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NUR 326 ADULT HEALTH EXAM 1 with
correct answers
A |diabetic |patient |has |the |following |presentation: |unresponsive |to |voice |or |touch, |tachycardia, | diaphoresis, |and |pallor. |Which |action |by |the |healthcare |provider |is |the |priority? a) |Fluid, |electrolyte |and |glucose |resuscitation b) |Administer |IV |Lantus |Insulin |per |protocol c) |Send |UA |and |CBC |to |lab |STAT d) |Administer |Oral |Glucose |- |✔✔a) |Fluid, |electrolyte |and |glucose |resuscitation Which |is |not |considered |characteristic |of |a |type | 1 |diabetic |in |DKA? a) |Right |lower |quadrant |pain b) |Plasma |glucose |greater |than | 250 c) |Ketones |in |the |urine d) |Ketoacidosis |- |✔✔a) |Right |lower |quadrant |pain Which |is |not |considered |a |risk |factor |for |the |development |of |DKA a) |Increased |activity |and |exercise b) |Concurrent |infection c) |Non-adherence |to |Medication d) |New |onset |of |diabetes |- |✔✔a) |Increased |activity |and |exercise All |are |differences |between |DKA |and |HHS |except? a) |HHS |is |primarily |noted |in |type | 1 |diabetics b) |In |HHS, |absence |of |ketones |is |noted c) |DKA |is |primarily |noted |in |type | 1 |diabetics
d) |In |HHS |early |manifestations |are |often |missed |- |✔✔a) |HHS |is |primarily |noted |in |type | 1 |diabetics You |are |caring |for |a |type | 1 |diabetic |currently |being |treated |for |pneumonia. |Treatment |has |been | initiated |and |the |nurse |you |are |assigned |with |is |asking |you |focus |on |his |diabetes |as |his |blood |glucose |is |325. |Which |nursing |diagnosis |statement |is |accurate |related |to |his |diabetic |needs? a) |Unstable |blood |glucose |related |to |stress |and |infection b) |compromised |blood |regulatory |mechanism |related |to |stress |and |infection |secondary |to |diabetes | aeb |blood |glucose |of |325. c) |diabetic |crisis |related |to |stress |and |infection |aeb |blood |glucose |of | 325 |and |current |antibiotic | therapy d) |risk |for |compromised |immune |response |related |to |stress |and |infection |secondary |to |diabetes |- | ✔✔a) |Unstable |blood |glucose |related |to |stress |and |infection You |are |caring |for |a |patient |with |cirrhosis |of |the |liver |being |treated |for |edema, |ascites |and |portal | hypertension. |They |are |placed |on |a |low |sodium |diet |for |support |and |started |on |a |higher |dose |of | diuretics |alongside |scheduled |paracentesis |for |support. |Which |lab |value |would |you |report |to |the | physician |if |noted |prior |to |initiating |therapy |and |orders? a) |Potassium |of |3. b) |Sodium |of | 147 c) |Albumin |of |3. d) |Magnesium |of |2.0 |- |✔✔a) |Potassium |of |3. A |client |with |cirrhosis |is |at |risk |for |developing |complications. |Which |condition |is |most |serious |and | potentially |life |threatening? a) |Esophageal |varices
c) |elevated |Ammonia, |bilirubin, |AST |and |ALT d) |fatigue |and |disorientation |- |✔✔a) |Glasgow |Coma |Scale |(GCS) |of | 15 cellulitis |- |✔✔an |infection |of |the |dermis |and |subcutaneous |tissue -can |be |an |extension/stem |from |pre-existing |wound -injury |or |a |manifestation |of |its |own |due |to |compromised |host/vector |relationship risk |factors |for |cellulitis: |include |but |are |not |limited |to |- |✔✔-co-morbid |conditions -diabetes | -vascular |compromise/poor |perfusion -immunocompromised -risky |behaviors |(drugs, |alcohol, |tobacco_ -poor |diet -inadequate |hygiene | -prior |known |resistant |infections -environmental |exposures/hazards -insect |bites the |main |culprits |for |cellulitis |- |✔✔generally |bacterial |infection: |usual |suspects |include: -staphylococcus |aureus |(SA) -methicillin |sensitive |SA |(MSSA) -methicillin |resistant |SA |(MRSA) -streptococcus |pyogens | *these |bacterium |rapidly |reproduce |and |spread: |very |common |to |progress |quickly |over |24-48 |hours assessment |for |cellulitis |- |✔✔-starts |out |as |a |reddened, |painful |localized |area -warm |to |touch |and |often |becomes |more |edematous |when |comparing |bilaterally -skin |becomes |taught, |may |or |may |not |blister |as |a |result |of |increased |swelling. |skin |may |peel -scattered |open |wounds |develop -systemic |symptoms: |fever, |chills, |malaise
-progressive |if |not |treated |may |turn |septic diagnostics |and |treatment |options |for |cellulitis: |- |✔✔-identify |to |causative |organism: |obtain |a |culture | and |sensitivity | -additional |diagnostics: |ultrasound |(US) |or | computerized |tomography(CT) |(abscess?) | -If |found- |may |need |aspiration |or |incision |and |drainage |(I&D) |which |is |also |done |using |US |or |CT -Progressive |infections |not |responsive |with |oral |or |IV |antibiotics |may |also |be |I&D'd |bedside |or |in | surgery. -Common |Antibiotics: |Until |culprit |is |identified: |treated |with |broad |spectrum |antibiotics |(Quinolones, | Carbapenems, |Cephalosporins, |Glycopeptides) -Once |organism(s) |identified: |goal |is |to |treat |based |on |patient |needs |and |ability |to |follow |through -Monitor |Labs: |CBC |(complete |blood |count), |CMP |(comprehensive |metabolic |panel), |repeat |culture? local |care |for |cellulitis |- |✔✔-Mark |the |area |to |monitor |progression |and |responsiveness |to |treatment -If |drainage |or |wound(s) |are |present: |local |topical |treatments, |dressing |and |support -Monitor |edema |progression -Warm |(moist) |or |cool |compresses -Elevation -Allow |to |drain |on |own; |avoid |squeezing |and |manipulation -Ensure |patient |education |provided patient |education |for |cellulitis |- |✔✔-Continuation |of |antibiotics |until |completed |or |advised |to |stop -Monitoring |of |site |at |least |daily |if |not |more -Avoidance |of |certain |activities |depending |on |location |of |infection |(ex: |if |on |lower |extremity |no | swimming, |hot |tubs |etc.) -Resist |the |urge |to |scratch, |pick, |rub |and |agitate -Dressing |change |needs -Follow |up |appointments -Mitigating |(prevent) |those |risk |factors |: |Tighter |glucose |control, |changing |the |environment, |diet | improvement- |refer |to |the |list |at |the |beginning |of |this |presentation
break |the |link: |susceptible |host |(cancer |patients, |elderly |patients, |surgical |patients, |burns, |diabetes | mellitus) |- |✔✔-treatment |of |primary |disease -recognize |high |risk |patients Urinary |Tract |Infection |(UTI) |- |✔✔Second |most |common |bacterial |disease Most |common |bacterial |infection |in |women- |why? Escherichia |coli |most |common |pathogen *Refer |to |table |45-1- |outlines |common |UTI |pathogens *Those |immunocompromised |may |have |a |UTI |develop |due |to |fungal |or |parasitic |pathogens Normally |urine |is |more |acidic |and |actual |flow |with |peristaltic |activity |help |to |rid |the |body |of |bacteria. | Urinary |tract |above |the |urethra |is |usually |sterile. However- |many |common |issues |halt |this |normal: |- |✔✔kidney |stones, |pregnancy, |congenital |defects, | aging, |chronic |health |issues |( |which |will |be |discussed |on |the |next |few |slides) Upper |UTI: |- |✔✔occur |in |the |renal |pelvis |and |ureters |and |are |often |showcased |through |systemic | manifestations: |flank |pain, |fever, |chills |and |malaise Lower |UTI's: |- |✔✔occur |in |urethra |and |bladder. |General |complaint |of |burning |( |also |need |to |rule |out | yeast |infection) Pyelonephritis |- |✔✔Kidney |infection |- |higher |up |in |the |urinary |tract Cystitis |- |✔✔ Urethritis |- |✔✔ Urosepsis |- |✔✔ classification |of |UTIs |- |✔✔Complicated |versus |uncomplicated Uncomplicated |UTIS |- |✔✔Occurs |in |otherwise |normal |urinary |tract Usually |involves |only |the |bladder complicated |UTIs |- |✔✔Those |with |coexisting |presence |of: *Obstruction, |Stones, |Catheters, |Existing |diabetes/neurologic |disease, |Pregnancy-induced |changes, | Recurrent |infection
Etiology |and |Pathophysiology |of |UTIs |- |✔✔Alteration |in |defense |mechanisms |increases |risk |of | contracting |UTI Predisposing |factors |for |UTI |- |✔✔-Factors |increasing |urinary |stasis Examples: |BPH, |tumor, |neurogenic |bladder -Foreign |bodies Examples: |Catheters, |calculi, |instrumentation -Anatomic |factors Examples: |Obesity, |congenital |defects, |fistula -Compromising |immune |response |factors Examples: |Age, |HIV, |diabetes -Functional |disorders Example: |Constipation -Other |factors Examples: |Pregnancy, |multiple |sex |partners |(women) Hospital-acquired |UTI |- |✔✔accounts |for |31% |of |all |nosocomial |infections |(hospital |acquired | infections) causes |for |hospital |acquired |UTI |- |✔✔*Often: |E. |coli *Catheter-acquired |UTIs |(CAUTI): Bacterial |biofilms |develop |on |inner |surface |of |catheter UTI |Symptoms |- |✔✔-Urinary |frequency | -Urgency -Incontinence -Nocturia
UTI |Symptoms |in |Elderly |- |✔✔Older |adults: -Symptoms |are |often |absent -Experience |non-localized |abdominal |discomfort |rather |than |dysuria -May |have |cognitive |impairment-confusion -Are |less |likely |to |have |a |fever Collaborative |Care: |Pain |management |for |UTI |- |✔✔-Phenazopyridine |(Uristat, |Pyridium) | -Acetaminophen |(Tylenol) | -other |OTC Collaborative |Care: |Antibiotics |for |UTI |- |✔✔-Selected |on |empiric |therapy |or |results |of |sensitivity | testing -Uncomplicated | *Short-term |course |(1 |to | 3 |days) -Complicated |UTIs | *Require |long-term |treatment |(7 |to | 14 |days) Recurrent |UTI's: |prophylactic |antibiotic |therapy |is |considered Nursing |Diagnoses |for |UTI |- |✔✔-Impaired |urinary |elimination -Ineffective |self-health |management -Acute |Pain -Altered |sensory |perception -Acute |confusion Patient |Outcomes |for |UTI |- |✔✔Patient |will |have:
-Relief |from |lower |urinary |tract |symptoms -Prevention |of |upper |urinary |tract |involvement -Prevention |of |recurrence -Adoption |of |adequate |hygiene |measures Acute |Care |Nursing |Interventions |for |UTI |- |✔✔-Wash |hands -Wear |gloves |for |care |of |urinary |system -Routine |and |thorough |perineal |care |for |all |hospitalized |patients -Avoid |catheters -Foley |catheter |care | -Avoid |incontinent |episodes Nursing |Interventions |and |Patient |Education |for |UTI |- |✔✔-Recognize |individuals |at |risk |(assessment/monitoring) -Emptying |bladder |regularly |and |completely -Regular |voiding |(every | 3 |to | 4 |hours) -Evacuating |bowel |regularly -Wiping |perineal |area |front |to |back |(education) -Drinking |adequate |fluids |(assess/monitor/educate/collaborate) *20% |fluid |comes |from |food -Void |and |clean |after |intercourse -Emphasize |compliance |with |drug |regimen *Take |all |antibiotics |as |ordered
D. |Respiratory |alkalosis |- |✔✔A. |Metabolic |Alkalosis |: |Loss |of |acidic |abdominal |contents |caused | alkalosis |. |How |would |the |body |compensate? You |are |caring |for |a |patient |admitted |with |an |exacerbation |of |asthma. |After |several |treatments, |the | ABG |results |are |pH |7.40, |PaCO2 | 40 |mm |Hg, |HCO3 | 24 |mEq/L, |PaO2 | 92 |mm |Hg, |and |O2 |saturation |of | 99%. |You |interpret |these |results |as |A. |within |normal |limits. |B. |slight |metabolic |acidosis. |C. |slight |respiratory |acidosis. |D. |slight |respiratory |alkalosis. |- |✔✔A. |Within |Normal |Limits. The |Process |of |excreting |bicarbonate |out |of |the |body |to |Correct |acid |base |imbalance | occurs |through |the |: |A. |Lungs |B. |Kidneys |C. |Liver |D. |Pancreas |- |✔✔B. |Kidneys *The |kidney |is |the |only |organ |that |deals |with |bicarbonate. | The |lung |manipulates |carbon |dioxide. | The |liver |metabolizes |nutrients |and |detoxifies |medications. The |pancreas |excretes |insulin, |glucagon |and |somatostatin. A |client |with |Diabetes |Mellitus |is |admitted |to |the | hospital |complaining |of |lethargy, |weakness, | headache, |nausea |and |vomiting. |Arterial |blood | gases |are |ordered. |The |nurse |suspects |the |lab | result |will |confirm. | |A. |Metabolic |Acidosis |B. |Metabolic |Alkalosis
|C. |Respiratory |Acidosis | |D. |Respiratory |Alkalosis |- |✔✔Metabolic |acidosis: |the |major |acid |base |imbalance |associated |with | diabetes |is |metabolic |acidosis Which |lab |value |indicates |Respiratory |acidosis? |A. |pH |7.40, |PCO2 |38,HCO3 | 23 | |B. |pH |7.33, |PCO2 |30, |HCO3 | 18 | |C. |pH |7.28. |PCO2 |48,HCO3 | 29 |D. |pH |7.46, |PCO2 |30. |HCO3 | 25 |- |✔✔Correct |answer |C. A |is |normal |value, |B |metabolic |acidosis |, |D |Alkalosis The |nurse |should |watch |for |what |electrolyte |imbalance |in |a |client |who |has |chronic |respiratory |acidosis? |A. |Hyperkalemia |B. |Hypomagnesemia |C. |Hyperphosphatemia |D. |Hypocalcemia |- |✔✔A. |Hyperkalemia |Hydrogen |ions |force |exchange |for |K+ |intracellular | Hyperkalemia: |In |acidosis |H+ |is |pushed |into |cells |and |K+ |comes |out |of |the |cells into |the |bloodstream |, |therefore |the |client |is |hyperkalemic. This |is |a |normal |compensatory |mechanism, |Magnesium |is |not |significantly | affected |in |acidosis |nor |is |phosporus. |In |acidosis |calcium |levels |tend |to |go |up | resulting |in |hypercalcemia. A |client |is |admitted |to |the |ED |with |a |diagnosis | of |Respiratory |Alkalosis. |The |nurse |recognizes |a |symptom |of |this |Acid |Base |imbalance |is: |A. |Nausea
(With |fluid |retention |the |rate |is |not |as |significant |as |a |bounding |characteristic |to |the |pulse) d. |Listen |to |the |client's |breath |sounds (Although |left |ventricular |failure |can |proceed |to |right |ventricular |failure, |the |client |has |given |no | indication |that |pulmonary |edema |may |be |developing) heart |failure |review |question |# When |performing |a |physical |assessment |of |a |client |with |heart |failure, |the |adaptation |that |would |be | unexpected |is? a. |Dependent |edema b. |Progressive |fatigue c. |Moist, |clammy |skin d. |Collapsed |neck |veins |- |✔✔d. |Collapsed |neck |veins Rationale: a. |Dependent |edema (This |is |an |expected |adaptation |in |clients |with |HF) b. |Progressive |fatigue (Same |as |answer |1) c. |Moist, |clammy |skin (This |is |associated |with |clients |who |are |decompensating |or |going |into |cardiac |shock |or |infarction) d. |Collapsed |neck |veins (With |heart |failure |the |veins |distend, |not |collapse |because |of |congestion |of |the |CV |system) heart |failure |review |question |# The |nurse |understands |that |heart |failure |can |be |best |be |described |as? a. |A |cardiac |condition |caused |by |inadequate |circulating |blood |volume b. |An |acute |state |in |which |the |pulmonary |circulation |decreases
c. |An |inability |of |the |heart |to |pump |blood |in |proportion |to |metabolic |needs d. |A |chronic |state |in |which |the |systolic |pressure |drops |below | 90 |mm |Hg |- |✔✔c. |An |inability |of |the | heart |to |pump |blood |in |proportion |to |metabolic |needs Rationale: a. |A |cardiac |condition |caused |by |inadequate |circulating |blood |volume (Heart |failure |is |related |to |an |increased, |not |decreased, |circulating |volume) b. |An |acute |state |in |which |the |pulmonary |circulation |decreases (The |condition |may |be |acute |or |chronic; |the |pulmonary |pressure |increases |and |capillary |fluid |is | forced |into |the |alveoli) c. |An |inability |of |the |heart |to |pump |blood |in |proportion |to |metabolic |needs (As |the |heart |fails, |cardiac |output |decreases; |eventually |the |decrease |will |reach |a |level |that |prevents | tissues |from |receiving |adequate |oxygen |and |nutrients) d. |A |chronic |state |in |which |the |systolic |pressure |drops |below | 90 |mm |Hg (The |blood |pressure |usually |does |not |drop) heart |failure |review |question |#4 | The |nurse |suggests |that |a |client |with |right |ventricular |failure |should: a. |Take |a |hot |bath |before |bedtime b. |Avoid |sleeping |in |an |air |conditioned |room c. |Avoid |emotionally |stressful |situations |when |possible d. |Exercise |daily |until |the |pulse |rate |exceeds | 100 |beats/minute |- |✔✔c. |Avoid |emotionally |stressful | situations |when |possible Rationale: a. |Take |a |hot |bath |before |bedtime (Low |cardiac |output |cannot |tolerate |extremes |of |temperature; |a |hot |bath |would |increase |oxygen | demands) b. |Avoid |sleeping |in |an |air |conditioned |room
***Normal |CO: |4-8 |L/Min heart |failure |characterized |by |- |✔✔-Ventricular |dysfunction *One |or |both |won't |work |correctly/effectively -Reduced |exercise |tolerance -Diminished |quality |of |life -Shortened |life |expectancy | ***Not |enough |perfusion |to |the |rest |of |their |body, |oxygen, |blood |that |is |why |they |feel |tired heart |failure |affects.... |- |✔✔-Affects |about | 5 |million |people |in |the |United |States -The |most |common |reason |for |hospitalization |in |adults |>65 |years |old!!! primary |risk |factors |for |heart |failure |- |✔✔-Coronary |Artery |Disease |(CAD) -Advancing |age contributing |risk |factors |for |heart |failure |- |✔✔-Hypertension -Diabetes -Tobacco |use -Obesity -High |serum |cholesterol -Genetic |predisposing |factors Types |of |Heart |Failure: |Left |- |✔✔-Left-sided |HF |(most |common) |from |left |ventricular |dysfunction | (e.g., |MI |hypertension, |CAD, |cardiomyopathy) -Symptoms |are |due |to |blood |backing |up -Backup |of |blood |into |the |left |atrium |and |pulmonary |veins | **Pulmonary |congestion | **Pulmonary |edema | !!! |Will |hear |crackles |in |the |lungs |bc |filled |up |with |fluids Compare |and |contrast |dilation |and |hypertrophy |for |heart |failure |- |✔✔-dilation= |refers |to |size |of | filling |space |(enlarged |atria |and |ventricles) | -hypertrophy= |refers |to |thickness |of |muscle |(thickened |heart |muscle) pulmonary |edema |- |✔✔fluid |may |leak |into |the |tissues |around |the |bronchioles...or |it |may |fill |up |the | alveoli |themselves
Types |of |Heart |Failure: |Right |- |✔✔-Right-sided |HF |from |left-sided |HF, |cor |pulmonale *Backup |of |blood |into |the |right |atrium |and |venous |systemic |circulation -Symptoms *Jugular |venous |distention *Hepatomegaly, |splenomegaly ----Liver |, |spleen | *Portal |HTN ----GI |area |- |back |into |the |esophagus |and |intestines | *Vascular |congestion |of |GI |tract *Peripheral |edema | Right |sided |- |blood |backs |up |to |the |rest |of |the |body |
- |Edema jugular |vein |distention |- |✔✔JVD: |Evidence |that |blood |is |backing |up |from |the |R |atrium-sitting |at | 45 | degrees clinical |manifestations |for |heart |failure |- |✔✔-Fatigue -Dyspnea, |orthopnea, |paroxysmal |nocturnal |dyspnea | -Persistent |cough, |white |or |pink |blood-tinged |sputum **Trying |to |clear |fluid |in |the |lungs | -Tachycardia (Worsening |- |exacerbation | Dyspnea |- |difficulty |breathing | Orthopnea |- |have |to |be |sitting |up |to |be |able |to |breathe |effectively) Clinical |Manifestations: |Chronic |HF |- |✔✔-Dependent |edema *Edema |may |be |pitting |in |nature- |recall |how |to |measure | *Sudden |weight |gain |of |>3 |lb |(1.4 |kg) |in | 2 |days |may |indicate |an |exacerbation |of |HF
