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NSG 320 FINAL EXAM QUESTIONS & DETAILED
ANSWERS (WELL VERIFIED) ALREADY GRADED A+
total perenteral nutrition (TPN) - CORRECT ANSWER >>> entire nutrition is inside an IV bag
and goes right into the blood
what line is TPN given through - CORRECT ANSWER >>> given CENTRAL LINE! not
peripheral IV
when are is central line feeding usually given - CORRECT ANSWER >>> to a client who is NPO
(patients with pancreatitis and crohns)
How should TPN be administered and stopped? - CORRECT ANSWER >>> start and stop
SLOW and GRADUALLY
patients receiving TPN are at high risk for - CORRECT ANSWER >>> hyper or hypoglycemia
how often should TPN tubing be changed? - CORRECT ANSWER >>> every 24 hours
what should the nurse do if the TPN bag is almost empty, but the next bag is not ready.. -
CORRECT ANSWER >>> Hang 10% dextrose water (to help avoid hypoglycemia)
nursing care for TPN - CORRECT ANSWER >>> - daily weights
- monitor electrolytes and I&Os
signs of hyperglycemia - CORRECT ANSWER >>> Polydipsia, polyuria, polyphagia, nausea,
HA, abdominal pain
enteral feeding - CORRECT ANSWER >>> Nutrients supplied to the gastrointestinal tract
orally or by feeding tube (NGT, PEG, G-Tube)
Complications of enteral feeding - CORRECT ANSWER >>> - tube displacement
- clogged tubes
- aspiration
- abdominal distention
Refeeding syndrome - CORRECT ANSWER >>> happens within 24-48 hours of starting
enteral or parenteral nutrition; giving too much nutrition in a short amount of time
Refeeding Syndrome S/S - CORRECT ANSWER >>> 24 - 48hrs of therapy d/t fluid shifts:
bradypnea, lethargy, confusion, weakness
how to avoid refeeding syndrome - CORRECT ANSWER >>> give GRADUALLY
increase calories SLOWLY
gastritis - CORRECT ANSWER >>> inflammation/irritation of the lining of the stomach
antacid administration teaching - CORRECT ANSWER >>> always take 1 hour before or after
other medications, NEVER TOGETHER
when should H2 blockers and PPIs be taken? - CORRECT ANSWER >>> take 30 minutes
before meals
what diagnostic assessment is done to determine the function of the LES - CORRECT
ANSWER >>> upper GI endoscopy
if an ulcer is suspected, what diagnosis assessment is done -^ CORRECT ANSWER
>>> esophagogastroduodenoscopy
signs of peritonitis - CORRECT ANSWER >>> - fever >100.
- rebound tenderness
- rigid or board like abdomen
- increase pain and tenderness
- restlessness
- increase HR and RR
after and endoscopy, what needs to be done? - CORRECT ANSWER >>> keep the client
NPO until the gag reflex returns, otherwise they are at risk for ASPIRATION
causes of PUD - CORRECT ANSWER >>> - H. pylori
- NSAIDs (naproxen, indomethacin, ibuprofen)
- stress
gastric ulcer s/s - CORRECT ANSWER >>> - increase pain WITH food (30-60 minutes after
meal)
- weight loss
- vomit blood (hematemesis)
duodenal ulcer s/s - CORRECT ANSWER >>> - DECREASE pain with food (2-3 hours after
meals)
- worse at night
- weight gain
- blood in stool (melena)
antibiotics of H. Pylori - CORRECT ANSWER >>> amoxicillin, clarithromycin, tetracycline,
metronidazole, bismuth (pepto)
Mucosal protective agents and teaching - CORRECT ANSWER >>> Sucralfate
- take on empty stomach
- dont take wit other medications
education for PUD - CORRECT ANSWER >>> - decrease diet irritants
- decrease stress
- avoid NSAIDS
- report black tarry stool
diet for diverticulosis - CORRECT ANSWER >>> - high fiber
- AVOID popcorn, seeds, nuts
hepatitis - CORRECT ANSWER >>> Inflammation of the liver, usually caused by a viral
infection, alcohol or autoimmune
Hepatitis A transmission - CORRECT ANSWER >>> fecal-oral (contaminated food, improper
handwashing)
Hepatitis B transmission - CORRECT ANSWER >>> blood and body fluids
- IV drug use, tattoos, piercings, sharing razor, unprotected sex
Hepatitis C transmission - CORRECT ANSWER >>> blood and body fluids
- IV drug use, tattoos, piercings, sharing razor, unprotected sex, semen, vaginal secretions
S/S of viral hepatitis - CORRECT ANSWER >>> - flulike symptoms (HA, fever, fatigue, N/V)
- elevated AST ALT, biliruben
S/S of Hepatitis - CORRECT ANSWER >>> - pruritus (from bile salts that build up under the
skin)
- elevated bilirubin
- jaundice
- dark colored urine
- clay color stools
- elevated PT and aPTT (bruising)
interventions for hepatitis itching (pruritus) - CORRECT ANSWER >>> - apply moisturizer
- avoid the sun
- apply COLD compress (not heat)
diagnostics for hepatitis - CORRECT ANSWER >>> - liver biopsy
client teaching after a liver biopsy - CORRECT ANSWER >>> lie on right side after procedure
to prevent bleeding
education for hepatitis - CORRECT ANSWER >>> - small frequent meals
- low protein
- low fat
- frequent rest periods
- protected sex
- avoid alcohol and acetaminophen
- avoid sharing razors and toothbrushes
what food needs to be decreased if ammonia levels are high -^ CORRECT ANSWER
>>> protein
cirrhosis - CORRECT ANSWER >>> scarring and dysfunction of the liver caused by chronic
liver disease
AIRWAY
- turn patient to the side
- no NG
- no straining
what lab levels are high in cirrhosis - CORRECT ANSWER >>> - ammonia
- AST ALT
what lab levels are low in cirrhosis - CORRECT ANSWER >>> - albumin
intervention for ascites - CORRECT ANSWER >>> Paracentesis
before a paracentesis, the nurse should - CORRECT ANSWER >>> 1. tell client to empty
bladder
- VS
- measure abdominal circumference and weight
- HOB High fowlers
Diet for cirrhosis - CORRECT ANSWER >>> - low protein (for hepatic encepholopathy)
- low sodium and fluid (for ascites
- no alcohol
- oral care before meal in patients with malnutrition
what medication is used for hepatic encephalopathy - CORRECT ANSWER >>> Lactulose
(lose ammonia via bowels)
- cholecystectomy (removal of the gallbladder)
diet education for Cholecystitis - CORRECT ANSWER >>> avoid fatty fried foods lose
weight
causes for flare ups for IBD - CORRECT ANSWER >>> - stress
ulcerative colitis - CORRECT ANSWER >>> chronic inflammation of the colon with presence
of ulcers that bleed
s/s of UC - CORRECT ANSWER >>> - 15 - 20 BLOODY liquid stools per day
(can cause anemia and decreased Hgb and Hct)
- rebound tenderness
- abdominal pain
Crohn's disease - CORRECT ANSWER >>> inflammation of the entire GI tract, sporadic skip
lesions that do NOT bleed (cobblestoning appearance)
S/S of Crohn's disease - CORRECT ANSWER >>> - 5 loose stools /day
- steatorrhea
- Abdominal pain, weight loss
nursing care for IBD - CORRECT ANSWER >>> - fluid and electrolyte replacement
- diet
- pain: administer analgesics
- avoid alcohol
- reduce caffeine
- reduce stress
fluid and electrolyte replacement for IBD - CORRECT ANSWER >>> - strict I&O
- 2L of water/day and increased with more diarrhea
- watch for hypokalemia
diet for IBD - CORRECT ANSWER >>> - high protein and calorie
- low fiber
- small frequent meals
- keep food journal
s/s of UTI - CORRECT ANSWER >>> dysuria, urgency, frequency, and cloudy foul smelling
urine
diagnostics for UTI - CORRECT ANSWER >>> - urinalysis
what may indicate UTI in the urine - CORRECT ANSWER >>> cloudy and smelly
presence of WBCs presence of nitrites
s/s of pyelonephritis - CORRECT ANSWER >>> - same at UTI
- costovertebral tenderness
common cause of glomerulonephritis - CORRECT ANSWER >>> strep infection
s/s of glomerulonephritis - CORRECT ANSWER >>> - increased proteinuria
- decreased albumin
- increase blood clot
- fever
- increase WBCs
- increase BUN and creatinine
- low UO
- fluid retention (increase BP, edema, JVD, crackles)
treatment for glomerulonephritis - CORRECT ANSWER >>> - Get rid of strep
- limit protein
- rest kidney by decrease BP
what is the number one cause of bladder cancer -^ CORRECT ANSWER
>>> smoking/tobacco use
s/s of bladder cancer - CORRECT ANSWER >>> painless hematuria
diagnostics for bladder cancer - CORRECT ANSWER >>> cystoscopy
Chronic Kidney Disease (CKD) - CORRECT ANSWER >>> progressive, irreversible loss of
kidney function
causes of CKD - CORRECT ANSWER >>> diabetes and hypertension
what elevated lab value indicates a bad kidney - CORRECT ANSWER >>> creatinine
creatinine clearance test - CORRECT ANSWER >>> test done to measure the total amount of
creatinine excreted in the urine, usually in a 24-hour period, to assess kidney function
what needs to be done to urine after urine collection - CORRECT ANSWER >>> put it on
ice and keep it cold discard the first specimen
s/s of CKD - CORRECT ANSWER >>> - oliguria
- Elevated serum creatinine levels
- Anemia due to decreased erythropoietin production in kidneys
- Metabolic acidosis
- Abnormalities in calcium & phosphorus
- Fluid retention(crackles, JVD, bounding pulses)
- uremic frost
- pruritis
what is the number one complication with CKD - CORRECT ANSWER >>> HTN crisis
what can be given for hyperkalemia in CKD - CORRECT ANSWER >>> - IV calcium gluconate
- IV 50% dextrose and regular insulin
Before dialysis - CORRECT ANSWER >>> - assess fluid status
- assess fistula (shunt)
- hold meds
fistula (shunt) assessment - CORRECT ANSWER >>> feel a thrill hear a
bruit
what is added to dialysis to prevent clots - CORRECT ANSWER >>> IV heparin
disequilibrium syndrome - CORRECT ANSWER >>> rapid change of extracellular fluid
composition during dialysis resulting in cerebral edema; RESTLESSNESS AND DISORIENTED
what is the intervention for disequilibrium syndrome - CORRECT ANSWER >>> stop/slow the
infusion and report to HCP
care for fistula (AV shunt) - CORRECT ANSWER >>> - squeeze/grip a rubber ball a few times a
day
- pitting edema is normal
- check for thrill and bruit
- no restrictive clothing
- no BP on affected arm
- no sleeping on affected arm
- can use cream and lotion
- no lifting over 5 lbs (no purse)
what should be done before peritoneal dialysis - CORRECT ANSWER >>> take weight and
warm solution
benign prostatic hyperplasia (BPH) - CORRECT ANSWER >>> prostate enlargement, which
compresses urethra and surrounding bladder, most common in men >
s/s of BPH - CORRECT ANSWER >>> - weak/intermittent stream (dribbling)
- Urinary retention
- sensation on incomplete emptying
- urgency and frequency
- Straining to void
- Recurrent UTI
- Hematuria
- Fatigue
- Anorexia
treatment for BPH - CORRECT ANSWER >>> - bladder training
- FInasteride (Proscar)
- TURP
- prostatectomy
Finasteride (Proscar) - CORRECT ANSWER >>> shrinks prostate, takes 6 months to work
