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 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?
- Kyphosis and clubbing of the fingers
- Dyspnea and hypoxemia
- Sepsis and pneumothorax
- 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.
A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?
- Bathe weekly to keep the perineal region clean.
- Avoid voiding immediately after sexual intercourse.
- Drink large amounts of fluids throughout the day.
- Void at least every 6 to 8 hours.
Explanation
Correct Answer: C) Drink large amounts of fluids throughout the day.
Increasing fluid intake is one of the most effective preventive measures for recurrent UTIs. Adequate hydration promotes frequent urination, which mechanically flushes bacteria from the urethra and bladder before they can colonize and cause infection. It also dilutes urine, reducing bacterial growth.
Bathing weekly is insufficient — daily perineal hygiene is recommended to reduce bacterial colonization near the urethra. Voiding after sexual intercourse is actually recommended, not avoided, as it helps flush bacteria introduced during intercourse. Voiding every 6 to 8 hours is too infrequent — voiding every 2 to 3 hours is encouraged to prevent bacterial stasis in the bladder.
When checking the neurologic status of a client admitted to the surgical floor, you note the right pupil is dilated more than the left pupil. What is your best first action?
- Check the chart to compare these findings to the client's pre-op findings
- Raise the head of the bed and administer oxygen
- Test the client's deep tendon reflexes on all four extremities
- Notify the physician
Explanation
Correct Answer: A) Check the chart to compare these findings to the client's pre-op findings
Before escalating to physician notification or initiating interventions, the nurse's best first action is to establish whether this is a new finding or a pre-existing baseline. Some patients have anisocoria (unequal pupils) as a normal anatomical variant or as a documented pre-operative finding. Comparing current assessment findings to the pre-op neurological baseline allows the nurse to determine clinical significance accurately. If the finding is indeed new and not previously documented, immediate physician notification would then be warranted as it could indicate increased intracranial pressure or cranial nerve III compression.
An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value?
- Highest airflow during a forced inspiration
- Highest airflow during a forced expiration
- Airflow during a normal inspiration
- Airflow during a normal expiration
Explanation
Correct Answer: B) Highest airflow during a forced expiration.
A peak flow meter measures the peak expiratory flow rate (PEFR) — the maximum speed at which air can be forcefully expelled from the lungs. In asthma, airway narrowing and bronchospasm reduce this value, making it a reliable indicator of airway obstruction and disease control. Patients use daily peak flow readings to monitor their asthma status and identify early signs of worsening before symptoms become severe.
The peak flow meter does not measure inspiratory flow — it specifically measures expiratory effort. Normal (non-forced) inspiration and expiration values are not what the peak flow meter is designed to capture, as the forced effort is what reflects the degree of airway obstruction.
The nurse is planning the care of a patient with Parkinson's disease. The nurse should be aware that treatment will be based on what pathophysiology?
- Premature degradation of acetylcholine
- Decreased availability of dopamine
- Insufficient synthesis of epinephrine
- Delayed reuptake of serotonin
Explanation
Correct Answer: B) Decreased availability of dopamine.
Parkinson's disease is caused by the progressive degeneration of dopaminergic neurons in the substantia nigra of the basal ganglia, leading to critically reduced levels of dopamine — a neurotransmitter essential for smooth, coordinated muscle movement. This dopamine deficiency results in the classic motor features of Parkinson's disease: tremor, rigidity, bradykinesia, and postural instability. Treatment is therefore aimed at restoring or mimicking dopamine activity, most commonly with levodopa/carbidopa.
Acetylcholine degradation is not the primary pathophysiology of Parkinson's — in fact, an imbalance between dopamine and acetylcholine exists, but the deficit is in dopamine. Epinephrine insufficiency is associated with adrenal disorders, not Parkinson's disease. Delayed serotonin reuptake is the mechanism targeted in depression treatment and is unrelated to Parkinson's pathophysiology.
What statement indicates that the client understands teaching about neutropenia?
- "I need to use a soft toothbrush."
- "I should not use sharp edged razors for shaving."
- "My grandchildren may get an infection from me."
- "I will call my doctor if I have an increase in temperature."
Explanation
Correct Answer: D) "I will call my doctor if I have an increase in temperature."
In neutropenia, the body has severely reduced ability to fight infections due to low neutrophil count. Fever is often the earliest and sometimes the only sign of a serious infection in a neutropenic patient, as the normal inflammatory response is blunted. Recognizing fever as a danger sign and reporting it immediately to the physician is the most critical self-care behavior demonstrating correct understanding of neutropenia management.
Using a soft toothbrush and avoiding sharp razors are bleeding precautions appropriate for thrombocytopenia (low platelets), not specifically neutropenia. The concern in neutropenia is that the patient is vulnerable to infections from others, not that they will transmit infections to their grandchildren — this statement reflects a misunderstanding of the condition.
A client with diabetes has proliferative retinopathy, nephropathy, and peripheral neuropathy. Which statement by the client indicates a good understanding of the disease and exercise?
- "I love to walk outside, but I probably better avoid doing that now."
- "Because I have so many complications, I guess exercise is not a good idea."
- "I should look into swimming or water aerobics to get my exercise."
- "I have so many complications that I better exercise hard to keep from getting worse."
Explanation
Correct Answer: C) "I should look into swimming or water aerobics to get my exercise."
Clients with diabetic complications such as proliferative retinopathy, nephropathy, and peripheral neuropathy must exercise with caution but should not avoid exercise entirely.
Swimming and water aerobics are low-impact exercises that are ideal for this client because they minimize stress on the feet and joints, reducing the risk of injury in a client with peripheral neuropathy, while avoiding high-impact or strenuous activities that could worsen retinopathy or increase blood pressure affecting the kidneys.
Options A and B are incorrect because exercise remains beneficial and should not be completely avoided. Option D is dangerous as vigorous exercise can worsen proliferative retinopathy by increasing intraocular pressure and can further stress the kidneys.
The following statement regarding Metformin (Glucophage) is true:
- It is a second generation sulfonylurea
- It increases the insulin secretion of the beta cells
- It works by increasing sensitivity to insulin
- It must be taken with an insulin regimen
Explanation
Correct Answer: C) It works by increasing sensitivity to insulin
Metformin (Glucophage) is a biguanide class medication and is the first-line oral drug for Type 2 diabetes. Its primary mechanisms of action include decreasing hepatic glucose production, decreasing intestinal glucose absorption, and improving insulin sensitivity in peripheral tissues, allowing cells to use insulin more effectively.
It does not stimulate insulin secretion from the beta cells, which is why it does not cause hypoglycemia when used alone. It is not a sulfonylurea — sulfonylureas such as glipizide work by stimulating beta cells to release more insulin. Metformin does not require concurrent insulin therapy and is often used as monotherapy in Type 2 diabetes management.
A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer?
- "Does your pain resolve when you have something to eat?"
- "Do over-the-counter pain medications help your pain?"
- "Does your pain get worse if you get up and do some exercise?"
- "Do you find that your pain is worse when you need to have a bowel movement?"
Explanation
Correct Answer: A) "Does your pain resolve when you have something to eat?"
A hallmark characteristic of duodenal peptic ulcers is that the epigastric pain is relieved by food intake, as food temporarily buffers gastric acid and reduces irritation to the ulcerated mucosa. This pattern — pain that worsens when the stomach is empty and improves after eating — is a classic distinguishing feature of peptic ulcer disease, making this the most diagnostically relevant assessment question.
OTC pain medications are non-specific and do not help differentiate peptic ulcer from other causes of epigastric pain. Pain worsening with exercise is more suggestive of cardiac or musculoskeletal causes. Pain worsening before bowel movements is more consistent with irritable bowel syndrome or bowel-related conditions, not peptic ulcer disease.
A patient has been diagnosed with uterine and ovarian cancer. The nurse is preparing her for surgery prior to her hysterectomy and oophorectomy. The nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent?
- "I know I'll be fine because the physician said he has done this procedure hundreds of times."
- "I know I'll have pain after the surgery but they'll do their best to keep it to a minimum."
- "The physician is going to remove my uterus and ovaries and told me about the risk of bleeding."
- "Because the physician isn't taking my ovaries, I'll still be able to have children."
Explanation
Correct Answer: C) "The physician is going to remove my uterus and ovaries and told me about the risk of bleeding."
Informed consent requires that the patient understands the nature of the procedure, the expected outcomes, and the associated risks. This statement demonstrates that the patient correctly understands what organs will be removed and has been informed of a specific risk, satisfying the core elements of informed consent.
Option A reflects confidence in the surgeon's experience but does not demonstrate understanding of the procedure or its risks. Option B shows awareness of post-operative pain management but lacks understanding of the procedure itself. Option D reveals a critical misunderstanding — an oophorectomy involves removal of the ovaries, meaning the patient has not been properly informed or has not retained key information, which invalidates informed consent.
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