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Basic Care & Comfort/Pain Management Alzheimer's Disease – Eating Problems

Test Id: 52084841 Question Id: 32803 (729561) 8 of 20

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The nurse is providing care for a client with Alzheimer disease who often becomes angry and agitated 20 minutes or more after eating. The client accuses the nurse of not providing food, saying, "I'm hungry. You didn't feed me." The nurse should take which action? Unordered Options

Ordered Response

1.

Give the client gentle reminders that the client has already eaten

2.

Say that the client can have a snack in a couple of hours Serve the client half of the meal initially and offer the other half later Take a picture of the client having a meal and show it when the client becomes upset

3. 4.

You answered this question incorrectly. Time Spent: 128 Seconds 39% of people answered this question correctly. Last Updated: 11/6/2015

Explanation

Most clients with Alzheimer disease experience eating and nutritional problems throughout the course of their disease. During the earlier stages, it is common for clients to forget that they have eaten recently. The best approach is for caregivers to give clients something to eat when they say they are hungry. Smaller meals throughout the day, along with low-calorie snacks, are effective strategies for clients who forget that they have eaten. (Option 1) Reality orientation has been recommended in the past as a way to deal with confusion (eg, dementia, Alzheimer disease), but research has shown that it may cause anxiety and distress. Validation therapy is a newer and more therapeutic approach that validates and accepts the client's reality. (Option 2) Offering to provide a snack later does not address the client's stated need to eat now. Delay in giving food will only further increase the client's anger and frustration. (Option 4) Showing a picture of the client having a meal is confrontational and will have no meaning to the client.

Educational objective: Clients with Alzheimer disease experience eating and nutritional problems throughout the course of the disease. During the earlier stages, it is common for them to forget that they have eaten recently. The best approach is for caregivers to give clients something to eat when they say they are hungry.

Cardiovascular Abdominal Aneurysm Repair - Immediate Follow-Up

Test Id: 52050973 Question Id: 33389 (729561) 1 of 20

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The nurse cares for a client who had an abdominal aortic aneurysm repair 6 hours ago. Which assessment would require immediate follow-up? Unordered Options

Ordered Response

1.

Abdomen is soft, nondistended, and tender to touch

2.

Blood pressure is 96/66 mm Hg and apical pulse is 112/min

3.

Client rates pain as 4 on a scale of 0-10

4.

Green bile is draining from the nasogastric tube

You answered this question incorrectly. Time Spent: 117 Seconds 77% of people answered this question correctly. Last Updated: 10/26/2015

Explanation Abdominal aortic aneurysms are surgically repaired when they measure about 6 cm or are causing symptoms. Repair can be done via femoral percutaneous placement of a stent graft (endovascular aneurysm repair) or via an open surgical incision of the aneurysm with synthetic graft placement. The client must be monitored postoperatively for graft leakage and hemodynamic stability. Adequate blood pressure is necessary to maintain graft patency, and prolonged hypotension can lead to the formation of graft thrombosis. Signs of graft leakage include a decreasing blood pressure and increasing pulse rate. (Option 1) Following surgery, the client will experience abdominal tenderness. The abdomen should remain soft and nondistended. A rigid, distended abdomen would indicate possible blood (graft leakage) in the cavity. (Option 3) Pain is an expected finding following abdominal surgery. However, increasing pain that is not relieved by medication can indicate possible graft leakage and should be investigated. (Option 4) During abdominal surgeries, it is customary to insert a nasogastric tube that is left in place during the immediate postoperative period. Green bile-colored drainage would be expected. Bloody drainage would cause concern. Educational objective: Following repair of an abdominal aortic aneurysm, hemodynamic stability is a priority. Prolonged hypotension can lead to graft thrombosis. A falling blood pressure and rising pulse rate can also signify graft leakage. Cardiovascular Bradycardia

Test Id: 52050973 Question Id: 30627 (729561) 2 of 20

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The nurse has just administered a dose of 0.5 mg atropine to a client with a heart rate of 48/min and blood pressure of 90/62 mmHg. Which rhythm strip would indicate that the medication achieved the desired outcome? Unorder ed Options

1.

2.

3.

Ordered Response

4.

You answered this question incorrectly. Time Spent: 41 Seconds 77% of people answered this question correctly. Last Updated: 10/31/2015

Explanation

Atropine is given to the client experiencing symptomatic bradycardia. In symptomatic bradycardia, the heart rate is 100 mL/hr), pain, and infection at the drainage site. The collection chamber should be inspected every hour for the first 8 hours following surgery, then every 8 hours until it is removed. Excess drainage of frank red blood is indicative of hemorrhage and must be managed immediately. The priority action is to contact the health care provider for further management. (Option 1) Clamping the chest tube prevents air or fluid from leaving the pleural space, which may cause a reciprocal tension pneumothorax. The chest tube is clamped only a few hours prior to removal, momentarily to check for an air leak, or if the drainage apparatus needs to be changed. (Option 2) Although a pulse oximetry of 92% is low, this is an expected finding following lung surgery. (Option 3) Pain following surgery is a concern and the client will require medication; however, hemorrhage is the priority. Educational objective: A client with a chest tube should be assessed for signs of air/fluid in the chest (eg, diminished breath sounds), excessive drainage (>100 mL/hr), pain, and infection at the drainage site. Excess drainage of frank red blood is indicative of hemorrhage and must be managed immediately.

Respiratory Chest Tube Drainage

Test Id: 52050973 Question Id: 33789 (729561) 8 of 20

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The nurse is assessing a client an hour after a left lung lobectomy. The client is awake, alert, and oriented, and reports pain of 6 on a 0-10 scale. Pulse oximetry is 92% on 4 L oxygen via nasal cannula. The chest tube is set to continuous water seal suction at -20 cm H2O. The collection chamber has accumulated 320 mL of frank red drainage in the last hour. What is the priority nursing action? Unordered Options

1. 2. 3. 4.

Ordered Response

Clamp the chest tube immediately Increase oxygen to 6 L via nasal cannula Medicate client for pain and document the findings Notify the health care provider immediately

You answered this question incorrectly. Time Spent: 84 Seconds 72% of people answered this question correctly. Last Updated: 1/26/2016

Explanation Following lung surgery, a chest tube is inserted into the pleural space to create a negative vacuum to re-inflate the lung and prevent air from re-entering the space. A client with a chest tube should be assessed for signs of air/fluid in the chest (eg,

diminished breath sounds), excessive drainage (>100 mL/hr), pain, and infection at the drainage site. The collection chamber should be inspected every hour for the first 8 hours following surgery, then every 8 hours until it is removed. Excess drainage of frank red blood is indicative of hemorrhage and must be managed immediately. The priority action is to contact the health care provider for further management. (Option 1) Clamping the chest tube prevents air or fluid from leaving the pleural space, which may cause a reciprocal tension pneumothorax. The chest tube is clamped only a few hours prior to removal, momentarily to check for an air leak, or if the drainage apparatus needs to be changed. (Option 2) Although a pulse oximetry of 92% is low, this is an expected finding following lung surgery. (Option 3) Pain following surgery is a concern and the client will require medication; however, hemorrhage is the priority. Educational objective: A client with a chest tube should be assessed for signs of air/fluid in the chest (eg, diminished breath sounds), excessive drainage (>100 mL/hr), pain, and infection at the drainage site. Excess drainage of frank red blood is indicative of hemorrhage and must be managed immediately. Endocrine Diabetes Mellitus

Test Id: 52050973 Question Id: 30147 (729561) 10 of 20

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A client with type I diabetes mellitus is brought to the emergency department by his wife. The client has fruity breath with rapid, deep respirations at 36 breaths per minute,

reports abdominal pain, and appears weak. The nurse should anticipate implementation of which prescription(s)? Select all that apply. Unordered Options

1.

Ordered Response

3.

Administer dextrose 50 mg intravenous (IV) push Instruct client to breathe into a paper bag to treat hyperventilation Perform a fingerstick and serum blood glucose test

4.

Prepare to administer an IV infusion of regular insulin

5.

Start an IV line and administer a bolus of normal saline

2.

You answered this question incorrectly. Correct answer is: 3,4,5 Time Spent: 364 Seconds 41% of people answered this question correctly. Last Updated: 10/31/2015

Explanation The client is exhibiting the cardinal signs and symptoms of diabetic ketoacidosis (DKA). DKA is an acute life-threatening complication, typically of type I diabetes, characterized by hyperglycemia, ketosis, and acidosis. It is caused by an intense deficit of insulin. Glucose cannot be used properly for energy when this deficit occurs and the body begins to break down fat stores, producing ketones, a byproduct of fat metabolism, resulting in metabolic acidosis. The lack of insulin also results in increased production of glucose in the liver, further exacerbating hyperglycemia. Because some of the symptoms of hypoglycemia and DKA overlap, a blood glucose level should be checked to ensure that hyperglycemia is present. Hyperglycemia can cause osmotic diuresis, leading to dehydration. In addition, ketones are excreted in the urine as the body tries to restore its pH balance. Vital electrolytes such as sodium, potassium, chloride, phosphate, and magnesium become depleted during the process. Cardinal signs of dehydration such as poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension, weakness, and lethargy can occur.

The nurse should start an IV and bolus the client with normal saline or 1/2 normal saline to reverse dehydration. This should occur prior to treating the hyperglycemia with regular insulin IV infusion. Because insulin promotes water, potassium, and glucose entrance into the cell, it can exacerbate vascular dehydration and imbalance of electrolytes, particularly potassium. A potassium level (along with other electrolytes) should also be assessed prior to beginning the prescribed insulin therapy. Other signs associated with DKA include Kussmaul respirations, deep, rapid respirations that have a fruity/acetone smell as the carbon dioxide is exhaled. This compensatory mechanism results in a lowered PaC0 2 in an attempt to restore the body's normal pH level and should not be reversed (Option 2). (Option 1) IV dextrose is administered during acute hypoglycemic episodes and would worsen DKA. Educational objective: DKA is an acute life-threatening complication, typically of type I diabetes, characterized by hyperglycemia, ketosis, and acidosis. It is caused by an intense deficit of insulin and should be treated first with rehydration (normal saline) and then insulin administration. Copyright © UWorld. All rights reserved Gastrointestinal/Nutrition Dumping Syndrome

Test Id: 52050973 Question Id: 30316 (729561) 11 of 20

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A client is being discharged today following a partial gastrectomy. Instructions for recuperating at home would include which of the following? Select all that apply.

Unordered Options

1. 2. 3. 4. 5.

Ordered Response

Avoid high fiber foods Avoid intake of fluids with meals Consume low-carbohydrate meals Have small, frequent meals Maintain a sitting-up position after eating

You answered this question incorrectly. Correct answer is: 2,3,4 Time Spent: 123 Seconds 13% of people answered this question correctly. Last Updated: 1/27/2016

Explanation Up to 50% of clients with partial gastrectomy may experience dumping syndrome. Dumping syndrome occurs when gastric contents are emptied too rapidly into the duodenum and cause a fluid shift into the small intestine. This fluid shift results in hypotension, abdominal pain, diarrhea, nausea, vomiting, dizziness, generalized sweating, and tachycardia. The symptoms usually diminish over time. Dietary recommendations are aimed at delaying gastric emptying and include the following:  





Small, frequent meals reduce the amount of food in the stomach at any one time. Eat slowly in a relaxed environment. Avoid meals high in simple carbohydrates, as these may trigger dumping syndrome as the carbohydrates are broken down into simple sugars. Instead, consume meals high in protein, fat, and fiber, as these take longer to digest and will remain in the stomach longer than carbohydrates (Option 1). Separate fluids from meals. If fluids are taken with meals, stomach contents pass more easily into the jejunum and worsen symptoms. Fluid intake should be only after or between meals, separated from solid intake by at least 30 minutes. Avoid sitting up after a meal. Gravity increases gastric emptying. Lying down after meals slows down the gastric emptying and is preferred (Option 5).

Educational objective: Dumping syndrome is a complication of gastrectomy. Measures that delay gastric emptying can reduce the risk of dumping syndrome. Clients should eat meals low in carbohydrates and high in fiber, proteins, and fats. Fluids should not be taken with meals. Symptoms usually diminish over time. Visual/Auditory Visual Disorders Of The Eye Graphic

Test Id: 52050973 Question Id: 33795 (729561) 12 of 20

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The client recently admitted to the assisted living center has impaired vision related to primary open-angle glaucoma. Select the graphic that best illustrates the effects of glaucoma on the client's vision. Unordered Options

Ordered Response

1.

2.

3.

4.

You answered this question incorrectly. Time Spent: 44 Seconds 40% of people answered this question correctly. Last Updated: 1/11/2016

Explanation Primary open-angle glaucoma (POAG) is an eye condition characterized by an increase in intraocular pressure and gradual loss of peripheral vision (ie, tunnel vision). The signs/symptoms of POAG develop slowly and include painless impairment of peripheral vision with normal central vision, difficulty with vision in dim lighting, increased sensitivity to glare, and halos observed around bright lights. POAG can lead to blindness if left untreated. (Option 1) Retinal detachment is separation of the retina from the underlying epithelium that allows fluid to collect in the space. The signs/symptoms include sudden onset of light flashes, floaters, cloudy vision, or a curtain appearing in the vision. (Option 2) Age-related macular degeneration is a degenerative eye disease that brings about the gradual loss of central vision, leaving peripheral vision intact. (Option 4) A cataract is cloudiness (ie, opacity) of the lens that may occur at birth or more commonly in older adults. The signs/symptoms of a cataract include painless, gradual loss of visual acuity with blurry vision; scattered light on the lens producing glare and halos, which are worse at night; and decreased color perception. Educational objective: Primary open-angle glaucoma is characterized by an increase in intraocular pressure and gradual loss of peripheral vision (ie, tunnel vision). Respiratory Over-Sedation And Respiratory Failure

Test Id: 52050973 Question Id: 31223 (729561) 13 of 20

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A client is brought to the emergency department due to loss of consciousness after binge drinking at a college party and then taking alprazolam. Pulse oximetry shows 87% on room air. Which findings would the nurse expect to assess on an arterial blood gas? Unordered Options

1. 2. 3. 4.

Ordered Response

Metabolic acidosis and hyperventilation Metabolic alkalosis and hypoventilation Respiratory acidosis and hypoventilation Respiratory alkalosis and hyperventilation

You answered this question correctly. Time Spent: 65 Seconds 61% of people answered this question correctly. Last Updated: 8/17/2015

Explanation The combination of excessive alcohol ingestion and the benzodiazepine alprazolam (Xanax) causes respiratory depression, which leads to alveolar hypoventilation secondary to carbon dioxide retention, and respiratory acidosis. Therefore, clients should be advised not to take multiple substances that increase the risk of respiratory depression (eg, opioids, benzodiazepines, alcohol, sedating antihistamines). (Option 1) Diarrhea, ketoacidosis, lactic acidosis, and renal failure can cause metabolic acidosis due to loss of bicarbonate or retention of acids; the lungs would compensate by hyperventilating. (Option 2) Vomiting, gastrointestinal suction, and administration of alkali (ie, sodium bicarbonate) are common causes of metabolic alkalosis; the lungs would compensate by hypoventilating.

(Option 4) Hypoxia, anxiety, and pain are common causes of respiratory alkalosis, which is due to alveolar hyperventilation (rapid breathing). Educational objective: Over-sedation, sleep apnea, anesthesia, drug overdose, progressive neuromuscular disease, and chronic obstructive pulmonary disease depress the respiratory center; this leads to alveolar hypoventilation, secondary to carbon dioxide retention, and respiratory acidosis. Infectious Disease West Nile Virus Prevention

Test Id: 52050973 Question Id: 32324 (729561) 14 of 20

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The nurse is answering questions at a hospital-sponsored health fair. What actions should the nurse encourage to help prevent contracting the West Nile virus? Select all that apply. Unordered Options

1. 2. 3. 4. 5.

Ordered Response

Avoid raw, unpeeled fruits or vegetables Limit contact with infected pets Use insect (mosquito) repellent Wash all bedding in hot water Wear long-sleeved, light-colored clothes

You answered this question incorrectly. Correct answer is: 3,5 Time Spent: 146 Seconds

38% of people answered this question correctly. Last Updated: 8/12/2015

Explanation West Nile virus is a mosquito-borne disease (encephalitis) that occurs mainly during the summer months, especially during humid weather. Prevention focuses on avoiding mosquitoes and using an insect repellent. Prevention also includes wearing long sleeves, long pants, and light colors and avoiding outdoor activities at dawn and dusk when mosquitoes ar...