Medical surgical Exam 1 (NSG 123)

The correct answer is D) Report to your healthcare provider if you experience any constipation or abdominal pain.

Why this answer is correct:

Amlodipine (Norvasc) is a calcium channel blocker (CCB) used to treat hypertension and angina by relaxing blood vessels, which lowers blood pressure and improves blood flow. Common side effects of amlodipine include peripheral edema, dizziness, flushing, headache, and gastrointestinal symptoms such as constipation and abdominal pain. While mild constipation may be managed with dietary changes, severe or persistent constipation and abdominal pain should be reported to the healthcare provider as they may indicate a more serious adverse reaction.

Why the other options are incorrect:

A) "This medication makes your kidneys work harder, so you may experience increased urine production."

This is incorrect because amlodipine is a vasodilator, not a diuretic. It does not directly increase urine production or force the kidneys to work harder. Instead, it relaxes the smooth muscles in the blood vessels, lowering blood pressure without affecting the kidney’s filtration process in the same way that diuretics do. Increased urination is not a typical effect of calcium channel blockers.

B) "Stop taking the medication immediately if you notice any edema in your legs."

This is incorrect because peripheral edema is a common side effect of amlodipine due to vasodilation and fluid accumulation in the lower extremities. However, stopping the medication abruptly without consulting a healthcare provider can be dangerous and may lead to rebound hypertension. Instead, the patient should report edema to their healthcare provider, who may adjust the dosage, prescribe a diuretic, or switch the patient to a different antihypertensive medication.

C) "You will need to have monthly blood specimens obtained to check your potassium level."

This is incorrect because amlodipine does not typically affect potassium levels. Routine potassium monitoring is necessary for patients taking diuretics (especially potassium-wasting diuretics like furosemide) or renin-angiotensin system inhibitors (ACE inhibitors or ARBs), but not for calcium channel blockers. Unless the patient is taking other medications that affect potassium or has an underlying condition, frequent potassium monitoring is unnecessary.

Summary:

The correct answer is D, as constipation and abdominal pain are potential side effects of amlodipine that should be reported to the healthcare provider.

Option A is incorrect because amlodipine does not increase urine production or strain the kidneys.

Option B is incorrect because peripheral edema is a common side effect of amlodipine, but the medication should not be stopped abruptly without consulting a healthcare provider.

Option C is incorrect because amlodipine does not significantly impact potassium levels, so routine potassium monitoring is not required.

Correct Answer: orlistat (Xenical)

Explanation:

Orlistat (Xenical) is an anti-obesity medication that works by inhibiting the absorption of dietary fats in the gastrointestinal tract. This reduces the number of calories absorbed, helping with weight loss. One of the important side effects of orlistat is that it can interfere with the absorption of fat-soluble vitamins (A, D, E, and K), which are absorbed with dietary fats. Therefore, it is recommended for clients taking orlistat to take a daily multivitamin that includes these vitamins to ensure adequate nutritional intake.

Why the Other Options Are Incorrect:

lorcaserin (Belviq):

Lorcaserin is a serotonin receptor agonist used to promote weight loss by affecting appetite regulation. It does not interfere with fat absorption and, therefore, does not require supplementation of fat-soluble vitamins.

liraglutide (Saxenda):

Liraglutide is a GLP-1 receptor agonist that helps with weight loss by reducing appetite and promoting satiety. Like lorcaserin, it does not affect the absorption of fat-soluble vitamins, so supplementation with these vitamins is not a specific recommendation for this medication.

phentermine (Adipex-P, Fastin):

Phentermine is a sympathomimetic amine used as an appetite suppressant. It does not affect fat absorption and does not require the supplementation of fat-soluble vitamins.

Summary:

The client is most likely taking orlistat (Xenical), as it is the only weight loss medication in the list that interferes with the absorption of fat-soluble vitamins (A, D, E, and K), necessitating the need for daily multivitamin supplementation.

The correct answer is Laboratory results.

Explanation:

In a client with persistent diarrhea, especially secondary to chemotherapy, the nurse's priority should be assessing laboratory results to monitor for dehydration, electrolyte imbalances, and any renal dysfunction that could be precipitated by fluid loss. Chemotherapy can significantly impact the body’s fluid balance, and laboratory results, such as serum electrolytes (e.g., sodium, potassium, chloride), creatinine, and blood urea nitrogen (BUN), will give the nurse critical information regarding the client’s current status and any potential complications.

Why the Other Options Are Less Prioritized:

Perianal excoriation

While it’s important to monitor for skin breakdown or excoriation, this is a secondary concern when compared to ensuring proper hydration and electrolyte balance. Perianal care can be addressed after stabilizing the client’s fluid status.

Abdominal auscultation

Abdominal auscultation may be important for identifying complications like ileus, but persistent diarrhea is more directly associated with fluid loss and electrolyte imbalances, which are best assessed by reviewing laboratory results.

Mucous membranes

While checking mucous membranes is important for identifying signs of dehydration, laboratory results provide a more comprehensive picture of the client’s overall fluid status and can guide interventions more precisely.

Summary:

For clients with diarrhea related to chemotherapy, laboratory results are the best tool to assess fluid and electrolyte imbalances and the client’s overall hydration status, making it the top priority for the nurse.

The correct answers are:

Increasing fluid intake

Providing education to prevent the spread of infection

Educating the client about TB treatment adherence

Explanation of the Correct Answers:

Increasing fluid intake:

Increasing fluid intake helps thin respiratory secretions, making it easier for the client to clear their airways. This is particularly important for clients with TB, as it can help reduce the risk of complications like mucus plugging and secondary infections.

Providing education to prevent the spread of infection:

TB is a highly contagious airborne infection. The nurse should educate the client on measures to prevent transmission, such as covering the mouth and nose when coughing, wearing a mask, and adhering to respiratory isolation precautions.

Educating the client about TB treatment adherence:

TB treatment involves a long course of antibiotics (typically 6–9 months). Adherence to the treatment regimen is critical to ensure the infection is fully eradicated and to prevent the development of drug-resistant TB. The nurse should emphasize the importance of taking medications exactly as prescribed.

Explanation of Why the Other Options Are Wrong:

Mantoux test will be repeated weekly:

The Mantoux test (tuberculin skin test) is used to diagnose TB, not to monitor treatment progress. Once a client has been diagnosed with TB, repeating the Mantoux test weekly is unnecessary and not part of the plan of care.

Decreasing activity:

While rest is important during the acute phase of illness, decreasing activity is not a standard part of TB care. Clients with TB are encouraged to maintain activity as tolerated to promote lung function and overall health. Bed rest is only indicated if the client is severely ill.

Summary:

The nurse should include increasing fluid intake, providing education to prevent the spread of infection, and educating the client about TB treatment adherence in the plan of care for a client with TB. These interventions address hydration, infection control, and medication adherence, which are critical for managing TB effectively. The other options (repeating the Mantoux test weekly and decreasing activity) are not appropriate for TB care.

The correct answer is D) 43-year-old male who had gastric bypass surgery one year ago.

Why this answer is correct:

Pernicious anemia is caused by a vitamin B12 deficiency due to a lack of intrinsic factor, a protein produced by the stomach that is essential for B12 absorption. Gastric bypass surgery alters the stomach’s ability to produce intrinsic factor, leading to malabsorption of vitamin B12, which increases the risk of developing pernicious anemia. Patients who have had gastric bypass or any procedure that removes or bypasses parts of the stomach (e.g., gastrectomy) are at a high risk of vitamin B12 deficiency and often require lifelong B12 supplementation via intramuscular injection or high-dose oral supplementation.

Why the other options are incorrect:

A) 35-year-old male recently diagnosed with chronic renal failure.

Chronic renal failure is more commonly associated with anemia due to reduced erythropoietin production, not pernicious anemia. Erythropoietin (produced by the kidneys) stimulates red blood cell production, so kidney failure leads to normocytic anemia, but it does not directly cause B12 deficiency.

B) 26-year-old woman in her second trimester of pregnancy.

Pregnancy can cause physiologic anemia due to increased plasma volume and a relative dilution of red blood cells. Pregnant women are more prone to folic acid deficiency anemia, not pernicious anemia, because B12 deficiency is not as common during pregnancy unless the woman has an underlying absorption issue. Folate, not vitamin B12, is the most critical nutrient for preventing neural tube defects in the fetus.

C) 50-year-old male who is following a high-fat and high-protein diet.

Dietary habits alone are not a direct risk factor for pernicious anemia. While a poor diet may contribute to nutritional deficiencies, pernicious anemia is caused by intrinsic factor deficiency, not just low B12 intake. People consuming high-protein diets likely get enough B12 from animal-based foods (meat, eggs, dairy), but if their body cannot absorb B12 due to intrinsic factor deficiency, diet alone will not prevent pernicious anemia.|

Summary:

The correct answer is D, as the gastric bypass surgery has altered the client's ability to absorb vitamin B12, putting them at high risk for pernicious anemia.

Option A is incorrect because chronic renal failure causes anemia due to low erythropoietin, not vitamin B12 deficiency.

Option B is incorrect because pregnant women are more at risk for folic acid deficiency anemia, not pernicious anemia.

Option C is incorrect because diet alone does not cause pernicious anemia—it results from intrinsic factor deficiency, not just low dietary B12 intake.

Correct Answer: C. Increased urine output

Explanation of the Correct Answer:

Increased urine output can occur in clients with fluid volume excess, particularly if the kidneys are functioning properly and the body is attempting to eliminate excess fluid. Diuresis may be a compensatory mechanism to help rid the body of retained fluid. The administration of diuretics, or the body's natural response to excess fluid, often leads to increased urine production.

Why the Other Options Are Incorrect:

A. Muscle cramps

Muscle cramps are more commonly associated with electrolyte imbalances, dehydration, or other conditions like hypokalemia, not fluid volume excess. Fluid volume excess generally causes symptoms related to fluid retention, such as edema, rather than muscle cramps.

B. Blood pressure 90/60 mm Hg

A blood pressure of 90/60 mm Hg is more likely to occur in cases of hypovolemia (low blood volume) or dehydration, not fluid volume excess. Fluid volume excess often causes increased blood pressure (hypertension) due to the additional volume in the vascular system.

D. Respiratory rate 10 breaths per minute

A respiratory rate of 10 breaths per minute is low and could indicate respiratory depression, which is not typically a sign of fluid volume excess. Fluid volume excess can lead to respiratory distress, especially if pulmonary edema develops, and this would be characterized by increased respiratory rate, not decreased.

Summary:

Increased urine output is the correct sign to expect in a client with fluid volume excess, especially if diuretics are being used or the kidneys are attempting to eliminate the excess fluid. The other options, such as muscle cramps, low blood pressure, and a low respiratory rate, are not consistent with fluid volume excess and may indicate other underlying conditions.

Correct Answer: "You should take the medication exactly as prescribed and avoid taking antacids at the same time."

Explanation:

H2 blockers (such as ranitidine, famotidine, or cimetidine) work by reducing stomach acid production, allowing ulcers to heal. The nurse should instruct the client to take the medication exactly as prescribed for full effectiveness. Additionally, antacids can interfere with the absorption of H2 blockers, so they should be taken at least one to two hours apart from the H2 blocker.

Why the Other Options Are Incorrect:

"This medication may need to be taken for one year before relief of symptoms occurs." 

Most peptic ulcers heal within 4 to 8 weeks with H2 blocker therapy. A year-long treatment is unnecessary unless the ulcer is recurrent or caused by an underlying chronic condition.

"Misoprostol is the most commonly prescribed medication in this class." 

Misoprostol is not an H2 blocker; it is a prostaglandin analog used to prevent gastric ulcers in clients taking long-term NSAIDs. The most commonly prescribed H2 blockers are famotidine, ranitidine (historically), and cimetidine.

"Taking this medication and avoiding any NSAIDs and aspirin for one week will eliminate your symptoms."

While avoiding NSAIDs and aspirin is crucial in preventing ulcer worsening, H2 blockers do not eliminate symptoms within one week. Healing takes time, usually several weeks, depending on the severity of the ulcer.

Summary:

The correct teaching point is that H2 blockers should be taken as prescribed and not taken simultaneously with antacids, as antacids can interfere with their absorption. The other options contain inaccuracies about treatment duration, drug classification, and symptom resolution timelines.

Correct Answer: A. Impaired gas exchange

Rationale:

Pneumocystis jiroveci pneumonia (PJP) is a common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). The infection affects the lungs and severely impairs oxygen exchange. As a result, the priority nursing diagnosis for this patient is impaired gas exchange due to the compromised ability of the lungs to oxygenate the blood effectively. The symptoms of PJP often include hypoxia, difficulty breathing, and low oxygen saturation levels, all of which lead to impaired gas exchange. The nurse should focus on monitoring oxygen levels, administering oxygen as prescribed, and assisting with respiratory interventions to improve the patient's oxygenation status.

Why the Other Options Are Incorrect:

B. Impaired oral mucous membranes:

While oral mucosal changes may occur in patients with AIDS due to infections (e.g., candidiasis), it is not as critical a concern in this situation as impaired gas exchange. The priority in PJP is supporting respiratory function.

C. Imbalanced nutrition: Less than body requirements:

Nutritional support is always important in patients with AIDS, especially since many experience weight loss and malnutrition. However, in the context of PJP, respiratory issues take precedence over nutritional concerns. Once the patient’s oxygenation is stabilized, nutritional support can be more effectively addressed.

D. Activity intolerance:

While activity intolerance is a common issue for patients with respiratory infections, particularly in PJP, it is not the most urgent diagnosis. The immediate priority is to manage the impaired gas exchange and stabilize the patient's respiratory status.

Summary:

The highest priority nursing diagnosis for a patient with AIDS and P. jiroveci pneumonia is A. Impaired gas exchange. This diagnosis addresses the patient's immediate respiratory needs, which is critical in treating PJP. While oral mucous membrane issues, nutrition, and activity intolerance are relevant concerns, they are secondary to stabilizing the patient's respiratory function.

The correct answer is A) "Stones that are lodged in the ureter cause symptoms like you are describing."

Why this answer is correct:

The symptoms described—severe, wavelike pain radiating down the thigh and to the genital area and a sensation of needing to void but only passing small amounts—are characteristic of ureteral stones. When a renal calculus (kidney stone) becomes lodged in the ureter, it causes severe colicky pain due to intermittent ureteral peristalsis trying to expel the stone. The radiating pain occurs because the ureters share nerve pathways with the thigh and genital region. Additionally, the irritation from the stone can mimic the sensation of needing to void, but urine flow is restricted, leading to only small amounts being passed.

Why the other options are incorrect:

B) "You will most likely pass the stones in the next few hours."

This statement is overly optimistic and misleading. While small stones (<5mm) can sometimes pass on their own within hours or days, larger stones may take weeks or require medical intervention. The location of the stone in the ureter does not guarantee immediate passage, and factors like stone size and hydration status influence whether it will pass spontaneously.

C) "Your symptoms are consistent with stones that are lodged in the bladder."

Bladder stones typically cause lower abdominal pain, frequent urination, hematuria, and difficulty urinating, but do not cause severe, wavelike pain radiating to the thigh and genital area. The pain pattern described in the question is much more indicative of a ureteral stone, making this answer incorrect.

D) "The stones will need to be removed through a procedure."

While some larger stones may require procedures like ureteroscopy, lithotripsy, or surgical removal, this is not always the case. Many stones, especially those smaller than 5mm, may pass spontaneously with hydration and pain management. The decision to intervene surgically depends on stone size, location, and symptom severity, so assuming immediate removal is necessary is incorrect.

Summary:

The best response is A) "Stones that are lodged in the ureter cause symptoms like you are describing." because severe, wavelike pain radiating to the thigh and genital area, along with urinary urgency and minimal voiding, strongly suggests a ureteral stone.

Option B is incorrect because stone passage is unpredictable and may take longer than a few hours.

Option C is incorrect because bladder stones cause different symptoms, such as lower abdominal pain and frequent urination.

Option D is incorrect because not all stones require procedural removal—many pass naturally depending on size and location.