NUR2571 PN2 Exam 3 -with 100% verified naswers-2024-2025.docx, Exams of Nursing

Download NUR2571 PN2 Exam 3 -with 100% verified naswers-2024-2025.docx and more Exams Nursing in PDF only on Docsity! NUR2571  PN2 Exam 3 -with 100% verified naswers- 2024-2025 Rheumatoid Arthritis 1. A nurse is working in an outpatient clinic is assessing a client who has rheumatoid arthritis. The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (Select all that apply.) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Increased blood pressure E. Pain a rest 2. A nurse is teaching a client who has a new diagnosis of rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? A. You can experience morning stiffness when you get out of bed B. You can experience abdominal pain C. You can experience weight gain D. You can experience low blood sugar 3. A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply.) A. Urinalysis B. Erythrocyte sedimentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count Multiple Sclerosis 1. A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eyelids 2. A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Areas of paresthesia B. Involuntary movements C. Alopecia D. Increased salivation E. Ataxia 5. A nurse is obtaining a health history from a client who is being evaluated for the cause of frequent headaches. Which of the following questions should the nurse ask to identify the aura type of migraine headache? A. Do the headaches occur multiple times a day B. Is your headache accompanied by profuse facial sweating C. Does your headache occur on one side of your head D. Do you have the same manifestations each time the headache occurs Benign Prostatic Hyperplasia, Erectile Dysfunction, Prostatitis 1. A nurse in a provider’s office is obtaining a history from a client who is undergoing an evaluation for benign prostatic hyperplasia. The nurse should identify that which of the following findings are indicative of this condition? (Select all that apply.) A. Backache B. Frequent urinary tract infection C. Weight loss D. Hematuria E. Urinary incontinence 2. A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia. The nurse should expect a prescription for which of the following medications? A. Oxybutynin B. Diphenhydramine C. Ipratropium D. Tamsulosin 3. A nurse is instructing a client who is scheduled for a transurethral resection of the prostate (TURP) about postoperative care. Which of the following information should the nurse include in the teaching? A. You might have a continuous sensation of needing to void even though  you have a catheter B. You will be on best rest for the first two days C. You will be instructed to limit your fluid intake after the procedure D. Your urine should be clear yellow the evening after the surgery 4. A nurse is providing discharge instructions to a client who is postoperative following a TURP. Which of the following instructions should the nurse include? (Select all that apply.) A. Avoid sexual intercourse for three months after the surgery B. If urine appears bloody stop activity and rest C. Avoid caffeinated beverages D. Take a stool softener once a day E. Treat pain with ibuprofen Infections Of The Renal And Urinary System 1. A nurse is planning care for a patient who has chronic pyelonephritis. Which of the following actions should the nurse plan to take? (Select all that apply.) A. Provide a referral for nutrition counseling B. Encourage daily fluid intake of 1 L C. Palpate the costovertebral angle D. Monitor urine output E. Administer antibiotics 2. A nurse is caring for a client who has a urinary tract infection. Which of the following is the priority intervention by the nurse? A. Offer a warm sitz bath B. Recommend drinking cranberry juice C. Encourage increased fluids D. Administer an antibiotic 3. A nurse is preparing educational material to present to a female client who has frequent urinary tract infections. Which of the following information should the nurse include? (Select all that apply.) A. Avoid sitting in a wet bathing suit B. Wipe the perineal area from back to front following elimination C. Empty the bladder when there is an urge to void D. Wear synthetic fiber underwear E. Take a shower daily 4. A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? (Select all that apply.) A. A client who is at 32 weeks gestation B. A client who has kidney calculi C. A client who has a urine pH of 4.2 D. A client who has a neurogenic bladder E. A client who has diabetes mellitus 5. A nurse is reviewing urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection? A. Positive for hyaline casts B. Positive for leukocyte esterase C. Positive for ketones D. Positive for crystals Disorders Of The Eye 1. A nurse is caring for a client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following diseases? A. Cataracts B. Open angle glaucoma C. Macular degeneration D. Closed angle glaucoma 2. A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? A. You can resume golfing in 2 days B. You need to tilt you head back when washing your hair C. You can get water in your eyes in one day D. You need to limit your housekeeping activities 3. A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease? (Select all that apply.) A. Sex B. Genetic predisposition C. Hypertension D. Age E. Diabetes mellitus 4. A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Eye pain B. Floating dots C. Blurred vision D. White pupils E. Bilateral red reflexes 5. A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables B. Administer eye drops twice daily C. Avoid bending at the waste D. Wear an eye patch at night AL T • 10-30 IU/mL o High: liver damage. AST • 8-46 U/L o Injury to liver and definitive liver damage when ALT is also elevated. Troponin • 0-0.0015 mEq/L o Most common blood test to determine a heart attack o High: cardiac muscle damage BNP • 0-100 mg/mL o High: heart failure or chronic heart failure o Look for wet cough, shortness of breath, edema in legs CRP • 0-3 mg/L o High: inflammation somewhere in the body HgA1C • Less than 7% o High: diabetes and blood sugar are not controlled Platelets • 100,000-400,000 o Low: impaired blood clotting. ANA • 1:40-1:60 o High: indication of RA RF • 0-20 u/mL o High: indicates RA Rheumatic Disorders  Autoimmune General Overview • The body isn’t aware and is super responsive to pathogens and invades itself o Can be super responsive to organs itself ▪ Characterized by inflammation, autoimmune markers, and degeneration ▪ Common symptoms: pain and fatigue ▪ Assessment: increased C-reactive protein, increased erythron sedimentation rate (ESR), increased antinuclear antibody (ANA), increased rheumatoid factor (RF) Lab Tests For RA (RF, ANA, CRP) • These values will be elevated. o ANA and RF are mainly used for the diagnosis since they are more specific to RA Rheumatoid Arthritis • Autoimmune disease of unknown etiology, synovial area breaks down with inflammation, increased production of synovial fluid, pannus formation. o Women are more affected than men o Hands, wrists, feet, and ankles are most affected ▪ Risk Factors: smoking, genetic formation, increased risk for atherosclerotic buildup ▪ Clinical Manifestations: pain, aches, joint stiffness in the morning that lasts for most of the morning, swelling, warmth, erythema, decreased range of motion, boggy/spongy on palpation. • Early Stages: pain, some limited range of motion, increased temperature (100 or above), weight loss, fatigue, anemia ▪ Assessment/Diagnostics: ESR, CRP, ANA, RF, palpation of joint, x- ray, potential joint aspiration ▪ Medical Management: DMARD drugs -> methotrexate, sulfadine, plaquedil, embryl ▪ Nursing Management: manage pain, fatigue levels, sleep disturbances Gout • Inflammatory arthritis, swollen inflamed joints with excess uric acid formation in the form of crystals in the joint • Can last 3-10 days with throbbing pain, increased inflammation, beefy red appearance o Etiology: autoimmune in origin, excessive intake of red meat, trauma, surgery, flu or bacterial illness, foods high in purines (shellfish, fish), high sugary diet, sweetened soft drinks, excessive alcohol consumption o Prevalence: 3 million diagnosed cases in a year in the US, men more than women, increases with age, higher BMI, alcoholism, use of diuretics ▪ Diagnostics: uric acid level (greater than 6.8), aspiration of the joint ▪ Clinical Manifestations: pain, throbbing sensation, can’t bend the joint ▪ Medical Management: Colschicine (absorbs uric acid crystals) want to see diarrhea in three days and then stop the medication, Allipurnol (breaks down purines long term ▪ Nursing Management: diet education (low in purines, sugars, red meat, shellfish), no smoking, drinking water, DASH diet, exercise, limit alcohol consumption • Clinical manifestations vary and have different patterns • Frequently the disease is relapsing and remitting, has exacerbations and recurrence of symptoms including fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain, and visual disturbances • Gerontologic Considerations: diagnosis over the age of 65 the disease is more severe, no decrease in symptoms • Prevalence: 400,000 US cases, northern US has more cases, women more than men • Signs and Symptoms: fatigue, visual disturbances, pain, spasticity/ataxia, balance, gait, pain, mental fatigue, mood, cognition, bladder, sexual dysfunction, bowel, restless legs, swallowing, hearing • Assessment/Diagnostics: MRI of brain, spinal tap, subjective history • Medical Management: immunomodulated therapies to decrease frequency and duration of relapses • Nursing Management: support, education, 5-7 years shorter life expectancy due to pneumonia due to lack of ambulation, pressure ulcers, other infections Myasthenia Gravis • An autoimmune disorder affecting the myoneural junction, characterized by varying degrees of weakness of the voluntary muscles (face and eyes) • Antibodies destroy the acetylcholine receptors resulting in involuntary muscle weakness. o Prevalence: 20:1,000,000 people, diagnosed during the 20-30s o Signs and Symptoms: ptosis (drooping eyelid), diplopia, phonia (voice impairment), generalized weakness o Assessment/Diagnostics: tensilon test (facial weakness resolves and then when the medication is stopped the symptoms return o Medical Management: ocular symptoms, Mestanon (decreases breakdown of acetylcholine) Degenerative Neurological  Parkinson’s Disease • A slowly progressing neurologic disease characterized by decreased levels of dopamine resulting in the inhibition of messages to the higher motor centers that control and refine movements o Detected when 80% of dopamine is lost • Prevalence: 1 million in the US, more men • Signs and Symptoms: occurs in the 50s, benign motor tremors, masked face (doesn’t display emotions), tremors, rigidity, bradykinesia (slow movements, shuffling of feet, hunched over), postural changes (two of the four for diagnosis) • Assessment/Diagnostics: dopamine levels, objective examination, MRI/CT of brain • Medical Management: dopamine (levadopal), control the symptoms, deep brain stimulation • Nursing Management: help with ADL, reassurance, support Assessments    And    Managements    Of    Patients    With    Biliary    Disorders     Cholelithiasis • Gall stones/calculi (cholesterol, fats) in the gall bladder o Gall stones: bio-pigment or cholesterol (75%) • Prevalence: increases with age, 50% of women by age 70, women 2-3 times more likely • Clinical Manifestations: silent for a long time, epigastric distress, abdominal distention, sense of fullness, right upper quadrant pain, radiating pain to the back, excessive burping, pain following a fatty meal, nausea, vomiting • Risk Factors: diabetes, frequent weight changes, high BMI, women, rapid weight loss • Assessment/Diagnostics: ultrasound (GBGI), CAT scan, endoscopic retrograde choliangio-pancreatography (ERCP) • Medical Management: pain control decrease spasms • Surgical Management: removal of the gall bladder, removal of gall stones Intestinal/Rectal  Constipation • Less than three bowel movements weekly, or movements that are small, dry, or hard to pass • Prevalence: 42 million Americans, pregnant women, older adults • Cause: dehydration, cancer, surgical reasons, medications, lack of exercise, disease processes • Gero Contributing Factors: foods eaten, access to fruit and vegetables, dull nerves, weaker peristalsis, low fiber • Signs and Symptoms: distention, bloating, straining, tenesmus (painful defecation), bleeding hemorrhoids • Assessment/Diagnostics: history, DRE, fecal hemoccult test, barium enema, sigmoidoscopy, colonoscopy • Complications: megacolon, fissures, fistulas, hemorrhoids, tears, perforation • Medical Management: hydration, diet, exercise, bulk laxatives, stool softeners • Nursing Management: diet diary, hydration, exercise, 25-30 grams of fiber Diarrhea • More than three bowel movements per day with a sense of urgency and perianal discomfort o Classifications: acute, persistent, chronic (acute and persistent due to virus or food) • Signs and Symptoms: watery stools, cramping, tenesmus, frequency, exscoriation, burning, hemorrhoids • Assessment/Diagnostics: DRE, CBC, electrolyte panel • Complications: dehydration, electrolyte imbalances • Medical Management: controlling symptoms, preventing electrolyte loss, high binding foods, antidiarrheal medications • Nursing Management: diarrheal diary, adhering to a binding diet Diverticulitis • Inflamed bulging sacs in the colon • Prevalence: half of all adults over 65 • Signs and Symptoms: typically asymptomatic, diarrhea, constipation, pain in left lower quadrant, fever, nausea, vomiting, increased WBC Kubler Ross Stages Of Loss And Grieving • Denial • Anger • Depression • Bargaining • Acceptance Signs And Symptoms Of Impending Death • Close Awareness: patient is not aware • Suspected Awareness: patient suspects something is wrong • Mutual Pretense Awareness: everyone is aware but not talking about it • Open Awareness: full awareness and acceptance o Signs and Symptoms: decreased heart rate, decreased blood pressure, irregular slow breathing, cool body temperature, rigid body, coma, incontinence Open Ended Alzheimer’s • Form of progressive, irreversible dementia that is a disease of the plaques o It has a slow progression that begins with memory loss and progresses into cognitive loss ▪ Diagnosis is based off of exclusion of all other diseases ▪ Aricept, Namenda, and Exelon are used as acetylcholine receptor to slow the progression and pauses the progression Delirium • Acute confusional state that is reversible once the underlying cause is identified and treated o Begins with disorientation and progresses into full confusion with hallucinations o If not treated it can progress to changes in consciousness, irreversible brain damage, or even death ▪ It is a sign and symptom for infection in the older adult since they have nontraditional presentations ▪ Goal is to figure out the underlying cause and treat it so it can be reversed Diabetes • Abnormally high blood sugars, hyperglycemia is the predominant symptom, defects in insulin secretion or action or both • 30 million Americans have diabetes • African Americans, Hispanic Americans, native Americans are at high risk • Leading cause of amputation, blindness, end stage kidney disease, cardiovascular disease, MI, peripheral vascular disease, hospital rates and admissions • Family history, BMI, greater than 30, culture, age greater than 45, previously identified impaired fasting glucose test, BP greater than 140/90, low HDL lower than 35, triglycerides greater than 250, history of delivering more than a 9 pound baby o Type I: manifests before 30, beta cells do not produce or produce very little insulin o Type II: insulin action or defects in amounts of insulin secretion ▪ Fasting blood sugar should be 70-110 ▪ Diabetic is 126 or greater for two tests ▪ HgA1C less than 6% ▪ Diabetic is greater than 6% on two tests