D454 Adult Health III
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Free D454 Adult Health III Questions
1. A patient admitted with chest pain is also found to have positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-Abs) tests, rashes on the palms and soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care?
- Assess for arterial aneurysms.
- Wear gloves for patient contact.
- Place the patient in a private room.
- Apply antibiotic ointment to the perineum.
Explanation
The patient presents with signs of secondary syphilis, which is highly infectious through direct contact with lesions. Standard precautions, including wearing gloves when providing care, are essential to prevent transmission. Private room placement is not required unless additional precautions are indicated, and topical antibiotics are not indicated for systemic syphilis. Assessment for arterial aneurysms is part of tertiary syphilis evaluation, not immediate nursing care in this phase.
2. In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes
- Teaching the patient to use Kegel exercises.
- Clamping and releasing a catheter to increase bladder tone.
- Teaching the patient biofeedback mechanisms to suppress the urge to void.
- Counseling the patient concerning choice of incontinence containment device.
Explanation
Kegel exercises strengthen the pelvic floor muscles, which support bladder function and improve voluntary control over urination. These exercises are a primary, noninvasive intervention to manage urinary incontinence. Clamping a catheter or using biofeedback can be used in certain contexts but are less central to routine bladder control enhancement. Counseling about incontinence devices addresses management, not improvement of bladder function, making Kegel exercises the most effective intervention for increasing bladder control.
3. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
- Infuse dextrose 50% by slow IV push.
- Administer 1 mg glucagon subcutaneously.
- Obtain a glucose reading using a finger stick.
- Have the patient drink 4 ounces of orange juice.
Explanation
The patient is exhibiting classic signs of hypoglycemia (lightheadedness, sweating) after discontinuation of an insulin drip. The first action should always be to obtain a rapid glucose reading using a finger stick to confirm hypoglycemia and guide appropriate treatment. Immediate treatment without confirmation may be unnecessary or unsafe in other conditions presenting with similar symptoms. Once hypoglycemia is confirmed, appropriate interventions, such as oral glucose or IV dextrose, can be administered. Administering glucagon or IV dextrose before confirming glucose levels is premature unless the patient is unable to swallow or is unconscious.
4. After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops
- Muscle weakness and weight loss.
- Hyperthermia and severe tachycardia.
- Hypertension and difficulty swallowing.
- Laryngospasms and tingling in the hands and feet.
Explanation
Damage or removal of the parathyroid glands during thyroid surgery can result in hypocalcemia because the parathyroid glands regulate calcium balance. Early signs of hypocalcemia include neuromuscular irritability manifested as laryngospasms, tingling, and numbness in the hands and feet. Muscle weakness, hyperthermia, tachycardia, hypertension, and swallowing difficulties are not specific indicators of hypocalcemia related to parathyroid injury. Prompt recognition and treatment are critical to prevent severe complications.
5. The nurse performing a focused examination to determine possible causes of infertility will assess for
- Hydrocele
- Varicocele
- Epididymitis
- Paraphimosis
Explanation
A varicocele, which is an enlargement of the veins within the scrotum, is a known and common cause of male infertility due to impaired testicular function and sperm production. During a focused assessment, the nurse palpates the scrotum to detect varicoceles and evaluates other reproductive structures. Hydrocele, epididymitis, and paraphimosis may affect comfort or reproductive health but are less directly linked to infertility.
6. Which statement by a patient who is being discharged from the emergency department (ED) after a concussion indicates a need for intervention by the nurse?
- "I will return if I feel dizzy or nauseated."
- "I am going to drive home and go to bed."
- "I do not even remember being in an accident."
- "I can take acetaminophen (Tylenol) for my headache."
Explanation
A patient with a concussion should not drive immediately after discharge due to potential cognitive impairment, slowed reaction time, and risk for further injury. The statement “I am going to drive home and go to bed” indicates a lack of understanding of safe post-concussion precautions, and the nurse must intervene to ensure the patient has safe transportation and appropriate monitoring. Returning for symptoms, taking acetaminophen for headache, and having retrograde amnesia are expected considerations after a concussion and do not require immediate intervention.
7. The nurse will plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily about the increased risk for
- Kidney stones
- Bladder cancer
- Bladder infection
- Interstitial cystitis
Explanation
Cigarette smoking is a major risk factor for bladder cancer because carcinogenic substances in tobacco are excreted in the urine and come into direct contact with the bladder lining, leading to cellular mutations over time. Teaching the patient about this risk is important for preventive health education, early detection, and motivating smoking cessation. While smoking can contribute to other health issues, it is not strongly associated with kidney stones, bladder infections, or interstitial cystitis in the same direct way as bladder cancer.
8. 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.
9. The nurse is caring for a patient who has a head injury and fractured right arm after being assaulted. Which assessment information requires rapid action by the nurse?
- The apical pulse is slightly irregular.
- The patient complains of a headache.
- The patient is more difficult to arouse.
- The blood pressure (BP) increases to 140/62 mmHg.
Explanation
A patient who is becoming more difficult to arouse may be exhibiting signs of increasing intracranial pressure, cerebral edema, or expanding hematoma—conditions that require immediate intervention to prevent permanent brain injury or death. While an irregular pulse, headache, or slightly elevated blood pressure are important findings, the change in level of consciousness is the most urgent and necessitates rapid assessment and intervention.
10. Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to
- A decrease in bladder sensory receptors
- A decrease in the number of functioning nephrons
- Decreased function of the loop of Henle and tubules
- Thickening of the basement membrane of Bowman's capsule
Explanation
The ability to concentrate urine declines with age primarily due to decreased function of the loop of Henle and renal tubules. These structures are critical for creating a concentration gradient in the kidney medulla, which allows water reabsorption and urine concentration. While a decrease in functioning nephrons and thickening of the basement membrane may occur with aging, they have a less direct impact on urine-concentrating ability. A decrease in bladder sensory receptors affects bladder sensation and emptying but does not significantly alter urine concentration.
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