Exam 1: NUR2502/ NUR 2502 (New 2023/ 2024 Update) Multidimensional Care III/ MDC 3 Exam| Questions and Verified Answers| 100% Correct| Grade A- Rasmussen

Exam 1: NUR2502/ NUR 2502 (New 2023/ 2024 Update) Multidimensional Care III/ MDC 3 Exam| Questions and Verified Answers| 100% Correct| Grade A- Rasmussen

Exam 1: NUR2502/ NUR 2502 (New 2023/
2024 Update) Multidimensional Care III/
MDC 3 Exam| Questions and Verified
Answers| 100% Correct| Grade ARasmussen
QUESTION
▪ What is the vaccine for cervical cancer?
▪ What age should you give it?
▪ Dose schedule?
▪ Who takes it?
Answer:
Gardasil (protects us from HPV)
▪ 11-13 for both boys and girls
▪ 3 doses total over 6 months
QUESTION
Treatment for Cervical Cancer
Answer:
cervical ablation
QUESTION
Post-cervical ablation care
Answer:
FOR AT LEAST 4 WEEKS
▪ Refraining from sexual intercourse for 2-3 days after the procedure.

▪ Do not use tampons or douche.
▪ Do not take tub baths.
▪ Avoid heavy lifting.
▪ Report vaginal bleeding, foul-smelling drainage, or fever.
▪ Bed rest
QUESTION
Causes: Acute Kidney Injury
Answer:
▪ medications
▪ drugs/alcohol
▪ infarct of kidney, liver, heart
▪ anything that causes decrease in perfusion (dehydration, hypovolemia, shock, cardiac)
▪ Decreased blood flow
▪ Damage to the kidneys by disease processes
▪ Blockage of the urinary tract
QUESTION
Treatment: Acute Kidney Injury
Answer:
▪ dialysis (severe) – ESRD, CKD
▪ treat the underlying cause
▪ fluid replacement for hypovolemia
▪ fluid restriction in low urine output
▪ hemodialysis
▪ diuretics
▪ Kayexalate 30 g – loose BMs is a successful treatment
▪ monitor I&Os and daily weights.
QUESTION
Prevention: Acute Kidney Injury
Answer:

• Avoid dehydration by drinking 2 to 3 L of water daily
• Stop smoking
• Maintain a healthy weight
• Control DM or HTN
• Take all antibiotics prescribed for infections
• Be aware of urine characteristic changes
• Avoid nephrotoxic substances-Antibiotics, Aminoglycosides, NSAIDS, Chemotherapy Drugs
• Potassium restricted foods: avoid dark leafy greens, potatoes, bananas
• exercise
• maintain proper glucose levels
• maintain a good diet
• maintain proper protein levels
  QUESTION
  Nursing Care: Dialysis
  Answer:
• Before treatment: Evaluate baseline vital signs, weight, laboratory tests
• Continually monitor patient for respiratory distress, pain, discomfort
• Monitor prescribed dwell time, initiate outflow
• Observe outflow amount and pattern of fluid
  ▪ monitor for hypotension
  ▪ daily weight
  ▪ thrombophlebitis
  ▪ signs of bleeding
  ▪ check fistula for thrill and bruit
  ▪ sterile technique with dressing changes
  ▪ port site clean with dialysis catheter
  QUESTION
  Patient Education: Fistula
  Answer:
  ▪ no blood pressure on that side
  ▪ no blood draws on that side
  ▪ no IV medications on that side
  ▪ put on a limb alert bracelet
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▪ chancre, fever, headache, muscle aches, rash

Late:
▪ organ failure, blindness, neuro changes

S/S: Syphilis

C. Syphilis

A 20-year-old sexually active male reports symptoms of a low-grade fever, headache, malaise, muscular aches, sore throat, and a rash on his hands and feet. What condition does the nurse anticipate?

A. HIV
B. HPV
C. Syphilis
D. Gonorrhea

Primary syphilis

Which stage of syphilis is this?

▪ Ulcer called chancre develop at the site of entry and can occur anywhere.
▪ Highly infectious stage, begins as a small papule, then breaks down to a painless, indurated, smooth weeping lesion

Secondary syphilis

Which stage of syphilis is this?

▪ Develops 6 weeks to 6 months, becomes systemic circulating in the blood.
▪ Commonly mistaken for the flu. Rash appears on the palmar surfaces of hands and feet. Patchy alopecia

▪ Penicillin G
▪ What do you ask before giving? “Do you have any allergies?”

Treatment: Syphilis

Azithromycin single dose 1 g IM

Treatment: Chlamydia

▪ Abstinence (7 days) until treatment is completed
▪ Expedited Partner Therapy (EPT) – Educate the patient on the importance of contacting their sexual partners to enable them to seek testing and possible treatment.

Patient Education: Chlamydia

• Wear cotton underwear.
• Always wipe front to back
• Do not douche or use feminine hygiene sprays.
• Do not use scented products.
• Use ice packs to help inflammation

Prevention: Vulvovaginitis

▪ iron levels, CBC (H&H), hormone levels, low blood pressure

S/S:
▪ dizziness, weakness, fatigue, SOB

Patient has heavy vaginal bleeding – What are you checking and what manifestations do you expect?

▪ Kegel exercises
▪ Bladder training
▪ No drinking after 5pm or 6pm
▪ Avoid foods or drinks with caffeine
▪ Skin care
▪ Proper hygiene

Patient Education: Urinary Incontinence

▪ distended bladder
▪ visible mass above the symphysis pubis
▪ difficulty initiating urination**
▪ decreased urine stream
▪ urinary hesitancy, frequency, urgency, retention, incontinence
▪ incomplete voiding
▪ dribbling post-void**
▪ nocturia
▪ hematuria
▪ straining with urination
▪ obstruction of urine flow

presents as a uniform, elastic non-tender enlargement**

S/S: BPH

alpha-1 blockers (doxazosin) – better for patients with hypertension too

Pharmaceutical Treatment: BPH

anticholinergics

What medications should patients with BPH avoid?

▪ phosphodiesterase – 5 (PDE-5) inhibitors (ex: sildenafil, vardenafil, tadalafil)

Pharmaceutical Treatment: Erectile Dysfunction

▪ Stress**
▪ Increasing age**
▪ Smoking**
▪ Obesity
▪ Hypertension**
▪ Medications such as antihypertensives**
▪ Endocrine disorders (Diabetes mellitus, thyroid)**
▪ Chemotherapy
▪ Alcohol and drug abuse**
▪ Trauma or surgery to the pelvic area**
▪ Lumbosacral injuries
▪ Pelvic fractures
▪ Neurological diseases (Parkinson’s and multiple sclerosis)
▪ Inflammation of seminal vesicles, urethra, and prostate
▪ Prostatectomy, TURP**
▪ Poor overall health that prevents sexual intercourse
▪ DVT, PE**
▪ Cardiac issues**

Risk factors for ED

▪ respect to privacy, nonjudgmental, open ended Qs

Therapeutic communication…

bone

Prostate Cancer – Where is the most common site for metastasis?

Phosphorus (>4.5)
Potassium (> 5.0)
Magnesium (> 2.5)
Calcium (>10.5)
Creatinine (> 1.2)
BUN (> 20)
Liver enzymes

Blood levels that might be elevated if prostate CA has metastasized to the bone

(SATA?)

▪ PSA
▪ age 40 (risk), 50 (non risk) + prostate exam

What do we use to screen prostate CA? And when should this start?

▪ often asymptomatic – if you’re not getting screened you won’t know!

late: hematuria, bone pain, scrotal edema

S/S: Prostate Cancer

▪ sperm banking, self examination

Patient Education: Testicular Cancer

Non-modifiable
▪ Increased age – primary risk factor for both men and women
▪ Genetics (mutations in BRCA1 and BRCA2)**
▪ Family history
▪ Late menopause
▪ Early menarche

Modifiable
▪ Lack of exercise
▪ Diet
▪ Alcohol consumption
▪ Obesity
▪ Lack of breastfeeding
▪ Breast implants
▪ Smoking
▪ Medications such as birth control and hormone therapy
▪ nulliparity**

Risk Factors: Breast CA

mammogram -> breast biopsy

If a patient comes in and found a breast lump, what is the process after that?

monthly self-examination
yearly mammograms – start at age 45

Screening: Breast CA

surgical
▪ total hysterectomy, salpingo-oophorectomy
non-surgical
▪ chemo and/or radiation

Treatment: Endometrial (Uterine) CA

▪ monitor VS and respiratory status
▪ monitor I/Os for retention
▪ check drains
▪ pain management (report sudden onset immediately)
▪ DVT/PE prophylaxis
▪ infection
▪ bleeding** (vaginal hyst.)
▪ mobilize the patient

Post-surgical care (ex: hysterectomy)

B. Heavy vaginal bleeding with clots

A client returns from surgery after a laparoscopic total abdominal hysterectomy. On initial assessment, which finding by the nurse requires immediate intervention?

A. Decreased bowel sounds in all quadrants
B. Heavy vaginal bleeding with clots
C. Temperature of 99 F (37.2 C)
D. Client statement that pain is a 4 on a scale of 0 to 10

Uterine Leiomyomas

Abdominal distention, bleeding, uterine enlargement, abdominal enlargement, heavy menstrual cycles – these are S/S of what?

Gardasil (protects from HPV)*

▪ 11-13 for both boys and girls
▪ 3 doses total over 6 months

▪ What is the vaccine for cervical cancer?
▪ What age should you give it?
▪ Dose schedule?
▪ Who takes it?

cervical ablation

Treatment for Cervical Cancer

FOR AT LEAST 4 WEEKS

▪ *Refraining from sexual intercourse for 2-3 days after the procedure.*
▪ *Do not use tampons or douche.*
▪ *Do not take tub baths.*
▪ Avoid heavy lifting.
▪ *Report vaginal bleeding, foul-smelling drainage, or fever.*
▪ *Bed rest*

Post-cervical ablation care

▪ medications
▪ drugs/alcohol
▪ infarct of kidney, liver, heart
▪ *anything that causes decrease in perfusion (dehydration, hypovolemia, shock, cardiac)*
▪ Decreased blood flow
▪ Damage to the kidneys by disease processes
▪ Blockage of the urinary tract

Causes: Acute Kidney Injury

▪ *dialysis (severe) – ESRD, CKD*
▪ *treat the underlying cause*
▪ *fluid replacement for hypovolemia*
▪ fluid restriction in low urine output
▪ hemodialysis
▪ diuretics
▪ Kayexalate 30 g – loose BMs is a successful treatment
▪ monitor I&Os and daily weights.

Treatment: Acute Kidney Injury

• *Avoid dehydration by drinking 2 to 3 L of water daily*
• Stop smoking
• Maintain a healthy weight
• Control DM or HTN
• Take all antibiotics prescribed for infections
• Be aware of urine characteristic changes
• Avoid nephrotoxic substances-Antibiotics, Aminoglycosides, NSAIDS, Chemotherapy Drugs
• Potassium restricted foods: avoid dark leafy greens, potatoes, bananas
• *exercise*
• *maintain proper glucose levels*
• *maintain a good diet*
• *maintain proper protein levels*

Prevention: Acute Kidney Injury

• Before treatment: Evaluate baseline vital signs, weight, laboratory tests
• Continually monitor patient for respiratory distress, pain, discomfort
• Monitor prescribed dwell time, initiate outflow
• Observe outflow amount and pattern of fluid
▪ *monitor for hypotension*
▪ *daily weight*
▪ *thrombophlebitis*
▪ *signs of bleeding*
▪ *check fistula for thrill and bruit*
▪ *sterile technique with dressing changes*
▪ *port site clean with dialysis catheter*

Nursing Care: Dialysis

▪ no blood pressure on that side
▪ no blood draws on that side
▪ no IV medications on that side
▪ put on a limb alert bracelet

Patient Education: Fistula

D. Check for a bruit and thrill by auscultation and palpation over the site.

A 70-year-old woman with chronic kidney disease and a history of type 2 diabetes had surgery two weeks ago to place a vascular graft access for hemodialysis. Which precaution will the nurse follow to ensure the function of the AV graft?

A. Insert an IV and run saline at 10 mL/hr.
B. Keep the patient’s arm elevated on two pillows.
C. Monitor blood pressure and radial pulses in both arms.
D. Check for a bruit and thrill by auscultation and palpation over the site.

▪ flank pain
▪ fever
▪ N/V
▪ difficulty urinating
▪ elevated WBC

S/S: Urolithiasis and Pyelonephritis

▪ pyelonephritis is the result of *repeated upper UTIs* in patients with anatomy abnormalities of the urinary tract
▪ imaging, like a CT scan

Since the s/s of urolithiasis and pyelonephritis are so similar, how you diagnose the difference?

B. 27-year-old female with urinary reflux

The nurse is caring for four patients. Which patient does the nurse identify as at highest risk for acute pyelonephritis?

A. 19-year-old male with spinal cord injury
B. 27-year-old female with urinary reflux
C. 37-year-old male with HIV infection
D. 44-year-old female with urinary tract stones

acute pyelonephritis

A 35-year-old patient is admitted to the ED with fever, chills, and severe right flank pain. His heart rate is 112/min and respiratory rate is 32/min. He was recently treated for a urinary tract infection. Assessment reveals tenderness of the right costovertebral angle (CVA).

What diagnosis does the nurse expect?

acute glomerulonephritis

________ occurs suddenly and result from an infection (often *streptococcal*) within the body often caused by streptococcal infections that originate in the upper respiratory tract, middle ear, and strep throat.

▪ fatigue
▪ anergia
▪ *hematuria*
▪ *proteinuria*
▪ nocturia
▪ *decreased urination*
▪ altered urinary elimination
▪ *painful urination
▪ weight loss
▪ N/V
▪ dyspnea
▪ edema lower extremities
▪ *elevated BP*
▪ jugular vein distention
▪ anemia from reduced production of erythropoietin
▪ hypercholesterolemia
▪ *“cardiac complications”*

S/S: Acute Glomerulonephritis

*Genetics*

▪ autosomal dominant, which usually appears between the ages of 30 to 50
▪ autosomal recessive, which has a childhood onset and progresses rapidly to end-stage kidney disease.

Risk Factors: Polycystic Kidney Disease

▪ *pain – first symptom*
▪ *CVA tenderness*
▪ constipation
▪ cyst bleeding
▪ changes in urine color or frequency
▪ hypertension
▪ headaches
▪ abdominal distention and pain
▪ dysuria
▪ hematuria
▪ nocturia
▪ kidney stone formation

S/S: Polycystic Kidney Disease

Nursing Interventions
▪ Administer medications as prescribed (antihypertensives) to *reduce cardiovascular complications* and slow the disease progression.
▪ Implement a low sodium diet.
▪ Monitor strict intake and output to assure adequate intake.
▪ Implement multimodal pain management strategies to include both pharmacological and non-pharmacological interventions.

Patient Education
▪ Get *genetic counseling* before you try to have children
▪ *Monitor blood pressure* and daily weight.

Nursing Care/Patient Ed.: Polycystic Kidney Disease

B. Blood pressure of 170/90

The nurse is caring for a patient with polycystic kidney disease. Which assessment finding requires immediate nursing intervention?

A. Temperature of 99° F
B. Blood pressure of 170/90
C. Heart rate of 100 beats/min
D. Urine output less than 30 cc/hr

nephrotic syndrome

▪ an immunologic kidney disorder in which *glomerular permeability increases* so larger molecules pass through the membrane into the urine and then excreted.

▪ This process causes a massive loss of protein into the urine, edema formation, and decreased plasma albumin levels.

▪ Most common cause is altered immunity with inflammation

▪ GFR

Lab Values to Watch: Nephrotic Syndrome

90-120 mL/min
• “Normal glomerular filtration rate (GFR) averages 125 mL/min, totaling about 180 L daily.”

What is the normal GFR?

▪ low protein diet (for an elevated GFR)
▪ maintain normal diet (for a normal GFR)

Treatment: Nephrotic Syndrome

A. Assess heart rate and rhythm.

Patients with ESKD experience significant fluid and electrolyte imbalances that are managed with medications and dialysis. Hyperkalemia can be a life-threatening event. In patients with kidney disease, the myocardial response (heart rate and rhythm) to hyperkalemia should be assessed to effectively determine appropriate treatment. High sodium can increase the patient’s risk for seizures, excessive fluid balance will negatively effect breathing, and patients with ESKD experience acid-base imbalances from an inability to synthesize bicarbonate.

A patient with end-stage kidney disease (ESKD) has this serum laboratory analysis

K+ 5.9 mEq/L
Na+ 152 mEq/L
Creatinine 6.2 mg/dL
BUN 60 mg/dL

What is the priority nursing intervention?
A. Assess heart rate and rhythm.
B. Implement seizure precautions.
C. Assess the patient’s respiratory status.
D. Evaluate the patient’s acid-base balance.