Nursing textbooks medical-surgical practice questions set 11

Correct answer:

Breathing in and out smoothly during quadricep-setting exercises maximizes lung inflation. The patient should perform quadricep-setting exercises two to three times per hour, four to six times a day, or as ordered. The patient should never hold their breath during exercise drills because this places a strain on the heart. Pushups are usually done three or four times a day and involve only the upper body. Dangling for a few minutes is done to adjust to the upright position; dangling for 30 to 60 minutes is impractical for the nurse to supervise and may prove unsafe. The nurse should place the bed in the lowest position or use a footstool for dangling.

Correct answer:

At the time of primary HIV infection, one third to more than one half of those infected develop acute retroviral syndrome, also called acute HIV syndrome, which often is mistaken for flu or some other common illness. Some manifestations include fever; swollen and tender lymph nodes; pharyngitis; rash about the face, trunk, palms, and soles; muscle and joint pain; headache; nausea and vomiting; and diarrhea. In addition, there may be enlargement of the liver and spleen, weight loss, and neurologic symptoms such as visual changes or cognitive and motor involvement. It is too soon after exposure for the client to develop Pneumocystis pneumonia or AIDS.

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The client who has history of playing many years of a physical sport such as soccer and use the head to redirect the ball may have had years of injury to the brain. When concussions occur repetitively, even though they may have not shown injury at that time, chronic traumatic encephalopathy may result. Chronic traumatic encephalopathy, which can produce neurodegeneration, will need specialized care. The client who has a history of seizures may have no brain injury. The client who was in a previous accident may have had injury, but it is not of a repetitive nature. The client with a father who has Parkinson's disease will have regular follow-up care.

Correct answer:

When teaching the client about the benefits of stem cell transplantation therapy, the nurse should explain how stem cells are used to treat a spinal cord injury. In particular, the education should emphasize that stem cells are harvested from the client's own bone marrow and can be reimplanted into the area surrounding the injury, replacing the damaged nerve cells when they are transplanted. The spinal cord loses the ability to regenerate when injured, and stem cells replace the injured spinal nerves rather than causing them to repair themselves, so the nurse would be incorrect to include these statements when discussing the therapy with the client.

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Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing these facts may be enough to convince the patient to remain medication compliant. The minor inconvenience of side effects as compared with feelings of depression is a convincing reason to remain on the medication. Withholding the drug, forcing oral fluids, and having the health care provider examine the patient are unnecessary steps. Independent nursing action is appropriate. Pursed-lip breathing is irrelevant.

Correct answer:

Integrative medicine is a combination of conventional medical practice with nontraditional physical and nonphysical approaches to treatment for which there is some scientific evidence of safety and effectiveness. It is not exclusively conventional medical practices or alternative therapies. It is not true that integrative medicine has been found to be ineffective in the treatment of diseases. Alternative therapies, not integrative medicine, are nonorthodox treatment methods that have no proven basis for effectiveness at promoting health. Integrative medicine does not promote exclusive use of herbal and other dietary supplements to treat disease.

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The patient's temperature should be monitored. Breast augmentation patients have drains in place in the surgical site to prevent hematoma formation and then removed 2 to 3 days after surgery, or when drainage is less than 20 to 30 mL per day. The drainage must be examined for colour and odour to detect postoperative infection or hemorrhage. A compression dressing is not kept in place for 5-7 days, dressings should be changed as necessary with sterile technique and prescribed. Depending on the extent of the operation, most women can resume normal activities within 2 to 3 weeks. Strenuous exercise may not be appropriate until several weeks later.

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A delayed hypersensitivity response may develop over several hours or days, or it may reach maximum severity after repeated exposure. Examples of a delayed hypersensitivity response include a blood transfusion reaction that occurs days to weeks after blood administration, rejection of transplanted tissues, and reaction to a tuberculin skin test. Anaphylaxis is a rapid and profound type I hypersensitivity response. Sensitization is the process by which cellular and chemical events occur after a second or subsequent exposure to an allergen. An immediate hypersensitivity response is due to antibodies interacting with allergens and occurs rapidly.

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The nurse should monitor for dyskinesia, which is an adverse reaction of the COMT inhibitors, in the client. The other adverse reactions include dizziness, hypersinesia, nausea, anorexia, diarrhea, orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious, and possibly fatal, adverse reaction that can occur with the administration of tolcapone, one of the COMT inhibitors, is liver failure. Increased hand tremor and constipation are adverse effects associated with the use of dopaminergic drugs. Urinary retention is an adverse reaction associated with the administration of cholinergic blocking drugs.

Correct answer:

Health maintenance organizations strive to keep their costs low and members out of the hospital through periodic screenings, health education, and preventive services. Managed care organizations are insurers who carefully plan and closely supervise the distribution of healthcare services. Preferred provider organizations are a community network of providers who are willing to discount their fees for service in exchange for a steady stream of referral customers. Point-of-service organizations involve a network of providers; clients select a primary care physician within the group who then serves as the gatekeeper for other healthcare services.