Adult Health Cramfest

symptoms of metabolic acidosis

-Headache, lethargy -Nausea, vomiting, diarrhea -Coma -Death

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information indicates a need for change in the medication or dosage? Select one: a. Uncontrolled head movement b. Shuffling gait c. Tremor at rest d. Cogwheel rigidity of limbs Feedback

Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease. The correct answer is: Uncontrolled head movement

A nurse assesses a client with Huntington disease. Which motor changes should the nurse monitor for in this client? Select one: a. Jerky hand movements b. Shuffling gait c. Continuous chewing motions d. Tremors of the hands

Feedback An imbalance between excitatory and inhibitory neurotransmitters leads to uninhibited motor movements, such as brisk, jerky, purposeless movements of the hands, face, tongue, and legs. Shuffling gait, continuous chewing motions, and tremors are associated with Parkinson disease. The correct answer is: Jerky hand movements

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? Select one: a. Insert a nasogastric (NG) tube and connect to suction. b. Administer 1 L of lactated Ringer's solution. c. Give an IV H2 receptor antagonist. d. Draw blood for typing and crossmatching.

Feedback The correct answer is: Administer 1 L of lactated Ringer's solution.

What accurately describes the PR interval? (select all that apply) Select one or more: a. 0.16 seconds b. <0.12 seconds c. 0.06 to 0.12 seconds d. 0.12 to 0.20 seconds e. time of depolarization and repolarization of ventricles f. measured from beginning of P wave to beginning of QRS complex

D, F

A Platelet count assesses overall hemostatic function (platelet response to injury and vasoconstrictive ability). Select one: True False

Feedback The correct answer is 'False'. Question 32 Correct 1.00 points out of 1.00 Flag question Question text

To prepare a patient with ascites for paracentesis, the nurse Select one: a. asks the patient to empty the bladder. b. assists the patient to lie flat in bed. c. places the patient on NPO status. d. positions the patient on the right side.

Feedback The correct answer is: asks the patient to empty the bladder.

A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's Select one: a. apical pulse. b. bowel sounds. c. breath sounds. d. abdominal girth.

Feedback The correct answer is: breath sounds.

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about Select one: a. the amount of saturated fat in the diet. b. use of nonsteroidal antiinflammatory drugs (NSAIDs). c. a family history of gastric or colon cancer. d. a history of a large recent weight gain or loss.

Feedback The correct answer is: use of nonsteroidal antiinflammatory drugs (NSAIDs).

The nurse calculates the mean arterial pressure (MAP) for a client whose BP is 152/90. What is the MAP in mmHg? (round to the nearest whole number). Select one: a. 111 b. 104 c. 81 d. 161

MAP = (SBP + 2 (DBP))/3 A

symptoms of respiratory acidosis

Rapid, shallow breathing, dyspnea, disorientation, muscle weakness

symptoms of respiratory alkalosis

lightheadedness, tremors, tinnitus; panic feeling, difficulty concentrating, sensation of chest tightness; seizures and circumoral and distal extremity paresthesias

The nurse is making initial rounds on the nursing unit to assess the condition of assigned clients. The nurse notes that a client's intravenous (IV) site is cool, pale, and swollen, and the solution is not infusing. The nurse concludes that which complication has occurred? Select one: a. infiltration b. infection c. phlebitis d. thrombosis

A

The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic and crackles are audible on auscultation. What additional signs would the nurse expect to note in this client if excess fluid volume is present? Select one: a. an increase in blood pressure b. flat neck and hand veins c. decreased central venous pressure (CVP) d. weight loss

A A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. Assessment findings associated with fluid colume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. Other Options identify signs noted in fluid volume deficit.

A patient with a positive Chvostek's sign, the Nurse should anticipate the IV administration of which medication Select one: a. Calcium gluconate b. Calcitonin c. Loop diuretics d. Vitamin D

A Feedback The correct answer is: Calcium gluconate Indicates hypocalcemia (less than 8.5 or so). Chvostek's sign is the twitching of the facial muscles in response to tapping over the area of the facial nerve.

A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient Select one: a. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. b. about radioactive precautions to take with all body secretions. c. to discontinue the antithyroid medications taken before the radioactive therapy. d. that symptoms of hyperthyroidism should be relieved in about a week.

A Iodine is needed for the synthesis of thyroid hormones so more iodine means more thyroid hormones

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? Select one: a. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L b. Patient who is taking carvedilol (Coreg) and has a heart rate of 58 c. Patient who is taking captopril and has a frequent nonproductive cough d. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache

A The patient's low potassium level increases the risk for digoxin toxicity and potentially fatal dysrhythmias. The nurse should assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their medications, but their symptoms do not indicate potentially life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 777 OBJ: Special Questions: Prioritization

A client with aortic valve stenosis develops heart failure (HF). Which pathophysiological finding occurs in the myocardial cells as a result of the increased cardiac workload? Select one: a. increase in size b. decrease in length c. increase in number d. decrease in excitability

A Your answer is correct. The correct answer is: increase in size

A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? Select one: a. Encourage 4000 mL of fluids daily. b. Institute routine seizure precautions. c. Assess for positive Chvostek's sign. d. Restrict the patient to bed rest.

A hypercalcemia puts the patient at risk of kidney stones so more fluid will help minimize this risk. Seizure precautions and checking for Chvostek's sign are indicated with hypocalcemia, not hyper. The patient should work out to help reduce calcium loss from the bones

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? Select one: a. hyperactive bowel sounds b. increased specific gravity of the urine c. muscle twitches d. decreased urinary output

A Hyponatremia is evidenced by serum sodium level lower than 135. Hyperactive bowel sounds indicated hyponatremia. Options 1, 2, and 4 are signs of hypernatremia. In hyponatremia, increased urinary output and decreased specific gravity of the urine would be noted.

All of the following are clinical manifestations of respiratory alkalosis except: Select one: a. muscle cramps b. seizures c. hyperreflexia d. tingling of extremities e. numbness f. tetany

A - muscle cramps

A patient with asthma has the following arterial blood gas (ABG) results early in an acute asthma attack: pH 7.48, PaCO2 30 mm Hg, PaO2 78 mm Hg. What is the most appropriate action by the nurse? Select one: a. Document the findings and monitor the ABGs for a trend toward acidosis -- trick question ******* b. Have the patient breathe in a paper bag to raise the PaCO2 c. Reduce the patient's oxygen flow rate to keep the PaO2 at the current level d. Prepare the patient for mechanical ventilation

A. Early in an asthma attack, an increased respiratory rate and hyperventilation create a respiratory alkalosis with increased pH and decreased PaCO2, accompanied by hypoxemia. As the attack progresses, pH shifts to normal, then decreases, with arterial blood gases (ABGs) that reflect respiratory acidosis with hypoxemia. During the attack, high-flow oxygen should be provided. Breathing in a paper bag, although used to treat some types of hyperventilation, would increase the hypoxemia.

A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the medication states: methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse administer?

Answer: Feedback A concentration of 125 mg in 2 mL will result in 100 mg in 1.6 mL. The correct answer is: 1.6

Why does ascites occur with liver failure?

Ascites is most often caused by liver scarring. This increases pressure inside the liver's blood vessels. The increased pressure can force fluid into the abdominal cavity, causing ascites. Liver damage is the single biggest risk factor for ascites.Sep 23, 2015

Which arterial blood gas (ABG) results would most likely indicate acute respiratory failure in a patient with chronic lung disease? Select one: a. PaO2 48 mmHg, PaCO2 54 mmHg, pH 7.38 b. PaO2 50 mmHg, PaCO2 54 mmHg, pH 7.28 c. PaO2 52 mmHg, PaCO2 56 mmHg, pH 7.4 d. PaO2, 46 mmHg, PaCO2 52 mmHg, pH 7.36

B Rationale: The pH is out of balance

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco2 of 30 mm Hg, and HCO3¯ of 20 mEq/L. The nurse analyzes these results as indicating which condition? Select one: a. respiratory acidosis, uncompensated b. respiratory alkalosis, compensated c. metabolic acidosis, compensated d. metabolic alkalosis, uncompensated

B Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider? Select one: a. Patient's blood pressure is 148/94 mm Hg. b. Patient stopped taking the medication 2 days ago. c. Patient has not been taking the prescribed vitamin D. d. Patient has bilateral 2+ pitting ankle edema.

B Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency. The other information will also be reported, but does not require rapid treatment

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? Select one: a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.

B The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient? Select one: a. The patient will choose a diet that distributes calories throughout the day. b. The patient will reach a glycosylated hemoglobin level of less than 7%. c. The patient will follow a diet and exercise plan that results in weight loss. d. The patient will state the reasons for eliminating simple sugars in the diet.

B.

You are caring for a client who is being discharged to home and will have lipid lab work drawn as an outpatient. You would need to educate your patient on which of the following? Select one or more: a. instruct the client to eat a diet low in yellow foods, avoiding foods such as carrots, yams, yellow beans, and pumpkin for 3 to 4 days before the blood is drawn. b. instruct the client to abstain from alcohol for 24 hours before the test c. oral contraceptives may increase the lipid level d. instruct the client to abstain from foods and fluid, except for water, for 12 to 14 hours before the test e. instruct the client to avoid consuming high-cholesterol foods with the evening meal before the test

BCDE No rationale found.

A client brought to the emergency department states that he has accidentally been taking two times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action? Select one: a. draw a sample for type and crossmatch and transfuse the client b. draw a sample for an activated partial thromboplastin time (aPTT) level c. draw a sample for prothrombin time (PT) and international normalized ratio (INR) d. prepare to administer an antidote

C The next action is to draw a sample for PT and INR level to determine the client's anticoagulation status and risk for bleeding. These results will provide information as to how to best treat this client (e.g., if an antidote such as vitamin K or a blood transfusion is needed). The aPTT monitors the effects of heparin therapy.

The nurse checks the laboratory result for a serum digoxin level that was prescribed for a client earlier in the day and notes that the result is 2.4 ng/mL. The nurse should take which immediate action? Select one: a. administer the next dose of the medication as scheduled. b. check the client's last pulse rate c. notify the health care provider d. record the normal value on the client's flow sheet

C The normal therapeutic range for digoxin is 0.5 to 2 ng/mL. A level of 2.4 ng/mL exceeds the therapeutic range and indicates toxicity. The nurse should notify the HCP, who may give further prescriptions about holding further doses of digoxin. The option that indicates to record the normal value on the client's flow sheet is incorrect because the level is not normal. The next dose should not be administered because the serum digoxin level exceeds the therapeutic range. Checking the client's last pulse rate may have limited value in this situation. Depending on the time that has elapsed since the last assessment, a current assessment of the client's status may be more useful.

The patient's laboratory results show a marked decrease in RBCs, WBCs, and platelets. What term should the Nurse use when reporting the results to the HCP? Select one: a. Hemolysis b. Thrombocytopenia c. Pancytopenia d. Leukopenia

C Deficiency of all three cellular components of the blood (red cells, white cells, and platelets). Origin 1940s: from pan- 'all' + cyto- 'cell' + Greek penia 'poverty, lack'.

The patient with severe CKD is receiving dialysis, and the Nurse observes excoriations on the patient's skin. All of the following pathophysiologic changes are likely contributing to this finding, except? Select one: a. Calcium-phosphate skin deposits b. Sensory neuropathy c. Uremic crystallization from high BUN d. Dry skin

C Feedback The correct answer is: Uremic crystallization from high BUN Pruritus is common in patients receiving dialysis. It causes scratching from dry skin, sensory neuropathy, and calcium-phosphate deposition in the skin. Vascular calcifications contribute to cardiovascular disease, not to itching skin. Uremic frost rarely occurs without BUN levels greater than 200 mg/dL, which should not occur in a patient on dialysis; urea crystallizes on the skin and also causes pruritis.

A 21-yr-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? Select one: a. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty. b. Biologic valves will require immunosuppressive drugs after surgery. c. Mechanical mitral valves need to be replaced sooner than biologic valves. d. Lifelong anticoagulant therapy is needed after mechanical valve replacement.

D Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.

A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. Which action should the nurse take? Select one: a. Auscultate the client's anterior and posterior lung fields. b. Administer pain medication and encourage the client to take deep breaths. c. Encourage the client to take shallow breaths to help with the pain. d. Ambulate the client in the hallway to promote deep breathing.

Feedback A chest tube is placed in the pleural space and may be uncomfortable for a client. The nurse should provide pain medication to minimize discomfort and encourage the client to take deep breaths. The other responses do not address the client's discomfort and need to take deep breaths to prevent complications. The correct answer is: Administer pain medication and encourage the client to take deep breaths.

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? Select one: a. Monitor intake and output. b. Provide a low-sodium diet. c. Weigh the client daily. d. Increase oral fluid intake.

Feedback A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful. The correct answer is: Provide a low-sodium diet.

After change-of-shift report on the Alzheimer's disease/dementia unit, which patient will the nurse assess first? Select one: a. Patient who has a stage II pressure ulcer on the coccyx b. Patient who developed a new cough after eating breakfast c. Patient who is refusing to take the prescribed medications d. Patient who has not had a bowel movement for 5 days

Feedback A new cough after a meal in a patient with dementia suggests possible aspiration, and the patient should be assessed immediately. The other patients also require assessment and intervention but not as urgently as a patient with possible aspiration or pneumonia. The correct answer is: Patient who developed a new cough after eating breakfast

A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? Select one: a. Use simple words and phrases to explain procedures. b. Assist with active range of motion (ROM). c. Give muscle relaxants as needed to reduce spasms. d. Observe for agitation and paranoia.

Feedback ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations. The correct answer is: Assist with active range of motion (ROM). ALS, or amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. A-myo-trophic comes from the Greek language. "A" means no. "Myo" refers to muscle, and "Trophic" means nourishment - "No muscle nourishment."

fter hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best? Select one: a. "Bacteria can often cause ulcers." b. "It prevents stress-related ulcers." c. "The medication keeps your blood pH low." d. "This operation often causes ulcers."

Feedback After surgery, anti-ulcer medications such as pantoprazole are often given to prevent stress-related ulcers. The other responses are incorrect. The correct answer is: "It prevents stress-related ulcers."

A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? Select one: a. Hemoglobin: 8.1 mg/dL b. Albumin: 2.1 g/dL c. International normalized ratio (INR): 4.2 d. Hematocrit: 28%

Feedback An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albumin is low and is an expected finding. The hematocrit and hemoglobin are also low, but this is expected in gastric cancer. The correct answer is: International normalized ratio (INR): 4.2 Why would albumin, H&H be low with gastric cancer? The most common cause of iron deficiency anemia is gastrointestinal bleeding, 11.5% of patients with sideropenic anemia have some form of cancer of the gastrointestinal tract, of which the most common are cancer of the colon and stomach cancer. Also chemotherapy ...Chemotherapy-induced anemia (see below) High levels of cytokines related to some cancers can slow the production of red blood cells by the bone marrow. Change in diet - Cancer itself can cause a poor appetite which can result in nutritional deficiencies which result in anemia.

A patient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering medications, the patient says, "I don't need the aspirin today. I don't have a fever." Which action should the nurse take? Select one: a. Explain that the aspirin is ordered to decrease stroke risk. b. Call the health care provider to clarify the medication order. c. Tell the patient that the aspirin is used to prevent a fever. d. Document that the aspirin was refused by the patient.

Feedback Aspirin is ordered to prevent stroke in patients who have experienced TIAs. Documentation of the patient's refusal to take the medication is an inadequate response by the nurse. There is no need to clarify the order with the health care provider. The aspirin is not ordered to prevent aches and pains. The correct answer is: Explain that the aspirin is ordered to decrease stroke risk.

A nurse delegates care for a client with early-stage Alzheimer's disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care? Select one: a. "Use validation therapy to recognize and acknowledge the client's concerns." b. "Reorient the client to the day, time, and environment with each contact." c. "Remove the clock from her room so that she doesn't get confused." d. "If she is confused, play along and pretend that everything is okay."

Feedback Clients who have early-stage Alzheimer's disease should be reoriented frequently to person, place, and time. The UAP should reorient the client and not encourage the client's delusions. The room should have a clock and white board with the current date written on it. Validation therapy is used with late-stage Alzheimer's disease. The correct answer is: "Reorient the client to the day, time, and environment with each contact."

A client is taking long-term corticosteroids for myasthenia gravis. What teaching is most important? Select one: a. Check blood sugars four times a day. b. Wear properly fitting socks and shoes. c. Avoid large crowds and people who are ill. d. Use two forms of contraception.

Feedback Corticosteroids reduce immune function, so clients taking these medications must avoid being exposed to illness. Long-term use can lead to secondary diabetes, but the client would not need to start checking blood glucose unless diabetes had been detected. Corticosteroids do not affect the effectiveness of contraception. Wearing well-fitting shoes would be important to avoid injury, but not just because the client takes corticosteroids. The correct answer is: Avoid large crowds and people who are ill.

A nurse plans care for a client with Parkinson disease. Which intervention should the nurse include in this client's plan of care? Select one: a. Keep the head of the bed at 30 degrees or greater. b. Ensure a fluid intake of at least 3 liters per day. c. Teach the client pursed-lip breathing techniques. d. Ambulate the client in the hallway twice a day.

Feedback Elevation of the head of the bed will help prevent aspiration. The other options will not prevent aspiration, which is the greatest respiratory complication of Parkinson disease, nor do these interventions address any of the complications of Parkinson disease. Ambulation in the hallway is usually implemented to prevent venous thrombosis. Increased fluid intake flushes out toxins from the client's blood. Pursed-lip breathing increases exhalation of carbon dioxide. The correct answer is: Keep the head of the bed at 30 degrees or greater.

A client experiences impaired swallowing after a stroke and has worked with speech-language pathology on eating. What nursing assessment best indicates that a priority goal for this problem has been met? Select one: a. Has clear lung sounds on auscultation b. Eats 75% to 100% of all meals and snacks c. Gains 2 pounds after 1 week d. Chooses preferred items from the menu

Feedback Impaired swallowing can lead to aspiration, so the priority goal for this problem is no aspiration. Clear lung sounds is the best indicator that aspiration has not occurred. Choosing menu items is not related to this problem. Eating meals does not indicate the client is not still aspirating. A weight gain indicates improved nutrition but still does not show a lack of aspiration. The correct answer is: Has clear lung sounds on auscultation

Admission vital signs for a brain-injured patient are blood pressure of 128/68 mm Hg, pulse of 110 beats/min, and of respirations 26 breaths/min. Which set of vital signs, if taken 1 hour later, will be of most concern to the nurse? Select one: a. Blood pressure of 110/70 mm Hg, pulse of 120 beats/min, respirations of 30 breaths/min b. Blood pressure of 154/68 mm Hg, pulse of 56 beats/min, respirations of 12 breaths/min c. Blood pressure of 134/72 mm Hg, pulse of 90 beats/min, respirations of 32 breaths/min d. Blood pressure of 148/78 mm Hg, pulse of 112 beats/min, respirations of 28 breaths/min

Feedback Systolic hypertension with widening pulse pressure, bradycardia, and respiratory changes represent Cushing's triad. These findings indicate that the intracranial pressure (ICP) has increased, and brain herniation may be imminent unless immediate action is taken to reduce ICP. The other vital signs may indicate the need for changes in treatment, but they are not indicative of an immediately life-threatening process. The correct answer is: Blood pressure of 154/68 mm Hg, pulse of 56 beats/min, respirations of 12 breaths/min

A nurse is caring for a client after a stroke. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) Select one or more: a. Cluster client care to allow periods of uninterrupted rest. b. Position the client supine with the head in a neutral midline position. c. Check and document oxygen saturation every 1 to 2 hours. d. Assess neurologic status with the Glasgow Coma Scale. e. Elevate the head of the bed to 45 degrees to prevent aspiration.

Feedback The UAP can take and document vital signs, including oxygen saturation, and keep the client's head in a neutral, midline position with correct direction from the nurse. The nurse assesses the Glasgow Coma Scale score. The nursing staff should not cluster care because this can cause an increase in the intracranial pressure. The head of the bed should be minimally elevated, up to 30 degrees. The correct answers are: Check and document oxygen saturation every 1 to 2 hours., Position the client supine with the head in a neutral midline position.

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort? Select one: a. Provide small, frequent feedings with no concentrated sweets. b. Administer morphine sulfate intravenously every 4 hours as needed. c. Maintain nothing by mouth (NPO) and administer intravenous fluids. d. Place the client in semi-Fowler's position with the head of bed elevated.

Feedback The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort. The correct answer is: Maintain nothing by mouth (NPO) and administer intravenous fluids.

Diets high in green leafy vegetables can increase the absorption of vitamin K, which shortens the PT. Select one: True False

Feedback The correct answer is 'True'. Question 31 Correct 1.00 points out of 1.00 Flag question Question text

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate? Select one: a. "Do you use any over-the-counter drugs?" b. "Do you have a history of IV drug use?" c. "Have you used corticosteroids for any reason?" d. "Have you recently traveled to a foreign country?"

Feedback The correct answer is: "Do you use any over-the-counter drugs?"

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching? Select one: a. "I frequently eat at restaurants, and my food has a lot of added salt." b. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon." c. "I had the flu earlier this week, so I couldn't take the hydrocortisone." d. "I always double my dose of hydrocortisone on the days that I go for a long run."

Feedback The correct answer is: "I had the flu earlier this week, so I couldn't take the hydrocortisone." Review: see picture DON'T STOP TAKING HYDROCORTISONE since this is the replacement for the cortisol you can't produce yourself

The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement? Select one: a. "I need to limit my fluid intake to no more than 1 quart of liquids a day." b. "I should eat foods high in potassium because diuretics cause potassium loss." c. "I should weigh myself daily and report any sudden weight loss or gain." d. "I need to shop for foods low in sodium and avoid adding salt to food."

Feedback The correct answer is: "I need to shop for foods low in sodium and avoid adding salt to food."

The nurse is planning a teaching session with a patient newly diagnosed with migraine headaches. To assess a patient's readiness to learn, which question should the nurse ask first? Select one: a. "Do you have any religious beliefs that are inconsistent with the planned treatment?" b. "What kind of work and leisure activities do you do?" c. "What information do you think you need right now?" d. "Can you describe the types of activities that help you learn new information?"

Feedback The correct answer is: "What information do you think you need right now?" Question 34 Correct 1.00 points out of 1.00 Flag question Question text

Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet? Select one: a. "You are likely to notice changes in how you feel after a few weeks of diet and exercise." b. "You will decrease your risk for future health problems such as diabetes by losing weight now." c. "It will be necessary to change lifestyle habits permanently to maintain weight loss." d. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat."

Feedback The correct answer is: "You are likely to notice changes in how you feel after a few weeks of diet and exercise."

After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first? Select one: a. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. b. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62 c. A patient who reported dizziness after receiving the first dose of captopril d. A patient who is cool and clammy, with new-onset confusion and restlessness

Feedback The correct answer is: A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion. Drug review: Nesiritide (Natrecor) is a recombinant form of human brain natriuretic peptide, which causes venous and arterial vasodilation. It does not affect cardiac contractility.1 Nesiritide is approved by the U.S. Food and Drug Administration (FDA) for use in the short-term treatment of hospitalized patients with acutely decompensated heart failure characterized by dyspnea at rest or by clinical evidence of fluid overload.1,2 Captopril: ACE inhibitor

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? Select one: a. Bowel sounds are present. b. Abdominal pain is decreased. c. Grey Turner sign resolves. d. Electrolyte levels are normal.

Feedback The correct answer is: Abdominal pain is decreased.

A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? Select one: a. Titrate the infusion of 5% dextrose in water. b. Teach the patient how to use desmopressin (DDAVP) nasal spray. c. Administer prescribed subcutaneous DDAVP. d. Assess the patient's overall hydration status every 8 hours.

Feedback The correct answer is: Administer prescribed subcutaneous DDAVP.

A patient who has diabetes and reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline ? Select one: a. Amitriptyline corrects some of the blood vessel changes that cause pain. b. Amitriptyline helps prevent transmission of pain impulses to the brain. c. Amitriptyline decreases the depression caused by your foot pain. d. Amitriptyline improves sleep and makes you less aware of nighttime pain.

Feedback The correct answer is: Amitriptyline helps prevent transmission of pain impulses to the brain. amitriptyline is an anti-depressant - which work on the brain

An older patient complains of having "no energy" and feeling increasingly weak. The patient has had a 12-lb weight loss over the past year. Which action should the nurse take initially? Select one: a. Ask the patient about daily dietary intake. b. Schedule regular range-of-motion exercise. c. Describe normal changes associated with aging to the patient. d. Discuss long-term care placement with the patient.

Feedback The correct answer is: Ask the patient about daily dietary intake. Question 37 Correct 1.00 points out of 1.00 Flag question Question text

The nurse plans to teach a patient and the caregiver how to manage high blood pressure (BP). Which action should the nurse take first? Select one: a. Teach the caregiver how to take the patient's BP using a manual blood pressure cuff. b. Give written information about hypertension to the patient and caregiver. c. Have the dietitian meet with the patient and caregiver to discuss a low-sodium diet. d. Ask the patient and caregiver to select information from a list of high BP teaching topics.

Feedback The correct answer is: Ask the patient and caregiver to select information from a list of high BP teaching topics. Question 36 Correct 1.00 points out of 1.00 Flag question Question text

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? Select one: a. Liver 3 cm below costal margin b. Elevated total bilirubin level c. Jaundiced sclera and skin d. Asterixis and lethargy

Feedback The correct answer is: Asterixis and lethargy

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? Select one: a. Jaundiced sclera and skin b. Elevated total bilirubin level c. Asterixis and lethargy d. Liver 3 cm below costal margin

Feedback The correct answer is: Asterixis and lethargy The patient's findings of asterixis and lethargy are consistent with grade 2 hepatic encephalopathy. Patients with acute liver failure can deteriorate rapidly from grade 1 or 2 to grade 3 or 4 hepatic encephalopathy and need early transfer to a transplant center. The other findings are typical of patients with hepatic failure and would be reported but would not indicate a need for an immediate change in the therapeutic plan.

What is the primary way that a Nurse will evaluate the patency of an AVF? Select one: a. Auscultate for the presence of a bruit at the site b. Palpate for pulses distal to the graft site c. Evaluate the color and temperature of the extremity d. Assess for the presence of numbness and tingling distal to the site

Feedback The correct answer is: Auscultate for the presence of a bruit at the site A patent arteriovenous fistula (AVF) creates turbulent blood flow that can be assessed by listening for a bruit or palpated for a thrill as the blood passes through the graft. Assessment of neurovascular status in the extremity distal to the graft site is important to determine that the graft does not impair circulation to the extremity but the neurovascular status does not indicate whether the graft is open.

The nurse and the patient who is diagnosed with hypertension develop this goal: "The patient will select a 2-gram sodium diet from the hospital menu for the next 3 days." Which evaluation method will be best for the nurse to use when determining whether teaching was effective? Select one: a. Compare the patient's sodium intake before and after the teaching was implemented. b. Check the sodium content of the patient's menu choices over the next 3 days. c. Ask the patient to identify which foods on the hospital menus are high in sodium. d. Have the patient list substitutes for favorite foods that are high in sodium.

Feedback The correct answer is: Check the sodium content of the patient's menu choices over the next 3 days. Question 35 Incorrect 0.00 points out of 1.00 Remove flag Question text

After the nurse provides diet instructions for a patient with diabetes, the patient can restate the information but fails to make the recommended diet changes. How would the nurse best evaluate the patient's situation? Select one: a. Choosing not to follow the diet is the behavior that resulted from learning. b. Learning did not occur because the patient's behavior did not change. c. The nurse's responsibility for helping the patient make diet changes has en fulfilled. d. The teaching methods were ineffective in helping the patient learn about the necessary diet changes.

Feedback The correct answer is: Choosing not to follow the diet is the behavior that resulted from learning.

All are examples of type I or IgE-mediated hypersensitivity reaction except? Select one: a. Angioedema b. Anaphylactic shock c. Allergic rhinitis d. Contact dermatitis e. Asthma

Feedback The correct answer is: Contact dermatitis Question 43 Incorrect 0.00 points out of 1.00 Remove flag Question text

A patient is admitted to the hospital with acute thyrotoxicosis. On physical assessment of the patient, what should the Nurse expect to find? Select one: a. Elevated temperature and signs of heart failure b. Bulging eyeballs and dysrhythmias c. Lethargy progressing suddenly to impairment of consciousness d. Hoarseness and laryngeal stridor

Feedback The correct answer is: Elevated temperature and signs of heart failure Question 40 Correct 1.00 points out of 1.00 Flag question Question text

What is the most appropriate snack to offer a patient with stage 4 CKD? Select one: a. Cheese b. Dill pickle c. Raisins d. Hard candy

Feedback The correct answer is: Hard candy Others have sodium and potassium. A patient with CKD may have unlimited intake of sugars and starches (unless the patient is diabetic) and hard candy is an appropriate snack and may help to relieve the metallic and urine taste that is common in the mouth. Raisins are a high-potassium food. Ice cream contains protein and phosphate and counts as fluid. Pickled foods have high sodium content.

A patient who recently had calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have? Select one: a. Hyperparathyroidism b. SIADH c. Hypothyroidism d. Cushing's syndrome

Feedback The correct answer is: Hyperparathyroidism Question 41 Correct 1.00 points out of 1.00 Flag question Question text

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? Select one: a. Report any worsening of symptoms to the provider. b. Take the medication as prescribed by the provider. c. Check with the pharmacist before taking other medications. d. Increase intake of calcium and vitamin D.

Feedback The correct answer is: Increase intake of calcium and vitamin D. (PPI's cause osteoporosis) All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? Select one: a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Elevated thyroid stimulating hormone level d. Distant and difficult to hear heart sounds

Feedback The correct answer is: Increased thyroxine (T4) level An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? Select one: a. Metformin (Glucophage) b. Glipizide (Glucotrol) c. Pioglitazone (Actos) d. Glimepiride (Amaryl)

Feedback The correct answer is: Metformin (Glucophage) Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast.

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis? Select one: a. Hypotonic bowel sounds b. Muscle twitching and finger numbness c. Nausea and vomiting d. Upper abdominal tenderness and guarding

Feedback The correct answer is: Muscle twitching and finger numbness Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings should also be reported to the health care provider, they do not indicate complications that require rapid action. Pancreatitis can be associated with tetany and hypocalcemia. It is caused primarily by precipitation of calcium soaps in the abdominal cavity, but glucagon-stimulated calcitonin release and decreased PTH secretion may play a role. When the pancreas is damaged, free fatty acids are generated by the action of pancreatic lipase. Insoluble calcium salts are present in the pancreas, and the free fatty acids avidly chelate the salts, resulting in calcium deposition in the retroperitoneum. In addition, hypoalbuminemia may be a part of the clinical picture, resulting in a reduction in total serum calcium. In patients with concomitant alcohol abuse, a poor nutritional intake of calcium and vitamin D, as well as accompanying hypomagnesemia, may predispose these patients to hypocalcemia. [18]

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? Select one: a. Resting apical pulse rate 112 beats/minute b. New-onset changes in the patient's voice c. Bruit audible bilaterally over the thyroid gland d. Elevation in the patient's T3 and T4 levels

Feedback The correct answer is: New-onset changes in the patient's voice Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action

A 28-yr-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time? Select one: a. Differences between hemodialysis and peritoneal dialysis b. Complications of renal transplantation c. Methods for treating severe chronic pain d. Options to consider for genetic counseling

Feedback The correct answer is: Options to consider for genetic counseling Because a 28-year-old patient may be considering having children, the nurse should include information about genetic counseling when teaching the patient. The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has chronic pain.

After change-of-shift report, which patient should the progressive care nurse assess first? Select one: a. Patient who is receiving IV heparin for a venous thromboembolism and has a partial thromboplastin time (PTT) of 101 sec b. Patient with arterial pressure monitoring who is 2 hours post-percutaneous coronary intervention and needs to void c. Patient who was extubated this morning and has a temperature of 101.4°F (38.6°C) d. Patient with bilevel positive airway pressure (BiPAP) for obstructive sleep apnea and a respiratory rate of 16

Feedback The correct answer is: Patient who is receiving IV heparin for a venous thromboembolism and has a partial thromboplastin time (PTT) of 101 sec A typical aPTT value is 30 to 40 seconds. If you get the test because you're taking heparin, you'd want your aPTT to be 60 to 80 seconds. If your number is higher than normal, it could mean several things, from a bleeding disorder to liver disease. The APTT ratio target for heparin therapy is 1.5 - 2.5. Reference: The reference range of the aPTT is 30-40 seconds. The reference range of the PTT is 60-70 seconds. Critical values that should prompt a clinical alert are as follows: aPTT: More than 70 seconds (signifies spontaneous bleeding) PTT: More than 100 seconds (signifies spontaneous bleeding) [1, 2] The findings for this patient indicate high risk for bleeding from an elevated (nontherapeutic) PTT. The nurse needs to adjust the rate of the infusion (dose) per the health care provider's parameters. The patient with BiPAP for sleep apnea has a normal respiratory rate. The patient recovering from the percutaneous coronary intervention will need to be assisted with voiding and this task could be delegated to unlicensed assistive personnel. The patient with a fever may be developing ventilator-associated pneumonia, but addressing the bleeding risk is a higher priority.

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? Select one: a. Patient with Addison's disease who takes hydrocortisone twice daily b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Hashimoto's thyroiditis and a heart rate of 102

Feedback The correct answer is: Patient with tetany who has a new order for IV calcium chloride

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? Select one: a. Place the patient on a cardiac monitor. b. Start an insulin infusion at 0.1 units/kg/hr. c. Administer IV potassium supplements. d. Ask the patient about home insulin doses.

Feedback The correct answer is: Place the patient on a cardiac monitor. Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patient's care.

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home? Select one: a. Ensure privacy for teaching by asking the family to leave. b. Provide written reminders of information taught. c. Offer multiple options for management of therapies. d. Delay teaching until closer to discharge date.

Feedback The correct answer is: Provide written reminders of information taught.

A 44-yr-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance? Select one: a. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. d. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance.

Feedback The correct answer is: Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

On assessment of the patient with a renal calculus passing down the ureter, what should the Nurse expect the patient to report? Select one: a. Severe, colicky back pain radiating to the groin b. Dull, costovertebral flank pain c. A feeling of bladder fullness with urgency and frequency d. A history of chronic UTIs

Feedback The correct answer is: Severe, colicky back pain radiating to the groin Question 16 Correct 1.00 points out of 1.00 Flag question Question text

A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective? Select one: a. The apical pulse rate is 68 beats/minute. b. Stools test negative for occult blood. c. Blood pressure is 140/90 mm Hg. d. The patient reports no chest pain.

Feedback The correct answer is: Stools test negative for occult blood. Because the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? Select one: a. Palpating the abdomen for distention b. Auscultating the chest for breath sounds c. Taking the blood pressure (BP) and pulse d. Measuring the quantity of emesis

Feedback The correct answer is: Taking the blood pressure (BP) and pulse

Which assessment finding of a 42-yr-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? Select one: a. The lungs have bibasilar crackles. b. The blood glucose is 192 mg/dL. c. The blood pressure (BP) is 88/50 mm Hg. d. The patient reports 6/10 incisional pain.

Feedback The correct answer is: The blood pressure (BP) is 88/50 mm Hg.

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? Select one: a. The patient has hypoactive bowel sounds in all four quadrants. b. The patient has no breath sounds in the left anterior chest. c. The patient is experiencing intermittent waves of nausea. d. The patient complains of 7/10 (0 to 10 scale) abdominal pain.

Feedback The correct answer is: The patient has no breath sounds in the left anterior chest. Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The nausea and abdominal pain should also be addressed but they are not as high priority as the patient's respiratory status. The patient's decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? Select one: a. The patient's bilirubin level decreases. b. The patient is alert and oriented. c. The patient denies nausea or anorexia. d. The patient has at least one stool daily.

Feedback The correct answer is: The patient is alert and oriented. The purpose of lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although lactulose may be used to treat constipation, that is not the purpose for this patient. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? Select one: a. The patient cleans the perianal area with soap after each stool. b. The patient uses witch hazel compresses to soothe irritation. c. The patient uses incontinence briefs to contain loose stools. d. The patient asks for antidiarrheal medication after each stool.

Feedback The correct answer is: The patient uses witch hazel compresses to soothe irritation.

Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level? Select one: a. The magnesium level b. The blood glucose c. The serum albumin d. The phosphate level

Feedback The correct answer is: The serum albumin The relationship between total serum calcium and albumin is defined by the following simple rule: the serum total calcium concentration falls by 0.8 mg/dL for every 1-g/dL fall in serum albumin concentration. This rule assumes that normal albumin equals 4.0 g/dL and normal calcium is 10.0 mg/dL. Ionized calcium binds to negatively charged sites on protein molecules, competing with hydrogen ions for the same binding sites on albumin and other calcium-binding proteins. This binding is pH dependent and alters the level of ionized calcium in the blood. An increase in pH, alkalosis, promotes increased protein binding, which decreases free calcium levels. Acidosis, on the other hand, decreases protein binding, resulting in increased free calcium levels.

A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? Select one: a. Blood pressure increases from 110/58 to 120/62 mm Hg b. Urine output via indwelling urinary catheter is 20 mL/hr c. A decrease in the client's weight by 6 kg d. Respiratory rate decreases from 18 to 14 breaths/min

Feedback The correct answer is: Urine output via indwelling urinary catheter is 20 mL/hr Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client's weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected (hmm, not true, but whatever...it's like 13 lbs)

All of these nutrients are essential for red blood cell production except? Select one: a. Folic acid b. Vitamin D3 c. Vitamin B12 d. Iron

Feedback The correct answer is: Vitamin D3 Question 44 Correct 1.00 points out of 1.00 Flag question Question text

A patient is being evaluated for Alzheimer's disease (AD). The nurse explains to the patient's adult children that Select one: a. the most important risk factor for AD is a family history of the disorder. b. new drugs have been shown to reverse AD deterioration dramatically in some patients. c. brain atrophy detected by magnetic resonance imaging (MRI) would confirm the diagnosis of AD. d. a diagnosis of AD is made only after other causes of dementia are ruled out.

Feedback The correct answer is: a diagnosis of AD is made only after other causes of dementia are ruled out. The diagnosis of AD is usually one of exclusion. Age is the most important risk factor for development of AD. Drugs may slow the deterioration but do not reverse the effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as well and does not confirm a diagnosis of AD.

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to Select one: a. remove the tube and replace it with a new one. b. notify the patient's health care provider. c. check for tube placement and reposition it. d. auscultate for hypotonic bowel sounds.

Feedback The correct answer is: check for tube placement and reposition it.

The nurse providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism should Select one: a. monitor the blood pressure every 4 hours. b. elevate the patient's legs to relieve edema. c. order the patient a potassium-restricted diet. d. monitor blood glucose level every 4 hours.

Feedback The correct answer is: monitor the blood pressure every 4 hours. Review: Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism

The nurse will anticipate teaching a patient experiencing frequent heartburn about Select one: a. proton pump inhibitors. b. a barium swallow. c. radionuclide tests. d. endoscopy procedures.

Feedback The correct answer is: proton pump inhibitors.

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to Select one: a. request that if testing is further delayed, the patient be returned to the unit to eat. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. save the lunch tray for the patient's later return to the unit.

Feedback The correct answer is: request that if testing is further delayed, the patient be returned to the unit to eat.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may Select one: a. have rashes caused by metformin-prednisone interactions. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. need a diet higher in calories while receiving prednisone.

Feedback The correct answer is: require administration of insulin while taking prednisone. Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone, but will not need a diet that is higher in calories.

Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)? Select one or more: a. "You should follow a low-calorie diet the day before the test." b. "Several blood samples will be obtained during the testing." c. "You will need to avoid smoking before the test." d. "Exercise should be avoided until the testing is complete." e. "The test requires that you fast for at least 8 hours before testing."

Feedback The correct answers are: "You will need to avoid smoking before the test.", "Several blood samples will be obtained during the testing.", "The test requires that you fast for at least 8 hours before testing." A two-hour, 75-gram oral glucose tolerance test (OGTT) is used to test for diabetes. ... They'll then ask you to drink 8 ounces of a syrupy glucose solution that contains 75 grams of sugar. You'll then wait in the office for two hours.

Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the Nurse provide? Select one: a. Check the patient's level of consciousness every 15 minutes for one hour b. Allow the patient to sleep as long as they feel sleepy c. Stimulate the patient to increase his level of consciousness d. Suction the patient's mouth before allowing them to sleep

Feedback The correct answers are: Allow the patient to sleep as long as they feel sleepy, Check the patient's level of consciousness every 15 minutes for one hour

Acute tubular necrosis (ATN) is the most common cause on intrarenal AKI. Which patient is most likely to develop ATN? Select one: a. Patient with overdose of Acetaminophen b. Patient with major surgery who required a blood transfusion for blood loss c. Patient with hypertensive crisis d. Patient with Diabetes mellitus

Feedback The correct answers are: Patient with major surgery who required a blood transfusion for blood loss, Patient with overdose of Acetaminophen "I will accept this answer but it is not completely correct, yes major surgery but not with a someone who requires a blood transfusion; ATN will occur with a blood transfusion reaction."

Acute tubular necrosis (ATN) is the most common cause on intrarenal AKI. Which patient is most likely to develop ATN? Select one: a. Patient with Diabetes mellitus b. Patient with major surgery who required a blood transfusion for blood loss c. Patient with overdose of Acetaminophen ATN occurs with hepatic necrosis which could occur with Acetaminophen overdose d. Patient with hypertensive crisis

Feedback The correct answers are: Patient with major surgery who required a blood transfusion for blood loss, Patient with overdose of Acetaminophen Question 42 Complete Not graded Remove flag Question text

A nurse is caring for a client with meningitis. Which laboratory values should the nurse monitor to identify potential complications of this disorder? (Select all that apply.) Select one or more: a. Sodium level b. Cardiac enzymes c. Clotting factors d. Creatinine level e. Liver enzymes

Feedback The correct answers are: Sodium level, Clotting factors Inflammation associated with meningitis can stimulate the hypothalamus and result in excessive production of antidiuretic hormone. The nurse should monitor sodium levels for early identification of syndrome of inappropriate antidiuretic hormone. A systemic inflammatory response (SIR) can also occur with meningitis. A SIR can result in a coagulopathy that leads to disseminated intravascular coagulation. The nurse should monitor clotting factors to identify this complication. The other laboratory values are not specific to complications of meningitis.

A 44-yr-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance? Select one: a. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. b. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. c. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. d. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.

Feedback The most reassuring and accurate communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices. The correct answer is: Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

A patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? Select one: a. The patient is oriented to person but disoriented to place and time. b. The patient was oriented and alert when admitted. c. The patient's speech is fragmented and incoherent. d. The patient has a history of increasing confusion over several years.

Feedback The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia. The correct answer is: The patient was oriented and alert when admitted.

A patient who is unconscious has ineffective cerebral tissue perfusion and cerebral tissue swelling. Which nursing intervention will be included in the plan of care? Select one: a. Position the patient with knees and hips flexed. b. Keep the head of the bed elevated to 30 degrees. c. Encourage coughing and deep breathing. d. Cluster nursing interventions to provide rest periods.

Feedback The patient with increased intracranial pressure (ICP) should be maintained in the head-up position to help reduce ICP. Extreme flexion of the hips and knees increases abdominal pressure, which increases ICP. Because the stimulation associated with nursing interventions increases ICP, clustering interventions will progressively elevate ICP. Coughing increases intrathoracic pressure and ICP. The correct answer is: Keep the head of the bed elevated to 30 degrees.

The ECG pattern of a patient with a regular HR reveals 20 small squares between each R-R interval. What is the patient's heart rate? Select one: a. 70 bpm b. 75 bpm c. 60 bpm d. 50 bpm

Feedback Your answer is correct. The correct answer is: 75 bpm Question 45 Correct 1.00 points out of 1.00 Remove flag Question text

During care of the patient with SIADH, what should the nurse do? Select one: a. Monitor neurologic status at least every 2 hours b. teach the patient receiving treatment with diuretics to restrict sodium intake c. keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release d. notify the healthcare provider if the patient's blood pressure decreases more than 20 mmHg from baseline

Feedback Your answer is correct. The correct answer is: Monitor neurologic status at least every 2 hours

The nurse is assigned to care for a group of clients. On review of the client's medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? Select one: a. a client receiving frequent wound irrigations b. a client with heart failure c. a client on long-term corticosteroid therapy d. a client with an ileostomy

Feedback Your answer is correct. The correct answer is: a client with an ileostomy

A client arrives in the emergency department complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.6 ng/mL. The nurse determines that this result indicates which finding? Select one: a. a level that indicates the presence of possible angina b. a normal level c. a low value that indicates possible gastritis d. a level that indicates a myocardial infarction

Feedback Your answer is correct. The correct answer is: a level that indicates a myocardial infarction

The nurse is informed that a client with pelvic inflammatory disease is returning to the unit from the post-anesthesia care unit following abdominal surgery. Which task is best to delegate to the unlicensed assistive personnel (UAP)? Select one: a. assess breathing pattern after transport is completed b. notify the family that the client is returning from surgery c. report to the charge nurse the appearance of the abdominal dressing d. assist the transport team with transferring the client to the bed

Feedback Your answer is correct. The correct answer is: assist the transport team with transferring the client to the bed

The nurse is providing medication instructions to an older client who is taking digoxin (Lanoxin) daily. The nurse notes that which age-related body change could place the client at risk for digoxin toxicity? Select one: a. decreased muscle strength and loss of bone density b. decreased lean body mass and decreased glomerular filtration rate c. decreased salivation and decreased gastrointestinal motility d. decreased cough efficiency and decreased vital capacity

Feedback Your answer is correct. The correct answer is: decreased lean body mass and decreased glomerular filtration rate

During neurologic assessment of the older adult, what should the nurse expect to find? Select one: a. absent deep tendon reflexes b. below-average intelligence score c. decreased sensation of touch and temperature d. decreased frequency of spontaneous awakening

Feedback Your answer is correct. The correct answer is: decreased sensation of touch and temperature

To treat cystitis, a 14 day course of treatment with cephalexin (ceclor) is prescribed for a client residing in a long-term care facility. Which action is most important for the nurse to take prior to administering the first dose of this medication? Select one: a. review the client's fasting blood glucose levels for a hypoglycemic trend b. determine if the client has ever had a hypersensitivity reaction to penicillins c. restrict the use of dairy products in the client's diet for the next 3 weeks d. take the client's vital signs prior to the first dose and once daily for 14 days

Feedback Your answer is correct. The correct answer is: determine if the client has ever had a hypersensitivity reaction to penicillins Question 13 Correct 1.00 points out of 1.00 Flag question Question text

A patient with symptomatic mitral valve prolapse (MVP) has atrial and ventricular dysrhythmias. In addition to monitoring for decreased cardiac output related to the dysrhythmias, what is an important nursing intervention related to the dysrhythmias identified by the nurse? (1 point) Select one: a. encourage calling for assistance when getting out of bed b. monitor breathing pattern related to hypervolemia c. give sleeping pills to decrease paroxysmal nocturnal dyspnea d. teach the patient exercises to prevent recurrence of dysrhythmias

Feedback Your answer is correct. The correct answer is: encourage calling for assistance when getting out of bed Question 46 Correct 1.00 points out of 1.00 Remove flag Question text

A client who has been taking a diuretic and ACE inhibitor for hypertension has a BP of 160/90. Today a new drug, carvedilol (coreg), is prescribed, and the client expresses concern about receiving so many different medications. What action should the nurse implement? Select one: a. explain the rationale for the administration of all 3 medications to the client b. withhold the newly prescribed medication until contacting the healthcare provider c. administer the newly prescribed medication and withhold the other 2 medications d. document the client's BP and refusal to take the newly prescribed medication

Feedback Your answer is correct. The correct answer is: explain the rationale for the administration of all 3 medications to the client

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? Select one: a. muscle twitches b. hyperactive bowel sounds c. decreased urinary output d. increased specific gravity of the urine

Feedback Your answer is correct. The correct answer is: hyperactive bowel sounds

A client with aortic valve stenosis develops heart failure (HF). Which pathophysiological finding occurs in the myocardial cells as a result of the increased cardiac workload? Select one: a. increase in size b. decrease in length c. increase in number d. decrease in excitability

Feedback Your answer is correct. The correct answer is: increase in size Question 27 Correct 1.00 points out of 1.00 Flag question Question text

Why is plasmapheresis indicated in the treatment of autoimmune disorders? (1 point) Select one: a. add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system b. decrease high lymphocyte levels in the blood to prevent immune responses c. remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. obtain plasma for analysis and evaluation of specific autoantibodies

Feedback Your answer is correct. The correct answer is: remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco2 of 30 mm Hg, and HCO3¯ of 20 mEq/L. The nurse analyzes these results as indicating which condition? Select one: a. metabolic alkalosis, uncompensated b. metabolic acidosis, compensated c. respiratory acidosis, uncompensated d. respiratory alkalosis, compensated

Feedback Your answer is correct. The correct answer is: respiratory alkalosis, compensated Question 28 Correct 1.00 points out of 1.00 Flag question Question text

A client with chronic kidney disease and sever anemia refuses blood transfusions. The healthcare provider prescribes epoetin alfa. Which action should the nurse explain to the client about the medication's therapeutic response? Select one: a. accelerates neutrophil production, maturation, and activation b. activates the immune system with development of T and B cells and natural killer cells c. stimulates erythropoiesis in the bone marrow to increase circulating erythrocytes d. increase production and maturation of granulocytes and macrophages

Feedback Your answer is correct. The correct answer is: stimulates erythropoiesis in the bone marrow to increase circulating erythrocytes

A client with chronic kidney disease and severe anemia refuses blood transfusions. The healthcare provider prescribes epoetin alfa. Which action should the nurse explain to the client about the medication's therapeutic response? Select one: a. accelerates neutrophil production, maturation, and activation b. activates the immune system with development of T and B cells and natural killer cells c. stimulates erythropoiesis in the bone marrow to increase circulating erythrocytes d. increase production and maturation of granulocytes and macrophages

Feedback Your answer is correct. The correct answer is: stimulates erythropoiesis in the bone marrow to increase circulating erythrocytes

Several laboratory tests are prescribed for a client, and the nurse reviews the results of the tests. Which abnormal laboratory test results should the nurse report? Select all that apply. Select one or more: a. Phosphorus, 3.6 mg/dL b. Neutrophils, 1000 cells/mm3 c. Magnesium, 1 mg/dL d. White blood cells, 3000 cells/mm3 e. Calcium, 7 mg/dL f. Serum creatinine, 1 mg/dL

Feedback Your answer is correct. The correct answers are: Calcium, 7 mg/dL (8.5-10.2) Magnesium, 1 mg/dL (1.5 - 2.5) Neutrophils, 1000 cells/mm3 (2500 - 7500 for absolute or 1.5-8.5 x 1000). White blood cells, 3000 cells/mm3 (4.5 - 11 x1000)

The nurse is monitoring a patient for increased ICP following a head injury. What are manifestations of increased ICP? (select all that apply). Select one or more: a. fever b. oriented to name only c. narrowing pulse pressure d. right pupil dilated greater than left pupil e. decorticate posturing to painful stimulus

Feedback Your answer is correct. The correct answers are: fever, oriented to name only, right pupil dilated greater than left pupil, decorticate posturing to painful stimulus

The nurse is monitoring a patient for increased ICP following a head injury. What are manifestations of increased ICP? (select all that apply). Select one or more: a. fever b. oriented to name only c. narrowing pulse pressure d. right pupil dilated greater than left pupil e. decorticate posturing to painful stimulus

Feedback Your answer is correct. The correct answers are: fever, oriented to name only, right pupil dilated greater than left pupil, decorticate posturing to painful stimulus *FYI: narrowing pulse pressure occurs when a pulse pressure is considered abnormally low if it is less than 25% of the systolic value. The most common cause of a low (narrow) pulse pressure is a drop in left ventricular stroke volume. ... A narrow pulse pressure is also caused by aortic valve stenosis and cardiac tamponade.

The nurse notes that a client's arterial blood gas results reveal a pH of 7.50 and a Pco2 of 30 mm Hg. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all that apply. Select one or more: a. lightheadedness b. confusion c. tachycardia d. hyperkalemia e. nausea f. bradypnea

Feedback Your answer is correct. The correct answers are: nausea, confusion, tachycardia, lightheadedness Question 29 Complete Not graded Remove flag Question text

The nurse is assigned to a 40-year-old client who has a diagnosis of chronic pancreatitis. The nurse anticipates the client's serum amylase level to be which value? Select one: a. 100 units/L b. 45 units/L c. 500 units/L d. 300 units/L

Feedback Your answer is incorrect. The correct answer is: 300 units/L 300 units/L The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value.

A 20 year-old patient has acute infective endocarditis. While obtaining a nursing history, what should the nurse ask the patient about? (select all that apply) Select one or more: a. renal dialysis b. IV drug abuse c. recent dental work d. cardiac catheterization e. recent urinary tract infection

Feedback Your answer is partially correct. You have correctly selected 3. The correct answers are: renal dialysis, IV drug abuse, recent dental work, cardiac catheterization, recent urinary tract infection

A young adult patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory test results to show Select one: a. increased urinary cortisol. b. elevated serum aldosterone levels. c. low urinary catecholamines excretion. d. decreased serum thyroxine.

Increased urinary cortisol Rationale: Increased secretion of ACTH by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of TSH by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.

The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions? Options: check pulse rate, document, notify HCP, obtain O2 sat

Obtain the O2 saturation.Check the patient's pulse rate.Document the change in status.Notify the health care provider. Assessment for physiologic causes of new onset confusion such as pneumonia, infection, or perfusion problems should be the first action by the nurse. Airway and oxygenation should be assessed first, then circulation. After assessing the patient, the nurse should notify the health care provider. Finally, documentation of the assessments and care should be done.

Review of Cushing's Syndrome

Pathophysiology of Cushing's Disease. When stimulated by ACTH, the adrenal gland secretes cortisol and other steroid hormones. ACTH is produced by the pituitary gland and released into the petrosal venous sinuses in response to stimulation by corticotropin-releasing hormone (CRH) from the hypothalamus (Figure 2).

The nurse is caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy. In which order will the nurse take actions? [Place the patient on contact precautions.] [Assess blood pressure and heart rate.] [Contact the health care provider.] [Give the PRN acetaminophen (Tylenol).]

Proton pump inhibitors including omeprazole (Prilosec) may increase the risk of Clostridium difficile-associated colitis. Because the patient's history and symptoms are consistent with C. difficile infection, the initial action should be initiation of infection control measures to protect other patients. Assessment of blood pressure and pulse is needed to determine whether the patient has symptoms of hypovolemia or shock. The health care provider should be notified so that actions such as obtaining stool specimens and antibiotic therapy can be started. Tylenol may be administered but is the lowest priority of the actions. The correct answer is: [Place the patient on contact precautions.] [Assess blood pressure and heart rate.] [Contact the health care provider.] [Give the PRN acetaminophen (Tylenol).]

symptoms of metabolic alkalosis

Tetany Confusion Respiratory depression -Respiration slow and shallow -Hyperactive reflexes ; tetany -Often related to depletion of electrolytes -Atrial tachycardia -Dysrhythmias

A nurse is caring for a client who has a tracheostomy tube. What actions may the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) Select one or more: a. Reminding the client to cough and deep breathe often b. Suctioning excess secretions through the tracheostomy c. Ensuring the humidification provided is adequate d. Performing oral care with alcohol-based mouthwash e. Applying water-soluble lip balm to the client's lips Feedback

The UAP can perform hygiene measures such as applying lip balm and reinforce teaching such as reminding the client to perform coughing and deep-breathing exercises. Oral care can be accomplished with normal saline, not products that dry the mouth. Ensuring the humidity is adequate and suctioning through the tracheostomy are nursing functions. The correct answers are: Applying water-soluble lip balm to the client's lips, Reminding the client to cough and deep breathe often

After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? Select one: a. "I will be certain to shake the inhaler well before I use it." b. "I will be careful not to let the drug escape out of my nose and mouth." c. "It may take a while before I notice a change in my asthma." d. "I will use the drug when I have an asthma attack."

The correct answer is: "I will use the drug when I have an asthma attack." Feedback Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. Salmeterol has a slow onset of action; therefore, it should not be used as a rescue drug. The drug must be shaken well because it has a tendency to separate easily. Poor technique on the client's part allows the drug to escape through the nose and mouth.

A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first? Select one: a. A 66-year-old client with a barrel chest and clubbed fingernails b. A 48-year-old client with an oxygen saturation level of 92% at rest c. A 27-year-old client with a heart rate of 120 beats/min and chest pain d. A 35-year-old client who has a longer expiratory phase than inspiratory phase

The correct answer is: A 27-year-old client with a heart rate of 120 beats/min and chest pain Feedback Tachycardia can indicate hypoxemia as the body tries to circulate the oxygen that is available. A barrel chest is not an emergency finding. Likewise, a pulse oximetry level of 92% is not considered an acute finding. The expiratory phase is expected to be longer than the inspiratory phase in someone with airflow limitation.

After receiving change-of-shift report on a medical unit, which patient should the nurse assess first? Select one: a. A patient with septicemia who has intercostal and suprasternal retractions b. A patient with cystic fibrosis who has thick, green-colored sputum c. A patient with emphysema who has an oxygen saturation of 90% to 92% d. A patient with pneumonia who has crackles bilaterally in the lung bases

The correct answer is: A patient with septicemia who has intercostal and suprasternal retractions Feedback This patient's history of septicemia and labored breathing suggest the onset of ARDS, which will require rapid interventions such as administration of O2 and use of positive-pressure ventilation. The other patients should also be assessed, but their assessment data are typical of their disease processes and do not suggest deterioration in their status. Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease occurring in critically ill patients. The main complication in ARDS is that fluid leaks into the lungs making breathing difficult or impossible.

A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. Which action should the nurse take? Select one: a. Administer pain medication and encourage the client to take deep breaths. b. Auscultate the client's anterior and posterior lung fields. c. Encourage the client to take shallow breaths to help with the pain. d. Ambulate the client in the hallway to promote deep breathing.

The correct answer is: Administer pain medication and encourage the client to take deep breaths. Feedback A chest tube is placed in the pleural space and may be uncomfortable for a client. The nurse should provide pain medication to minimize discomfort and encourage the client to take deep breaths. The other responses do not address the client's discomfort and need to take deep breaths to prevent complications.

A patient has a ruptured cerebral aneurysm and subarachnoid hemorrhage. Which intervention will the nurse include in the plan of care? Select one: a. Apply intermittent pneumatic compression stockings. b. Insert an oropharyngeal airway to prevent airway obstruction. c. Encourage patient to cough and deep breathe every 4 hours. d. Assist to dangle on edge of bed and assess for dizziness.

The correct answer is: Apply intermittent pneumatic compression stockings. Feedback The patient with a subarachnoid hemorrhage usually has minimal activity to prevent cerebral vasospasm or further bleeding and is at risk for venous thromboembolism. Activities such as coughing and sitting up that might increase intracranial pressure or decrease cerebral blood flow are avoided. Because there is no indication that the patient is unconscious, an oropharyngeal airway is inappropriate.

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respirations of 42 breaths/min. Which action should the nurse take first? Select one: a. Elevate the head of the bed to a semi-Fowler's position. b. Notify the patient's health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Administer anticoagulant drug therapy.

The correct answer is: Elevate the head of the bed to a semi-Fowler's position. Feedback The patient has symptoms consistent with a pulmonary embolism (PE). Elevating the head of the bed will improve ventilation and gas exchange. The other actions can be accomplished after the head is elevated (and O2 is started). A spiral CT may be ordered by the health care provider to identify PE. Anticoagulants may be ordered after confirmation of the diagnosis of PE.

A patient with an obstruction of the renal artery causing renal ischemia exhibits hypertension. What is one factor that may contribute to this hypertension? Select one: a. Increased ADH secretion b. Decreased aldosterone secretion c. Increased synthesis and release of prostaglandins d. Increased renin release

The correct answer is: Increased renin release decreased blood volume triggers release of renin from juxtaglomerular cells...

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? Select one: a. Ask the patient about symptoms of depression. b. Measure the ankle-brachial index. c. Assess for unilateral or bilateral foot drop. d. Check for changes in skin pigmentation. Feedback

The correct answer is: Measure the ankle-brachial index. Technique for Measuring the Ankle Brachial Index. The ABI is performed by measuring the systolic blood pressure from both brachial arteries and from both the dorsalis pedis and posterior tibial arteries after the patient has been at rest in the supine position for 10 minutes.The normal range for the ankle-brachial index is between 0.90 and 1.30. An index under 0.90 means that blood is having a hard time getting to the legs and feet: 0.41 to 0.90 indicates mild to moderate peripheral artery disease; 0.40 and lower indicates severe disease.

After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care? Select one: a. Support the surgical incision during patient coughing and turning in bed. b. Remind the patient that PCA use may slow the return of bowel function. c. Irrigate the nasogastric (NG) tube frequently. d. Offer sips of fruit juices at frequent intervals.

The correct answer is: Support the surgical incision during patient coughing and turning in bed.

A client with a markedly distended bladder is diagnosed with hydronephrosis and left hydroureter after an IV pyelogram (IVP). The nurse catheterizes the client and obtains a residual urine volume of 1650 ml. This finding supports which pathophysiological cause of the client's urinary tract obstruction? Select one: A) Obstruction at the urinary bladder neck. B) Ureteral calculi obstruction. C) Ureteropelvic junction stricture. D) Partial post-renal obstruction due to ureteral stricture.

The correct answer is: obstruction at the urinary bladder neck Hydroureter (dilation of the renal pelvis), vesicoureteral reflux (backward movement of urine from the lower to upper urinary tracts), and hydronephrosis (dilation or enlargement of the renal pelvis and calyces) result from post-renal obstruction which can consequently result in chronic pyelonephritis and renal atrophy. Ascending urinary reflux occurs when normal ureteral peristaltic pressure is met with an increase in urinary pressure occurring during bladder filling if the urinary bladder neck is obstructed (A). A large residual urine does not occur with (B, C, and D) because the urine can not get to the bladder.

A client is receiving a continuous bladder irrigation at 1000 ml/hour after a prostatectomy. The nurse determines the client's urine output for the past hour is 200 ml. What action should the nurse implement first? Select one: a. notify the healthcare provider b. stop the irrigation flow c. irrigate the catheter with a large piston syringe d. document the finding and continue to observe

The correct answer is: stop the irrigation flow The urinary output should be at least the volume of irrigation input plus the client's actual urine. A significant decrease in output indicates obstruction in the drainage system, and the irrigation flow should be stopped (B) to prevent severe bladder distention. The next action is to check the external system for kinks or obstruction. If no output occurs, the catheter is irrigated with 30 to 50 ml of normal saline using a large iston syringe (D). If the obstruction is not resolved, then the healthcare provider (A) should be implemented.

What are common diagnostic studies done for a patient with severe renal colic? (select all that apply). Select one or more: a. CT scan b. urinalysis c. cystoscopy d. ureteroscopy e. abdominal ultrasound

The correct answers are: CT scan, urinalysis, abdominal ultrasound

The nurse notes that a client's arterial blood gas results reveal a pH of 7.50 and a Pco2 of 30 mm Hg. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all that apply. Select one or more: a. tachycardia b. hyperkalemia c. bradypnea d. nausea e. lightheadedness f. confusion

The correct answers are: nausea, confusion, tachycardia, lightheadedness Symptoms of alkalosis can include any of the following: Confusion (can progress to stupor or coma) Hand tremor. Lightheadedness. Muscle twitching. Nausea, vomiting. Numbness or tingling in the face, hands, or feet. Prolonged muscle spasms (tetany)

A 63-yr-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol? Drag and drop the actions into the correct order in the list below. Obtain CT scan without contrast.Infuse tissue plasminogen activator (tPA).Administer oxygen to keep O2 saturation >95%.Use National Institute of Health Stroke Scale to assess patient.

The initial actions should be those that help with airway, breathing, and circulation. Baseline neurologic assessments should be done next. A CT scan will be needed to rule out hemorrhagic stroke before tPA can be administered.

Review of cause/symptoms of Cushing's Syndrome

The most common cause is the use of steroid drugs, but it can also occur from overproduction of cortisol by the adrenal glands. Cushing syndrome can develop from a cause outside of your body (exogenous Cushing syndrome). One example is taking oral corticosteroid medications in high doses over an extended period of time. These medications, such as prednisone, have the same effect in the body as does cortisol produced by your body. Your own body causes it...This may occur from excess production by one or both adrenal glands, or overproduction of the adrenocorticotropic hormone (ACTH), which normally regulates cortisol production. Causes for this include: A pituitary gland tumor (pituitary adenoma). A noncancerous (benign) tumor of the pituitary gland, located at the base of the brain, secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol. When this form of the syndrome develops, it's called Cushing disease. It occurs much more often in women and is the most common form of endogenous Cushing syndrome. An ectopic ACTH-secreting tumor. Rarely, when a tumor develops in an organ that normally does not produce ACTH, the tumor will begin to secrete this hormone in excess, resulting in Cushing syndrome. These tumors, which can be noncancerous (benign) or cancerous (malignant), are usually found in the lungs, pancreas, thyroid or thymus gland. A primary adrenal gland disease. In some people, the cause of Cushing syndrome is excess cortisol secretion that doesn't depend on stimulation from ACTH and is associated with disorders of the adrenal glands. The most common of these disorders is a noncancerous tumor of the adrenal cortex, called an adrenal adenoma. Cancerous tumors of the adrenal cortex (adrenocortical carcinomas) are rare, but they can cause Cushing syndrome as well. Occasionally, benign, nodular enlargement of both adrenal glands can result in Cushing syndrome. Familial Cushing syndrome. Rarely, people inherit a tendency to develop tumors on one or more of their endocrine glands, affecting cortisol levels and causing Cushing syndrome.

The nurse uses the Situation-Background-Assessment-Recommendation (SBAR) format to communicate a change in patient status to a health care provider. In which order should the nurse make the following statements?

The nurse uses the Situation-Background-Assessment-Recommendation (SBAR) format to communicate a change in patient status to a health care provider. In which order should the nurse make the following statements? ["This is the nurse on the surgical unit. After assessing the patient, I am very concerned about increased shortness of breath over the past hour."] ["The patient was admitted yesterday with heart failure and has been receiving furosemide (Lasix) for diuresis, but urine output has been low."] ["The patient has crackles audible throughout the posterior chest, and the most recent oxygen saturation is 89%. Her condition is very unstable."] ["The patient needs to be evaluated immediately and may need intubation and mechanical ventilation."]

Activated partial thromboplastin time (aPTT) screens for deficiencies and inhibitors of all factors, except factors VII and XIII. Select one: True False

True

Diets high in green leafy vegetables can increase the absorption of vitamin K, which shortens the PT. Select one: True False

True

Troponin is a regulatory protein found in striated muscle. Select one: True False

True

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? Drag and drop the actions into the correct order in the list below. [Rotate NPH vial.] [Inject 20 units of air into NPH vial.] [Inject 2 units of air into regular insulin vial.] [Withdraw regular insulin.] [Withdraw 20 units of NPH.]

When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and the additives in the NPH that slow the onset, peak, and duration of activity in the longer-acting insulin. The correct answer is: [Rotate NPH vial.] [Inject 20 units of air into NPH vial.] [Inject 2 units of air into regular insulin vial.] [Withdraw regular insulin.] [Withdraw 20 units of NPH.]

The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions? Drag and drop the actions into the correct order in the list below. [Obtain the O2 saturation.] [Check the patient's pulse rate.] [Notify the health care provider.] [Document the change in status.]

[Obtain the O2 saturation.] [Check the patient's pulse rate.] [Notify the health care provider.] [Document the change in status.]Assessment for physiologic causes of new onset confusion such as pneumonia, infection, or perfusion problems should be the first action by the nurse. Airway and oxygenation should be assessed first, then circulation. After assessing the patient, the nurse should notify the health care provider. Finally, documentation of the assessments and care should be done.

The nurse is caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy. In which order will the nurse take actions? Drag and drop the actions into the correct order in the list below. [Place the patient on contact precautions.] [Assess blood pressure and heart rate.] [Contact the health care provider.] [Give the PRN acetaminophen (Tylenol).]

[Place the patient on contact precautions.] [Assess blood pressure and heart rate.] [Contact the health care provider.] [Give the PRN acetaminophen (Tylenol).] Proton pump inhibitors including omeprazole (Prilosec) may increase the risk of Clostridium difficile-associated colitis. Because the patient's history and symptoms are consistent with C. difficile infection, the initial action should be initiation of infection control measures to protect other patients. Assessment of blood pressure and pulse is needed to determine whether the patient has symptoms of hypovolemia or shock. The health care provider should be notified so that actions such as obtaining stool specimens and antibiotic therapy can be started. Tylenol may be administered but is the lowest priority of the actions.

Review the renin-angiotensin system.

low renal blood flow>JG cells release renin into blood, causes angiotensinogen to slip off angiotensin I> to lungs where enzymes form angiotensin II: powerful vasoconstrictor causes rapid vasoconstriction by acting on vascular smooth muscle, decreasing BP; also Angiotensin II stim the adrenal gland to release aldosteron> increases Na reabsorption in distal tubules and causes water reabsorption; net effect is increase vasc volume and increase BP

A client who has been taking a diuretic and ACE inhibitor for hypertension has a BP of 160/90. Today a new drug, carvedilol (coreg), is prescribed, and the client expresses concern about receiving so many different medications. What action should the nurse implement? Select one: a. explain the rationale for the administration of all 3 medications to the client b. withhold the newly prescribed medication until contacting the healthcare provider c. administer the newly prescribed medication and withhold the other 2 medications d. document the client's BP and refusal to take the newly prescribed medication

A

To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take? Select one: a. Remind the patient that exercise improves self-esteem. b. Teach the patient about the effects of exercise on glucose level. c. Give the patient a list of activities that are moderate in intensity. d. Determine what types of activities the patient enjoys.

D pretty obvious

Duplex scanning confirms the presence of a deep venous thrombosis (DVT) for a client with swelling and pain of the lower leg. While the client is receiving a continuous heparin infusion, what actions should the nurse implement? Select the most appropriate. Select one: a. avoid any intramuscular medications to prevent localized bleeding b. have vitamin K available in the event the client begins to bleed c. notify the healthcare provider if the partial thromboplastin time is greater than 50 seconds d. start instruction for self-administered subcutaneous heparin injections for long-term home therapy

A

A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? Select one: a. Chronically low blood pressure b. Bronzed appearance of the skin c. Purplish streaks on the abdomen d. Decreased axillary and pubic hair

Feedback The correct answer is: Purplish streaks on the abdomen

A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for the next 24 hours?

250 mL + 100 mL + 600 mL (insensible losses) = 950 mL fluid restriction The general rule for calculating fluid restrictions is to add all fluid losses for the previous 24 hours, plus 600 mL for insensible losses: (250 + 100 + 600 = 950 mL).

The nurse observes an empty secondary infusion of diltiazem (Cardizem) is attached to the client's IV pump, but realizes that this client has no order for Cardizem. What would be the nurse's first priority? Select one: a. measure the client's vital signs b. review medications the client is taking c. notify the healthcare provider d. complete an incident/occurrence report

A

The cardiac monitor of a 50 year old client admitted for cocaine ingestion shows ventricular tachycardia (VT) converting to ventricular fibrillation (VF). What is the priority nursing action to implement? Select one: a. prepare for intubation b. defibrillate at 200 joules c. insert intravenous catheter d. obtain arterial blood gases

B

An adult male with a history of heart failure (HF) tells the nurse that his lower extremities and feet swell when he sits at his computer all day. Which response is best for the nurse to provide? Select one: a. limit the amount of table salt that you add to your meals b. take a daily vitamin with minerals to correct imbalances c. get up and walk around frequently during the day d. elevate your feet every night to reduce swelling

C

A nurse working in a geriatric clinic sees clients with "cold" symptoms and rhinitis. Which drug would be appropriate to teach these clients to take for their symptoms? Select one: a. Hydroxyzine (Vistaril) b. Chlorpheniramine (Chlor-Trimeton) c. Fexofenadine (Allegra) d. Diphenhydramine (Benadryl)

C Feedback First-generation antihistamines are not appropriate for use in the older population. These drugs include chlorpheniramine, diphenhydramine, and hydroxyzine. Fexofenadine is a second-generation antihistamine. Some first-generation H1 antihistamines block alpha-adrenergic receptors, serotonin receptors, and cardiac ion currents, contributing to cardiovascular toxicities such as dysrhythmias, prolongation of the QT interval, and postural hypotension.

The nurse reviews a patient's glycosylated hemoglobin (A1C) results to evaluate Select one: a. fasting preprandial glucose levels. b. hypoglycemic episodes in the past 3 months. c. glucose control over the past 90 days. d. glucose levels 2 hours after a meal.

C Glycated hemoglobin is a form of hemoglobin that is covalently bound to glucose. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been: A normal A1C level is below 5.7 percent Prediabetes is between 5.7 to 6.4 percent. Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may need retests every year. Type 2 diabetes is above 6.5 percent If you have diabetes, you should have the A1C test at least twice a year. The A1C goal for many people with diabetes is below 7. It may be different for you. Ask what your goal should be. If your A1C result is too high, you may need to change your diabetes care plan.

A 19-yr-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal premature ventricular contractions (PVCs). What action should the nurse take next? Select one: a. Insert an IV catheter for emergency use. b. Have the patient taken to the nearest emergency department (ED). c. Ask the patient about current stress level and caffeine use. d. Start supplemental O2 at 2 to 3 L/min via nasal cannula.

C In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.

A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium has a prothrombin time (PT) of 35 seconds. On the basis of the prothrombin time, the nurse anticipates which prescription? Select one: a. adding a dose of heparin sodium b. administering the next dose of warfarin c. increasing the next dose of warfarin d. holding the next dose of warfarin

D The normal PT is 9.6 to 11.8 seconds (male adult) or 9.5 to 11.3 seconds (female adult). A therapeutic PT level is 1.5 to 2 times higher than the normal level. Because the value of 35 seconds is high (and perhaps near the critical range), the nurse should anticipate that the client would not receive further doses at this time. Therefore the prescriptions noted in the remaining options are incorrect.

How do corticosteroids (long-term) affect immunity?

Is it because it suppresses inflammation? Don't really know but here is a list of potential side FX. Some concerns patients have over long-term side effects of corticosteroids include: uclers / gastrointestinal bleeding osteoperosis increase risk of heart disease decrease in bone density increased risk of infections thin skin, bruise easily, slower healing of wounds

The nurse assumes care of a patient who just returned from surgery for a total laryngectomy and radical neck dissection and notes the following problems. In which order should the nurse address the problems? Drag and drop the actions into the correct order in the list below. [The patient is in a side‑lying position with the head of the bed flat.] [The patient is coughing blood‑tinged secretions from the tracheostomy.] [The wound drain in the neck incision contains 200 mL of bloody drainage.] [The nasogastric (NG) tube is disconnected from suction and clamped off.]

[The patient is in a side‑lying position with the head of the bed flat.] [The patient is coughing blood‑tinged secretions from the tracheostomy.] [The wound drain in the neck incision contains 200 mL of bloody drainage.] [The nasogastric (NG) tube is disconnected from suction and clamped off.] The patient should first be placed in a semi-Fowler's position to maintain the airway and reduce incisional swelling. The blood-tinged secretions may obstruct the airway, so suctioning is the next appropriate action. Then the wound drain should be drained because the 200 mL of drainage will decrease the amount of suction in the wound drain and could lead to incisional swelling and poor healing. Finally, the NG tube should be reconnected to suction to prevent gastric dilation, nausea, and vomiting.