4 HESI RN CASE STUDY CYSTIC FIBROSIS (A+ Guide)

4 HESI RN CASE STUDY CYSTIC FIBROSIS Physiological Integrity/Clinical Manifestations The nurse suspects that Darla may have cystic fibrosis (CF).1.ID: 96 Which statement by the mother supports the diagnosis of CF? A. "My daughter went to bed feeling fine last night and woke up with a high fever and a sore throat." "Lately Darla's eyes appear to have a yellow discoloration." "When I kiss my daughter, her skin tastes like salt." Correct D."I can hear her heart beating when I lay my head on her chest." Although this can indicate a heart defect, it may be normal in some children. Awarded 1.0 points out of 1.0 possible points. 3. The healthcare provider (HCP) reviews Darla's medical chart. 4. 2.ID: 99 Which documentation further supports the diagnosis of CF? (Select all that apply.) A.A history of frequent respiratory infections. Correct An elevated white blood cell count (WBC). The WBC count is not affected by CF. C. Reports of episodic abdominal pain and crying. These are not signs or symptoms of CF. D. A sweat chloride level of 35 mEq/L. A sweat chloride level below 40 mEq/L is a normal finding. E. Reports of foul-smelling stools that have white streaks and are sticky. Correct Safe and Effective Care/Diagnostic Test The HCP prescribes a sweat test to confirm Darla's diagnosis of CF. 3. 3.ID: 88 What information will the nurse include when teaching about the sweat test? A. Informed consent will be needed for this invasive, diagnostic test. It will take 2 hours to obtain the sweat. The procedure usually takes about an hour. This procedure must be done twice a week for 3 weeks before confirming diagnosis. It is a simple, painless, reliable test that measures the chloride in sweat. Correct Physiological Integrity/Psychosocial Integrity The HCP meets with Darla’s parents and informs them that the sweat-chloride test results highly suggest the diagnosis of CF. Darla’s mother is very upset about the news and insists that there is another explanation for Darla’s small stature and that some girls are just more petite than others. Darla’s father asks the HCP if there is another test to definitely confirm the diagnosis. The HCP explains that there is another test and arranges for a DNA test to attempt to identify mutations on chromosome 7, which is responsible for the cystic fibrosis disease. 3. 4.ID: 33 Donald and Pamela have been at Darla's bedside since she was admitted to the hospital. Donald asks to speak to the nurse outside in the hall. He tells the nurse that Pamela is telling everyone that Darla is going to be fine and that there has just been a mistake and everything will be all right as long as they pray. What action should the RN take first? A. Schedule an appointment for Pamela with the hospital's chaplain. B. Suggest that Donald and his wife sit down and talk about the situation. C. Refer Pamela to a professional counselor. D. Make arrangements to meet with Pamela privately at the first opportunity. Correct 1. Ethical Issues The nurse meets with Pamela to discuss her denial of Darla's diagnosis. During the conversation, Pamela finally breaks down crying and tells the nurse, "I just can't believe what I have been thinking. Darla is going to die, and it is all my husband’s fault! I should have never married him. No one in my family has ever had this disease. My husband is adopted and his parents do not know anything about his biological background. His biological parents must have had this nasty disease and