Adaptive Quizzing Questions - MCA 1 Test 4: Diabetes, Renal & Urologic System, Visual & Auditory

A patient reports an inability to understand speech in spite of being able to hear sounds properly. The patient has a history of Paget's disease of the bone and is being treated with antibiotics. The nurse recognizes that the patient is most likely experiencing which type of hearing loss? a) Mixed hearing loss b) Conductive hearing loss c) Sensorineural hearing loss d) Central and functional hearing loss Correct answer- c) Sensorineural hearing loss The patient is able to hear sound but is unable to understand speech. The patient also has a history of Paget's disease of the bone and is receiving antibiotic therapy. These factors lead to sensorineural hearing loss. Sensorineural hearing loss is caused by impairment of function of the inner ear or the vestibulocochlear nerve. Mixed hearing loss occurs due to a combination of conductive and sensorineural causes. In conductive hearing loss, the patient often speaks softly because he can hear his own voice quite loud. The patient hears better in a noisy environment. In central and functional hearing loss, the patient is unable to interpret sound, including speech. This is caused mainly due to a problem in the brain area controlling speech. The nurse is providing care for a 73-year-old male patient who has sought care because of a loss in hearing acuity over the past several years. Which statement by the nurse is most accurate? a) "This is often caused by an infection that will resolve on its own." b) "Many people experience an age-related decline in their hearing." c) "This is likely an effect of your medications. Try stopping them for a few days." d) "You can likely accommodate for your hearing loss with a few small changes in your routine." Correct answer- b) "Many people experience an age-related decline in their hearing." Presbycusis is a loss of hearing that is both common and age related. Infections most often are accompanied by different symptoms. It would be inappropriate to counsel the patient to stop medications. It would be simplistic to advise the patient to accommodate the hearing loss rather than seek intervention. A 22-year-old female patient had a physical for a new job. Her blood pressure was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure? a) Renal trauma b) Renal artery stenosis c) Renal vein thrombosis d) Benign nephrosclerosis Correct answer- b) Renal artery stenosis Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually causes hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension. After providing education to a patient with otosclerosis, the nurse determines that the teaching was effective when the patient states that the hearing loss is due to what? a) A tumor in the middle ear b) Too much ear wax buildup c) Taking too much aspirin over the years d) A problem with the bones in the middle ear Correct answer- d) A problem with the bones in the middle ear Otosclerosis, the deterioration of the bones of the middle ear, is the most common cause of conductive hearing loss. Tumors, too much ear wax, and too much aspirin are problems that may affect hearing but are not related to otosclerosis. What substance is most appropriate for the nurse to use to remove an insect from a patient's ear? a) Water b) Alcohol c) Mineral oil d) Hydrogen peroxide Correct answer- c) Mineral oil Mineral oil causes the least amount of trauma and irritation to the ear canal. Water and hydrogen peroxide should not be used because the insect could swell, which would make it more difficult to remove. Alcohol may cause both irritation of the ear canal and swelling of the insect. A patient presents with diabetic ketoacidosis (DKA). The nurse initiates the collaborative plan of care with the understanding that the initial goal of the treatment plan is: a) Treatment for hypokalemia b) Rapid reduction of elevated blood glucose c) Rehydration through intravenous fluid replacement d) Reduction of ketosis by encouraging oral nourishment Correct answer- c) Rehydration through intravenous fluid replacement Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish intravenous (IV) access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored, because insulin therapy, which is needed to correct the hyperglycemia, may further reduce the potassium level. Insulin therapy will be used to lower the blood glucose gradually, to prevent rapid drops in serum glucose, which could lead to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy, because excess glucose is not being transported to the cells and used as a source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen. Which are immune diseases that cause glomerulonephritis? Select all that apply. a) Scleroderma b) Diabetic nephropathy c) Goodpasture syndrome d) Wegener's granulomatosis e) Systemic lupus erythematosus (SLE) Correct answer- a) Scleroderma c) Goodpasture syndrome e) Systemic lupus erythematosus (SLE) Scleroderma, Goodpasture syndrome, and SLE are immune diseases that cause glomerulonephritis. Diabetic nephropathy results in scarring of glomeruli. Wegener's granulomatosis is a form of vasculitis that causes glomerulonephritis. After administering glucagon to an unconscious patient, the nurse should place the patient in which position? a) Supine b) Side-lying c) High-Fowler's d) Semi-Fowler's Correct answer- b) Side-lying Nausea is a common reaction after glucagon injection. The patient should be placed in the side-lying position to prevent aspiration should the patient vomit. The supine, high- Fowler's, and semi-Fowler's positions are not advisable because of the risk of aspiration of vomitus. A patient has undergone a nephrectomy due to a renal tumor. What nursing interventions are appropriate for the postoperative care of this patient? Select all that apply. a) Record urine output. b) Weigh the patient daily. c) Monitor abdominal distention. d) Instruct the patient to minimize coughing. e) Allow oral intake immediately after operation. f) Provide adequate pain relief through analgesics Correct answer- a) Record urine output. b) Weigh the patient daily. c) Monitor abdominal distention. f) Provide adequate pain relief through analgesics It is important to record hourly fluid intake and output to assess kidney function in the patient. Abdominal distension is commonly present in patients who have had abdominal surgery due to paralytic ileus caused by manipulation and compression of bowel during surgery. The patient may be reluctant to turn, cough, and deep breathe because of the incisional pain. Adequate pain medication should be given to ensure patient's comfort and ability to perform coughing and deep breathing exercises. It is important to weigh the patient daily, because a significant change in daily weight can indicate a retention of fluids. Oral intake is restricted until bowel sounds are present (usually 24 to 48 hours after surgery). The nurse is caring for a patient with obstructing urinary calculi. The patient is treated with tamsulosin to help ease passage of the stones. In addition, opioids are administered to relieve colic pain. What actions should the nurse perform to ensure treatment effectiveness and patient safety? Select all that apply. a) Restrict fluid intake. b) Advise complete bed rest. c) Encourage the patient to move. d) Strain all urine voided by the patient. e) Avoid letting the patient ambulate unattended. Correct answer- c) Encourage the patient to move. d) Strain all urine voided by the patient. e) Avoid letting the patient ambulate unattended. Encouraging the patient to move helps promote the movement of the stone from the upper to the lower urinary tract, resulting in the passage of stones. The nurse should also strain all urine voided by the patient using gauze or a urine strainer to ensure that any spontaneously passed stones are retrieved. To ensure safety, the patient is not left to walk unattended while experiencing acute renal colic, particularly when opioid analgesics are being given. Restricting fluid intake does not help; instead increasing fluid helps to dilute the urine and eases the spontaneous passage of stones. Bed rest is advised only if ordered, during which the patient should be moved every two hours. Which nursing intervention should the nurse include in immediate postoperative management of urinary diversion? a) Keeping the urine alkaline b) Inserting a nasogastric tube c) Notifying the charge nurse of stoma shreds in the drainage bag d) Encouraging the patient to notify the primary health care provider in case of mucus in urine Correct answer- b) Inserting a nasogastric tube With the removal of part of the bowel, there is an increased incidence of small bowel obstruction and paralytic ileus. Therefore a nasogastric tube is inserted for few days. The urine should be acidic to prevent alkaline encrustations. Stoma shreds into the drainage bag and mucus in the urine are common in first few days after the surgery. Which of the following must be completed by a registered nurse and is not in the scope of practice of a vocational or licensed practice nurse? a) Identifying type of incontinence b) Placement of the indwelling catheter placement c) Administering medications via bladder instillation d) Using a bladder scanner to measure postvoid residual volume (PRV) Correct answer- a) Identifying type of incontinence It is a registered nurse's responsibility to assess and identify the type of incontinence and to consult with the primary health care provider on the appropriate interventions for treatment. Catheterization is within the scope of practice of any nurse. A registered nurse or a licensed practical nurse with the consent of healthcare provider can administer medications via bladder instillation. A registered nurse or a licensed practical nurse can use a bladder scanner to measure postvoid residual volume (PRV). The nurse is preparing to perform irrigation of the ear canal for a patient with impacted cerumen. What is the correct order of steps for this process? Place the patient in a sitting position. Pull the auricle up and back. Put the emesis basin under the ear. Direct the flow of solution above or below the impaction. Correct answer- 1. Place the patient in a sitting position. 2. Put the emesis basin under the ear. 3. Pull the auricle up and back. 4. Direct the flow of solution above or below the impaction. Management of cerumen impaction involves irrigation of the ear canal with body temperature solutions to soften the cerumen using special syringes. First, the patient should be placed in a sitting position, and an emesis basin is put under the ear. The nurse should then pull the auricle up and back. Finally, the solution is to be flowed directly above or below the impaction. A patient receiving injectable gentamicin for acute diarrhea complains of tinnitus, diminished hearing, and dizziness. What is the most appropriate nursing action? a) Stop the drug immediately. b) Decrease the drug dosage. c) Plug the ear canals with cotton. d) Reassure the patient that the effects are temporary Correct answer- a) Stop the drug immediately. Gentamicin is an aminoglycoside drug and is an ototoxic drug, and the nurse should monitor the patient for ototoxic effects, such as tinnitus, diminished hearing, and changes in equilibrium. If the patient experiences these symptoms, the drug should be immediately stopped. The symptoms may reverse after discontinuing the drug. Decreasing the dosage may still be ototoxic. Reassuring the patient that symptoms may be temporary and plugging the ears may not contribute to management of symptoms. A patient with urinary incontinence (UI) is on tamsulosin therapy. Which patient outcome indicates effective therapy? a) The patient will not have periodic urination without warning. b) The patient will not have involuntary urination with urinary urgency. c) The patient will not have leakage of urine while coughing and sneezing. d) The patient will not have leakage of small amounts of urine during the day and night. Correct answer- d) The patient will not have leakage of small amounts of urine during the day and night. Tamsulosin is an α-adrenergic blocker used in the treatment of overflow incontinence. Overflow incontinence results in leakage of small amounts of urine frequently throughout the day and night. Absence of leakage of small amounts of urine throughout the day and night indicates effectiveness of the therapy. Diazepam or baclofen therapy results in preventing periodic urination without warning. No involuntary urination with urinary urgency indicates the effectiveness of anticholinergic therapy. Pelvic floor muscle exercises result in no leakage of urine during coughing and sneezing. What instructions should the nurse include when teaching a patient how to administer ear drops? Select all that apply. a) Administer cold, not warm, drops. b) The tip of the dropper should not touch the ear. c) The ear should be positioned so that the drops can run into the canal. d) The drops should not be put in using a cotton wick placed in the ear canal. e) The position of the ear should be maintained for two minutes to let the drops spread. Correct answer- b) The tip of the dropper should not touch the ear. c) The ear should be positioned so that the drops can run into the canal. e) The position of the ear should be maintained for two minutes to let the drops spread. When administering ear drops, the patient should position the ear so that the drops run into the canal, and this position should be maintained for two minutes to let the drops spread. The dropper should not touch the ear; avoiding contact reduces the spread of infection. The ear drops should be at room temperature when administered. Cold drops can cause vertigo; very warm drops can burn the tympanic membrane. Sometimes the drops are placed onto a wick of cotton that is placed in a canal. Which surgical procedure is beneficial to treat a patient who is diagnosed with an obstructive urethral stricture? a) Urethroplasty b) Laser lithotripsy c) Spence procedure d) Retrograde urethrography Correct answer- a) Urethroplasty Urethroplasty is an open surgical procedure that is the most definitive therapy for an obstructive urethral stricture. Laser lithotripsy is used to fragment ureteral and large bladder stones. Spence procedure involves marsupialization (creation of a permanent opening) of the diverticular sac in the vagina. Retrograde urethrography is also used for urethral stricture, but is used to determine the stricture length, location, and caliber. Which is the most serious complication the nurse can expect when providing care to a patient diagnosed with polycystic kidney disease (PKD)? a) Cerebral aneurysm b) Periurethral abscess c) Squamous cell cancer of the bladder d) Hypercoagulability with thromboembolism Correct answer- a) Cerebral aneurysm Cerebral aneurysm is a serious complication of PKD; it can rupture and cause bleeding and even irreversible brain damage. Periurethral abscess is a complication seen most frequently with the long-term use of indwelling catheters. Squamous cell cancer of the bladder occurs in individuals with chronic recurrent renal calculi. Hypercoagulability with thromboembolism is a serious complication of nephrotic syndrome. Which nursing intervention is most appropriate for facilitating communication with a patient who has a hearing impairment? a) Speaking loudly and shouting if necessary b) Asking the patient questions that can be answered with a yes or no response c) Standing close to the patient and speaking slowly and clearly in a normal tone d) Standing to one side of the patient when speaking and directing the voice directly into the patient's ear Correct answer- c) Standing close to the patient and speaking slowly and clearly in a normal tone Standing close to and directly in front of the patient will greatly facilitate communication. The nurse also should ensure that the patient can see the nurse's mouth to help facilitate lip-reading. Shouting at the patient with a hearing impairment distorts the voice and further hinders understanding. Asking yes-or-no questions and standing to one side and speaking directly into the patient's ear are not appropriate or effective means of communicating with the patient who has a hearing impairment. A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the "classic triad" occurring in patients with renal cancer? a) Fever, chills, flank pain b) Hematuria, flank pain, palpable mass c) Hematuria, proteinuria, palpable mass d) Flank pain, palpable abdominal mass, and proteinuria Correct answer- b) Hematuria, flank pain, palpable mass There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease. Fever, chills, and proteinuria are not signs of renal carcinoma. While caring for a patient with suprapubic catheterization, the nurse administers an opium suppository. Which outcome in the patient indicates effective treatment? a) The patient will not experience flank pain. b) The patient will not experience bladder spasms. c) The patient will not experience urine loss after voiding. d) The patient will not experience overdistention of the kidney pelvis. Correct answer- b) The patient will not experience bladder spasms. The patient with suprapubic catheterization may have urine leakage due to bladder spasms. An opium suppository is administered to decrease the bladder spasms. Acute pyelonephritis involves flank pain and administration of ciprofloxacin reduces the flank pain. Administration of trimethoprim will help to reduce urine loss after voiding in a urinary tract infection. Overdistention of the kidney pelvis is a complication associated with nephrostomy tubes. Instilling 5 mL of sterile saline solution will help to prevent overdistention of the kidney pelvis. The nurse is providing instructions about pelvic floor muscle exercises to a patient with stress incontinence. Which statement made by the patient indicates the need for further teaching? a) "I can do this exercise in a sitting or lying position." b) "I can do quick two-second squeezes periodically." c) "I am doing it right when I release the muscle to urinate." d) "I can tighten the muscle for 10 seconds, relax, and repeat." Correct answer- c) "I am doing it right when I release the muscle to urinate." When there is strong urge for urination, the patient should tighten the pelvic muscle quickly and squeeze hard several times until the urge passes. Pelvic floor muscle exercises should be performed in a sitting or lying down position. To perform long squeezes, the pelvic muscle should be tightened for 5 to 10 seconds before relaxing. Short squeezes require tightening the muscle quickly, squeezing for two seconds, and then relaxing. A patient is diagnosed with overflow incontinence. Which medication is beneficial to enhance bladder contraction in the patient? a) Baclofen b) Diazepam c) Finasteride d) Bethanechol Correct answer- d) Bethanechol Overflow incontinence occurs when the pressure of the urine in an overfull bladder overcomes sphincter control. Bethanechol enhances bladder contraction by increasing detrusor muscle tone in the bladder wall. Baclofen and diazepam are used to relax the external sphincter in reflex incontinence. Finasteride is a reductase inhibitor used to decrease outlet resistance in overflow incontinence. Which condition involves inflammation of the vitreous cavity? a) Uveitis b) Blepharitis c) Otitis media d) Endophthalmitis Correct answer- d) Endophthalmitis Endophthalmitis is intraocular inflammation of the vitreous cavity. Uveitis is inflammation of the uvea. Inflammation of the margins of the eyelids is called blepharitis. Infection of the tympanum, ossicles, and space of the middle ear is called otitis media. The nurse would refrain from administering a prescribed dose of pilocarpine two drops to both eyes if it was documented that the patient has which comorbidity? a) Secondary glaucoma b) Macular degeneration c) Benign prostatic hypertrophy