Medical Surgical Exam 4 (NSG 123)

The correct answer is D: elevated BG level & low plasma bicarb level.

Explanation for the correct answer:

D. elevated BG level & low plasma bicarb level

Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketoacidosis, and dehydration. The key findings typically include:

Elevated blood glucose (BG) levels, often greater than 250 mg/dL, due to insufficient insulin.

Low plasma bicarbonate levels, because the body begins to metabolize fat for energy, producing ketones that result in metabolic acidosis, lowering the pH and bicarbonate levels.

Why the other options are incorrect:

A. comatose state

While severe DKA can result in altered mental status or coma if left untreated, it is not a given in all cases. Many clients with DKA present with symptoms like polyuria, polydipsia, nausea, and vomiting rather than being comatose. Therefore, this is not a guaranteed finding.

B. decreased urine output

In DKA, polyuria (increased urine output) is more common as the body tries to eliminate excess glucose. This leads to dehydration and electrolyte imbalances, but decreased urine output would not typically be expected in the initial stages of DKA. Oliguria (decreased urine output) may occur later due to kidney dysfunction from dehydration.

C. increased respirations & increase in pH

In DKA, Kussmaul breathing (deep, rapid respirations) is seen as a compensatory mechanism for metabolic acidosis. However, the pH in DKA is typically low due to the accumulation of ketones, not increased. The increase in respirations is a response to low pH rather than an increase in pH.

Summary:

In DKA, the nurse would expect elevated blood glucose (BG) levels and low plasma bicarbonate levels, reflecting the metabolic acidosis and hyperglycemia characteristic of the condition.

The correct answer is D: administer analgesics.

Explanation for the correct answer:

D. Administer analgesics

Acute otitis media (AOM) is a common condition in toddlers, and it is often associated with significant pain due to the inflammation of the middle ear. The priority action is to relieve the child's pain. Administering analgesics, such as acetaminophen or ibuprofen, will help reduce the discomfort and provide relief while other treatments or interventions are initiated.

Why the other options are incorrect:

A. Provide emotional support to the family

Although emotional support is important for the family, the priority action for the nurse in this situation is addressing the child’s pain. Once the pain is managed, emotional support can be provided to the family.

B. Educate family on care of the child

While education is an essential part of care, the priority is to address the child’s pain first. Once the pain is managed, the nurse can educate the family on proper care and follow-up.

C. Provide diversional activity

Diversional activities can be helpful in distracting the child, but the priority is to manage the pain. Once the pain is controlled, diversional activities can be used to keep the child comfortable.

Summary:

The priority action for a toddler with acute otitis media is to administer analgesics to manage the child’s pain. Providing emotional support, educating the family, and offering diversional activities are all important but should come after addressing the child’s immediate comfort.

The correct answer is D: Liver function tests.

Explanation for the correct answer:

D. Liver function tests

Acarbose is an alpha-glucosidase inhibitor used to manage type 2 diabetes mellitus (DM). It works by slowing the breakdown of carbohydrates in the intestines, which helps to control postprandial blood glucose levels.

Liver function tests should be monitored because acarbose can have hepatic side effects. Though rare, it can lead to liver enzyme abnormalities or hepatotoxicity, so it is important to monitor liver function periodically during treatment.

Why the other options are incorrect:

A. WBC (White Blood Cell count)

Acarbose is not known to have a direct effect on the white blood cell count. WBC count is typically monitored for infections or immune system concerns, not for acarbose treatment.

B. Amylase

Amylase levels are typically used to assess pancreatic function or for pancreatitis. Acarbose does not directly affect amylase levels, so monitoring amylase is not necessary for this medication.

C. Platelet count

Platelet count is typically monitored for conditions affecting blood clotting or bone marrow production. Acarbose does not have a significant effect on platelets, so monitoring the platelet count is unnecessary for clients on acarbose therapy.

Summary:

The most relevant lab test for a client taking acarbose is liver function tests due to the potential hepatic side effects of the medication. The other options are not associated with acarbose use, making them less relevant for monitoring during treatment.

The correct answer is A: Cancer does not make you sterile, but sometimes the therapy can

Explanation for the correct answer:

A. Cancer does not make you sterile, but sometimes the therapy can.

This response is the most accurate and informative for the client. It acknowledges that while bladder cancer itself does not cause sterility, treatments such as surgery, chemotherapy, or radiation may affect fertility. This answer provides the client with factual information about fertility and encourages further discussion about the impact of cancer treatment on reproductive health, allowing for the exploration of options if desired.

Why the other options are wrong:

B. Are you concerned you can't have children?

While this question might seem empathetic, it places the focus on the nurse's perception of the client’s feelings, rather than providing factual information. It's more helpful to address the client's concern directly and provide the information they are seeking, as option A does. This response also lacks the necessary information about how cancer treatments can affect fertility.

C. You will be able to have as many children as you want.

This statement is overly optimistic and misleading. It assumes that fertility will not be affected by the cancer treatment, which is not necessarily true. By stating this, the nurse may inadvertently provide false hope and fail to address the potential effects of cancer treatment on the client’s ability to conceive.

D. Let me have the chaplain come to talk with you about this.

While involving a chaplain may be beneficial for spiritual support, this response does not directly address the client’s concern regarding fertility. The nurse’s role is to provide accurate information, and a chaplain might not be the most appropriate resource for discussing fertility concerns. It may be important to refer the client to a fertility specialist or oncologist for more detailed guidance, but this response avoids the core issue.

Summary:

The best response is A because it provides accurate, relevant information regarding the potential effects of cancer therapy on fertility. It helps manage the client’s expectations by acknowledging that cancer treatments can impact fertility, without making overly optimistic or dismissive statements.

The correct answer is A: Identifying the underlying cause.

Explanation for the correct answer:

A. Identifying the underlying cause

Delirium is typically a symptom of an underlying medical issue, such as infection, medication side effects, metabolic disturbances, or other acute conditions. The priority in treating delirium is to identify and address the underlying cause. If the underlying cause, such as a urinary tract infection, dehydration, or electrolyte imbalance, is treated, the delirium may resolve or improve. Identifying the cause is critical to providing effective treatment and preventing further complications.

Why the other options are incorrect:

B. Keeping the environment quiet

While maintaining a quiet environment can help reduce stimulation for a client with delirium, it is not the priority. Environmental modifications are helpful but will not address the root cause of the delirium. Identifying and treating the underlying cause is more urgent.

C. Reorienting the client often

Reorienting the client is important to reduce confusion and anxiety in delirium, but it is not the priority. While reorientation can help, it will not be effective unless the underlying cause is treated. Reorienting the client should be done in conjunction with addressing the root cause.

D. Monitoring nutritional intake

Monitoring nutrition is important for overall health, but it is not the priority in the immediate treatment of delirium. Nutritional support can be a part of the overall care plan, especially if the delirium is associated with malnutrition or dehydration, but identifying and treating the underlying cause should be the first step.

Summary:

`The priority for treating delirium is identifying the underlying cause because delirium is often the result of an acute medical condition. Addressing the cause will be key in managing and resolving the symptoms. While environmental modifications, reorientation, and nutritional monitoring are all important aspects of care, they are secondary to identifying and addressing the underlying medical issue causing the delirium.

The correct answer is A: Perform a tape test.

Explanation for the correct answer:

A. Perform a tape test

The tape test (also known as the scotch tape test) is the recommended diagnostic test for detecting Enterobius vermicularis (pinworm) infection. It involves applying a piece of clear tape to the perianal area early in the morning before the child uses the toilet, and then examining the tape under a microscope for the presence of pinworm eggs.

This test is effective because Enterobius vermicularis lays its eggs around the anus, especially during the night, and the tape collects the eggs for examination.

Why the other options are incorrect:

B. Collect stool specimen for culture

A stool specimen for culture is typically used to diagnose bacterial infections (e.g., Salmonella, Shigella), not parasitic infections like pinworms. Enterobius vermicularis is not cultured in stool, so this test would not be useful for diagnosing this condition.

C. Test stool for occult blood

Testing stool for occult blood is used to detect gastrointestinal bleeding, which is not typically associated with Enterobius vermicularis. Pinworm infections generally do not cause blood in the stool, so this would not be an appropriate diagnostic test for this condition.

D. Initiate IV fluids

IV fluids are not necessary for a child suspected of having a pinworm infection unless there are signs of dehydration or other underlying issues. Enterobius vermicularis typically causes mild gastrointestinal symptoms, such as itching around the anus, and does not require IV fluids as part of initial management.

Summary:

To diagnose Enterobius vermicularis (pinworm infection), the nurse should perform a tape test to collect eggs from the perianal area. Other diagnostic tests, such as stool cultures or occult blood tests, are not appropriate for this parasitic infection.

The correct answer is D: client has smoked 2 packs of cigarettes a day for 20 years

Explanation for the correct answer:

D. Client has smoked 2 packs of cigarettes a day for 20 years

Smoking is the primary risk factor for small cell lung cancer (SCLC), which is strongly associated with a history of smoking, particularly in individuals who have smoked a pack a day or more for many years. Small cell lung cancer is often diagnosed in individuals with a significant smoking history, and the carcinogens in tobacco smoke are a major cause of lung cancer. Therefore, the information that the client has smoked 2 packs of cigarettes a day for 20 years is highly significant for the diagnosis of small cell lung cancer.

Why the other options are wrong:

A. Client worked with asbestos for a short time many years ago

While asbestos exposure is a known risk factor for lung cancer, particularly mesothelioma and non-small cell lung cancer (NSCLC), it is less strongly associated with small cell lung cancer (SCLC). Asbestos exposure increases the risk of lung cancer, but smoking is considered a much stronger and more significant risk factor for small cell lung cancer.

B. Client has no family history for this type of lung cancer

A family history of lung cancer can increase an individual's risk, but most cases of small cell lung cancer are caused by environmental factors, particularly smoking. The absence of a family history does not negate the significant risk associated with smoking, which is the leading cause of small cell lung cancer.

C. Client has numerous tattoos covering both upper and lower arms

There is no established link between having tattoos and an increased risk for small cell lung cancer. This information does not provide significant insight into the client's risk factors for developing small cell lung cancer, as smoking is a far more significant risk factor.

Summary:

The most significant information for the diagnosis of small cell carcinoma of the lung is the client’s history of smoking, as it is the primary risk factor for this disease. The other factors mentioned (asbestos exposure, family history, tattoos) are less directly linked to small cell lung cancer.

The correct answer is B: relief of symptoms or improved quality of life

Explanation for the correct answer:

B. relief of symptoms or improved quality of life

Palliative surgery is focused on providing relief of symptoms associated with cancer rather than curing the cancer itself. The primary goal is to improve the patient's comfort and quality of life by alleviating pain, obstruction, or other distressing symptoms caused by the tumor. Palliative surgery can be performed when curative surgery is not an option, but the focus is on symptom management.

Why the other options are wrong:

A. cure of cancer

Curing cancer is not the goal of palliative surgery. Curative surgery is aimed at completely removing the tumor and eradicating the cancer. Palliative surgery, on the other hand, does not aim to cure the cancer but rather to improve comfort and manage symptoms.

C. allowing other therapies to be more effective

While palliative surgery can sometimes improve the effectiveness of other treatments (such as by removing an obstruction or providing better tissue access), this is not the primary goal. The main purpose remains the improvement of quality of life through symptom relief.

D. prolonging client's survival time

Palliative surgery is not focused on extending survival time, though it may sometimes result in a slight extension by improving quality of life. The primary goal remains symptom management and enhancing the patient’s comfort, not survival.

Summary:

The goal of palliative surgery for cancer patients is relief of symptoms or improved quality of life (B). It is not aimed at curing cancer, prolonging survival time, or improving the effectiveness of other therapies, although it may have indirect benefits in those areas.

The correct answer is C: Hypothyroidism can cause extreme fatigue.

Explanation for the correct answer:

Hypothyroidism can cause extreme fatigue.: One of the hallmark symptoms of hypothyroidism is extreme fatigue or a feeling of being tired all the time. This occurs because the thyroid hormone is essential for regulating metabolism and energy production. When there is an insufficient amount of thyroid hormone, the body's metabolism slows down, leading to decreased energy levels and feelings of fatigue.

Why the other options are incorrect:

A.This disorder is more common in men than women: This statement is incorrect. Hypothyroidism is actually more common in women than in men. It is estimated that women are more likely to develop hypothyroidism, especially as they age. In contrast, men have a lower incidence of the condition.

B. Low thyroid hormone levels may increase the heart rate.: This statement is incorrect. Low thyroid hormone levels (hypothyroidism) actually lead to a slower heart rate (bradycardia), not an increased heart rate. When the thyroid hormone levels are low, the metabolic processes slow down, including the heart rate.

D. People often lose weight unexpectedly when they have this condition.: This statement is incorrect. People with hypothyroidism typically experience weight gain, not weight loss. Because the metabolism is slowed down, the body may have difficulty burning calories efficiently, leading to weight gain. Unexpected weight loss is more commonly associated with hyperthyroidism, where there is an overproduction of thyroid hormone.

Summary:

Hypothyroidism can cause extreme fatigue as the thyroid hormone is critical in regulating metabolism and energy production. Contrary to the other statements, hypothyroidism is more common in women than in men, leads to a slower heart rate, and typically results in weight gain rather than weight loss. Therefore, C. Hypothyroidism can cause extreme fatigue is the correct answer.