Bianca Module #1 Final Review

Questions and Answers

After teaching a patient with COPD the proper technique for using a metered-dose inhaler (MDI), which action by the nurse best evaluates the effectiveness of the education?

Ask the patient to verbally explain the steps

Observe the patient using a placebo inhaler (correct)

Have the patient demonstrate on a diagram

Schedule a follow-up appointment in one week

A patient with heart failure presents with new onset peripheral edema, weight gain, and increased dyspnea. Which combination of interventions should the nurse prioritize?

Administer furosemide, elevate legs, and restrict fluids (correct)

Start oxygen therapy, obtain ECG, and administer digoxin

Initiate CPAP, administer morphine, and start IV nitroglycerine

Perform chest physiotherapy, start antibiotics, and obtain chest x-ray

A patient with heart failure presents with new onset peripheral edema, weight gain, and increased dyspnea. Which combination of interventions should the nurse prioritize?

Administer furosemide, elevate legs, and restrict fluids (correct)

Start oxygen therapy, obtain ECG, and administer digoxin

Initiate CPAP, administer morphine, and start IV nitroglycerine

Perform chest physiotherapy, start antibiotics, and obtain chest x-ray

A patient with metabolic syndrome is struggling to make lifestyle changes. Which approach is most likely to promote long-term adherence?

Collaborate with the patient to set small, achievable goals Signup and view all the answers

A patient with chronic kidney disease has a potassium level of 6.5 mEq/L. Which combination of interventions should the nurse anticipate? (Select all that apply)

Administer sodium polystyrene sulfonate and restrict dietary potassium Signup and view all the answers

A patient with a history of stroke develops sudden right-sided weakness and aphasia. Which action should the nurse take first?

Assess vital signs and neurological status Signup and view all the answers

A patient with asthma presents with severe wheezing, use of accessory muscles, and difficulty speaking. Which treatment should the nurse prepare to administer first?

Nebulized short-acting beta-agonist Signup and view all the answers

A patient with pneumonia is having difficulty clearing secretions. Which combination of interventions would be most effective?

Start chest physiotherapy, use an incentive spirometer, and administer mucolytics Signup and view all the answers

A patient taking a beta-blocker for hypertension reports dizziness and fatigue. Which assessment finding would be most concerning?

Heart rate of 52 bpm Signup and view all the answers

A patient with hypothyroidism has a TSH level of 12 mIU/L despite levothyroxine therapy. Which factor is most likely contributing to the elevated TSH?

Consuming levothyroxine with calcium supplements Signup and view all the answers

A patient with chronic kidney disease has a GFR of 25 mL/min. Which set of dietary recommendations should the nurse provide?

Low protein, low phosphorus, moderate sodium restriction Signup and view all the answers

A patient with epilepsy experiences a tonic-clonic seizure lasting 6 minutes. Which sequence of interventions should the nurse implement?

Administer IV lorazepam, place in recovery position, assess vital signs Signup and view all the answers

A patient with tuberculosis is non-adherent to the medication regimen. Which strategy is most likely to improve compliance?

Implement directly observed therapy (DOT) Signup and view all the answers

A patient presents with chest pain, diaphoresis, and ST-segment elevation on ECG. Which set of interventions should the nurse prioritize?

Start oxygen therapy, obtain 12-lead ECG, and prepare for PCI Signup and view all the answers

A patient with type 1 diabetes is scheduled for surgery. Which perioperative management plan is most appropriate?

Hold all insulin, start IV insulin infusion, maintain blood glucose 140-180 mg/dL Signup and view all the answers

A patient with acute renal failure has a serum creatinine of 4.5 mg/dL and oliguria. Which combination of interventions should the nurse anticipate?

Prepare for hemodialysis, restrict potassium and phosphorus, and monitor for uremic symptoms Signup and view all the answers

A patient with Cushing's syndrome is preparing for adrenalectomy. Which preoperative education is most important for the nurse to provide?

Explain the need for lifelong glucocorticoid replacement Signup and view all the answers

A patient with a C5 spinal cord injury develops sudden bradycardia, hypertension, and diaphoresis above the level of injury. Which action should the nurse take first?

Assess for and remove noxious stimuli Signup and view all the answers

A patient with cystic fibrosis has thick, tenacious sputum. Which combination of interventions would be most effective in mobilizing secretions?

Nebulized hypertonic saline, chest physiotherapy, and deep breathing exercises Signup and view all the answers

A patient with atrial fibrillation has a ventricular rate of 150 bpm and is hemodynamically stable. Which sequence of interventions should the nurse anticipate?

Amiodarone loading dose, rate control, and anticoagulation Signup and view all the answers

A patient with diabetic ketoacidosis has a blood glucose of 600 mg/dL and a pH of 7.1. Which set of interventions should the nurse prioritize? (Select one)

IV fluid resuscitation, electrolyte monitoring, and insulin infusion Signup and view all the answers

A patient with Addison’s disease presents with weakness, hypotension, and electrolyte imbalances. Which combination of interventions is most appropriate?

Administer hydrocortisone, start IV fluids, and correct electrolyte abnormalities Signup and view all the answers

A patient with glomerulonephritis exhibits hematuria, proteinuria, and edema. Which set of interventions should the nurse implement?

Sodium restriction, monitor fluid balance, and administer ACE inhibitors Signup and view all the answers

A patient with a subdural hematoma develops unequal pupils and decreased level of consciousness. Which sequence of interventions should the nurse prioritize?

Elevate head of bed, administer mannitol, and prepare for emergent craniotomy Signup and view all the answers

A patient with COPD experiences an acute exacerbation with increased dyspnea and purulent sputum. Which combination of interventions is most appropriate?

Start antibiotics, increase bronchodilators, and initiate systemic corticosteroids Signup and view all the answers

A patient with heart failure develops acute pulmonary edema. Which set of interventions should the nurse implement first?

Position upright, administer high-flow oxygen, and give sublingual nitroglycerin Signup and view all the answers

A patient with type 2 diabetes has a fasting blood glucose of 180 mg/dL despite maximum oral medication doses. Which treatment modification should the nurse anticipate?

Initiate basal insulin therapy Signup and view all the answers

A patient with hyperthyroidism develops thyroid storm. Which combination of interventions is most critical?

Administer propylthiouracil, start beta-blockers, and give iodine solution Signup and view all the answers

A patient with polycystic kidney disease presents with severe flank pain and hematuria. Which diagnostic test should the nurse prepare the patient for first?

Renal ultrasound Signup and view all the answers

A patient with traumatic brain injury has an ICP of 25 mmHg and a CPP of 55 mmHg. Which intervention should the nurse implement first?

Elevate head of bed to 30 degrees Signup and view all the answers

A patient with emphysema has a PaCO2 of 60 mmHg and a pH of 7.30. Which intervention is most appropriate?

Start noninvasive positive pressure ventilation Signup and view all the answers

A patient with atrial fibrillation is started on warfarin. Which combination of patient education topics is most important?

Dietary vitamin K intake, INR monitoring, and signs of bleeding Signup and view all the answers

A patient with diabetic ketoacidosis has a potassium level of 2.8 mEq/L. Which modification to the standard DKA protocol is most appropriate?

Administer potassium replacement before starting insulin Signup and view all the answers

A patient with hypothyroidism reports fatigue and weight gain despite levothyroxine therapy. Which factor should the nurse assess first?

Adherence to medication regimen Signup and view all the answers

A patient with chronic kidney disease stage 4 is considering treatment options. Which factor is most important for the nurse to assess when discussing dialysis modalities?

Patient’s lifestyle and preferences Signup and view all the answers

A patient with a spinal cord injury at T6 develops autonomic dysreflexia. Which intervention should the nurse implement first? (Select one)

Loosen tight clothing or devices Signup and view all the answers

A patient with tuberculosis is started on isoniazid. Which laboratory value should the nurse monitor most closely?

Liver function tests Signup and view all the answers

A patient with unstable angina develops chest pain unrelieved by sublingual nitroglycerin. Which intervention should the nurse prepare to implement next?

Administer morphine sulfate Signup and view all the answers

A patient with type 1 diabetes experiences recurrent hypoglycemia. Which modification to the insulin regimen is most appropriate?

Decrease basal insulin dose Signup and view all the answers

A patient with Cushing’s syndrome is preparing for bilateral adrenalectomy. Which postoperative complication should the nurse monitor for most closely?

Adrenal crisis Signup and view all the answers

A patient with a C6 spinal cord injury reports a severe headache and blurred vision. Which action should the nurse take first?

Administer antihypertensive medication Signup and view all the answers

A patient with cystic fibrosis is admitted with a respiratory infection. Which combination of interventions should the nurse prioritize?

Administer IV antibiotics, perform chest physiotherapy, and encourage increased fluid intake Signup and view all the answers

A patient with atrial fibrillation is started on digoxin. Which assessment finding would indicate digoxin toxicity?

Visual disturbances Signup and view all the answers

A patient with Addison's disease is admitted with an acute adrenal crisis. Which intervention should the nurse implement first?

Administer IV hydrocortisone Signup and view all the answers

A patient with diabetic ketoacidosis is receiving IV insulin and fluids. Which laboratory value should the nurse monitor most closely?

Serum potassium Signup and view all the answers

A patient with glomerulonephritis is prescribed prednisone. Which instruction is most important for the nurse to provide?

Avoid exposure to infections Signup and view all the answers

A patient with a subdural hematoma is receiving mannitol. Which assessment finding would indicate the medication is effective?

Decreased intracranial pressure Signup and view all the answers

A patient with COPD is using a metered-dose inhaler (MDI) incorrectly. After teaching proper technique, which action by the nurse best evaluates the effectiveness of the education?

Observe the patient using a placebo inhaler Signup and view all the answers

A patient with heart failure is prescribed spironolactone. Which laboratory value should the nurse monitor most closely?

Serum potassium Signup and view all the answers

A patient with COPD is receiving oxygen therapy at 4 L a minute via nasal cannula. Which assessment finding would indicate the need to adjust the oxygen flow rate?

SpO2 of 88% Signup and view all the answers

Study Notes

COPD and Inhaler Technique

Evaluating education effectiveness involves observing the patient’s correct use of the metered-dose inhaler (MDI).

Heart Failure Management

New onset of peripheral edema, weight gain, and dyspnea in heart failure patients requires interventions like diuretics, fluid restriction, and monitoring weight.

Metabolic Syndrome Adherence

Long-term adherence strategies include personalized lifestyle changes with continuous support and motivation.

Chronic Kidney Disease and Potassium Levels

In patients with a potassium level of 6.5 mEq/L, anticipate interventions like dietary potassium restriction and possible administration of calcium gluconate.

Stroke Intervention

For sudden right-sided weakness and aphasia post-stroke, prioritizing a rapid assessment and notifying a provider is critical.

Asthma Treatment

Prepare to administer bronchodilators first in cases of severe wheezing and respiratory distress.

Pneumonia Care

Effective management for difficulty in clearing secretions includes hydration, chest physiotherapy, and expectorants.

Beta-Blocker Side Effects

Dizziness and fatigue in patients on beta-blockers can signal hypotension, necessitating immediate assessment.

Hypothyroidism Management

A TSH level of 12 mIU/L despite therapy could be due to inadequate dosing or poor absorption of the medication.

Dietary Recommendations for CKD

For a GFR of 25 mL/min, recommend low-protein, low-sodium, and low-potassium diet adjustments.

Epilepsy Seizure Protocol

During a tonic-clonic seizure lasting 6 minutes, ensure the patient's safety, administer oxygen if necessary, and monitor vital signs.

Tuberculosis Compliance

Improve medication adherence in tuberculosis patients through directly observed therapy (DOT).

Chest Pain Prioritization

Chest pain with diaphoresis and ST-segment elevation requires immediate administration of antithrombotics and monitoring.

Diabetes Perioperative Plan

Pre-surgery management for type 1 diabetes involves insulin adjustment and glucose monitoring.

Acute Renal Failure Interventions

Anticipated actions include fluid management, monitoring electrolytes, and possible renal replacement therapy.

Cushing's Syndrome Education

Important preoperative education includes the understanding of potential for adrenal crisis post-surgery.

Autonomic Dysreflexia Response

First response includes sitting the patient upright and relieving any identified triggers.

Cystic Fibrosis Interventions

Mobilizing secretions in cystic fibrosis patients involves chest physiotherapy, hydration, and bronchodilators.

Atrial Fibrillation Management

Anticipated interventions may include anticoagulation therapy and rate control.

Diabetic Ketoacidosis Management

Prioritize fluid resuscitation, insulin therapy, and electrolyte monitoring with a focus on potassium.

Addison's Disease Interventions

For weakness, hypotension, and electrolyte imbalances, immediate administration of IV fluids and steroids is critical.

Glomerulonephritis Management

Implement monitoring of vital signs, fluid balance, and administering medications as prescribed.

Subdural Hematoma Protocol

Prioritize neurological assessments and prepare for potential surgical intervention.

COPD Exacerbation Management

Address acute exacerbations with bronchodilators, systemic corticosteroids, and oxygen therapy.

Heart Failure Pulmonary Edema Response

Interventions include diuretics, oxygen therapy, and positioning the patient for comfort.

Diabetes Treatment Adjustment

In response to fasting blood glucose of 180 mg/dL, consider adding or adjusting medication types, including insulin.

Thyroid Storm Interventions

Critical interventions involve beta-blockers, corticosteroids, and strict monitoring of vital signs.

Polycystic Kidney Disease Diagnostics

First diagnostic test to prepare for is an abdominal ultrasound to assess kidney structure.

ICP and CPP Management

In cases of increased ICP, interventions may include elevating the head of the bed and administering hypertonic saline.

Acid-Base Homeostasis

In patients with emphysema and respiratory acidosis, assist with increasing ventilation support.

Warfarin Patient Education

Key educational points include managing dietary vitamin K intake and monitoring for signs of bleeding.

DKA Protocol Modification

For potassium levels at 2.8 mEq/L, modify the DKA protocol to include potassium replacement.

Hypothyroidism Assessment Focus

Assess absorption issues or possible non-compliance as reasons for fatigue and weight gain despite therapy.

Dialysis Decision Factors

Key factors include the patient’s lifestyle, preferences, and long-term prognosis.

Autonomic Dysreflexia First Action

First implement measures to relieve bladder distension or bowel impaction.

Tuberculosis Medication Monitoring

Closely monitor liver function tests, particularly during isoniazid therapy.

Unstable Angina Next Steps

Prepare to administer intravenous nitroglycerin for chest pain unrelieved by sublingual medication.

Insulin Regimen Adjustment

For recurrent hypoglycemia, a reduction in insulin dose or adjustment of carbohydrate intake is advisable.

Cushing’s Postoperative Complications

Monitor patients for adrenal insufficiency or infection post-adrenalectomy.

Severe Headache and Vision Issues

Undertake a thorough blood pressure check and assess for potential increasing intracranial pressure.

Cystic Fibrosis Respiratory Infection Management

Prioritized interventions include IV antibiotics, chest physiotherapy, and maintaining airway patency.

Digoxin Toxicity Indicators

Look for symptoms like changes in heart rate or rhythm, such as bradycardia.

Acute Adrenal Crisis Response

First, administer IV hydrocortisone or equivalent steroid therapy.

DKA Monitoring Focus

Closely monitor blood glucose levels and electrolytes during IV insulin treatment.

Prednisone Instruction

Emphasize the importance of taking medication as prescribed and monitoring for infection risk.

Mannitol Effectiveness Assessment

Evaluate neurological status and reduction in ICP as indicators of mannitol efficacy.

COPD Oxygen Therapy Assessment

Adjust oxygen flow rate if the patient exhibits signs of hypoxemia or hypercapnia.

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