to smaller polypeptide units)
Where is the nurse most likely to observe signs of pancreatic hemorrhage?
In the flank and umbilical area
A patient with pancreatitis is exhibiting irritability, muscle twitching and lethargy. What laboratory value would account for these symptoms?
Which is an initial treatment for acute episodes of pancreatitis?
Insertion of an NG tube
When giving oral pancreatic enzymes, the nurse should
Give the medication with meals to aid in digestion of nutrients
One indication that an episode of acute pancreatitis is resolving is
A change in the color of the patient's stools
One diagnostic indicator of chronic pancreatitis is
steatorrhea (abnormally high fecal excretion of non-digested fat; fat in the stool)
Two common diagnostic tests for chronic pancreatitis are
Serum alkaline phosphatase and GTT (The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose)
Nutritional management for chronic alcoholism includes a diet that is high in ______ with ______ and ______ injections?
High in carbohydrates with vitamin K and B12 injections
The nurse should know that all of the following three symptoms are primarily associated with portal hypertension
Abdominal ascites, difficulty breathing and esophageal varices (Stretched veins in the esophagus that occur when the liver is not working properly)
Which is a gastrointestinal symptom associated with cirrhosis?
Dyspepsia (indigestion)
Which is a typical nursing diagnosis associated with a buildup of bile pigments and bleeding related to chronic cirrhosis?
Alterations in integument
Which two elevated enzyme levels would the nurse expect to see in a patient with chronic cirrhosis?
Elevated AST and ALT (both are liver enzymes that play a role in protein metabolism. Elevated serum levels of AST and ALT are signs of liver damage from disease or drugs)
Which medication might the nurse expect the physician to order following a liver transplant?
Cyclosporine (A drug prescribed to help prevent rejection of the transplanted organ by suppressing the immune system)
Esophageal varices are often treated with
Double-balloon tamponade
The amnesia associated with chronic alcoholism can best be treated with
Daily doses of folic acid
Portal-systemic encephalopathy and hepatic coma are related to the accumulation of what in blood?
A nurse might observe which symptom in a patient with advanced portal-systemic encephalopathy?
Asterixis (involuntary, jerking or flapping movements, especially of the hands. Extending the patient's arm with the wrist bend in a backward position may induce this form of tremor, which may be associated with advanced liver disease)
For what purpose would the nurse give a patient lactulose or sorbitol?
To reduce bacteria in the bowel
Excessive urination is a symptom of diabetes. What causes it?
Blood glucose levels rise and increase the osmotic pressure of internal body fluids
Three diagnostic symptoms of diabetes mellitus are
Increased urinary output, increased thirst and weight loss
With type I diabetes, the pancreas fails to produce
A patient is admitted to the emergency room with the following symptoms: abdominal pain, fruity odor breath, hypotension and vomiting. What medications will probably be ordered?
Regular insulin and IV isotonic saline
A newly diagnosed type I diabetic is on long-acting insulin therapy. When is this patient most likely to experience symptoms of hypoglycemia?
In the middle of the night
Blood analysis of the newborn of a mother with uncontrolled gestational diabetes might reveal
A sixty-five year old woman with type II diabetes asks the nurse how to best prevent the long-term complications of her disease. Which piece of advice will be most helpful?
Schedule annual eye exams
Which is the most probable nursing diagnosis for a patient with diabetic neuropathy?
Altered sensory perception
What fasting glucose level would indicate a need for further diagnostic testing?
A fasting blood glucose level of 140 mg/dL
Which patient would be the most likely candidate for a glycosylated hemoglobin (HbA1c) test?
A patient who is noncompliant with insulin therapy (HbA1c is a blood test that reflects average blood sugar levels over the preceding 2-3 months by measuring the amount of glucose adhering to hemoglobin, a protein in red blood cells. The product formed by the attachment of glucose to hemoglobin is known as HbA1c)
What teaching would a nurse give prior to glycosylated hemoglobin (HbA1c) testing?
Avoid taking aspirin prior to the test
Insulins differ in the following three ways
Time of onset, speed of action and length of action
A physician orders IV insulin for a patient. Which insulin would the nurse prepare?
A patient with a new prescription for Humalog insulin asks the nurse why the doctor changed his medication. What is a probable reason?
The patient was experiencing hyperglycemia following meals
A patient is taking Ultralente insulin. When would the nurse want to be especially careful to observe the patient?
In the middle of the night
What is the best action for a patient to take in order to prevent hypoglycemic attacks in the middle of the night?
Eating a bedtime snack of cheese and crackers
How are insulin injections ordered?
Dosage is ordered in units
A patient who works out on a treadmill each day and on weight machines every other day would most likely benefit from insulin injections given
In the abdomen
What is the most practical means for preventing lipodystrophy?
Rotating injection sites
The physician has ordered sliding-scale coverage for a patient. The order is to give one unit of regular insulin for every 25 mg/dL that the patient's BG is above 180 mg/dL. The patient's BG is 255. How much insulin should the nurse give?
3 units
What teaching should the nurse give to a patient who is taking Diabinese?
Avoid consuming alcoholic beverages with the medication (this is a blood-glucose lowering drug)
Lactic acidosis is a rare but serious side effect that can occur from what antidiabetic medication?
Metformin (Glucophage)
The nurse tells a patient with type II diabetes to carry glucose tablets with him at all times. What antidiabetic medication is the patient most likely taking?
Acarbose (Precose)
The nurse is teaching a patient and his family about signs of hypoglycemia. Which of the following sets of symptoms should the nurse include in her teaching?
Irritability, shakiness and slurred speech
After a patient recovers from a hypoglycemic attack and her blood glucose stabilizes, what should she do next?
Eat a cheese sandwich
A nurse's aide reports that a diabetic patient is perspiring, shaky and confused. The patient's skin is cool and clammy. What should be the initial nursing action?
Give the patient a glass of orange juice
One primary characteristic that is seen in DKA but not in HHNS is
Kussmaul's breathing (DKA, or diabetic ketoacidosis, is an emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine) and (Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine.)
An EKG reading might indicate high levels of which of the following electrolytes in a patient with diabetic ketoacidosis?
A seventy-five year old patient with type II diabetes insists on checking his urine for glucose because he refuses to "stick himself with a needle" for weekly blood testing. What is the most appropriate step for the nurse to take?
Have him demonstrate testing of a double voided specimen prior to discharge
When a patient is admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), nursing assessment should focus on
The condition of the skin
Which set of laboratory values would the nurse most likely to see in a patient with untreated ketoacidosis?
pH < 7.35; serum bicarbonate < 15mEq/L
A patient has accidentally taken an overdose of insulin. He checks his blood glucose and finds it elevated. What two hormones should he expect to be secreted less?
He should recognize that his body may be secreting excess glucagon and epinephrine.
Which would be an appropriate nursing diagnosis for a diabetic patient with complications resulting from poor sanitary conditions?
Altered integument
What percent is considered normal carbohydrate intake for an adult diabetic diet?
60 percent
What three items would be included in teaching a diabetic patient about how to prevent renal complications?
Annual testing for protein in the urine, monthly blood pressure checks and a diet high in complex carbohydrates.
Which of the following meals would be appropriate for a patient with hypoparathyroidism?
Salmon salad, broccoli casserole and tea