Exam 2 PrepUs

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

Severe AS is consistent with all of the following except Pulmonary edema Increased CO Right-sided heart failure Left ventricular hypertrophy

Increased CO

The nurse is using a hydrocolloid dressing for a patient who is undergoing autolytic debridement of a necrotic venous ulcer. What is characteristic of this type of debridement? Accomplished by applying enzymatic ointment to the lesion Left in place for 3 to 7 days The fastest method of debridement Accomplished by applying saline impregnated gauze to the ulcer

Left in place for 3 to 7 days

The nurse is working with a patient who has a hematological disorder. The nurse is aware that, in the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what broad cell types do myeloid stem cells differentiate? Select all that apply.

Leukocytes Platelets Erythrocytes

Which characteristic is consistent with an arterial ulcer? Pink or beefy red appearance with granulation tissue May have severe edema Darkened color tissue in gaiter area Pale and cool extremity

Pale and cool extremity

Which cells have the lifespan of approximately 7.5 days and one-third of their population remains in the spleen (unless needed to fight significant bleeding)?

Platelets Platelets have a life span of approximately 7.5 days. Two-thirds circulate in the blood and contribute to homeostasis. The remaining one-third is stored in the spleen, where they remain unless needed in cases of significant bleeding.

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?

RR interval The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?

Management of patients with cardiomyopathy is directed at preventing and treating heart failure. The treatment of heart failure includes (select all that apply): Reducing circulating blood volume Reducing myocardial oxygen needs Increasing CO by improving contractility or reducing peripheral resistance Increasing preload

Reducing circulating blood volume Reducing myocardial oxygen needs Increasing CO by improving contractility or reducing peripheral resistance

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?

The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells.

A patient has a diagnosis of dilated cardiomyopathy (DCM) and was admitted 24 hours ago for treatment. Which of the following principles should the nurse integrate into the planning of this patient's care?

The patient will benefit from bed rest in the short term, and activity should be introduced slowly.

Which of the following is the most common site for a dissecting aneurysm?

Thoracic area

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD?

To decrease workload of the heart Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?

Chronic diarrhea

A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered a medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient?

Digoxin

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity?

Do not lift more than 10 pounds.

Which diagnostic test is preferred for evaluation of heart function? Electrocardiogram Chest x-ray Echocardiogram Cardiac catheterization

Echocardiogram

A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention?

Eliminate caffeine and alcohol

Which blood test confirms the presence of antibodies to HIV?

Enzyme-linked immunosorbent assay (ELISA)

The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia?

Heart rate of 42 beats per minute (bpm).

A new postsurgical patient has been prescribed unfractionated heparin to prevent DVT. What is a true statement regarding the use of heparin? Heparin has a half-life of approximately 60 minutes. Therapeutic PT level is three times the baseline control Vitamin K interferes with the action of heparin Heparin is administered by gravity drip

Heparin has a half-life of approximately 60 minutes

Which of the following is not a reliable indicator of a possible DVT? Calf tenderness Edema of the extremity Homan sign Increased circumference of affected extremity

Homan sign

The nurse is caring for a patient diagnosed with peripheral arterial disease. Based on assessment, which clinical manifestation would be inconsistent with acute arterial occlusion? Pallor Paresthesia Hyperthermia Poikilothermia

Hyperthermia

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin?

In 3 to 5 days

A patient presents to a clinic on May 1 and tells the nurse practitioner that he had a 1-month sexual relationship with a friend who did not disclose that he was HIV positive. The relationship ended last week. The nurse tells the patient that after infection with HIV, the immune system responds by making antibodies against the virus; therefore the patient should expect this to happen by:

June 5

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the

Lateral position with one leg flexed

Incomplete closure of the mitral valve results in backflow of blood from the

LV to LA

A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.

5

The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of what?

Adrenal gland

The following are symptoms associated with AS Angina, syncope, dyspnea Diastolic murmur, syncope, dyspnea Syncope, diastolic murmur, angina Dyspnea, angina, diastolic murmur

Angina, syncope, dyspnea

The medical plan of treatment for chronic mitral regurgitation would include medications to reduce afterload, such as:

Angiotensin-converting enzyme (ACE) inhibitors. Afterload reduction refers to arterial dilation, which occurs with ACE inhibitors.

The nurse is providing teaching to a client with an implanted cardiac device. Which client statement indicates that teaching has been effective?

"I will not place my cell phone in my chest pocket."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?

"The pain occurred while I was mowing the lawn."

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)

The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis?

reports of constant chest pain