ch 29 Flashcards
Based on the significant effects of chronic idiopathic fatigue, what is the nurse’s priority assessment?
a. Cholesterol level and lipid profile
b. Creatinine and BUN levels
c. Memory loss testing
d. Mental health evaluation
ANS: D
Fatigue does not cause death or organ failure, but mortality from suicide was higher than the general population in patients with chronic idiopathic fatigue. Therefore a mental health evaluation is a priority assessment. Cholesterol and lipid levels are indicative of heart disease. Creatinine and BUN levels are indicators of kidney function. Memory loss is not a significant effect of chronic fatigue.
The nurse is assessing for fatigue in a patient diagnosed with multiple sclerosis. Which self -reporting tool is best for the nurse to utilize?
a. Multidimensional Assessment of Fatigue (MAF)
b. Fatigue Severity Scale (FSS)
c. Brief Fatigue Inventory (BFI)
d. Multidimensional Fatigue Inventory (MFI)
ANS: B
The FSS was developed for patients with multiple sclerosis and lupus. The MAF was designed for arthritis patients and is also used in cancer patients and those with chronic pulmonary disease. The BFI is used for cancer patients. The MFI is used with various patient populations, including cancer, chronic fatigue syndrome, and COPD.
A patient presents to the clinic complaining of nausea, vomiting, and fatigue. Lab results reveal elevated BUN and creatinine levels. Which acute condition is this patient at most risk for developing?
a. Influenza
b. Mononucleosis
c. Acute renal failure
d. Pneumonia
ANS: C
The patient’s symptoms are most congruent with dehydration. Hypovolemia, due to dehydration, can lead to decreased perfusion to the kidneys resulting in acute renal failure. Influenza symptoms include headache, fever, body aches, and fatigue. Mononucleosis can manifest as severe fatigue. Pneumonia presents with cough, respiratory distress, and decreases in oxygen saturation.
The nurse is caring for a patient diagnosed with amyotrophic lateral sclerosis. The nurse should assess for which priority problem?
a. Fatigue
b. Bradypnea
c. Hypertension
d. Fall risk
ANS: B
Amyotrophic lateral sclerosis is a chronic condition that causes fatigue; however specific respiratory muscle fatigue leading to bradypnea is the priority safety risk. Respiratory muscle fatigue can lead to bradypnea, decreased ventilation, and eventually cessation of breathing which is the condition of highest importance with this illness. Hypertension is not a high priority problem specifically related to ALS. While the patient is a fall risk due to overall skeletal muscle fatigue, respiratory depression is the priority safety risk.
A patient with chronic kidney disease is most likely to complain of which symptom? a. Fatigue
b. Thirst
c. Constipation
d. Excess bleeding
ANS: A
Erythropoietin is produced by the kidneys. A patient with chronic kidney disease produces less erythropoietin, resulting in anemia and fatigue as a common symptom. Thirst, or polydipsia, is a common sign of hyperglycemia and diabetes which can lead to chronic kidney disease. Constipation is not a common symptom of chronic kidney disease. Excessive bleeding can result from a decrease in platelets and clotting factors that are produced by the liver, not the kidneys.
A patient has been recently diagnosed with chronic fatigue syndrome and asks the nurse about the cause of this illness. What is the nurse’s best response?
a. “The provider will be able to tell you when the lab results are back.”
b. “An exact cause may not be determined, but a treatment plan will be discussed.”
c. “Stress is the main cause; a referral to a counselor may be helpful.”
d. “This is considered a psychiatric illness requiring behavioral medicine.”
ANS: B
Chronic fatigue syndrome is considered an illness with an unknown etiology. There are no specific lab results that reveal chronic fatigue syndrome. Stress and mental illnesses may be contributing factors, but are not classified as exact causes of chronic fatigue syndrome.
The nurse palpates swollen nodes in a patient’s neck who presented to the clinic with complaints of fatigue lasting at least 2 weeks. What is the nurse’s best action?
a. Advise patient this finding is normal.
b. Review patient’s thyroid lab work.
c. Perform deep tendon reflexes.
d. Notify the healthcare provider.
ANS: D
The nurse should notify the healthcare provider for further evaluation. Palpation is indicated to assess for the presence of lymphadenopathy, thyroid nodules or goiter. These findings could implicate the need to test further for cancer, thyroid disease or infection. These conditions should be ruled out by the healthcare provider. Thyroid nodules or changes in size indicate the need for further assessment of the thyroid. Deep tendon reflexes are part of a neuro-muscular examination and are not directly related to cervical node enlargement.
The nurse is assessing a patient for risk factors of chronic fatigue syndrome. Which factors should the nurse identify as placing the patient at risk for chronic fatigue syndrome? (Select all that apply.)
a. Feeling tired upon awakening
b. Chronic migraines
c. Tenderness under the jaw
d. 5 episodes tonsillitis/past year
e. Swollen, painful knees
ANS: A, C, D, E
The individual has severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted). The fatigue significantly interferes with daily activities and work. The individual concurrently has four or more of the following eight symptoms:
* Post exertion malaise lasting more than 24 hours
* Unrefreshing sleep
* Significant impairment of short-term memory or concentration
* Muscle pain
* Multi-joint pain without swelling or redness
* Headaches of a new type, pattern, or severity
* Tender cervical or axillary lymph nodes
* Frequent or recurring sore throat
The occupational health nurse is making rounds in a factory. Which employees need further education about energy conservation strategies? (Select all that apply.)
a. Workers reaching up to high shelf often to obtain cleaning supplies
b. Workers bending over to lift boxes onto conveyer belt
c. Workers who have delegated out parts of their activities
d. Workers standing for long periods
e. Workers standing at desks at waist level
ANS: A, B, D
The employee health nurse should provide teaching to employees about energy conservation strategies to protect workers from job-related injuries. These strategies include: placing frequently used items within reach; using proper body mechanics (not bending over and straining the back); and standing for long periods of time. Delegating parts of activities is an appropriate energy conserving strategy. When standing is necessary, it is important that desks or tables are at waist level of the employee to prevent excess reaching or straining.
The nurse recognizes that which patients are at highest risk for physiologic fatigue? (Select all that apply.)
a. Parents of a newborn
b. Adolescent with anorexia
c. 25-year-old pregnant female
d. Grandmother who takes 12 mile walks
e. Businessman who consumes six cups coffee/day
ANS: A, B, C, E
Physiologic causes of fatigue include: protein–calorie malnutrition, excessive physical activity, sleep deprivation, excessive caffeine or alcohol use, and pregnancy. Parents of a newborn are likely experiencing sleep deprivation. A patient with anorexia is
likely not consuming adequate amounts of protein. Consumption of six cups of coffee/day is considered excessive. A 12 mile walk is an appropriate exercise for an older adult and not considered excessive physical activity.
Which are treatment related causes of fatigue? (Select all that apply.)
a. Blood transfusion
b. Chemotherapy
c. Radiation therapy
d. Surgery
e. Side effects of medications
ANS: B, C, D, E
Cancer treatments, such as chemotherapy and radiation, commonly cause fatigue. A risk of any surgery is blood loss, which can possibly lead to fatigue if the hemoglobin and hematocrit drop significantly. Fatigue is a side effect of many medications. A blood transfusion is more likely to lead to increased energy versus fatigue as the hematocrit and hemoglobin levels would be expected to rise with the transfusion.
