Exam #2
A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. A. Reduces myocardial oxygen consumption B. Decreases the urge to use tobacco C. Dilates blood vessels D. Decreases ischemia E. Relieves pain
A. Reduces myocardial oxygen consumption C. Dilates blood vessels D. Decreases ischemia E. Relieves pain
The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient? a) Peritoneal dialysis b) Hemodialysis c) Continuous a
b) Hemodialysis
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Kayexalate c) IV dextrose 50%d) Sorbitol
b) Kayexalate
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Serum potassium level of 3.5 mEq/L b) Blood pH of 7.25 c) Loss of 2.2 lb (1 kg) in 24 hours d) Serum sodium level of 135 mEq/L
c) Loss of 2.2 lb (1 kg) in 24 hours
The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? a) The patient will have enemas until the urine is clear. b) The patient is restricted from eating or drinking from midnight until after the test. c) The patient may have liquids before the test. d) A liquid restriction for 8 to 10 hours before the test is required
c) The patient may have liquids before the test.
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Elevated urobilinogen in the urine b) Straw-colored urine c)Reduced hematocrit d) Clay-colored stools
d) Clay-colored stools
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? a) WBC (white blood cell) count b) Troponin I c) C-reactive protein d) Myoglobin
d) Myoglobin
34. A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? a) Epinephrine b) Vasopressin c) Vitamin K d) Octreotide
d) Octreotide
A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client? a) Spironolactone (Aldactone) b) Propranolol (Inderal) c) Lactulose (Cephulac) d) Vasopressin (Pitressin)
d) Vasopressin (Pitressin)
A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?
decrease the heart rate
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for?
diarrheal stools
The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs? enalapril dopamine furosemide metoprolol
dopamine
In patient with chronic pancreatitis stools become frequent, frothy, and foul smelling because of impaired fat digestion, which results in stools with a high content referred to as steatorrhea.
fat
A patient who is receiving radiation therapy for breast cancer is most likely to experience which side effect? A. Fatigue B. Mucositis C. Hair loss D. Nausea and vomiting
fatigue
What type of cancer is the most common type of secondary malignancy in patients with Hodgkin's disease?
lung
A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to taking blood pressure."
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?
"You don't need to do any fasting before this noninvasive test."
A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: 1. Hematuria 2. Weight loss 3. Increased urine output 4. Increased blood pressure
2. Weight loss
The nurse reviews a patient's medical record and suspects heparin-induced thrombocytopenia (HIT). Which finding supports the nurse's conclusion? 1 Patient has a viral infection 2 Patient has hemolytic anemia. 3 Patient has a platelet count of 100,000/µL. 4 Patient has systemic lupus erythematosus.
3 Patient has a platelet count of 100,000/µL.
A client with chronic renal failure (CRF) has developed a faulty red blood cell production. The nurse should monitor this client for: 1) nausea and vomiting 2) dyspnea and cyanosis 3) fatigue and weakness 4) thrush and circumoral pallor
3) fatigue and weakness
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? a) Blood pressure b) Temperature c) Respirations d) Pulse
D) Pulse
One of the unique manifestations of sickle cell disease is ________________________, a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs.
acute chest syndrome
What pathophysiological concept related to sickle cell disease predisposes a client with sickle cell disease to pneumonia? Damage to the spleen increases the risk for infection. Damage to the lymphatic system increases the risk for infection. Sequestration of sickled cells lead to infection in the area of sequestration. Sequestration of sickled cells lead to infection in the area distal to the sequestration.
Damage to the spleen increases the risk for infection
The nursing instructor is teaching nursing students about myocardial contractility and ejection fractions. What diagnostic tests can determine client ejection fractions? Select all that apply. A) Echocardiogram B) Cardiac catheterization C) Magnetic resonance imaging D) Positron emission tomography scan E) Troponin levels
A) Echocardiogram B) Cardiac catheterization C) Magnetic resonance imaging
Which of the following are possible complications following a Percutaneous Transluminal Coronary Angioplasty (PTCA)? Select all that apply: A) Hematoma formation B) Acute Renal Failure C) Hypothermia D) Cardiac Tamponade E) Bradycardia
A) Hematoma formation B) Acute Renal Failure D) Cardiac Tamponade
6. A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem? A) Severe pancreatitis with possible peritonitis B) Acute cholecystitis C) Chronic pancreatitis D) Acute appendicitis with possible per
A) Severe pancreatitis with possible peritonitis
A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? A. Elevated urine amylase levels B. Increased serum calcium levels C. Decreased liver enzyme levels D. Decreased white blood cell count
A. Elevated urine amylase levels
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? Notify the physician Administer aspirin (ASA) 325 mg po, as ordered Administer acetaminophen 500 mg po, as ordered Reposition the client to a high Fowler position and continue to monitor the pain
Administer acetaminophen 500 mg po, as ordered
The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation?
Allopurinol
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?Check the client's history.Assess the client's pulse and blood pressure.Assess the client's hemoglobin and platelets.Assess the client's skin.
Assess the client's hemoglobin and platelets.
A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to A) Continue with the present infusion rate of heparin. B) Consult with the physician about discontinuing heparin. C) Begin treatment with the prescribed warfarin (Coumadin). D) Increase the heparin infusion by 100 units per hour.
B) Consult with the physician about discontinuing heparin.
8. The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what? A) Development of an atrial-septal defect B) Myocardial ischemia C) Formation of a pulmonary embolism D) Release of potassium ions from cardiac cells
B) Myocardial ischemia
A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal?
B-type natriuretic peptide (BNP)
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
24. A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client? A) Vaso-occlusive crisis B) Pneumocystis pneumonia C) Acute chest syndrome D) Acute muscular strain
C) Acute chest syndrome
21. A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan? A) Bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis. B) Reduced activity protects the physical integrity of pancreatic cells. C) Bed rest lowers the metabolic rate and reduces enzyme production. D) Inactivity reduces caloric need and gastrointestinal motility.
C) Bed rest lowers the metabolic rate and reduces enzyme production.
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows:pH 7.30PaO2 97PaCO2 37HCO3 18The nurse would expect which of the following sets of assessment findings? Headache, blood pressure 90/54, dry skin Blood pressure 188/120, nausea, vomiting Confusion, respiratory rate 8 breaths/min, dry skin Clammy skin, blood pressure 86/46, headache
Clammy skin, blood pressure 86/46, headache
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Elevated urobilinogen in the urine b) Straw-colored urine c) Reduced hematocrit d) Clay-colored stools
Clay-colored stools
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Induction therapy Supportive therapy Antimicrobial therapy Standard therapy
Induction therapy
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? Fourth heart sound (S4) Orthostatic hypotension Increased PR interval Irregularly irregular heart rate
Irregularly irregular heart rate
A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam?
It visualizes the gallbladder and bile duct
A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order?
KUB
A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor
LOC
A nurse in the emergency department is caring for a client with acute heart failure. Which laboratory value is most important for the nurse to check before administering medications to treat heart failure? White blood cell (WBC) count Potassium Platelet count Calcium
Potassium
After undergoing a liver biopsy, a client should be placed in which position?
Right lateral decubitus position
The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator? Serum calcium Serum bilirubin Serum amylase Serum lipase
Serum lipase
The client asks the nurse why a stress test is needed. What statement best explains the rationale for the health care provider to order a cardiac stress test?
The health care provider wants to identify if the heart failure is from coronary artery disease.
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?
Vitamin B12 Deficiency
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35%
White blood cell (WBC) count of 20,000/mm3
A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply.
Withhold oral feedings to limit the release of secretin. Encourage bed rest to decrease the client's metabolic rate. Teach client about correlation between alcohol intake and pain.
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Loss of 2.2 lb (1 kg) in 24 hours b) Serum sodium level of 135 mEq/L c) Serum potassium level of 3.5 mEq/L d) Blood pH of 7.25
a) Loss of 2.2 lb (1 kg) in 24 hours
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: an overdistended bladder. renal calculi. acute prostatitis. interstitial cystitis.
renal calculi.
The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include?
suction equipment
Before a transesophageal echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes no active gag reflex. What nursing action is a priority?
withhold food and fluids.
A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment?
iron overload
What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? A. Therapeutic paracentesis B. Platelet infusions C. Diuretic therapy D. Albumin infusion
D. Albumin infusion
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's vital signs are: Temperature 99.8 F (37.7 C); BP 104/68; pulse 76. The nurse detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry and swollen. What is the most appropriate action for the nurse to take? A. Encourage the client to perform isometric leg exercise to improve circulation in the legs. B. Document findings and check the client again in 1 hour. C. Slow the IV fluid rate to prevent any more swelling at the puncture site. D. Contact the health care provider and report the findings.
D. Contact the health care provider and report the findings.
A nurse is assessing an older adult client with gallstones. The nurse is aware that the client may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly client may include what examples? A. Fever and pain B. Chills and jaundice C. Nausea and vomiting D. Signs and symptoms of septic shock
D. Signs and symptoms of septic shock
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? Diminished erythropoietin production Azotemia Impaired immunologic response Electrolyte imbalances
Diminished erythropoietin production
The nurse is admitting a patient to the cardiac care unit with complaints of dyspnea on exertion and fatigue. The patient's electrocardiogram (ECG) shows dysrhythmias associated with left ventricular hypertrophy. What diagnostic tool would be the most helpful in diagnosing cardiomyopathy?
Echocardiogram
A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?
Folic acid deficiency
The nurse is preparing to administer hydralazine and isosorbide dinitrate. When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse? Hold the medication and call the health care provider. Administer the medication and check the blood pressure in 30 minutes. Administer a saline bolus of 250 mL and then administer the medication. Administer the hydralazine and hold the dinitrate.
Hold the medication and call the health care provider.
A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? a) Oral b) Subcutaneous (subQ) c) I.M. d) I.V.
I.M.
A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?
IV administration of octreotide (Sandostatin)
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: a. renal calculi. b. an overdistended bladder. c. interstitial cystitis. d. acute prostatitis.
a. renal calculi.
The nurse is teaching a client about the functionality of heart muscle. What factor may decrease a client's myocardial contractility? acidosis alkalosis sympathetic activity administration of digoxin
acidosis
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. If the physician's
albumin
A nurse is caring for a client with acute pancreatitis. His physical examination reveals that he has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, his lab results indicate that he is hypovolemic. Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity?
albumin
A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the xlient has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis?
aplastic anemia
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. A. With ACE inhibitors, assess for bradycardia. b. Beta-blockers may cause sedation. c. Direct vasodilators may cause headache and tachycardia. d. Cough is a common side effect of adrenergic inhibitors. e. With thiazide diuretics, monitor serum potassium concentration.
c. Direct vasodilators may cause headache and tachycardia. e. With thiazide diuretics, monitor serum potassium concentration.
A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for: paresthesia. dehydration. pruritus. cardiac arrhythmia.
cardiac arrhythmia.
______ is the end product of muscle metabolism. It is a better indicator of renal function than BUN because it does not vary with protein intake and metabolic state.
creatinine
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? a) Blood pressure b) Temperature c) Respirations d) Pulse
d) Pulse
After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from:
perforation of the colon caused by the liver biopsy.
A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:
phytonadione (Mephyton).
The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates?
preload is reduced
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? A. Variant B. Intractable C. Refractory D. Unstable
D. Unstable
A client undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client?
Palpate the pulses in the legs and feet.
What is a major concern for the nurse when caring for a patient with chronic pancreatitis? a) Mental status changes b) Weight loss c) Nausead ) Pain
b) Weight loss
Which of the following medications or drug classes is most commonly used as an intervention for patients with heart failure? a. Non-dihydropyridine Calcium channel Blockers b. ACE inhibitors c. Tricyclic Antidepressants (TCAs) d. Dihydropyridine Calcium channel blockers e. Anticholinergics f. Glucocorticoids
b. ACE inhibitors
A nurse is preparing a client for cardiac catheterization. The nurse knows that which nursing intervention must be provided when the client returns to the room after the procedure? a. Withhold analgesics for at least 6 hours after the procedure. b. Assess the puncture site frequently for hematoma formation or bleeding. c. Inform the client that he or she may experience numbness or pain in the leg. d. Restrict fluids for 6 hours after the procedure.
b. Assess the puncture site frequently for hematoma formation or bleedi
