Patho exam 2 practice questions

Which findings in a client who has had major abdominal surgery indicate a possible venous thrombosis of the leg? Select all that apply. A. Edema B. Skin breakdown C. Pruritis D. Tender area of the skin E. Warmth along leg

A, D, E

Which of the following is the most common symptom of a myocardial infarction (MI)? A. Chest pain B. Dyspnea C. Edema D. Palpitations

A- Chest pain The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

How can a nurse explain heart failure to a client? A cardiac condition caused by inadequate circulating blood volume An acute state in which the pulmonary circulation pressure decreases An inability of the heart to pump blood in proportion to metabolic needs A chronic state in which the systolic blood pressure drops below 90 mm Hg

An inability of the heart to pump blood in proportion to metabolic needs

A client with heart failure suddenly becomes tachycardic, is gasping for breah, and begins coughing frothy, pink-tinged sputum. A nurse listens to breath sounds, expecting to hear bilateral: A. RHonchi B. Crackles C. Wheezes D. Diminished breath sounds

B- Crackles This client has heart failure, dyspnea and breathlessness and is experiencing pulmonary edema (coughing up pink, frothy sputum) due to pulmonary congestion. These are the cardinal signs of left-sided heart failure. In clients with left-sided heart failure, the fluid backs up and accumulates in the pulmonary circulation. This leads to crackles being heard on ausculation- also recall that the location of crackles can indicate how severe the pulmonary edema is, and hence how severe the heart failure may be.

Aortic stenosis results in the incomplete emptying of the: A. Right atrium B. Left ventricle C. Left atrium D. Right ventricle

B- Left ventricle Aortic stenosis results in obstruction to aortic outflow from the left ventricle into the aorta during systole. This is when the aortic valve narrows, causing stenosis.

A patient with COPD has the following blood gases: pH 7.26, PCO2 59, HCO3 24. Which of the following conditions is presenting? A. Respiratory Alkalosis B. Respiratory Acidosis C. Metabolic Alkalosis D. Metabolic Acidosis

B- Respiratory Acidosis We are looking for a DECREASED pH, INCREASED PaCO2 and WNL HCO3. - pH of 7.26 ↓ - PaCO2 of 59 ↑- HCO3 of 24 WNL

The nurse is analyzing the arterial blood gas (AGB) results of a patient diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? A. pH 7.49, PaCO2 37, HCO3 29 B. pH 7.20, PaCO2 65, HCO3 26 C. pH 7.25, PaCO2 42, HCO3 21 D. pH 7.33, PaCO2 36, HCO3 16

B- pH 7.20, PaCO2 65, HCO3 26 We are looking for a value where the pH is DECREASED, the PaCO2 is INCREASED and the HCO3 is WNL

A client being treated for respiratory failure has the following arterial blood gas results: pH 7.30, PaCO2 58 mmHg and HCO3 25 mEq/L. The nurse interprets that the client has which acid-base disturbance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C

A patient is in metabolic alkalosis due to diuretic therapy. How do you expect the pH and bicarbonate level to be affected? A. Increased pH, decreased HCO3 B. Decreased pH, normal HCO3 C. Increased pH, increased HCO3 D. Increased pH, normal HCO3

C- Increased pH, increased HCO3 In metabolic alkalosis, the pH and HCO3 are INCREASED; the PCO2 is WNL

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, and bicarbonate (HCO3) of 26 mEq/L. What disorder is indicated by these findings? A. Respiratory Acidosis B. Metabolic Acidosis C. Respiratory Alkalosis D. Metabolic Alkalosis

C- Respiratory Alkalosis Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. - pH of 7.52 ↑- PaCO2 of 30 ↓ - HCO3 of 26 WNL Remember... if there is an issue with the CO2, it is a respiratory problem! Issue with HCO3? Metabolic!

A client tells the nurse, "My legs begin to hurt after walking for several blocks. The pain goes away when I stop walking, but it comes back again when I resume walking." Which condition would the nurse consider as the most likely cause of the client's pain? A. Spinal stenosis B. Buerger disease C. Rheumatoid arthritis D. Intermittent claudication

D

Which of the following conditions is most closely associated with fatigue, dependent edema and distended jugular veins? A. Stable angina B. Cardiomyopathy C. Left-sided heart failure D. Right-sided heart failure

D- Right-sided heart failure Right-sided heart failure means that the right side of the heart is not pumping blood as well as normal. Typically this occurs because of a problem with the left ventricle. As blood begins to back up behind the failing left ventricle and into the lungs, it will become harder for the right ventricle to pump returning blood through the lungs. The right ventricle will weaken with time and start to fail. Symptoms like fatigue, dependent edema, distended jugular veins, ascites and enlarged liver and spleen are most commonly seen.

Which statement by a client is consistent with a diagnosis of heart failure? I see spots before my eyes I am tired at the end of the day I feel bloated when I eat a large meal I have trouble breathing when I climb a flight of stairs

I have trouble breathing when I climb a flight of stairs

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis

Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels? Contusion Thrombosis Atherosclerosis Tourniquet effect

atherosclerosis

When assessing a client with left ventricular failure, which finding would the nurse expect? Crushing chest pain Dyspnea on exertion Jugular vein distention Extensive peripheral edema

dyspnea on exertion

An arterial blood gas report indicates that the client's pH is 7.25, PCO2 is 35 mm Hg and HCO3 is 20 mEq/L. Which disturbance would the nurse identify based on these results? metabolic acidosis metabolic alkalosis respiratory acidosis respiratory alkalosis

metabolic acidosis

The nurse is reviewing the cardiac markers for a client who is admitted after reporting chest pain that occurred last week. Which laboratory value elevation should the nurse identify as a late marker after myocardial injury? LDH levels CK-MB levels Myoglobin level Troponin level

troponin level

The nurse is caring for a client who has been admitted to the hospital for an acute exacerbation of heart failure. Blood pressure is 104/62 mm Hg, pulse is 96/min, respirations are 22/min, and oxygen saturation is 91%. Which of these findings supports the diagnosis of heart failure? A. B-type natriuretic peptide (BNP) 1382 pg/mL (1382 pmol/L) B. Flat jugular veins when seated at a 45-degree angle C. Sodium 150 mEq/L (150 mmol/L) D. Urine output greater than 100 mL/hr

A- B-type natriuretic peptide (BNP) 1382 pg/mL (1382 pmol/L) Remember what the hallmark diagnostic marker is for heart failure- BNP! BNP is secreted in response to ventricular stretch and wall tension when cardiac filling pressures are elevated. The BNP level is used to differentiate dyspnea of heart failure from dyspnea of noncardiac etiology. The level of circulating BNP correlates with both severity of left ventricular filling pressure elevation and mortality. A normal BNP level is <100 pg/mL [<100 pmol/L]. The nurse would expect a high BNP in a client exhibiting symptoms of heart failure.

An elderly client tells the nurse "I have experienced leg pain for several weeks when I walk to the mailbox each afternoon, but it goes away once I stop walking." What is most likely happening with this client? A. Intermittent claudication B. Lymphedema C. Venous Thrombosis D. Atherosclerosis

A- Intermittent Claudication Intermittent claudication is pain with activity in the affected limb that improves with rest. This is due to peripheral artery disease, which impairs circulation to the extremities. Poor circulation can place the cliet at increase risk for the development of arterial ulcers and infection.

A client with a history of angina tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. The nurse interprets that the client is experiencing which of the following types of angina? A. Stable B. Unstable C. Variant D. Intractable

A- Stable Stable angina is triggered by a predictable amount of effort. It occurs when there is an increased demand for oxygen- in this case, walking up 2 flights of steps after walking 4 blocks. Unstable and variant are more likely to occur at rest. Intractable angina is a condition in which patients of heart disease continue to suffer from recurrent restricting angina, even though they are following the right medication plan.

A nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse's findings? A. pH 7.25, PCO2 50 B. pH 7.35, PCO2 40 C. pH 7.50, PCO2 52 D. pH 7.52, PCO2 28

A- pH 7.25, PCO2 50 A condition that occurs when the lungs can't remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 causes the pH of blood and other bodily fluids to decrease, making them too acidic due to depression of the respiratory center Remember that we are looking for a decreased pH (acidosis) and and increased PCO2.

When caring for a client who presents to the emergency department with an ST-segment-elevation myocardial infarction (STEMI), which laboratory result will the nurse expect? A. Decreased white blood cell count B. Elevated serum troponins I and T C. Decreased creatinine kinase-MB (CK-MB) D. Decreased B-type natriuretic peptide (BNP)

B- Elevated serum troponins I and T Elevations of troponin I and T levels are indicative and specific for cardiac muscle damage as would occur with a STEMI. White blood cell count would increase in the first days after an MI because of the inflammatory response associated with myocardial death. CK-MB is found in cardiac muscle and levels increase with myocardial cell death. BNP levels are not directly reflective of MI, but might increase if the client develops heart failure as a complication of myocardial infarction.

A client is admitted to the hospital with a diagnosis of pericarditis. The nurse assesses the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? A. Anterior chest pain B. Friction rub C. Weakness and irritability D. Chest pain that worsens on inspiration

B- Friction Rub Pericarditis is an inflammation of the pericardium (the sac that surrounds the heart) and can be associated with trauma, infection, myocardial infarction, malignant disease or other disorders. The client exhibits inflammation, fever, chest pain, tachycardia, and a friction rub, which sounds like a grating sound, heard when the breath is held.

Which assessment finding will the nurse expect when caring for a client with right ventricular failure? A. Pulmonary congestion B. Lower leg edema C. Paroxysmal nocturnal dyspnea D. Crackles in the lungs

B- Lower leg edema Right-sided heart failure causes increased pressure in the systemic venous system, which leads to a fluid shift in the interstitial spaces. Because of gravity, the edema is seen in the lower extremities. Crackles, paroxysmal nocturnal dyspnea and pulmonary congestion are seen in left-sided heart failure because of increased pressure in the pulmonary capillaries and movement of fluid into the alveoli.

A client has arterial blood gas (ABG) indicating a decreased pH, normal partial pressure of arterial carbon dioxide (PaCO2) and decreased bicarbonate (HCO3). What is this client likely experiencing? A. Respiratory Acidosis B. Metabolic Acidosis C. Respiratory Alkalosis D. Metabolic Alkalosis

B- Metabolic acidosis In metabolic acidosis, there is a DECREASE in HCO3 to less than 22 mEq/L, and a DECREASE in blood pH to less than 7.35 - pH of 7.12 ↓- PaCO2 of 40 WNL- HCO3 of 15 ↓

A nurse is caring for a client who has been vomiting for 3 days and is extremely dehydrated. Blood gas results indicated a pH of 7.50 and a PC02 of 35 and a Bicarbonate of 28. What imbalance is represented by these values? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

B- Metabolic alkalosis Deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes Metabolic Alkalosis as a result of the loss of hydrochloric acid.

The nurse monitors for which acid-base disorder that can likely occur in a client who is on mechanical ventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

B- Respiratory alkalosis Respiratory alkalosis occurs when there is a reduction in the CO2 levels in the blood. Individuals who are on mechanical ventilation are at risk for respiratory alkalosis because the machines deliver a fixed breath volume for each breath. Soemtimes this volume rate can be set too high and this can lead to hyperventilation when patients breathe faster. When you breath faster than usual, you'll be exhaling, or "blowing off", CO2 faster than usual, too. As the CO2 decreases, so does the H+. Before you know it, this loss of acid (H+) causes blood pH to increase and become more alkaline- leading to respiratory alkalosis.

Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels? A. Contusion B. Thrombosis C. Atherosclerosis D. Tourniquet effect

C

A client is diagnosed with lower-extremity deep venous thrombosis (DVT) after a cross-country road trip. Which clinical manifestations most characteristic of a DVT does the nurse expect to assess? Select all that apply. A. Blue, cyanotic toes B. Calf pain C. Dry, shiny, hairless skin D. Edema E. Warmth and erythema

Calf pain, edema, warmth and erythema DVT is the most common form of venous thromboembolism and occurs most often (80%) in the proximal deep veins (iliac, femoral) of the lower extremities. It is a common complication of hospitalization, surgery, and immobility or inactivity. This client is at greater risk due to prolonged inactivity from traveling. Although DVT can be silent, clinical manifestations characteristic of a lower-extremity DVT include unilateral edema, calf pain or tenderness to touch, warmth and erythema, and low-grade temperature.

Which of the following is NOT a cause of metabolic acidosis? A. Kidney disease B. Liver failure C. Diabetic ketoacidosis D. NG suctioning

D- NG suctioning Vomiting or nasogastric (NG) suctioning generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever a hydrogen ion is excreted, a bicarbonate ion is gained in the extracellular space.

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis? A. Metabolic Alkalosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Respiratory Acidosis

D- Respiratory Acidosis Respiratory acidosis is reflected in the ABG as an increased PCO2 and decreased pH level as well as headache, blurred vision, irritability, muscle twitching, and psychological disturbances. Headache due to dilation of vessels Carbonic acid crosses blood brain barrier- ie neurological symptoms

A client is diagnosed with Buerger's disease (thromboangiitis obliterans). The nurse anticipates teaching the client about which treatment option? A. Avoidance of warm temperatures B. Initiation of statin C. Initiation of warfarin D. Smoking cessation

D- Smoking cessation Buerger's Disease produces varying degrees of inflammation and obstruction in the arteries and veins. Smoking cessation is essential to effective treatment. If patients do not abstain from smoking, the disease is progressive, and amputation may be necessary.

The nurse reviews laboratory data for a client admitted to the emergency department with chest pain. Which serum value requires the most immediate action by the nurse? A. Glucose 200 mg/dL (11.1 mmol/L) B. Hematocrit 38% (0.38) C. Potassium 3.4 mEq/L (3.4 mmol/L) D. Troponin 0.7 ng/mL (0.7 mcg/L)

D- Troponin 0.7 ng/mL (0.7 mcg/L) Serum cardiac markers are proteins released into the bloodstream from necrotic heart tissue after a myocardial infarction (MI). Troponin is a highly specific cardiac marker for the detection of MI. A troponin value of 0.7 ng/mL (0.7 mcg/L) indicates cardiac muscle damage and should be the priority and immediate focus of the nurse. Normal value is <0.5 ng/mL.

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? A. Acute decompensated heart failure (ADHF) B. Chronic heart failure C. Left-sided heart failure D. Right-sided heart failure

D- right-sided heart failure Keep in mind the symptoms associated with the types of heart failure. Jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure. Issues around pulmonary congestion, fluid backing up into the lungs, paroxysmal nocturnal dyspnea- those are all left-sided symptoms. Remember L for LUNG and LEFT

Which of the following are considered initial signs and symptoms of an MI? Select All That Apply A. Diaphoresis B. Nausea and Vomiting C. Fever D. Pain radiating to the neck and shoulders E. Decrease heart rate F. Hypertension

Diaphoresis, nausea and vomiting, fever, pain radiating to neck and shoulders and hypertension Decreased heart rate is not seen initially- the heart rate and blood pressure are elevated, in an attempt to compensate for what is happening. Then the blood pressure will drop, secondary to a drop in the cardiac output.

A nurse notes that a client's arterial blood gas results reveal a pH of 7.50 and a Pco2 of 30. Which causes might have contributed to this client's blood gas imbalance? Select all that apply: A. Sepsis B. Hypoxemia C. Antacid overuse D. Alcohol Withdrawal E. Anxiety F. NG suctioning

Sepsis, hypoxemia, alcohol withdrawal and anxiety They are in Respiratory alkalosis (decrease in hydrogen in H+) Causes include disorders that cause reduction of carbon dioxide levels in the blood and decrease in carbonic acid concentrations