You did the initial assessment on Mr. Kaplan when he came to your unit. What classical signs and symptoms did you note?
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Solution
Weakness, anorexia, pruritus
Option B: Weakness and anorexia are due to progressive renal damage; pruritus is secondary to presence of urea in the perspiration.
Option A: Fruity-smelling breath is found in diabetic ketoacidosis.
Option C: Polyuria, polydipsia, polyphagia are signs of DM and early diabetic ketoacidosis. Oliguria is seen in chronic renal failure.
Option D: The skin is more sallow or brown as renal failure continues.
You know that all but one of the following may eventually result in uremia. Which option is not implicated?
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Solution
all of the above
Options A, B and C: These are potential causes of renal damage and eventually renal failure. Individuals can live very well with only one healthy kidney.
One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. You explain that this is called:
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Solution
A pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
Option A: Correct by definition.
Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During your discussion, you describe the macular area as:
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Solution
The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
Options A and C: These refer to the optic disc.
Option D: This describes the color of the retina.
You also explain common eye changes associated with aging. One of these is presbyopia, which is:
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Solution
A gradual lessening of the power of accommodation
Option A: This defines astigmatism.
Option B: This defines myopia.
Option C: This defines hyperopia.
You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from their care provider?
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Solution
tonometry
Option A: This is most often used to detect corneal lesions;
Option B: This is a test for visual acuity;
Option D: This is used to focus on layers of the cornea and lens looking for opacities and inflammation.
Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to this medication?
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Solution
take his radial pulse for one minute
Option B: All options have some validity. However, option B relates best to the action of digitalis. If the pulse rate drops below 60 or is markedly irregular, the digitalis should be held and the physician consulted.
Option A: Blood pressure measurement is also helpful; providing the client has the right size cuff and he or she and/or significant other understand the technique and can interpret the results meaningfully.
Option C: Serum potassium levels should be monitored periodically in clients on digitalis and diuretics, as potassium balance is essential for prevention of arrhythmias. However, the client cannot do this at home.
Option D: Daily weights may make the client alert to fluid accumulation, an early sign of CHF.
On his second day in CCU, Mr. Duffy suffers a life-threatening cardiac arrhythmia. Considering his diagnosis, which is the most probable arrhythmia?
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Solution
ventricular fibrillation
Option B: Ventricular irritability is common in the early post-MI period, which predisposes the client to ventricular arrhythmias.
Options C and D: Heart block and atrial arrhythmias may also be seen post-MI but ventricular arrhythmias are more common.
During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most common following an MI?
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Solution
CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
Option C: Although the timing of initial elevation, peak elevation, and duration of elevation vary with sources, current literature favors option letter c.
The nurse is aware of several important tasks that should all be done immediately in order to give Mr. Duffy the care he needs. Which of the following nursing interventions will relieve his current myocardial ischemia?
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Solution
O2 therapy, analgesia
Option B: All the nursing interventions listed are important in the care of Mr. Duffy. However, relief of his pain will be best achieved by increasing the O2 content of the blood to his heart and relieving the spasm of coronary vessels.