D454 Adult Health III
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Free D454 Adult Health III Questions
1. The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following?
- a. "I should stop having coffee and orange juice for breakfast."
- b. "I will buy calcium glycerophosphate (Prelief) at the pharmacy."
- c. "I will start taking high potency multiple vitamins every morning."
- d. "I should call the doctor about increased bladder pain or foul urine."
Explanation
Patients with interstitial cystitis are encouraged to avoid foods and beverages that irritate the bladder, such as coffee and citrus, and can use calcium glycerophosphate (Prelief) to help reduce dietary acid. They should also contact their provider if they experience increased pain or foul-smelling urine, which may indicate infection. However, taking high-potency multivitamins can worsen symptoms because some vitamins (especially vitamin C) are acidic and can irritate the bladder, so this indicates the patient needs further instruction.
2. The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to
- Protect the patient's skin.
- Monitor for signs of infection.
- Balance fluids and electrolytes.
- Prevent emotional disturbances.
Explanation
After an adrenalectomy, the immediate postoperative priority is maintaining fluid and electrolyte balance. The adrenal glands produce hormones, including aldosterone and cortisol, which regulate sodium, potassium, and water balance. Removal of adrenal tissue can lead to potentially life-threatening imbalances such as hypotension, hyponatremia, and hyperkalemia. While preventing infection, protecting skin, and addressing emotional disturbances are important, these are secondary to stabilizing the patient’s fluid and electrolyte status to prevent acute complications.
3. In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through
- The bloodstream
- The lymphatic system
- A descending infection
- An ascending infection
Explanation
Pyelonephritis, a bacterial infection of the kidney, most commonly occurs when bacteria ascend from the lower urinary tract (urethra and bladder) to the kidneys. This ascending infection pathway is the primary route for organisms such as Escherichia coli. While infection can occasionally spread through the bloodstream or lymphatic system, these routes are far less common. Understanding this mechanism is important for teaching prevention strategies, such as proper hygiene and urination habits.
4. To determine possible causes, the nurse will ask a patient admitted with acute glomerulonephritis about
- A recent bladder infection.
- History of kidney stones.
- Recent sore throat and fever.
- Antihypertensives.
Explanation
Acute glomerulonephritis often develops as a post-infectious complication, commonly following a streptococcal throat infection or skin infection. Asking the patient about a recent sore throat and fever helps identify a potential precipitating streptococcal infection, which is a key piece of information for diagnosis and treatment planning. While bladder infections, kidney stones, and antihypertensive use are relevant to overall renal health, they are less directly associated with the typical cause of acute glomerulonephritis and would not provide the most immediate diagnostic insight.
5. The nurse recommends genetic counseling for the children of a patient with
- Nephrotic syndrome
- Chronic pyelonephritis
- Malignant nephrosclerosis
- Adult-onset polycystic kidney disease
Explanation
Adult-onset polycystic kidney disease (PKD) is an inherited autosomal dominant disorder, meaning children of an affected individual have a 50% chance of inheriting the disease. Genetic counseling helps families understand the risk of transmission, implications for screening, and early interventions. Other conditions such as nephrotic syndrome, chronic pyelonephritis, and malignant nephrosclerosis are not primarily inherited in a predictable genetic pattern, so routine genetic counseling is not indicated for these disorders.
6. Which problem can the nurse expect for a patient who has a positive Romberg test result?
- Pain
- Falls
- Aphasia
- Confusion
Explanation
A positive Romberg test indicates a loss of balance or impaired proprioception, which increases the patient’s risk for falls. The nurse should implement fall precautions and provide assistance as needed. Pain, aphasia, and confusion are not directly assessed by the Romberg test, which specifically evaluates postural stability and balance.
7. The nurse in the women's health clinic has four patients who are waiting to be seen. Which patient should the nurse see first?
- 22-year-old with persistent red-brown vaginal drainage 3 days after having balloon thermotherapy
- 42-year-old with secondary amenorrhea who says that her last menstrual cycle was 3 months ago
- 35-year-old with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month ago
- 19-year-old with menorrhagia who has been using superabsorbent tampons and has fever with weakness
Explanation
The 19-year-old patient with menorrhagia, fever, and weakness presents with signs of possible infection and significant blood loss, which can be life-threatening. Fever indicates a systemic response, and superabsorbent tampon use may increase risk of toxic shock syndrome. This patient requires immediate assessment and intervention. The other patients have concerning symptoms, but none are as acutely emergent.
8. A nursing diagnosis that is likely to be appropriate for a 67-yr-old patient who has just been diagnosed with stage III ovarian cancer is
- Sexual dysfunction related to loss of vaginal sensation.
- Risk for infection related to impaired immune function.
- Anxiety related to cancer diagnosis and need for treatment decisions.
- Situational low self-esteem related to guilt about delaying medical care.
Explanation
A new diagnosis of stage III ovarian cancer can provoke significant emotional distress due to the severity of the disease and complex treatment decisions. Anxiety related to the diagnosis and uncertainty about treatment is a common and appropriate nursing diagnosis, as it addresses the patient’s emotional response and need for support and education. Other options focus on long-term or specific physical effects that may not be immediately applicable at the time of diagnosis.
9. The nurse will plan to teach a 67-yr-old patient who has been diagnosed with orchitis about
- Pain management
- Emergency surgery
- Application of heat to the scrotum
- Aspiration of fluid from the scrotal sac
Explanation
Orchitis often causes significant scrotal pain and swelling. Noninvasive interventions such as applying warm compresses or heat to the scrotum can help relieve discomfort and promote circulation. Teaching the patient about proper pain management and supportive measures is an essential part of care. Emergency surgery and fluid aspiration are not standard initial treatments for uncomplicated orchitis.
10. The plan of care for a patient immediately after a perineal radical prostatectomy will include decreasing the risk for infection related to
- Urinary incontinence
- Prolonged urinary stasis
- Fecal wound contamination
- Suprapubic catheter placement
Explanation
After a perineal radical prostatectomy, infection risk is high due to the proximity of the surgical site to the rectum, which increases the potential for fecal contamination of the wound. Nursing interventions focus on meticulous perineal care, monitoring for signs of infection, and maintaining a clean and dry environment to reduce the likelihood of postoperative infection. While urinary catheters are used, the primary concern for infection is fecal wound contamination because of the surgical approach.
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