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adult health i > Exam 3 - In Class Questions > Flashcards

Exam 3 - In Class Questions Flashcards

1
Q

Which gastrointestinal changes occur in older adults? SATA

A. Increased hydrochloric acid secretion
B. Decreased absorption of iron + B12
C. Decreased peristalsis may cause constipation
D. Increased cholesterol synthesis
E. Decreased lipase with decreased fat absorption and digestion
F. Decreased liver enzyme activity depresses drug metabolism

A

B, C, E ,F

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2
Q

What type of exam is an EGD and what does it evaluate?

A

Visual exam of the esophagus, stomach, and duodenum

Use of fiber optic scope

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3
Q

Prep for EGD

A

NPO for 6-8 hours
— avoid anticoagulants, aspirins, NSAIDS several days before procedure

*moderate sedation is used

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4
Q

Post EGD:

A

Keep pt NPO until gag reflex returns

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5
Q

The nurse is caring for a patient scheduled for a colonoscopy in three days after discharge. What does the nurse teach the patient about preparations for this dx test? SATA

A. Take only clear liquids the day before procedure
B. You may drink red, orange, or purple beverages the day before test
C. You will have watery diarrhea shortly after taking the medications prescribed for cleansing the bowel
D. You will have an IV placed to receive medication to help you relax during the procedure
E. Avoid aspirin, anticoagluants, or antiplatelet medications for several days before the procedure

A

A, C, D, E

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6
Q

What is the goal for bowel prep?

A

PREP IS IMPORTANT
Clear the bowel for procedure
— if bowel is not clear, colonoscopy is useless

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7
Q

What should the nurse monitor for post procedure?

A

Bleeding + perforation = can lead to infection

Scope can cut the bowel, bowel spills into peritoneal cavity causing infection

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8
Q

What is a type of secondary stomatitis?

A

Candida

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9
Q

Long-term antibiotic therapy destroys other normal flora and allows it to overgrow. What type of infection is this?

A

Fungal-yeast

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10
Q

What might put a patient at risk for this infection?

A

Immunocompromised

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11
Q

What nursing interventions should the nurse include for this patient?

A

— remove dentures
— soft brushes/swabs
— swab mouth with medication - mystatin
— oral hygiene
— avoid things with acid

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12
Q

Most common cause of GERD is the excessive relaxation of the ?
Which allows the reflux of gastric contents into the esophagus and exposure of the esophageal mucosa to acidic gastric contents

A

Lower esophageal sphincter - needs to stay tight

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13
Q

What are key features of GERD?

A

Dyspepsia
Regurgitation
*Pyrosis - GI cocktail given to rule out heart problems

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14
Q

What can aggravate GERD?

A

Positioning
Foods: spicy, acidic

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15
Q

How is GERD diagnosed?

A

Barium swallow, ph test, EGD
Ph 4 or lower indicates GERD

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16
Q

Which statements about Barrett’s esophagus is accurate? SATA

A. Considered to be a premalignant condition
B. Associated with excessive intake of fresh flirts and veggies
C. Results from exposure to acid and pepsin
D. Associated with increased risk for cancer in patients with prolonged GERD
E. Ulceration of lower esophagus

A

A, C, D, E

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17
Q

What patient teaching about health promotion and lifestyle changes should the nurse provide to a patient with GERD?

A

— stop smoking
— limit alcohol, caffeine, spicy food, carbonation
— remain upright after meals
— loose fit clothing
— eat slow - small meals
— do not eat before bed
— overweight = more pressure (lose weight)

Goals:
— medications
— decrease symptoms
— prevent GERD

Drugs:
— antacids
— prokinetics
— h2 anagonists

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18
Q

Many patients with hiatal hernia are __
But some may have daily symptoms similar to those with __

A
  1. Asymptomatic
  2. GERD
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19
Q

Nonsurgical interventions are similar to those for GERD; provider typically prescribes what?

A

Antacids
PPIs

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20
Q

What are key features of gastritis?

A

— heartburn
— epigastric pain
— nausea/vomiting
— dyspepsia

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21
Q

What are interventions for gastritis?

A

— drug therapy = antacids, antibiotic, vitamin B12, PPIs, h2 antagonists, mucosal barriers before meals
— avoid spicy + acidic foods
— stop smoking
— lower stress
— no NSAIDS, steroids

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22
Q

Which types of ulcers are included in peptic ulcer disease? SATA

A. Esophageal ulcers
B. Gastric ulcers
C. Pressure ulcers
D. Duodenal ulcers
E. Stress ulcers

A

B, D, E

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23
Q

What complications are possible with ulcers?

A

Perforation - life threatening; die very fast from sepsis

Hemorrhage - stomach bleeding; can be life threatening
— EGD

Pyloric obstruction - scarring from irritation

Intractable disease - medications are not working

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24
Q

Etiology of peptic ulcers primarily associated with what?

A

H. Pylori + NSAIDS

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25
Q

What health promotion and maintenance interventions should patients practice to avoid colorectal cancer diagnosis?

A

— screening at age 50
— fecal occult blood testing and colonoscopy every 10 years
— diet: decrease fat and refined carbohydrates, increase fiber, eat baked or broiled foods
— avoid smoking and heavy alcohol
— increase physical activity

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26
Q

Colon cancer treatment:

A

Radiation
Chemo
Surgery

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27
Q

The nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills?

A. I will have my spouse change the bag for me
B. If I have leakage, I should reinforce the barrier with tape
C. A dark purple stoma is normal and would not concern me
D. I will apply nonalcoholic skin sealant around the stoma and allow it to dry prior to applying the bag

A

D

28
Q

Describe the causes of mechanical and non mechanical intestinal obstructions

A

Mechanical:
Bowel is physically blocked by problems outside the intensities, in the bowel wall or within intestinal lumen
Ex: adhesions, crohn’s, tumors

Non-mechanical:
Most common cause handling of the intestines during abdominal surgery
— paralytic ileus
— peristalsis is decreased or absent

29
Q

What CM of ulcerative colitis creates a higher risk for decreased oxygenation and fatigue?

A. Blood stools
B. Fever
C. Electrolyte abnormalities
D. Elevated inflammatory markers

A

A. Bloody stools

30
Q

The patient is scheduled for a flexible sigmoidoscopy and barium enema. How should the nurse explain the flexible sigmoidoscopy?

A. X-ray used for visualize the large intestine after barium is instilled
B. Visual exam using fiberoptic scope of the upper GI tract
C. Visual exam using a fiberoptic scope of the rectum and sigmoid colon
D. A digital rectal exam after an enema

A

C

31
Q

What is the prep for a sigmoidoscopy?

A

— clear liquids the day before and NPO day of procedure
— one to two enemas the day of procedure
— does not require total bowel cleanse as required for a colonoscopy

32
Q

What post op procedure instructions should the nurse include post barium enema?

A

Increase fluids to facilitate the excretion of the barium from the colon

33
Q

Which CM would be concerning to the nurse following the flexible sigmoidoscopy?

A. Temp
B. Rigid abdomen
C. Decreased urine output
D. Inelastic skin turgor

A

B. Rigid abdomen

34
Q

A client is admitted to the hospital with left lower quadrant pain, an elevated temperature. What problem might the nurse expect based on these clinical manifestations?

A. Gastroenteritis
B. Diverticulitis
C. Ulcerative colitis
D. Crohn’s disease

A

B. Diverticulitis

CM:
— LLQ pain
— temp <101F
— lower GI bleed
— nausea

35
Q

An abdominal computerized tamography (CT) is performed to confirm the dx of diverticulitis. A complete blood count is also completed. What results does the nurse anticipate?

A. Elevated hemoglobin
B. Decreased platelet
C. Elevated white blood cell count
D. Decreased bilirubin

A

C. Elevated white blood cell

36
Q

The nurse is performing a musculoskeletal assessment on an older adult living independently in a senior housing apartment. What normal physiological changes does the nurse expect? SATA

A. Increased bony prominence
B. Slowed movement
C. Decreased range of motion
D. Narrowed gait
E. Cartilage regeneration

A

A, B, C

37
Q

Which diagnostic test is used to assess for muscle weakness?

A

Electromyography (EMG)

38
Q

What are risk factors for osteoporosis?

A

LOW BODY WEIGHT
— chronic low calcium/vitamin D intake
— smoking
— estrogen/androgen deficiency
— high alcohol intake
— lack of physical activity or prolonged immobility
— carbonated drinks: increased phosphate
— caffeine: decreased bone density

39
Q

What dx test is used to diagnose and monitor progression of osteoporosis?

A

DEXA scan

40
Q

Which statement by the patient regarding lifestyle changes indicates a need for further teaching?

A. I will get rid of my scatter rugs
B. I will cut back to 3 martinis a day
C. I will increase my calcium and vitamin D intake
D. I am going to walk every day

A

B

41
Q

Which patients are at risk for developing osteoarthritis? SATA

A. Obese, older woman living alone
B. Slender, non smoking middle aged man
C. Middle aged man with 25 years working in construction
D. Young woman with a family hx of cancer
E. Middle aged adult with multiple knee surgeries from high school soccer

A

A, C, E

42
Q

What are the risk factors for osteoarthritis?

A

— age
— genetics
— OBESITY
— joint injury
— occupation

43
Q

Postoperative care of a total knee replacement may include which of the following? SATA

A. Hot compress to incisional area
B. Continuous passive movement used immediately or several days post op
C. Ice packs to incisional area
D. Check circulation, movement, sensation
E. Maintain abduction

A

B, C, D

E. Maintaining abduction — important for hips

44
Q

The nurse is preparing an educational session for nursing students on the orthopedic units. Which three signs of hip dislocation would be included? SATA

A. Increased pain
B. Hip flexing at 45 degrees
C. Shortening of affected leg
D. Leg rotation
E. Skin breakdown near the incision

A

A, C, D

45
Q

Which interventions does the nurse encourage with a patient dx with osteomalacia? SATA

A. Increase intake of milk and enriched cereal
B. Drink 8 cups of coffee a day
C. Use of calcium supplment
D. Increase time outside
E. Use of vitamin B12 supplement

A

A, D

Osteomalacia is caused by vitamin D deficiency and causes bones to soften

46
Q

The nurse admits a patient diagnosed with Paget’s disease. The nurse anticipates that the patient will have which condition?

A. Progressive muscle weakness
B. Low body weight, thin build
C. Enlarged, thick skull
D. Bone infection

A

C. Enlarged, thick skull

Paget’s disease is a metabolic disease characterized by bones excessively breaking down and then being reformed. Bones are disorganized and weak

47
Q

A female patient with osteoporosis comes to the ED after falling suddenly while opening her car door. She said it felt as though her “leg gave away” and caused her to fall. What type of fracture does this patient likely have?

A. Pathologic
B. Spiral
C. Impacted
D. Incomplete

A

A

48
Q

A 30 year old patient who is hospitalized for repair of a fractured tibia and fibula is experiencing altered mental status. Which complications related to the injury might the patient be experiencing?

A. Hypovolemic shock
B. Fat embolism
C. Acute compartment syndrome
D. Pneumonia

A

B

49
Q

A patient has a fracture of the right wrist. What is an early sign that indicates this patient may be having a complication?

A. Patient loses ability to wiggle fingers without pain
B. Fingers are cold and pale; cap refill is sluggish
C. Pain is severe and seems out of proportion to injury
D. Patient reports numbness and tingling

A

D

50
Q

The nurse is reviewing the orders for a patient who was admitted for 24 hour observation of a leg fracture. A cast is in place; which order should the nurse question?

A. Oxycodone PO PRN for pain
B. Neuro vascular assessment every 8 hours
C. CBC and BMP in the morning
D. Regular diet as tolerated

A

B

We want to perform this more frequent than q 8 hours

51
Q

A nurse cares for four patients in casts on the orthopedic units. Which patient should the nurse prepare for a window procedure?

A. Patient in a full leg cast, toes slightly cool, takes ibuprofen for pain
B. Patient developed pressure ulcer ulcer the cast
C. Patient in a partial cast, toes slightly swollen and warm
D. Patient whose cast become soiled with urine

A

B

52
Q

Which of the following statements identifies the patient as a highest risk for musculoskeletal trauma?

A. I removed my area rugs at home so I do not trip over them
B. My mother had osteoporosis, so I am very careful when I ride my motorcycle
C. I don’t drink alcohol if I have to dive
D. I always wear my helmet when I ride my bicycle

A

B

Significant trauma with motorcycle accidents; family hx

53
Q

What renal change associated with aging does the nurse expect an older adult client to report?

A. Concentrated urine
B. Hematuria
C. Dysuria
D. Decreased GFR

A

D

GFR decreases with aging + renal failure

54
Q

The nurse is talking to a group of older women about changes in the urinary system related to aging. What symptoms is likely to be the common concern?

A. Incontinence
B. Retention
C. Dysuria
D. Oliguria

A

A

55
Q

The nurse is assessing a client newly admitted to the nephrology unit. Which of the following questions would you ask? SATA

A. Have you noticed any changes with urination lately?
B. What is your average fasting BG?
C. How much fluid do you drink in 24 hours?
D. What medications are you taking?
E. Have you noticed any changes with bowel elimination?

A

A, B, C, D

*diabetes and hypertension are leading causes of renal failure

56
Q

What is the average urine output of a healthy adult for a 24 hour period?

A. 500 ml to 1000 ml
B. 1500 ml to 2000 ml
C. 3000 ml to 5000 ml
D. 5000 ml to 7000

A

B

*30 ml an hour MINIMUM

57
Q

The client describes the OTC medications she is taking. Which medication would alert the nurse to further explore for potential impact on kidney function?

A. Mouthwash with alcohol
B. Metamucil
C. Vitamin c
D. Ibuprofen

A

D

58
Q

The nursing student is measuring urine output and is observing for urine characteristics in a client. Which finding is the most urgent and must be reported?

A. Output has decreased
B. Specific gravity decreased
C. Ph has decreased
D. Color is dark amber

A

A

*decreased urine output tells us about circulation

59
Q

The nurse is determining whether a client has risk factors for potential kidney disease. Which question is best to elicit this information?

A. Have you ever been under increased stress?
B. Have you had your cholesterol checked?
C. When was the last time you had your BP checked?
D. Have you ever been told that your BP was high?

A

D

60
Q

Which of the following labs indicates impaired kidney function?

A. Potassium 6.3
B. BUN 34
C. Creatinine 7
D. Phosphorus 6.5

A

C

*creatinine = 0.5-1.2

BUN = 10-20; dehydration

61
Q

Which of the following microorganisms is the most common cause of urinary tract infections?

A. Streptococcus
B. Staphylococcus
C. Escherichia coli
D. Enterococcus

A

C

62
Q

Which of the following terminology means accumulation of nitrogenous wastes in blood?

A. Nítrenla
B. Albuminemia
C. Proteinemia
D. Azotemia

A

D

63
Q

The client is scheduled to have a kidney, ureter, and bladder X-ray (KUB). What prep instructions should the nurse include?

A. No special prep required
B. Client will be NPO for 6 hours
C. Sedative will be given
D. Enema will be given

A

A

64
Q

A client is scheduled for an abdominal CT with contrast. Which medication should be discontinued 24 hours before procedure and 48 hours after?

A. Furosemide - lasix
B. Acetylcysteine
C. Tylenol
D. Metformin

A

D

*can cause lactic acidosis
- muscle pain, fast shallow breathing, weakness, diarrhea, abdominal pain

65
Q

A client has undergone a kidney biopsy. What does the nurse monitor for in this client related to this procedure?

A. Nausea and vomiting
B. Amount and color of urine
C. Urinary retention and pain
D. Urgency and dysuria

A

B

adult health i (19 decks)

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