D454 Adult Health III
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Free D454 Adult Health III Questions
1. A 62-yr-old with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient
- About radioactive precautions to take with all body secretions.
- Those symptoms of hyperthyroidism should be relieved in about a week.
- Those symptoms of hypothyroidism may occur as the RAI takes effect.
- To discontinue the antithyroid medications taken before radioactive therapy.
Explanation
Radioactive iodine therapy works by destroying overactive thyroid tissue, which can eventually lead to hypothyroidism. Patients should be informed that hypothyroid symptoms may develop weeks to months after treatment and require lifelong monitoring and possible thyroid hormone replacement. Precautions for radioactive material mainly apply to urine and saliva, not all body secretions, and symptom relief is not immediate, often taking several weeks. Antithyroid medications may need to be continued or adjusted based on provider instructions, but the key teaching point is the potential development of hypothyroidism.
2. A patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease?
- Ideal weight.
- Value system.
- Activity level.
- Visual changes.
Explanation
Understanding the patient’s value system is crucial when helping them adapt to a chronic disease like type 2 diabetes. The value system influences motivation, health behaviors, and willingness to adhere to lifestyle modifications, diet, medication, and self-monitoring routines. While ideal weight, activity level, and visual changes are important clinical considerations, they are secondary to understanding the patient’s personal beliefs and priorities, which guide how they will incorporate necessary lifestyle changes into daily life. Tailoring teaching and interventions to the patient’s values enhances long-term adherence and successful disease management.
3. Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?
- "Do you feel bloated after eating?"
- "Have you seen any skin changes?"
- "Do you need to increase your insulin dosage when you are stressed?"
- "Have you noticed any painful new ulcerations or sores on your feet?"
Explanation
Autonomic neuropathy in diabetes affects involuntary bodily functions, including gastrointestinal motility. Asking whether the patient feels bloated after eating can reveal delayed gastric emptying or gastroparesis, a common manifestation of autonomic neuropathy. Skin changes and painful foot ulcerations are more associated with peripheral neuropathy or vascular complications, while insulin dosage adjustments for stress relate to glycemic control rather than autonomic dysfunction. Therefore, questions about gastrointestinal symptoms provide the most direct insight into autonomic neuropathy.
4. A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first?
- a. Ask about the usual urinary pattern and any measures used for bladder control.
- b. Assist the patient to the toilet at scheduled times to help ensure bladder emptying.
- c. Check the patient for urinary incontinence every 2 hours to maintain skin integrity.
- d. Use intermittent catheterization on a regular schedule to avoid risk of infection.
Explanation
The first step in caring for a patient with a neurogenic bladder is to obtain a thorough history about usual urinary patterns and methods of bladder management. This information guides individualized care and helps prevent complications such as urinary retention, infection, or incontinence. Interventions like scheduled toileting or intermittent catheterization are implemented based on the patient’s established pattern and current needs.
5. 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.
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. Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider?
- Changes in visual field.
- Milk leaking from breasts.
- Blood glucose 150 mg/dL.
- Nausea and projectile vomiting.
Explanation
Nausea and projectile vomiting in a patient with a large pituitary adenoma may indicate increased intracranial pressure or compression of surrounding brain structures, which is a potentially life-threatening complication requiring immediate attention. While changes in visual fields and galactorrhea are important manifestations of pituitary adenomas, they are not immediately life-threatening. Mild hyperglycemia is a secondary concern. Prompt reporting of signs of increased intracranial pressure is critical to prevent neurological deterioration.
8. An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that:
- Successful transplantation usually provides a better quality of life than that offered by dialysis.
- If rejection of the transplanted kidney occurs, no further treatment for the renal failure is available.
- The immunosuppressive therapy that is required following transplantation causes fatal malignancies in many patients.
- Hemodialysis replaces the normal functioning of the kidneys and patients do not have to live with the continual fear of rejection.
Explanation
Kidney transplantation is generally associated with better quality of life and improved survival compared with long-term dialysis because it restores more normal kidney function and reduces the dietary and fluid restrictions required with dialysis. Rejection is a risk but treatable with immunosuppressive therapy, and fatal malignancies are uncommon with current regimens. Hemodialysis does not eliminate the chronic disease burden, including complications, dietary restrictions, and the need for ongoing treatment.
9. 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.
10. The home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which patient statement indicates that the teaching has been effective?
- "I will buy seven new catheters weekly and use a new one each day."
- "I will use a sterile catheter and gloves for each time I self-catheterize."
- "I will clean the catheter carefully before and after each catheterization."
- "I will take prophylactic antibiotics to prevent any urinary tract infections."
Explanation
Effective intermittent self-catheterization requires maintaining sterility to prevent urinary tract infections while being practical for home use. Using a sterile catheter and gloves each time the patient catheterizes ensures proper infection control and reflects correct understanding of safe technique. Daily replacement of catheters is not necessary, cleaning reusable catheters is less ideal than using sterile disposable ones, and routine prophylactic antibiotics are not recommended due to the risk of resistance and are only used in specific clinical situations.
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