244+ Adult-eyes+reproductive

Question 1

retinal detachment

Answer 1

flashes of light, floaters, or black spots across the field of vision, the sense of a curtain being drawn over the eye, and loss of a portion of the visual field.

ocular emergency as permanent blindness may result without intervention

Question 2

hearing aids

Answer 2

pull the ear up and back before insertion

A high-pitched whistling sound can indicate that the hearing aid volume is too high. The client should turn the volume down to eliminate the whistling sound.

cleaned with alcohol wipes or a soft cloth and should not be immersed in water, which can damage the electrical components.

Question 3

Ocular chemical burns

Answer 3

copious eye irrigation with sterile saline or water should begin immediately to flush the chemical irritant out

Irrigation is continued until the pH of the eye returns to normal (pH 6.5-7.5), which typically requires 30-60 minutes depending on the type of chemical.

Question 4

Primary open-angle glaucoma

Answer 4

increase in intraocular pressure

gradual loss of peripheral vision (ie, tunnel vision)

Question 5

acute angle-closure glaucoma

Answer 5

sudden elevation in intraocular pressure

Blurry vision
Unilateral headache
Sudden, severe eye pain
Conjunctival redness
Middilated pupils (4-6 mm) nonreactive to light

Question 6

Ocular trauma caused by a penetrating foreign body

Answer 6

Stabilizing the foreign object to prevent further movement and injury

Avoiding increases in intraocular pressure
avoiding blowing nose,
elevating head of bed 45 degrees
Placing the client on NPO status

Question 7

ophthalmic drops

Answer 7

Pulling the lower eyelid down

Applying pressure over the inner corner of the eye (eg, lacrimal duct) to avoid systemic absorption

Holding the dropper ½-¾ in (1-2 cm)

Waiting at least 5 minutes between drops

Clarify before taking over-the-counter medications (eg, decongestants, anticholinergics, antihistamines) because certain medications can trigger a subsequent episode of
acute angle-closure glaucoma

Ophthalmic medications for glaucoma decrease the IOP and prevent further vision loss. Damage that was previously done is irreversible; therefore, vision does not improve.

Question 8

Dialysis disequilibrium syndrome (DDS)

take BP for hypotension

Answer 8

a complication of hemodialysis (HD) characterized by cerebral edema that occurs during or immediately following a client’s initial dialysis treatment.

Because the manifestations of DDS (eg, vomiting, headache, restlessness, confusion) and HD-induced hypotension (eg, nausea, vomiting, chest pain) can be similar, the priority nursing action is to check the client’s blood pressure

Question 9

Creatinine clearance

measure of glomerular function and is a sensitive indicator of renal disease progression

For a 24-hour urine collection, the first urine specimen is discarded; then all other voided urine for the next 24 hours is collected in a container.

Answer 9

A timed urine collection measures substances (eg, creatinine, protein, adrenal hormones) excreted in the urine over time (eg, 12 hr, 24 hr

For a 24-hour urine collection, the first urine specimen is discarded, and the time is noted. All voided urine for the next 24 hours is collected in a container and kept cool

At the end of the 24 hours, the client should void one last time and add the specimen to the container.

Blood is drawn to measure the serum creatinine level, in addition to urine creatinine.

Question 10

Pyelonephritis

vs

kidney stones

Answer 10

pain is dull, constant, and maximal at the costovertebral angle area.

vs

Pain from renal stones is excruciating, sharp, and often radiates toward the groin from the flank

Question 11

Stress incontinence

Answer 11

small amounts of involuntary urine leakage precipitated by sudden increases in intraabdominal pressure (eg, sneezing, laughing, strenuous exercise)

Minimizing ingestion of bladder irritants (eg, caffeine, alcohol)

Voiding every 2 hours while awake to decrease the risk for incontinence episodes

Using incontinence pads to prevent skin breakdown from excess moisture

Performing pelvic floor muscle (Kegel) exercises to strengthen the sphincter and structural supports

Question 12

Urge incontinence

Answer 12

overactive bladder) occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate followed by urine leakage

Administering an antispasmodic (eg, tolterodine, oxybutynin) to reduce the frequency of bladder spasms

Assessing the client’s readiness to quit smoking because nicotine is a bladder irritant

Advising the client to avoid ingestion of bladder irritants (eg, caffeine, alcohol)

Instructing the client to perform pelvic floor exercises (eg, Kegel) to strengthen the pelvic muscles and help prevent urinary leakage

Teaching timed voiding (eg, voiding every 2 hr) and urge suppression techniques

consume a high-fiber diet to prevent constipation

Question 13

kidney biopsy

Bleeding is a complication

Answer 13

After the procedure, monitor vital signs at least every 15 minutes for the first hour as tachycardia, tachypnea, and hypotension can indicate blood loss.

positioned on the affected side for 30-60 minutes and on bed rest for 24 hours

Question 14

Hyperkalemia

Answer 14

IV calcium gluconate

to reduce myocardial irritability and protect the myocardium from potassium-induced dysrhythmias

Question 15

void 6-8 hours postoperatively

Answer 15

Urinary retention is common after surgical intervention and is often caused by anesthesia, opioid medications, edema from lower abdominal/pelvic surgeries, and outlet obstruction due to benign prostatic hyperplasia.

Assisting the client to ambulate to the bathroom because ambulation, normal body position, and privacy promote spontaneous urination

Encouraging oral fluid intake to stimulate adequate urine production

bladder scan

Turning on the water

Question 16

Percutaneous nephrolithotripsy

blocked = irrigate

insertion of a nephroscope through the skin into the pelvis of the kidney to break up and remove kidney stones

Answer 16

Flank discomfort/pain, nausea, and no drainage from the nephrostomy tube may indicate obstruction of urine flow that can lead to kidney injury.

Gentle irrigation of the nephrostomy tube with a small volume of sterile saline (as prescribed or per protocol) using aseptic technique is the most appropriate intervention

Question 17

greatest risk factor for bladder cancer

Answer 17

cigarette smoking or other tobacco use

Question 18

arteriovenous fistula

bruit and thrill = want

Answer 18

a surgical connection of an artery to a vein created to provide vascular access for hemodialysis therapy in clients with kidney disease

Daily hand exercises such as squeezing handgrips or a rubber ball are performed to help properly mature the fistula.

it is imperative to monitor for signs of potential clotting of the fistula such as absence of a bruit or thrill, decreased capillary refill, and numbness or tingling of the extremity.

Question 19

pessary

Answer 19

vaginal device that provides support for the bladder.

Clients can remain sexually active

can insert and remove the pessary themselves

When the client cannot remove the pessary regularly, removal by an HCP at 2- to 3-month intervals is recommended.

Increased vaginal discharge is a common side effect. However, if an odor is present, the client should be instructed to notify the HCP to be treated for a possible infection

Question 20

acute nephrolithiasis

kidney stone

Answer 20

Administering pain medications (eg, NSAIDs [ketorolac], opioids) to treat renal colic.

Straining the client’s urine to monitor for spontaneous passage of the kidney stone. Most kidney stones <5 mm pass spontaneously; however, when stones are larger or an obstruction occurs in the upper urinary tract, spontaneous resolution becomes less likely.

Administering antiemetics

Lithotripsy may be necessary if stones are larger in size (ie, >10 mm) and are causing infection, impaired kidney function, and severe, persistent pain

Question 21

teaching for a client with a calcium oxalate kidney stone

eat calcium, limit oxalate foods and Na

Answer 21

Limiting dietary intake of high-oxalate foods (eg, spinach, potatoes, tofu) to prevent recurrence of calcium oxalate stones

daily walks to help increase blood flow to the kidneys and improve filtration of waste
drink 2-3 L of water per day
decrease sodium intake

Question 22

ileal conduit

Answer 22

client’s ureters are connected to the ileal conduit, which is used to create an abdominal stoma that allows the passage of urine

Question 23

worsening Chronic kidney disease

Answer 23

persistent metallic taste in the mouth

Difficulty with memory and concentration

Fluid overload

Loss of appetite

Question 24

Recommended foods for a client with CKD

Answer 24

oatmeal and apple slices,

low in sodium, potassium, and phosphorus

Question 25

pursed-lip breathing technique helps to decrease shortness of breath by preventing airway collapse, promoting carbon dioxide elimination, and reducing air trapping in clients with chronic obstructive pulmonary disease (COPD)

Answer 25

Relax the neck and shoulders

Inhale for 2 seconds through the nose with the mouth closed

Exhale for 4 seconds through pursed lips. If unable to exhale for this long, exhale twice as long as inhaling

Question 26

Cystic fibrosis

Answer 26

genetic disorder in which a defective protein causes the exocrine glands to produce thick and sticky secretions that can plug small airways and ducts (eg, gastrointestinal tract)

S/s
ineffective airway clearance, risk of infection, and eventually chronic lung disease (bronchiectasis). CF also damages alveoli, which can burst suddenly, resulting in pneumothorax]

Clients with CF often have low baseline oxygen saturation; however, a sudden drop in SpO2 (eg, from 92% to 88% on room air) indicates a possible mucus plug airway obstruction and the need for urgent intervention (eg, physiotherapy, mucolytic medications)

Question 27

Elevated eosinophils are seen in allergy

Answer 27

high eosinophil count would indicate an allergic trigger

Question 28

Accidental decannulation
or dislodgment of a tracheostomy tube

Answer 28

mature tracheostomy (ie, >7 days after insertion)= attempt to open the stoma with a curved hemostat and insert a new tracheostomy tube with an obturator

immature tracheostomies (ie, <7 days after insertion)=
Covering the stoma with a sterile, occlusive dressing (eg, petroleum gauze, foam tape) and ventilating with a bag-valve mask over the mouth and nose

Question 29

Allergy skin testing

Answer 29

client should avoid antihistamines (eg, diphenhydramine [Benadryl], loratadine [Claritin], promethazine [Phenergan]) for up to 2 weeks prior to the test

Systemic corticosteroids, used to treat the inflammatory component of asthma, may also affect the accuracy of allergy skin testing; therefore, the use of these medications is assessed by the health care provider.

Question 30

hallmark of acute respiratory distress syndrome (ARDS)

Answer 30

Refractory hypoxemia
the inability to improve oxygenation with increases in oxygen concentration

Therapeutic options include prone positioning, use of pulmonary vasodilators such as nitric oxide and prostacyclins, neuromuscular blockade to reduce patient-ventilatory dyssynchrony, corticosteroid therapy, conservative fluid management, maintaining negative fluid balance, and ECMO.

Question 31

Venturi mask

Answer 31

COPD

because the adapter allows precise control of the fraction of inspired oxygen that the client will receive.

oxygen should be titrated to the minimum amount necessary to maintain an oxygen saturation of 88%-92%

Question 32

chest drainage system

bubbling + meaning

Answer 32

Gentle, continuous bubbling in the suction control chamber = the presence of suction in the system and is an expected finding

An air leak would cause bubbling in the air leak gauge (section C) or water seal chamber

Question 33

ETT placement

should auscultate breath sounds immediately if tube dislodgment (eg, change in insertion depth) is suspected.

Answer 33

placement can be assessed by auscultating breath sounds

Diminished breath sounds indicate the ETT in the hypopharynx.

Absent breath sounds indicate the ETT is not providing ventilation to the lungs.

Right-sided only breath sounds indicate the ETT is in the right mainstem bronchus and is ventilating only the right lung.

Sounds of air over the gastric area indicate the ETT is in the esophagus and oxygen is being delivered to the stomach.

Question 34

bronchoscopy

Answer 34

a small amount of blood-streaked sputum may be expected

a moderate to large amount of bright red sputum = hemorrhage, should immediately notify HCP

Moderate sedation and topical anesthetics (eg, lidocaine, benzocaine) are typically administered to suppress the gag and cough reflexes, prevent laryngospasm, and facilitate passage of the scope

Question 35

Chronic obstructive pulmonary disease (COPD)

clarify the order for morphine

Answer 35

chronic inflammation, airway remodeling, and reduced expiratory airflow.

air trapping due to alveolar enlargement and hyperinflation

airway obstruction due to inflammation and increased sputum production

clarify the order for morphine because older adult clients and those with respiratory conditions such as COPD are at risk for increased sensitivity and may require lower doses to prevent respiratory depression

Question 36

suctioning a mechanical vent

Answer 36

To minimize both the amount of oxygen removed and mucosal trauma, suction is applied when removing the catheter from the artificial airway, not while inserting it

If secretions are thick and difficult to remove, increasing hydration, not suctioning time, is indicated. Aerosols of sterile normal saline or mucolytics such as acetylcysteine administered by nebulizer can also be used to thin secretions

Morphine is administered to promote breathing synchrony with the mechanical ventilator, reduce anxiety, and promote comfort in clients receiving mechanical ventilation (MV).

Preoxygenation with 100% oxygen for 30 seconds before suctioning

It is appropriate to suction the client when the high-pressure alarm on the MV sounds, oxygen saturation drops, rhonchi are auscultated, and secretions are audible or visible. These manifestations can indicate excessive secretions impairing airway patency.

Question 37

282

Obstructive sleep apnea

Answer 37

Limit alcohol intake at bedtime

Lose weight

Use a continuous positive airway pressure device CPAP

Avoid sedating medications (eg, benzodiazepines, antihistamines)

don’t eat before bed

Question 38

Criteria for activating the rapid response team

Answer 38

Any staff member is worried about the client’s condition

OR

An acute change in any of the following:
Heart rate <40 or >130/min
Systolic blood pressure <90 mm Hg
Respiratory rate <8 or >28/min
Oxygen saturation <90% despite oxygen
Urine output <50 mL in 4 hours
Level of consciousness

Question 39

evaluating ABG

Answer 39

1. Evaluate the pH:

A pH >7.45 indicates alkalosis, which could be respiratory or metabolic.

pH <7.35 = acidosis

2. Analyze the metabolic component
3. Analyze the respiratory component

PaCO2 (an acid) is decreased, which occurs with respiratory alkalosis or as compensation for metabolic acidosis

Determine if compensation is present: This client is not experiencing metabolic compensation. A decrease in HCO3− would indicate that the metabolic system is attempting to normalize the pH by decreasing the amount of base

Question 40

peak flow meter

Answer 40

handheld device that measures the client’s ability to push air out of the lungs (peak expiratory flow rate [PEFR]).

use the peak flow meter 3 times in a row and record the highest of the 3 readings in the peak flow log

If the PEFR is <50% of the client’s personal best, the client should seek emergency treatment.

exhale quickly

Before each use, the client should position the indicator at the bottom of the peak flow meter scale (eg, in the lowest position, at 0)

colour zones:
Green zone =asthma is under control, and PEF is 80%-100% of personal best. There is no cough, wheezing, or trouble breathing present

Yellow zone indicates caution, and PEF is 50%-79% of personal best. The client should take prescribed rescue medications; if the level returns to green, no further medications are needed. If the level does not return to green within 1 hour, the client should continue the rescue medication, begin a prescribed oral corticosteroid (eg, prednisone), and notify the HCP

Red zone indicates PEF <50% of personal best and is a medical emergency. The client should go to the emergency department if the level does not return to yellow within 15 minutes of taking rescue medications

Question 41

Carbon monoxide (CO) toxicity (poisoning)

The nurse’s primary action is to administer highly concentrated (100%) oxygen using a nonrebreather mask at 15 L/min in order to reverse this displacement of oxygen

hypoxia that is not reflected by a pulse oximeter reading

Answer 41

colorless, odorless gas produced by burning fuel (eg, oil, kerosene, coal, wood) in a poorly ventilated setting.

nonspecific S/s:
(eg, headache, nausea, dizziness) and the diagnosis can be missed

ASK:
Similar symptoms in other family members or an illness in an indoor pet that developed at the same time.

Fuel-burning heating/cooking appliances; the risk for CO toxicity increases in the fall and winter due to increased use of heat sources in an enclosed space

Question 42

low tidal volume alarm

do:
manual ventilation with a bag-valve resuscitator connected to high-flow oxygen (15 L/min)

Answer 42

=volume of air being delivered by the ventilator is lower than the set volume.

due to a disconnection, loose connection, or leak in the ventilator circuit (ie, tubing), leaking of air around the cuff of the endotracheal tube (ETT)

if the client is showing signs of inadequate oxygenation, the ventilator should be disconnected to allow manual ventilation with a bag-valve resuscitator connected to high-flow oxygen (15 L/min)

Question 43

Pleurisy

Answer 43

stabbing chest pain that usually increases on inspiration or with cough

caused by inflammation of the visceral pleura (over the lung) and the parietal pleura (over the chest cavity)

pleural space (between the 2 layers) normally contains about 10 mL of fluid to help the layers glide easily with respiration. When inflamed, they rub together, causing pleuritic pain.

S/s:
pleural friction rub is auscultated in the lateral lung fields over the area of inflammation
squeaking, crackling, or the sound heard when the palm is placed over the ear and the back of the hand is rubbed with the fingers

Question 44

Pursed lip breathing

in emphysema in COPD

Answer 44

help reduce respiration rate

lessen dyspnea

improve airflow by providing positive pressure that prolongs exhalation and expels trapped air from the alveoli

Question 45

Gonorrhea and chlamydia can lead to pelvic inflammatory disease (PID) and infertility.

Question 46

vasectomy

Answer 46

Following the procedure, it can take several months for the remaining sperm to be ejaculated or absorbed.

Alternative birth control should be used until the health care provider confirms that semen samples taken at a follow-up appointment are free of sperm; otherwise, pregnancy can occur

Question 47

Pap testing

Human papillomavirus (HPV), an extremely common sexually transmitted infection (STI), causes almost all cases of cervical cancer.

Answer 47

early detection of cervical dysplasia (ie, abnormal cell growth) that may indicate cervical cancer

Cervical cancer screening is typically initiated at age ≥21, regardless of age at onset of sexual activity

every 3 years in the United States or every 1-3 years in Canada

Question 48

Breast cancer
risks

Answer 48

Having a first-degree, biological relative (eg, mother, sister) with a history of breast cancer, particularly if the relative was diagnosed at a young age (ie, age <45)

Inheriting a mutation of breast cancer 1 or 2 ( BRCA1 , BRCA2 ) genes, which can affect the body’s ability to suppress breast tumor growth

Gaining excessive weight in the postmenopausal years because fat cells store estrogen, which can stimulate growth of malignant breast tissue

Using menopausal hormone therapy (eg, estrogen and progestin pills) for >5 years because it can stimulate tumor growth in estrogen-sensitive tissues (eg, breast) and age ≥50

early menarche (ie, age <12) or late menopause (ie, age >55) have an increased risk due to prolonged estrogen exposure.

Question 49

Infertility

Answer 49

12 months in female clients age <35
6 months in female clients age ≥35

Age ≥35 because eggs become lower in quality as age increases

Conditions that affect the ability of the pregnancy to implant in the uterus (eg, endometriosis)

Conditions that affect ovulation (eg, polycystic ovary syndrome, thyroid disorders)

Pelvic inflammatory disease, which leads to scarring of the fallopian tubes and is caused by recurrent/untreated sexually transmitted infections (eg, chlamydia, gonorrhea)

Question 50

vaginal hysterectomy

Answer 50

monitored for:
excessive vaginal bleeding,
urinary retention,
backache,
decreased urinary output,
the development of signs and symptoms of complications such as DVT

report
more than one perineal pad in an hour

Question 51

phenylketonuria + pregnancy

Answer 51

an inherited metabolic disease that results from a deficiency or absence of an enzyme needed to metabolize phenylalanine, an amino acid that is present in proteins.

As unconverted phenylalanine accumulates, irreversible neurologic damage can occur, which is particularly concerning for the developing fetus and infant.

A low-phenylalanine diet before and during pregnancy

avoid high-protein foods (eg, meats, dairy, nuts, eggs) to maintain phenylalanine levels in a safe range.

provide the infant with special formulas that are low in phenylalanine.

PKU is a genetically inherited autosomal recessive trait. Genetic counseling should be completed prior to conception as parents may not realize they are carriers of a recessive gene.

Adequate observation of newborn feeding is important in order to obtain accurate results as PKU cannot be detected if the newborn has not been exposed to phenylalanine via breastmilk or formula

Question 52

cervical cap

Answer 52

barrier method of contraception used with spermicide

should remain in place for ≥6 hours after sexual intercourse to allow time for sperm to die, but the cap should be removed within 48 hours after intercourse to prevent toxic shock syndrome.

Question 53

Syphilis during pregnancy

Answer 53

crosses the placenta + may cause fetal harm or death

The only adequate treatment available during pregnancy is an IM penicillin injection

Question 54

Clomiphene

Answer 54

an infertility treatment for women that works by stimulating ovulation

engage in frequent sexual intercourse 5 days after completing the medication regimen

Clomiphene may cause mood swings, nausea, hot flashes, and headaches and increases the risk of multiple gestation.

Question 55

Pelvic inflammatory disease (PID)

Answer 55

leading cause of ectopic pregnancy and infertility

occurs when bacteria from the genital tract spread upward through the cervix and cause infection of the female reproductive organs (eg, uterus, fallopian tubes, ovaries) and pelvic cavity.

S/s:
-pelvic or lower abdominal pain
-menstrual irregularities or increased menstrual cramps
-painful intercourse
-fever
-abnormal vaginal discharge.

Untreated sexually transmitted infections (STIs) (eg, gonorrhea, chlamydia) are the most common cause of PID.

Question 56

Priapism

Answer 56

a sustained, painful erection often associated with sickle cell anemia, as the sickling (crescent shaping) of red blood cells can lead to penile vascular occlusion, erectile tissue hypoxia, and tissue necrosis.

Bluish discoloration is of most concern as it can be a sign of ischemia to the penis.

Question 57

Testicular cancer

Answer 57

(high risk for developing a tumor) = history of undescended testis= encouraged to perform a monthly TSE

Perform TSE monthly on the same day (easy to remember)
Perform TSE while taking a warm shower or bath as warm temperatures will relax the scrotal tissue and make the testis hang lower in the scrotum
Use both hands to feel each testis separately
Palpate each testicle gently, using the thumb and first 2 fingers
Check that the testicle is normally egg-shaped and movable with a smooth surface

S/s to report to HCP:

Painless, hardened lump on testes
Scrotal swelling or heaviness
Dull ache in pelvis or scrotum

Question 58

Ovarian cancer

Answer 58

Symptoms are often subtle and may include:
abdominal bloating
pelvic pain or pressure
abdominal girth increase
early satiety
abdominal, back, or leg pain
urinary urgency/frequency
gastrointestinal disturbances

Question 59

postmenopause

Answer 59

have cholesterol levels monitored

consume calcium-rich foods (eg, low-fat dairy products; green, leafy vegetables)

engage in weight-bearing exercise

seek support for emotional symptoms.

Question 60

Clients with Marfan syndrome

Answer 60

are at high risk of mortality during pregnancy due to the potential for aortic dissection

Clients should be instructed about the importance of consistently using reliable birth control methods to prevent pregnancy

Question 61

Over-the-counter emergency contraception pills (eg, high-dose levonorgestrel)

Answer 61

most effective:

within 3 days of unprotected sexual intercourse

intrauterine devices (IUDs) offer emergency contraception for up to 5 days.