NUR 3316 Exam 2 Tutoring

NUR 3316 Exam 2 Tutoring

By Breanne Wilburn, DNP, RN, CMSRN

Multiple Select

Which statement by a patient indicates understanding of nursing instructions about their peripherally implanted catheters (PICC)? SELECT ALL THAT APPLY.

• •“I will need to watch for signs and symptoms of phlebitis for up to 10 days after the PICC is inserted.”

• •“A PICC line is usually only used to access up to six months, but it can be left in longer.”

• •“I can safely take my blood pressure in the arm with the PICC as long as the cuff is below the insertion site.”

• •“A PICC has fewer side effects than a central venous catheter, such as lower infection rates and fewer insertion complications.”

• “Because the dressing seals off the insertion site, I may continue to take showers or go swimming.”

​RATIONALE

Patients need to check for phlebitis for up to 10 days after the PICC is inserted. PICC lines are typically used for access for up to six months, and they can be left in longer. PICC lines have fewer side effects than central venous catheters. Blood pressure should not be taken on an arm with a PICC line because inflation of the cuff can lead to the risk of vein damage or thrombosis. Although the dressing seals the insertion site, the risk for infection is high and the patient should not keep the site submerged in water. Ask yourself: do you know the advantages/disadvantages when comparing PICCs to regular CVADs? When comparing CVADs to PIVs?

Harding et al., 2020, p. 292-293

Multiple Choice

When planning the care of a patient with dehydration, which data would the nurse instruct the unlicensed assistive personnel (UAP) to report?

• 60mL urine output in 90 minutes

• 1200mL urine output in 24 hours

• 300mL urine output per 8-hour shift

• 20mL urine output for 2 consecutive hours

RATIONALE

The minimal urine output necessary to maintain kidney function is 30mL/hr. If the output is less than this for two consecutive hours, the nurse should be notified so that additional fluid volume replacement therapy can be instituted.

Harding et al., 2020, p. 274

Multiple Choice

Upon review of the morning laboratory studies, which patient would have the risk of developing hypomagnesemia?

• 83yo man with lung cancer and hypertension

• 65yo homeless woman with a history of chronic alcoholism

• 32yo pregnant woman who has been treated for eclampsia

• 63yo man with benign prostatic hyperplasia (BPH) and a UTI

RATIONALE

Causes of hypomagnesemia include chronic alcoholism, diarrhea, vomiting, malabsorption syndromes, prolonged malnutrition, and NG suction. Lung cancer, hypertension, eclampsia, BPH, and UTIs are not causes of hypomagnesemia.

Harding et al., 2020, p. 284

Multiple Choice

Which patient statement would prompt the nurse to include cancer prevention strategies in the plan of care?

• "My diet primarily consists of fast food."

• "I walk three miles at least five days a week."

• "I don't drink alcohol because alcoholism runs in my family."

• "My parents smoked for years, but they quit when I was in high school."

​RATIONALE

Dietary fat is a risk factor for cancer; therefore the statement regarding the consumption of fast food meals should cause the nurse to include information regarding cancer prevention within the patient’s plan of care. Regular exercise promotes health; the action is not associated with an increased risk for cancer. Although alcohol is a risk factor, this patient does not consume alcoholic beverages. Although secondhand smoke is a risk factor for cancer, this patient is an adult and does not smoke so there are no modifiable risk factors for the patient to learn regarding tobacco use (Harding et al., 2020, p. 239)​

Multiple Choice

Which statement will the nurse recognize as incorrect teaching about the application of sunscreen lotion and creams?

• Reapply immediately after swimming.

• Apply 20-30 minutes before going outdoors.

• Reapply after six hours.

• Sunscreens should have a minimum sun protection factor (SPF) of 15.

​RATIONALE

Sunscreens are creams and lotions that filter both ultraviolet A and ultraviolet B rays and can prevent dermatologic problems. Although many sunscreens are waterproof, they should be reapplied immediately after swimming in case the sunscreen is diluted in the water or rubbed off. Sunscreen should be applied on the skin 20-30 minutes before going outdoors. When choosing a sunscreen, the patient should consider one with SPF 15 or higher. Because the effect of sunscreen decreases with time, it should be reapplied every two hours (Harding et al., 2020, p. 410)

Multiple Choice

Which clinical manifestations would the nurse anticipate when providing care for a patient with a potassium level of 6.1? SELECT ALL THAT APPLY.

• 1+ deep tendon reflexes

• Rapid, shallow respirations

• Serum blood glucose level of 250mg/dL

• Numbness and tingling in the hands and feet

• Ventricular fibrillation noted on the ECG

​RATIONALE

Assessment findings associated with hyperkalemia include decreased reflexes, paresthesia, and an irregular HR. These are manifested in 1+ deep tendon reflexes, numbness tingling in the hands and feet, and v. fib. noted on an ECG, respectively. Rapid and shallow respirations and hyperglycemia would be anticipated with hypokalemia.

Harding et al., 2020, p. 279

Multiple Choice

A patient’s arterial blood gas (ABG) results are pH 7.32; PaCO 2 56 mm Hg; HCO 3 - 24 mEq/L. Which acid-base imbalance would the nurse use in development of the patient’s plan of care?

• Metabolic Acidosis

• Metabolic Alkalosis

• Respiratory Acidosis

• Respiratory Alkalosis

​RATIONALE

Use the memory device ROME. For respiratory conditions, the pH and PaCO2 go in opposite directions.

Respiratory alkalosis: pH high, PaCO2 low

Respiratory acidosis: pH low, PaCO2 high

In metabolic conditions, the pH and HCO3- go in the same direction (equal).

Metabolic alkalosis: pH and HCO3- are high

Metabolic acidosis: pH and HCO3- are low

​Normal pH: 7.35-7.45

Normal PaCO2: 35-45mmHg

Normal HCO3-: 22-26 mEq/L

​

Multiple Choice

A patient awaiting a biopsy pathology report states, "I am afraid to die." Which response would the nurse make?

• Actively listen and allow the patient to talk about his or her fears.

• Teach the patient about the seven warning signs of cancer.

• Discuss the need to make changes in an unhealthy lifestyle.

• Remind the patient the there is probably no reason to worry.

​RATIONALE

While patients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. It is not an appropriate time to teach about the warning signs of cancer or to provide patient teaching regarding lifestyle changes. Do not provide false reassurances by telling the patient there is nothing to worry about.

Harding et al., 2020, p. 240

Multiple Choice

Which term will the nurse use to describe pink-purple, non-blanching macular pinpont lesions?

• Purpura

• Petichiae

• Hematoma

• Ecchymosis

RATIONALE

Petechiae are small, pink-to-purplish macular lesions 1-3mm in diameter, usually caused by minor hemorrhage of capillary blood vessels. Purpura  are red or purple discolorations of the skin that do not blanch when pressure is applied. Purpura are associated with bleeding under the skin and are seen in various bleeding disorders. A hematoma is a localized collection of blood outside blood vessels that is generally the result of hemorrhage. Ecchymosis is a collection of blood under the skin, larger than petechiae, with diffuse boarders.

Harding et al., 2020, p. 402​

Multiple Choice

The nursing student provides dietary education for a patient with acute kidney injury (AKI). The nurse intervenes when the student encourages the patient to increase the intake of which foods?

• Foods rich in fiber

• Foods rich in potassium

• Foods rich in calcium

• Foods rich in carbohydrates

​RATIONALE

Hyperkalemia is a complication associated with AKI. Foods rich in potassium will further increase that potassium level in the blood; these foods should not be included in the patient's diet plan. Foods rich in fiber do not cause any harm to the patient’s health and can be included. There are no contraindications for patients with AKI to consume foods high in calcium or foods rich in carbohydrates.

Harding et al., 2020, p. 1063

Subject | Subject

Some text here about the topic of discussion

Multiple Select

Which patient statements about their hypercalcemia indicate understanding of content taught by the nurse? SELECT ALL THAT APPLY.

• "I can use antacids as needed for heartburn."

• "I should restrict my fluid intake to less than 200mL/day."

• "Increasing my daily fluid intake to 3-4L/day is good."

• "Renal calculi may occur as a complication of hypercalcemia."

• "Weight-bearing exercises can help keep my calcium in my bones."

​RATIONALE

A daily fluid intake of 3-4L is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Weight-bearing exercise does enhance bone mineralization. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia.

Harding et al., 2020, p. 282

Multiple Select

The nurse recognizes which hair and nail assessment findings are age-related changes of the older patient? SELECT ALL THAT APPLY.

• Thicker hair

• Scaly scalp

• Thinner nails

• Longitudinal ridging on nails

• Prolonged blood return when nails are blanched

​RATIONALE

Decreased oil leads to dry, course hair and a scaly scalp. Longitudinal ridging in the nails also may occur with aging as a result of increased keratin. There is prolonged blood return to the nails when they are blanched because of decreased circulation. The hair becomes thinner, not thicker. Nails become thicker and more brittle and may have diminished growth with age.

Harding et al., 2020, p. 398

Multiple Choice

Which instruction would the nurse include when teaching a female patient the technique for obtaining and storing a clean-catch urine specimen?

• Clean the periurethral area with an antiseptic solution.

• Refrigerate the specimen within four hours of obtaining it.

• Wipe the periurethral area from back to front with a damp cloth.

• Collect the specimen one to two seconds after initiating urination.

​RATIONALE

The clean-catch, or midstream, urine collection technique may be ordered to obtain a urine culture. The specimen is obtained by initiating the urinary stream for one to two seconds, then placing the sterile container for collection. Antiseptics should not be used, as they may cause specimen contamination and false-positive results. The specimen should be refrigerated immediately after collection and stored for no longer than 24 hours. The female patient should be instructed to spread the labia and wipe the periurethral area from front to back using a moistened, clean, gauze sponge.

Harding et al., 2020, p. 1018

Subject | Subject

Some text here about the topic of discussion

Multiple Choice

A patient with diabetes mellitus presents to the emergency room with a blood sugar of 400 mg/dL. Which type of acid-base imbalance would the nurse monitor for the clinical manifestations

• Metabolic Acidosis

• Metabolic Alkalosis

• Respiratory Acidosis

• Respiratory Alkalosis

​RATIONALE

Diabetic ketoacidosis (DKA) can occur in cases of uncontrolled hyperglycemia. This condition leads to acid accumulation, which causes metabolic acidosis. Respiratory acidosis is typically associated with chronic pulmonary diseases, such as COPD. Respiratory alkalosis occurs in cases on hyperventilation; this condition leads to a decreased amount of acid in the blood and an elevated pH. Metabolic alkalosis occurs with the loss of acid and causes an elevated (alkalotic) pH.

Harding et al., 2020, p. 287

Multiple Choice

When caring for a patient that is receiving hemodialysis, which is a priority action by the nurse?

• Recording vital signs every 30-60 minutes

• Checking the patient's skin condition

• Recording the patient's weight during the procedure

• Checking the BP on the extremity with vascular access

RATIONALE

BP fluctuates during dialysis, and a change in vital signs can indicate rapid changes in BP. Therefore the nurse should record the vital signs every 30-60 minutes during dialysis. The patient’s skin condition should be assessed before dialysis for determining the site for vascular access. The patient’s weight should be recorded before and after the procedure to determine the amount of fluid to be removed. BP should not be checked from the same extremity with vascular access because this may cause clotting of the vascular access.

Harding et al., 2020, p. 1079

Multiple Choice

A patient is scheduled to undergo peritoneal dialysis (PD). Which is a high priority action that the nurse performs before starting the procedure?

• Obtain the patient's weight.

• Administer pain medication to the patient.

• Place the patient in a high-Fowler's position.

• Place the patient in the Trendelenburg position.

​RATIONALE

The nurse must check the patient’s weight before and after PD to determine how much fluid has been removed. The patient should assume a position of comfort, such as a low Fowler’s, unless there is difficulty with removing the effluent, in which case the nurse will position the patient to facilitate drainage. Administering pain medication is not a priority in regard to PD. There is no indication that the patient is experiencing pain. Placing the patient in a high-Fowler’s or Trendelenburg position is not recommended for patients during PD.

Harding et al., 2020, p. 1078-1079

Multiple Choice

For which assessment finding would the nurse monitor a patient with a total serum calcium level of 11.2 mg/dL?

• Hypotension

• Chvostek's sign

• Trousseau's sign

• Nephrolithiasis

​RATIONALE

Plasma concentration of calcium >10.2mg/dL indicated hypercalcemia, which results in increased concentrations of calcium in the urine. This impairs sodium and water reabsorption and causes polyuria. Hypercalcemia can cause kidney stones, or nephrolithiasis, because an increased concentration of calcium in the urine deposits crystals in the kidney, which combine to form kidney stones. Hypotension, Chvostek’s sign, and Trousseau’s sign are assessment findings associated with hypocalcemia (Harding et al., 2020, p.282)

Multiple Choice

Which assessment finding would the nurse not find when assessing a patient with primary hypoparathyroidism?

• Easy fatigability

• Depressed reflexes

• Circumoral numbness

• Positive Trousseau's sign

​RATIONALE

Primary hypoparathyroidism can result in a lack of parathyroid hormone, leading to hypocalcemia. Assessment findings associated with low serum calcium levels include easy fatigability, depression, anxiety, confusion, numbness and tingling in extremities and the region around the mouth, hyperreflexia, muscle cramps, positive Chvostek’s and Trousseau’s signs, and others. Anorexia and depressed reflexes are associated with hypercalcemia (Harding et al., 2020, p. 282).​

Multiple Choice

Which serum phosphate level would the nurse associate with the patient experiencing alcohol withdrawal symptoms?

• 1.4 mg/dL

• 3.1 mg/dL

• 3.8 mg/dL

• 4.8 mg/dL

​RATIONALE

Alcohol withdrawal can result in hypophosphatemia. Phosphate levels of less than 2.4 mg/dL indicate hypophosphatemia. The nurse would be likely to find the patient’s phosphate level at 1.4 mg/dL. Phosphate levels of 3.1, 3.8, and 4.8 mg/dL indicate normal levels or hyperphosphatemia. A patient with symptoms of alcohol withdrawal does not have hyperphosphatemia (Harding et al., 2020, p.284).​

Multiple Choice

A patient with lung cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." In which way would the nurse respond?

• "Nnone of us knows when we are going to die."

• "Would you like me to call your spiritual advisor?"

• "What are your feelings about thinking you may die soon?"

• "Perhaps you are depressed about your illness and need some medication."

​RATIONALE

The best response to psychosocial questions is to acknowledge the patient’s feelings and explore his or her concerns. “What are your feelings…” does both and is a helpful response that encourages further communication between patient and nurse. Ignoring the patient’s feelings is not respectful or therapeutic communication between patient and nurse. Ignoring the patient’s feelings is not respectful or therapeutic communication. Calling the spiritual advisor is reasonable but shuts off communication in the short term. The patient is expressing feelings; medication is not indicated. (Harding et al., 2020, p. 240)​

Multiple Choice

Per evidence-based practice guidelines, which guideline effectively reduces catheter-associated urinary tract infections (CAUTI)?

• Empty the catheter;s collection resevoir every hour.

• Administer topical and oral antibiotics prophylactically.

• Clean the sample port of the urinary cathetor with alcohol prior to accessing.

• Avoid unneccesary catheterization and aim for early removal of urinary catheters.

​RATIONALE

Evidence-based practice guidelines indicate patients who have fewer days with an indwelling urinary catheter have significantly less incidence of CAUTI than those patients with more urinary drainage days. Emptying the catheter’s collection reservoir periodically is necessary; however, emptying the reservoir hourly does not decrease incidence of CAUTI. Administration of prophylactic antibiotics is not encouraged, as this only strengthens an organism's bacterial resistance to the drugs. Cleaning the sample port of a urinary catheter is good nursing practice but not the most effective way to reduce CAUTI.

Harding et al., 2020, p. 1028.