Fox Valley Technical College Nursing Health Alterations Section 1.
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Free Fox Valley Technical College Nursing Health Alterations Section 1. Questions
An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?
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Apply a heating pad PRN to relieve pain and pruritis
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Massage area to enhance blood flow to the area
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Apply hydrocortisone cream PRN
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Avoid rubbing or scratching the affected area
Explanation
Correct Answer: D) Avoid rubbing or scratching the affected area.
Radiation-induced erythema results in fragile, easily damaged skin. The priority intervention is to protect the integrity of the irradiated skin by avoiding any mechanical trauma such as rubbing or scratching, which can worsen breakdown, introduce infection, and delay healing. Keeping the area undisturbed is the cornerstone of managing radiation skin reactions.
Applying a heating pad is contraindicated as heat increases inflammation and can further damage already compromised skin. Massaging the area is also contraindicated as it causes friction and can worsen skin breakdown. Hydrocortisone cream is not routinely recommended for radiation dermatitis without specific physician orders, as it may interfere with the skin's healing process.
A client who has had a stroke with left-sided hemiparesis has been referred to a rehabilitation center. The client asks, "Why do I need rehabilitation?" How does the nurse respond?
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Rehabilitation will reverse any physical deficits caused by the stroke.
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If you do not have rehabilitation, you may never walk again.
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Rehabilitation will help you function at the highest level possible.
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Your doctor knows best and has ordered this treatment for you.
Explanation
Correct Answer: C) Rehabilitation will help you function at the highest level possible.
The primary goal of rehabilitation following a stroke is to maximize the patient's functional independence and quality of life. Rehabilitation programs focus on restoring as much physical, cognitive, and communicative ability as possible through targeted therapies. This response is both accurate and empowering, supporting the patient's understanding and motivation to engage in the recovery process.
An admitting nurse is assessing a patient with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what?
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Kyphosis and clubbing of the fingers
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Dyspnea and hypoxemia
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Sepsis and pneumothorax
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Bradypnea and pursed lip breathing
Explanation
Correct Answer: B) Dyphnea and hypoxemia.
Diminished breath sounds in a COPD patient indicate air trapping, mucus plugging, or worsening airflow obstruction — all of which reduce effective gas exchange. This directly puts the patient at risk for dyspnea (difficulty breathing) and hypoxemia (decreased oxygen levels in the blood), which are the most immediate and clinically significant complications to monitor for.
Kyphosis and finger clubbing are chronic long-term changes associated with COPD but are not acute monitoring priorities based on diminished breath sounds. Sepsis and pneumothorax are serious conditions but are not the primary concerns directly indicated by diminished breath sounds in COPD. Bradypnea and pursed lip breathing may occur in COPD but are not the most critical monitoring priorities in this context.
When reviewing the chart on your 24-year-old client, which of the following would require follow-up with the physician? Select all that apply.
Vital Signs (1/3/2024 0700): Temperature 99 | Pulse 98 | Resp. 16 | BP 104/67 | O₂ Sat. 97
Intake & Output (0700–1500): Intake 1,200ml | Output 160ml | Total +1040
Lab Results: WBC 7 | RBC 5.1 | Hemoglobin 8.2 | Hematocrit 36 | Platelets 68,000 | Sodium 129 | Potassium 3.5 | Chloride 96 | Calcium 8.6 | Glucose 80 | BUN 23 | Creatinine 3.2 | GFR 63
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White blood cells
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Hemoglobin
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Platelets
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Potassium
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Sodium
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Creatinine
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Pulse of 98
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Urine output
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I) BP
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J) Temperature
Explanation
Correct Answers: B, C, E, F, H, I.
Hemoglobin of 8.2 is critically low (normal 13–18), indicating significant anemia requiring follow-up. Platelets of 68,000 are below the normal range of 130,000–400,000, increasing bleeding risk and requiring physician notification. Sodium of 129 is below the normal range of 135–145, indicating hyponatremia which can cause neurological complications. Creatinine of 3.2 is significantly elevated above the normal range of 0.6–1.8, indicating impaired renal function requiring urgent follow-up. Urine output of only 160ml over an 8-hour shift is critically low — normal urine output should be at least 30ml/hour (240ml over 8 hours), suggesting possible renal compromise or fluid retention. Blood pressure of 104/67 is low for a 24-year-old and warrants physician notification, particularly in the context of low hemoglobin and reduced urine output.
WBC of 7, potassium of 3.5, pulse of 98, and temperature of 99 are all within or at acceptable limits and do not independently require urgent physician follow-up.
The nurse is monitoring a client with hypoglycemia. Glucagon provides which function?
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It converts excess glucose into glycogen, lowering blood glucose levels in times of excess.
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It is a storage form of glucose and can be broken down for energy when blood glucose levels are low.
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It enhances the activity of insulin, restoring blood glucose levels to normal more quickly after a high-calorie meal.
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It aides in reversing hypoglycemia by promoting release of glycogen (stored glucose) from the liver.
Explanation
Correct Answer: D) It aides in reversing hypoglycemia by promoting release of glycogen (stored glucose) from the liver.
Glucagon is a hormone secreted by the alpha cells of the pancreas in response to low blood glucose levels. Its primary function is to stimulate glycogenolysis — the breakdown of stored glycogen in the liver — releasing glucose back into the bloodstream, thereby raising blood glucose levels. This makes it a critical counter-regulatory hormone in hypoglycemia management.
A nurse is caring for a post-op day one prostatectomy client. The urologist has ordered a continuous bladder irrigation. What color output should the nurse expect to find in the drainage bag?
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Ketchup red colored
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Tea colored
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Light pink
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Amber
Explanation
Correct Answer: C) Light pink
Following a prostatectomy, continuous bladder irrigation (CBI) is used to prevent clot formation and maintain catheter patency. On post-operative day one, it is normal and expected for the drainage to appear light pink in color, indicating a small amount of blood mixed with the irrigating fluid.
Ketchup red or bright red drainage would indicate active arterial bleeding and requires immediate intervention. Tea-colored urine suggests old blood or myoglobinuria. Amber is the color of normal urine without bleeding. The gradual transition from light pink to clear drainage over the following days indicates normal healing progress.
You suspect your client has Cholecystitis. Where would the client complain of pain?
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Right lower quadrant
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Right upper quadrant
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Left upper quadrant
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Epigastric region radiating to the back
Explanation
Correct Answer: B) Right upper quadrant.
Cholecystitis, which is inflammation of the gallbladder, classically presents with pain in the right upper quadrant (RUQ) of the abdomen. The pain is often described as severe, cramping, or colicky and may radiate to the right shoulder or scapula due to referred pain via the phrenic nerve. A hallmark physical finding is Murphy's sign — cessation of inspiration upon deep palpation of the RUQ due to pain.
Right lower quadrant pain is characteristic of appendicitis, not cholecystitis. Left upper quadrant pain is associated with conditions involving the spleen or stomach. Epigastric pain radiating to the back is more characteristic of pancreatitis, though cholecystitis can sometimes cause epigastric discomfort, the primary and most specific location remains the right upper quadrant.
You are to give 1000ml of IV fluid over 8 hours. You hung a new bag at 2200. At 0100 you found that 425ml has infused. To finish the fluids on time, what would your adjusted hourly rate be? Do not label, just type the number only.
Explanation
Correct Answer: 115
From 2200 to 0100 is 3 hours elapsed, leaving 5 hours remaining to finish on time (by 0600). The amount infused is 425ml, so the remaining volume is 1000 − 425 = 575ml. Dividing 575ml by 5 hours gives an adjusted rate of 115 ml/hr.
The child weighs 77 pounds. The safe dose of the medication is 50-60mg/kg/day. The order is for 150mg BID. Is this a safe dose? How much would you prepare if the medication were available in 50mg scored tablets?
Explanation
Correct Answer:
Step 1 — Convert weight from pounds to kg: 77 lbs ÷ 2.2 = 35.0 kg (rounded to the tenth)
Step 2 — Calculate the safe daily dose range:
- Minimum: 35.0 kg × 50 mg/kg/day = 1,750 mg/day
- Maximum: 35.0 kg × 60 mg/kg/day = 2,100 mg/day
Step 3 — Calculate the ordered daily dose: 150 mg BID (twice daily) = 150 × 2 = 300 mg/day
Step 4 — Is the dose safe? 300 mg/day falls far below the minimum safe dose of 1,750 mg/day.
Answer: No — the ordered dose is below the safe therapeutic range and is therefore not a safe (subtherapeutic) dose.
Step 5 — Number of tablets for the morning dose: Each tablet = 50 mg. Morning dose = 150 mg. 150 mg ÷ 50 mg/tablet = 3 tablets
Summary of Answers:
- Is the dose safe? → No
- Child's weight in kg → 35.0
- Number of tablets for the morning dose → 3
You are providing your client with education on preventing renal calculi. What would you include in this teaching?
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Weigh yourself daily
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Drink fluids (ideally water) every 1-2 hours during the day and 2 glasses at night
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Increase activity as it enhances blood flow to the kidney
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Increase your sodium to assist with retention of fluids
Explanation
Correct Answer: B) Drink fluids (ideally water) every 1-2 hours during the day and 2 glasses at night.
The most effective preventive measure for renal calculi is high fluid intake, particularly water, throughout the day and night. Adequate hydration dilutes the urine, reduces the concentration of stone-forming substances such as calcium, oxalate, and uric acid, and promotes their excretion before crystals can form. Drinking regularly during the day and maintaining hydration at night helps prevent the concentrated urine that favors stone formation.
Weighing daily is relevant for fluid balance monitoring in conditions like heart failure but is not a prevention strategy for kidney stones. While activity has general health benefits, it is not specifically recommended as a primary prevention measure for renal calculi. Increasing sodium is contraindicated — high sodium intake increases urinary calcium excretion, which actually promotes calcium stone formation.
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