Exam 4

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  1. anuria
    Formation and excretion of less than 100 mL of urine in 24 hours
  2. bladder ultrasound
    • BUS
    • A noninvasive technology that can estimate the volume of urine in the bladder
  3. catheter-associated urinary tract infection
    • (CAUTI)
    • A urinary tract infection that develops when an indwelling urinary catheter is in place greater than 2 days prior to the onset of infection
  4. cystectomy
    A urinary diversion procedure in which the bladder is surgically removed
  5. cystocele
    The protrusion or herniation of the bladder into the vaginal canal
  6. detrusor muscle
    Smooth muscle of the urinary bladder
  7. diuresis
    Formation and excretion of large amounts of urine
  8. diuretic
    Medications administered to remove body fluid by increasing urine output
  9. dysuria
    Painful voiding
  10. enuresis
    Involuntary voiding with underlying pathophysiologic origin after the age that bladder control is usually achieved; nocturnal enuresis is bedwetting
  11. hematuria
    Presence of blood in urine
  12. hydronephrosis
    Distention of the kidney pelvis with urine secondary to the increased resistance caused by obstruction to normal urine flow
  13. ileal conduit
    an isolated segment of ileum serving as a substitution for the urinary bladder, into which ureters can be implanted, the lumen of which is connected to the skin; used following total cystectomy or other loss of normal bladder function requiring supravesical diversion.
  14. intermittent catheterization
    In-and-out catheterization performed on a routine, scheduled basis for a particular patient
  15. micturition
  16. nocturia
    Voiding during normal sleeping hours
  17. oliguria
    Formation and excretion of less than 500 mL of urine in 24 hours
  18. overactive bladder
    Frequency and urgency to urinate occurring together
  19. polyuria
    Formation and excretion of large amounts of urine in the absence of a concurrent increase in fluid intake
  20. pyuria
    Presence of pus in urine
  21. urgency
    The subjective feeling of needing to void immediately
  22. urinary incontinence
    Involuntary loss of urine from the bladder
  23. urinary retention
    Inability to empty the bladder of urine
  24. The voluntary process of micturition is stimulated by:
    stretch of the detrusor muscle as the bladder fills with urine.
  25. A normal void consists of:
    Between 250 and 400 mL of clear, yellow, aromatic urine per void is considered normal.
  26. As children approach _________ age, their kidneys mature and they achieve voluntary control over urinary elimination; kidney function declines in older adults because of __________.
    • 2 to 3 years of
    • normal age-related changes
  27. Many factors, such as _____________, can affect urinary elimination.
    fluid intake, loss of body fluid, dietary intake, body position, psychological state, obstruction, infection, hypotension, neurologic injury, decreased muscle tone, pregnancy, surgery, and medications
  28. Manifestations of altered urinary function include:
    dysuria, polyuria, oliguria, urgency, frequency, nocturia, hematuria, pyuria, urinary retention, urinary incontinence, and enuresis.
  29. Physical assessment of urinary function includes:
    inspection of urine and use of the bladder scanner to quantify residual urine in the bladder.
  30. Diagnostic tests and procedures that are helpful in identifying urinary dysfunction include:
    urinalysis, urine culture and sensitivity, BUN, creatinine, cystoscopy, and urodynamic studies.
  31. Nursing measures to promote normal urinary function include:
    ensuring adequate fluid intake, preventing UTIs, and promoting optimal perineal muscle tone.
  32. Independent nursing interventions for urinary
    • incontinence include:
    • behavioral interventions such as timed voiding, prompted voiding, habit training, bladder training, use of external catheters and absorbent products, and perineal hygiene.
  33. Collaborative nursing interventions for management of altered urinary function include:
    insertion of indwelling catheters and closed bladder irrigation.
  34. Self-management of many urologic problems occurs _______ with adequate support from _________.
    • in the home setting
    • the family, the community, and the healthcare provider
  35. Selective reabsorption of water and ions occurs in which part of the nephron?
    A. Bowman capsule
    B. Tubules
    C. Small intestine
    D. Glomerulus
    B. The tubules are passageways that permit urine to flow to the renal pelvis and then to the ureters, selectively reabsorbing or secreting substances from the urine to maintain fluid and electrolyte balance. Bowman capsule surrounds the glomerulus (a network of blood vessels), where urine formation begins. The small intestine reabsorbs some water and ions but is not part of the nephron and is not as selective in reabsorption.
    (this multiple choice question has been scrambled)
  36. Micturition occurs when:
    A. Glomerular filtration enters the tubule
    B. Increased pressure stretches the detrusor muscle
    C. Pelvic muscles relax and abdominal muscles contract
    D. Sympathetic impulses cause stimulation of the internal sphincter
    C. Emptying of the bladder or voiding (micturition) occurs when the external bladder sphincter relaxes, abdominal muscles contract, and pelvic floor muscles relax. Detrusor muscles are the three layers of muscle in the body of the bladder itself; bladder fullness is not micturition. Sympathetic impulses stimulate the internal sphincter, keeping urine in the bladder.
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  37. Your patient is diagnosed with a UTI. Which urinary signs would best support this diagnosis?
    A. Sediment in the catheter tubing
    B. No odor from urinal
    C. Cloudy urine
    D. Dark amber color
    C. Cloudy urine represents pus in the urine. Dark amber color may be related to urine volume and when occurring alone does not indicate an infection. Odor may be caused by concentration, time prior to emptying container, and certain medications or foods. Sediment may occur when urine is sitting unemptied in a device.
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  38. Which patient condition would you expect to have decreased urinary output (volume)?
    a. A postoperative patient in recovery room
    b. An elderly patient with urinary frequency
    c. A pregnant patient with occasional nausea
    d. A patient following a cerebrovascular accident (CVA)
    e. All of the above
    • a. Postoperative patients have decreased fluid volume due to limited intake and loss of body fluid. Stress of surgery also increases the release of antidiuretic hormone, which decreases urine output. Urinary frequency alters the intervals in voiding but not the volume. A pregnant patient may have increased frequency but should not have decreased volume, particularly if not vomiting frequently. CVA patients may experience continence difficulty but should not exhibit decreased urinary volume.
    • p. 1043
    • p. 1044
  39. Which urinary output represents abnormal findings?
    A. Nocturia in elderly male patient
    B. Newborn voids 30 to 40 times per day
    C. Nighttime incontinence in a 6 year old
    D. Incontinence in an elderly female patient
    D. Incontinence is not normal or an inevitable part of aging, although aging is a risk factor and is twice as likely in women. Newborns should void 30 to 40 times per day. Nighttime incontinence is normal until about 7 years of age. Nocturia is voiding during normal sleeping hours and is not abnormal.
    (this multiple choice question has been scrambled)
  40. Which of the following are expected findings?
    a. Polyuria in a patient with poorly managed diabetes
    b. Anuria in a patient with end-stage renal disease
    c. Hematuria in a patient with a UTI
    d. Urinary retention in patient with thoracic spinal cord injury
    e. All of the above
    e. Polyuria in hyperglycemia, anuria in ESRD, hematuria in a urinary tract infection, and urinary retention in a thoracic spinal cord injury are all expected findings.
  41. Your patient had a urinary catheter removed at 06:00, and it is now 14:00. What would you do first?
    A. Encourage increased oral intake
    B. Perform BUS
    C. Assess sensations of fullness, distention
    D. Assist patient to bathroom to void
    C. Assessment of sensations of fullness and distention is the first step in the nursing process. A bladder ultrasound is an appropriate diagnostic tool following physical assessment. Encouraging oral intake and assisting the patient to the bathroom are interventions and should be done following assessments.
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  42. Your assessment of an elderly female indicates the following: alert and oriented, ambulates independently, reports urinary frequency, and incontinence with coughing. Which nursing diagnosis best describes this patient’s condition?
    A. Stress incontinence
    B. Reflex urinary incontinence
    C. Urge incontinence
    D. Functional urinary incontinence
    A. Stress incontinence is the sudden, involuntary loss of small amounts of urine that accompanies a sudden increase in intra-abdominal pressure such as during coughing, sneezing, laughing, lifting, and jumping. Urge incontinence is involuntary loss of urine after perceiving the need to urinate; inability to hold urine until reaching the bathroom. Functional urinary incontinence involves the inability of a person with normal bladder control to reach the bathroom in time to void. Environmental barriers, disorientation, or physical limitations may contribute. Reflex urinary incontinence is involuntary loss of urine at predictable intervals when a specific bladder volume is reached. Examples include neurologic impairment, CVA, or brain tumor.
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  43. You are working with an elderly patient with altered mental status and urinary incontinence. What nursing interventions would be most appropriate?
    a. Encourage patient to avoid smoking and drinking coffee
    b. Schedule toileting at least every 2 hours
    c. Provide medications to improve bowel function
    d. Request physician order to insert urinary catheter
    a, b. Timed and prompted voiding schedules are effective with cognitively impaired older adults. Encouraging a patient to avoid bladder irritants is not the best choice since the patient presents with an altered mental status. Medications to improve bowel function are not indicated. Requesting an order for a urinary catheter is not indicated based on altered mental status and incontinence and could increase the risk of a UTI.
  44. Indwelling urinary catheters are not indicated in which of the following patient conditions?
    A. Recurrent urinary retention
    B. Incontinence with pressure ulcers
    C. Surgical procedures with general anesthetic
    D. Impaired mobility
    D. Indwelling catheters are indicated for recurrent urinary retention not relieved by intermittent catheterization, surgical procedures with general anesthetic for 1 to 2 days, and incontinence with pressure ulcers. Impaired mobility is not an indication without other factors present.
    (this multiple choice question has been scrambled)
  45. borborygmi
    Loud, rumbling sounds produced by the normal movement of gas through the intestines, referred to as “stomach growling”
  46. Clostridium difficile
    • (C-diff)
    • Organism that causes a severe gastrointestinal infection resulting in frequent loose and often bloody bowel movements; the most common cause of hospital-acquired diarrhea in the United States
  47. colonoscopy
    An endoscopic procedure that can visualize the colon up to the ileocecal valve
  48. colostomy
    Opening of a part of the colon onto the abdominal skin surface
  49. constipation
    Infrequent, sometimes painful passage of hard, dry stool
  50. defecation reflex
    Involuntary response of intestinal contraction and anal sphincter relaxation to rectal distention
  51. diarrhea
    Frequent evacuation of watery stools
  52. distention
    Condition of being stretched or inflated
  53. enema
    Insertion of fluid into the rectum and colon
  54. fecal impaction
    The accumulation of hardened feces in the rectum
  55. fecal occult blood test
    • (FOBT)
    • Evaluates stool for blood that is not apparent upon visual examination
  56. flatus
    Gas in the gastrointestinal tract
  57. gastric lavage
    Irrigation of the stomach
  58. hemorrhoids
    Enlarged or varicose veins in the anal canal
  59. ileostomy
    Opening of the ileum onto the abdominal skin surface via a stoma
  60. meconium
    First feces of a newborn
  61. paralytic ileus
    Condition in which the bowel is temporarily paralyzed and distention occurs
  62. peristalsis
    Motility and movement of the intestines
  63. sigmoidoscopy
    Diagnostic examination of the rectum and sigmoid colon
  64. stoma
    Artificially created opening of bowel on the abdominal skin surface
  65. suppository
    Medication inserted into the rectum or vagina
  66. Valsalva’s maneuver
    The combination taking a deep breath against a closed glottis (to move the diaphragm down), contracting the abdominal muscles (to increase intra-abdominal pressure), and contracting the pelvic floor muscles (to push the feces downward) to defecate
  67. Defecation, the process of eliminating feces from the body, is initiated by:
    reflexes in response to intestinal distention.
  68. Many lifestyle habits affect stool __________. Physiologic alterations of the intestines also can adversely affect bowel elimination.
    consistency and the pattern of bowel elimination
  69. The characteristics of feces and bowel elimination patterns change:
    during the life span.
  70. Altered bowel elimination can be a source of:
    physiologic, psychological, and social distress.
  71. The manifestations of altered bowel elimination are:
    constipation, fecal impaction, diarrhea, incontinence, flatulence, and abdominal distention.
  72. A focused nursing assessment of bowel elimination includes:
    patient history, inspection of stool characteristics, and physical examination of the abdomen and perirectal area.
  73. The nurse has ________ responsibilities in laboratory analysis of the feces and other diagnostic procedures.
  74. The nurse can diagnose and collaboratively treat altered bowel elimination. Treatment measures include:
    medications, enemas, rectal tubes, nasogastric intubation, fecal impaction removal, bowel training, fecal collection during incontinence, and stoma care.
  75. Discharge planning considers the home environment, such as:
    access to facilities, finances, and use of specialized equipment, and the unique learning needs of the patient and family.
  76. Continuation, modification, and termination of nursing strategies are based on:
    systematic evaluation of patient response to therapy.
  77. Which of the following bowel habits are abnormal?
    A. Elderly adult with fecal incontinence
    B. Toddler smearing or playing with feces
    C. Breast-fed infant with stool once every 3 days
    D. Preschooler with bowel control but not bladder control
    A. Fecal incontinence is always an abnormal finding in adults. It is a normal finding in breast-fed infants to stool once every 3 days. It is not unusual that sometime during toddlerhood smearing or playing with feces will occur. Most children attain bowel control before 4 years of age and usually achieve bowel control before bladder control.
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  78. You are assessing factors related to constipation in your postoperative patient. Which of the following could contribute to constipation? Select all that apply:
    a. Opioid analgesics
    b. Decreased mobility
    c. Fear of pain
    d. Supine position
    e. Lack of privacy
    a, b, c, d, e. Postoperative use of opioids, reduced activity, and fear of pain inhibit normal bowel motility, as does bowel manipulation during surgery. Supine position may also decrease the urge to defecate. Lack of privacy may lead to the patient feeling psychologically uncomfortable defecating and thus ignoring the urge to defecate.
  79. This morning, your adult patient reports new onset of frequent diarrhea with mucus and a foul odor. Which medication class would you suspect as being related?
    A. Diuretic
    B. Antibiotic
    C. Dietary supplement
    D. Opioid analgesic
    B. Antibiotics can promote diarrhea by irritating the gastrointestinal mucosa or by inhibiting the growth of normal intestinal flora. When normal flora is altered, Clostridium difficile can proliferate and release toxins. Dietary supplements would not cause diarrhea. Opioids could lead to constipation rather than diarrhea because they decrease gastrointestinal motility. Diuretics are unrelated to overactive bowel function, although high doses may lead to constipation.
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  80. Which of the following findings are abnormal?
    A. Tympany in LUQ
    B. Convex shape
    C. Borborygmi present
    D. Positive FOBT guaiac
    D. Positive guaiac indicates blood in the stool and is an abnormal finding. Borborygmi are the normal sounds of gastrointestinal peristalsis. Hollow tympany is the normal sound on percussion over the left upper quadrant (stomach); dull sound or tympany over other quadrants would be abnormal. A convex, symmetric abdominal shape is expected; hollow, distended or asymmetric would be an abnormal finding.
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  81. You perform a FOBT guaiac test on a stool sample from a patient with a history of gastrointestinal bleeding. Which step would you do first after applying stool to the Hemoccult slide?
    A. Open flap on reverse side.
    B. Document.
    C. Wait 3 to 5 minutes.
    D. Apply developing solution.
    C. After applying a smear of stool, close the slide cover and wait 3 to 5 minutes, then open the reverse side flap and apply two drops of Hemoccult developing solution onto each window and one onto the control window. Documentation of the result would be the final step.
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  82. You are caring for a female patient who is concerned that she has not had a bowel movement since yesterday and hasn’t taken her laxative. You assess her abdomen and find bowel tones throughout all quadrants, reports of flatus, and abdomen is soft and not distended or tender. Which nursing diagnosis would be most appropriate for this patient?
    A. Perceived Constipation
    B. Constipation
    C. Deficient Fluid Volume
    D. Anxiety
    A. Perceived constipation describes a self-diagnosis of constipation (not supported by nursing assessment). A patient may act on this perception through abuse of laxatives, enemas, and suppositories to ensure daily bowel movement. A nursing diagnosis of constipation would be supported by the following nursing assessments: decreased bowel tones, lack of flatus, and distended/firm/tender abdomen. Deficient Fluid Volume would be related to large losses of fluid through diarrhea (altered bowel function). Anxiety could lead to diarrhea, not constipation.
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  83. You determine that your patient is at risk for constipation related to his postoperative status. What interventions can you provide to reduce this risk?
    A. Encourage foods high in magnesium.
    B. Request high-protein foods to be included on the dietary tray.
    C. Promote intake of cold fluids.
    D. Promote ambulation as tolerated.
    D. Promoting ambulation will assist with the return of gastric motility related to general anesthesia and can begin the earliest. High-fiber foods would be appropriate once bowel function has returned. Warm, not cold, liquids could also promote gastrointestinal motility.
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  84. You have just placed a nasogastric tube for gastric decompression secondary to a paralytic ileus. What is the first thing that you need to do?
    A. Irrigate tube to maintain patency.
    B. Ensure accurate placement.
    C. Provide liquid medications via tube.
    D. Connect tubing to intermittent suction.
    B. Ensuring accurate placement of the nasogastric tube is essential prior to connecting to suction or administering medications. Irrigation should occur after medication administration.
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  85. You are providing discharge teaching to a patient with a colostomy. You include the following instructions about applying the colostomy wafer and bag. Select all that apply:
    a. Ensure that the opening in the wafer is tight to the stoma to prevent leakage.
    b. Leakage of colostomy contents to the surrounding area may lead to skin breakdown.
    c. Stoma coloring that is dusky or pale like the surrounding skin is normal.
    d. Some bleeding may occur because stoma tissues are fragile.
    a, b, d. The wafer should be tight to the stoma without restricting blood flow. Leakage of acidic bowel contents onto surrounding skin can cause irritation and skin breakdown. Bleeding may occur in small amounts because stoma tissues are fragile. Stomas should be a healthy pink. Dusky or pale color suggests inadequate circulation and should be reported.
  86. The wound nurse is visiting a patient with a new colostomy for a final appointment prior to discharge. Which patient statements would be most concerning?
    A. “The stoma is beefy red, which is normal.”
    B. “I can’t stand to even look at my stomach!”
    C. “I have trouble securing the wafer because of abdominal discomfort.”
    D. “I know that I have to empty the bag when it is one third full.”
    B. New colostomies often affect body image, but continued inability to look at the site by the time of discharge presents barriers to self-care. Colostomy bags should be emptied when one-third full, and a “beefy” red stoma is normal. Some abdominal discomfort is not unusual but should not affect discharge.
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  87. absorption
    The process by which a medication enters the bloodstream
  88. anorexia
    Loss of appetite
  89. anorexia nervosa
    Eating disorder in which the person refuses to eat from fear of becoming overweight, even with normal or less than ideal body weight
  90. basal metabolism
    Amount of energy required to carry out involuntary activities at rest
  91. calorie (kilocalorie)
    Unit of heat, commonly used to describe the energy value of food
  92. carbohydrates
    Food group containing simple and complex sugars composed of carbon, hydrogen, and oxygen
  93. complete proteins
    Proteins that contain sufficient amounts of essential amino acids to maintain body tissues and to promote body growth
  94. digestion
    • Mechanical and chemical processes necessary to convert food to an absorbable state
    • disaccharide
  95. gastric residual volumes (GRVs)
    Volume aspirated from the stomach as a way to assess tolerance of enteral feeding
  96. glycogenesis
    Anabolic process or glycogen storage; formation of glycogen from glucose
  97. incomplete proteins
    Proteins that do not contain enough amino acids to independently maintain life, build tissue, or promote growth
  98. macronutrients
    Carbohydrates, proteins and fats; used by the body in large amounts
  99. metabolism
    • (1) Chemical reactions in the cells that produce heat as a byproduct;
    • (2) Breakdown of a drug (usually in the liver) to an inactive form
  100. micronutrients
    Vitamins and minerals; used by the body in small quantities
  101. monosaccharide
    Simple sugar
  102. monounsaturated fatty acid
    • (MUFA)
    • “Unsaturated” double bond that forms between two side-by-side carbon atoms when an unsaturated fat has a single hydrogen atom missing from each of two carbon atoms
  103. nutrients
    Food containing elements for normal body functioning
  104. obese
    Body mass index (BMI) over 30 kg/m2 or more
  105. overweight
    Body mass index (BMI) between 25 and 29.9 kg/m2
  106. partially complete proteins
    Proteins that contain sufficient amounts of amino acids to maintain life but do not promote growth
  107. polysaccharide
    Complex sugar
  108. polyunsaturated fatty acid
    • (PUFA)
    • Two or more carbonto-carbon double bonds when an unsaturated fat has a single hydrogen atom missing from each of two carbon atoms
  109. proteins
    Organic compounds composed of polymers of amino acids connected by peptide bonds
  110. saturated fats
    Chemically, two hydrogen atoms attached to each of the carbon atoms in the carbon atom chain
  111. small-bore feeding tubes
    Flexible tubes of small diameter designed for comfort during tube feeding
  112. trans fatty acids
    Unsaturated fat molecules with an unusual configuration around the double carbon bond(s)
  113. trace elements
    Subgroup of minerals found in small amounts in food
  114. underweight
    Body mass index (BMI) below the ideal BMI of 20 to 25 kg/m2
  115. unsaturated fats
    Fats with a single hydrogen atom missing from each of two side-by-side carbon atoms
  116. vitamins
    Organic compounds that do not supply energy but are necessary to the body in small amounts for growth, development, maintenance, and reproduction
  117. Adequate nutritional intake is important to maintain:
    body functions, healthy tissues, and body temperature; to promote healing; and to build resistance to infection.
  118. Essential nutrients are:
    carbohydrates, protein, fat, vitamins, minerals, and water.
  119. The complex processes of digestion, absorption, and metabolism permit the body to:
    break down food and use it as energy.
  120. Great variations exist in dietary intake among people, but _____ are useful when evaluating adequate intake.
  121. Manifestations of altered nutrition include:
    body weight that is less or greater than the IBW; recent significant weight gain or loss; decreased energy; altered bowel patterns; and altered skin, teeth, hair, or mucous membranes.
  122. A nutritional health assessment includes:
    collecting subjective data about normal eating patterns, risk factors for nutritional deficits, and altered nutrition.
  123. What objective data is gathered to help assess a patient's nutritional state?
    Accurate anthropometric measurements (height and weight, BMI, skinfold measurements, and arm circumference), calorie counts, and swallowing evaluation provide objective data to help assess a patient’s nutritional state.
  124. NANDA-I nursing diagnoses in the area of nutrition are
    • Imbalanced Nutrition: Less Than Body Requirements;
    • Imbalanced Nutrition: More Than Body Requirements;
    • Readiness for Enhanced Nutrition;
    • Overweight;
    • Obesity; and
    • Impaired Swallowing.
  125. Health promotion for optimal nutrition includes:
    patient teaching, measures to encourage healthy eating habits, and physical activity.
  126. Therapeutic diets are used to promote:
    health, manage disease, or encourage healing.
  127. Various ______ are useful for patients who have nutritional needs.
    community programs
  128. You are taking care of an elderly patient with osteoporosis. Which dietary supplements would be most appropriate as a treatment regimen?
    A. Iron and calcium
    B. Calcium and vitamin D
    C. Vitamin K and B-complex vitamins
    D. Fluoride and iron
    B. Vitamin D actively assists in calcium absorption; osteoporosis is defined as a reduction in bone mass and is commonly related to chronic insufficient calcium intake; thus, increasing calcium intake is necessary. Iron is not indicated for osteoporosis but is more appropriate treatment for a low red blood cell (RBC) count and low hemoglobin. Vitamin K is indicated for formation of prothrombin and other clotting factors; B-complex vitamins assist in various carbohydrate, protein, and glycogen metabolism (B1, B2, B3, folic acid) and formation of RBCs (B12). Fluoride maintains bone/tooth structure but is not directly related to osteoporosis.
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  129. Impaired liver function related to chronic alcohol use may result in inadequate digestive function. Which of the following processes would be impacted? Select all that apply:
    a. Digestion
    b. Absorption
    c. Metabolism
    d. Excretion
    b, c. Alcohol’s toxic effect on the intestinal mucosa can impair the normal absorption of nutrients. Chronic alcohol use can cause irreversible changes to the liver cells, affecting the liver’s role in metabolic pathways.
  130. The following groups must increase their calcium, protein, and iron intakes to prevent nutritional deficits:
    A. Pregnant women
    B. Older adults
    C. Newborns
    D. Lactating women
    A. The diet for pregnant women should include substantial increases in calories, protein, calcium, folic acid, and iron. Lactating women do not need to increase iron, older adults do not need a high-protein diet, and newborns do not need dietary supplements.
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  131. You are providing patient education for a patient with anemia. Which of the following foods should you recommend that the patient includes in her regular diet? Select all that apply:
    a. Beef
    b. Spinach
    c. Milk
    d. Enriched whole wheat bread
    a, b, d. Meat is an excellent source of protein, B-complex vitamins, iron, and zinc. Vegetables provide vitamins A and C, folate, magnesium, and iron. Enriched breads and cereals are good sources of thiamine, iron, niacin, and riboflavin. Milk contains little iron.
  132. In caring for a patient with a history of alcohol abuse, you administer thiamine, niacin, folate, and IV TPN with lipids. Your patient education should consist of which of the following? Select all that apply:
    a. “B-complex vitamin supplements are quickly used up in alcohol metabolism, leaving your body at a deficit.”
    b. “Liver damage impairs your ability to metabolize fats and nutrients.”
    c. “Nutrient absorption in the intestines is impaired by alcohol’s effects on the mucosa.”
    d. “Your appetite and oral intake is excellent; I’ll talk to the physician about canceling these supplements.”
    a, b, c. These are true statements. It is not appropriate to discontinue the vitamins and parenteral nutrition based on oral intake because absorption and metabolism are impaired.
  133. You hear in report that your elderly patient was admitted for malnutrition. In planning for discharge to home, you discuss which of the following issues with the social worker? Select all that apply:
    a. Local food availability
    b. History of depression
    c. Poor-fitting dentures
    d. Impaired mobility
    a, b, c, d. All are important considerations related to nutrition and food availability, particularly for elderly patients.
  134. Your physical assessment findings include poor blood clotting, muscle weakness, and delayed fracture healing. Which of the following nutritional deficits is most likely based on these findings?
    A. Iron deficiency
    B. B-complex deficiency
    C. Calcium deficiency
    D. Protein deficiency
    C. Calcium is important in the conversion of prothrombin to thrombin and other steps of the coagulation process as well as nerve impulse transmission via the formation of acetylcholine and contraction/relaxation of muscles, most notably the heart muscle. Increase in bone fractures and delayed fracture healing are also common in osteoporosis.
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  135. Your patient reports that he just started a new diet including spinach salads daily for lunch and kale, chard, or broccoli for dinner. He has been taking Coumadin for a history of deep vein thrombosis. Which of the following symptoms would be most concerning?
    A. Bleeding gums
    B. International normalized ratio (INR) 2.6
    C. Serum iron within normal limits
    D. Leg pain and swelling
    D. Spinach, kale, chard, and broccoli are all high in vitamin K, which decreases the effectiveness of the anticoagulant Coumadin. Leg pain and swelling would be symptoms of a DVT or clot. Dietary intake of vitamin K should be consistent while on Coumadin; adoption of a new diet indicates the time of highest risk. Bleeding gums indicate anticoagulation, normal levels of iron indicate no blood loss, and an international normalized ratio (INR) of 2.6 is therapeutic while on Coumadin.
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  136. You suspect that your patient is experiencing acute malnutrition. Which lab would give you the best indication of the patient’s current nutritional status?
    A. Low prealbumin
    B. Elevated white blood cell count
    C. Low albumin
    D. Elevated cholesterol
    A. Prealbumin has a half-life of 2 days and accurately assesses protein synthesis and nitrogen balance. It is considered a very sensitive and specific marker for nutritional status. Low albumin indicates a more chronic nutritional problem since the half-life is about 18 days. Low albumin may also be related to overhydration. Elevated white blood cell count may indicate infection not directly related to nutritional status. Low white blood cell count may be exhibited in severe nutritional depletion. Elevated cholesterol does not indicate malnutrition.
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  137. You are monitoring a tube feeding for a patient with altered mental status following a CVA. Which of the following would you do to prevent aspiration?
    A. Hold tube feeding if residual volumes are greater than 100 mL.
    B. Monitor blood glucose two to four times per day while on tube feeding.
    C. Check residual volumes hourly.
    D. Maintain the head of the bed greater than 30 degrees.
    D. Maintaining the head of the bed at 30 to 45 degrees in Fowler’s position at all times when feedings are infusing and 30 minutes after completion of intermittent or continuous feedings minimizes the risk of aspiration. Gastric residual volumes (GRVs) are not correlated with gastric emptying and aspiration and thus cannot be relied on to protect patients. Blood glucose monitoring is not indicated in relation to aspiration.
    (this multiple choice question has been scrambled)
  138. cultural diversity
    Plurality of ideas and opinions for behavior to which people are exposed, adding to the texture and complexity of a society
  139. cultural relativity
    Principle that meaning is created by one’s culture and truth is culture-specific; the same experience may carry different meanings to people of different cultures
  140. culturally competent nursing
    Nursing that has the “attitudes, knowledge, and skills necessary to provide quality care to diverse populations”
  141. culture
    • (1) A society’s behavior and institutions
    • (2) Growth of microorganisms in a specialized medium under precise conditions
  142. culture shock
    Failure to comprehend the culture in which one is living
  143. ethnicity or ethnic identity
    Shared cultural characteristics that symbolize a common group origin
  144. ethnocentrism
    Use of one’s own culture to judge the beliefs, behaviors, attitudes, and values of people of another culture
  145. health disparity
    A “particular type of health difference that is closely linked with social or economic disadvantage”
  146. health equity
    “Attainment of the highest level of health for all people”
  147. implicit bias
    An extension of implicit cultural perspectives that is frequent and long-lasting, functioning at an unconscious level and impacting one’s views, conduct, and recall of events
  148. key informants
    Persons who know and will discuss certain aspects of their culture with someone outside that culture
  149. minority
    Smaller segment of society
  150. race
    Group defined by biologic characteristics
  151. racism
    Oppression and exploitation of people of a different skin color or ethnic origin
  152. rituals
    Common and observable expressions of culture
  153. stereotypes
    Preconceived beliefs about a person or people
  154. subculture
    • Beliefs held by a portion (e.g., occupational or age group) of the larger population
    • transcultural nursing
  155. Culture is defined as:
    a belief system that the members of the culture hold, consciously or unconsciously, as absolute truth. This belief system guides everyday behavior and makes it routine; provides answers to the unanswerable questions of life, sickness, and death; and makes the world make sense. Because culture is unequally shared by its members, culture is more evident in groups or societies than it is in individuals.
  156. Culture enables a person to ______ in contexts that the person shares with members of the same culture.
    behave reasonably
  157. Culture is an integral component of:
    nursing’s knowledge base.
  158. Accurate nursing assessments require that the nurse ______ his or her ethnocentric tendencies and ______ cultural sensitivity.
    • minimize
    • maximize
  159. Patient assessments that consider the patient’s ______ are most likely to yield diagnoses and interventions appropriate to the patient.
  160. Methods to gain the patient’s perspective include:
    open-ended interviewing, a variant of which is the ethnographic interview; the use of key informants; observation over time; and use of the patient’s language.
  161. Which of the following are characteristics of culture? Select all that apply:
    a. Learned
    b. Dynamic
    c. Ethnocentric
    d. Relative to context
    e. Logical
    f. A set of traits
    a, b, c, d. Culture is learned from other people (not innate), changes at variable rates, uses one’s own culture as the correct standard, and is related to the socioecologic context in which it is embedded. Culture is not necessarily logical or reasonable to the outside observer and varies on the level of the individual (not a prescribed set of traits).
  162. Nursing care may be influenced by the culture of both the patient and nurse. Which of the following techniques will assist nurses in performing culturally competent care? Select all that apply:
    a. Minimize ethnocentric tendencies
    b. Knowledge of biocultural variation
    c. Use family as bilingual interpreters
    d. Consider patient perspective
    e. Assign to specific category based on culture
    a, b, d. Accurate nursing assessments require that the nurse minimize ethnocentric tendencies and maximize cultural sensitivity. Patient assessments that consider the patient’s perspective are most likely to yield diagnoses and interventions appropriate to the patient. Trained interpreters are important because interpretation of behavior goes beyond translation of words, thus family members should not be used. Assigning behaviors to a specific category is the definition of a stereotype, and such preconceived descriptors may lead to incorrect assessments and inappropriate and potentially harmful or unethical interventions.
  163. Shared culture is most accurately seen among people with which of the same traits?
    A. Ethnicity
    B. Language
    C. Skin color
    D. Rituals
    D. Rituals are common, observable expressions of culture, particularly used in times of stress and uncertainty. Ethnicity refers to self-conscious, past-oriented form of identity, and meaning depends on who is using it. Skin color and other biologic markers are not necessarily associated with belief systems and may be a detrimental assumption if associated with negative beliefs or actions, as in racism. Language is not indicative of cultural beliefs, and meaning can be modified depending on cultural background or understanding. Verbal language also only accounts for one third of social interaction and may not accurately depict cultural beliefs.
    (this multiple choice question has been scrambled)
  164. When language differences exist between the nurse and patient, the nurse should do which of the following first?
    A. Obtain a key informant to navigate patient’s cultural cues
    B. Act in the patient’s best interest
    C. Establish whether a trained interpreter is needed
    D. Use a bilingual family member to facilitate assessment/care
    C. Trained interpreters assist in behavioral and language translation; interpreters should be provided when requested and at any time when plans for care are being established. Attempting to act in the patient’s best interest may result in incongruence between the nurse’s interpretation of the patient’s best interest and the patient’s actual beliefs. The use of a bilingual family member may limit behavioral interpretation needed for healthcare assessment and interventions. Key informants may be valuable in providing cultural insight; however, in the hospital or clinic setting, the most useful key informants are bicultural trained interpreters.
    (this multiple choice question has been scrambled)
  165. Examples of subcultures include which of the following communities? Select all that apply:
    a. Deaf or hearing impaired
    b. Lesbian, gay, bisexual, transgender, queer (LGBTQ)
    c. HIV/AIDs
    d. Truck drivers
    e. Impoverished
    a, b, c, d. Subcultural identity adheres to a holistic belief system that differs from that of the larger population or maintains beliefs and standards that are unique to a particular social capacity, such as an occupational group. Like ethnic identity, subcultural identity can be a source of social support. The subculture of poverty has been disproven by demonstrating that broad societal mechanisms maintain people in poverty rather than a cultural practice.
  166. anticipatory grief
    Pattern of psychological and physiologic responses a person makes to the impending loss (real or imagined) of a significant person, object, belief, or relationship
  167. bereavement
    Response to the death of a significant person
  168. death
    Cessation of heart-lung function, or of whole-brain function, or of higher-brain function
  169. dying
    End-of-life process in which the lungs become less efficient for gas diffusion and oxygenation, the heart and blood vessels become inadequate to maintain circulation and to perfuse tissues, and the brain ceases to regulate vital centers
  170. dysfunctional grief
    Grief that falls outside normal parameters; may manifest as absence of, delayed, exaggerated, or prolonged grief
  171. grief
    Psychological and physiologic response after the loss of a significant person, object, belief, or relationship
  172. hospice
    Family-focused health service that provides care for terminally ill patients
  173. loss
    Experience of parting with an object, person, belief, or relationship that one values and the sadness that follows the loss requires a reorganization of one or more aspects of the person’s life
  174. mourning
    Behavior after the death of a significant other, which varies among cultures
  175. palliative care
    Specialized care for people with serious illness that emphasizes symptom management and improved quality of life
  176. Loss is a universal experience, and grieving is a ____ response to loss.
  177. Models of the grief process provide direction for
    nursing assessment.
  178. The grief process is similar regardless of
    the type of loss experienced.
  179. A major loss results in
    a long-term life transition.
  180. Response to loss is influenced by the person’s
    stage of development.
  181. The characteristics of the loss, personal resources and stressors, and sociocultural resources and stressors affect
    the grief process.
  182. The outcome of a loss experience is not predetermined but rather is determined by the balance of
    stressors and resources present during the grief period.
  183. Risk of dysfunctional grieving can be identified through analysis of
    the stressors and resources that the patient is experiencing.
  184. Physical health and psychosocial adjustment during the grief process are
    intricately intertwined.
  185. _____ should be based on knowledge of the long-term nature of the grief process.
    Nursing interventions
  186. Many grief manifestations, identified in previous literature as dysfunctional, are considered to be components of
    • the normal grief process.
    • Caution should be used in labeling a patient as having dysfunctional grieving.
  187. Discharge planning must consider the long-term nature of
    the grief process.
  188. End-of-life care should promote quality of life through
    comfort care measures and open communication.
  189. Palliative care should be offered to all patients experiencing
    a serious or life-threatening illness.
  190. Hospice care is a viable option for
    dying patients and their families.
  191. In admitting a patient with confusion and labile affect, the nurse discovers that the patient recently lost his son in a motor vehicle accident. Which nursing diagnosis best describes this patient?
    A. Impaired Family Processes
    B. Anticipatory Grieving
    C. Dysfunctional Grieving
    D. Ineffective Health Maintenance
    C. Dysfunctional Grieving describes unsuccessful use of intellectual and emotional responses by which individuals attempt to work through the process of modifying self-concept based on the perception of loss. Characteristics include difficulty expressing loss, interference with life functioning, and labile affect. Anticipatory Grieving does not reflect the time period following the son’s death. There is not enough information to conclude that there is either Ineffective Health Maintenance or Impaired Family Processes.
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  192. The nurse is caring for an East African family that has just experienced a fetal demise at full term. The family initially refuses to see the stillborn infant. What should the nurse do first?
    A. Provide educational materials about loss of an infant
    B. Assist family members to see the infant in order to gain closure
    C. Evaluate the need for emotional and practical help
    D. Ask the family about their expectations for mourning
    D. Religious and ethnic beliefs and customs should be observed as much as possible in the grief process and caring for the deceased. Assessment of these aspects is a priority according to the nursing process and should also be done prior to interventions or evaluation. Gaining closure through viewing the body is a Western construct of mourning and may not be appropriate for this family. Other interventions and evaluation should follow assessment.
    (this multiple choice question has been scrambled)
  193. A nurse is talking with a wife whose husband just expired. What would appropriate nursing interventions be for someone in the Shock Phase of the Grief Cycle Model? Select all that apply:
    a. Help mobilize a support system
    b. Encourage expression of diverse feelings
    c. Help to establish coping behaviors used in past
    d. Provide role models who have coped with similar loss
    a, c. Helping to mobilize a support system and establish coping behaviors used in the past are appropriate interventions for the Shock Phase. Encouraging the expression of diverse feelings and providing role models are appropriate for the Protest Phase of the Grief Cycle Model.
  194. The nurse is caring for a patient newly diagnosed with metastatic lung cancer. What would be the most appropriate statement for the nurse to make regarding palliative care resources?
    A. “Palliative care is for when you have a prognosis of less than 6 months.”
    B. “Palliative care can only be done once you discharge from the hospital.”
    C. “Palliative care focuses on quality of life and may be used from the time of diagnosis.”
    D. “Once you decide that you don’t want to receive further treatment, palliative care will help keep you comfortable.”
    C. Palliative care is the “active total care for those patients whose diseases are no longer curable and the focus of the treatment is to achieve the best possible quality of care for patients and their families.” It may be used from as early as diagnosis, may be used together with curative treatments, and may occur in the hospital.
    (this multiple choice question has been scrambled)
  195. The nurse is caring for an actively dying, unresponsive patient while the family sits at the bedside. The husband asks “Isn’t she hungry? She hasn’t had anything to eat in 24 hours.” Which response by the nurse would be most appropriate?
    A. “The body doesn’t need food at this stage.”
    B. “Here is a menu—we can order some foods that she enjoys eating.”
    C. “Motility of the stomach and intestines are decreased, so eating could make her nauseous.”
    D. “We should talk to the physician about placing a feeding tube to help with intake.”
    A. Nutrient and metabolic needs are decreased in active stages of dying. Placing a feeding tube would not be appropriate in an actively dying patient since this is a surgical procedure. Ordering desirable foods may be appropriate for dying patients; however, this patient is unresponsive. Gastromotility is decreased in the dying process, but this is not the best answer since the patient is unable to eat due to her lack of responsiveness; nausea is not the primary concern.
    (this multiple choice question has been scrambled)
  196. agnosticism
    Belief that God’s reality is unknown and unknowable
  197. atheism
    Denial of God’s existence
  198. faith
    Belief held; a relational phenomena
  199. holism
    Seeing the universe—and the patient—as a system of connected parts rather than a sum of isolated parts
  200. spiritual care
    Mutual, potentially healing or integrating process in which the patient’s spiritual needs are met
  201. spiritual crisis
    A unique form of grieving or loss, which is accompanied by profound questioning about life and its meaning
  202. spiritual dimension
    Quality beyond religious affiliation that strives for inspiration, reverence, awe, meaning, and purpose, even for those who do not believe in any god
  203. spirituality
    Sacred or holy matters that belong to or relate to a god or church
  204. spiritual need
    Normal expression of a person’s inner being that seeks meaning in all experience and a dynamic relationship with self, others, and the supreme other as the person defines it
  205. spiritual well-being
    Condition marked by an affirmation of life and a sense of unity with God, self, community, and environment
  206. theism
    Belief in God
  207. Spirituality, like the role of philosophy, is to help people ask the right questions and develop a view of
    life rather than answer the questions.
  208. The spiritual dimension is the essence of a person and is expressed in the need to
    seek meaning in experiences and to make a spiritual journey through life.
  209. Spiritual well-being is the condition in which a person is at peace with
    God, self, community, and environment.
  210. Fowler’s stages of faith have parallels to
    Piaget’s stages of cognitive development and Erikson’s stages of psychosocial development.
  211. Nurses may provide _________ care if they have not fully addressed their own spirituality and spiritual well-being and if they hesitate to encourage the patient to speak of personal spirituality.
    inadequate or inappropriate
  212. Altered spiritual function may be expressed
    verbally or through various altered behaviors.
  213. Every patient has the right to practice his or her spirituality according to personal preference. The nurse should not be judgmental but should
    assist the patient in fulfilling those needs.
  214. Nursing interventions include use of
    self, spiritual support, support of religious practices, listening and supporting, and referral.
  215. A teen has recently survived a car accident in which his friend was killed. The nurse assigns the nursing diagnosis of Spiritual Distress. Which of the following statements would best support this diagnosis?
    A. “I just want to sleep!”
    B. “Why did I have to survive?”
    C. “I need some time alone; can’t we do this later?”
    D. “I don’t want those pills!”
    B. Evidence of survivor guilt is related to spiritual distress. Requesting time alone may indicate effective coping or spiritual well-being. Using sleep as a coping mechanism may be ineffective but does not indicate spiritual distress. Refusing medications or refusing to participate in the therapeutic regimen is evidence of noncompliance, not spiritual distress.
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  216. An elderly woman has recently become a resident in a skilled nursing facility as a result of her worsening health conditions. Which of the following may lead to impaired spiritual health? Select all that apply:
    A. Anger at treatment regimen
    B. Lack of transportation to usual meditation group
    C. Lack of concentration and short-term memory
    D. Fear about living in a new environment
    B. Lack of transportation to attend a spiritual group could cause impaired spiritual health. Anger, lack of concentration or memory, and fear describe manifestations of altered spiritual function.
    (this multiple choice question has been scrambled)
  217. A Catholic patient is anxious related to her hospitalization. The nurse attending to her is Buddhist. Which statement is most appropriate for the nurse to make?
    A. “Don’t worry; many patients are anxious about being in the hospital.”
    B. “I have to give pain medications to another patient, so I’ll leave you alone to pray.”
    C. “Do you have a Bible or book of Psalms that I can read to you?”
    D. “I can’t pray with you; we believe in different Gods.”
    C. Statement C best displays understanding of the patient’s spiritual needs by the nurse, despite differing beliefs. Statement A shows avoidance and a lack of attention to the importance of spiritual care. Statement B shows fear and a lack of comfort with spiritual care. Statement D fails to address the patient’s need for spirituality for coping.
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  218. A nurse is developing outcome criteria for a patient’s plan of care regarding the patient with spiritual distress. Which of the following is an appropriate criterion?
    A. Patient identifies support provided by family.
    B. Patient verbalizes feelings.
    C. Patient expresses satisfaction with tie to faith community within 1 month.
    D. Patient expresses increased understanding and acceptance of current situation.
    C. Outcome criteria phrasing should be specific, measurable, and include a time frame. Other statements lack time frames or reflect broad patient goals.
    (this multiple choice question has been scrambled)
  219. A nurse is caring for a patient with terminal lung cancer. Which of the following would indicate potential risk for spiritual distress? Select all that apply:
    a. Patient has had many visitors while hospitalized.
    b. Patient formerly sang in the local choir, quitting due to shortness of breath.
    c. Patient is a member of a church group and attends regular mass.
    d. Disease prognosis is terminal with projected mortality within 3 months.
    b, d. Illness that forces a patient to change his or her way of living may lead to spiritual distress. A terminal diagnosis also may lead the patient to question meaning in life and end of life beliefs. Many visitors indicate social support and reinforce spirituality. Membership in a group, particularly a religious or spiritual group, indicates both social support and a strong faith-based belief system that may assist in coping.
  220. circadian rhythms
    Regular occurrence of certain phenomena in cycles of about 24 hours
  221. enuresis
    Involuntary voiding with underlying pathophysiologic origin after the age that bladder control is usually achieved; nocturnal enuresis is bedwetting
  222. fatigue
    A subjective state of weariness; lack of energy
  223. hypnotics
    Medications that induce or maintain sleep
  224. hypopnea
    Shallow breathing
  225. insomnia
    Difficulty sleeping; may be characterized by trouble falling or staying asleep or by waking too early
  226. narcolepsy
    Sleep disorder characterized by sudden, uncontrollable episodes of sleep
  227. parasomnias
    Group of disorders (e.g., sleepwalking, enuresis) involving autonomic and motor activity associated with partial arousal from sleep
  228. polysomnography
    Polygraph recordings of electrophysiologic changes in brain waves (electroencephalogram), eye movements (electrooculogram), and muscles (electromyogram)
  229. rest
    Physical and emotional state of decreased muscle and cognitive activity
  230. sleep
    Readily reversible state of altered consciousness in which awareness and responsiveness to the environment are decreased
  231. sleep deficiency
    An inadequate amount of, or mistimed, sleep
  232. sleep-disordered breathing
    • (SDB)
    • A cluster of disorders associated with difficulty breathing and sleeping at the same time
  233. sleep health
    Sleep of adequate duration occurring at appropriate times of the day with sustained alertness during waking hours
  234. sleepiness
    Refers to an urge of varying intensity to go to sleep
  235. sleep latency
    Time it takes one to get to sleep after going to bed
  236. sleep loss
    Lack of sufficient sleep
  237. somnambulism
  238. sleep sufficiency
    Also called sleep health, is sleep of adequate duration occurring at appropriate times of the day with sustained alertness during waking hours
  239. Sleep is a naturally occurring behavioral state of
    decreased awareness and responsiveness to environmental surroundings.
  240. Rest is a physical and emotional state of
    decreased muscle and cognitive activity.
  241. Sleep and rest are important for
    health and recovery from illness.
  242. The two main types of sleep are
    • NREM and REM sleep:
    • NREM sleep consists of three stages—stage N1, stage N2, and stage N3 or SWS.
    • REM sleep is similar to wakefulness in terms of brain activity, but muscle tone is absent and vital signs are highly variable.
  243. Young adults progress through stages 1–2–3–2–REM in cycles of
    approximately 90 minutes.
  244. Sleep duration and architecture change
    throughout the life span.
  245. Infants have frequent sleep cycles ______ throughout the day and night.
    evenly distributed
  246. Adequate sleep is associated with
    waking up feeling alert and refreshed and with an absence of daytime sleepiness.
  247. Factors affecting sleep and rest include
    environmental stimuli, nutrition, exercise, illness, and hospitalization.
  248. Sleep disorders are common in both adults and children and include
    insomnia, SDB, narcolepsy, RLS, and PLMD, and the parasomnias.
  249. Anticipating changes in sleep and needs for rest can contribute to promotion of a healthy balance between
    rest and activity and a recognition that sleep changes are developmentally normal.
  250. A patient seen at an annual physical is observed to be irritable and unable to concentrate. When questioned about his behavior, he attributes it to working two full-time jobs. What nursing diagnosis would be most appropriate?
    A. Sleep deprivation
    B. Coping
    C. Activity intolerance
    D. Disturbed sleep pattern
    A. Sleep deprivation is prolonged periods of time without sleep. Disturbed sleep patterns are characterized by complaints of difficulty falling asleep, awakening, dissatisfaction, and statements of fatigue. Coping may be indicated if the patient has normal sleep patterns but desires sleep as a method of avoidance. Activity intolerance is not evident in this statement.
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  251. A postoperative patient with a history of OSA is admitted to your unit. With which assessment finding would you be most concerned?
    A. Oxygen desaturation to 90% when asleep
    B. Oxygen saturation of 94% when transferred to the room
    C. Blood pressure 138/90
    D. Patient difficult to arouse
    E. Apneic periods lasting more than 10 seconds
    D. Apneic and other chronically sleep deprived patients may have more pronounced sedation due to medications effects. Apneic periods for more than 10 seconds are a normal finding for a patient with obstructive sleep apnea (OSA). During transfer, a patient would be disturbed and not likely apneic at that time. Continuous monitoring of patients with OSA should be done to capture saturation levels while asleep. Patients with OSA commonly have elevated blood pressure; this blood pressure is not the most concerning finding.
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  252. A patient complains about inability to sleep in the hospital. Which of the following nursing interventions would be most beneficial to do first?
    A. Clustering nursing care to limit disturbances at night
    B. Providing warm milk like the patient has at home
    C. Transferring the patient to a room away from the nursing station
    D. Complete a pain assessment
    D. A pain assessment should be done first to determine if pain is the stimuli disturbing the patient’s sleep.
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  253. Which of the following factors influence sleep and rest needs? Select all that apply.
    A. Relationships
    B. Nutrition
    C. Shift work
    D. Developmental stage
    E. Alcohol
    D. The amount of sleep/rest may vary with developmental stage. Relationships, nutrition, alcohol, and shift work are factors in acquiring sleep/rest, not in amount needed.
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  254. Normal circadian rhythms would be seen in which of the following individuals?
    A. A 1-year-old pediatric patient
    B. A patient who is homebound without social contact
    C. Nurse who works in a hospital with variable night shifts
    D. Businesswoman traveling abroad
    A. A 1-year-old pediatric patient should exhibit normal circadian rhythms. People living alone without regular occupational or social contact are at risk for disturbed circadian rhythms. Variable night shift work and travel across time zones can impair the sleep–wake cycle.
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  255. Laxatives are used to
    ease or stimulate defecation.
  256. Laxatives work by
    softening the stool, increasing stool volume, hastening fecal passage through the intestine, and facilitating evacuation from the rectum.
  257. When properly used, laxatives are valuable medications. However, these agents are also
    subject to abuse.
  258. Misuse of laxatives is largely the result of
    misconceptions about what constitutes normal bowel function.
  259. The term laxative effect refers to production of
    a soft, formed stool over a period of 1 or more days.
  260. The term catharsis refers to
    a prompt, fluid evacuation of the bowel.
  261. The principal function of the colon is to
    absorb water and electrolytes.
  262. When the colon is working correctly, the extent of fluid absorption is such that the resulting stool is
    soft (but formed) and capable of elimination without strain.
  263. When fluid absorption is excessive, as can happen when transport through the intestine is delayed, the resultant stool is _____________. Conversely, if insufficient fluid is absorbed, _______ result.
    • dehydrated and hard
    • watery stools
  264. Frequency of bowel evacuation
    varies widely among individuals.
  265. Proper function of the bowel is highly dependent on
    dietary fiber.
  266. Fiber facilitates colonic function in two ways:
    • (1) fiber absorbs water, thereby softening the feces and increasing their mass;
    • (2) fiber can be digested by colonic bacteria, whose subsequent growth increases fecal mass.
  267. Constipation is defined in terms of symptoms, which include
    hard stools, infrequent stools, excessive straining, prolonged effort, a sense of incomplete evacuation, and unsuccessful defecation.
  268. Constipation is determined more by _______ than by ______________.
    • stool consistency (degree of hardness)
    • how often bowel movements occur
  269. A common cause of constipation is
    • poor diet
    • specifically, a diet deficient in fiber and fluid.
    • Other causes include dysfunction of the pelvic floor and anal sphincter, slow intestinal transit, and use of certain drugs.
  270. In most cases, constipation can be readily corrected. Stools become softer and more easily passed within days of
    increasing fiber and fluid in the diet.
  271. Laxatives can be highly beneficial when used for
    valid indications.
  272. Laxatives may be used in association with
    episiotomy, hemorrhoids, anorectal lesions, cardiovascular disease, and loss of muscle tone in the abdomen and perineum, and as an adjunct to anthelmintic therapy.
  273. Applications for laxatives include
    • (1) emptying of the bowel before surgery and diagnostic procedures;
    • (2) modifying the effluent from an ileostomy or colostomy;
    • (3) preventing fecal impaction in bedridden patients;
    • (4) removing ingested poisons; and
    • (5) correcting constipation associated with pregnancy and certain drugs, especially opioid analgesics.
  274. Laxatives are contraindicated for individuals with
    certain disorders of the bowel, acute surgical abdomen, or fecal impaction or obstruction of the bowel.
  275. Laxatives should not be used
    habitually to manage constipation.
  276. Laxatives should be used with caution during
    pregnancy and lactation.
  277. Traditionally, laxatives have been classified according to general mechanism of action. This scheme has four major categories:
    • (1) bulk-forming laxatives,
    • (2) surfactant laxatives,
    • (3) stimulant laxatives, and
    • (4) osmotic laxatives.
  278. From a clinical perspective, it can be useful to classify laxatives according to therapeutic effect:
    • Group I agents act rapidly (within 2 to 6 hours) and give a watery consistency to the stool.
    • Group II agents have an intermediate latency (6 to 12 hours) and produce a stool that is semifluid.
    • Group III laxatives act slowly (in 1 to 3 days) to produce a soft but formed stool.
  279. The bulk-forming laxatives have actions and effects much like those of dietary fiber.
    • After ingestion, these agents, which are nondigestible and nonabsorbable, swell in water to form a viscous solution or gel, thereby softening the fecal mass and increasing its bulk.
    • Transit through the intestine is hastened because swelling of the fecal mass stretches the intestinal wall, thereby stimulating peristalsis.
  280. Bulk-forming laxatives are preferred agents for
    temporary treatment of constipation.
  281. Bulk-forming laxatives are widely used in patients with
    diverticulosis and irritable bowel syndrome.
  282. Bulk-forming laxatives, by altering fecal consistency, they can provide symptomatic relief of
    diarrhea and can reduce discomfort and inconvenience for patients with an ileostomy or colostomy.
  283. Bulk-forming laxatives side effects:
    Untoward effects are minimal.
  284. Bulk-forming laxatives should be administered with
    a full glass of water or juice.
  285. If their passage through the intestine is arrested, bulk-forming agents may
    produce an intestinal obstruction or impaction.
  286. The surfactants are group _____ laxatives; they produce a soft stool ______ after the onset of treatment.
    • III
    • several days
  287. Surfactants alter stool consistency by
    lowering surface tension, which facilitates the penetration of water into the feces.
  288. The surfactants may also act on the intestinal wall to:
    • (1) inhibit fluid absorption and
    • (2) stimulate secretion of water and electrolytes into the intestinal lumen.
  289. The surfactant family consists of
    two docusate salts: docusate sodium and docusate calcium.
  290. Administration of surfactant laxatives should be accompanied by
    a full glass of water.
  291. The stimulant laxatives have two effects on the bowel.
    • (1) they stimulate intestinal motility.
    • (2) they increase the amount of water and electrolytes within the intestinal lumen.
  292. Most stimulant laxatives are group ____ agents—they act on the colon to produce a semifluid stool within _____ after treatment.
    • II
    • 6 to 12 hours
  293. Stimulant laxatives are widely used—and abused—by the general public and are a concern for this reason. They have few
    legitimate applications.
  294. Two applications of stimulant laxatives that are legitimate are
    • (1) treatment of opioid-induced constipation and
    • (2) treatment of constipation resulting from slow intestinal transit.
  295. ______ is unique among the stimulant laxatives in that it can be administered by rectal suppository as well as by mouth.
  296. Oral bisacodyl acts within
    6 to 12 hours.
  297. Bisacodyl suppositories act ______ (in _____ minutes).
    • rapidly
    • 15 to 60
  298. ______, a type of stimulant laxative, is plant-derived and contains anthraquinones, its active ingredients.
    • Senna
    • The actions and applications of senna are similar to those of bisacodyl.
  299. ______ is the only stimulant laxative that acts on the small intestine.
    • Castor oil
    • As a result, the drug acts quickly (in 2 to 6 hours) to produce a watery stool.
    • Castor oil belongs to group I.
  300. The laxative salts are poorly absorbed salts that have an ______ action that draws water into the intestinal lumen.
  301. Accumulation of water causes the fecal mass to _____, thereby ____ the intestinal wall, which stimulates peristalsis.
    • soften and swell
    • stretching
  302. The two groups of laxative salts are:
    • (1) magnesium salts (magnesium hydroxide, magnesium citrate, and magnesium sulfate), and
    • (2) one sodium salt (sodium phosphate).
  303. Osmotic laxatives can cause substantial loss of water. To prevent dehydration, patients should:
    increase their fluid intake.
  304. In patients with renal impairment, magnesium can accumulate to toxic levels. Accordingly, magnesium salts are contraindicated in patients with
    kidney disease.
  305. Sodium absorption (from sodium phosphate) can cause fluid retention, which in turn can exacerbate
    heart failure, hypertension, and edema.
  306. Polyethylene glycol (PEG) is an _____ laxative used widely for chronic constipation.
    • osmotic
    • Like the laxative salts, PEG is a nonabsorbable compound that retains water in the intestinal lumen, causing the fecal mass to soften and swell.
  307. The most common adverse effects of osmotic laxatives are:
    nausea, abdominal bloating, cramping, and flatulence. High doses may cause diarrhea.
  308. Lubiprostone is the first representative of a new class of drugs:
    the selective chloride channel activators.
  309. By activating chloride channels in epithelial cells lining the intestine, lubiprostone:
    • (1) promotes the secretion of chloride-rich fluid into the intestine and
    • (2) enhances motility in the small intestine and colon. The result is spontaneous evacuation of a semisoft stool, usually within 24 hours.
  310. Lubiprostone has two indications:
    • (1) chronic idiopathic constipation in adults and
    • (2) irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
  311. Lubiprostone should be taken with _______ to avoid nausea, the most common side effect.
    food and water.
  312. Other gastrointestinal (GI) effects of lubiprostone
    • include diarrhea, abdominal distention, abdominal pain, gas, vomiting, and loose stools.
    • Headache is the major non-GI effect.
  313. Colonoscopy is the most effective method for
    early detection of colorectal cancer, the second leading cause of cancer deaths in the United States. Before the procedure, the bowel must be cleansed to permit good visualization.
  314. Three kinds of bowel cleansers are used to prepare the bowel for a colonoscopy:
    • (1) polyethylene glycol (PEG), a nonabsorbable osmotic agent, plus electrolytes (ELS);
    • (2) sodium phosphate; and
    • (3) a combination of sodium picosulfate, magnesium oxide, and citric acid.
  315. The PEG-ELS bowel-cleansing solutions are _____ with body fluids; therefore, water and electrolytes are neither absorbed from nor secreted into the intestinal lumen.
  316. PEG-ELS products are generally well tolerated. The most common adverse effects are
    nausea, bloating, and abdominal discomfort.
  317. Sodium phosphate is an ______ laxative that draws water into the intestinal lumen, which then softens and swells the fecal mass, which then stretches the intestinal wall to stimulate peristalsis.
  318. The sodium phosphate products can cause:
    nausea, bloating, and abdominal discomfort.
  319. By drawing a large volume of fluid into the intestinal lumen, sodium phosphate can cause:
    • dehydration.
    • To prevent dehydration, patients must drink a large volume of clear fluid before, during, and after dosing.
  320. One combination product, magnesium oxide/anhydrous citric acid/sodium picosulfate (Prepopik) is approved for
    preparation of colonoscopy in adults.
  321. As with _______ products, Prepopik can cause __________. Caution must be employed in patients with __________. The most common adverse reactions are ___________.
    • sodium phosphate
    • electrolyte and fluid imbalances, renal impairment, seizures, and arrhythmia secondary to electrolyte abnormalities
    • reduced renal function
    • nausea, headache, and vomiting
  322. Many people believe that a _______ bowel movement is a requisite of good health and that any deviation from this pattern merits correction.
    daily and bountiful
  323. Laxatives can ________ their own use. Strong laxatives can purge the entire bowel. When this occurs, spontaneous evacuation is impossible until bowel content has been replenished, which can take 2 to 5 days.
    help perpetuate
  324. The first step in breaking the laxative habit is _______ of laxative use. After drug withdrawal, bowel movements will be absent for several days; the patient should be informed of this fact.
    abrupt cessation
  325. Any _______ that the patient has about bowel function should be corrected.
  326. The patient should be taught that a ________ bowel movement may not be normal for him or her and that stool quality is more important than frequency or quantity.
    • once-daily
    • Instruction on bowel training, fiber, fluid, and exercise should be provided.
  327. A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement when?
    A. In 15 minutes to 1 hour
    B. In 2 to 4 hours
    C. In 1 to 3 days
    D. In 6 to 12 hours
    • D. In 6 to 12 hours
    • Low-dose (30 mL) milk of magnesia, an osmotic laxative, acts to retain water and soften the feces. Fecal swelling promotes peristalsis in 6 to 12 hours.
  328. A patient with hepatic encephalopathy receives lactulose. The nurse expects which therapeutic outcome if the medication is having the desired effect?
    A. Less ascitic fluid
    B. Normal serum sodium level
    C. Reduced ammonia level
    D. Release of glycogen stores
    • C. Reduced ammonia level
    • Some practitioners use lactulose to reduce blood ammonia levels by forcing ammonia from the blood into the colon. Lactulose is useful for treating patients with hepatic encephalopathy. It does not result in less ascitic fluid, a normal serum sodium level, or release of glycogen stores.
  329. A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium [Metamucil] for 2 weeks. Which is the nurse's priority action?
    A. Consult the physician about another laxative choice.
    B. Check the dose, because an increase may be indicated.
    C. Ask whether the patient is toileting at the same time every day.
    D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.
    • D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.
    • Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240 mL) of liquid, plus additional liquid each day, to prevent intestinal impaction. Another laxative may not be necessary at this time. A dosage increase and monitoring are appropriate after proper mixing of the medication has been validated.
  330. A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl [Dulcolax]. When does the nurse administer the medication?
    A. Just before bedtime
    B. Before the morning bath
    C. At the evening meal
    D. After ambulating
    • A. Just before bedtime
    • Oral bisacodyl is a stimulant laxative that acts within 6 to 12 hours. When given at bedtime, it produces a response the next morning. Administration at another time might produce a bowel movement at an inconvenient time, such as during a meal or in the middle of the night.
  331. A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative?
    A. Mineral oil
    B. Polyethylene glycol–electrolyte solution [GoLYTELY]
    C. Magnesium salts (magnesium citrate)
    D. Docusate sodium [Colace]
    • B. Polyethylene glycol–electrolyte solution [GoLYTELY]
    • GoLYTELY, an osmotic laxative, produces a watery stool in 2 to 6 hours. It is isosmotic with body fluids, so it causes no fluid or electrolyte imbalance and thus can be used safely in patients with an electrolyte impairment. Magnesium salts are contraindicated in patients with renal dysfunction. Mineral oil is more useful when administered by enema for fecal impaction. Docusate sodium produces results in 1 to 3 days.
  332. A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug?
    A. "My doctor says that I've developed colon polyps."
    B. "I only have a bowel movement when I take the medicine."
    C. "The dental hygienist said I was losing the enamel on my teeth."
    D. "I've noticed that I'm having tremors now in my left hand."
    • B. "I only have a bowel movement when I take the medicine."
    • Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.
  333. The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in 2 doses. The nurse knows that this medication is used for which indication?
    A. Preparation before a colonoscopy
    B. Preparation before an abdominal surgery
    C. Prevention of constipation
    D. Treatment of constipation
    • A. Preparation before a colonoscopy
    • Magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] is approved for preparation of colonoscopy in adults. Sodium picosulfate is a stimulate laxative and the magnesium oxide and citric acid combine to form magnesium citrate, an osmotic laxative. Prepopik is given in a split dose regimen. The first dose is taken the evening before the colonoscopy and the second dose the next morning prior to the procedure.
  334. The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication?
    A. In the morning, before breakfast
    B. In the morning, after breakfast
    C. In the afternoon, before lunch
    D. In the evening, before bed
    • B. In the morning, after breakfast
    • Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bed time so as to avoid disrupting sleep. For convenience and patient ease, a fast acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.
  335. The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.)
    A. Abdominal pain
    B. Diverticulitis
    C. Constipation
    D. Bowel obstruction
    E. Pregnancy
    • A. Abdominal pain
    • B. Diverticulitis
    • D. Bowel obstruction
    • Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.
  336. The nurse expects laxatives to be ordered for which of the following patients? (Select all that apply.)
    A. A patient with chronic pain
    B. A patient recovering from cardiac surgery
    C. A patient who recently delivered a child
    D. A patient with acute food poisoning
    E. A patient with no bowel sounds
    • A. A patient with chronic pain
    • B. A patient recovering from cardiac surgery
    • C. A patient who recently delivered a child
    • Laxatives are used for correcting constipation associated with certain drugs, especially opioid analgesics, which would probably be used for chronic pain. By softening the stool, laxatives can reduce the painful elimination that can be associated with episiotomy and with hemorrhoids associated with child birth. In patients with cardiovascular diseases (eg, aneurysm, myocardial infarction, disease of the cerebral or cardiac vasculature), softening the stool decreases the amount of strain needed to defecate, thereby avoiding dangerous elevation of blood pressure.
  337. What are the 4 types of gastrointestinal (GI) drugs.
    • (1) antiemetics,
    • (2) antidiarrheals,
    • (3) drugs for irritable bowel syndrome, and
    • (4) drugs for inflammatory bowel disease.
  338. Antiemetics are given to suppress
    nausea and vomiting.
  339. Emesis is a complex reflex brought about by activation of
    • the vomiting center, a nucleus of neurons in the medulla oblongata.
    • Some stimuli activate the vomiting center directly; others act indirectly.
  340. Direct-acting stimuli that may induce vomiting include signals from:
    • the cerebral cortex (anticipation or fear),
    • sensory organs (upsetting sights, noxious odors, or pain), and
    • the vestibular apparatus of the inner ear.
  341. Indirect-acting stimuli that may induce vomiting first activate the ______________, which in turn activates the vomiting center.
    chemoreceptor trigger zone (CTZ)
  342. Activation of the CTZ occurs in two ways:
    • (1) by signals from the stomach and small intestine (traveling along vagal afferents); and
    • (2) by the direct action of emetogenic compounds carried to the CTZ in the blood.
  343. Once activated, the vomiting center signals the ___________; the resulting coordinated response expels gastric contents.
    stomach, diaphragm, and abdominal muscles
  344. _______________ are the most effective drugs available for suppressing nausea and vomiting caused by cisplatin and other highly emetogenic anticancer drugs, radiation therapy, anesthesia, viral gastritis, and pregnancy.
    Serotonin receptor antagonists
  345. Four serotonin antagonists are available for treating emesis:
    • ondansetron,
    • granisetron,
    • dolasetron, and
    • palonosetron.
  346. Ondansetron was the first serotonin receptor antagonist approved for ______________. The drug is also used to prevent nausea and vomiting associated with radiotherapy and anesthesia. In addition, the drug is used off-label to treat nausea and vomiting from other causes, including childhood viral gastritis and morning sickness of pregnancy.
    chemotherapy-induced nausea and vomiting (CINV)
  347. Benefits of ondansetron derive from blocking of _____________ located in the CTZ and on afferent vagal neurons in the upper GI tract.
    type 3 serotonin (5-hydroxytryptamine) receptors (5-HT3 receptors)
  348. Ondansetron is very effective by itself and even more effective when combined with
  349. The most common side effects of ondansetron are:
    headache, diarrhea, and dizziness.
  350. What are the two glucocorticoids commonly used to suppress CINV, even though they are not approved for this application by the U.S. Food and Drug Administration (FDA).
    • methylprednisolone and dexamethasone
    • Glucocorticoids are effective alone and in combination with other antiemetics.
    • The mechanism by which glucocorticoids suppress emesis is unknown.
  351. What are the two substance P/neurokinin1 antagonists currently available?
    • aprepitant and fosaprepitant
    • fosaprepitant is a prodrug that undergoes conversion to aprepitant in the body
    • Their principal application is prevention of CINV.
    • Owing to its unique mechanism of action—blockade of neurokinin1-type receptors (for substance P) in the CTZ—aprepitant can enhance responses when combined with other antiemetic drugs.
  352. Aprepitant is generally well tolerated. Compared with patients receiving ondansetron and dexamethasone, those receiving aprepitant plus ondansetron and dexamethasone experience:
    • more fatigue, asthenia, hiccups, dizziness, and diarrhea.
    • (asthenia - abnormal physical weakness or lack of energy.)
  353. Aprepitant is a substrate for, inhibitor of, and inducer of ____________, a major drug-metabolizing enzyme.
    CYP3A4 (the 3A4 isoenzyme of cytochrome P450)
  354. What is used in combination regimens to suppress CINV.
  355. Lorazepam has three principal benefits:
    sedation, suppression of anticipatory emesis, and production of anterograde amnesia.
  356. Lorazepam may help control _________________ caused by phenothiazine antiemetics.
    extrapyramidal reactions
  357. The phenothiazines suppress emesis by blocking _______________ receptors in the CTZ.
  358. These drugs can reduce emesis associated with surgery, cancer chemotherapy, and toxins.
  359. Side effects of phenothiazines include:
    extrapyramidal reactions, anticholinergic effects, hypotension, and sedation.
  360. What phenothiazine is the most widely used antiemetic in young children, despite its dangers (respiratory depression and local tissue injury) and despite the availability of safer alternatives (e.g., ondansetron).
    • promethazine
    • Respiratory depression from promethazine can be severe. Deaths have occurred. Because of this risk, promethazine is contraindicated in children under 2 years of age.
  361. What two butyrophenones are used as antiemetics?
    haloperidol and droperidol
  362. The butyrophenones suppress emesis by blocking
    • _____________receptors in the CTZ.
    • dopamine2
  363. Butyrophenones are effective against:
    postoperative nausea and vomiting, as well as emesis caused by cancer chemotherapy, radiation therapy, and toxins.
  364. Potential side effects of butyrophenones are:
    extrapyramidal reactions, sedation, and hypotension.
  365. What drug may pose a risk of fatal dysrhythmias owing to prolongation of the QT interval?
    • Droperidol
    • Accordingly, patients receiving the drug should undergo electrocardiography prior to administration.
  366. Metoclopramide suppresses emesis through blockade of __________ receptors in the CTZ.
  367. What drug can suppress postoperative nausea and vomiting, as well as emesis caused by anticancer drugs, opioids, toxins, and radiation therapy.
  368. What are the two cannabinoids approved for medical use in the United States.
    • dronabinol and nabilone
    • Both drugs are related to marijuana.
    • Both dronabinol and nabilone are approved for suppression of CINV.
    • The mechanism underlying their benefits is unknown but most likely results from activation of the cannabinoid receptors in and around the vomiting center.
  369. Because of their psychotomimetic effects and abuse potential, the ______________ are considered second-line drugs for CINV and therefore should be reserved for patients who are unresponsive to or intolerant of preferred agents.
  370. In addition to its use in CINV, ____________ is approved for stimulating appetite in patients with acquired immunodeficiency syndrome.
    • dronabinol (but not nabilone)
    • Potential unpleasant effects include temporal disintegration, dissociation, depersonalization, and dysphoria.
  371. Due to their abuse potential, _____________ is classified under Schedule III and __________ under Schedule II of the Controlled Substances Act.
    • dronabinol
    • nabilone
  372. Many anticancer drugs cause:
    severe nausea and vomiting, leading to dehydration, electrolyte imbalances, nutrient depletion, and esophageal tears. Worse yet, these reactions can be so intense that patients may discontinue chemotherapy rather than endure further discomfort.
  373. Chemotherapy is associated with three types of emesis:
    • (1) anticipatory,
    • (2) acute, and
    • (3) delayed.
  374. Antiemetics are more effective at _________ CINV than at _______________.
    • preventing
    • suppressing CINV that has already begun
    • Accordingly, antiemetics should be administered before chemotherapy.
  375. The antiemetic regimen for a particular patient is based on the ___________ of the chemotherapy drugs used.
    emetogenic potential
  376. The current regimen of choice for patients taking highly emetogenic drugs consists of three agents:
    • aprepitant plus dexamethasone plus a 5-HT3 antagonist.
    • Lorazepam may be added to reduce anxiety and anticipatory emesis and to provide amnesia.
  377. Nausea and vomiting of pregnancy (NVP) is extremely common, especially during
    the first trimester.
  378. NVP can be managed with
    drugs and with nondrug measures.
  379. NVP first-line drug therapy consists of a two-drug combination:
    doxylamine plus vitamin B6.
  380. If doxylamine and vitamin B6 fail to suppress NVP, alternatives include
    prochlorperazine, metoclopramide, and ondansetron.
  381. What drug may be tried as a last resort for NVP, but only after 10 weeks of gestation.
  382. Motion sickness can be caused by sea, air, automobile, and space travel. Symptoms are
    nausea, vomiting, pallor, and cold sweats.
  383. Drug therapy for motion sickness is most effective when given
    prophylactically rather than after symptom onset.
  384. __________, a muscarinic antagonist, is the most effective drug for preventing and treating motion sickness.
  385. Scopolamine's benefits derive from suppression of:
    nerve traffic in the neuronal pathway that connects the vestibular apparatus of the inner ear to the vomiting center.
  386. The most common side effects of scopolamine are:
    dry mouth, blurred vision, and drowsiness.
  387. The antihistamines used most often for motion sickness are:
    dimenhydrinate, meclizine, and cyclizine.
  388. Suppression of motion sickness appears to result from blocking of ________ and ____________ receptors in the neuronal pathway that connects the inner ear to the vomiting center.
    • histaminergic (H1)
    • muscarinic cholinergic
  389. The most prominent side effect—sedation—results from blocking of ____ receptors. Other side effects—dry mouth, blurred vision, urinary retention, and constipation—result from blocking of _____ receptors.
    • H1
    • muscarinic
  390. Diarrhea is characterized by stools of:
    excessive volume and fluidity and by increased frequency of defecation.
  391. Management of diarrhea is directed at:
    • (1) diagnosis and treatment of the underlying disease,
    • (2) replacement of lost water and salts,
    • (3) relief of cramping, and
    • (4) reducing passage of unformed stools.
  392. Antidiarrheal drugs are divided into two major groups:
    • (1) specific antidiarrheal drugs and
    • (2) nonspecific antidiarrheal drugs.
  393. ______ are the most effective antidiarrheal agents available.
  394. By activating ________ receptors in the GI tract, these drugs reduce intestinal motility and thus slow intestinal transit, which allows more time for the absorption of fluid and electrolytes.
    • opioid
    • In addition, activation of opioid receptors reduces the secretion of fluid into the small intestine and increases the absorption of fluid and salt.
    • At the doses used to relieve diarrhea, subjective effects and dependence do not occur. However, excessive doses can elicit typical morphine-like subjective effects.
  395. What are the several opioid preparations are approved for diarrhea.
    diphenoxylate, difenoxin, loperamide, paregoric, and opium tincture
  396. What opioid preparations are the most frequently used?
    diphenoxylate and loperamide
  397. ________ is an opioid used only for diarrhea. It is formulated in combination with atropine. The atropine is present to discourage _______ abuse; doses of the combination that are sufficiently high to produce euphoria from the _______ would produce unpleasant side effects from the correspondingly high dose of atropine.
  398. ____________ is a structural analog of __________. The drug is used to treat diarrhea and to reduce the volume of discharge from ileostomies.
    • Loperamide
    • meperidine
  399. Infectious diarrhea may be produced by enteric infection with a variety of
    • bacteria and protozoa.
    • These infections usually are self-limited.
    • In many cases, no treatment is required at all.
  400. Antibiotics should be administered for diarrhea only when clearly indicated. Indiscriminate use of antibiotics is undesirable in that
    • (1) it can promote the emergence of antibiotic resistance; and
    • (2) it can produce an asymptomatic carrier state by killing most, but not all, of the infectious agents.
  401. Tourists often are plagued by
    infectious diarrhea.
  402. In most cases, the causative organism for infectious diarrhea is
    • Escherichia coli.
    • As a rule, treatment is unnecessary; infection with E. coli is self-limited and runs its course in a few days.
  403. If symptoms from infectious diarrhea are especially severe, treatment with one of the __________ antibiotics is indicated; __________ is preferred for children.
    • fluoroquinolone
    • azithromycin
  404. Several measures can reduce the acquisition of traveler’s diarrhea. Two measures ______ and ______ are highly effective.
    • avoiding local drinking water
    • carefully washing foods
  405. ___________ is a gram-positive, anaerobic bacillus that infects the bowel. Injury results from the release of bacterial toxins. Symptoms range from relatively mild to very severe, even death.
    Clostridium difficile
  406. __________ is the most common disorder of the GI tract.
    Irritable bowel syndrome (IBS)
  407. IBS is characterized by
    crampy abdominal pain, sometimes severe, that occurs in association with diarrhea, constipation, or both.
  408. IBS has four major forms, characterized by:
    • 1 - Abdominal pain in association with diarrhea (diarrhea-predominant IBS, IBS-D)
    • 2 - Abdominal pain in association with constipation (constipation-predominant IBS, IBS-C)
    • 3 - Abdominal pain in association with alternating episodes of diarrhea and constipation (mixed IBS, IBS-M)
    • 4 - Abdominal pain in association with alternating episodes of diarrhea and constipation less than 25% of the time (unsubtyped IBS, IBS-U)
    • Despite extensive research, no underlying pathophysiologic mechanism has been identified; the bowel simply appears to be hypersensitive and hyperresponsive.
  409. Two groups of drugs are used for treatment of IBS:
    • nonspecific drugs
    • drugs specifically for IBS
  410. Only three drugs are approved for IBS:
    • alosetron (approved for IBS-D) and
    • lubiprostone and tegaserod (both approved for IBS-C).
    • Owing to a risk of serious cardiovascular events, tegaserod is used rarely and then only in emergency situations.
  411. ______ is a potentially dangerous drug approved for severe IBS-D in women.
  412. IBS-D is considered severe if the patient experiences one or more of the following:
    • (1) frequent and severe abdominal pain or discomfort,
    • (2) frequent bowel urgency or fecal incontinence, and
    • (3) disability or restriction of daily activities because of IBS.
  413. Alosetron causes selective blockade of _____ receptors, which are found primarily on neurons that innervate the viscera.
  414. In patients with IBS-D, alosetron can:
    reduce abdominal pain, increase colonic transit time, reduce intestinal secretions, and increase absorption of water and sodium.
  415. Alosetron has _______ interactions with other drugs.
    no known adverse
  416. Although alosetron is generally well tolerated, it can cause severe adverse effects including:
    • Death
    • The most common problem is constipation, which can be complicated by impaction, bowel obstruction, and perforation.
    • In addition, alosetron can cause ischemic colitis.
  417. To ensure the best possible benefit/risk ratio, the manufacturer and the FDA have established a risk management program that involves the active participation of:
    the patient, prescriber, and pharmacist.
  418. Inflammatory bowel disease (IBD) has two forms:
    Crohn’s disease and ulcerative colitis.
  419. Crohn’s disease is characterized by ___________ and usually affects ____________, but it also can affect ______________.
    • transmural inflammation
    • the terminal ileum
    • all other parts of the GI tract
  420. Ulcerative colitis is characterized by:
    inflammation of the mucosa and submucosa of the colon and rectum.
  421. Both Crohn's disease and ulcerative colitis produce _____________. Ulcerative colitis may cause ___________ as well.
    • abdominal cramps and diarrhea
    • rectal bleeding
  422. There is general agreement that IBD results from:
    an exaggerated immune response directed against normal bowel flora, but only in genetically predisposed people.
  423. Five types of drugs are used in therapy:
    • 5-aminosalicylates,
    • glucocorticoids,
    • immunosuppressants,
    • immunomodulators, and
    • antibiotics.
    • None of these drugs is curative; at best, drugs may control the disease process.
  424. The ____________ are used to treat mild or moderate ulcerative colitis and Crohn’s disease and to maintain remission after symptoms have subsided.
  425. What four types of aminosalicylates are available:
    sulfasalazine, mesalamine, olsalazine, and balsalazide.
  426. Sulfasalazine belongs to the same chemical family as ___________. However, although similar to the ______________, sulfasalazine is not used to treat _________. Its only approved indications are ____________.
    • the sulfonamide antibiotics
    • sulfonamides
    • infections
    • IBD and rheumatoid arthritis
  427. 5-Aminosalicylic acid (5-ASA) is the component responsible for reducing _________; sulfapyridine is responsible for _______________.
    • inflammation
    • adverse effects
  428. Possible mechanisms by which 5-ASA reduces inflammation include:
    suppression of prostaglandin synthesis and suppression of the migration of inflammatory cells into the affected region.
  429. Nausea, fever, rash, and arthralgia are common adverse effects of:
  430. Hematologic disorders (e.g., agranulocytosis, hemolytic anemia, macrocytic anemia) also may occur with use of:
  431. ____________ can relieve symptoms of ulcerative colitis and Crohn’s disease. Their benefits derive from antiinflammatory actions.
  432. Glucocorticoids are indicated primarily for___________ in ulcerative colitis and Crohn's disease, not for long-term maintenance.
    induction of remission
  433. Prolonged use of glucocorticoids can cause severe adverse effects, including
    adrenal suppression, osteoporosis, increased susceptibility to infection, and a cushingoid syndrome.
  434. Immunosuppressants are used for long-term therapy of selected patients with:
    ulcerative colitis and Crohn’s disease.
  435. Although not approved for IBD, ______ and _______ have been used with success to induce and maintain remission in patients with either ulcerative colitis or Crohn’s disease.
    • azathioprine and mercaptopurine
    • Because these drugs are more toxic than aminosalicylates or glucocorticoids, they are generally reserved for patients who have not responded to traditional therapy.
  436. What three immunomodulators are inhibitors of tumor necrosis factor-alpha (TNF), and what fourth immunomodulator interferes with alpha4 integrin are
    • all used to treat IBD?
    • infliximab, certolizumab, and adalimumab
    • natalizumab
    • Some authorities now recommend their use early in treatment, with the hope of inducing remission quickly and maintaining remission longer.
  437. In clinical trials, _____________ reduced symptoms in 65% of patients with moderate to severe Crohn’s disease and produced clinical remission in 33%. Good responses are also seen in ulcerative colitis.
  438. _______ drugs increase the tone and motility of the GI tract. Indications include gastroesophageal reflux disease, CINV, and diabetic gastroparesis.
  439. Metoclopramide has two beneficial actions:
    it increases upper GI motility and suppresses emesis.
  440. In high-dose therapy using metoclopramide, what side effects are common? What can long-term high-dose therapy cause?
    • sedation and diarrhea
    • irreversible tardive dyskinesia
  441. __________ is the first drug to be approved for reducing oral mucositis (OM), a serious and painful complication of cancer chemoradiotherapy.
  442. Palifermin acts through ___________ receptors (which are not found on cells of hematopoietic origin) and stimulates proliferation, differentiation, and migration of epithelial cells.
    keratinocyte growth factor
  443. __________ is approved for reducing the incidence and duration of severe oral mucositis (OM), but only in patients with hematologic malignancies and then only in those receiving high-dose chemotherapy and whole-body irradiation.
  444. Palifermin is generally well tolerated. The most common reactions are:
    rash, erythema, edema, pruritus, distortion of taste, thickening and/or discoloration of the tongue, and oral or perioral dysesthesias.
  445. A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective?
    A. Scopolamine [Transderm Scop] and lorazepam [Ativan]
    B. Prochlorperazine [Compazine] and diphenhydramine [Benadryl]
    C. Ondansetron [Zofran] and dimenhydrinate [Dramamine]
    D. Aprepitant [Emend] and ondansetron [Zofran]
    • D. Aprepitant [Emend] and ondansetron [Zofran]
    • Regimens for preventing CINV may include medications such as a serotonin receptor antagonist (ondansetron); the substance P/neurokinin1antagonist aprepitant; and a benzodiazepine (lorazepam). Scopolamine and dimenhydrinate are indicated for motion sickness, not CINV; diphenhydramine is an antihistamine indicated for allergic reactions.
  446. A patient going on a vacation cruise is prescribed a scopolamine transdermal patch for motion sickness. The nurse teaches the patient to recognize which side effect?
    A. Increased heart rate
    B. Dry mouth
    C. Irritability
    D. Urinary frequency
    • B. Dry mouth
    • Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance that is a common cause of motion sickness. The most common side effects are dry mouth, blurred vision, and drowsiness. Urinary retention occurs less frequently. An increased heart rate and irritability are not associated effects.
  447. A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent?
    A. Loperamide [Imodium]
    B. Alosetron [Lotronex]
    C. Bismuth subsalicylate [Pepto-Bismol]
    D. Paregoric (camphorated opium tincture)
    • A. Loperamide [Imodium]
    • Opioids are the most effective antidiarrheal agents that activate opioid receptors in the gastrointestinal tract, thus slowing intestinal transit. This action allows more time for fluid and electrolyte absorption in the colon. Loperamide, a structural analog of meperidine, is used to reduce the volume of discharge from ileostomies. Alosetron is a dangerous medication that is approved only for irritable bowel syndrome–diarrhea (IBS-D). Paregoric is not appropriate as an antidiarrheal for longer-term use, because it has moderate potential for abuse. Bismuth subsalicylate is effective only for mild diarrhea.
  448. A nurse should offer which fluid choice to a patient with acute diarrhea?
    A. Low-fat milk
    B. Apple juice
    C. Coffee with cream
    D. Prune juice
    • B. Apple juice
    • Managing fluids and electrolytes is a high priority for patients with acute diarrhea because of the risk for dehydration. Clear liquids, such as apple juice, do not irritate the gastrointestinal (GI) tract. Milk products and other liquids, such as prune juice, which is not considered a clear liquid, could further irritate the GI tract.
  449. A nurse administers metoclopramide [Reglan] to a patient who is having nausea and vomiting postoperatively. The nurse should expect which therapeutic action if the medication is having the desired result?
    A. Blocking of serotonin and dopamine receptors
    B. Inactivation of histaminergic (H1) receptors
    C. Activation of chloride channels in the intestine
    D. Reduced motility in the small intestine
    • A. Blocking of serotonin and dopamine receptors
    • Metoclopramide works by blocking serotonin and dopamine receptors in the chemoreceptor trigger zone (CTZ) and by increasing motility in the small intestine. This action minimizes gastric distention and the accompanying stimulation of the vomiting center. Metoclopramide does not block H1 receptors or activate chloride channels in the intestine.
  450. A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine [Azulfidine]. Which statement by the patient would indicate understanding of the information?
    A. "My tongue may become discolored and my taste altered."
    B. "I may have constipation, so I'll increase my fluid intake."
    C. "I'll report any fatigue or sore throat and fever to my doctor."
    D. "I'll immediately report any chest pain or shortness of breath."
    • C. "I'll report any fatigue or sore throat and fever to my doctor."
    • Sulfasalazine is used to treat ulcerative colitis by suppressing inflammation. It has the adverse hematologic effects of agranulocytosis, hemolytic anemia, and macrocytic anemia. Patients should report any signs of infection and/or fatigue. Altered taste, tongue discoloration, constipation, chest pain, and shortness of breath are not effects associated with sulfasalazine.
  451. A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy?
    A. Brain
    B. Breast
    C. Leukemia
    D. Lung
    • C. Leukemia
    • In the treatment of oral mucositis, palifermin acts through keratinocyte growth factor (KGF) receptors to stimulate the proliferation and migration of epithelial cells. Because these receptors are not found on cells of hematopoietic origin, palifermin is used only in hematologic malignancies. Palifermin is not indicated for oral mucositis treatment in patients with solid tumors of the brain or breast or for lung cancer.
  452. A patient who has had a pancreatectomy is taking pancrelipase [Viokase]. Which finding would the nurse use to evaluate the effectiveness of this drug?
    A. Increase in flatulence
    B. Reduction in fatty stools
    C. Resolution of jaundice
    D. Decrease in abdominal distention
    • B. Reduction in fatty stools
    • A deficiency of pancreatic enzymes through pancreatectomy or pancreatitis may compromise digestion, especially the digestion of fats. Fatty stools are characteristic of the deficiency. Replacement of pancreatic enzymes with pancrelipase results in a reduction of fat excretion through the stools. An increase in flatulence, resolution of jaundice, and a decrease in abdominal distention are not therapeutic effects of pancrelipase.
  453. A nurse should teach a patient who takes alosetron [Lotronex] for diarrhea-prominent irritable bowel syndrome (IBS-D) to stop the medication immediately if the patient develops which condition?
    A. Blurred vision
    B. Heart palpitations
    C. Bruising
    D. Constipation
    • D. Constipation
    • Alosetron selectively blocks serotonin receptors on neurons that innervate the viscera, thereby reducing the symptoms associated with IBS-D. Serious complications of constipation and ischemic colitis can be life-threatening. According to the risk management program established by the manufacturer and the U.S. Food and Drug Administration (FDA), treatment with alosetron should be stopped immediately if either of these conditions develops. Blurred vision, heart palpitations, and bruising are not adverse effects of alosetron.
  454. Why is intramuscular (IM) administration of promethazine [Phenergan] preferred over intravenous (IV) administration?
    A. The risk of respiratory depression is eliminated with IM injection.
    B. Extravasation of IV promethazine can lead to abscess formation or tissue necrosis.
    C. Extrapyramidal reactions do not occur when the drug is administered IM.
    D. IM injection has a more rapid onset of action.
    • B. Extravasation of IV promethazine can lead to abscess formation or tissue necrosis.
    • Extravasation of IV promethazine can lead to abscess formation, tissue necrosis, and gangrene, leading to amputation; therefore, IV administration should be avoided. If it must be done, promethazine should be given through a large-bore IV line. Respiratory depression and extrapyramidal side effects can occur regardless of the route of administration. Drugs administered IM have a longer onset of action than those given IV.
  455. An adult patient in a physician's office reports severe diarrhea after returning from a trip to Mexico. Which medication might be prescribed for this patient?
    1. Ciprofloxacin [Cipro] 500 mg twice daily
    2. Sulfasalazine [Azulfidine] 500 mg daily
    3. Metoclopramide [Reglan] 10 mg three times daily 30 minutes before meals and at bedtime
    4. Ondansetron [Zofran] 8 mg three times daily
    • 1. Ciprofloxacin [Cipro] 500 mg twice daily
    • Traveler's diarrhea, when severe, can be treated with ciprofloxacin, levofloxacin, or norfloxacin. Sulfasalazine is indicated for the treatment of mild to moderate ulcerative colitis; it is not used for the treatment of infection. Oral metoclopramide, a prokinetic agent, is administered for the treatment of diabetic gastroparesis and suppression of gastroesophageal reflux. Ondansetron is used for the treatment of emesis related to chemotherapy, radiation, and anesthetic agents.
  456. Which medication is useful for stimulating the appetite in patients with acquired immunodeficiency syndrome (AIDS)?
    1. Aprepitant [Amend]
    2. Ondansetron [Zofran]
    3. Dronabinol [Marinol]
    4. Metoclopramide [Reglan]
    • 3. Dronabinol [Marinol]
    • Dronabinol is used to stimulate the appetite in patients with AIDS. It is administered before lunch and dinner. Aprepitant, ondansetron, and metoclopramide are used to prevent and treat emesis.
  457. Which medications are used in the treatment plan for chemotherapy-induced nausea and vomiting? (Select all that apply.)
    1. Lorazepam [Ativan]
    2. Meclizine [Antivert]
    3. Dolasetron [Anzemet]
    4. Loperamide [Imodium]
    5. Dexamethasone [Decadron]
    • 1. Lorazepam [Ativan]
    • 3. Dolasetron [Anzemet]
    • 5. Dexamethasone [Decadron]
    • Lorazepam, a benzodiazepine, is used in combination regimens to suppress CINV. Dolasetron and dexamethasone also are used in the treatment of CINV. Meclizine is most often used to treat motion sickness, and loperamide is used to treat diarrhea.
  458. Palliative care is:
    • a holistic approach to care or treatment that focuses on reducing the severity of disease symptoms, rather than trying to delay or reverse the progression of the disease itself or provide a cure.
    • Treatment should align with the patients’ preferences for care and cultural beliefs and values.
  459. The overall goals of palliative care are to:
    • (1) prevent and relieve suffering and
    • (2) improve quality of life for patients with serious, life-limiting illnesses.
  460. Palliative care includes:
    curative care, hospice, end of life, and bereavement following death.
  461. Hospice is:
    not a place but a concept of care that provides compassion, concern, and support for the dying.
  462. Hospice care is provided by:
    an interprofessional team of professionals and volunteers in a variety of locations including the home, inpatient setting, and long-term care facilities.

    Hospice care can be on a part-time, intermittent, on-call, regularly scheduled, or continuous basis. Hospice services are available 24 hours a day and 7 days a week to provide help to patients and families in their homes.
  463. Admission to a hospice program has two criteria:
    • (1) The patient must desire the services and
    • (2) two physicians must certify that the patient has 6 months or less to live.
    • Patients must not be receiving curative, life-prolonging treatments.

    • Death occurs when:
    • all vital organs and body systems irreversibly cease to function.
    • Brain death is:
    • an irreversible loss of all brain functions, including the brainstem.
    • Brain death is a clinical diagnosis.
  464. End-of-life care (EOL care) is the term currently used for:
    issues related to death and dying, as well as services provided to address these issues.
  465. The goals for EOL care are to:
    • (1) provide comfort and supportive care during the dying process,
    • (2) improve the quality of the patient’s remaining life,
    • (3) help ensure a dignified death, and
    • (4) provide emotional support to the family.
  466. Certain symptoms are more prevalent at the EOL, including:
    • respiratory distress and shortness of breath (dyspnea).
    • The sensation of air hunger results in anxiety for the patient and family.
  467. Noisy, wet-sounding respirations, termed the death rattle or terminal secretions, are caused by:
    mouth breathing and accumulation of mucus in the airways.
  468. Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of:
    apnea and deep, rapid breathing.
  469. Most terminally ill and dying people:
    do not want to be alone and fear loneliness.
  470. Grief is a normal reaction to loss. It is dynamic and includes both:
    psychologic and physiologic responses following a loss.
  471. Priority interventions for grief must focus on providing:
    an environment that allows the patient to express feelings.
  472. Bereavement is:
    the period following the death of a loved one during which grief is experienced and mourning occurs.
  473. The objective of a bereavement program is to provide:
    support and to assist survivors in the transition to a life without the deceased person.
  474. People who are dying deserve and require:
    the same physical care as people who are expected to recover.
  475. To meet the holistic needs of the patient, collaborate with:
    the social worker, chaplain, physical therapist, occupational therapists, unlicensed assistive personnel (UAP), and physician.
  476. Spirituality is defined as:
    • those beliefs, values, and practices that relate to the search for existential meaning and purpose and that may or may not include a belief in a higher power.
    • The patient’s and family’s preferences related to spiritual guidance or pastoral care services should be noted.
  477. Culture affects decision-making with regard to:
    life support and withholding and withdrawing of treatments.
  478. Legal issues that should be discussed prior to death are the choice for
    • (1) organ and tissue donations,
    • (2) advance directives (e.g., medical power of attorney, living wills), and
    • (3) resuscitation.
  479. Advance directives are:
    written statements of a person’s wishes regarding medical care, including the desire to withhold or withdraw treatments.
  480. A DNR is:
    a written medical order that documents a patient’s or family’s wishes regarding resuscitation—most importantly, the desire for the use of CPR.
  481. __________ and _______ need ongoing information of the disease, signs and symptoms of the dying process, and any care that will be provided.
    Patients and families
  482. Assessment of the terminally ill or dying patient varies with:
    the patient’s condition and proximity of approaching death.
  483. As death approaches, you need to respond appropriately to the patient’s psychosocial manifestations, including:
    fear, anxiety, anger, powerlessness, and hopelessness.
  484. Physical care at the end of life focuses on:
    • oxygen, nutrition, pain relief, elimination, and skin care.
    • People who are dying deserve the same physical care as people who are expected to recover.
  485. It is important not to _______ pain relief measures to a terminally ill patient.
    delay or deny
  486. Skin integrity is difficult to maintain at the end of life because of:
    • immobility;
    • urinary and bowel incontinence;
    • dry skin;
    • nutritional deficits;
    • anemia;
    • friction; and
    • shearing forces.
  487. The patient near death may seem to be withdrawn from the physical environment, but maintaining the ability to:
    hear while not able to respond.
  488. After the patient is pronounced dead, prepare or delegate preparation of the body for immediate viewing by the family with consideration for _____________ and in accord with ______ and _______ and _______.
    • cultural customs
    • state law and agency policies and procedures

    • The role of caregivers includes:
    • working and communicating with the patient, supporting the patient’s concerns, helping the patient resolve any unfinished business, working with other family members and friends, and dealing with the caregiver’s own needs and feelings.
  489. An understanding of the grieving process as it affects both is of great importance.
    the patient and family
  490. Recognizing signs and behaviors among family members who may be at risk for ________ is an important nursing intervention.
    abnormal grief reactions
  491. Caring for dying patients is ______ and ______. It is important to consider interventions that help to ease physical and emotional stress for you.
    intense and emotionally charged
  492. Caring for patients and their families at the end of life is:
    challenging and rewarding, but also intense and emotionally charged.
  493. It is common to feel helpless and powerless when dealing with death. It is important to recognize your own:
    values, attitudes, and feelings about death.
  494. To promote your own health when caring for patients and their families at end of life focus on strategies to decrease stress:
    Get involved in hobbies or other interests, schedule time for yourself, ensure time for sleep, maintain a peer support system, and develop a support system beyond the workplace.
  495. During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness?
    A. Frustration with pain
    B. Anorexia and nausea
    C. Feelings of hopelessness
    D. Inability to carry out activities of daily living
    C. Feelings of hopelessness
    Feelings of hopelessness are likely to be present in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. The nurse should routinely assess for depression when working with patients with a terminal illness.

    A patient with terminal cancer tells the nurse, “I know I am going to die pretty soon, perhaps in the next month.” What is the most appropriate response by the nurse?
    A. “What are your feelings about being so sick and thinking you may die soon?”
    B. “None of us know when we are going to die. Is this a particularly difficult day?”
    C. “Would you like for me to call your spiritual advisor so you can talk about your feelings?”
    D. “Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you.”
    • A. “What are your feelings about being so sick and thinking you may die soon?”
    • The most appropriate response to psychosocial questions is to acknowledge the patient’s feelings and explore his or her concerns. This option does both and is a helpful response that encourages further communication between the patient and nurse.
  496. The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. How would the nurse interpret the general prognosis of the patient?
    A. 3 months or less to live
    B. 6 months or less to live
    C. 12 months or less to live
    D. 18 months or less to live
    • B. 6 months or less to live
    • There are two criteria to be eligible for hospice care. The first is that the patient wishes to receive hospice, not curative care, and the second is that the physician certifies that the patient has a prognosis of 6 months or less to live.
  497. A patient has been receiving palliative care for the past several weeks in light of a worsening condition after a series of strokes. The caregiver has rung the call bell, stating that the patient now “stops breathing for a while, then breathes fast and hard, and then stops again.” What should the nurse document that the patient is experiencing?
    A. Apnea
    B. Bradypnea
    C. Death rattle
    D. Cheyne-Stokes respirations
    • D. Cheyne-Stokes respirations
    • Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing. This type of breathing is usually seen as a person nears death.
  498. A patient died after a myocardial infarction experienced while performing yard work. What would indicate that his spouse is experiencing prolonged grief disorder?
    A. Initially, the spouse denied the death.
    B. Talking about the spouse extensively in year after the death
    C. Stating that the spouse will return on the anniversary of the death
    D. Crying uncontrollably and unpredictably in the weeks after the spouse’s death
    • C. Stating that the spouse will return on the anniversary of the death
    • Denial of an individual’s death that persists beyond 6 months is indicative of prolonged grief disorder. Strong emotions or denial immediately after the death are considered to be expected responses. Talking about the deceased loved one is not considered to be evidence of the disorder.
  499. How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient’s life?
    A. Assess the individual patient’s wishes.
    B. Call a pastor or priest for the family to help them cope.
    C. Assess the beliefs and preferences of the patient and family.
    D. Do not insult African Americans by suggesting hospice care.
    • C. Assess the beliefs and preferences of the patient and family.
    • Differences among spiritual and culture beliefs and values related to death and dying are innumerable. The individual patient and family must be assessed to avoid stereotyping individuals with different spiritual and cultural belief systems.
  500. When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death?
    A. The patient responds to noises.
    B. The patient’s skin is mottled and waxlike.
    C. The heart rate and blood pressure increase.
    D. The patient is reviewing his life with his family.
    • B. The patient’s skin is mottled and waxlike.
    • When a patient is very near death, the skin will be waxlike, cold, clammy, and mottled or cyanotic. Although hearing is the last sense patients lose before death, it is unlikely that they will be responding to noises when very near death. Initially, the heart rate increases but later slows, and the blood pressure decreases. Near death, speaking may be slow and unusual and indicate confusion.
  501. When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue?
    A. Euthanasia
    B. Organ donor card
    C. Advance directives
    D. Do not resuscitate (DNR)
    • C. Advance directives
    • Advance directives are written documents that provide information about the patient’s wishes for medical care and treatments and his or her designated spokesperson. Euthanasia is not a form; it is a deliberate act of hastening death. Organ donor cards only state that the patient wants to donate organs or their body for transplants or for scientific research. DNR or comfort measures is a written order from the physician that documents a patient’s wishes to avoid CPR.
  502. A dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient’s needs?
    A. Encourage more physical activity.
    B. Assess for pain, constipation, and urinary retention.
    C. Assess for spiritual distress and restrain in varying positions.
    D. Assess for quality, intensity, location, and contributing factors of discomfort.
    • B. Assess for pain, constipation, and urinary retention.
    • Assessing for all reversible causes of delirium (i.e., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness. Encouraging more physical activity may prevent further skin breakdown, but it will be difficult because weakness and fatigue are expected at the end of life. Keeping the skin clean and dry and preventing shearing forces will better avoid further skin breakdown. Spiritual distress may be a cause of restlessness, but the patient should not be restrained.
  503. The nurse is evaluating whether a hospice referral is appropriate for a patient with end-stage liver failure. What is one of the two criteria necessary for admission to a hospice program?
    A. The hospice medical director certifies admission to the program.
    B. The physician guarantees the patient has less than 6 months to live.
    C. The patient has completed both advance directives and a living will.
    D. The patient wants hospice care and agrees to terminate curative care.
    • D. The patient wants hospice care and agrees to terminate curative care.
    • There are two criteria for admission to a hospice program. The first criterion is the patient must desire the services and agree in writing that only hospice care (and not curative care) can be used to treat the terminal illness. The second criterion is that the patient must be considered eligible for hospice. Two physicians must certify that the patient’s prognosis is terminal with less than 6 months to live.
  504. The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family?
    A. The patient will be incontinent of urine after frequent seizures.
    B. The skin will feel cold and clammy, with mottling on the extremities.
    C. The patient will have increased pain, and the sense of touch will be enhanced.
    D. The gag reflex is exaggerated, and the patient will exhibit deep, rapid respirations.
    • B. The skin will feel cold and clammy, with mottling on the extremities.
    • As death approaches, the following physical manifestations occur: cold, clammy skin; mottling on hands, feet, arms, and legs; jerking (not seizures), which occurs in patients on large amounts of opioids; bowel and bladder incontinence; decreased perception of pain and touch; loss of gag reflex; and Cheyne-Stokes respirations.
  505. A patient near death from metastatic cancer becomes restless and confused. What interventions would be the most appropriate for the nursing management of these symptoms?
    A. Avoid administering pain medication until the patient is calm and alert.
    B. Stay physically close to the patient and use a soothing voice and soft touch.
    C. Turn on the television to provide a distraction and contact the hospital chaplain.
    D. Restrain the patient to prevent injury and ask family and visitors to leave the room.
    • B. Stay physically close to the patient and use a soothing voice and soft touch.
    • Appropriate interventions for restlessness and confusion when a patient is near death include using soft touch and voice, staying physically close to the patient, and remaining calm. Use soothing music instead of the radio or television. Make referrals (e.g., hospital chaplain, spiritual leader) based on patient’s spiritual and cultural preferences. Family visitors may provide comfort. Uncontrolled pain may be the cause of restlessness and confusion. Withholding pain medication or restraining the patient would be inappropriate and may cause more restlessness.
  506. A patient admitted for pneumonia informs the nurse that no one is to attempt CPR. What is important for the nurse to verify in the medical record related to the patient’s directive?
    A. The physician has written and signed the DNR order.
    B. The living will is signed by the patient and two witnesses.
    C. The patient’s durable power of attorney agrees with the decision.
    D. There is an advance directive related to artificial nutrition and hydration.
    • A. The physician has written and signed the DNR order.
    • CPR will be performed for respiratory or cardiac arrest unless a DNR (do not resuscitate) order is written and signed by the physician in the patient’s medical record. The DNR order documents the patient’s desire to avoid CPR.
  507. After a patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient?
    A. Maintain daily contact with the adolescent’s family for the next 2 to 3 months.
    B. Request a prescription for an anxiolytic to aid in dealing with the death of this patient.
    C. Attend a debriefing session with interprofessional team to allow expression of feelings.
    D. Avoid caring for any other patients who are terminally ill until the feelings of grief subside.
    • C. Attend a debriefing session with interprofessional team to allow expression of feelings.
    • The nurse needs to express feelings of loss and grief. Interventions such as a peer support, professionally assisted groups, and informal discussion sessions are appropriate ways for the nurse to express feelings related to death and dying.
  508. Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply.)?
    A. Strong spiritual beliefs
    B. Advanced age of the patient
    C. Medical diagnosis of the patient
    D. Acceptance of the expected death of the patient
    E. Adequate time for the caregiver to prepare for the death
    • A. Strong spiritual beliefs
    • D. Acceptance of the expected death of the patient
    • E. Adequate time for the caregiver to prepare for the death
    • Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief. The age and diagnosis of the patient are not key factors in influencing the quality of the anticipatory grief of the caregiver.
  509. Sleep is a state during which:
    an individual lacks conscious awareness of environmental surroundings and from which he or she can be easily aroused. It is a basic, dynamic, highly organized, and complex behavior that is essential for normal functioning and survival.
  510. Most adults require _____ hours of sleep within a 24-hour period.
    7 to 8
  511. Sleep duration equal to or less than __ hours and more than or equal to __ hours in adults is associated with higher illness rates and early death.
    • 6
    • 9
  512. ______ controls the cyclic changes between waking and sleeping.
    The central nervous system (CNS)
  513. Wake behavior is associated with:
    • an activated cortical brain wave pattern.
    • Various neurotransmitters and neuropeptides (glutamate, acetylcholine, noradrenaline, dopamine, histamine, serotonin, orexin) are involved in wake behavior.
  514. Sleep behavior is regulated by:
    • a variety of neurologic structures.
    • Sleep-promoting neurotransmitters and peptides include GABA, galanin, melatonin, adenosine, somatostatin, growth-hormone–releasing hormone, and proinflammatory cytokines.
  515. Sleep architecture is based on _________ recordings, sleep is divided into rapid eye movement (REM) and non–rapid eye movement (NREM) sleep.
    polysomnography (PSG)
  516. Sleep disturbances resulting in insufficient sleep are associated with:
    poor sleep quality and with health problems such as obesity.
  517. Sleep loss alters:
    immune function, reduces body temperature, and decreases growth hormone and prolactin.
  518. Fragmented or broken sleep is common in patients with:
    medical and psychiatric disorders.
  519. With respect to sleep patterns, hospitalization, especially in the intensive care unit (ICU), is associated with:
    sleep loss and sleep disturbances.
  520. What contributes to poor sleep?
    Environmental factors, medications, illness severity, and mechanical ventilation contribute to poor sleep.
  521. You have a critical role in creating an environment conducive to sleep, such as:
    scheduling activities, turning off lights, and reducing noise.
  522. The most common sleep disorder is:
  523. What contributes to acute and chronic insomnia?
    Behaviors, lifestyle, diet, and medications contribute to acute and chronic insomnia.
  524. Symptoms of insomnia include:
    difficulty falling asleep (long sleep latency), frequent awakenings (fragmented sleep), prolonged nighttime awakenings or awakening too early and not being able to fall back to sleep, and feeling unrefreshed on awakening.
  525. The diagnosis of insomnia is made based on:
    symptom self-report and on an evaluation of a 1- or 2-week sleep log or diary completed by the patient.
  526. Treatments for insomnia are oriented toward:
    symptom management and behavior change.
  527. Many individuals with insomnia self-medicate with:
    over-the-counter sleep aids.
  528. ___________ is recommended as a first-line therapy for chronic insomnia.
    Sleep hygiene
  529. _________ and _______ medications are effective for improving sleep, but the benefits for improving daytime functioning are less certain.
    Hypnotic and sedative
  530. Nonpharmacologic therapies for sleep include:
    cognitive behavioral therapy-insomnia (CBT-I), yoga, and stress management.
  531. Sleep assessment is important in helping patients to:
    identify behaviors and environmental factors (e.g., noise, temperature) that contribute to poor sleep.
  532. Specific nursing diagnoses identified as related to sleep include:
    readiness for enhanced sleep, sleep deprivation, disturbed sleep pattern, and insomnia.
  533. Good sleep hygiene practices provide:
    sustained benefit for the patient.
  534. The term sleep-disordered breathing (SDB) indicates:
    abnormal respiratory patterns associated with sleep.
  535. Obstructive sleep apnea (OSA) is:
    the most commonly diagnosed sleep-disordered breathing problem.
  536. Clinical manifestations of OSA include:
    partial or complete upper airway obstruction during sleep, frequent arousals during sleep, insomnia, excessive daytime sleepiness, snoring, and witnessed apneic episodes.
  537. Mild sleep apnea may respond to simple measures:
    e.g., sleeping on one’s side rather than on the back
  538. In patients with more severe symptoms from OSA, ______ is the treatment of choice.
    continuous positive airway pressure (CPAP) by mask
  539. When patients with OSA are hospitalized, be aware that the use of _____ and _____ may worsen OSA symptoms by depressing respiration. Patients should continue CPAP use in the hospital.
    opioid analgesics and sedating medications
  540. Periodic limb movement disorder (PLMD) is characterized by:
    involuntary, continual movement of the legs and/or arms occurring only during sleep.
  541. Periodic limb movement disorder (PLMD) is managed through:
    medications that improve sleep and reduce the incidence of leg movements, particularly newer-generation dopaminergic drugs.
  542. Circadian rhythm disorders occur when:
    the circadian timekeeping system loses synchrony with sleep and wake cycles.
  543. Jet lag disorder occurs when:
    • an individual travels across multiple time zones.
    • One’s body time is not synchronized with environmental time. Patients can be taught strategies to combat jet lag.
  544. Narcolepsy is:
    a chronic neurologic disorder characterized by excessive daytime sleepiness and unpredictable transitions from wake to sleep. The cause of narcolepsy remains unknown, but it is considered an autoimmune disease.
  545. Narcolepsy is diagnosed based on:
    a history of sleepiness, PSG, and daytime multiple sleep latency tests (MSLTs).
  546. Drug therapy with _________ and _______ is the main treatment for narcolepsy.
    amphetamine-like stimulants (modafinil [Provigil]), and tricyclic antidepressant drugs
  547. High doses of _________ may be prescribed for the management of cataplexy.
    • selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine [Prozac], venlafaxine [Effexor])
    • Cataplexy is a sudden, brief loss of voluntary muscle tone triggered by strong emotions such as laughter. The condition is most commonly associated with narcolepsy, a sleep disorder affecting less than 1% of the general population. Cataplexy occurs during waking hours.
  548. None of the current drug therapies cure narcolepsy or allow patients to consistently maintain a full, normal state of alertness. Drug therapy is combined with:
    behavioral strategies.
  549. Parasomnias are:
    unusual and often undesirable behaviors that occur with sleep or during arousal from sleep. They are due to central nervous system activation and often involve complex behaviors.
  550. What are two types of arousal parasomnias?
    Sleepwalking and sleep terrors are arousal parasomnias.
  551. __________ are a parasomnia characterized by recurrent awakening with recall of the frightful or disturbing dream.
    • Nightmares
    • Nightmares are commonly reported by patients in the ICU.
  552. All aspects of sleep, including the duration, depth, and continuity of sleep, change with:
  553. Older adults self-report _______ problems getting to and maintaining sleep compared with younger adults.
    • greater
    • The prevalence of sleep disorders increases with age.
  554. Nurses on permanent night or rapidly rotating shifts are at increased risk of experiencing:
    shift work sleep disorder, insomnia, sleepiness, and fatigue.
  555. Chronic fatigue in nurses on permanent night or rapidly rotating shifts is associated with:
    errors and reduced patient safety.
  556. Strategies, for nurses on night shifts, such as ___________ and ___________ may help to reduce sleep symptoms associated with shift work.
    prophylactic napping and sleeping prior to work
  557. Which individual most clearly exhibits the signs and symptoms of primary insomnia?
    A. A patient in the habit of having a cappuccino in the late evening while watching TV
    B. A patient whose increased sleep latency is not clearly attributable to any particular cause
    C. A patient who has experienced frequent nighttime awakenings since the recent death of a spouse
    D. A patient whose corticosteroid therapy causes him to feel “edgy” and unable to fall asleep at night
    • B. A patient whose increased sleep latency is not clearly attributable to any particular cause.
    • Insomnia that is not directly attributable to a cause is considered primary or idiopathic. The stimulants such as caffeine, prescription medications, or psychologic trauma result in secondary insomnia.
  558. A patient is seeking care for problems related to an inability to sleep and stay asleep over the past several months. What does the nurse anticipate teaching the patient regarding?
    A. Melatonin
    B. Benzodiazepines
    C. Sleep hygiene practices
    D. Over-the-counter sleep aids
    • C. Sleep hygiene practices
    • Sleep hygiene practices are effective in the management of insomnia and should be the first line of therapy. Melatonin may be helpful for jet lag but has a short duration of action. Benzodiazepines have a prolonged half-life and may result in daytime sleepiness. Over-the- counter sleep aids may lead to tolerance or have anticholinergic side effects.
  559. Which question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)?
    A. “Do you smoke?”
    B. “Do you tend to awaken early in the morning?”
    C. “Are you under a lot of stress at work or at home right now?”
    D. “Do you have a history of chronic obstructive pulmonary disease?”
    • A. “Do you smoke?”
    • Smoking is a major etiologic factor in OSA. Early wakening and stress are associated with insomnia, not OSA in particular. COPD exacerbates the hypoxemia associated with OSA but does not precipitate the onset of OSA itself.
  560. An obese patient is scheduled to begin treatment with continuous positive airway pressure (CPAP). When developing the plan of care, what outcome would be appropriate for this patient?
    A. The patient will be calm.
    B. The patient will have no airway collapse.
    C. The patient will have increased gas exchange.
    D. The patient will breathe through the nose rather than mouth.
    • B. The patient will have no airway collapse.
    • CPAP maintains sufficient positive pressure (5-25 cm H2O) in the airway during inspiration and expiration to prevent airway collapse. CPAP does not exclusively require the patient to breathe through his or her nose.
  561. What principle should guide the nurse’s practice when providing care for older patients?
    A. Drug therapy should be used conservatively.
    B. Older adults require less sleep than younger adults.
    C. Cognitive-behavioral interventions are less effective than among younger adults.
    D. Patient teaching should focus on older adults accepting age-related changes in their sleep cycles.
    • A. Drug therapy should be used conservatively.
    • Drug therapy for sleep difficulties should be used conservatively in older adults. They do not necessarily need less sleep, and cognitive-behavioral therapies should still be used. Changes in sleep cycles do accompany aging, but teaching should not simply focus on accepting, rather than addressing, these changes.
  562. A patient informs the nurse that he is working the night shift and has difficulty sleeping during the day. What suggestions can the nurse offer to assist him with sleeping in the daylight hours?
    A. Make the bedroom warmer.
    B. Use room-darkening window shades.
    C. Drink warm tea at the end of the shift.
    D. Go to the gym to work out before going home to sleep.
    • B. Use room-darkening window shades.
    • Light is the strongest time cue for the sleep–wake rhythm. Darkening the room will help the hypothalamus to adjust to this change in sleep pattern. Measures to facilitate sleep include a quiet and cool room, no caffeine intake 4 to 6 hours before bedtime, and avoiding exercise 6 hours before bedtime. Scheduling sleep and waking time to just before going to work may also increase alertness and vigilance at work.
  563. A patient informs the nurse that she is having difficulty getting to sleep and staying asleep. Which studies does the nurse anticipate educating the patient about?
    A. EEG
    B. Self-report
    C. Actigraphy
    D. Polysomnography
    • B. Self-report
    • The diagnosis of insomnia is based on self-report of difficulty falling or remaining asleep. EEG is used with polysomnography sleep studies to diagnose other sleep disorders. Actigraphy measures gross motor activity.
  564. A patient in the intensive care unit is becoming more irritable from lack of sleep. What nursing action will best help facilitate the patient’s sleeping?
    A. Give the patient a back rub.
    B. Keep the lights on during the day.
    C. Talk to the patient when waking up at night.
    D. Cluster activities to allow longer rest periods.
    • D. Cluster activities to allow longer rest periods.
    • Combining patient care activities to avoid frequently disturbing the patient’s sleep will help the patient get more sleep and thus be less irritable. A back rub may help, but keeping the lights off in the room at night and only talking to the patient if the patient wants to talk will best facilitate sleep.
  565. The nurse is preparing a patient to have a sleep study to determine if sleep apnea is present. What should the nurse teach the patient to do until the test can be completed?
    A. Take sleep medications.
    B. Use the spouse’s CPAP mask.
    C. Sleep in a side-lying position.
    D. Do not use pillows when sleeping.
    • C. Sleep in a side-lying position.
    • Conservative treatment for mild obstructive sleep apnea (OSA) begins with sleeping on one’s side. Sleep medication often makes OSA worse. CPAP is adjusted for the patient and used with more severe symptoms after diagnosis. Elevating the head of the bed may eliminate OSA.
  566. A patient diagnosed with narcolepsy wants to know what can be done to cure it. What is the best response the nurse can give this patient?
    A. “If you take your medicine and naps, you will be cured.”
    B. “Patient support groups may be able to help you feel better.”
    C. “Drug therapy and behavioral strategies will be used to help treat it.”
    D. “Safety precautions must only be when you are driving an automobile.”
    • C. “Drug therapy and behavioral strategies will be used to help treat it.”
    • Narcolepsy cannot be cured. Measures to treat narcolepsy include drug therapy for promoting wakefulness during the day, sleep hygiene measures, and other behavioral strategies to enhance nighttime sleep. A patient support group may help the patient feel better, but it will not cure narcolepsy. Safety precautions are needed with driving, but also with other activities as falling asleep or losing muscle control can transform actions that are ordinarily safe (e.g., walking down a long flight of stairs) into hazards.
  567. A patient is experiencing insufficient sleep and having health issues as a result. What disorder does the nurse inform the patient can be related to sleep disorders?
    A. Insufficient sleep is linked to a decreased risk for type 2 diabetes mellitus.
    B. Inadequate sleep in people with hypertension leads to future decreases in blood pressure.
    C. Short sleep duration may result in metabolic changes that are linked to obesity.
    D. Radiation for cancer treatment is associated with fragmented sleep and fatigue.
    • C. Short sleep duration may result in metabolic changes that are linked to obesity.
    • Short sleep duration may result in metabolic changes that are linked to obesity. Insufficient sleep is linked to an increased risk for type 2 diabetes mellitus. Inadequate sleep leads to further elevations in blood pressure in people with hypertension. Chemotherapy for cancer treatment is associated with fragmented sleep and fatigue, but inadequate sleep does not contribute to cancer.
  568. The nurse providing care to a group of patients during the night sets a goal of promoting restful sleep. How would the nurse best define sleep?
    A. An unconscious state in which arousal is not easily accomplished
    B. A basic but unorganized behavior that is not necessary for survival
    C. A state of chemical balance among acetylcholine, norepinephrine, and serotonin
    D. A state during which a person lacks conscious awareness but can easily be aroused
    • D. A state during which a person lacks conscious awareness but can easily be aroused
    • Sleep is a state during which an individual lacks conscious awareness of environmental surroundings and from which one can be easily aroused. Sleep is a basic, highly organized behavior.
  569. The nurse teaches a patient with a sleep disorder about sleep hygiene. Which statement, if made by the patient, indicates understanding of the instructions?
    A. “I will go to bed at the same time whether I am sleepy or not.”
    B. “I should set the temperature in my bedroom under 70° F at night.”
    C. “I must stop drinking alcoholic beverages 2 hours before I go to bed.”
    D. “I can use the prescribed sleeping pills every night to help me stay asleep.”
    • B. “I should set the temperature in my bedroom under 70° F at night.”
    • Good sleep hygiene should include a cool, dark, and quiet bedroom; going to bed only when sleepy; avoiding sleeping pills or using them cautiously; and avoiding alcohol for at least 4 to 6 hours before bedtime.
  570. The nurse is caring for a patient who is diagnosed with narcolepsy and cataplexy. What therapeutic drug regimen will the nurse educate the patient about?
    A. Valerian and diazepam
    B. Melatonin and ropinirole
    C. Modafinil and desipramine
    D. Diphenhydramine and low dose fluoxetine
    • C. Modafinil and desipramine
    • Narcolepsy drug management includes amphetamine-like stimulants or nonamphetamine wake-promotion drugs (e.g., modafinil) to relieve excessive daytime sleepiness and antidepressant drug therapy (e.g., desipramine) to control cataplexy. Drugs that often cause drowsiness such as diazepam, melatonin, and diphenhydramine are not indicated for use in patients with narcolepsy.
  571. Which patient is at highest risk for obstructive sleep apnea (OSA)?
    A. 82-yr-old man with Parkinson’s disease who has dysphagia
    B. 68-yr-old obese man who smokes one pack of cigarettes per day
    C. 18-yr-old woman with cystic fibrosis who has recurrent pneumonia
    D. 35-yr-old woman with a BMI of 22 kg/m2 who has seasonal allergies to pollen
    • B. 68-yr-old obese man who smokes one pack of cigarettes per day
    • Risk of OSA increases with obesity (BMI >30 kg/m2), age older than 65 years, neck circumference greater than 17 inches, craniofacial abnormalities, and acromegaly. Smokers are more at risk for OSA, and OSA is more common in men than women (until menopause).
  572. A patient on the surgical unit after coronary artery bypass grafting complains of vivid nightmares. What assessment should the nurse complete to determine the most likely cause of the nightmares?
    A. Ask the patient about a history of posttraumatic stress disorder.
    B. Determine if the patient has a history of sleep apnea or narcolepsy.
    C. Evaluate the medications the patient is receiving for possible side effects.
    D. Review the documentation record to determine if the patient had a fever last night.
    • C. Evaluate the medications the patient is receiving for possible side effects.
    • Medication side effects are the most common cause of nightmares in patients in acute care settings. Drug classes most likely to cause nightmares are sedative-hypnotics, α-adrenergic antagonists, dopamine agonists, and amphetamines.
Card Set:
Exam 4
2017-11-29 16:21:55

Exam 4 Terms etc (from Steph's doc!)
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