D454 Adult Health III
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Free D454 Adult Health III Questions
1. Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements would be true related to nutritional therapy (select all that apply)
- Fluid is not usually restricted for patients receiving peritoneal dialysis.
- Sodium and potassium may be restricted in someone with advanced CKD.
- Decreased fluid intake and low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis.
- Decreased fluid intake and low-potassium diet are hallmarks of the diet for a patient receiving peritoneal dialysis.
- Decreased fluid intake and a diet of phosphate-rich foods are hallmarks of a diet for a patient receiving hemodialysis.
Explanation
Nutritional therapy in CKD varies depending on the stage of disease and type of dialysis. Sodium and potassium restrictions are common in advanced CKD to prevent fluid overload and hyperkalemia. Patients receiving hemodialysis typically require fluid and potassium restriction, while those on peritoneal dialysis often have fewer restrictions on fluid because dialysis is continuous. Phosphate intake is usually limited rather than increased, and peritoneal dialysis does not typically require strict fluid restriction, making the first and second statements correct.
2. The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with
- Antibiotics
- Antifungals
- Anticoagulants
- Antihypertensives
Explanation
Patients with nephrotic syndrome are at increased risk for thromboembolic events due to the loss of anticoagulant proteins in the urine, which makes their blood more prone to clotting. Flank pain in this context may indicate the development of a renal vein thrombosis or another thrombotic complication. Therefore, teaching the patient about anticoagulant therapy is appropriate to prevent further clot formation and manage this risk. Antibiotics or antifungals are not indicated unless there is a documented infection, and antihypertensives address blood pressure but do not prevent thromboembolic events.
3. A 68-yr-old male patient who has bladder cancer had a cystectomy with the creation of an Indiana pouch. Which topic will be included in patient teaching?
- Application of ostomy appliances.
- Barrier products for skin protection.
- Catheterization technique and schedule.
- Analgesic use before emptying into the pouch.
Explanation
An Indiana pouch is a continent urinary diversion that uses a segment of the intestine to create an internal reservoir for urine. Patients do not require an external ostomy appliance but must learn to catheterize the pouch regularly to empty urine and prevent complications such as infection or overdistention. Teaching focuses on proper catheterization technique and establishing a regular schedule for emptying the pouch. Skin barrier products and ostomy appliance care are relevant for patients with external stomas, which is not the case with an Indiana pouch. Analgesic use may be discussed for comfort but is secondary to the essential skill of catheterization.
4. A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that
- The tumor is not likely to be responsive to hormone therapy.
- HER-2 receptor testing was repeated for a total of three samples.
- Treatment with chemotherapy is not likely to be recommended.
- Estrogen receptor testing identified the three hormones causing the cancer.
Explanation
Triple-negative breast cancer lacks estrogen receptors, progesterone receptors, and HER2 expression, making it unresponsive to hormone therapy or HER2-targeted treatments. This subtype often requires chemotherapy as the primary systemic treatment. The term does not refer to repeated HER2 testing or hormone identification. Educating the patient about the implications of receptor status is essential for understanding treatment options.
5. A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should
- Notify the physician
- Notify the charge nurse
- Irrigate the drainage tube
- Document it as a normal observation
Explanation
Mucous in the drainage bag is a normal finding after an ileal conduit diversion because the ileum continues to produce mucus even after being used to form the urinary conduit. This mucus may appear as shreds in the urine collected in the drainage bag and does not indicate infection or obstruction. Therefore, the appropriate nursing action is to document the observation as a normal postoperative finding rather than notifying the physician or irrigating the tube unnecessarily.
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. 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.
8. The nurse determines a need for additional instruction when a patient with newly diagnosed type 1 diabetes says which of the following?
- "I will need a bedtime snack because I take an evening dose of NPH insulin."
- "I can choose any foods, as long as I use enough insulin to cover the calories."
- "I can have an occasional beverage with alcohol if I include it in my meal plan."
- "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."
Explanation
The statement "I can choose any foods, as long as I use enough insulin to cover the calories" reflects a misunderstanding of proper diabetes management. Insulin dosing cannot safely compensate for an unrestricted diet; carbohydrate counting and balanced meal planning are essential to prevent hyperglycemia, hypoglycemia, and long-term complications. The other statements demonstrate appropriate understanding: a bedtime snack with NPH insulin helps prevent nocturnal hypoglycemia, moderate alcohol intake can be safely included in meal planning, and eating at mealtimes prevents hypoglycemia.
9. The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes
- Hyperaldosteronism
- Serotonin deficiency
- Adrenal insufficiency
- Hyperparathyroidism
Explanation
Hyperparathyroidism leads to elevated levels of parathyroid hormone, which increases calcium reabsorption from bone and raises calcium levels in the blood and urine. Elevated urinary calcium significantly increases the risk of developing calcium-based urinary calculi (kidney stones). Hyperaldosteronism, serotonin deficiency, and adrenal insufficiency do not directly contribute to stone formation and are less relevant in assessing risk for urinary calculi.
10. 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.
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