Fox Valley Technical College Nursing Health Alterations Section 1.
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Free Fox Valley Technical College Nursing Health Alterations Section 1. Questions
The provider tells a patient that she will take albuterol (Proventil) via a metered dose inhaler (MDI). When instructing the patient about using the MDI, you should include which of the following information?
- Take a short, quick breath prior to using the inhaler.
- Wait at least 1 minute before inhaling the second puff.
- Rinse mouth prior to using the inhaler.
- Block one nasal passage while inhaling.
Explanation
Correct Answer: B) Wait at least 1 minute before inhaling the second puff.
When using a metered dose inhaler, patients should wait at least 1 full minute between puffs to allow the first dose to adequately open the airways, enabling the second puff to penetrate deeper into the bronchial tree for maximum therapeutic effect. Proper MDI technique also includes exhaling fully before use, holding the inhaler correctly, inhaling slowly and deeply — not with a short quick breath — and holding the breath for approximately 10 seconds after inhalation. Rinsing the mouth after use (not before) is recommended specifically for inhaled corticosteroids to prevent oral candidiasis, not for albuterol.
The nurse is caring for a client who had a stroke. Which nursing intervention does the nurse implement during the first 72 hours to prevent complications?
- Administer prescribed analgesics to promote pain relief.
- Cluster nursing procedures together to avoid fatiguing the client.
- Monitor neurologic status and vital signs closely to identify early changes.
- Position with the head of the bed flat to enhance cerebral perfusion.
Explanation
Correct Answer: C) Monitor neurologic status and vital signs closely to identify early changes.
During the first 72 hours following a stroke, the patient is at highest risk for neurological deterioration, cerebral edema, and extension of the infarct. Frequent and thorough neurological assessments along with vital sign monitoring allow the nurse to detect early warning signs of deterioration — such as changes in level of consciousness, pupillary changes, or worsening deficits — enabling timely intervention.
Analgesics may be administered if pain is present but are not the primary preventive intervention in the first 72 hours. Clustering nursing procedures can increase intracranial pressure by causing sustained stimulation and is generally avoided in acute stroke care. The head of the bed is typically elevated 30 degrees in stroke patients to reduce intracranial pressure, not kept flat.
A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses anger and irritation when her call light isn't answered immediately. What would be the most appropriate response?
- "You seem like you're feeling angry. Is that something that we could talk about?"
- "Try to remember that stress can make your symptoms worse."
- "Would you like to talk about the problem with the nursing supervisor?"
- "I can see you're angry. I'll come back when you've calmed down."
Explanation
Correct Answer: A) "You seem like you're feeling angry. Is that something that we could talk about?"
This response demonstrates therapeutic communication by acknowledging the patient's emotional state without judgment and inviting her to express her feelings. Patients with chronic illnesses like SLE often experience frustration, fear, and loss of control, and opening a dialogue validates their experience and builds trust. This approach addresses the emotional need directly and compassionately.
Reminding the patient that stress worsens symptoms, while factually correct, can feel dismissive and may increase the patient's distress. Escalating to a nursing supervisor is premature and does not address the patient's emotional needs. Telling the patient to come back when she has calmed down is dismissive, non-therapeutic, and can damage the nurse-patient relationship.
Your client has been on long term oral steroids to manage end-stage COPD. You know that utilizing steroids for a long period will _______ immunity and potentially cause _______.
- osteoarthritis
- decrease
- increase
- osteoporosis
Explanation
Correct Answer: decrease immunity and potentially cause osteoporosis.
Long-term use of oral corticosteroids suppresses the immune system by inhibiting inflammatory and immune responses, thereby decreasing the body's ability to fight infections. This is a well-known adverse effect that puts COPD patients on chronic steroid therapy at increased risk for opportunistic infections.
Additionally, prolonged corticosteroid use interferes with calcium absorption, increases calcium excretion, and suppresses osteoblast activity, leading to decreased bone density and osteoporosis. This makes long-term steroid users highly susceptible to fragility fractures, particularly of the spine and hips.
Osteoarthritis is a degenerative joint disease not directly caused by steroid use. Steroids do not increase immunity — rather they are immunosuppressive by nature, which is the mechanism by which they reduce inflammation but also increase infection risk.
The home care nurse visits a client who has diabetes. The client is awake and alert, but shaky, diaphoretic, and weak. She checks his glucose using the last glucose strip available in the home and it is 55. The nurse gives the client 4 ounces of orange juice. The client's clinical manifestations have not changed 15 minutes later. Which is the nurse's best next action?
- Call the rescue squad for transportation to the hospital.
- Administer 1 mg glucagon intramuscularly.
- Administer 10 units of regular insulin subcutaneously.
- Give the client another 4 ounces of orange juice.
Explanation
Correct Answer: A) Call the rescue squad for transportation to the hospital.
The client has a blood glucose of 55 mg/dL with active symptoms of hypoglycemia including shakiness, diaphoresis, and weakness. The standard initial treatment of 15 grams of fast-acting carbohydrates (4 ounces of orange juice) was administered, but symptoms have not improved after 15 minutes. Since there are no more glucose strips available to recheck blood glucose and symptoms persist, the nurse cannot safely reassess the client's response to treatment at home.
The safest and most appropriate action is to call the rescue squad for immediate transport to the hospital where IV dextrose can be administered and blood glucose can be continuously monitored.
Administering insulin would be dangerous and contraindicated in hypoglycemia. Glucagon would be appropriate if the client were unconscious and unable to swallow, but calling emergency services remains the priority given the home care setting and lack of monitoring supplies.
The nurse is teaching a client about self-management of gastroesophageal reflux. Which statement by the nurse is most appropriate?
- "You may include orange or tomato juice with your breakfast."
- "No specific foods or spices need to be cut from your diet."
- "Eat four to six small meals each day."
- "Eat a small evening snack 1 to 2 hours before bed."
Explanation
Correct Answer: C) "Eat four to six small meals each day."
Eating smaller, more frequent meals is a key dietary modification for managing GERD. Large meals increase gastric pressure and promote reflux of stomach acid into the esophagus. Smaller meals reduce this pressure and minimize symptoms.
Option A is incorrect because citrus and tomato-based juices are highly acidic and known triggers for GERD that should be avoided. Option B is incorrect as certain foods and spices such as caffeine, alcohol, fatty foods, chocolate, and mint are well-established GERD triggers that should be eliminated. Option D is incorrect because eating close to bedtime increases the risk of nocturnal reflux — clients should avoid eating at least 2 to 3 hours before lying down.
A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patient's daily dose of metformin, the nurse should prioritize which of the following assessments?
- Monitoring the patient's neutrophil levels
- Assessing the patient for constipation
- Monitoring the patient's level of consciousness and behavior
- Reviewing the patient's creatinine and BUN levels
Explanation
Correct Answer: D) Reviewing the patient's creatinine and BUN levels.
Metformin is primarily excreted by the kidneys, and its use is contraindicated or requires dose adjustment in patients with renal impairment. When metformin accumulates due to decreased renal clearance, it increases the risk of lactic acidosis — a rare but potentially fatal complication. Reviewing creatinine and BUN levels assesses kidney function and ensures it is safe to increase the metformin dose.
Neutrophil levels are not affected by metformin and are not a relevant monitoring parameter. Constipation is not a common side effect of metformin — gastrointestinal side effects such as nausea, diarrhea, and abdominal discomfort are more typical. Monitoring level of consciousness is important in hypoglycemia, but metformin alone rarely causes hypoglycemia, making this less of a priority than renal function assessment.
A client is being discharged from the hospital with atrial fibrillation. Which discharge teaching should the nurse discuss with the client?
- Instruct the client to take a daily blood pressure.
- Discuss the importance of having a monthly PTT drawn.
- Teach the client about enoxaparin (Lovenox) injections for a month.
- Teach the client about the importance of taking warfarin.
Explanation
Correct Answer: D) Teach the client about the importance of taking warfarin.
Patients with atrial fibrillation are at significantly increased risk for thromboembolic events, particularly stroke, due to blood stasis in the fibrillating atria promoting clot formation. Warfarin (or other oral anticoagulants) is the standard long-term anticoagulation therapy prescribed for AFib patients to prevent stroke. Teaching the patient about warfarin adherence, INR monitoring, dietary considerations, and bleeding precautions is essential discharge education.
Daily blood pressure monitoring is helpful but is not the priority discharge teaching specific to AFib. PTT monitoring is used to monitor heparin therapy, not warfarin — INR is the correct monitoring lab for warfarin. Enoxaparin injections are used for short-term anticoagulation (e.g., bridging therapy) and are not the standard long-term treatment for AFib at discharge.
Hiatal hernias are caused by:
- Regurgitation due to relaxation of the pyloric sphincter
- Long term use of NSAIDS
- The protrusion of the stomach through the opening of the diaphragm
- The excessive relaxation of the lower esophageal sphincter
Explanation
Correct Answer: C) The protrusion of the stomach through the opening of the diaphragm
A hiatal hernia occurs when a portion of the stomach pushes upward through the esophageal hiatus — the natural opening in the diaphragm through which the esophagus passes — into the chest cavity. This structural defect can be caused by weakening of the diaphragmatic muscle, increased intra-abdominal pressure, or aging.
Option A is incorrect as the pyloric sphincter connects the stomach to the small intestine and is unrelated to hiatal hernia formation. Option B is incorrect because while NSAIDs can cause gastric ulcers and irritation, they do not cause hiatal hernias. Option D describes a contributing factor to GERD symptoms but is not the cause of a hiatal hernia itself.
Key features of peritonitis include: (select all that apply)
- Pain
- Nausea
- Bradycardia
- Rigid, board like abdomen
- High fever
- Polyuria
- Elevated BNP
- Increased hunger
- I) Hematuria
- J) Bilateral lower extremity edema
Explanation
Correct Answer: A) Pain, B) Nausea, D) Rigid board-like abdomen, E) High fever
Peritonitis is inflammation of the peritoneum, typically caused by bacterial infection from a perforated organ or abdominal injury. Pain is the hallmark symptom, often severe and diffuse. Nausea occurs due to GI involvement and systemic inflammation. A rigid, board-like abdomen results from involuntary muscle guarding over the inflamed peritoneum — a classic sign. High fever reflects the body's significant inflammatory and infectious response.
Bradycardia is incorrect because peritonitis causes tachycardia due to pain and sepsis. Polyuria is unrelated; septic patients may have decreased urine output. Elevated BNP is a cardiac biomarker associated with heart failure. Increased hunger is wrong as patients typically experience anorexia. Hematuria suggests urinary or renal pathology. Bilateral lower extremity edema is associated with heart failure or venous insufficiency, not peritonitis.
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