Chronic Care Exam 1

28. The patient comes to the HCP office with pain, edema, and warm skin on her lower left leg. What test should the nurse expect to be ordered first? a. Duplex ultrasound b. Complete blood count (CBC) c. Magnetic resonance angiography d. Computed venography (phlebogram)

28. a. With manifestations of a VTE, the Duplex ultrasound is most widely used to diagnose VTE by identifying where a thrombus is found and its extent. D-dimer may also be drawn to determine if a VTE exists.

31. Which indirect thrombin inhibitor is only given subcutaneously and does not need routine coagulation tests? a. Warfarin (Coumadin) b. Unfractionated heparin c. Hirudin derivatives (bivalirudin [Angiomax]) d. Low-molecular-weight heparin (enoxaparin [Lovenox])

31. d. Low-molecular-weight heparin (LMWH) (enoxaparin [Lovenox]) is only given subcutaneously and does not need routine coagulation testing. Unfractionated heparin is the only other indirect thrombin inhibitor option. It can be given subcutaneously or IV and therapeutic effects must be monitored with coagulation testing.

32. Which characteristics describe the anticoagulant warfarin (Coumadin) (select all that apply)? a. Vitamin K is the antidote b. Protamine sulfate is the antidote c. May be given orally or subcutaneously d. May be given intravenously or subcutaneouslye. e. Monitor dosage using international normalized ratio (INR) f. Monitor dosage using activated partial thromboplastin time (aPTT)

32. a, e. Warfarin (Coumadin) is a vitamin K antagonist, so vitamin K is the antidote. It is monitored with the INR. It is only given orally. Protamine sulfate is the antidote for unfractionated heparin (UH) and LMWH. UH can be given subcutaneously or IV. It is monitored with activated

37. What is the most important measure in the treatment of venous leg ulcers? a. Elevation of the affected leg b. Application of topical antibiotics c. Graduated compression stockings d. Application of moist to dry dressings

37. c. Although leg elevation, moist dressings, and systemic antibiotics are useful in treatment of venous stasis ulcers, the most important factor is compression, which minimizes venous stasis, venous hypertension, and edema and prevents recurrence. Compression may be applied with various methods including stockings, elastic bandages or wraps, or a Velcro wrap, among others.

11. The nurse determines patient teaching about a high-calorie, high-protein diet has been effective when the patient selects which breakfast option from the hospital menu? a. Two poached eggs, hash brown potatoes, and whole milk b. Two slices of toast with butter and jelly, orange juice, and skim milk c. Three pancakes with butter and syrup, 2 slices of bacon, and apple juice d. Cream of wheat with 2 tbsp of skim milk powder, one-half grapefruit, and a high-protein milkshake

A

13. Patient-Centered Care: When planning nutritional interventions for a healthy, 83-year-old widowed man, the nurse recognizes what factor is most likely to affect his nutritional status? a. Living alone on a fixed income b. Changes in cardiovascular function c. An increase in GI motility and absorption d. Snacking between meals, resulting in obesity 1

A

14. When considering enteral nutrition (EN) for a patient with severe protein-calorie malnutrition, what is an advantage of a gastrostomy tube versus a nasogastric (NG) tube? a. There is less irritation to the nasal and esophageal mucosa. b. The patient experiences the sights and smells associated with eating. c. Aspiration resulting from reflux of formulas into the esophagus is less common. d. Routine checking for placement is not needed because gastrostomy tubes do not become displaced.

A

15. Which surgical therapy for an AAA is most likely to have the postoperative complication of renal injury? a. Open aneurysm repair (OAR) above the level of the renal arteries b. Excising only the weakened area of the artery and suturing the artery closed c. Bifurcated graft used in aneurysm repair when the AAA extends into the iliac arteries d. Endovascular graft procedure with an aortic graft inside the aneurysm via the femoral artery

A

16. In preparation for an AAA repair surgery, what should the nurse include in patient teaching? a. Prepare the bowel on the night before surgery with laxatives or an enema. b. Use moisturizing soap to clean the skin three times the day before surgery. c. Eat a high-protein and high-carbohydrate breakfast to help with healing postoperatively. d. Take the prescribed oral antibiotic the morning of surgery before going to the operating room.

A

16. What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis? a. Providing adequate nutritional intake b. Promoting strict bed rest during the icteric phase c. Providing pain relief without using liver-metabolized drugs d. Providing quiet diversional activities during periods of fatigue

A

20. Priority Decision: The nurse is caring for a patient receiving 1000 mL of parenteral nutrition solution over 24 hours. When it is time to change the solution, 150 mL remain in the bottle. What is the most appropriate action by the nurse? a. Hang the new solution and discard the unused solution. b. Open the IV line and rapidly infuse the remaining solution. c. Notify the health care provider for instructions regarding the infusion rate. d. Wait to change the solution until the remaining solution infuses at the prescribed rate.

A

25. Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help improve nutrient intake? a. Oral hygiene before meals and snacks b. Provide all foods the patient likes to eat c. Improve oral intake by feeding the patient d. Limit snack offers to when the patient is hungry

A

46. In a radical pancreaticoduodenectomy (Whipple procedure) for treatment of cancer of the pancreas, what resection most affects the patient's nutritional status? a. Duodenum b. Part of the stomach c. Head of the pancreas d. Common bile duct and gall bladder

A

50. The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse teach the patient about this test? a. It is noninvasive and is a very reliable method of detecting gallstones. b. It is the only test to use when the patient is allergic to contrast medium. c. It will outline the gallbladder and the ductal system to enable visualization of stones. d. It is an adjunct to liver function tests to determine whether the gallbladder is inflamed.

A

51. What treatment for acute cholecystitis will prevent further stimulation of the gallbladder? a. NPO with NG suction b. Incisional cholecystectomy c. Administration of antiemetics d. Administration of anticholinergics

A

54. What must the nurse do to care for a T-tube in a patient after a cholecystectomy? a. Keep the tube supported and free of kinks. b. Attach the tube to low, continuous suction. c. Clamp the tube when ambulating the patient. d. Irrigate the tube with 10-mL sterile saline every 2 to 4 hours.

A

6. What contributes to increased protein-calorie needs? a. Surgery b. Vegan diet c. Lowered temperature d. Cultural or religious beliefs

A

A patient asks the nurse about taking phentermine and topiramate (Qsymia) for weight loss. To avoid side effects, it is important for the nurse to determine whether the patient has a history of a. glaucoma. b. hypertension. c. valvular heart disease. d. irritable bowel disease.

A

A patient has an admitting diagnosis of acute left-sided infective endocarditis. What is the best test to confirm this diagnosis? a. Three blood cultures b. Complete blood count c. Cardiac catheterization d. Transesophageal echocardiogram

A

A patient with inflammatory bowel disease has a nursing diagnosis of impaired nutritional status; etiology: decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis? a. Pallor and hair loss b. Frequent diarrhea stools c. Anorectal excoriation and pain d. Hypotension and urine output below 30 mL/hr

A

A patient with rheumatic heart disease with carditis asks the nurse how long his activity will be restricted. What is the best answer by the nurse? a. "Full activity will be allowed as soon as acute symptoms have subsided." b. "Bed rest will be continued until symptoms of heart failure are controlled." c. "Nonstrenuous activities can be performed as soon as antibiotics are started." d. "Bed rest must be maintained until antiinflammatory therapy has been discontinued."

A

Nursing management of the patient with chronic gastritis includes teaching the patient to a. maintain a nonirritating diet with 6 small meals a day. b. take antacids before meals to decrease stomach acidity. c. eliminate alcohol and caffeine from the diet when symptoms occur. d. use nonsteroidal antiinflammatory drugs (NSAIDs) instead of aspirin for minor pain relief.

A

Patient-Centered Care: The nurse formulates the nursing diagnosis of acute pain from the effects of medication and decreased GI motility for a postoperative patient with abdominal pain and distension with an inability to pass flatus. Which nursing intervention is most appropriate for this patient? a. Ambulate the patient more frequently. b. Assess the abdomen for bowel sounds. c. Place the patient in high Fowler's position. d. Withhold opioids because they decrease bowel motility.

A

Priority Decision: A patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer which fluid first? a. Water b. Hot tea c. Gatorade d. Warm broth

A

Priority Decision: A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the priority action by the nurse? a. Check the patency of the NG tube. b. Place the patient in a recumbent position. c. Assess the patient's vital signs and circulatory status. d. Encourage the patient to deep breathe and consciously relax.

A

Priority Decision: A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? a. Measure the ileostomy output to determine the status of the patient's fluid balance. b. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. c. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. d. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

A

Priority Decision: An 82-year-old man is admitted with an acute attack of diverticulitis. What is most important for the nurse to include in his care? a. Monitor for signs of peritonitis. b. Treat with daily medicated enemas. c. Prepare for surgery to resect the involved colon. d. Provide a heating pad to apply to the left lower quadrant.

A

Priority Decision: Before selecting a weight reduction plan with an obese patient, what is most important for the nurse to first assess? a. The patient's motivation to lose weight b. The length of time that the patient has been obese c. Whether financial considerations will affect the patient's choices d. The patient's height, weight, BMI, waist-to-hip ratio, and skinfold thickness

A

Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers? a. Acid back diffusion into the mucosa b. The release of histamine from gastrointestinal (GI) cells c. Ammonia formation in the mucosal wall d. Breakdown of the gastric mucosal barrier

A

The health care provider prescribes spironolactone (Aldactone) for the patient with chronic HF. What diet modifications related to the use of this drug should the nurse include in the patient teaching? a. Decrease both sodium and potassium intake. b. Increase calcium intake and decrease sodium intake. c. Decrease sodium intake and increase potassium intake. d. Decrease sodium intake by using salt substitutes for seasoning.

A

The nurse plans long-term goals for the patient who has had a heart transplant with the knowledge that what is the most common cause of death in heart transplant patients during the first year? a. Infection b. HF c. Embolization d. Malignant conditions

A

The nurse plans teaching for the patient with a colostomy, but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient? a. Encourage the patient to share concerns and ask questions. b. Refer the patient to a chaplain to help cope with this situation. c. Explain that there is nothing the patient can do about it and must take care of it. d. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.

A

The patient with chronic HF is being discharged with a diuretic, a renin-angiotensin-aldosterone system (RAAS) inhibitor, and a β-adrenergic blocker. When received from the pharmacy, which medication should not be included for this patient? a. Dopamine b. Losartan (Cozaar) c. Carvedilol (Coreg) d. Hydrochlorothiazide

A

What are characteristics of gingivitis? a. Formation of abscesses with loosening of teeth b. Caused by upper respiratory tract viral infection c. Shallow, painful vesicular ulcerations of lips and mouth d. Infectious ulcers of mouth and lips because of systemic disease

A

What information should be included in the dietary teaching for the patient after a Roux-en-Y gastric bypass? a. Avoid sugary foods and fluids to prevent dumping syndrome. b. Gradually increase the amount of food ingested to preoperative levels. c. Maintain a long-term liquid diet to prevent damage to the surgical site. d. Consume foods high in complex carbohydrates, protein, and fiber to add bulk to contents.

A

What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have? a. Melena b. Occult blood c. Coffee-ground emesis d. Profuse bright-red hematemesis

A

When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about a. dietary intake. b. sports involvement. c. environmental exposure to carcinogens. d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).

A

Which initial physical assessment finding would the nurse expect to be present in a patient with acute left-sided HF? a. Bubbling crackles and tachycardia b. Hepatosplenomegaly and tachypnea c. Peripheral edema and cool, diaphoretic skin d. Frothy, blood-tinged sputum and distended jugular veins

A

Which manifestation of infective endocarditis is a result of fragmentation and microembolization of vegetative lesions? a. Petechiae b. Roth's spots c. Osler's nodes d. Splinter hemorrhages

A

Which method is preferred for immediate treatment of an acute episode of constipation? a. An enema b. Increased fluid c. Stool softeners d. Bulk-forming medication

A

Which patient is at highest risk of having a gastric ulcer? a. 55-year-old female smoker with nausea and vomiting b. 45-year-old female admitted for illicit drug detoxification c. 27-year-old male who is being divorced and has back pain d. 37-year-old male smoker who was in an accident while looking for a job

A

Which statement by a patient with dumping syndrome should lead the nurse to determine that further dietary teaching is needed? a. "I should eat bread and jam with every meal." b. "I should avoid drinking fluids with my meals." c. "I should eat smaller meals about 6 times a day." d. "I need to lie down for 30 to 60 minutes after my meals."

A

Which type of gastritis is most likely to occur in a college student who has an isolated drinking binge? a. Acute gastritis b. Chronic gastritis c. Helicobacter pylori gastritis d. Autoimmune metaplastic atrophic gastritis

A

Which statements accurately describe heart failure (HF) (select all that apply)? a. A common cause of HF with preserved ejection fraction (HFpEF) is left ventricular dysfunction. b. A primary risk factor for HF is coronary artery disease (CAD). c. Systolic failure results in a normal left ventricular ejection fraction. d. HF with reduced ejection fraction (HFrEF) is characterized by abnormal resistance to ventricular filling. e. Hypervolemia precipitates HF by decreasing cardiac output and increasing oxygen consumption.

A,BHeart failure with preserved ejection fraction (HFpEF) (diastolic failure) is characterized by abnormal resistance to ventricular filling. Hypertension, coronary artery disease (CAD), advanced age, and diabetes are all risk factors for heart failure (HF). Ejection fraction (EF) is decreased in systolic HF. Decreased cardiac output (CO) and increased workload and oxygen requirements of the myocardium precipitate HF because of left ventricle dysfunction.

44. The nurse is teaching a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)? a. Avoid nicotine. b. Eat bland foods. c. Observe stools for steatorrhea. d. Eat high-fat, low-protein, high-carbohydrate meals. e. Take prescribed pancreatic enzymes immediately after meals.

ABC

A 20-year-old patient has acute infective endocarditis. What topics should the nurse ask the patient about during the health history (select all that apply)? a. Renal dialysis b. IV drug abuse c. Recent dental work d. Cardiac catheterization e. Recent urinary tract infection

ABCDE

47. Which characteristics are most commonly associated with cholelithiasis (select all that apply). a. Obesity b. Age over 40 years c. Multiparous female d. History of excessive alcohol intake e. Family history of gallbladder disease f. Use of estrogen or oral contraceptives

ABCEF

7. During assessment of the patient with protein-calorie malnutrition, what should the nurse expect to find (select all that apply)? a. Frequent cold symptoms b. Decreased bowel sounds c. Cool, rough, dry, scaly skin d. A flat or concave abdomen e. Prominent bony structures f. Decreased reflexes and lack of attention

ABCEF

21. Patient-Centered Care: A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)? a. Weight loss b. Diabetes management c. Ulcerative colitis dietary changes d. Dietary management of hyperlipidemia e. Maintaining blood pressure with increased sodium and fluid intake

ABD

For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel (select all that apply)? a. NPO b. IV fluids c. Bed rest d. Sedatives e. NG suction f. Parenteral nutrition

ABDEF

Priority Decision: The nurse is teaching a moderately obese woman interventions for the management of obesity. Initially, which strategies will support restricting dietary intake to below energy requirements (select all that apply)? a. Limit alcohol b. Rest when fatigued c. Determine portion sizes d. 1800- to 2200-calorie diet e. Attend Overeaters Anonymous f. Park farther away from destination

AC

. Which medications are used to decrease gastric or HCl secretion (select all that apply)? a. Famotidine (Pepcid) b. Sucralfate (Carafate) c. Omeprazole (Prilosec) d. Misoprostol (Cytotec) e. Bethanechol (Urecholine)

ACD

20. The patient is an older woman with cirrhosis who has anemia. What pathophysiologic changes may contribute to this patient's anemia (select all that apply)? a. Vitamin B deficiencies b. Stretching of liver capsule c. Vascular congestion of spleen d. Decreased prothrombin production e. Decreased bilirubin conjugation and excretion

ACD

48. Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)? a. Fasting b. Hypothyroidism c. Parenteral nutrition d. Prolonged immobility e. Streptococcus pneumoniae f. Absence of bile in the intestine

ACD

Which teaching points are important when providing information to a patient with metabolic syndrome (select all that apply)? a. Stop smoking. b. Monitor weight daily. c. Increase level of activity. d. Decrease saturated fat intake. e. Reduce weight and maintain lower weight. f. Check blood glucose each morning before eating.

ACDE

A 20-year-old patient with a history of Crohn's disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn's disease (select all that apply)? a. Weight loss b. Rectal bleeding c. Abdominal pain d. Toxic megacolon e. Has segmented distribution f. Involves the entire thickness of the bowel wall

ACEF

The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods or beverages that decrease LES pressure. What should be included in this list (select all that apply)? a. Alcohol b. Root beer c. Chocolate d. Citrus fruits e. Fatty foods f. Cola sodas

ACEF

Duodenal and gastric ulcers have similar as well as differentiating features. What characteristics are unique to duodenal ulcers (select all that apply)? a. Pain is relieved with eating food. b. They have a high recurrence rate. c. Increased gastric acid secretion occurs. d. Associated with Helicobacter pylori infection. e. Hemorrhage, perforation, and obstruction may result. f. There is burning and cramping in the midepigastric area.

ACF

The patient calls the clinic and describes a bump at the site of a previous incision that disappears when he lies down. The nurse suspects that this is which type of hernia (select all that apply)? a. Ventral b. Inguinal c. Femoral d. Reducible e. Incarcerated f. Strangulated

AD

10. During the incubation period of viral hepatitis, what should the nurse expect the patient to report? a. Dark urine and easy fatigability b. No symptoms except diagnostic results c. Anorexia and right upper quadrant discomfort d. Constipation or diarrhea with light-colored stools

B

12. When teaching the older adult about nutritional needs during aging, what does the nurse emphasize? a. The need for all nutrients decreases as a person ages. b. Fewer calories, but the same or slightly increased amount of protein, are required as one ages. c. Fats, carbohydrates, and protein should be decreased, but vitamin and mineral intake should be increased. d. High-calorie oral supplements should be taken between meals to ensure that recommended nutrient needs are met.

B

13. The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse? a. "No immunization is available for hepatitis A, nor are you likely to get the disease." b. "Those who have had household or close contact with the patient should receive IG." c. "All family members should receive the hepatitis A vaccine to prevent or modify the infection." d. "Only those people who have had sexual contact with the patient should receive immunization."

B

14. During preoperative preparation of the patient scheduled for an AAA, why should the nurse establish baseline data for the patient? a. All physiologic processes will be changed postoperatively. b. The cause of the aneurysm is a systemic vascular disease. c. Surgery will be canceled if any physiologic function is not normal. d. BP and heart rate (HR) will be maintained well below baseline levels during the postoperative period.

B

15. Priority Decision: A patient with chronic HF is treated with hydrochlorothiazide, digoxin, and lisinopril. To prevent the risk of digitalis toxicity with these drugs, what is most important that the nurse monitor for this patient? a. HR b. Potassium levels c. BP d. Gastrointestinal function

B

15. The nurse identifies a need for further teaching when the patient with acute hepatitis B makes which statement? a. "I should avoid alcohol completely for at least a year." b. "I must avoid all physical contact with my family until the jaundice is gone." c. "I should use a condom to prevent spread of the disease to my sexual partner." d. "I will need to rest several times a day, gradually increasing my activity as I tolerate it."

B

2. Which statement accurately describes vitamin deficiencies? a. Vitamin deficiencies in adults are always clinically manifested by disorders of the skin. b. Surgery on the GI tract causing impaired absorption contributes to vitamin deficiencies. c. The two nutrients most often lacking in the diet of a vegan are vitamin B6 and folic acid. d. Vitamin imbalances occur frequently in the United States because of excessive fat intake.

B

20. Priority Decision: A patient who is postoperative following repair of an AAA has been receiving IV fluids at 125 mL/hr continuously for the last 12 hours. Urine output for the last 4 hours has been 60 mL, 42 mL, 28 mL, and 20 mL, respectively. What is the priority action that the nurse should take? a. Monitor for a couple more hours. b. Contact the HCP and report the decrease in urine output. c. Send blood for electrolytes, blood urea nitrogen (BUN), and creatinine. d. Decrease the rate of infusion to prevent blood leakage at the suture line.

B

24. What laboratory test results should the nurse expect to find in a patient with cirrhosis? a. Serum albumin: 7.0 g/dL (70 g/L) b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L) c. Serum cholesterol: 260 mg/dL (6.7 mmol/L) d. Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L)

B

30. A patient with advanced cirrhosis has a nursing diagnosis of impaired low nutritional intake because of anorexia and an inadequate food intake. What would be an appropriate midday snack for the patient? a. Peanut butter and salt-free crackers b. A fresh tomato sandwich with salt-free butter c. Popcorn with salt-free butter and herbal seasoning d. Canned chicken noodle soup with low-protein bread

B

39. Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis? a. Increased serum calcium b. Increased serum amylase c. Increased urinary amylase d. Decreased serum glucose

B

4. Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer? a. HAV b. HBV c. HCV d. HEV

B

45. What is a risk factor associated with pancreatic cancer? a. Alcohol intake b. Cigarette smoking c. Exposure to asbestos d. Increased dietary intake of spoiled milk products

B

49. A patient with an obstruction of the common bile duct has clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this manifestation? a. Water-soluble (conjugated) bilirubin in the blood excreted into the urine b. Absence of bilirubin and bile salts in the small intestine prevents conversion to urobilinogen and fat emulsion and digestion c. Contraction of the inflamed gallbladder and obstructed ducts stimulated by cholecystokinin when fats enter the duodenum d. Obstruction of the common duct prevents bile drainage into the duodenum, resulting in congestion of bile in the liver and subsequent absorption into the blood

B

8. What test will be done before prescribing treatment for the patient with positive testing for HCV? a. Anti-HCV b. HCV genotyping c. FibroSure (FibroTest) d. HCV RNA quantitation

B

A large number of children at a public school have suddenly developed profuse diarrhea and bloody stools. The school nurse suspects food poisoning related to food from the school cafeteria and requests analysis and culture of which food? a. Milk b. Ground beef c. Commercially canned fish d. Salads with mayonnaise dressing

B

A patient with a small AAA is not a good surgical candidate. What should the nurse teach the patient is the best way to prevent expansion of the lesion? a. Avoid strenuous physical exertion. b. Control hypertension with prescribed therapy. c. Comply with prescribed anticoagulant therapy. d. Maintain a low-calcium diet to prevent calcification of the vessel.

B

A patient with acute pericarditis has markedly distended jugular veins, decreased BP, tachycardia, tachypnea, and muffled heart sounds. What does the nurse recognize as the cause of these findings? a. The pericardial space is obliterated with scar tissue and thickened pericardium. b. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. c. The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction d. Fibrin accumulation on the visceral pericardium infiltrates the myocardium, creating myocardial dysfunction.

B

A patient with cancer of the stomach at the lesser curvature undergoes a total gastrectomy with an esophagojejunostomy. Postoperatively, what should the nurse teach the patient to expect? a. Rapid healing of the surgical wound b. Lifelong administration of cobalamin c. To be able to return to normal dietary habits d. Close follow-up for development of peptic ulcers in the jejunum

B

A patient with chronic HF has atrial fibrillation and a left ventricular ejection fraction (LVEF) of 18%. To decrease the risk of complications from these conditions, what drug does the nurse anticipate giving? a. Diuretic b. Anticoagulant c. β-Adrenergic blocker d. Potassium supplement

B

A patient with infective endocarditis of a prosthetic mitral valve develops a left hemiparesis and visual changes. What should the nurse expect to be included in interprofessional care of the patient? a. Embolectomy b. Surgical valve replacement c. Administration of anticoagulants d. Higher-than-usual antibiotic dosages

B

A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On initial postoperative assessment of the patient, what should the nurse expect to find? a. A rectal tube set to low continuous suction b. A loop ileostomy with a plastic rod to hold it in place c. A colostomy stoma with an NG tube in place to provide pouch irrigations d. A permanent ileostomy stoma in the right lower quadrant of the abdomen

B

A woman is 5 ft 6 in (166 cm) tall and weighs 200 lb (90.9 kg) with a waist-to-hip ratio of 0.7. The nurse counsels the patient with the knowledge that the patient is at greatest risk for a. diabetes. b. osteoporosis. c. heart disease. d. endometrial cancer.

B

An HCP just told a patient that she has a volvulus. When the patient asks the nurse what this is, what is the best description for the nurse to give her? a. Bowel folding in on itself b. Twisting of bowel on itself c. Emboli of arterial supply to the bowel d. Protrusion of bowel in weak or abnormal opening

B

An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to a. offer ice chips to suck as needed. b. provide mouth care frequently. c. irrigate the tube with normal saline every 8 hours. d. keep the patient supine with the head of the bed elevated 30 degrees.

B

How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics b. Avoidance of milk and milk products c. Supplementation with pancreatic enzymes d. Avoidance of gluten found in wheat, barley, oats, and rye

B

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

B

Patient-Centered Care: A patient has been on a 1000-calorie diet with a daily exercise routine. In 2 months, the patient has lost 20 lb (9 kg) toward a goal of 50 lb (23 kg) but is now discouraged that no weight has been lost in the last 2 weeks. What should the nurse tell the patient about this? a. A steady weight may be caused by water gain from eating foods high in sodium. b. Plateaus where no weight is lost normally occur during a weight loss program. c. A weight considered by the body to be most efficient for functioning has been reached. d. A return to former eating habits is the most common cause of not continuing to lose weight.

B

Patient-Centered Care: A patient with oral cancer has a history of heavy smoking, excess alcohol intake, and personal neglect. During the patient's early postoperative course, what does the nurse anticipate that the patient may need? a. Oral nutritional supplements b. Drug therapy to prevent substance withdrawal symptoms c. Counseling about lifestyle changes to prevent recurrence of the tumor d. Less pain medication because of cross-tolerance with central nervous system (CNS) depressants

B

Priority Decision: A patient is admitted to the emergency department with profuse bright-red hematemesis. During the initial care of the patient, what is the nurse's first priority? a. Establish 2 IV sites with large-gauge catheters. b. Perform a focused nursing assessment of the patient's status. c. Obtain a thorough health history to assist in determining the cause of the bleeding. d. Perform a gastric lavage with cool tap water in preparation for endoscopic examination.

B

Priority Decision: A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will first be included in interprofessional care? a. Oral administration of broth and tea b. IV replacement of fluid and electrolytes c. Administration of parenteral antiemetics d. Insertion of a nasogastric (NG) tube for suction

B

Priority Decision: A patient with a gunshot wound to the abdomen reports increasing abdominal pain several hours after surgery to repair the bowel. What action should the nurse take first? a. Notify the HCP. b. Assess the patient's vital signs. c. Position the patient with the knees flexed. d. Determine the patient's IV intake since the end of surgery.

B

Priority Decision: A patient with acute pericarditis has pain from pericardial inflammation. What is the best nursing intervention for the patient? a. Administer opioids as prescribed on a round-the-clock schedule. b. Promote progressive relaxation exercises with the use of deep, slow breathing. c. Position the patient on the right side with the head of the bed elevated 15 degrees. d. Position the patient in Fowler's position with a padded table for the patient to lean on.

B

Priority Decision: A patient with symptomatic mitral valve prolapse 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? a. Monitor breathing pattern related to hypervolemia. b. Encourage calling for assistance when getting out of bed. c. Give sleeping pills to decrease paroxysmal nocturnal dyspnea. d. Teach the patient exercises to prevent recurrence of dysrhythmias.

B

Priority Decision: Following a patient's esophagogastrostomy for cancer of the esophagus, what is most important for the nurse to do? a. Report any bloody drainage from the NG tube. b. Maintain the patient in semi-Fowler's or Fowler's position. c. Monitor for abdominal distention that may disrupt the surgical site. d. Expect to find decreased breath sounds bilaterally because of the surgical approach.

B

Priority Decision: Older patients may have cardiac or renal insufficiency and be more susceptible to problems from vomiting and antiemetic drug side effects. What nursing intervention is most important to implement with these patients? a. Keep the patient flat in bed to decrease dizziness. b. Do hourly visual checks and implement fall precautions. c. Give IV fluids as rapidly as possible to prevent dehydration. d. Keep the patient NPO until nausea and vomiting have stopped.

B

Priority Decision: The nurse is admitting a patient for bariatric surgery. Which finding in a patient's history should be brought to the surgeon's attention before proceeding with further patient preparation? a. Hypertension b. Untreated depression c. Multiple attempts at weight loss d. Sleep apnea treated with continuous positive airway pressure (CPAP)

B

Priority Decision: What is the most important role of the nurse in preventing rheumatic fever? a. Teach patients with infective endocarditis to adhere to antibiotic prophylaxis. b. Identify patients with valvular heart disease who are at risk for rheumatic fever. c. Encourage the use of antibiotics for treatment of all infections involving a sore throat. d. Promote the early diagnosis and immediate

B

Priority Decision: When caring for a patient following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurse's primary concern? a. Achieving pain relief b. Maintaining a patent airway c. Promoting a positive body image d. Giving tube feedings to provide nutrition

B

Priority Decision: When caring for a patient with irritable bowel syndrome (IBS), what is most important for the nurse to do? a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed. b. Develop a trusting relationship with the patient to provide support and symptomatic care. c. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation. d. Inform the patient that new medications are available and effective for treatment of IBS manifested by either diarrhea or constipation.

B

Priority Decision: When medications are used in the treatment of obesity, what is most important for the nurse to teach the patient? a. Over-the-counter (OTC) diet aids are safer than other agents and can be useful in controlling appetite. b. Drugs should be used only as adjuncts to a diet and exercise program as treatment for a chronic condition. c. All drugs used for weight control can affect central nervous system function and should be used with caution. d. The primary effect of medications is psychologic, controlling the urge to eat in response to feelings of rejection.

B

The patient asks the nurse to explain what the HCP meant when he said the patient had an anorectal abscess. Which description should the nurse use to explain this to the patient? a. Ulcer in anal wall b. Collection of perianal pus c. Sacrococcygeal hairy tract d. Tunnel leading from the anus or rectum

B

The patient has persistent and continuous pain at McBurney's point. The nursing assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing interventions for this patient include? a. Laxatives to move the constipated bowel b. NPO status in preparation for possible appendectomy c. Parenteral fluids and antibiotic therapy for 6 hours before surgery d. NG tube inserted to decompress the stomach and prevent aspiration

B

The patient is admitted postradiation therapy with symptoms of cardiomyopathy (CMP). Which type of CMP should the nurse suspect that the patient is experiencing? a. Dilated b. Restrictive c. Takotsubo d. Hypertrophic

B

The patient is admitted with angina, syncope, and dyspnea on exertion. In the assessment, the nurse notes a systolic murmur with a prominent S4. What will the nurse suspect is occurring with this patient? a. Mitral valve stenosis b. Aortic valve stenosis c. Acute mitral valve regurgitation d. Chronic mitral valve regurgitation

B

What effect does valvular regurgitation have on a patient? a. It causes a pressure gradient difference across an open valve. b. A pericardial friction rub is heard on the right sternal border of the chest. c. It leads to decreased flow of blood and hypertrophy of the preceding chamber. d. There is a backward flow of blood and volume overload in the preceding chamber.

B

What is a nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy? a. Applying heat to the inguinal area b. Elevating the scrotum with a scrotal support c. Applying a truss to support the operative site d. Encouraging the patient to cough and deep breathe

B

What is the pathophysiologic mechanism that results in the pulmonary edema of left-sided HF? a. Increased right ventricular preload b. Increased pulmonary hydrostatic pressure c. Impaired alveolar oxygen and carbon dioxide exchange d. Increased lymphatic flow of pulmonary extravascular fluid

B

What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes? a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind should be avoided. c. Antacids should be taken with all prescribed medications to prevent gastric irritation. d. Misoprostol (Cytotec) should be used to protect the gastric mucosa in individuals with peptic ulcers.

B

When teaching the patient with PAD about modifying risk factors associated with the condition, what should the nurse emphasize? a. Amputation is the ultimate outcome if the patient does not alter lifestyle behaviors. b. Modifications will reduce the risk of other atherosclerotic conditions, such as stroke. c. Risk-reducing behaviors started after angioplasty can stop the progression of the disease. d. Maintenance of normal body weight is the most important factor in controlling arterial disease.

B

Which esophageal disorder is described as a precancerous lesion and is associated with GERD? a. Achalasia b. Barrett's esophagus c. Esophageal strictures d. Esophageal diverticula

B

Which female patient is most likely to have metabolic syndrome? a. BP 128/78 mm Hg, triglycerides 160 mg/dL, fasting blood glucose 102 mg/dL b. BP 142/90 mm Hg, high-density lipoproteins 45 mg/dL, fasting blood glucose 130 mg/dL c. Waist circumference 36 in, triglycerides 162 mg/dL, high-density lipoproteins 55 mg/dL d. Waist circumference 32 in, high-density lipoproteins 38 mg/dL, fasting blood glucose 122 mg/dL

B

Which infection or inflammation is found related to systemic disease and cancer chemotherapy? a. Parotitis b. Stomatitis c. Oral candidiasis d. Vincent's infection

B

Which patient is at highest risk for complications of obesity? a. A 30-year-old woman who is 5 ft (151 cm) tall, weighs 140 lb (63.6 kg), and carries weight in her thighs b. A 56-year-old woman with a BMI of 38 kg/m2, a waist measurement of 38 in (96 cm), and a hip measurement of 36 in (91 cm) c. A 42-year-old man with a waist measurement of 36 in (91 cm) and a hip measurement of 36 in (91 cm) who is 5 ft 6 in (166 cm) tall and weighs 150 lb (68.2 kg) d. A 68-year-old man with a waist measurement of 38 in (96 cm) and a hip measurement of 42 in (76 cm) who is 5 ft, 11 in (179 cm) tall and weighs 200 lb (90.9 kg)

B

Which patient is most likely to be diagnosed with short bowel syndrome? a. History of ulcerative colitis b. Extensive resection of the ileum c. Diagnosis of irritable bowel syndrome d. Colectomy performed for cancer of the bowel

B

26. The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply) a. gastrointestinal (GI) bleeding. b. hypokalemia. c. renal function. d. body image disturbances. e. increased clotting tendencies.

BC

When considering the following causes of acute abdomen, the nurse should know that surgery would be indicated for (select all that apply)? a. pancreatitis b. acute ischemic bowel c. foreign body perforation d. ruptured ectopic pregnancy e. pelvic inflammatory disease f. ruptured abdominal aneurysm

BCDF

A patient with PAD has a nursing diagnosis of ineffective tissue perfusion. What should be included in the teaching plan for this patient (select all that apply)? a. Apply cold compresses when the legs become swollen. b. Wear protective footwear and avoid hot or cold extremes. c. Walk at least 30 minutes per day, at least 3 times per week. d. Use nicotine replacement therapy as a substitute for smoking. e. Inspect lower extremities for pulses, temperature, and any injury.

BCE

Which statements describe the use of antacids for peptic ulcer disease (select all that apply)? a. Used in patients with verified H. pylori b. Neutralize HCl in the stomach c. Produce quick, short-lived relief of heartburn d. Cover the ulcer, protecting it from erosion by acids e. High incidence of side effects and contraindications f. May be given hourly after an acute phase of GI bleeding

BCF

In the patient with HF, which medications or treatments require careful monitoring of the patient's serum potassium level to prevent further cardiac dysfunction (select all that apply)? a. Enalapril (Vasotec) b. Furosemide (Lasix) c. Nesiritide (Natrecor) d. Spironolactone (Aldactone) e. Metoprolol CR/XL (Toprol XL)

BD

Which conditions characterize critical limb ischemia (select all that apply)? a. Cold feet b. Arterial leg ulcers c. Venous leg ulcers d. Gangrene of the leg e. No palpable peripheral pulses f. Rest pain lasting more than 2 weeks

BDF

What characteristics describe adjustable gastric banding (select all that apply)? a. 75% of the stomach is removed b. Stomach restriction can be reversed c. Eliminates hormones that stimulate hunger d. Malabsorption of fat-soluble vitamins occurs e. Inflatable band allows for modification of gastric stoma size f. Stomach with a gastric pouch surgically anastomosed to the jejunum

BE

Which statements explain the measurement of pulsus paradoxus with cardiac tamponade (select all that apply)? a. A difference of < 10 mm Hg occurs. b. A difference of > 10 mm Hg occurs. c. It is measured with an automatic sphygmomanometer. d. Rapidly inflate the cuff until you hear sounds throughout the respiratory cycle. e. Subtract the number when sounds are heard in the respiratory cycle from the number when the first Korotkoff sound during expiration is heard.

BE

1. The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing, and what serum bilirubin results would be expected? a. Hemolytic jaundice with normal conjugated bilirubin b. Posthepatic icterus with decreased unconjugated bilirubin c. Obstructive jaundice with increased unconjugated and conjugated bilirubin d. Hepatocellular jaundice with decreased conjugated bilirubin in severe disease

C

10. Which diagnostic test is most useful in differentiating dyspnea related to pulmonary effects of HF from dyspnea related to pulmonary disease? a. Exercise stress testing b. Cardiac catheterization c. B-type natriuretic peptide (BNP) levels d. Determination of blood urea nitrogen (BUN)

C

14. A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse? a. "Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon." b. "There are no specific drug therapies that are effective for treating acute viral hepatitis." c. "Lamivudine (Epivir) and interferon both decrease viral load and help prevent complications." d. "No drugs are used for the treatment of viral hepatitis because of the risk of additional liver damage."

C

17. During the patient's acute postoperative period following repair of an AAA, the nurse should ensure that which goal is achieved? a. Hypothermia is maintained to decrease oxygen need. b. IV fluids are given to maintain urine output of 100 mL/hr. c. BP and all peripheral pulses are assessed at least every hour.

C

17. When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis? a. Does not manifest hepatomegaly or jaundice b. Experiences less liver inflammation and damage c. Is treated with corticosteroids or other immunosuppressive agents d. Is an older adult who has used a wide variety of prescription and over-the-counter drugs

C

18. Priority Decision: Following an ascending aortic aneurysm repair, what is an important finding that the nurse should report immediately to the HCP? a. Shallow respirations and poor coughing b. Decreased drainage from the chest tubes c. A change in level of consciousness and inability to speak d. Lower extremity pulses that are decreased from the preoperative baseline

C

18. The patient has been newly diagnosed with Wilson's disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect? a. Pruritus b. Acute kidney injury c. Corneal Fleischer rings d. Increased serum iron levels

C

18. What is an indication for parenteral nutrition that is not an appropriate indication for enteral tube feedings? a. Head and neck cancer b. Hypermetabolic states c. Malabsorption syndrome d. Protein-calorie malnutrition

C

22. Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices? a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction b. Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders c. Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension d. Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein

C

28. Patient-Centered Care: To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient's family? a. Use reduces portal venous pressure. b. It will eliminate blood from the GI tract. c. It traps ammonia and eliminates it in the feces. d. It decreases bacteria to decrease ammonia formation.

C

29. Priority Decision: The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe? a. Turn the patient every 3 hours. b. Encourage increasing ambulation. c. Assist the patient to the bathroom. d. Prevent constipation to reduce ammonia production.

C

32. Priority Decision: During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do? a. Prepare the patient for immediate portal shunting surgery. b. Perform guaiac testing on all stools to detect occult blood. c. Maintain the patient's airway and prevent aspiration of blood. d. Monitor for the cardiac effects of IV vasopressin and nitroglycerin.

C

34. In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse teach the patient? a. A daily exercise regimen is important to increase the blood flow through the liver. b. Cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition. c. Abstinence from alcohol is the most important factor in improvement of the patient's condition. d. The only over-the-counter analgesic that should be used for minor aches and pains is acetaminophen.

C

35. A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge? a. Chemotherapy is highly successful in the treatment of liver cancer. b. The patient will undergo surgery to remove the involved portions of the liver. c. Supportive care that is appropriate for all patients with severe liver damage is indicated. d. Metastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver.

C

40. What treatment measure is used in managing the patient with acute pancreatitis? a. Surgery to remove the inflamed pancreas b. Pancreatic enzyme supplements administered with meals c. Nasogastric (NG) suction to prevent gastric contents from entering the duodenum d. Endoscopic pancreatic sphincterotomy using endoscopic retrograde cholangiopancreatography (ERCP)

C

41. A patient with acute pancreatitis has a nursing diagnosis of acute pain resulting from distension of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care? a. Provide diversional activities to distract the patient from the pain. b. Provide small, frequent meals to increase the patient's tolerance to food. c. Position the patient on the side with the head of the bed elevated 45 degrees for pain relief. d. Ambulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion.

C

42. Patient-Centered Care: The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement? a. "I should observe for fat in my stools." b. "I must not use alcohol to prevent future attacks of pancreatitis." c. "I shouldn't eat any salty foods or foods with high amounts of sodium." d. "I will not need to monitor my blood glucose levels when I am at home."

C

43. What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis? a. Has acute abdominal pain b. The need to abstain from alcohol c. Malabsorption and diabetes mellitus d. Require a high-carbohydrate, high-protein, low-fat diet

C

5. Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination? a. Anti-HBc immunoglobulin (Ig)G b. Surface antigen HBs Ag c. Surface antibody anti-HBs d. Core antigen anti-HBc IgM

C

5. What may occur with failure of the sodium-potassium pump during severe protein depletion? a. Ascites b. Anemia c. Hyperkalemia d. Hypoalbuminemia

C

53. A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse? a. "A low-fat diet will prevent the development of further gallstones and should be continued." b. "Yes; because you will not have a gallbladder to store bile, you will not be able to digest fats adequately." c. "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile." d. "Removing the gallbladder will eliminate the source of your pain that was associated with fat intake, so you may eat whatever you like."

C

55. During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching? a. Keep the incision area clean and dry for at least a week. b. Report the need to take pain medication for shoulder pain. c. Report any bile-colored or purulent drainage from the incisions. d. Expect some postoperative nausea and vomiting for several days.

C

9. The nurse monitors the laboratory results of the patient with protein-calorie malnutrition during treatment. Which result indicates an improvement in the patient's condition? a. Decreased lymphocytes b. Increased serum potassium c. Increased serum transferrin d. Decreased serum prealbumin

C

A 2400-mg sodium diet is prescribed for a patient with chronic HF. The nurse recognizes that additional teaching is necessary when the patient makes which statement? a. "I should limit my milk intake to 2 cups a day." b. "I can eat fresh fruits and vegetables without worrying about sodium content." c. "I can eat most foods as long as I do not add salt when cooking or at the table." d. "I need to read the labels on prepared foods and medicines for their sodium content."

C

A 40-year-old female patient has extreme obesity and type 2 diabetes. She wants to lose weight. After learning about the surgical procedures, she thinks a combination of restrictive and malabsorptive surgery would be best. Which procedure should the nurse teach her about? a. Lipectomy b. Sleeve gastrectomy c. Roux-en-Y gastric bypass d. Adjustable gastric banding

C

A 60-year-old black woman is afraid she may have anal cancer. What assessment finding puts her at high risk for anal cancer? a. Alcohol use b. Only 1 sexual partner c. Human papillomavirus (HPV) d. Use of a condom with sexual intercourse

C

A patient is diagnosed with celiac disease following a workup for iron-deficiency anemia and decreased bone density. The nurse identifies that additional teaching about disease management is needed when the patient makes which statement? a. "I should ask my close relatives to be screened for celiac disease." b. "If I do not follow the gluten-free diet, I will likely develop malnutrition." c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms." d. "It is going to be hard to follow a gluten-free diet because it is found in so many foods."

C

A patient is scheduled for an open surgical valvuloplasty of the mitral valve. What information about this surgery should the nurse use to plan care? a. Cardiopulmonary bypass is not required with this procedure. b. Valve repair is a palliative measure, while valve replacement is curative. c. The operative mortality rate is lower in valve repair than in valve replacement. d. Patients with valve repair do not need postoperative anticoagulation as do those who have valve replacement.

C

A patient is scheduled for biopsy of a painful tongue ulcer. Based on knowledge of risk factors for oral cancer, what should the nurse specifically ask the patient about when obtaining a history? a. Excessive exposure to sunlight b. Recurrent herpes simplex infections c. Use of any type of tobacco products d. Difficulty swallowing and pain in the ear

C

A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report? a. Vomiting of bright-red blood b. Projectile vomiting of undigested food c. Sudden, severe generalized abdominal and back pain d. Hyperactive bowel sounds and upper abdominal swelling

C

A patient with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. What should the nurse suspect that the patient is experiencing? a. Pulmonary embolization from valve vegetations b. Vegetative embolization to the coronary arteries c. Valvular incompetence with resulting heart failure d. Nonspecific manifestations that accompany infectious diseases

C

A surgical repair is planned for a patient who has a 5.5-cm abdominal aortic aneurysm (AAA). On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and dysphagia b. Severe back pain with flank ecchymosis c. Presence of a bruit in the periumbilical area d. Weakness in the lower extremities progressing to paraplegia

C

Corticosteroid medications are associated with the development of peptic ulcers because of which pathophysiologic mechanism? a. The enzyme urease is produced. b. Secretion of hydrochloric acid is increased. c. The rate of mucous cell renewal is decreased. d. The synthesis of mucus and prostaglandins is inhibited.

C

During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? a. "It is very rare for polyps to become malignant, but you should continue to have routine colonoscopies." b. "Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps." c. "All polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present." d. "All polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps."

C

In which patient would a mechanical prosthetic valve be preferred over a biologic valve for valve replacement? a. 41-year-old man with peptic ulcer disease b. 22-year-old woman who wants to have children c. 35-year-old man with a history of seasonal asthma d. 62-year-old woman with early Alzheimer's disease

C

Priority Decision: A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction, IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four hours after admission, the patient experiences nausea and vomiting. What is a priority nursing intervention for the patient? a. Assess the abdomen for distention and bowel sounds. b. Inspect the surgical site and drainage in the Jackson-Pratt. c. Check the characteristics of gastric drainage and the patency of the NG tube. d. Administer prescribed ondansetron (Zofran) to control the nausea and vomiting.

C

Priority Decision: During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider (HCP) if the patient has a. fever and redness at the incision site. b. 2 + edema of the extremity and pain at the incision site. c. a loss of palpable pulses and numbness and tingling of the feet. d. increasing ankle-brachial indices and serous drainage from the incision.

C

Priority Decision: During care of the patient with extreme obesity, what is most important for the nurse to do? a. Avoid any reference to the patient's weight to avoid embarrassing the patient. b. Emphasize to the patient how important it is to lose weight to maintain health. c. Plan for necessary modifications in equipment and nursing techniques before starting care. d. Recognize that a full assessment may not be possible because of numerous layers of skinfolds.

C

Priority Decision: Following teaching about medications for PAD, the nurse determines that more instruction is needed when the patient makes which statement? a. "I should take 1 aspirin a day to prevent clotting in my legs." b. "The lisinopril I use for my blood pressure may help me walk further without pain." c. "I will need to have frequent blood tests to evaluate the effect of the pentoxifylline I will be taking." d. "Cilostazol should help me increase my walking distance and speed and help prevent pain in my legs."

C

Priority Decision: What is the most important thing the nurse should do when caring for a patient who has contracted Clostridium difficile? a. Clean the entire room with ammonia. b. Feed the patient yogurt with probiotics. c. Wear gloves and wash hands with soap and water. d. Teach the family to use alcohol-based hand cleaners.

C

The medications prescribed for the patient with IBD include cobalamin and iron injections. What is the reason for using these drugs? a. Alleviate stress b. Combat infection c. Correct malnutrition d. Improve quality of life

C

The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement? a. "I should stop all my medications if I develop any side effects." b. "I should continue my treatment regimen as long as I have pain." c. "I have learned some relaxation strategies that decrease my stress." d. "I can buy whatever antacids are on sale because they all have the same effect."

C

The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea makes which statement? a. "I can use A&D ointment or Vaseline jelly around the anal area to protect my skin." b. "Gatorade is a good liquid to drink because it replaces the fluid and salts I have lost." c. "I may use over-the-counter loperamide or paregoric when I need to control the diarrhea." d. "I must wash my hands after every bowel movement to prevent spreading the diarrhea to my family."

C

The nurse should teach the patient with chronic constipation that which food has the highest dietary fiber? a. Peach b. Popcorn c. Dried beans d. Shredded wheat

C

The patient asks the nurse why she needs to have surgery for a femoral, strangulated hernia. What is the best explanation the nurse can give the patient? a. "The surgery will relieve your constipation." b. "The abnormal hernia must be replaced into the abdomen." c. "The surgery is needed to allow intestinal flow and prevent necrosis." d. "The hernia is because the umbilical opening did not close after birth as it should have."

C

The patient has peritonitis, which is a major complication of ruptured appendix. What treatment should the nurse plan to include? a. Peritoneal lavage b. Peritoneal dialysis c. IV fluid replacement d. Increased oral fluid intake

C

The patient is receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease? a. Corticosteroids b. 6-Mercaptopurine c. Antidiarrheal agents d. Sulfasalazine (Azulfidine)

C

What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease? a. Maintain a bland, soft, low-residue diet. b. Use alcohol and caffeine in moderation and always with food. c. Eat as normally as possible, eliminating foods that cause pain or discomfort. d. Avoid milk and milk products because they stimulate gastric acid production.

C

What is the main underlying risk factor for metabolic syndrome? a. Age b. Heart disease c. Insulin resistance d. High cholesterol levels

C

What laboratory findings are expected in ulcerative colitis because of diarrhea and vomiting? a. Increased albumin b. Elevated white blood cells (WBCs) c. Decreased serum Na+, K+, Mg+, Cl-, and HCO3- d. Decreased hemoglobin (Hgb) and hematocrit (Hct)

C

What should the nurse teach the patient with diverticulosis to do? a. Use antibiotics routinely to prevent future inflammation. b. Have an annual colonoscopy to detect malignant changes in the lesions. c. Maintain a high-fiber diet and encourage fluid intake of at least 2 L daily. d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel.

C

When planning care for the patient with hypertrophic CMP, what should the nurse include? a. Ventricular pacing b. Administration of vasodilators c. Teach the patient to avoid strenuous activity and dehydration d. Surgery for cardiac transplantation will have to be done soon

C

Which explanation about weight reduction should be included when teaching the obese patient and her obese husband? a. Weight gain is caused by psychologic factors. b. Daily weighing is recommended to monitor weight loss. c. Progressively increasing physical activity helps decrease weight, cholesterol, and BP levels. d. Men lose weight less quickly than women because they have a higher percentage of metabolically less active fat.

C

Which laboratory findings should the nurse expect in the patient with persistent vomiting? a. ↓ pH, ↑ sodium, ↓ hematocrit b. ↑ pH, ↓ chloride, ↓ hematocrit c. ↑ pH, ↓ potassium, ↑ hematocrit d. ↓ pH, ↓ potassium, ↑ hematocrit

C

Which patients should the nurse expect to be scheduled for percutaneous transluminal balloon valvuloplasty? a. Any patient with aortic regurgitation b. Older patients with aortic regurgitation c. Older patients with stenosis of any valve d. Young adult patients with mild mitral valve stenosis

C

Which statement accurately describes mitral valve prolapse? a. Rapid onset prevents left chamber dilation b. May be caused by pulmonary hypertension c. Buckling of valve into left atrium during ventricular systole d. Rapid development of pulmonary edema and cardiogenic shock

C

What describes the action of the natriuretic peptides and nitric oxide in their counterregulatory processes in response to HF? a. Excretion of potassium b. Increased release of ADH c. Vasodilation and decreased BP d. Decreased glomerular filtration rate and edema d. Decreased glomerular filtration rate and edema

C. Both the natriuretic peptides and nitric oxide contribute to vasodilation, decreased BP, and decreased afterload. The natriuretic peptides also increase excretion of sodium by increasing glomerular filtration rate and diuresis (renal effects) as well as interfere with ADH release and inhibit aldosterone and renin secretion (hormonal effects).

In preparing to care for the obese patient with cancer, what physiologic problems is this patient at a greater risk for having (select all that apply)? a. Tinnitus b. Fractures c. Sleep apnea d. Type 2 diabetes e. Trousseau's sign f. Gastroesophageal reflux disease (GERD)

CDF

A 20-year-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. For which type of anemia is this patient most at risk? a. Aplastic anemia b. Hemolytic anemia c. Iron-deficiency anemia d. Folic acid deficiency anemia

Correct Action:d. Folic acid deficiency megaloblastic anemia is related to dietary deficiency as seen in anorexia and with the use of oral contraceptives and antiseizure medications. The other anemias are unrelated to this patient's history.

What early manifestation(s) is the patient with primary hypertension likely to report? a. No symptoms b. Cardiac palpitations c. Dyspnea on exertion d. Dizziness and vertigo

Correct Answer a. Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the silent killer. The absence of symptoms often leads to noncompliance with medical treatment and a lack of concern about the disease in patients. With severe hypertension, symptoms may include fatigue, palpitations, angina, dyspnea, and dizziness.

12. The nurse determines that teaching about pernicious anemia has been effective when the patient says, a. "This condition can kill me unless I take injections of the vitamin for the rest of my life." b. "My symptoms can be completely reversed after I take a cobalamin (vitamin B12) supplement." c. "If my anemia does not respond to cobalamin therapy, my only other alternative is a bone marrow transplant." d. "The least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high in cobalamin."

Correct Answer A. Without cobalamin replacement, individuals with pernicious anemia will die in 1 to 3 years, but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reversed with therapy, but long-standing neuromuscular complications may not be reversed. Because pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.

A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. Which explanation should the nurse give to the patient? a. Sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy. b. When RBCs sickle, they occlude small vessels, which causes more local hypoxia and more sickling. c. The primary problem during a sickle cell crisis is destruction of the abnormal cells, resulting in fewer RBCs to carry oxygen. d. Oxygen therapy does not alter the shape of the abnormal erythrocytes but only allows

Correct Answer B. During a sickle cell crisis, the sickling cells clog small capillaries, and the resulting hemostasis promotes a self-perpetuating cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling. Administration of oxygen may reverse sickling at first, but eventually the sickling becomes irreversible because of cell membrane damage from recurrent sickling.

Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease

Correct Answer B: Aplastic anemia has a decrease of all blood cell types and hypocellular bone marrow. Thalassemia is characterized by inadequate production of normal Hgb and decreased erythrocyte production. Megaloblastic anemias (cobalamin deficiency and folic acid deficiency anemias) are caused by impaired DNA synthesis, which results in the presence of large red blood cells (RBCs). Anemia of chronic disease occurs with chronic inflammation, autoimmune and infectious disorders, heart failure, malignancies, or bleeding episodes. It manifests with underproduction of RBCs and shortened RBC survival.

What is the primary BP effect of β-adrenergic blockers, such as atenolol (Tenormin)? a. Vasodilation of arterioles by blocking movement of calcium into cells b. Decrease Na+ and water reabsorption by blocking the effect of aldosterone c. Decrease CO by decreasing rate and strength of the heart and renin secretion by the kidneys d. Vasodilation caused by inhibiting sympathetic outflow from the central nervous system (CNS)

Correct Answer C. Cardioselective β-adrenergic blockers decrease CO, reduce sympathetic vasoconstrictor tone, and decrease renin secretion by kidneys. Calcium channel blockers reduce BP by causing blocked movement of calcium into cells, which causes vasodilation of arterioles. Spironolactone blocks the effect of aldosterone. Central adrenergic antagonists, such as clonidine (Catapres) inhibit sympathetic outflow from the central nervous system (CNS).

During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux

Correct Answer C. Neurologic manifestations of weakness, paresthesia of the feet and hands, and impaired thought processes are characteristic of cobalamin deficiency and pernicious anemia. Hepatomegaly and jaundice often occur with hemolytic anemia. The patient with cobalamin deficiency often has achlorhydria or decreased stomach acidity and would not experience effects of gastric hyperacidity.

Priority Decision: A 76-year-old woman has an Hgb of 7.3 g/dL (73 g/L) and is experiencing ataxia, confusion, weakness, and fatigue on admission to the hospital. What is the priority nursing intervention for this patient? a. Provide a darkened, quiet room. b. Have the family stay with the patient c. Keep top bedside rails up and call bell in close reach. d. Question the patient about possible causes of anemia.

Correct Answer C: Keeping the top bedside rails up and the call bell within reach will facilitate safety and safe mobility for this patient. In the older adult, confusion, ataxia, fatigue, and weakness are common manifestations of anemia and place the patient at risk for injury. Nursing interventions should include safety precautions to prevent falls and injury when these symptoms are present. The nurse, not the patient's family, is responsible for the patient, and although a quiet room may promote rest, it is not as important as protection of the patient.

What are nonmodifiable risk factors for primary hypertension (select all that apply)? a. Age b. Obesity c. Gender d. Ethnicity e. Genetic link

Correct Answer a, c, d, e. Hypertension progresses with increasing age. It is more prevalent in men before early middle age and above the age of 64 years in women. Blacks have a higher incidence of hypertension than do whites. Children and siblings of patients with hypertension should be screened and taught about healthy lifestyles.

A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. Decreased renal function b. Increased baroreceptor reflexes c. Increased peripheral vascular resistance d. Increased adrenergic receptor sensitivity e. Increased collagen and stiffness of the myocardium f. Loss of elasticity in large arteries from arteriosclerosis

Correct Answer a, c, e, f. The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis. The baroreceptor reflexes are blunted. The adrenergic receptor sensitivity and renin response are both decreased with aging.

A patient with aplastic anemia has impaired oral mucous membranes. This problem can be related to the effects of what deficiencies (select all that apply)? a. RBCs b. Ferritin c. Platelets d. Coagulation factor VIII e. White blood cells (WBCs)

Correct Answer a, c, e. Aplastic anemia may cause an inflamed, painful tongue. Oxygen is not delivered without RBCs. The thrombocytopenia may contribute to blood-filled bullae in the mouth and gingival bleeding. The leukopenia may lead to stomatitis and oral ulcers and infections. MCV will be normal or slightly increased. Ferritin and coagulation factors are not affected in aplastic anemia.

Which statements accurately describe chronic lymphocytic leukemia (CLL) (select all that apply)? a. Most common leukemia of adults in Western countries b. Only cure is bone marrow transplant c. Neoplasm of activated B lymphocytes d. Increased incidence in survivors of atomic bombs e. Philadelphia chromosome is a diagnostic hallmark f. Mature-appearing but functionally inactive lymphocytes

Correct Answer a, c, f. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in Western countries. It is a neoplasm of activated B lymphocytes that are mature appearing but functionally inactive. As it progresses, pressure on nerves from enlarged lymph nodes causes pain and paralysis. Mediastinal node enlargement leads to pulmonary symptoms. The other characteristics are related to chronic myelogenous leukemia (CML).

Priority Decision: While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2° F (39° C). What is the priority action for the nurse to take? a. Stop the transfusion and instill normal saline. b. Notify the health care provider and the blood bank. c. Add a leukocyte reduction filter to the blood administration set. d. Recognize this as a mild allergic transfusion reaction and slow the transfusion.

Correct Answer a. Chills and fever are symptoms of an acute hemolytic or febrile transfusion reaction, and if these develop, the nurse should stop the transfusion, infuse saline through the IV line, notify the HCP and blood bank immediately, recheck the ID tags, and monitor vital signs and urine output. The addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. Mild and transient allergic reactions indicated by itching and hives may permit restarting the transfusion after treatment with antihistamines.

A patient has a BP of 222/148 mm Hg and confusion, nausea, and vomiting. Which goal should the nurse try to achieve by titrating medications? a. Decrease the mean arterial pressure (MAP) to 129 mm Hg b. Lower the BP to the patient's normal within the second to third hour c. Decrease the SBP to 160 mm Hg and the DBP to 100 mm Hg as quickly as possible d. Reduce the SBP to 158 mm Hg and the DBP to 90 mm Hg within the first 2 hours

Correct Answer a. Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure (MAP) by no more than 20% to 25% in the first hour, with further gradual reduction over the next 24 hours. In this case, the MAP is 222 + 2(148)/3 = 172, so decreasing it by 25% equals 129. Lowering the BP too far or too fast may cause a stroke, myocardial infarction (MI), or renal failure. Only when the patient has an aortic dissection, angina, or signs of an ischemic stroke does the SBP have to be lowered to 100 to 120 mm Hg or less as quickly as possible.

In providing care for a patient hospitalized with an acute exacerbation of polycythemia vera, the nurse gives priority to which activity? a. Maintaining protective isolation b. Promoting leg exercises and ambulation c. Protecting the patient from injury or falls d. Promoting hydration with a large oral fluid intake

Correct Answer b. Active or passive leg exercises and ambulation should be implemented to prevent thrombus formation. Thrombus and embolization are the major complications of polycythemia vera because of hypervolemia and hyperviscosity. Isolation is not needed and falls are not expected. Hydration therapy is important to decrease blood viscosity. However, because the patient already has hypervolemia, a careful balance of intake and output must be maintained and fluids are not increased injudiciously.

What causes the anemia of sickle cell disease? a. Intracellular hemolysis of sickled RBCs b. Accelerated breakdown of abnormal RBCs c. Autoimmune antibody destruction of RBCs d. Isoimmune antibody-antigen reactions with RBCs

Correct Answer b. Because RBCs become abnormal related to hypoxia or infection in sickle cell anemia, the spleen accelerates RBC breakdown as the sickling increases. Antibody reactions with RBCs may be seen in other types of hemolytic anemias but are not present in sickle cell anemia.

A patient with thrombocytopenia with active bleeding is to receive 2 units of platelets. To administer the platelets, what should the nurse do? a. Check for ABO compatibility. b. Agitate the bag periodically during the transfusion. c. Take vital signs every 15 minutes during the procedure. d. Refrigerate the second unit until the first unit has transfused.

Correct Answer b. Because platelets adhere to the plastic bags, the bag should be gently agitated throughout the transfusion. Platelets do not have A, B, or Rh antibodies, and ABO compatibility is not a consideration. Baseline vital signs should be taken before the transfusion is started, and the nurse should stay with the patient during the first 15 minutes. Platelets are stored at room temperature for 1 to 5 days.

Priority Decision: A patient with stage 2 hypertension who is taking chlorothiazide (Diuril) and lisinopril (Zestril) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention. b. Change position slowly and avoid prolonged standing. c. Use sugarless gum or candy to help relieve dry mouth. d. Take the pulse daily to note any slowing of the heart rate.

Correct Answer b. Chlorothiazide is a thiazide diuretic that causes orthostatic hypotension. Prazosin is an α-adrenergic blocker that causes dilation of arterioles and veins and causes orthostatic hypotension. The patient may feel dizzy, weak, and faint when assuming an upright position after sitting or lying down and should be taught to change positions slowly, avoid standing for long periods, do leg exercises to increase venous return, and lie or sit down when dizziness occurs. Direct-acting vasodilators often cause fluid retention; dry mouth may occur with diuretic use, and centrally acting α- and β-blockers may cause bradycardia.

A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy

Correct Answer b. Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary leakage. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy and severely reduced platelet counts.

A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing intervention for the patient? a. Wrapping the knee with an elastic bandage b. Placing the patient on bed rest and applying ice to the joint c. Administering nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain d. Gently performing range-of-motion (ROM) exercises to the knee to prevent adhesions

Correct Answer b. During an acute bleeding episode in a joint, it is important to rest the involved joint totally and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with range-of-motion (ROM) exercises and physical therapy.

Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure

Correct Answer b. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the patient with aplastic anemia. The patient will experience fatigue from anemia, but bleeding and infection are the major causes of death in aplastic anemia.

In teaching the patient with pernicious anemia about the disease, the nurse explains that it results from a lack of a. folic acid. b. intrinsic factor. c. extrinsic factor. d. cobalamin intake.

Correct Answer b. Pernicious anemia is a type of cobalamin (vitamin B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Folic acid deficiency may contribute to folic acid deficiency anemia, not pernicious anemia. Extrinsic factor may be a factor in some cobalamin deficiencies but not in pernicious anemia. Lack of cobalamin intake can cause cobalamin deficiency but not pernicious anemia. Increasing cobalamin intake cannot improve pernicious anemia without intrinsic factor to aid its absorption.

Collaboration: The unit is very busy and short staffed. What could the RN delegate to the unlicensed assistive personnel (UAP)? a. Administer antihypertensive medications to stable patients. b. Obtain orthostatic BP readings for older patients. c. Check BP readings for the patient receiving IV sodium nitroprusside. d. Teach about home BP monitoring and use of automatic BP monitoring equipment.

Correct Answer b. The UAP may check postural changes in BP as directed. The LPN may administer antihypertensive medications to stable patients. The RN must monitor the patient receiving IV sodium nitroprusside, as the patient is in a hypertensive crisis. The RN must also do the teaching related to home BP monitoring.

The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain b. Heart c. Retina d. Kidney

Correct Answer b. The increased systemic vascular resistance (SVR) of hypertension directly increases the workload of the heart, and heart failure occurs when the heart can no longer pump effectively against the increased resistance. The heart may be indirectly damaged by atherosclerotic changes in the blood vessels, as are the brain, retina, and kidney.

41. What characteristics should the nurse be aware of in planning care for the patient with Hodgkin's lymphoma? a. Staging of Hodgkin's lymphoma is not important to predict prognosis. b. Management of the patient being treated for Hodgkin's lymphoma includes measures to prevent infection. c. Hodgkin's lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys. d. An important nursing intervention in the care of patients with Hodgkin's lymphoma is increasing fluids to manage hypercalcemia.

Correct Answer b. The patient is monitored for infection because leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin's disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.

A 45-year-old patient has symptoms including arthralgia, impotence, weight loss, and liver enlargement. His laboratory results include an elevated serum iron, total iron binding capacity (TIBC), and serum ferritin levels. Which disorder does this describe and which treatment will be used? a. Thalassemia; combination chemotherapy b. Hemochromatosis; deferoxamine (Desferal) c. Myelodysplastic syndrome; blood transfusions d. Delayed transfusion reaction; deferasirox (Exjade)

Correct Answer b. The symptoms describe hemochromatosis, which is treated with iron chelating agents to remove accumulated iron via the kidneys. Thalassemia involves inadequate production of normal hemoglobin, is asymptomatic or has growth and development deficits, and is treated with blood transfusion and chelating agents (e.g., deferasirox). Myelodysplastic syndrome has disordered and ineffective hematopoiesis and is treated supportively with hematologic monitoring, antibiotic therapy, transfusions, iron chelators, or intensive chemotherapy and/or hematopoietic stem cell transplantation (HSCT). Delayed transfusion reactions exhibit delayed hemolytic reactions, infections, and iron overload and have no acute treatment unless severe enough to warrant further transfusions.

A patient with hemophilia comes to the clinic for treatment. What should the nurse anticipate that he or she will need to administer? a. Whole blood b. Thromboplastin c. Coagulation factor d. Fresh frozen plasma

Correct Answer c. Although whole blood and fresh frozen plasma contain the clotting factors that are deficient in hemophilia, specific coagulation factors have been developed that are purer and safer in preventing infection transmission. Thromboplastin is factor III and is not deficient in patients with hemophilia.

Which type of transfusion reaction occurs with leukocyte or plasma protein incompatibility and may be avoided with leukocyte reduction filters? a. Allergic reaction b. Acute hemolytic reaction c. Febrile, nonhemolytic reaction d. Massive blood transfusion reaction

Correct Answer c. Febrile nonhemolytic reaction is the most common transfusion reaction. Allergic reactions occur with sensitivity to foreign plasma proteins and can be treated prophylactically with antihistamines. Acute hemolytic reactions are related to the infusion of ABO-incompatible blood or components with 10 mL or more of RBCs. Massive blood transfusion reactions occur when patients receive more RBCs or blood than the total blood volume.

A patient diagnosed with secondary hypertension asks why it is called secondary and not primary. What is the best explanation for the nurse to provide? a. Has a more gradual onset than primary hypertension b. Does not cause the target organ damage that occurs with primary hypertension c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age

Correct Answer c. Secondary hypertension has an underlying cause that will be treated, in contrast to primary or essential hypertension, which has no single known cause. Isolated systolic hypertension occurs when the systolic BP (SBP) is consistently equal to or over 130 mm Hg and the diastolic BP (DBP) is consistently equal to or over at 80 mm Hg.

A 38-year-old man is treated for hypertension with triamterene and hydrochlorothiazide and metoprolol (Lopressor). Four months after his last clinic visit, his BP returns to pretreatment levels, and he admits he has not been taking his medication regularly. What is the nurse's best response to this patient? a. "Try always to take your medication when you carry out another daily routine so that you do not forget to take it." b. "You probably would not need to take medications for hypertension if you would exercise more and stop smoking." c. "The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing any problems in this area?" d. "You need to remember that hypertension can be only controlled with medication, not cured, and you must always take your medication."

Correct Answer c. Sexual dysfunction, which can occur with many of the antihypertensive drugs, including thiazide and potassium-sparing diuretics and β-adrenergic blockers, can be a major reason that a male patient does not adhere to his treatment regimen. It is helpful for the nurse to raise the subject because sexual problems may be easier for the patient to discuss and handle once it has been explained that the drug may be the source of the problem.

Following a splenectomy for the treatment of ITP, what laboratory test result would the nurse expect to find? a. Decreased RBCs b. Decreased WBCs c. Increased platelets d. Increased immunoglobulins

Correct Answer c. Splenectomy may be indicated for treatment for ITP, and when the spleen is removed, platelet counts increase significantly in most patients. In any of the disorders in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.

A patient with AML is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient? a. "Your bone marrow is destroyed by radiation, and new bone marrow cells from a matched donor are injected into your bones." b. "A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse." c. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation, and new bone marrow cells from a donor are infused." d. "During chemotherapy and/or total-body irradiation to destroy all of your blood cells, you may be given transfusions of RBCs and platelets to prevent complications."

Correct Answer c. Whether the donor bone marrow is from a human leukocyte antigen (HLA)-matched donor or taken from the patient during a remission for later use, HSCT always involves the use of chemotherapy and/or total-body radiation to eliminate leukemic cells and the patient's bone marrow stem cells totally before IV infusion of the donor cells. A severe pancytopenic period follows the transplant, during which the patient must be in protective isolation and during which RBC and platelet transfusions may be given.

What is a nursing intervention that is indicated for the patient during a sickle cell crisis? a. Frequent ambulation b. Application of antiembolism hose c. Restriction of sodium and oral fluids d. Administration of large doses of continuous opioid analgesics

Correct Answer d. Because pain is the most common symptom with a sickle cell crisis and may last for 4 to 6 days, pain control is an essential part of treatment. Rest is indicated to reduce metabolic needs. Although thrombosis does occur in capillaries, antiembolism stockings that primarily affect venous circulation are not indicated; anticoagulants are more effective. Fluids and electrolytes are administered to reduce blood viscosity and maintain renal function.

The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron-deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia

Correct Answer d. Because red meats are the primary dietary sources of cobalamin, a strict vegetarian is most at risk for cobalamin deficiency anemia. Meats are also an important source of iron and folic acid, but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies..

In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find? a. An absence of factor IX b. A decreased platelet count c. A prolonged bleeding time d. A prolonged partial thromboplastin time (PTT)

Correct Answer d. A prolonged PTT occurs when there is a deficiency of clotting factors, such as factor VIII associated with hemophilia A. Factor IX is deficient in hemophilia B and prolonged bleeding time, and decreased platelet counts are associated with platelet deficiencies.

18. What is included in the correct technique for BP measurements? a. Always take the BP in both arms. b. Position the patient supine for all readings. c. Place the cuff loosely around the upper arm. d. Take readings at least 2 times at least 1 minute apart.

Correct Answer d. Correct technique in measuring BP includes taking and averaging 2 or more readings at least 1 minute apart. Initially BP measurements should be taken in both arms to detect any differences. If there is a difference, the arm with the higher reading should be used for all subsequent BP readings. The patient may be supine or sitting. The important points are that the arm being used is at the heart level and the cuff needs to fit snugly.

Dietary teaching that includes eating dietary sources of potassium is indicated for the hypertensive patient taking which drug? a Enalapril b. Labetalol c. Spironolactone d. Hydrochlorothiazide

Correct Answer d. Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium loss through the kidneys. High-potassium foods should be included in the diet, or potassium supplements may be used to prevent hypokalemia. Enalapril and spironolactone may cause hyperkalemia by inhibiting the action of aldosterone, and potassium supplements should not be used by patients taking these drugs. As a combined α/β-blocker, labetalol does not affect potassium levels.

Which drugs are most commonly used to treat hypertensive crises? a. Labetalol and bumetanide (Bumex) b. Esmolol (Brevibloc) and captopril (Captopril) c. Enalaprilat (Vasotec) and minoxidil (Minoxidil) d. Fenoldopam (Corlopam) and sodium nitroprusside (Nitropress)

Correct Answer d. Hypertensive crises are treated with IV administration of antihypertensive drugs, including the vasodilators sodium nitroprusside, fenoldopam, and nicardipine; adrenergic blockers, such as labetalol, esmolol, and phentolamine; the ACE inhibitor enalaprilat; the calcium channel blocker clevidipine; nitroglycerin for myocardial ischemia; hydralazine with other medications; and oral captopril. Sodium nitroprusside is the most effective parenteral drug for hypertensive emergencies.

What does the nursing responsibility in the management of the patient with hypertensive urgency include? a. Monitoring hourly urine output for drug effectiveness b. Titrating IV drug dosages based on BP and HR measurements every 2 to 3 minutes c. Providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs d. Instructing the patient to follow up with a health care provider within 24 hours after outpatient treatment

Correct Answer d. Hypertensive urgencies are often treated with oral drugs on an outpatient basis, but it is important for the patient to be seen by a HCP within 24 hours to evaluate the effectiveness of the treatment. Hourly urine measurements, titration of IV drugs, and Electrocardiogram (ECG) monitoring are indicated for hypertensive emergencies.

During discharge teaching of a patient with newly diagnosed sickle cell disease, what should the nurse teach the patient to do? a. Limit fluid intake. b. Avoid humid weather. c. Eliminate exercise from the lifestyle. d. Seek early medical intervention for upper respiratory infections.

Correct Answer d. The patient with sickle cell disease is particularly prone to upper respiratory infection, and infection can precipitate a sickle cell crisis. Patients should seek medical attention quickly to counteract upper respiratory infections because pneumonia is the most common infection in patients with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis. Moderate activity is permitted. Dehydration in hot weather may precipitate a sickling episode, but humid weather alone will not do so.

The patient asks the nurse about valsartan (Diovan), the new medication prescribed for blood pressure. What is the best explanation the nurse can use to explain the action of this medication? a. Prevents the conversion of angiotensin I to angiotensin II b. Acts directly on smooth muscle of arterioles to cause vasodilation c. Decreases extracellular fluid volume by increasing Na+ and Cl− excretion with water d. Vasodilation, prevents the action of angiotensin II, and promotes increased salt and water excretion

Correct Answer d. Valsartan (Diovan) is an angiotensin II receptor blocker (ARB). ARBs prevent the action of angiotensin II, produce vasodilation, and increase salt and water excretion. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II. Direct vasodilators act directly on smooth muscle of arterioles to cause vasodilation. Thiazide diuretics decrease extracellular fluid volume by increasing Na+ and Cl− excretion with water.

What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)? a. The drug should never be stopped abruptly. b. The drug should be taken early in the day to prevent nocturia. c. The first dose should be taken when the patient is in bed for the night. d. Because aspirin will decrease the drug's effectiveness, Tylenol should be used instead.

Correct Answer-a. Centrally acting α-adrenergic blockers may cause severe rebound hypertension if the drugs are abruptly discontinued, and patients should be taught about this effect because many are not consistently compliant with drug therapy. Diuretics should be taken early in the day to prevent nocturia. The profound orthostatic hypotension that occurs with first-dose peripheral acting α-adrenergic blockers can be prevented by taking the initial dose at bedtime. Aspirin use may decrease the effectiveness of ACE inhibitors.

A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. Considering the severity of anemia, what other manifestation would the nurse expect the patient to exhibit? a. Pallor b. Dyspnea c. A smooth tongue d. Sensitivity to cold

Correct Answer: B The patient's hemoglobin (Hgb) level indicates a moderate anemia, and at this severity, additional findings usually include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hgb level is below 6 g/dL (60 g/L).

During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse? a. Anorexia b. Bone pain c. Hepatomegaly d. Dyspnea at rest

Correct Answer: D Dyspnea at rest indicates that the patient is making an effort to provide adequate amounts of oxygen to the tissues. If oxygen needs are not met, angina, myocardial infarction, heart failure, and pulmonary and systemic congestion can occur. The other manifestations are present in severe anemia, but they do not reflect hypoxemia, a priority problem.

Which statements accurately describe thrombocytopenia (select all that apply)? a. Patients with platelet deficiencies can have internal or external hemorrhage. b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP). c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets. e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination of the patient is ecchymosis.

Correct Answer: a, c, d. Platelet deficiencies lead to internal and external hemorrhage. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP) is characterized by decreased platelets and RBCs with enhanced agglutination of the platelets. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common manifestation of thrombocytopenia.

What causes most organ damage in hypertension? a. Increased fluid pressure exerted against organ tissue b. Atherosclerotic changes in vessels that supply the organs c. Erosion and thinning of blood vessels in organs from constant pressure d. Increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces

Correct Answer: b. Elevated BP causes endothelial damage, which causes the inner lining of arterioles to become thickened and stiffened and affects coronary circulation, cerebral circulation, peripheral vessels, and renal and retinal blood vessels. The narrowed vessels lead to ischemia and ultimately to damage of these organs.

Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stomach f. May occur with removal of the duodenum

Correct Answer: c, d, f. Iron-deficiency anemia is the most common type of anemia and occurs with chronic blood loss or malabsorption mal-absorption in the duodenum so it may occur with duodenal removal. The other options are associated with cobalamin deficiency.

Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patient on strict bed rest to prevent injury c. Monitoring the patient for headaches, vertigo, or confusion d. Removing the oral crusting and scabs with a soft brush 4 times a day

Correct Answer: c. The major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. Cerebral hemorrhage may be fatal, and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.

Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, this patient also manifests jaundice. d. A patient who has acute blood loss may have postural hypotension and increased heart rate. e. Initial clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss.

Correct Answers a, d, e. With rapid blood loss, hypovolemic shock may occur. Clinical manifestations, such as postural hypotension and increased heart rate, will be more reliable than laboratory values as they reflect the body's attempt to meet oxygen requirements. As the percentage of blood loss increases, clinical manifestations worsen.

When teaching the patient about a new prescription for oral iron supplements, what does the nurse teach the patient to do? a. Increase fluid and dietary fiber intake. b. Take the iron preparations with meals. c. Use enteric-coated preparations taken with orange juice. d. Report the presence of black stools to the health care provider.

Correct a. Constipation is a common side effect of oral iron supplementation, and increased fluids and fiber should be consumed to prevent this effect. Because iron is best absorbed in an acid environment and can be bound in the gastrointestinal (GI) tract by food, it should be taken before meals, unless gastric side effects of the supplements necessitate its ingestion with food. Taking iron with ascorbic acid or orange juice enhances absorption of the iron, but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed. Black stools are an expected result of oral iron preparations.

Which manifestation is an indication that a patient is having hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP (SBP) > 180 mm Hg and a diastolic BP (DBP) > 110 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks

Correct c. Hypertensive emergency, a type of hypertensive crisis, is a situation in which a patient's BP is severely elevated with evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular, renal, or retinal). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke. Hypertensive crises are defined by the degree of organ damage and how rapidly the BP rises, not by specific BP measurements. A hypertensive urgency is a less severe crisis, in which a patient's BP becomes severely elevated over hours or days but there is no evidence of target organ damage.

Which bleeding disorder affects both genders, is autosomal dominant, and will have laboratory results showing prolonged bleeding time? a. Hemophilia A b. Hemophilia B c. Thrombocytopenia d. von Willebrand disease

Correct d. This description is characteristic of von Willebrand disease with prolonged bleeding time occurring because of defective platelets, which does not occur with either type of hemophilia. Although inherited thrombocytopenia is believed to be autosomal dominant, the number of platelets is decreased.

. A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include which test? a. Angiography b. Ultrasonography c. Echocardiography d. CT scan

D

10. To evaluate the long-term effect of nutritional interventions for a patient with protein-calorie malnutrition, what is the best indicator for the nurse to use? a. Height and weight b. Body mass index (BMI) c. Weight in relation to ideal body weight d. Midupper arm circumference and triceps skinfold

D

11. The occurrence of acute liver failure is most common in which situation? a. A person with hepatitis A b. A person with hepatitis C c. Antihypertensive medication use d. Use of acetaminophen with alcohol use

D

12. Following a needle stick, what is used as prophylaxis against HBV? a. Interferon b. HBV vaccine c. Hepatitis B immune globulin (HBIG) d. HBIG and HBV vaccine

D

15. What manifestations most strongly support a diagnosis of acute rheumatic fever? a. Carditis, polyarthritis, and erythema marginatum b. Polyarthritis, chorea, and decreased antistreptolysin-O titer c. Organic heart murmurs, fever, and elevated erythrocyte sedimentation rate (ESR) d. Positive C-reactive protein, elevated white blood cells (WBCs), and subcutaneous nodules

D

19. The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient? a. Cirrhosis b. Acute liver failure c. Hepatorenal syndrome d. Primary sclerosing cholangitis

D

19. Which observation should indicate to the nurse the presence of the complication of graft thrombosis after an AAA repair? a. Cardiac dysrhythmias or chest pain b. Absent bowel sounds, abdominal distention, or diarrhea c. Increased temperature and increased white blood cell count d. Decreased pulses and cool, painful extremities below the level of repair

D

2. The patient had a blood transfusion reaction. What is the best explanation the nurse can give the patient as to why hemolytic jaundice has occurred? a. A malaria parasite has broken apart red blood cells (RBCs) b. It results from liver's altered ability from hepatocellular disease c. Jaundice results from decreased flow of bile through the liver or biliary system d. It is caused by increased breakdown of RBCs that increases serum unconjugated bilirubin

D

21. Following discharge teaching with a male patient with an AAA repair, the nurse determines that further instruction is needed when the patient makes which statement? a. "I should avoid heavy lifting for 6 weeks." b. "I may have some sexual dysfunction because of the surgery." c. "I should maintain a low-fat and low-cholesterol diet to help keep the new graft open." d. "I will take the pulses in my legs and let the doctor know if they get too fast or too slow."

D

22. Patient-Centered Care: An 18-year-old female patient with anorexia nervosa is admitted to the hospital for treatment. On admission, she weighs 82 lb (37 kg) and is 5 ft 3 in (134.6 cm). Her laboratory test results include the following: K+ 2.8 mEq/L (2.8 mmol/L), hemoglobin (Hgb) 8.9 g/dL (89 g/L), and blood urea nitrogen (BUN) 64 mg/dL (22.8 mmol/L). In planning care for the patient, the nurse gives the highest priority to which of the following nursing diagnoses? a. Risk for injury; etiology: dizziness and weakness resulting from anemia b. Impaired low nutritional intake; etiology: inadequate food intake c. Risk for impaired urinary system function; etiology: elevated BUN resulting from renal failure d. Risk for impaired cardiac function; etiology: dysrhythmias resulting from hypokalemia

D

22. The evaluation team for cardiac transplantation is evaluating patients. Which patient is most likely to receive the most benefit from a new heart? a. A 24-year-old man with Down syndrome who has received excellent care from parents in their 60s b. A 46-year-old single woman with a limited support system who has alcohol-induced cardiomyopathy c. A 60-year-old man with inoperable CAD who has not been compliant with lifestyle changes and rehabilitation programs d. A 52-year-old woman with end-stage CAD who has limited financial resources but is emotionally stable and has strong social support

D

23. Which conditions contribute to the formation of abdominal ascites? a. Esophageal varices contribute to 80% of variceal hemorrhages b. Increased colloidal oncotic pressure caused by decreased albumin production c. Hypoaldosteronism causes increased sodium reabsorption by the renal tubules d. Blood flow through the portal system is obstructed, which causes portal hypertension

D

27. What patient manifestation does the nurse recognize as an early sign of hepatic encephalopathy? a. Manifests asterixis b. Becomes unconscious c. Has increasing oliguria d. Impaired computational skills

D

3. The patient returned from a 6-week mission trip to Somalia with reports of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted? a. Hepatitis B (HBV) b. Hepatitis C (HCV) c. Hepatitis D (HDV) d. Hepatitis E (HEV)

D

3. What is the most common cause of chronic disease-related or secondary protein-calorie malnutrition in the United States? a. The unavailability of foods high in protein b. A lack of knowledge about nutritional needs c. A lack of money to purchase high-protein foods d. A problem with ingestion, digestion, absorption, or metabolism

D

31. The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant? a. Alcohol intake is now okay. b. HBIG will be required to prevent rejection. c. Elevate the head 30 degrees to improve ventilation when sleeping. d. Monitor closely for infection because of the immunosuppressive medication.

D

33. A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a splenorenal shunt. Because of this procedure, what should the nurse expect the patient to experience? a. An improved survival rate b. Decreased serum ammonia levels c. Improved metabolism of nutrients d. Improved hemodynamic function and renal perfusion

D

36. A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse? a. "If you are interested in a transplant, you really should talk to your doctor about it." b. "Liver transplants are indicated only in young people with irreversible liver disease." c. "Rejection is such a problem in liver transplants that it is seldom attempted in patients with cirrhosis." d. "Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

D

37. Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a. Tetany b. Pseudocyst c. Pleural effusion d. Pancreatic abscess

D

38. When assessing a patient with acute pancreatitis, the nurse would expect to find a. hyperactive bowel sounds. b. hypertension and tachycardia. c. a temperature greater than 102° F (38.9° C). d. severe left upper quadrant (LUQ) or midepigastric pain.

D

52. After a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? a. Return to work in 2 to 3 weeks b. Be hospitalized for 3 to 5 days postoperatively c. Have a T-tube placed in the common bile duct to provide bile drainage d. Have up to 4 small abdominal incisions covered with small dressings

D

6. The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best explanation about the test for the nurse to explain to the patient? a. Shows an ongoing infection with HBV b. Indicates co-infection with HBV and HDV c. Determines any previous infection or immunization to HBV d. Indicates viral replication and effectiveness of therapy for chronic HBV

D

7. Although HAV antigens are not tested in the blood, they stimulate specific IgM and IgG antibodies. Which antibody indicates there is acute HAV infection? a. Anti-HBc IgG b. Anti-HBc IgM c. Anti-HAV IgG d. Anti-HAV IgM

D

7.Priority Decision: A patient hospitalized for 1 week with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy is planned. During discharge planning with the patient, what is it most important for the nurse to do? a. Plan how his needs will be met while he continues on bed rest. b. Encourage the use of diversional activities to relieve boredom and restlessness. c. Teach the patient to avoid crowds and exposure to upper respiratory infections. d. Assess the patient's home environment in terms of family assistance and hospital access.

D

8. A patient with which problem has the highest risk for poor nutritional balance related to decreased ingestion? a. Tuberculosis infection b. Malabsorption syndrome c. Treatment of draining decubitus ulcers d. Severe anorexia resulting from radiation therapy

D

9. What causes the systemic effects of viral hepatitis? a. Toxins produced by the infected liver b. Impaired portal circulation from fibrosis c. Cholestasis from chemical hepatotoxicity d. Complement system activation by antigen-antibody complexes

D

A 22-year-old patient calls the outpatient clinic reporting nausea and vomiting and right lower abdominal pain. What should the nurse advise the patient to do? a. Use a heating pad to relax the muscles at the site of the pain. b. Drink at least 2 quarts of juice to replace the fluid lost in vomiting. c. Take a laxative to empty the bowel before examination at the clinic. d. Have the symptoms evaluated right away by a health care provider (HCP) at a hospital's ED.

D

A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best nursing intervention for this patient? a. Have the patient's sexual partner reassure the patient that he is still desirable. b. Reassure the patient that sexual function will return when healing is complete. c. Remind the patient that affection can be expressed in ways other than through sexual intercourse. d. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

D

A nurse is doing a nursing assessment on a patient with chronic constipation. What data obtained during the interview may be a factor contributing to the constipation? a. Taking methylcellulose (Citrucel) daily b. High dietary fiber with high fluid intake c. History of hemorrhoids and hypertension d. Suppressing the urge to defecate while at work

D

A patient is admitted to the hospital with a suspected acute pericarditis. What is the best method for the nurse to use in assessing for the presence of a pericardial friction rub? a. Timing the sounds with the respiratory pattern b. Place the bell of the stethoscope at the apical area of the heart c. Use the diaphragm of the stethoscope to auscultate for a high-pitched continuous rumbling sound d. Place the stethoscope at the lower left sternal border, patient leaning forward and holding breath

D

A patient with upper GI bleeding and melena is treated with several drugs. Which drug should the nurse recognize as a priority to administer before, during, and potentially after endoscopy? a. Oral nizatidine (Axid) b. Epinephrine injection c. Vasopressin injection d. IV esomeprazole (Nexium)

D

Collaboration: A registered nurse (RN) is working with a licensed practical nurse/licensed vocational nurse (LPN/VN) in caring for a group of patients on a cardiac telemetry unit. Which nursing activity could be delegated to the LPN? a. Explain the reason for planning frequent periods of rest. b. Evaluate the patient's understanding of his disease process. c. Monitor BP, heart rate (HR), respiratory rate (RR), and arterial oxygen saturation by pulse oximetry (SpO2) before, during, and after ambulation. d. Teach the patient which activities to choose that will gradually increase endurance.

D

Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by a. distention of the smaller stomach by too much food and fluid intake. b. hyperglycemia caused by uncontrolled gastric emptying into the small intestine. c. irritation of the stomach lining by reflux of bile salts because the pylorus has been removed.

D

Following a hemorrhoidectomy, what should the nurse advise the patient to do? a. Use daily laxatives to facilitate bowel emptying. b. Use ice packs to the perineum to prevent swelling. c. Avoid having a bowel movement for several days until healing occurs. d. Take warm sitz baths several times a day to promote comfort and cleaning.

D

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

D

Ondansetron (Zofran) is prescribed for a patient with cancer chemotherapy-induced vomiting. What should the nurse understand about this drug? a. It is a derivative of cannabis and has a potential for abuse. b. It has a strong antihistamine effect that provides sedation and induces sleep. c. It is used only when other agents are ineffective because of side effects of anxiety and hallucinations. d. It relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying.

D

Priority Decision: A patient is admitted to the emergency department with ADHF. Which IV medication would the nurse expect to administer first? a. Digoxin (Lanoxin) b. Morphine sulfate c. Nesiritide (Natrecor) d. Furosemide (Lasix)

D

Priority Decision: A patient with esophageal cancer is scheduled for a partial esophagectomy. Which nursing intervention has highest priority preoperatively? a. Practice turning and deep breathing. b. Brush the teeth and mouth well each day. c. Teach about postoperative tubes and care. d. Encourage a high-calorie, high-protein diet.

D

Priority Decision: In instituting a bowel training program for a patient with fecal incontinence, what should the nurse plan to do first? a. Teach the patient to use a perianal pouch. b. Insert a rectal suppository at the same time every morning. c. Place the patient on a bedpan 30 minutes before breakfast. d. Assist the patient to the bathroom at the time of the patient's normal defecation.

D

Priority Decision: When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse take first? a. Irrigate the patient's NG tube. b. Notify the health care provider. c. Place the patient in high-Fowler's position. d. Assess the patient's abdomen and vital signs.

D

Priority Decision: While caring for a patient following a subtotal gastrectomy with a gastroduodenostomy anastomosis, the nurse determines that the NG tube is obstructed. Which action should the nurse take first? a. Replace the tube with a new one. b. Irrigate the tube until return can be aspirated. c. Reposition the tube and then attempt irrigation. d. Notify the surgeon to reposition or replace the tube.

D

The nurse assesses the patient with chronic biventricular HF for paroxysmal nocturnal dyspnea (PND) by questioning the patient regarding a. the presence of restlessness and confusion. b. frequent awakening to void during the night. c. the presence of swelling in dependent body areas. d. waking in a panic with a feeling of suffocation.

D

The nurse evaluates that management of the patient with upper GI bleeding is effective when assessment and laboratory findings reveal which result? a. Hematocrit (Hct) of 35% b. Urinary output of 20 mL/hr c. Urine specific gravity of 1.030 d. Decreasing blood urea nitrogen (BUN)

D

The nurse has completed initial instruction with a patient about a weight loss program. Which patient comment indicates to the nurse that the teaching has been effective? a. "I will keep a diary of daily weight to illustrate my weight loss." b. "I plan to lose 4 lb/week until I have lost the 60 lb I want to lose." c. "I should not exercise more than what is required so I don't increase my appetite." d. "I plan to join a behavior modification group to help establish long-term behavior changes."

D

The nurse monitors the patient receiving treatment for ADHF with the knowledge that marked hypotension is most likely to occur with the IV administration of which medication? a. Milrinone b. Furosemide c. Nitroglycerin d. Nitroprusside

D

The patient comes to the ED with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is obstructed? a. Large intestine b. Esophageal sphincter c. Distal small intestine d. Proximal small intestine

D

The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? a. The pouch can be worn for up to 2 weeks before changing it. b. Decrease the amount of fluid intake to decrease the amount of drainage. c. The pouch can be removed when bowel movements have been regulated. d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch.

D

What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease? a. Celiac disease and gallstones b. Peptic ulcer disease and uveitis c. Conjunctivitis and colonic dilation d. Erythema nodosum and osteoporosis

D

What is a postoperative nursing intervention for the obese patient who has had bariatric surgery? a. Irrigating and repositioning the nasogastric (NG) tube as needed b. Delaying ambulation until the patient has enough strength to support self c. Keeping the patient positioned on the side to facilitate respiratory function d. Providing adequate support to the incision during coughing and deep breathing

D

What is an accurate description of eosinophilic esophagitis? a. Adenocarcinoma or squamous cell tumors of the esophagus b. Dilated veins in the esophagus caused by portal hypertension c. Inflammation of the esophagus from irritants or acidic gastric reflux d. Swelling of the esophagus from an allergic response to food or environmental triggers

D

What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation? a. Stop spillage of GI contents into the peritoneal cavity. b. Remove excess fluids and undigested food from the stomach. c. Feed the patient the nutrients missing from the lack of ingestion. d. Remove stimulation for hydrochloric acid (HCl) acid and pepsin secretion by keeping the stomach empty.

D

What physiologically occurs with vomiting? a. The acid-base imbalance most commonly associated with persistent vomiting is metabolic acidosis caused by loss of bicarbonate. b. Stimulation of the vomiting center by the chemoreceptor trigger zone (CTZ) is commonly caused by stretch and distention of hollow organs. c. Vomiting requires the coordination of activities of structures including the glottis, respiratory expiration, relaxation of the pylorus, and closure of the lower esophageal sphincter (LES). d. Immediately before the act of vomiting, activation of the parasympathetic nervous system causes increased salivation, increased gastric motility, and relaxation of the LES.

D

What should the nurse teach the patient who has endocarditis about preventing recurrence of the infection? a. Start on antibiotic therapy when exposed to persons with infections. b. Take one aspirin a day to prevent vegetative lesions from forming around the valves. c. Always maintain continuous antibiotic therapy to prevent the development of any systemic infection. d. Obtain prophylactic antibiotic therapy before certain invasive medical or dental procedures (e.g., dental cleaning).

D

When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect the patient to have? a. An abdominal dressing b. An abdominal wound and drains c. A temporary colostomy and drains d. A perineal wound, drains, and a stoma

D

When obtaining a health history from a 72-year-old man with peripheral arterial disease (PAD) of the lower extremities, the nurse asks about a history of related conditions, including a. venous thrombosis. b. venous stasis ulcers. c. pulmonary embolism. d. coronary artery disease (CAD).

D

When obtaining a nursing history for a patient with myocarditis, what should the nurse specifically question the patient about? a. Prior use of digoxin for treatment of cardiac problems b. Recent symptoms of a viral illness, such as fever and malaise c. A history of coronary artery disease (CAD) with or without an MI d. A recent streptococcal infection requiring treatment with penicillin

D

When teaching a patient about weight reduction diets, the nurse teaches the patient that what is an appropriate single serving of a food? a. A 6-inch bagel b. 1 cup of chopped vegetables c. A piece of cheese the size of 3 dice d. A chicken breast the size of a deck of cards

D

Which aneurysm is uniform in shape and a circumferential dilation of the artery? a. False aneurysm b. Pseudoaneurysm c. Saccular aneurysm d. Fusiform aneurysm

D

Which cardiac valve disorder causes a sudden onset of cardiovascular collapse? a. Mitral valve stenosis b. Tricuspid valve disease c. Pulmonic valve stenosis d. Acute aortic regurgitation

D

Which medication shows improvement for hypertension and angina in black patients with HFrEF? a. Captopril b. Nitroglycerin c. Spironolactone (Aldactone) d. Isosorbide dinitrate and hydralazine (Bidil)

D

Which statement by a patient after mechanical valve replacement indicates to the nurse that further instruction is needed? a. "I may begin an exercise program to gradually increase my cardiac tolerance." b. "I will always need to have my blood checked once a month for its clotting function." c. "I should take prophylactic antibiotics before I have dental or invasive medical procedures." d. "The biggest risk I have during invasive health procedures is bleeding because of my anticoagulants."

D

Which statement by the patient with chronic HF should cause the nurse to determine that additional discharge teaching is needed? a. "I will call my health clinic if I wake up breathless at night." b. "I will look for sodium content on labels of foods and over-the-counter medicines." c. "I plan to organize my household tasks so I don't have to constantly go up and down the stairs." d. "I should weigh myself every morning and go on a diet if I gain more than 2 or 3 pounds in 2 days."

D

Which statement describes Janewayʼs lesions as manifestations of infective endocarditis? a. Hemorrhagic retinal lesions b. Black longitudinal streaks in nail beds c. Painful red or purple lesions on fingers or toes d. Flat, red, painless spots on the palm of hands and soles of feet

D

The acronym FACES is used to help teach patients to identify early symptoms of HF. What does this acronym mean? a. Frequent activity leads to cough in the elderly and swelling b. Factors of risk: activity, cough, emotional upsets, salt intake c. Follow activity plan, continue exercise, and know signs of problems d. Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath

D. FACES is used to teach patients to identify early HF symptoms. F = Fatigue; A = Activity limitations; C = Chest congestion/cough; E = Edema; S = Shortness of breath. The other options are not correct.

Collaboration: The registered nurse (RN) coordinating the care for a patient who is 2 days postoperative following an abdominal-perineal resection (APR) with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)? a. Irrigate the colostomy. b. Teach ostomy and skin care. c. Assess and document stoma appearance. d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

DE

Which statements accurately describe dilated CMP (select all that apply)? a. Characterized by ventricular stiffness b. The least common type of CMP c. The hyperdynamic systolic function creates a diastolic failure d. Echocardiogram reveals cardiomegaly with thin ventricular walls e. Often follows an infective myocarditis or exposure to toxins or drugs f. Differs from chronic heart failure in that there is no ventricular hypertrophy

DEF

27. Patient-Centered Care: The surgery area calls the transfer report for a 68-year-old, postmenopausal, female patient who smokes and takes hormone therapy. She is returning to the clinical unit after a lengthy hip replacement surgery. Which factors present in this patient increase her risk for developing venous thromboembolism (VTE) related to Virchow's triad (select all that apply)? a. Smoking b. IV therapy c. Dehydration d. Estrogen therapy e. Orthopedic surgery f. Prolonged immobilization

a, b, d, e, f. This patient is a smoker and on hormone therapy, both of which increase blood hypercoagulability. She will have an IV, and her fractured hip can cause VTE by damaging the venous endothelium. She is an older patient who has had an orthopedic surgery and may have experienced prolonged immobility postinjury and through her "lengthy hip replacement surgery," which contributes to venous stasis. These are representative of Virchow's triad in this patient. The other options are also related to Virchow's triad but not present in this patient via the transfer report.

29. Collaboration: The nursing care area is very busy with new surgical patients. Which care could the registered nurse (RN) delegate to the unlicensed assistive personnel (UAP) for a patient with VTE? a. Assess the patient's use of herbs. b. Measure the patient for elastic compression stockings. c. Remind the patient to flex and extend the legs and feet every 2 hours. d. Teach the patient to call emergency response system with signs of pulmonary embolus.

a, b, d, e, f. This patient is a smoker and on hormone therapy, both of which increase blood hypercoagulability. She will have an IV, and her fractured hip can cause VTE by damaging the venous endothelium. She is an older patient who has had an orthopedic surgery and may have experienced prolonged immobility postinjury and through her "lengthy hip replacement surgery," which contributes to venous stasis. These are representative of Virchow's triad in this patient. The other options are also related to Virchow's triad but not present in this patient via the transfer report.

35. The nurse teaches the patient with any venous disorder that the best way to prevent venous stasis and increase venous return is to a. take short walks. b. sit with the legs elevated. c. frequently rotate the ankles. d. always wear elastic compression stockings.

a. During walking, the muscles of the legs continuously knead the veins, promoting movement of venous blood toward the heart. Walking is the best measure to prevent venous stasis and will be increased gradually. Elevating the legs will decrease edema. The other methods will help venous return, but they do not provide the benefit that ambulation does.

23. A patient with a type A dissection of the arch of the aorta has a decreased LOC and weak carotid pulses. What should the nurse anticipate that initial treatment of the patient will include? a. Immediate surgery to replace the torn area with a graft b. Administration of anticoagulants to prevent embolization c. Administration of packed red blood cells (RBCs) to replace blood loss d. Giving antihypertensives to maintain a mean arterial pressure of 70 to 80 mm Hg

a. Immediate surgery is indicated when complications (such as occlusion of the carotid arteries) occur. Otherwise, initial treatment for aortic dissection involves a period of lowering the BP and myocardial contractility to diminish the pulsatile forces in the aorta. Anticoagulants would prolong and intensify the bleeding. Blood is given only if the dissection ruptures.

How does myelodysplastic syndrome (MDS) differ from acute leukemias? a. MDS has a slower disease progression. b. MDS does not result in bone marrow failure. c. MDS is a clonal disorder of hematopoietic cells. d. MDS affects only the production and function of platelets and WBCs.

a. Myelodysplastic syndromes, like leukemias, are a group of disorders in which hematopoietic stem cells of the bone marrow undergo clonal change and may cause eventual bone marrow failure. However, the primary difference from leukemias is that myelodysplastic cells have some degree of maturation, and the disease progression is slower than in acute leukemias.

24. The nurse evaluates that treatment for the patient with an uncomplicated aortic dissection is successful when what happens? a. Pain is relieved. b. Surgical repair is completed. c. BP is increased to normal range. d. Renal output is maintained at 30 mL/hr.

a. Relief of pain is a sign that the dissection has stabilized, and it may be treated conservatively for an extended time with drugs that lower the BP and decrease myocardial contractility. Surgery is usually indicated for Type A aortic dissection or if complications occur.

25. What are characteristics of PAD (select all that apply)? a. Pruritus b. Thickened, brittle nails c. Dull ache in calf or thigh d. Decreased peripheral pulses e. Pallor on elevation of the legs f. Ulcers over bony prominences on toes and feet

b, d, e, f. PAD is manifested as thick, brittle nails; decreased peripheral pulses; pallor when the legs are elevated; ulcers over bony prominences on the toes and feet; and paresthesia. The other options are characteristic of venous disease and paresthesia could occur with venous thromboembolism (VTE).

26. The patient is diagnosed with a superficial vein thrombosis (SVT). Which characteristic should the nurse know about SVT? a. Embolization to lungs may result in death. b. Clot may extend to deeper veins if untreated. c. Vein is tender to pressure and there is edema. d. Typically found in the iliac, inferior, or superior vena cava.

b, d, e, f. PAD is manifested as thick, brittle nails; decreased peripheral pulses; pallor when the legs are elevated; ulcers over bony prominences on the toes and feet; and paresthesia. The other options are characteristic of venous disease and paresthesia could occur with venous thromboembolism (VTE).

33. The patient with VTE is receiving therapy with heparin and asks the nurse whether the drug will dissolve the clot in her leg. What is the best response by the nurse? a. "This drug will break up and dissolve the clot so that circulation in the vein can be restored." b. "The purpose of the heparin is to prevent growth of the clot or formation of new clots where the circulation is slowed." c. "Heparin won't dissolve the clot, but it will inhibit the inflammation around the clot and delay the development of new clots." d. "The heparin will dilate the vein, preventing turbulence of blood flow around the clot that may cause it to break off and travel to the lungs."

b. Anticoagulant therapy with heparin or warfarin (Coumadin) does not dissolve clots but prevents propagation of the clot, development of new thrombi, and embolization. Clot lysis occurs naturally through the body's intrinsic fibrinolytic system or by the administration of thrombolytic agents.

22. During the nursing assessment of the patient with a type B aortic dissection, what should the nurse expect the patient to manifest? a. Altered level of consciousness (LOC) with dizziness and weak carotid pulses b. A cardiac murmur characteristic of aortic valve insufficiency c. Severe "ripping" back or abdominal pain with decreased urine output d. Severe hypertension and orthopnea and dyspnea of pulmonary edema

c. A Type B aortic dissection involves the distal descending aorta and is usually characterized by a sudden, severe, tearing pain in the back. As it progresses down the aorta, the kidneys, abdominal organs, and lower extremities may begin to show evidence of ischemia. Type A aortic dissections of the ascending aorta and aortic arch may affect the heart and circulation to the head, with the development of cerebral ischemia, murmurs, ventricular failure, and pulmonary edema.

What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia? a. The development of infection at these sites b. Increased compensatory production of blood cells by these organs c. Infiltration of the organs by increased numbers of WBCs in the blood d. Normal hypertrophy of the organs in an attempt to destroy abnormal cells

c. Almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, and CNS by excessive WBCs in the blood.

The nurse determines that treatment of HF has been successful when the patient experiences a. weight loss and diuresis. b. warm skin and less fatigue. c. clear lung sounds and decreased HR. d. absence of chest pain and improved level of consciousness (LOC).

c. Successful treatment of HF is indicated by an absence of symptoms of pulmonary edema and hypoxemia, such as clear lung sounds and a normal HR. Weight loss and diuresis, warm skin, less fatigue, and improved level of consciousness (LOC) may occur without resolution of pulmonary symptoms. Chest pain is not a common finding in HF unless coronary artery perfusion is impaired.

Which leukemia is seen in 80% of adults with acute leukemia and exhibits proliferation of precursors of granulocytes? a. Hairy cell leukemia b. Biphenotypic leukemia c. Acute lymphocytic leukemia (ALL) d. Acute myelogenous leukemia (AML)

d. Acute myelogenous leukemia (AML) is seen in 80% of adults with acute leukemia and is characterized by hyperplasia of the bone marrow with uncontrolled proliferation of myeloblasts, the precursors of granulocytes. Hairy cell leukemia is a rare cancer with hairy-looking abnormal lymphocytes. Biphenotypic leukemia is a rare form of both types of acute leukemia. Acute lymphocytic leukemia (ALL), the other acute leukemia, is most common in children and is characterized by small, immature lymphocytes, primarily of B-cell origin, proliferated in the bone marrow.

34. A patient with VTE is to be discharged on long-term warfarin (Coumadin) therapy and is taught about prevention and continuing treatment of VTE. The nurse determines that discharge teaching for the patient has been effective when the patient makes which statement? a. "I should expect that Coumadin will cause my stools to be somewhat black." b. "I should avoid all dark green and leafy vegetables while I am taking Coumadin." c. "Massaging my legs several times a day will help increase my venous circulation." d. "Swimming is a good activity to include in my exercise program to increase my circulation."

d. Exercise programs for patients recovering from VTE should emphasize swimming, which is particularly beneficial because of the gentle, even pressure of the water. Coumadin will not blacken stools. If this occurs, it could be a sign of gastrointestinal bleeding. Dark green and leafy vegetables have high amounts of vitamin K and should not be increased during Coumadin therapy, but they do not need to be restricted. The legs must not be massaged because of the risk for dislodging any clots that may be present.

30. To help prevent embolization of a thrombus in a patient with acute VTE and severe edema and limb pain, what should the nurse teach the patient to do first? a. Dangle on the edge of the bed q2-3hr. b. Ambulate around the bed 3 to 4 times a day. c. Keep the affected leg elevated above the level of the heart. d. Maintain bed rest until edema is relieved and anticoagulation is established.

d. With acute VTE, prevention of emboli formation, decreased edema and pain can be achieved initially by bed rest and limiting movement of the involved extremity. Ambulation will be the next priority. Dangling the legs promotes venous stasis and further clot formation. Elevating the affected limb will promote venous return, but it does not prevent embolization.