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HERZING NSG 521 FUNDAMENTALS/HEALTH ASSESSMENT EXAM 3 LATEST VERSION
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HERZING NSG 521 FUNDAMENTALS/HEALTH ASSESSMENT EXAM 3 LATEST VERSION...
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True or False: Patients with an indwelling catheter do not need peri-care(answer: False to reduce infection risk).
Which of the following assertions concerning toilet training is incorrect?
1) Nighttime continence happens after the daytime.
2) Girls get bladder control faster than guys.
3)Before beginning toilet training, children must be able to express their need to
urinate.
4)Bladder control exists at one year of age - ANSWER 4)Bladder control is
present by one year of age (we normally start potty training around two years
old).
True or false.
To collect a sterile urine specimen from a Foley catheter, drain urine from the
collection bag. False (We do not want old urine remaining in the bag. To collect
urine from the tube, clamp it if there is no urine in it, clean the collection port,
collect 10mL for UA and 3mL for urine culture, label the sterile cup with
patient identifiers, time/date, and unclamp it.
True or false.
When performing a rectal exam, the patient should be positioned in a semi-
fowler position - False. (Semi-Fowlers are semi-reclined/sitting up.) It is
recommended to stand or lie on your left side.
During the exam, the patient may feel the need to urinate or poop.
You are doing a focused examination of a patient's urine output. Which of the
following findings does not warrant further investigation? Select all that apply.
1) Lower back pain during urinating
2) Urine containing mucus
3) Discharge from the urinary meatus
4)Urine sample with 4.8 pH - ANSWER 4) Urine sample with pH 4.8
(The pH of urine usually ranges between 4.6 and 8.2—normally 5-6)
, pee specific gravity typically ranges from 1.005 to 1.030, with concentrated pee
≥1.025 and dilute urine ≤1.001 to 1.010.
The nurse is assessing a patient who has peaked T waves, an abnormal rhythm
on the telemetry monitor, and complaints of chest fluttering. The nurse suspects
which of the following electrolyte disorders?
1)Sodium
2)Calcium
3)Magnesium
4)Potassium - Answer 4) Potassium (High potassium, high T waves) (Low
potassium: diuretics, N/V, laxative).
True or False: Patients on a renal diet should consume foods high in potassium
and sodium (answer: False) due to renal failure or dialysis.
(Constipation patients should follow a high fiber diet that includes beans and
vegetables.)
If this electrolyte imbalance is not treated promptly, the long-term implications
of an increased amount could cause: kidney stones, renal failure, osteoporosis,
and disorientation. - ANSWER Calcium
(Symptoms of hypocalcemia include numbness and tingling in the fingers, lips,
or feet; tetany; muscle cramps; and convulsions.
Hypercalcemia symptoms include nausea, vomiting, constipation, bone pain,
increased urination, thirst, disorientation, drowsiness, and slurred speech.
Which of the following physiological systems affects the acid-base balance,
causing compensatory alterations in a patient with metabolic acidosis.
1)Vascular/veins
2)Hepatic/liver
3)Renal/kidneys
4)Respiratory/lungs: ANSWER 4)Respiratory/Lungs
(Metabolic acidosis is an acidic state in the kidneys; the lungs assist
compensate, and vice versa.)
Is prolonged nausea, vomiting, and diarrhea a cause of hypervolemia? Answer:
False.
(Hypervolemia is excess fluid buildup, such as high sodium/water retention.)
(Hypovolemia is low fluid induced by, for example, N/V).
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