NUR 311 Exam 3 Jeopardy/Powerpoint Questions

Your patient just came back from cath lab after an angioplasty. The left groin was used. How you are going to care for the patient? What are your priorities? What concept?

- Keep the patient supine. Watch for any signs of bleeding. Monitor pulses and peripheral perfusion in case of any clots forming. Make sure the patient is not up and moving. - The priorities are watching for bleeding from the groin site, then monitoring for any perfusion problems.

The home care nurse visits a patient with chronic heart failure who is taking digoxin and furosemide. The patient complains of nausea and vomiting. Which action is most appropriate for the nurse to take? a.Perform a dipstick urine test for protein. b.Notify the health care provider immediately. c.Have the patient eat foods high in potassium. d.Ask the patient to record a weight every morning.

Answer: b Rationale: Administration of furosemide increases excretion of potassium and may cause hypokalemia. The risk for digitalis toxicity increases if potassium levels are below normal and digoxin is administered. Signs and symptoms of digitalis toxicity include anorexia, nausea and vomiting, visual disturbances (such as "yellow" vision), and dysrhythmias.

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide, spironolactone , and enalapril. Which assessment should the nurse complete to best evaluate the patient's response to these drugs? a.Observe skin turgor b.Auscultate lung sounds c.Measure blood pressure d.Review intake and output

Answer: b Rationale: Left-sided heart failure will prevent normal blood flow and will cause blood to back up into the left atrium and into the pulmonary veins. The increased pulmonary pressure causes fluid extravasation from the pulmonary capillary bed into the interstitium and then the alveoli, which manifests as pulmonary congestion and edema. The most important assessment to determine if the drugs are improving the patient's condition is to auscultate lung sounds. The other assessments are important, but the best indicator of improvement of left ventricular function is a reduction in adventitious lung sounds (crackles).

Your patient has Chest pain at rest. What are you going to do? What is the difference between angina and acute coronary syndrome?

Assess the quality and details about the pain. Give nitrates (3 times in 5-minute intervals). Obtain 12-lead EKG. Give morphine. Angina is chest pain or pressure that occurs when the heart muscle doesn't get enough blood. ACS is a term for a group of conditions that suddenly stop or severely reduce blood from flowing to the heart muscle. When blood cannot flow to the heart muscle, the heart muscle can become damaged. Heart attack and unstable angina are both acute coronary syndromes

You are giving furosemide IVP. What do you need to know before you give? How do you give and then what do you monitor for after? What does the nurse need to know about Digoxin safety? What are the signs of toxicity?

Careful monitoring of the patient's, daily weight, fluids intake, urine output, electrolytes, i.e., potassium and magnesium, kidney function monitoring with serum creatinine and serum blood urea nitrogen. Give the intravenous dose slowly (over 1 minute to 2 minutes). You want to monitor for ototoxicity during and after administration. Digoxin has a very narrow therapeutic index and you need to monitor for signs of too low serum content or toxicity. Signs of toxicity include a low HR, nausea, and seeing yellow halos around lights.

The patient is being discharged home with furosemide. When providing discharge teaching, which instruction will the nurse include? A.Avoid prolonged exposure to the sun. B.Avoid foods high in potassium content. C.Stop taking the medication if you feel dizzy. Weigh yourself once a week and report a gain or loss of more than 1 lb.

Correct answer: A Rationale: Patients taking furosemide (Lasix) should avoid prolonged exposure to the sun because the drug can cause photosensitivity. Although orthostatic hypotension is a possible adverse effect of the medication, patients should not stop taking the medication without consultation with their health care provider. Patients should weigh themselves once a day and report a weight gain or loss of approximately 3 lb. Patients taking furosemide (Lasix) should be encouraged to eat foods rich in potassium.

When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? A.lithium B.acetaminophen C.penicillin D.theophylline

Correct answer: A Rationale: Use of loop diuretics with lithium can increase the risk of lithium toxicity. Drug interactions with loop diuretic therapy can occur with concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs), and vancomycin can cause increased neuro- and ototoxicity when used with loop diuretics. There is no associated risk of drug interaction when taking acetaminophen, penicillin, or theophylline with loop diuretics.

Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide? A.Hypocalcemia B.Hypophosphatemia C.Hypokalemia Hypomagnesemia

Correct answer: C Rationale: Of all of the adverse effects of furosemide (Lasix) administration, hypokalemia is of serious clinical importance. To prevent hypokalemia, patients often receive potassium supplements along with furosemide. The other electrolyte disturbances listed do not occur as a result of furosemide (Lasix) therapy.

A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? A. Apical heart rate of 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL

Correct answer: C Rationale: The hypokalemia may precipitate digoxin toxicity; therefore, it is the biggest concern. The apical pulse is slightly under 60 beats/min, but bradycardia may occur with digoxin therapy, and the heart rate should be monitored. The ankle edema may be a manifestation of his HF and not a new concern. The digoxin level is within the normal range.

After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. For how many seconds should the heart rate be counted? A. 10 seconds B. 15 seconds C. 30 seconds D. 60 seconds

Correct answer: D Rationale: After cardiac catheterization, the heart rate should be counted for a full minute to detect evidence of dysrhythmias or bradycardia. The other options are insufficient lengths of time to detect a dysrhythmia after a cardiac catheterization.

Which patient is the best candidate to receive nesiritide therapy? A.A patient with atrial fibrillation who has not responded to other drugs B.A patient needing initial treatment for HF C.A patient with reduced cardiac output D.A patient with acutely decompensated HF who has dyspnea at rest

Correct answer: D Rationale: At this time, nesiritide is generally used in the intensive care setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. The manufacturer recommends that nesiritide not be used as a first-line drug for this purpose. In 2005, an expert panel reviewed nesiritide at the request of the U.S. Food and Drug Administration in response to reports of worsened renal function and mortality. The expert panel stated that the use of nesiritide should be strictly limited to treatment of patients with acutely decompensated HF who have dyspnea at rest. It should not be used to replace diuretics and should not be used repetitively or to improve renal function.

Your patient has heart failure. Explain the difference between Right and left. What care is needed regardless of the type of heart failure. What drugs might you give? What teaching is needed?

Right Side: Blood backs up into the body and can't get to the lungs. Symptoms are all in the body (edema, ascites, fluid build up, etec...) Left Side: Blood backs up into the lungs. Symptoms are in the lungs (crackles, wet cough, SOB, pallor, etec...) Regardless of the type, daily weights will be important, adherence to medications, managing stress, getting exercise, low sodium diet. Diuretics: Loop (furosemide) & K+ sparing (spironolactone). Digoxin. NO NSAIDS (it will increase fluid retention). Calcium Channel Blockers. With Diuretics, depending on K+ activity, monitor for signs of hyper/hypokalemia. For loop diuretics monitor potassium, BP, and kidney function. Know the signs of digoxin toxicity (low HR, nausea/vomiting, seeing yellow halos around lights.

What are all of the congenital heart defects and what care is needed for each? What is a TET spell? What would you do?

Tetralogy of Fallot: Ventricular septal defect (A hole in the wall between the two lower chambers of the heart). Pulmonary stenosis (A narrowing of the pulmonary valve and main pulmonary artery). Enlarged aortic valve (The aortic valve opens to the aorta and seems to open from both ventricles). Right ventricular hypertrophy (A hypertrophy of the right ventricle). Care of TET spells, surgery is the only cure. Atrial Septal Defect: When there is a hole or opening in the septum between the atria. There are usually no signs or symptoms. It will normally close on its own. A TET spell is an exacerbation of Tetralogy of Fallot. The patient can turn blue, hypoxic, and very irritable. You would first put the patient into a knees to chest position, give O2, then give morphine to decrease the O2 demand

Your patient has PAD. How will they look? What care is needed? What is the priority teaching? What medications would be used?

There are 4 different stages and the patient will present differently in each. 1. asymptomatic (no s/s of PAD) 2. claudication (cramps/pain with movement, reproducible) 3. rest pain 4. Necrosis/gangrene/death Priority teaching is smoking cessation, exercise therapy (30-45 min at least 3 times a week), dependent positioning, no ice/heat therapy due to risk of injury, skin/feet checks, diet changes (low sodium &/or cholesterol). Statins to decrease cholesterol. Antihypertensives (ACE inhibitors, CCBs, beta blockers), blood thinners (aspirin, clopidogrel), phosphodieasterase inhibitors (silastozole, pentoxifylin) for claudication.

•A nurse is providing education to a patient taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol over other beta2 agonists such as albuterol? A.Longer duration of action B.Extended time of action C.Quicker peak action D.Shorter onset of action

•A •Salmeterol has a longer duration of action, requiring the patient to use it only twice a day instead of three or four times a day with albuterol.

•The parents of a child who is newly diagnosed with cystic fibrosis ask what is happening within the body that causing effects in multiple organ systems. Which response by the nurse is most accurate? A.Mechanical obstruction is caused by increased viscosity of mucous gland secretions. B.Atrophic changes occurs in the mucosal wall of intestines and alveoli. C.There is decreased activity of the autonomic nervous system. The hyperactivity of sweat glands causes major fluid loss

•A Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas. Thick mucous secretions are the probable cause of the multi-system involvement. There is an identified autonomic nervous system anomaly, but it is not decreased. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement

•The parent of a child with cystic fibrosis calls the clinic nurse and describes signs and symptoms of tachypnea, tachycardia, dyspnea, pallor, and cyanosis. What does the nurse suspect the child is experiencing? A.A pneumothorax B.Bronchodilation C.Carbon dioxide retention D.Extremely thick sputum

•A The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the symptoms listed. Carbon dioxide retention would not produce the symptoms listed. An increased viscosity of sputum is characteristic of cystic fibrosis. The described change in respiratory status is potentially due to a pneumothorax

•A client has just undergone arterial revascularization. Which statement by the client indicates a need for further teaching related to postoperative care? A."My leg might turn very white after the surgery." B."I must be concerned if my foot turns blue." C."I must report a fever or any drainage." D."Warmness, redness, and swelling are expected."

•A •A need for further postoperative teaching about arterial revascularization is needed when the client says that "my leg might turn very white after the surgery." Pallor is one of the signs of decreased perfusion along with increased pain, poikilothermia, paresthesia, pulselessness, and paralysis. The foot turning blue is a sign of poor perfusion. Fever or drainage would indicate an infection. Warmness, redness, and swelling indicate reperfusion, which is a good sign.

•The nurse is caring for a patient with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention? A.Defibrillation B.Cardiopulmonary resuscitation (CPR) C.Administration of epinephrine D.Administration of oxygen

•A •Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over. In asystole, there is no rhythm to interrupt. Therefore, this intervention is not used. If drug therapy fails to restore effective rhythm, CPR is initiated. Epinephrine is used to increase heart rate in asystole. Hypoxia may be a cause of cardiac arrest, so the administration of oxygen would be appropriate.

•The nurse discusses the importance of restricting sodium in the diet for a client with heart failure. Which statement made by the client indicates that the client needs further teaching A."I need to avoid eating hamburgers." B."I must cut out bacon and canned foods." C."I won't put the salt shaker on the table anymore." D."I need to avoid lunchmeats but may cook my own turkey."

•A •Further teaching about restricting sodium in the diet for a client with heart failure is needed when the client says, "I need to avoid eating hamburgers." Cutting out beef or hamburgers made at home is not necessary, but fast-food hamburgers are to be avoided owing to higher sodium content. Bacon, canned foods, lunchmeats, and processed foods are high in sodium, which promotes fluid retention, and must be avoided. The client correctly understands that adding salt to food must be avoided.

•Which statement by the nurse would be included when teaching a client about the proper use of metered-dose inhalers? A."Wait 1 to 2 minutes before you take a second puff of the same drug." B."Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler." C."After you inhale the medication once, repeat until you obtain relief." D."Make sure that you puff out air several times after you inhale the medication."

•A •If a second puff of the same drug is ordered, instruct the patient to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the patient to wait 2 to 5 minutes between the medications or to take as prescribed.

•An infant with a congenital heart defect is receiving palivizumab. Teaching by the nurse is correct if what information is discussed with the parents? A.This medication should prevent respiratory syncytial virus (RSV) infection. B.Synagis is known to prevent secondary bacterial infection. C.This drug minimizes the side effects of antiviral agents. D.This medication makes isolation of the infant with RSV unnecessary.

•A •Palivizumab is a monoclonal antibody specific for RSV. Monthly administration is initiated to prevent infection with RSV. The antibody is specific to RSV but not bacterial infection. Synagis does not decrease the side effects of antiviral agents. This drug will not affect the need to isolate the infant if RSV develops.

•A 4-year-old child needing to use a metered-dose inhaler to treat asthma cannot coordinate her breathing to use it effectively. The appropriate intervention by the nurse is to use which piece of respiratory equipment? A.A spacer B.A nebulizer C.A peak expiratory flowmeter D.An incentive spirometer

•A •The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. This is a measure of pulmonary function not related to medication administration. This item helps patients to increase their lung expansion and to be able to see their progress.

•The nurse is caring for a client who has had a lobectomy and placement of a chest tube 8 hours ago. When performing an initial assessment, which of these requires immediate follow up? A.200 mL red drainage from chest tube over 2 hours B.Client sleepy but able to be aroused C.3 cm area of red drainage on the incisional dressing D.Report of pain at the chest tube insertion site

•A •The nurse must immediately report 200 mL of red drainage over a 2 hour span of time. Chest drainage should slow down after surgery. More than 70 mL of drainage/hour must be reported to the surgeon. A client who had a surgical procedure, anesthesia, and analgesia may spend most of the day sleeping, but should be able to be aroused. A small amount of drainage after surgery is expected, such as a 3 cm area. The nurse should circle the area and report increasing amounts to the surgeon. Pain at the surgical and chest tube insertion site is expected and will be managed by the nurse in collaboration with the provider after airway, breathing, and circulation are ensured.

•The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer? A.Heparin B.Atropine C.Dobutamine D.Magnesium sulfate

•A •The nurse plans to administer heparin in addition to the antidysrhythmic. AF is the loss of coordinated atrial contractions that can lead to pooling of blood, resulting in thrombus formation. The patient is at high risk for pulmonary and systemic embolism. Heparin and other anticoagulants (e.g., enoxaparin [Lovenox], warfarin [Coumadin], and novel oral anticoagualants, when nonvalvular, such as dabigatran [Pradaxa], rivaroxaban [Xarelto], apixaban [Eliquis], or edoxaban [Savaysa]) are used to prevent thrombus development in the atrium, leading to the risk of embolization (i.e., stroke).Atropine is used to treat bradycardia and not rapid heart rate associated with AF. Dobutamine is an inotropic agent used to improve cardiac output; it may cause tachycardia, thereby worsening atrial fibrillation. Although electrolyte levels are monitored in clients with dysrhythmia, magnesium sulfate is not used unless depletion is noted.

•A client with COPD calls the pulmonary clinic reporting the last 24 hours the peak flow meter readings have been in the yellow range. Which of these interventions by the nurse is appropriate at this time? A.Use your prescription for rescue medication and retest yourself. B.This is a satisfactory reading, continue your present regimen. C.Go to the nearest emergency department. D.Increase your controller medication dose.

•A •The nurse would tell the client to use the rescue medication and then retest. This instruction by the nurse is appropriate. Reliever drugs (also called "rescue" drugs) are used to stop an attack once it has started or when the peak flow meter is in the yellow range or 50%-80% of personal best range. The reading is not satisfactory. Frequent readings in the yellow zone indicate the need to reassess the asthma plan and the need to possibly change controller drugs. Satisfactory readings are in the green zone and are at least 80% of or better than the personal best readings. The client needs to seek care in the ED when the readings are in the red zone or below 50% of the personal best reading. Nurses do not prescribe medications or change dosing.

•A client with chronic obstructive pulmonary disease (COPD) has a prescription to adjust oxygen to maintain SpO2 between 90% and 92%. Which action can be delegated to an unlicensed assistive personnel (UAP) under the supervision of an RN? A.Adjust the position of the oxygen tubing. B.Assess for signs and symptoms of hypoventilation. C.Change the O2 flow rate to keep SpO2 as prescribed. D.Select the O2 delivery device used for the client.

•A •The scope of a UAPs role includes positioning of oxygen tubing for client comfort. Assessing for signs and symptoms of hypoventilation, choosing which O2 delivery device to use, and changing the O2 flow rate are actions that are skills that should be performed by skilled personnel and are beyond the scope of practice for a UAP.

•The nurse is providing education for a client who is taking isoniazid, rifampin, and ethambutol for tuberculosis. Which of these points does the nurse include in the plan of care? Select all that apply. A.Take a supplement containing B vitamins. B.Avoid alcohol containing beverages. C.Have kidney function tests monthly. D.Report changes in vision to the health care provider. Notify the health care provider for red-orange urine

•ABD Teach the client to take a daily multiple vitamin that contains the B-complex vitamins while on this drug as deficiency may occur. These medications can cause liver damage, which is potentiated by alcohol. Ethambutol can cause optic neuritis, leading to blindness at high doses. When discovered early and the drug is stopped, problems can usually be reversed. Contact lenses will also be stained and oral contraceptives will be less effective.Rifampin will cause the urine and all other secretions to have a yellowish-orange color; this is harmless and expected. Both isoniazid and pyrazinamide may cause liver failure. Side effects of major concern include jaundice, bleeding, and abdominal pain

•Which are risk factors that are known to contribute to atherosclerosis-related diseases? Select all that apply. A.Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL (4.14 mmol/L) B.Smoking C.Aspirin (acetylsalicylic acid [ASA]) consumption D.Type 2 diabetes E.Vegetarian diet

•ABD •Risk factors that contribute to atherosclerosis-related diseases include LDL-C of 160 mg/dL (4.14 mmol/L), smoking, and type 2 diabetes. Having an LDL-C value of less than 100 mg/dL (2.59 mmol/L) is optimal. 100 to 129 mg/dL (2.59 to 3.34 mmol/L) is near or less than optimal. LDL-C 130 to 159 mg/dL (3.37 to 4.12 mmol/L) is borderline high. The client with a LDL-C of 160 mg/dL (4.14 mmol/L) is advised to modify diet and exercise. Smoking is a modifiable risk factor and needs to be avoided or terminated. Diabetes is a risk factor for atherosclerotic disease. ASA is used as prophylaxis for atherosclerotic disease/coronary artery disease to prevent platelet adhesion. A diet high in whole grains, fruits, and vegetables is desirable to prevent atherosclerosis. Vegetarians usually consume fruits, vegetables, and nonanimal sources of protein.

•The nurse is caring for a patient who has developed a bradycardia. Which possible causes does the nurse investigate? Select all that apply A.Bearing down for a bowel movement B.Patient stating that he just had a cup of coffee C.Patient becoming emotional when visitors arrived D.Diltiazem (Cardizem) administered 1 hour ago

•AD •Valsalva maneuvers such as bearing down for a bowel movement or gagging may cause excessive vagal (parasympathetic) stimulation to the heart leading to decreased rate of sinus node discharge - causing bradycardia. Calcium channel blockers such as diltiazem may cause bradycardia. Caffeine intake results in an increased heart rate. Stress, such as an emotional encounter, can result in tachycardia.

•A client with peripheral arterial insufficiency is scheduled for surgery. On admission, the client complains of discomfort and aches in the legs and feet. To safely position this client the nurse takes into consideration that the feet and legs should be: a.Placed dependent to the torso b.Dependent by using a fully extended knee gatch c.Raised to a two pillow height above the buttocks d.Elevated by raising the foot of the bed on blocks

•ANSWER: A •Gravity will assist the flow of blood to the dependent legs and feet. An extended knee gatch keeps extremities horizontal, not dependent, and does not facilitate blood flow to the feet. Elevation impedes flow of arterial blood to the extremities; it facilitates venous return.

•The client is diagnosed with peripheral arterial disease (PAD) and the nurse is discussing lifestyle modifications. Which of these is the most beneficial lifestyle modification the nurse should teach this client? a.Stop smoking b.Take an aspirin once daily c.Start a walking program d.Eat a low-fat, low-cholesterol diet

•ANSWER: A •In clients with PAD, the goal is to promote vasodilation and prevent vasoconstriction. Complete abstinence from smoking or chewing tobacco products is considered the most effective method of preventing vasoconstriction. Smoking cessation should be encouraged. Although aspirin or other antiplatelets drugs are often prescribed for clients with PAD, it is not the primary means of risk reduction. Although a sedentary lifestyle is a contributing factor, it is not the primary risk factor for PAD. Although a high-fat, high-cholesterol diet is a contributing factor, it is not the primary risk factor for PAD.

•When assessing the client with peripheral arterial disease, the nurse anticipates the presence of which clinical manifestations? Select all that apply. a. Dependent rubor b.Warm extremities c.Ulcers on the toes d.Thick, hardened skin e. Delayed capillary refill

•ANSWER: A C E •Peripheral arterial disease affects arterial circulation and results in delayed and impaired circulation to the extremities. As a result, the extremities exhibit rubor while in the dependent position and pallor while elevated, ulcers on the feet and toes, cool skin, and capillary refill greater than three seconds. Warm extremities and thick, hardened skin occur in the presence of venous disease.

•A client with peripheral arterial insufficiency tells the nurse that walking sometimes results in severe pain in the calf muscles. The nurse responds that this pain is called: a.Rest pain b.Intermittent claudication c.Phantom limb sensation d.Raynaud's phenomenon

•ANSWER: B •Intermittent claudication is pain that results when the arterial system is unable to provide adequate blood flow to the tissues in the presence of increased demands for oxygen and nutrients during exercise; it is relieved by rest. Rest pain is not a response to exercise; it occurs in the extremities during rest, especially at night. Phantom limb sensation is the presence of unusual sensations or pain in the residual limb after an amputation. Raynaud's phenomenon is intermittent episodes of constricted arteries and arterioles in response to extreme cold or emotional stress, causing pallor, paresthesias, and pain.

When supporting vasodilation by the use of warmth for a client with peripheral arterial insufficiency, the nurse cautions the client to avoid: a.Applying a hot water bottle to the abdomen b. Using a heating pad to warm the extremities c.Drinking a warm cup of tea when feeling chilly d.Turning the room thermostat above 72 degrees

•ANSWER: B •The client's extremities are less sensitive to thermal stress because of peripheral vascular problems, and burns may occur. Applying heat to the abdomen causes reflex dilation of the arteries in the extremities and increases blood flow without untoward effects. Raising the internal temperature by drinking warm fluid prevents vascular constriction and warms the extremities. Increasing heat of the external environment is an effort to prevent cold, chilling, and further constriction of peripheral vasculature.

The nurse takes blood pressures at a health fair. The nurse identifies which person as most at risk for developing hypertension? 1. A 52-year-old male who smokes and has a parent with hypertension 2. A 30-year-old female advertising agent who is unmarried and lives alone 3. A 68-year-old male who uses herbal remedies to treat an enlarged prostate gland 4. A 43-year-old female who travels extensively for work and exercises only on weekends

•Answer: 1 •Rationale: Hypertension is more prevalent in men who are older than 55 years of age. Smoking tobacco greatly increases the risk of cardiovascular disease. A history of a close blood relative (e.g., parents, sibling) with hypertension is associated with an increased risk for developing hypertension. Other risk factors would include increasing age, sedentary lifestyle, and stress.

A patient's blood pressure has not responded to the prescribed drugs for hypertension. Which of the following should the nurse assess first? 1. Progressive target organ damage 2. Potential for drug interactions 3. Patient's adherence to drug therapy 4. Possible use of recreational drugs

•Answer: 3 •Rationale: Side effects of antihypertensive drugs are common and may be so severe or undesirable that the patient does not comply with therapy.

A patient returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse? 1. Pedal pulses are 2+ bilaterally. 2. Apical pulse is 54 beats/minute. 3. Mean arterial pressure is 72 mm Hg. 4. ST-segment elevation develops on the ECG.

•Answer: 4 •Rationale: ST elevation on ECG indicates myocardial ischemia with partial or total occlusion of a coronary artery. This assessment finding requires immediate action. Actions would include assessment for chest pain, 12-lead ECG, administration of nitroglycerin or morphine, and notification of the health care provider. Option 1 would need further assessment but is not critical unless the patient is symptomatic (chest pain, shortness of breath, hypotension, etc.). Options 2 and 3 are normal findings.

The nurse teaches a patient with peripheral arterial disease. The nurse determines that further teaching is needed if the patient makes which statement? a."I should not use heating pads to warm my feet." b."I should cut back on my walks if it causes pain in my legs." c."I will examine my feet every day for any sores or red areas." d."I can quit smoking if I use nicotine gum and a support group."

•Answer: B •Rationale: Patients should be taught to exercise to the point of discomfort, stop and rest, and then resume walking until the discomfort recurs. Smoking cessation and proper foot care are also important interventions for patients with peripheral arterial disease.

Which patient is most at risk for developing coronary artery disease? a.A hypertensive patient who smokes cigarettes b.An overweight patient who uses smokeless tobacco c.A patient who has diabetes and uses methamphetamines d.A sedentary patient who has elevated homocysteine levels

•Answer: a •Rationale: The four major modifiable risk factors for coronary artery disease are elevated serum lipids, hypertension, tobacco use, and physical inactivity. Other risk factors include diabetes mellitus, metabolic syndrome, psychologic states, high levels of homocysteine, and substance abuse.

A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to a.Perform defibrillation. b.Initiate cardiopulmonary resuscitation. c.Prepare for synchronized cardioversion. d.Administer IV antidysrhythmic drugs per protocol.

•Answer: b •Rationale: Immediate treatment for ventricular fibrillation is the initiation of cardiopulmonary resuscitation, followed by the use of defibrillation and definitive drug therapy according to advanced cardiac life support guidelines.

The most significant factor in long-term survival of a patient with sudden cardiac death is a.Absence of underlying heart disease. b.Rapid institution of emergency services and procedures. c.Performance of perfect technique in resuscitation procedures. d.Maintenance of 50% of normal cardiac output during resuscitation efforts.

•Answer: b •Rationale: Rapid cardiopulmonary resuscitation and prompt defibrillation (with an automated external defibrillator) and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest.

The nurse is caring for a patient who survived a sudden cardiac death. What should the nurse include in the discharge instructions? a."Because you responded well to CPR, you will not need an implanted defibrillator." b."Your family members should learn how to perform CPR and practice these skills regularly." c."The most common way to prevent another arrest is to take your prescribed drugs." d."Since there was no evidence of a heart attack, you do not need to worry about another episode."

•Answer: b •Rationale: Rapid cardiopulmonary resuscitation, prompt defibrillation (with an automated external defibrillator), and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest.

The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says, a."I should not eat any red meat such as beef, pork, or lamb." b."I should have some type of fish at least 3 times a week." c."Most of my fat intake should be from olive oil or the oils in nuts." d."If I reduce the fat in my diet to about 5% of my calories, I will be much healthier."

•Answer: c •Rationale: Monounsaturated fats are found in natural foods such as nuts and avocados, and are the main component of tea seed oil and olive oil (oleic acid). Canola oil is 57% to 60% monounsaturated fat, olive oil is about 75% monounsaturated fat, and tea seed oil is commonly more than 80% monounsaturated fat. Other sources include macadamia nut oil, grapeseed oil, groundnut oil (peanut oil), sesame oil, corn oil, popcorn, whole grain wheat, cereal, oatmeal, safflower oil, sunflower oil, tea-oil Camellia, and avocado oil. Fat intake should be between 25% and 35% of calories (with most from monounsaturated fats and less from saturated fats); red meats should be reduced or eliminated from the diet. Only fatty fish (such as tuna and salmon) should be included in the diet because fatty fish is high in omega-3 fatty acids.

A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit a.Palpitations. b.Hypertension. c.Warm, flushed skin. d.Shortness of breath.

•Answer: d •Rationale: Signs of symptomatic bradycardia include pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion or disorientation; and shortness of breath.

•When caring for the client with chronic bronchitis, which of these interventions will assist the client in mobilizing secretions? A.Elevate the head of the bed 45 degrees B.Consume at least 2 liters of fluid daily C.Avoid triggers which cause coughing D.Assume the tripod position

•B •Clients with chronic bronchitis tend to have thick secretions. Hydration with at least 2 liters of fluid daily thins tenacious (sticky) secretions, making them easier to expectorate. The goal is to consume fluid to thin secretions and perform controlled coughing. If health issues require fluid restriction, the client would attempt to consume the total amount permitted. Head of bed elevation may promote oxygenation and lung expansion, but does not promote secretion mobilization. Clients need to sit with both feet on the floor when performing controlled coughing. The tripod position is assumed during episodes of hypoxemia, but will not facilitate mobilization of fluid.

•Which statement by a patient best indicates an understanding of the teaching on flunisolide? A."I will wash the plastic inhaler casing once a month." B."I will rinse my mouth with water after each use." C."I will take two puffs to treat an acute asthma attack." D."I will not use my albuterol inhaler while I am taking AeroBid."

•B •Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the patient's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.

•The nurse is reviewing the admission assessment of an elderly client with pneumonia. For which symptom of pneumonia, typical to older adults, does the nurse assess? A.Bradycardia B.Confusion C.Eupnea D.Pale skin

•B •The most common symptom of pneumonia in the older adult client is acute confusion from hypoxia. Fever and cough may be absent, but hypoxemia is often present. Symptoms of pneumonia include flushing, not pale skin, anxiety, chest pain or discomfort, myalgia, headache, chills, fever, cough, tachycardia, not bradycardia, dyspnea, tachypnea not eupnea, hemoptysis, and sputum production. Severe chest muscle weakness also may be present from sustained coughing. Crackles, wheezing may be heard over areas of fluid, decreased breath sounds are present and wheezing may be heard where the airways are narrowed by exudate.

•The nurse is educating a group of young women who have sickle cell disease (SCD). Which statement from a class member indicates further teaching is necessary? A."The pneumonia vaccine is protection that I need." B."Getting an annual 'flu shot' would be dangerous for me." C."I must take my penicillin pills as prescribed, all the time." D."Frequent handwashing is an important habit for me to develop."

•B •Further teaching is needed when a young women with sickle cell disease says, "Getting an annual 'flu shot' would be dangerous for me." The client with SCD can receive annual influenza and pneumonia vaccinations. This helps prevent the development of these infections, which could cause a sickle cell crisis.The pneumonia vaccine is also appropriate for the client with sickle cell disease to receive. Prophylactic penicillin is given to clients with SCD orally twice a day to prevent the development of infection. Handwashing is a very important habit for the client with SCD to develop because it reduces the risk for infection.

•The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? A.Urine output of 1500 mL on the preceding day B.Crackles in the lung fields C.Pedal edema D.Expectoration of yellow sputum

•B •Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields. A urine output of 1500 mL is normal. Edema is a sign of right ventricular heart failure. Yellow sputum indicates the presence of white blood cells and possible infection.

•When administering furosemide to a client who does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels? A.Increase red meat in the diet. B.Consume melons and baked potatoes. C.Add several portions of dairy products each day. D.Try replacing your usual breakfast with oatmeal or Cream of Wheat.

•B •Melons and baked potatoes are foods high in potassium. Red meat is high in saturated fat and is to be consumed sparingly. Dairy products are high in calcium. Cereals are fortified with iron. Oatmeal contains fiber but not potassium.

•The nurse is teaching a client the precautions to take while on warfarin therapy. Which statement made by the client demonstrates that teaching has been effective? A."I can use an electric razor or a regular razor." B."Eating foods like green beans won't interfere with my Coumadin therapy." C."If I notice I am bleeding a lot, I should stop taking Coumadin right away." D."When taking Coumadin, I may notice some blood in my urine."

•B •Teaching about the precautions of warfarin has been effective when the client says "that eating foods like green beans won't interfere with my Coumadin therapy." Vitamin K is not found in foods such as green beans, so these foods will not interfere with the anticoagulant effects of Coumadin. Warfarin "thins" the blood, so the risk for cutting oneself and bleeding is very high with the use of a regular razor. The client needs to use an electric razor. Clients must apply pressure to bleeding wounds and must seek medical assistance immediately. They do not need to discontinue warfarin therapy. Blood in the urine of a client taking warfarin therapy is not a side effect. The client must notify the primary health care provider immediately if this occurs.

•The home health nurse visits a client with heart failure who has gained 5 pounds (2.3 kg) in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? A.Assess the client for peripheral edema. B.Auscultate the client's posterior breath sounds. C.Notify the health care provider about the client's weight gain. D.Remind the client about dietary sodium restrictions.

•B •The action the home care nurse takes first is to auscultate the heart failure client's posterior breath sounds. Because the client is at risk for pulmonary edema and hypoxemia, the breath sounds must be assessed. Assessment of edema may be delayed until after breath sounds are assessed. After a full assessment, the nurse must notify the health care provider. After physiologic stability is attained, then ask the client about behaviors that may have caused the weight gain, such as increased sodium intake or changes in medications.

•The client says, "I hate this stupid COPD." What is the best response by the nurse? A."Stopping smoking will help your lungs heal." B."You sound fed up with managing your illness." C."Does anyone in your family have COPD?" D."Most clients get used to it after a few months."

•B •The best response by the nurse is "You sound fed up with managing your illness." This response encourages the client to express his or her feelings about the disease and its challenges. Lecturing the client regarding his smoking habits disregards the client's need for support. "Why" questions can seem accusatory and may make a client less likely to talk about what he or she is feeling. Asking the client if anyone in the family has COPD is a "yes" or "no" question and does not encourage the client to talk about his or her feelings. The client's feelings should never be minimized.

Prompt pain management with myocardial infarction is essential for which reason? A.The discomfort will increase client anxiety and reduce coping. B.Pain relief improves oxygen supply and decreases oxygen demand. C.Relief of pain indicates that the MI is resolving. D.Pain medication would not be used until a definitive diagnosis has been established.

•B •The focus of pain relief is to improve oxygen supply and to reduce myocardial oxygen demand. Chest discomfort will increase anxiety, but it may not affect coping. Relief of pain does not mean that the MI is resolving. Although it is used to be true that pain medication was not to be used for undiagnosed abdominal pain, this does not relate to MI.

•The nurse is caring for a patient with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol. Which monitoring is essential when administering the medication? A.ST segment B.Heart rate C.Troponin D.Myoglobin

•B •The monitoring of the patient's heart rate is essential. The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand.ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI, but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS, but does not address needed monitoring related to metoprolol.

•A client with pneumonia is receiving 100% oxygen via a non-rebreather mask. Which of these situations requires immediate intervention by the nurse? A.The client's skin has pink color. B.The oxygen reservoir deflates during inspiration. C.The client has crackles at the lung bases. D.The client is expectorating rust colored sputum.

•B •The nurse intervene immediately if the reservoir bag is deflated. Suffocation can occur if the reservoir bag deflates, kinks, or if the oxygen source disconnects. The nurse needs to remove the device, refill the reservoir, and then reapply the mask. It is anticipated that the client's color is now pink. The client's color is expected to improve (from ashen or gray to pink) because of an increase in PaO2 level. Crackles in lung bases are an expected finding in a client with pneumonia, as is expectorating rust-colored sputum. Monitoring for adventitious breath sounds is important for the nurse to assess.

•The nurse is caring for a patient with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? A.Defibrillate the patient at 200 joules. B.Check the patient for a pulse. C.Cardiovert the patient at 50 joules. D.Give the patient IV lidocaine.

•B •The nurse needs to first assess the patient to determine stability before proceeding with further interventions. If the patient has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for stable ventricular tachycardia with a pulse is amiodarone. If the patient is pulseless or nonresponsive, the patient is unstable and defibrillation is used and not cardioversion. Also, if the patient is pulseless, lidocaine may be given after defibrillation.

•A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon? A.Temperature 98.2°F (36.8°C) B.Chest tube drainage 175 mL last hour C.Serum potassium 3.9 mEq/L (3.9 mmol/L) D.Incisional pain 6 on a scale of 0 to 10

•B •The nurse needs to report chest drainage over 150 mL/hr to the surgeon. Although some bleeding is expected after surgery, 175 mL per hour is excessive. Although hypothermia is a common problem after surgery, a temperature of 98.2°F (36.8°C) is a normal finding. Serum potassium of 3.9 mEq/L (3.9 mmol/L) is a normal finding. Incisional pain of 6 on a scale of 0-10 is expected immediately after major surgery; the nurse would administer prescribed analgesics.

•Which risk factors are known to contribute to atrial fibrillation? Select all that apply A.Use of beta-adrenergic blockers B.Excessive alcohol use C.Advancing age D.High blood pressure E.Palpitations

•BCD •Risk factors contributing to atrial fibrillation include excessive alcohol use, advancing age, and hypertension. Other risk factors involve previous ischemic stroke, transient ischemic attack or other thromboembolic event, coronary heart disease, diabetes mellitus, heart failure, mitral valve disease, obesity, and chronic kidney disease. The incidence of atrial fibrillation also occurs more often in those of European ancestry and African Americans. Beta-adrenergic blocking agents, which reduce heart rate, are used to treat atrial fibrillation. Palpitations are a symptom of atrial fibrillation, rather than a risk or a cause.

•The nurse in the community health clinic is planning education related to tuberculosis (TB). Which of these groups will the nurse target? Select all that apply. A.Breast cancer survivors B.Those in the local prison C.Homeless adults D.Recent immigrants to the United States E.Those who have received bacille Calmette-Guérin (BCG) vaccine

•BCD •The groups the nurse plans to educate include those adults who live in crowded areas such as prisons and homeless shelters, and those who are recent immigrants to the USA. Other groups at higher risk for tuberculosis include those who abuse injection drugs or alcohol and those groups of lower socioeconomic status. Breast cancer survivors who are no longer undergoing immunocomprising therapy have the same risk as the general population. Receiving BCG, an immunization often given to individuals from overseas, is designed to prevent rather than cause TB. Clients who have received BCG vaccine within the last 10 years will have a positive skin test that can complicate interpretation.

•A client recently diagnosed with asthma has a prescription to use an inhaled medication with a spacer. The nurse evaluates the client has correct understanding of the use of an inhaler with a spacer when the client states which of these? Select all that apply A."I don't have to wait a minute between the two puffs if I use a spacer." B."If the spacer makes a whistling sound, I am breathing in too rapidly." C."I should rinse my mouth and then swallow the water to get all of the medicine." D."I should shake the canister when I want to see whether it is empty." E."I should hold my breath for at least ten seconds after inhaling the medication."

•BE •Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the client of which technique needs to be used. The client should hold the breath for at least 10 seconds, however attempting to hold the breath for a minute is unnecessary and could pose a threat to oxygenation. The client must wait 1 minute between puffs regardless of the method of delivery of the medication. The client should rinse the mouth but not swallow the water. The mouth needs to be rinsed after using an inhaler with or without a spacer. This is especially important if the inhaled medication is a corticosteroid; rinsing will help prevent the development of an oral fungal infection. An empty inhaler will float on its side in water while a full inhaler will sink. Shaking an inhaler helps ensure that the medication is dispersed and the same dose is delivered in each puff.

•Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? A.Serum potassium level of 3.2 mEq/L (3.2 mmol/L) B.Ejection fraction of 60% C.B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) D.Chest x-ray report showing right middle lobe consolidation

•C •A BNP of 760 pg/ml (760 ng/dL) is consistent with a diagnosis of heart failure. BNP is produced and released by the ventricles when the client has fluid overload as a result of HF. A normal BNP value is less than 0-99 picograms per milliliter (pg/mL) or 0-99 nanograms per liter (ng/L).Hypokalemia (serum potassium level of 3.2 mEq/L [3.2 mmol/L]) may occur in response to diuretic therapy for HF, but may also occur with other conditions. It is not specific to HF. Ejection fraction of 60% represents a normal value of 50% to 70%. Consolidation on chest x-ray may indicate pneumonia.

What teaching does the nurse include for a patient with atrial fibrillation who has a new prescription for warfarin? A."It is important to consume a diet high in green leafy vegetables." B."You would take aspirin or ibuprofen for headache." C."Report nosebleeds to your provider immediately." D."Avoid caffeinated beverages."

•C •A nosebleed could be indicative of excessive dosing of warfarin. Warfarin is an anticoagulant and causes decreased ability for blood to clot.Green leafy vegetables are high in vitamin K, which may antagonize the effects of warfarin; these vegetables would be eaten in moderate amounts. Aspirin and nonsteroidal anti-inflammatory agents may prolong the prothrombin time and the international normalized ratio, causing predisposition to bleeding. These agents would be avoided. It is not necessary to avoid caffeine because this does not affect clotting; however, green tea may interfere with the effects of warfarin.

A client with peripheral arterial disease (PAD) has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure? A.Ankle-brachial index B.Dye allergy C.Pedal pulses D.Gag reflex

•C •After a client with PAD has had a PTA, it is essential for the nurse to assess for pedal pulses. Priority nursing care focuses on assessment for bleeding at the arterial puncture site and monitoring distal pulses to ensure adequate perfusion. Pulse checks must be assessed post procedure to detect improvement (stronger pulses) or complications (diminished or absent pulses).Ankle-brachial index is a diagnostic study used to detect the presence of PAD. This is not necessary after PTA, which is an intervention to treat PAD. It is imperative to assess for dye allergy before performing PTA. Gag reflex is checked after procedures affecting the throat (e.g., endoscopy, bronchoscopy). The femoral artery is generally the access site for PTA.

•What is the role of corticosteroids in the treatment of acute respiratory disorders? A.They stimulate the immune system. B.They increase gas exchange in the alveoli. C.They decrease inflammation. They directly dilate the bronchi

•C •Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

•The nurse is teaching a group of teens about prevention of heart disease. Which point is most important for the nurse to emphasize? A.Reduce abdominal fat. B.Avoid stress. C.Do not smoke or chew tobacco. D.Avoid alcoholic beverages.

•C •The most important point for the nurse to emphasize when teaching a group of teens about heart disease prevention is not to smoke or chew tobacco. Tobacco exposure, including secondhand smoke, reduces coronary blood flow, causing vasoconstriction, endothelial dysfunction, and thickening of the vessel walls. Smoking also increases carbon monoxide and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure. Teens are not likely to experience metabolic syndrome from obesity but are very likely to use tobacco. Avoiding stress is a less modifiable risk factor, which is less likely to cause heart disease in teens. The risk of smoking outweighs the risk of alcohol use.

•A 32-year-old client is recovering from a sickle cell crisis. The client's discomfort is controlled with pain medications and discharge planning has been initiated. What medication will the nurse anticipate to be prescribed before discharge? A.Heparin B.Warfarin C.Hydroxyurea D.Tissue plasminogen activator (t-PA)

•C •The nurse anticipates Hydroxyurea to be prescribed for pain for a sickle cell disease client who is being discharge. Hydroxyurea (Droxia) has been used successfully to reduce sickling of cells and pain episodes associated with sickle cell disease (SCD).Clients with SCD are not prescribed anticoagulants such as heparin or warfarin (Coumadin). t-PA is used as a "clot buster" in clients who have had ischemic strokes.

•After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions? A."All asthma drugs help everybody breathe better." B."I must carry my emergency inhaler when activity is anticipated." C."I must have my emergency inhaler with me at all times." D."Preventive drugs can stop an attack."

•C •The statement by the client that indicates a correct understanding of the instructions is that the emergency inhaler must be with the client at all times. Because asthma attacks cannot always be predicted, clients with asthma must always carry a rescue inhaler such as a short-acting beta agonist (e.g., albuterol).Asthma medications are specific to the disease and to the client and should never be shared or used by anyone other than the person for whom they are prescribed. They are not always good for everyone and, in fact, may do harm. An emergency inhaler should be carried all the time and not just when activity is anticipated. Preventive drugs are those that are taken every day to help prevent an attack from occurring, and do not stop an attack once it begins.

•Which teaching point does the nurse include for a client with peripheral arterial disease (PAD)? A."Elevate your legs above heart level to prevent swelling." B."Inspect your legs daily for brownish discoloration around the ankles." C."Walk to the point of leg pain, then rest, resuming when pain stops." D."Apply a heating pad to the legs if they feel cold."

•C •The teaching point the nurse include for a client with PAD is walk to the point of leg pain, rest, and then resume when pain stops. Exercise may improve arterial blood flow by building collateral circulation. Instruct the client to walk until the point of claudication, stop and rest, and then walk a little farther. Elevating the legs in PAD decreases blood flow and increases ischemia. Brown discoloration around the ankles is characteristic of venous occlusive disease. Application of heat must be avoided in clients with PAD due to a lack of sensation and possible burns to the legs.

Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin therapy? A.Avoid drinking large amounts of green tea. B.Cranberry juice will provide you with needed nutrients while taking warfarin. C.You must never eat spinach. D.You can only eat lettuce once a month.

•Correct answer: A •Rationale: For patients taking warfarin therapy, it is recommended to avoid eating or drinking large amounts of kale, spinach, Brussels sprouts, collard or mustard greens, lettuce, chard, and green tea. Beverages that may increase the effect of warfarin and to be avoided include cranberry juice and alcohol.

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? A.Pressure should be applied to the lump for 3 to 5 minutes. B.He will need to take two doses of warfarin tonight to prevent blood clotting. C.He needs to be examined for possible internal bleeding from the fall. D.As long as there is no bleeding, there is no concern.

•Correct answer: C •Rationale: Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall even if superficial bleeding is not noted.

A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. What is the concern with taking these two drugs together? A.increased risk of gastric ulcer. B.decreased action of the aspirin because of the interaction with the ginkgo. C.increased risk of bleeding because of the ginkgo. D.antagonism of the action of the aspirin because of the multivitamins.

•Correct answer: C •Rationale: Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes.

When converting from IV heparin to oral warfarin therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A.Platelet levels B.aPTT C.Red blood cell count D.PT/INR

•Correct answer: D •Rationale: For conversion from heparin to an oral anticoagulant such as warfarin, the dose of the oral drug is the usual initial dosage amount, with the prescriber using the PT/INR levels to determine the next appropriate dosage of warfarin. When there is continuous therapeutic anticoagulation coverage and warfarin has reached therapeutic levels, the heparin or LMWH may be discontinued without tapering.

The patient accidentally takes too much of the prescribed warfarin and is readmitted to the hospital with bleeding. The nurse anticipates administration of A.protamine sulfate. B.alteplase. C.reteplase. D.vitamin K.

•Correct answer: D •Rationale: High doses of vitamin K (10 mg) given IV will reverse the anticoagulation of warfarin within 6 hours. Protamine sulfate is used to reverse heparin. Alteplase, and reteplase are thrombolytics.

•How does the nurse recognize that atropine has produced a positive outcome for the patient with bradycardia? A.The patient states he is dizzy and weak. B.The nurse notes dyspnea. C.The patient has a heart rate of 42 beats/min. D.The monitor shows an increase in heart rate.

•D •An expected outcome after the administration of atropine is an increased heart rate. By definition, the bradydysrhythmia has resolved when the heart rate is greater than 60 beats/min.Dizziness and weakness indicate symptoms of decreased cerebral perfusion and intolerance to the bradydysrhythmia. Dyspnea indicates intolerance to the bradydysrhythmia. A heart rate of 42 beats/min after atropine has been given indicates that bradycardia is unresolved.

•The nurse is providing education to a client with chronic bronchitis who has a new prescription for a mucolytic. Which of these will the nurse teach the client about the purpose of the medication? A.Mucolytics decrease secretion production. B.Mucolytics increase gas exchange in the lower airways. C.Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease. D.Mucolytics thin secretions, allowing for easier expectoration.

•D •Client with chronic bronchitis typically produces large amounts of thick mucus interfering with gas exchange. Mucolytic means "breaking down mucus," resulting in thinner secretions which are easier to expectorate. Mucolytics do not decrease secretion production. Mucolytics may increase gas exchange as secretions are cleared, but this is an indirect property and is not the main function. Mucolytics do not have any bronchodilation properties.

•The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who has hypoxemia and hypercarbia. The nurse recognizes that a positive outcome to therapy has been achieved by which of these findings? A.The pCO2 is within normal range. B.The client's face is very pink. C.The client reports decreased distress. D.The oxygen saturation is between 88% and 90%.

•D •Clients with hypoxemia, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and maintain SpO2 levels between 88% and 92%.Gases diffuse independently, therefore applying oxygen will not decrease the carbon dioxide level; hypoxemia may still be present. Flushing of the face can be a symptom of hypercarbia. A report of less distress is appropriate. The nurse, in any case, needs to use an objective measure of oxygenation such as pulse oximetry or blood gas results.

•Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for further preoperative teaching? A."I will be awake during this procedure." B."I will have a balloon in my artery to widen it." C."I must lie still after the procedure." D."My angina will be gone for good."

•D •In this situation, further teaching is needed when the client states that angina will be gone after the PTCA. The client's angina may not be eliminated. Reocclusion is possible after PTCA. The client is typically awake, but drowsy, during this procedure. PTCA uses a balloon to widen the artery, and the client will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the hole to heal and prevent hemorrhage.

•The nurse is assessing a client admitted with status asthmaticus. The nurse finds a sudden absence of wheezing in the lung fields and sets which of these as the priority action? A.Education to prevent future exacerbations B.Administration of a bronchodilator C.Measures to reduce anxiety D.Activation of the rapid response team to secure an airway

•D •Sudden absence of wheezing in a client having an asthma attack indicates complete airway obstruction and requires immediate action; a tracheotomy may be required. This is an emergency and educating the client is not appropriate. A bronchodilator is given when breath sounds are present and the client can inhale. Reducing anxiety is not a consideration in an emergency situation.

•A recently admitted client who is in sickle cell crisis requests "something for pain." What medication would the nurse be prepared to administer? A.Oral ibuprofen B.Oral morphine sulfate C.Intramuscular (IM) morphine sulfate D.Intravenous (IV) hydromorphone

•D •The client with sickle cell disease needs IV pain relief, and it needs to be administered on a routine schedule (i.e., before the client has to request it).Nonsteroidal anti-inflammatory drugs may be used for clients with SCD for pain relief once their pain is under control. However, in a crisis, this choice of analgesic is not strong enough. Moderate pain may be treated with oral opioids, but this client is in a sickle cell crisis. IV analgesics would be used until his or her condition stabilizes. Morphine is not administered intramuscularly (IM) to clients with sickle cell disease (SCD). In fact, all IM injections are avoided because absorption is impaired by poor perfusion and sclerosed skin.

•A client who smokes is being discharged home on oxygen. The client states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response? A.You can quit when you are ready." B."It's never too late to quit." C."For safety, turn off your oxygen when you smoke." D."Let's discuss why smoking around oxygen is dangerous."

•D •The nurse best response is to ask the client to discuss why smoking around oxygen is dangerous. The nurse would use this opportunity to educate the client about the dangers of smoking in the presence of oxygen, as well as the benefits of quitting. Telling the client it is okay to quit when ready, or that it's never too late to quit, does not address the safety issue of smoking in the presence of oxygen. Recommending that the client turn off the oxygen when smoking also puts the client at risk for harm.

•The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F (37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the nurse take? A.Give the digoxin; reassess the heart rate in 30 minutes. B.Give the digoxin; document assessment findings in the medical record. C.Hold the digoxin, and obtain a prescription for an additional dose of furosemide. D.Hold the digoxin, and obtain a prescription for a potassium supplement.

•D •The nurse needs to hold the digoxin and get a prescription for a potassium supplement. Digoxin causes bradycardia and hypokalemia potentiates digoxin toxicity. Furosemide decreases circulating blood volume and depletes potassium. There is no indication suggesting that the client has fluid volume excess at this time.

•A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? A.Combination medication therapy is effective in eliminating cough and fever. B.Combination medication therapy improves adherence. C.Combination medication therapy has fewer side effects, particularly liver damage. D.The use of multiple medications destroys organisms quickly and reduces the development of drug-resistant organisms.

•D •The nurse tells the client that multiple drug regimens are able to destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. Combination drug therapy is the most effective method for treating TB and preventing transmission. As the disease responds to treatment, the symptoms will decrease, but they are not eliminated. Combination drug therapy does not improve adherence to drug therapy. Isoniazid, rifampin, and pyrazinamide may cause liver damage.

•The nurse suspects that a client has developed an acute arterial occlusion of the right lower extremity based on which signs/symptoms? Select all that apply. A.Hypertension B.Tachycardia C.Bounding right pedal pulses D.Cold right foot E.Numbness and tingling of right foot F.Mottling of right foot and lower leg

•DEF •Signs/symptoms of acute arterial occlusion of the right lower extremity include cold right foot, numbness and tingling of the right foot, and mottling and tingling of the right foot. Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cool limb), and mottled color are characteristics of acute arterial occlusion. Hypertension presents risk for atherosclerosis, but not for acute arterial occlusion. The pulse rate does not indicate occlusion, but rather quality. Absence of pulse, rather than bounding pulse, is a symptom of acute arterial occlusion.