Module 3 Summer - Texas Tech University Health Sciences Center El Paso
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Free Module 3 Summer - Texas Tech University Health Sciences Center El Paso Questions
The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply.
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Vague lower right quadrant abdominal discomfort
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Positive Cullen's sign
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Fever
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Pain in the upper right quadrant after a fatty meal
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Palpable mass in the left upper quadrant
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Complaints of abdominal pain 30-60 minutes after eating
Explanation
Acute cholecystitis classically presents with right upper quadrant pain that is triggered or worsened by ingestion of fatty foods, typically occurring 30-60 minutes after eating due to gallbladder contraction against an obstructed or inflamed cystic duct. Fever is also a common finding, reflecting the underlying inflammatory or infectious process within the gallbladder.
Why the other options are incorrect:
A. Vague lower right quadrant abdominal discomfort — This finding is more characteristic of appendicitis, not cholecystitis, which presents with right upper quadrant symptoms.
B. Positive Cullen's sign — This finding, periumbilical ecchymosis, is associated with retroperitoneal hemorrhage such as in hemorrhagic pancreatitis, not cholecystitis.
E. Palpable mass in the left upper quadrant — Cholecystitis, when a mass is palpable, typically presents in the right upper quadrant, not the left, corresponding to the anatomical location of the gallbladder.
A nurse in a busy emergency department is caring for three clients with contusions, strains, and sprains. Which intervention should the nurse anticipate being included in the initial treatment plan for all of these injuries?
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Encourage early active range-of-motion exercises to prevent joint immobility.
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Massage the injured area gently to promote venous return and decrease edema.
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Apply warm compresses intermittently to improve circulation and reduce stiffness.
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Apply intermittent cold therapy, compression, and elevation while limiting movement of the affected area.
Explanation
First, calculate the hourly rate: 1,000 mL ÷ 8 hours = 125 mL/hr. Next, convert to gtt/min: (125 mL/hr × 15 gtt/mL) ÷ 60 min/hr = 31.25, which rounds to 31 gtt/min.
Correct Answer Is:
31 gtt/min
A 40-year-old male is brought to the ED by paramedics from a house fire with full-thickness burns on his chest and arms and is approximately 42% burned with 2nd and 3rd-degree burns. The client has also suffered smoke inhalation. What is the team's priority in the care of a client who has been burned and suffered smoke inhalation?
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Place a large endotracheal tube and visualize the airway.
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Place 2 large bore IV catheters for burn resuscitation.
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Get a carboxyhemoglobin level and prepare for B12 infusion.
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Place a Foley catheter and measure the initial urinary output.
Explanation
Following the ABC (airway, breathing, circulation) priority framework, airway management is always the first priority, particularly critical in a client with suspected smoke inhalation, who is at high risk for rapid airway edema and obstruction due to thermal and chemical injury to the respiratory tract. Early intubation and airway visualization are essential before airway swelling progresses to the point where intubation becomes difficult or impossible.
Why the other options are incorrect:
B. Place 2 large bore IV catheters for burn resuscitation — While fluid resuscitation is a critical component of burn care, it follows airway management in the priority sequence, as securing the airway takes precedence over circulation interventions.
C. Get a carboxyhemoglobin level and prepare for B12 infusion — While assessing for carbon monoxide poisoning is important in smoke inhalation, and hydroxocobalamin (a B12 derivative) may be used for cyanide toxicity, these diagnostic and treatment steps come after securing the airway, not before.
D. Place a Foley catheter and measure the initial urinary output — Monitoring urinary output is important for assessing fluid resuscitation adequacy, but it is a lower priority than establishing and securing the airway in this acute emergency.
Clinical findings in neurogenic shock related to spinal injury above T6 are related to which of the following?
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Increase in both parasympathetic and sympathetic stimulation
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Loss of sympathetic nervous system stimulation
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Parasympathetic nervous system suppression
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Focal injury to cerebral hemispheres
Explanation
Spinal cord injuries above T6 disrupt the sympathetic nervous system's outflow pathways, resulting in unopposed parasympathetic activity. This loss of sympathetic tone leads to the classic clinical findings of neurogenic shock, including hypotension, bradycardia, and vasodilation, since the sympathetic nervous system's ability to maintain vascular tone and cardiac rate is impaired.
Why the other options are incorrect:
A. Increase in both parasympathetic and sympathetic stimulation — This is incorrect, as neurogenic shock involves a loss of sympathetic stimulation rather than an increase in both systems simultaneously.
C. Parasympathetic nervous system suppression — This is the opposite of what occurs; the parasympathetic system remains active and unopposed due to the loss of sympathetic input, not suppressed.
D. Focal injury to cerebral hemispheres — Neurogenic shock results from spinal cord injury disrupting autonomic pathways, not from a focal cerebral hemisphere injury.
A nurse is administering an IV infusion of 1,000 mL of normal saline over 8 hours. The IV tubing has a drop factor of 15 gtt/mL. What is the infusion rate in gtt/min?
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"Most families are very supportive after surgery."
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"Why do you think your family would feel differently?"
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"You're concerned about how your family will react."
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"Have they said anything to make you feel that way?"
Explanation
This response uses therapeutic communication through reflection, restating the client's underlying feeling back to them in a way that validates their emotional experience and opens the door for further discussion. This technique encourages the client to continue expressing their fears and concerns without imposing judgment or assumptions, fostering a supportive therapeutic relationship.
Why the other options are incorrect:
A. "Most families are very supportive after surgery." — This response offers false reassurance by making a generalized statement that dismisses the client's individual feelings and concerns rather than acknowledging them.
B. "Why do you think your family would feel differently?" — Asking "why" questions can come across as challenging or put the client on the defensive, and it does not validate the client's emotional experience.
D. "Have they said anything to make you feel that way?" — This response shifts focus to seeking factual information rather than addressing and validating the client's emotional concern in the moment.
Correct Answer Is:
(C) "You're concerned about how your family will react."
A nurse is preparing a plan of care for a client with stage 1 hepatic encephalopathy. Which nursing interventions should be implemented? Select the best answer.
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Teach family about high protein diet with balancing ammonia levels
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Balancing protein needs with ammonia levels
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Consult physical therapy to assist with asterixis.
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Teach family about preparing high fatty meals for this client.
Explanation
In hepatic encephalopathy, protein metabolism produces ammonia, which the impaired liver cannot adequately clear, contributing to worsening neurological symptoms. However, completely restricting protein is no longer recommended, as it can lead to malnutrition and muscle wasting; instead, the goal is to balance adequate protein intake, often through the use of vegetable or dairy-based proteins and branched-chain amino acids, with strategies to manage ammonia levels, such as lactulose administration.
Why the other options are incorrect:
A. Teach family about high protein diet with balancing ammonia levels — Recommending a high protein diet without appropriate context could worsen ammonia accumulation and precipitate further encephalopathy; the focus should be on balanced, not high, protein intake.
C. Consult physical therapy to assist with asterixis — Asterixis, the characteristic "liver flap" tremor seen in hepatic encephalopathy, is a neurological manifestation of ammonia toxicity and is not addressed through physical therapy; it requires medical management of the underlying ammonia levels.
D. Teach family about preparing high fatty meals for this client — High-fat meals are not the appropriate nutritional focus for hepatic encephalopathy management; the priority is balancing protein intake with ammonia-reducing strategies.
Which of the following statements regarding burn resuscitation urine output are true? Select all that apply (SATA)
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For thermal injury, the goal is to have a urine output between 75-100 cc per hour
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For thermal injury, the goal is to have an initial urine output goal of 75-100 cc an hour
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For thermal injury, we continue high-flow urine output until there are signs of myoglobin
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For thermal injury, the goal is to have a urine output between 30-50 cc per hour
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For electrical injury, the goal is to have an initial urine output goal of 75-100 cc an hour
Explanation
For standard thermal burn injuries, the target urine output during resuscitation is 30-50 cc per hour, reflecting adequate renal perfusion without over- or under-resuscitation. However, for electrical injuries, a higher urine output goal of 75-100 cc per hour is required because these injuries often cause significant muscle damage and myoglobin release, and the increased urine flow helps flush myoglobin from the renal tubules to prevent acute kidney injury.
Why the other options are incorrect:
A. For thermal injury, the goal is to have a urine output between 75-100 cc per hour — This higher urine output target applies to electrical injuries with myoglobinuria risk, not standard thermal burns, where the goal is lower at 30-50 cc/hr.
B. For thermal injury, the goal is to have an initial urine output goal of 75-100 cc an hour — This is incorrect for the same reason; this higher target is specific to electrical injury resuscitation, not thermal burns.
C. For thermal injury, we continue high-flow urine output until there are signs of myoglobin — This statement incorrectly applies the high-flow urine output strategy (used for myoglobin clearance in electrical injury) to thermal injury, where it is not the standard goal.
The nurse is caring for a client in cardiogenic shock. The patient is receiving Milrinone in addition to IV fluids. The nurse knows which of the following is true?
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Milrinone decreases the strength of myocardial activity (negative inotrope)
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Milrinone reduces cardiac output (increased systemic vascular resistance)
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Milrinone increases the strength of myocardial activity (positive inotrope)
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The drug should be discontinued immediately after the blood pressure increases by 20 mmHg
Explanation
Milrinone is a phosphodiesterase-3 inhibitor that acts as a positive inotrope, increasing the strength and force of myocardial contractions, while also functioning as a vasodilator. This combination improves cardiac output in clients with cardiogenic shock by enhancing the heart's pumping ability and reducing the workload against which the heart must pump.
Why the other options are incorrect:
A. Milrinone decreases the strength of myocardial activity (negative inotrope) — This is the opposite of milrinone's actual effect; it is a positive inotrope that increases, not decreases, myocardial contractility.
B. Milrinone reduces cardiac output (increased systemic vascular resistance) — Milrinone actually decreases systemic vascular resistance through its vasodilatory effects, and it increases, not reduces, cardiac output.
D. The drug should be discontinued immediately after the blood pressure increases by 20 mmHg — This is not an appropriate or standard clinical parameter for discontinuing milrinone; the medication should be titrated and managed based on the client's overall hemodynamic status and provider orders, not a specific arbitrary blood pressure increase.
When thinking about cardiogenic shock, which of the following statements is the most true?
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The patient has an ineffective pump, adequate volume, and un-dilated vessels.
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The patient has an effective pump, adequate volume, and over-dilated vessels.
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The patient has an effective pump, adequate volume, and over-dilated vessels.
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The patient has an ineffective pump, inadequate volume, and over-dilated vessels.
Explanation
Cardiogenic shock results from the heart's inability to pump effectively, meaning the primary problem is pump failure rather than a volume or vascular tone issue. Blood volume typically remains adequate, and the vasculature is not pathologically dilated, distinguishing it from other shock types such as hypovolemic or distributive shock.
Why the other options are incorrect:
B. The patient has an effective pump, adequate volume, and over-dilated vessels — This describes distributive shock (such as septic or anaphylactic shock), not cardiogenic shock, where the pump itself is the primary problem.
C. The patient has an effective pump, adequate volume, and over-dilated vessels — This is a duplicate description of distributive shock and does not reflect the pump failure that defines cardiogenic shock.
D. The patient has an ineffective pump, inadequate volume, and over-dilated vessels — This combination inaccurately attributes inadequate volume and vessel dilation to cardiogenic shock, which are not primary features of this shock type.
Nursing Statements | True/False
- The patient should be taught to eat small frequent meals. — True
- Mr. Smith should be advised to avoid spicy food and caffeine. — True
- Diets for patients with acute pancreatitis should be high in fat. — False
- Nutrition education should begin prior to Mr. Smith's discharge. — True
- The patient should be taught to drink beer instead of whiskey. — False
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The patient should be taught to eat small frequent meals. — True
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Mr. Smith should be advised to avoid spicy food and caffeine. — True
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Diets for patients with acute pancreatitis should be high in fat. — False
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Nutrition education should begin prior to Mr. Smith's discharge. — True
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The patient should be taught to drink beer instead of whiskey. — False
Explanation
Nutritional management of acute pancreatitis focuses on reducing pancreatic stimulation and inflammation while supporting adequate intake. Small, frequent meals help minimize the digestive workload on the pancreas compared to large meals, and avoiding spicy foods and caffeine reduces gastric and pancreatic stimulation that can exacerbate symptoms. A low-fat diet, not a high-fat diet, is recommended, since fat is a strong stimulant of pancreatic enzyme secretion and can worsen pancreatic inflammation. Nutrition education should begin before discharge to ensure the client understands necessary dietary modifications to prevent recurrence. Finally, given that alcohol is a major causative factor in this client's pancreatitis, complete alcohol cessation, not substitution of one type of alcohol for another, is the appropriate teaching point, since beer would still cause the same harmful effects on the pancreas.
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