D454 Adult Health III
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Free D454 Adult Health III Questions
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
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Sexual dysfunction related to loss of vaginal sensation.
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Risk for infection related to impaired immune function.
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Anxiety related to cancer diagnosis and need for treatment decisions.
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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.
A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will
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Have the patient empty the bladder completely; obtain the next urine specimen that the patient is able to void.
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Teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup.
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Insert a short sterile "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen.
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Clean the area around the meatus with a povidone-iodine (Betadine) swab and then have the patient void into a sterile container.
Explanation
A clean-catch urine specimen is designed to minimize contamination and provide an accurate sample for culture and sensitivity. The correct procedure involves teaching the patient to clean the urethral area, void a small amount of urine into the toilet to flush out contaminants, and then collect the midstream urine in a sterile cup. This method ensures that the sample reflects the urinary tract flora rather than external contamination. Catheterization is invasive and only used if the patient cannot provide a specimen naturally. Using povidone-iodine is unnecessary and can alter the sample, while collecting the first urine or fully emptying the bladder would not yield a midstream specimen.
The nurse teaches the female patient who has frequent UTIs that she should
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Take tub baths with bubble bath
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Urinate before and after sexual intercourse
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Take prophylactic sulfonamides for the rest of her life
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Restrict fluid intake to prevent the need for frequent voiding
Explanation
Frequent urination before and after sexual intercourse helps flush bacteria from the urethra, reducing the risk of urinary tract infections. Bubble baths, fluid restriction, or lifelong prophylactic antibiotics are either ineffective or unnecessary as routine measures for preventing UTIs. Encouraging frequent voiding and good perineal hygiene are evidence-based strategies to minimize infection risk, especially in women prone to recurrent UTIs.
After receiving a change-of-shift report about the following four patients, which patient should the nurse assess first?
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A 31-yr-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL.
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A 70-yr-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134.
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A 53-yr-old male patient who has Addison's disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef).
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A 22-yr-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L.
Explanation
The 70-yr-old patient taking levothyroxine with an irregular pulse of 134 bpm presents a potential life-threatening situation. This could indicate thyroid storm, arrhythmia, or cardiac complications related to hyperthyroidism or over-replacement of levothyroxine. Rapid assessment and intervention are necessary to prevent cardiac arrest. The other patients, while needing monitoring and ongoing care (hyperglycemia in Cushing syndrome, medication timing for Addison’s disease, mild hyponatremia in SIADH), do not exhibit immediate life-threatening signs as compared to the patient with the dangerously high pulse.
A 79-yr-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?
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Limit fluid intake to no more than 1000 mL/day.
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Leave a light on in the bathroom during the night.
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Ask the patient to use a urinal so that urine can be measured.
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Pad the patient's bed to accommodate overflow incontinence.
Explanation
For a patient with benign prostatic hyperplasia (BPH), nocturia and difficulty with urination are common concerns. Safety is a priority because patients are at increased risk for falls due to nighttime trips to the bathroom. Leaving a light on in the bathroom at night helps reduce fall risk and provides a safer environment, allowing the patient to navigate the bathroom without strain or disorientation. Limiting fluids is not routinely recommended, as adequate hydration is important, and padding the bed is only necessary if incontinence occurs, not as a routine preventive measure. Asking the patient to use a urinal for measurement is more relevant for strict output monitoring but does not address the common safety concern in BPH.
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?
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Infuse dextrose 50% by slow IV push.
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Administer 1 mg glucagon subcutaneously.
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Obtain a glucose reading using a finger stick.
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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.
Patients with chronic kidney disease have an increased incidence of cardiovascular disease related to (select all that apply)
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Hypertension
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Vascular calcification
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A genetic predisposition
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Hyperinsulinemia causing dyslipidemia
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Increased high-density lipoprotein levels
Explanation
CKD is strongly associated with cardiovascular disease due to multiple interrelated factors. Hypertension and vascular calcification contribute to arterial stiffness and atherosclerosis. Hyperinsulinemia can lead to dyslipidemia, further increasing cardiovascular risk. While genetic predisposition may play a role, it is not as prominent as the other factors listed. Increased high-density lipoprotein (HDL) is protective rather than a risk factor, so it does not contribute to cardiovascular complications in CKD patients.
A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by
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Progressive irreversible destruction of the kidneys
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A rapid decrease in urine output with an elevated BUN
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An increasing creatinine clearance with a decrease in urine output
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Prostration, somnolence, and confusion with coma and imminent death
Explanation
Chronic kidney disease (CKD) involves progressive, irreversible loss of kidney function over months to years, eventually leading to end-stage renal disease if not managed appropriately. This distinguishes CKD from acute kidney injury, which is often reversible. CKD is characterized by declining glomerular filtration rate and accumulation of waste products, but the course is gradual rather than sudden. Symptoms such as prostration and coma represent end-stage complications, not the defining characteristic of CKD itself.
The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of
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Aspirin use
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Tobacco use
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Chronic alcohol abuse
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Use of artificial sweeteners
Explanation
A 28-yr-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?
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Complications of renal transplantation.
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Methods for treating severe chronic pain.
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Options to consider for genetic counseling.
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Differences between hemodialysis and peritoneal dialysis.
Explanation
Polycystic kidney disease (PKD) is an inherited disorder. At the time of diagnosis, it is important to address the genetic implications for the patient and their family. Teaching about options for genetic counseling allows the patient to understand the risk of passing the condition to offspring and consider family planning. While renal replacement therapies and pain management may be relevant later, the immediate priority is understanding the hereditary nature of the disease.
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