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73 Cards in this Set

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cons syndrome

Adrenal adenoma

Conn’s syndrome is primary hyperaldosteronism. Excessive secretion of aldosterone by the adrenal glands due to an adrenal adenoma results in Conn’s syndrome
The symptom of the fulminant stage
Which part of the kidney produces the hormone bradykinin?
Juxtaglomerular cells of the arterioles
The renin-producing granular cells produce the renin hormone that raises blood pressure as a result of angiotensin and aldosterone secretion.
kidney tissues produce prostaglandins
The kidney tissues produce prostaglandins that regulate internal blood flow by vasodilation or vasoconstriction.

The proximal tubule

The proximal tubule of the nephron secretes creatinine and hydrogen ions. It also reabsorbs water and electrolytes. The glomerulus filters the blood selectively. The ascending loop of Henle reabsorbs sodium and chloride, whereas the descending loop of Henle concentrates the filtrate. The collecting duct reabsorbs water.

Antidiuretic hormone is also called vasopressin. Growth hormone can be called somatotropin. Luteinizing hormone is a gonadotropin. Thyroid-stimulating hormone can be called thyrotropin.
reduced urinary output
A reduced urinary output of less than 400 mL in a 24-hour interval is called oliguria. Anuria is the absence of urination. Painful or difficult urination is called dysuria. Frequent urination at night is called nocturia.
Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color?
Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This drug may affect the kidneys but is not associated with reddish-orange colored urine.
Which ovulation stimulant is derived from the urine of postmenopausal women?
Menotropins are a standardized mixture of follicle-stimulating hormones and luteinizing hormones. These chemicals are derived from the urine of postmenopausal women. Clomiphene is a synthetic ovulation stimulant. Oxytocin and dinoprostone are synthetic uterine stimulants.
8.A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse mostlikely observe written in the client’s medical record?
Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria.

Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness.

What is the recommended size of the urinary catheter that can be used in a 3-year-old child?
The recommended size of a urinary catheter that can be used in a 3-year-old child is 8 to 10 Fr. A urinary catheter of 5 to 6 Fr is generally used in infants. A length of 14 to 16 Fr is recommended for most adult clients. A length of 16 to 18 Fr is commonly used in adult males.
A nurse in the pediatric clinic is examining a toddler with suspected enterobiasis (pinworm infestation). For which first sign of an infestation should the nurse assess the child?
In enterobiasis the adult pinworm lays her eggs around the anal opening, producing itchy irritation.

Scaly skin patches are commonly seen with eczema or dermatitis. A maculopapular rash may be seen with hookworm ( Necator americanus), not pinworm ( Enterobius vermicularis), infestation. A bald spot is produced by ringworm of the scalp (tinea capitis), a fungal infection of the skin.

Which herbal therapies can be recommended to a client with breast pain?
Herbal therapies for breast pain include chamomile, bugleweed, and chaste tree fruit.

Dong quai is recommended for menstrual cramping and dysmenorrhea. Black cohosh root eases premenstrual discomfort and tension.

A client with emphysema is admitted to the hospital with pneumonia. On the third hospital day, the client complains of a sharp pain on the right side of the chest. The nurse suspects a pneumothorax. What breath sound is most likely to be present when the nurse assesses the client's right side?
Because the affected lung will not expand, aeration of the lung is not complete, and breath sounds are diminished.

Crackling sounds occur with pulmonary edema, not with a pneumothorax; with a pneumothorax there is no air in the alveoli to produce crackles. Wheezing sounds occur with asthma, not with a pneumothorax. "Adventitious sounds" is a broad term that includes all abnormal breath sounds; it is not specific to pneumothorax.

A client with a skin infection reports an itching sensation associated with pain at the site of infection. The assessment finding shows erythematous blisters and interdigital scaling and maceration. What could be the possible condition in the client?
Tinea pedis is a fungal infection with an itching sensation associated with pain.

It is clinically manifested as interdigital scaling and maceration and a scaly plantar surface, sometimes with erythema and blistering. Tinea cruris is a fungal infection that is clinically manifested with well-defined scaly plaque in the groin area. Tinea corporis is clinically manifested as an erythematous, annular, ring-like scaly appearance with well-defined margins. Tinea unguium or onychomycosis is manifested with scaliness under the distal nail plate.

Which statement indicates a nurse has a correct understanding about trigeminal autonomic cephalalgia (cluster headaches)?
It is caused by an overactive hypothalamus
A 29-weeks pregnant client reports dull backache pain and abdominal cramps. Which condition does the nurse suspect?
A client in the 29th week of gestation who reports dull backache pain and abdominal cramps is experiencing preterm labor.

Uterine atony causes postpartum hemorrhage after delivery. Uterine fibroids have the same symptoms, but they may occur in nonpregnant women. Pelvic inflammatory disease leads to an ectopic pregnancy.

A client who had a cesarean birth is unable to void 3 hours after the removal of an indwelling catheter. How would the nurse evaluate the client for bladder distension?
Palpation will indicate whether bladder distention is present.
The increased intra-abdominal space available after birth can result in bladder distention without discomfort. Assessment should be done before interventions. Trauma to the area makes surrounding organs atonic; the client may have a full bladder and not feel the urge to void.
Which hormonal deficiency causes diabetes insipidus in a client?
ADH deficiency causes diabetes insipidus.

Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. LH deficiency causes menstrual abnormalities, decreased libido, and breast atrophy.

Which diagnostic tests are used to measure the kidney size of a client with kidney dysfunction? Select all that apply.
A radiography and a computed tomography (CT) are diagnostic tests used to measure kidney size in clients with kidney dysfunction.

A cystoscopy is used to identify abnormalities of the bladder wall in clients with kidney dysfunction. A cystography and a cystourethrography are used to examine the structure of the urethra and to detect backward flow of urine.

What is the action of vasopressin?
Vasopressin is also known as an antidiuretic hormone (ADH). It helps in the reabsorption of water into the capillaries.

Aldosterone promotes sodium reabsorption. Natriuretic hormones promote tubular secretion of sodium. Erythropoietin stimulates bone marrow to make red blood cells (RBCs).

A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan to encourage this client to modify dietary intake?
Lack of mineralocorticoids ( aldosterone) leads to loss of sodium ions in the urine and subsequent hyponatremia.

Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids. Increasing protein is needed to heal the adrenal tissue and thus cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing; nor will they help the client gain weight.

A nurse educates the client about the relationship between the kidneys and blood pressure. Which term should the nurse use to describe the part of the kidney that senses changes in blood pressure?
The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood.

Calices are cup-like structures, present at the end of each papilla that collect urine. The glomerulus is the initial part of the nephron, which filters blood to make urine. Juxtaglomerular cells secrete renin. Renin is produced when sensing cells in the macula densa sense changes in blood volume and pressure.

After several episodes of intermittent abdominal pain and vomiting, a 5-month-old infant is admitted to the pediatric unit. A diagnosis of intussusception is made. What is the priority nursing assessment that will help confirm the diagnosis?
Intussusception is a type of intestinal obstruction in which the intestine telescopes and becomes trapped within its lumen; the resulting stools are red and currant jelly–like because of the mixture of stool with blood and mucus.

Bowel sounds may not be significantly affected. High-pitched crying is a result of cerebral irritation; this is not expected with intussusception. Accurate fluid intake and output records are important, but they are not essential to confirming this diagnosis.

A client has surgery for the creation of a colostomy. Postoperatively, what color does the nurse expect a viable stoma to be?
Brick red describes a stoma that has adequate vascular perfusion.

Pale pink indicates inadequate perfusion of the stoma. Light gray is indicative of poor tissue perfusion. Dark purple indicates inadequate perfusion of the stoma.

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations?
Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body's inability to metabolize glucose adequately.

Although polydipsia and polyuria occur with type 1 diabetes, lethargy occurs because of a lack of metabolized glucose for energy. Although polydipsia and weight loss occur with type 1 diabetes, frequent urination occurs throughout a 24-hour period because glucose in the urine pulls fluid with it. Although polyphagia and polyuria occur with type 1 diabetes, diaphoresis occurs with severe hypoglycemia, not hyperglycemia.

Which organ-specific autoimmune disorder is associated with a client’s kidney?
Goodpasture syndrome is an autoimmune disorder associated with the client’s kidney.

Graves’ disease and Addison’s disease are autoimmune disorders associated with the endocrine system. Guillain-Barré syndrome is an autoimmune disorder associated with the central nervous system.

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms?
T 3, T 4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client's signs and symptoms

. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.

After prostate surgery a client’s indwelling catheter and continuous bladder irrigation (CBI) are to be removed. The nurse discusses with the client the procedure and what to expect after the removal. Which statement by the client indicates teaching by the nurse is understood?
Because of the trauma to the mucous membranes of the urinary tract, burning on urination is an expected response that should subside gradually.

The urine should no longer be dilute after the continuous bladder irrigation is discontinued and removed. However, the urine may have a slight pink tinge because of the trauma from the surgery and the presence of the catheter. An inability to urinate should not occur unless the indwelling catheter is removed too soon and there is still edema of the urethra. Production of dark red urine is a sign of hemorrhage, which should not occur.

A healthcare provider prescribes a diuretic for a client with hypertension. What should the nurse include in the teaching when explaining how diuretics reduce blood pressure?
Diuretics block sodium reabsorption and promote fluid loss, decreasing blood volume and reducing arterial pressure.

Direct relaxation of arteriolar smooth muscle is accomplished by vasodilators, not diuretics. Vasodilators, not diuretics, act on vascular smooth muscle. Drugs that act on the nervous system, not diuretics, inhibit sympathetic vasoconstriction.

Which vaccine may cause intussusception in children?
Rotavirus vaccines very rarely cause intussusception, a form of bowel obstruction in which the bowel telescopes in on itself.

Hepatitis vaccines can cause anaphylactic reactions. The measles, mumps, and rubella vaccine may cause thrombocytopenia. The diphtheria, tetanus, and pertussis vaccine carries a small risk of causing acute encephalopathy, convulsions, and a shock-like state.

A client who had a transurethral resection of the prostate is transferred to the postanesthesia care unit with an intravenous (IV) line and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?
After transurethral surgery [1] [2], hemorrhage is common because of venous oozing and bleeding from many small arteries in the area.

Sepsis is unusual, and if it occurs it will manifest later in the postoperative course. Phlebitis is assessed for, but it is not the most important complication. Hemorrhage is more important than phlebitis. Leaking around the IV catheter is not a major complication.

Which hormone may be excreted in urine during pregnancy?
Human chorionic gonadotropin hormone may be isolated from the urine during pregnancy

. Estrogen, oxytocin, and progestin may induce ovulation but cannot be isolated from urine.

The nurse is educating student nurses about the anatomy and physiology of the kidneys. What term does the nurse explain is used for the tip of the pyramid of a kidney?
Pyramids are components of renal medulla, and the tip of each pyramid is called a papilla

. A calyx is a structure that collects the urine at the end of each pyramid. The renal calices join together to form the renal pelvis. A renal column is a cortical tissue that separates the pyramids.

A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child?
Dark, frothy urine is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to take this appearance.

The child may be somewhat, not severely, lethargic. Blood pressure is normal or decreased; hypertension is associated with glomerulonephritis. Children with nephrotic syndrome usually have a pale complexion and are not flushed and ruddy in appearance.

A registered nurse teaches a nursing student about the physiologic changes that occur during pregnancy and their impact on drug disposition and dosing. Which statement of the nursing student indicates the need for further education?
The hepatic metabolism of the drugs is increased in pregnancy, which increases the drug response.

Elimination of the drugs is increased because the renal blood flow doubles in the third trimester. The intestinal transit time of drugs increases because the motility of the bowel decreases in pregnancy. This action also leads to an increase in the drug’s gastrointestinal absorption.

A client is taking fertility drugs for the first time. Which adverse effect of the drug should the nurse inform the client about?
Constipation is seen in the clients who are treated with fertility drugs for the first time. Fertility drugs do not cause vaginitis and swelling of joints. Deep vein thrombosis is an adverse effect of prolonged use of fertility drugs.
A nurse is evaluating a client’s understanding of peritoneal dialysis. Which information in the client’s response indicates an understanding of the purpose of the procedure?
Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution.

Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment.

A nurse is performing a health history and physical assessment of a client with cholelithiasis and obstructive jaundice. Which clinical finding should the nurse expect this client to exhibit?
The gallbladder is located in the right upper quadrant. Pain occurs after fatty meals and may radiate to the right back or shoulder.

Hematuria occurs with nephrolithiasis, not cholelithiasis. The stool will be clay-colored, not dark brown, because of the lack of bile. When the level of bile in blood increases, bile will be present in urine, causing it to have a dark color.

Why would a client with acquired immunodeficiency syndrome (AIDS) be prescribed diphenoxylate hydrochloride?
Diphenoxylate hydrochloride is an antidiarrheal drug prescribed to clients with AIDS to manage frequent diarrhea experienced by a client with AIDS.

Opioid analgesics such as tramadol are used to manage pain. Ketoconazole can be used to treat candidal esophagitis associated with AIDS. Behavioral problems are managed with psychotropic drugs.

The nurse providing postoperative care for a client who had kidney surgery reviews the client’s urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider?
The glomeruli are not permeable to large proteins such as albumin or red blood cells (RBCs), and it is abnormal if albumin or RBCs are identified in the urine;

their presence should be reported. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative; these are normal findings.

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect?
Mild abdominal cramping is the only side effect of docusate sodium;

this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

A 37-year-old client with endometriosis visits the women’s health clinic because she has dysmenorrhea and dyspareunia. Which statement is the most accurate description of dysmenorrhea?
Dysmenorrhea is defined as pain with menses.

Endometrial hyperplasia results from anovulation and persistent estrogen stimulation. Bleeding between menses is metrorrhagia. Heavy bleeding with menses is menorrhagia.

A nurse has administered sublingual nitroglycerin. Which parameter should the nurse use to determine the effectiveness of sublingual nitroglycerin?
Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain.

Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in blood pressure is a reason why IV nitroglycerin may be administered, decreased blood pressure is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Although superficial vessels dilate, lowering the blood pressure and creating a flushed appearance, dilation of superficial blood vessels is not the basis for evaluating the drug's effectiveness.

Which herbal therapies would be beneficial to a client with menstrual cramping? Select all that apply.
Herbal drugs such as catnip, fennel, and black haw are used to treat menstrual cramping and dysmenorrhea.

Bugleweed and chamomile are used to treat breast pain.

Which anesthetic drug is commonly used for short procedures on pediatric clients?
Fentanyl is recommended for short procedures on pediatric clients.

For long procedures in which pain is anticipated even after the procedure, morphine should be administered. Meperidine and hydromorphone are used to achieve mild to moderate sedation in pediatric clients.

A client is admitted to the cardiac intensive care unit with intense chest pain. What pain relief medication does the nurse expect to find on the plan of care for this client?
Morphine is the drug of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety.

Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

A client presents with chief complaints of unexplained weight gain and back pain from a compression fracture of the vertebrae. On assessment, there is truncal obesity with excessively thin extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. The symptoms described are suggestive of what disease?
Common symptoms of Cushing disease are weight gain, truncal obesity, buffalo hump, and moon face because of deposits of adipose tissue.

The condition is caused by excess cortisol secretion caused by hypersecretion of adrenocorticotropic hormone (ACTH). Other characteristics are diabetes mellitus, muscle wasting, osteoporosis, ecchymosis, and slow healing of wounds. Addison disease is adrenal insufficiency. Symptoms of Addison disease include hypotension, dehydration, hypoglycemia, and hyperpigmentation of the skin. Multiple sclerosis is a progressive disease involving destruction of the myelin sheath, leading to nerve damage. Kaposi sarcoma is a cancer associated with acquired immunodeficiency syndrome (AIDS).

The nurse provides discharge teaching to a client with a history of angina. The nurse instructs the client to call for emergency services immediately if the client’s pain exhibits which characteristic?
When neither rest nor nitroglycerin relieves the pain, the client may be experiencing an acute myocardial infarction.

Angina may cause mild diaphoresis; acute myocardial infarction causes profuse diaphoresis, which should be reported. Chest pain after exercise is expected; activity increases cardiac output, which can cause angina. Anginal pain can, and often does, radiate.

A nurse is obtaining a health history from the parents of a preschooler with celiac disease. What characteristic does the nurse expect when the parents describe their child's stools?
Children with celiac disease have a gluten-induced enteropathy and are unable to absorb fats from the intestinal tract, resulting in the typical characteristics of their stools. The stools are large and fatty or frothy, not mucoid. Although the stools are large and frothy, they are pale because of their high fat content. The stools are large and foul-smelling and have little color.
A client is admitted to the hospital with a long history of hypertension. The nurse should assess the client for which complication?
Some renal impairment usually is present even with mild hypertension and is attributed to the ischemia resulting from narrowed renal blood vessels and increased intravascular pressure;

decreased blood flow causes atrophy of renal structures, such as tubules, glomeruli, and nephrons, leading to kidney failure. Retinopathy, resulting in blurred vision, retinal hemorrhage, and blindness, occurs with a long history of hypertension because of increased intravascular pressure, not cataracts. Esophagitis is caused by esophageal reflux disease, not a long history of hypertension. Hypertension does not cause diabetes mellitus; however, chronic elevations of serum glucose accelerate atherosclerosis, resulting in the development of hypertension.

Which statement indicates the nurse has a correct understanding about kidney ultrasonography?
Kidney ultrasonography is a minimal risk diagnostic procedure. Ultrasonography makes use of sound waves which, when reflected from internal organs of varying density, will produce the images of the kidneys, bladder, and associated structures on the display screen.

While a dye can be used in computed tomography (CT), it is not the primary method. Generally kidney ultrasonography is performed on the client with full bladder. A CT gives three-dimensional information about the kidney and associated structures.

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone?
Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes.

Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

A client is diagnosed with hepatitis A. The nurse provides the client with information about untoward signs and symptoms related to hepatitis. The nurse instructs the client to contact the primary healthcare provider if the client develops what symptom?
Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines.

It is unnecessary to call the healthcare provider because fatigue and anorexia are characteristic of hepatitis from the onset of clinical manifestations. Yellow is the expected color of urine.

The nurse provides discharge instructions to a male client who had an ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). For which indicators of a UTI should the nurse instruct the client?
Urgency or frequency of urination occur with a urinary tract infection [1] [2] because of bladder irritability;

burning on urination and fever are additional signs of a UTI. Increase of ketones is associated with diabetes mellitus, starvation, or dehydration. The inability to maintain an erection is not related to a UTI. Pain radiating to the external genitalia is a symptom of a urinary calculus, not infection.

On the second day after an abdominoperineal resection, the nurse anticipates that the colostomy stoma will have what appearance?
The surface of a stoma is mucous membrane and should be dark pink to red, moist, and shiny;

the stoma usually is raised beyond the skin surface. The stoma should be moist, not dry; pale pink indicates a low hemoglobin level. Although some stomas can be flush with the skin, a raised stoma is more common. The stoma should be moist, not dry; purple indicates compromised circulation. A depressed stoma is retracted and unexpected. Although the stoma should be moist and dark pink to red, it should not be painful; although some stomas can be flush with the skin, a raised stoma is more common.

A nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which diet should the nurse teach the client to maintain because it will help minimize clinical manifestations of dumping syndrome?
Small feedings reduce the amount of bulk passing into the jejunum and therefore reduce the fluid that shifts into the jejunum.

Although a diet high in roughage may be avoided, a low-residue, bland diet is not necessary. Total fluid intake does not have to be restricted; however, fluids should not be taken immediately before, during, or after a meal because they promote rapid stomach emptying. Concentrated sweets pass rapidly out of the stomach and increase fluid shifts; the diet should be low in carbohydrates. Relatively high protein is needed to promote tissue repair.

What should the nurse teach a client about how to care for the skin around a colostomy stoma?
Soap and water remove fecal debris and microorganisms;

this promotes skin integrity and prevents infection. Hydrogen peroxide is too irritating and should be avoided. Applying ointment to this extent is contraindicated, because it will interfere with adherence of the appliance. Vigorous rubbing may be irritating and may promote conditions that contribute to infection.

A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first?
Some bright red blood at this point is an expected finding that should be monitored; large amounts of blood or bleeding should be reported immediately. Clamping the nasogastric tube is contraindicated; secretions will accumulate and cause pressure on the suture line. Also, clamping the tube prevents observation of gastric drainage. If the tube is draining, there is no need to irrigate; also, irrigations are traumatic. Reducing suction pressure allows secretions to accumulate and causes pressure on the suture line.
A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe?
Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines.

Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply.
Decreased blood flow to the kidneys leads to oliguria or anuria. Irritability, along with restlessness and anxiety, occurs because of a decrease in oxygen to the brain. Hypotension and a narrowing of the pulse pressure occur because of declining blood volume.

Restlessness, not lethargy, usually occurs because of decreased cerebral blood flow. There are various changes in sensorium, but slurred speech is not a manifestation of shock.
After several episodes of intermittent abdominal pain and vomiting, a 5-month-old infant is admitted to the pediatric unit. A diagnosis of intussusception is made. What is the priority nursing assessment that will help confirm the diagnosis?

looking at the stool

Intussusception is a type of intestinal obstruction in which the intestine telescopes and becomes trapped within its lumen; the resulting stools are red and currant jelly–like because of the mixture of stool with blood and mucus. Bowel sounds may not be significantly affected. High-pitched crying is a result of cerebral irritation; this is not expected with intussusception. Accurate fluid intake and output records are important, but they are not essential to confirming this diagnosis.

A healthcare provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system?
Furosemide acts in the ascending limb of the loop of Henle in the kidney.

Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.

stool stages

Which hormone overproduction is associated with carpel tunnel syndrome in clients?
Overproduction of growth hormone is associated with carpel tunnel syndrome.

Overproduction of aldosterone hormone is associated with Conn’s syndrome. Antidiuretic hormone overproduction can result in syndrome of inappropriate antidiuretic hormone. Overproduction of parathyroid hormone results in hyperparathyroidism.

Often when a family member is dying, the client and the family are at different stages of grieving. During which stage of a client's grieving is the family likely to require more emotional nursing care than the client?

In the stage of acceptance, the client frequently detaches from the environment and may become indifferent to family members.

In addition, the family may take longer to accept the inevitable death than does the client. Although the family may not understand the anger, dealing with the resultant behavior may serve as a diversion. Denial often is exhibited by the client and family members at the same time. During depression, the family often is able to offer emotional support, which meets their needs.

An adolescent having premenstrual syndrome displays pelvic fullness, irritability, depression, fatigue, and backaches. What instructions should the nurse provide to the adolescent to help obtain relief? Select all that apply.
30 to 80% of women will experience premenstrual syndrome. Regular exercise, especially in the luteal phase, is extremely helpful in overcoming the symptoms and reducing anxiety. Stress reduction techniques may also aid in relieving symptoms. Eating three small to moderate sized meals with a high content of carbohydrates and fiber may also grant relief from symptoms. Medications that can be used to provide symptomatic relief include NSAIDs, progesterone, and diuretics.

Clients should avoid smoking, alcohol, sweets, salt, meat, and alcohol.

An isolated older adult is diagnosed with cancer and fears death. Which intervention provided would help to induce relaxation and to communicate interest in the client?
Touch is a therapeutic tool that helps induce relaxation, provide physical and emotional comfort, and communicate interest in an older adult.

Reminiscence helps to bring meaning and understanding to the patient’s present situation and resolves current conflicts by recollecting the past. Reality orientation involves making an older adult more aware of time, place, and person. Therapeutic communication helps to perceive and respect the older adult’s healthcare expectations.

A cognitively impaired client’s family member requests that the nurse list the benefits of using a respite care service. What information should the nurse provide about respite care services? Select all that apply.
Respite care service is offered at home, in day care settings, or in a health care institution that provides overnight care. Currently, Medicare does not cover respite care service and Medicaid has strict requirements for services and eligibility. Respite care services provide short-term relief or "time off" for people providing home care to an ill, disabled, or frail older adult. Assisted living includes services like laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping. In assistive living, a group of residents live together, but each resident has his or her own room and shares dining and social activity areas.
A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. Which nursing care should be included in the client’s plan of care?
The presence of a bruit indicates patency of the AV fistula. The presence of a vibration or thrill indicates patency of the AV fistula. Drawing blood is avoided to prevent damage to the AV fistula.

An AV fistula is internal and is not irrigated. The AV fistula is under the skin and is not clamped.

A slightly overweight client is to be discharged from the hospital after a cholecystectomy. What is most important for the nurse to include in teaching the client about nutrition?
Explaining that fatty foods may not be tolerated for several weeks