Med surg review 2

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? A. Acute pyelonephritis B. Osmotic dieresis. C. Dysrhythmias D. Renal calculi

D. Renal calculi

Which of the following is a cerebrovascular manifestation of heart failure?

Dizziness

The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart?

Echocardiogram

A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? A. Attach a pulse oximeter probe and obtain values. B. Listen for breath sounds over the epigastrium. C. Observe for mist in the endotracheal tube. D. Call for a chest x-ray.

D. Call for a chest x-ray.

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment? A. "Have you had any episodes of dizziness or fainting?" B. "Have you had any episodes when you are to nauseous?" C. "Have you had any episodes of mottling in your hands?" D. "Have you had any episodes of pain radiating into your lower extremities?"

A. "Have you had any episodes of dizziness or fainting?

Which of the following would be a factor that may decrease myocardial contractility? A. Acidosis B. Alkalosis C. Sympathetic activity D. Administration of digoxin (Lanoxin)

A. Acidosis

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? A. Anemia B. Acidosis C. Hyperkalemia D. Pericarditis

A. Anemia

he nurse is caring for a client with a damaged tricuspid valve. The nurse knows that the tricuspid valve is held in place by which of the following? A. Chordae tendineae B. Atrioventricular tendons C. Semilunar tendineae D. Papillary tendons

A. Chordae tendineae Attached to the mitral and tricuspid valves are cordlike structures known as chordae tendineae, which in turn attach to papillary muscles, two major muscular projections from the ventricles. Options B, C, and D are distractors for the question.

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? A. Donors are selected from compatible living donors. B. Donors must be relatives. C. Donors with hypertension may qualify. D. The client is placed on a transplant list at the local hospital.

A. Donors are selected from compatible living donors.

A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? A. JVD is noted 4 cm above the sternal angle. B. JVD is noted at the level of the sternal angle. C. No JVD is present. D. JVD is noted 2 cm above the sternal angle.

A. JVD is noted 4 cm above the sternal angle.

The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings? A. Obtain an oxygen saturation level. B. Assess the client's capillary refill. C. Assess the client for pitting edema. D. Obtain a 12-lead ECG tracing.

A. Obtain an oxygen saturation level.

Which of the following occurs late in chronic glomerulonephritis? A. Peripheral neuropathy B. Nosebleed C. Stroke D. Seizure

A. Peripheral neuropathy

The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following? A. Pitting edema B. Oliguria S3 ventricular gallop sign CDecreased O2 saturation levels

A. Pitting edema

Which of the following arteries carries deoxygenated blood? A. Pulmonary artery B. Left coronary artery C. Right coronary artery D. Left anterior descending artery

A. Pulmonary artery

The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? A. Pulse pressure B. Auscultatory gap C.Pulse deficit D. Korotkoff sound

A. Pulse pressure The difference between the systolic and the diastolic pressures is called the pulse pressure.

Which of the following would be inconsistent as a lifestyle change directive for the patient diagnosed with heart failure? A. Push fluids B. Restrict dietary sodium C. Avoid excess alcohol D. Abstinence from smoking

A. Push fluids

Which of the following nursing interventions is most appropriate when caring for a client with a nursing diagnosis of risk for injury related to side effects of medication (enoxaparin [Lovenox])? A. Report any incident of bloody urine, stools, or both. B. Administer calcium supplements. C. Assess for hypokalemia. D. Assess for clubbing of the fingers.

A. Report any incident of bloody urine, stools, or both.

The nurse documents pitting edema in the bilateral lower extremities of the client. What does this documentation mean? A. There is excess fluid volume in the interstitial space in areas affected by gravity. B. There is excess fluid volume in the venous system of the lower extremities. C. There is excess fluid volume in the arterial system of the lower extremities. D. There is excess fluid volume in the hepatic system.

A. There is excess fluid volume in the interstitial space in areas affected by gravity.

A client has been diagnosed with acute glomerulonephritis. This condition causes: A. proteinuria. B. pyuria. C. polyuria. D. No option is correct.

A. proteinuria.

The diagnosis of heart failure is usually confirmed by which of the following? A.Echocardiogram B.Chest x-ray Ventriculogram C.Electrocardiogram (12-lead)

A.Echocardiogram

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? A. Administer the medications as ordered. B. Hold the medications until after dialysis. C. Check with the dialysis nurse about the medications. D. Ask if the client wants to take the medications.

B. Hold the medications until after dialysis.

A 58-year-old man has a longstanding diagnosis of poorly controlled type 2 diabetes. As a result of hyperglycemia, the man has developed chronic glomerulonephritis. In light of this new diagnosis, the nurse who is caring for this patient would anticipate that he will exhibit: A. Hypokalemia B. Proteinuria C. Hematuria D. Arrhythmias

B. Proteinuria

Which clinical finding should a nurse look for in a client with chronic renal failure? A. Hypotension B. Uremia C. Metabolic alkalosis D. Polycythemia

B. Uremia

The nurse is assessing a client with heart failure. The breath sounds commonly auscultated in clients with heart failure are? A. tracheal. B. fine crackles. C.coarse crackles. D. friction rubs.

B. fine crackles

following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. which finding most strongly suggest left sided heart failure. A) a drop in central venous pressure B) an increase in cardiac index C) a rise in pulmonary artery diastolic pressure D) a decline in mean pulmonary artery pressure

C) a rise in pulmonary artery diastolic pressure

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? A. "Squamous cell carcinomas do not present with detectable symptoms." B. "You should have sought treatment earlier." C. "Very few symptoms are associated with renal cancer." D. "Painless gross hematuria is the first symptom in renal cancer."

C. "Very few symptoms are associated with renal cancer."

A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range? A. 0.25 mg/mL B. 4.0 mg/mL C. 2.0 mg/mL D. 3.2 mg/mL

C. 2.0 mg/mL

The triage nurse in the ED is assessing a patient with chronic HF who has presented with worsening symptoms. In reviewing the patient's medical history, what is a potential primary cause of the patient's heart failure? A) Endocarditis B) Pleural effusion C) Atherosclerosis D) Atrial-septal defect

C. Atherosclerosis Feedback: Atherosclerosis of the coronary arteries is the primary cause of HF. Pleural effusion, endocarditis, and an atrial-septal defect are not health problems that contribute to the etiology of HF.

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? A. Count the radial pulse for 20 to 25 seconds. B. Calculate the palpated volume. C. Count the heart rate at the apex. D. Calculate the pauses between pulsations.

C. Count the heart rate at the apex.

On assessment, the nurse knows that a patient who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity would have heart failure classified as Stage: A. I B. II C. III D. IV

C. III

A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? A. Cystic fibrosis B. Pulmonary embolus C. Myocardial ischemia D. Ineffective right ventricular contraction

C. Myocardial ischemia

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from? A. The AV node B. The Purkinje fibers C. The sinoatrial node D. The ventricles

C. The sinoatrial node

The nurse is caring for a patient admitted with unstable angina. The laboratory results reveal that the initial troponin I level is elevated in this patient. What conclusion should the nurse draw from this fact? A. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B. Because the entry diagnosis is unstable angina, this is a poor indicator of myocardial injury. C. This is an accurate indicator of myocardial injury. D. It is only an accurate indicator of skeletal muscle injury.

C. This is an accurate indicator of myocardial injury.

Which is a classic sign of cardiogenic shock? A. High blood pressure B. Hyperactive bowel sounds C.Tissue hypoperfusion D. Increased urinary output

C.Tissue hypoperfusion

A client has had an echocardiogram to measure ejection fracton. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? A. 50% B. 40% C. 45% D. 55%

D. 55%

Diastole

Is the period in which the atria and ventricles are in a relaxed state, allowing the ventricles to fill with blood.

afterload

Is the resistance to ejection of blood from the ventricle, arteriole vasoconstriction, increased afterload or resistance = decreased stroke volume?

Which of the following is a characteristic of right-sided heart failure

JVD

A new client has been admitted with right-sided heart failure. The nurse knows to look for which of the following assessment findings when assessing this client?

Jugular venous distention

Contractility

Refers to the force generated by the contracting myocardium under any given condition. Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications (Diogoxin, IV dopamine etc)

Systole

Refers to the period of myocardial contraction.

The nurse is discussing cardiac hemodynamics with a nursing student, who understands the following formula: CO = HR X SV (cardiac output equals heart rate times stroke volume). The student asks what determines stroke volume. The correct response by the nurse is which of the following?

Stroke volume depends on three factors: preload, afterload, and contractility.

A client with heart failure must be monitored closely after starting diuretic therapy. The best indicator for the nurse to monitor is: a) urine specific gravity. b) weight. c) vital signs. d) fluid intake and output.

b) weight.

Left sided failure

fluid/blood accumulates in the pulmonary vascular bed; as hydrostatic pressure increase, fluid transudates across into tissue and alveoli, resulting in dyspnea, orthopnea, pulmonary edema

preload

is the degree of stretch of the cardiac muscle fibers at the end of diastole, highest at end of diastole highest at end of diastole when ventricles are filling, with increased preload = increased stroke volume?

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure?

right-sided heart failure

Right sided failure

uid/blood accumulates in systemic venous system leading to peripheral edema, congestive hepatospleenomegaly, venous distension