Semester 3 Unit 6

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LEWIS 35-When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patients heart rate as ____.

50 There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.

GIDDENS 33-A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understands that the goal of cognitive therapy will be met when what is reported by the patient? a. I will tell myself that I am a good person when things dont go well at work. b. My medications will make my problems go away. c. My family will help take care of my children while I am in the hospital. d. This therapy will improve my response to neurotransmitter impulses.

LEWIS 33-A patient who has recently started taking pravastatin (Pravachol) and niacin (Nicobid) reports the following symptoms to the nurse. Which is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness when changing positions quickly c. Nausea when taking the drugs before eating d. Flushing and pruritus after taking the medications

Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about childs injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

Varacolis-Which medications are currently approved for the treatment of male erectile disorder? Select all that apply. a. Sildenafil (Viagra) b. Flibanserin (Addyi) c. Tadalafil (Cialis) d. Vardenafil (Levitra) e. Avanafil (Stendra)

A,C,D,E

LEWIS 33-A patient had a nonST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Evaluation of the patients response to walking in the hallway b. Completion of the referral form for a home health nurse follow-up c. Education of the patient about the pathophysiology of heart disease d. Reinforcement of teaching about the purpose of prescribed medications

EVOLVE LEWIS 35-The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? Myocardia injury Myocardial ischemia Myocardial infarction A pacemaker is present.

Myocardial ischemia Correct

EVOLVE LEWIS 33-The nurse is examining the electrocardiogram (ECG) of a patient just admitted with a suspected MI. Which ECG change is mostindicative of prolonged or complete coronary occlusion? Sinus tachycardia Pathologic Q wave Fibrillatory P waves Prolonged PR interval

Pathologic Q wave Correct

EVOLVE LEWIS 35-A patient informs the nurse of experiencing syncope. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup? Preparing to assist with a head-up tilt-test Preparing an IV dose of a β-adrenergic blocker Assessing the patient's knowledge of pacemakers Teaching the patient about the role of antiplatelet aggregators

Preparing to assist with a head-up tilt-test Correct

EVOLVE LEWIS 35-The nurse observes ventricular tachycardia (VT) on the patient's monitor. What evaluation made by the nurse led to this interpretation? Unmeasurable rate and rhythm Rate 150 beats/min; inverted P wave Rate 200 beats/min; P wave not visible Rate 125 beats/min; normal QRS complex

Rate 200 beats/min; P wave not visible Correct

EVOLVE LEWIS 35-Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the electrocardiogram (ECG)? The length of time it takes to depolarize the atrium The length of time it takes for the atria to depolarize and repolarize The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers The length of time it takes for the electrical impulse to travel from the sinoatrial (SA) node to the atrioventricular (AV) node

The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers Correct

NCO-The school nurse is conducting a teacher's in-service on signs that may indicate that a child is a victim of bullying. Which sign should the nurse include in the teaching session? 1 The child wants to try out for the basketball team. 2 The child asks for extra work to make better grades. 3 The child is participating in several extracurricular activities after school. 4 The child asks to go to the nurse's office frequently with vague complaints

NCO-What is the best room assignment for a 5-year-old child admitted with injuries that may be related to abuse? 1 In an isolation room 2 With a friendly older child 3 With a child of the same age 4 In a room near the nurses' desk

. A common characteristic of those who sexually abuse children is that they: a. Pressure the victim into secrecy. b. Are usually unemployed and unmarried. c. Are unknown to victims and victims families. d. Have many victims that are each abused only once.

. When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that: a. The examiners hand should be placed over the fundus before, during, and after contractions. b. The frequency and duration of contractions is measured in seconds for consistency. c. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. d. The resting tone between contractions is described as either placid or turbulent.

LEWIS 35-After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patients heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions

NCO-The transition phase during which ovarian function and hormone production decline is called: a. the climacteric. b. menarche. c. menopause. d. puberty.

EVOLVE LEWIS 33-The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply.)? Flushing Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds

Ashen skin Correct Diaphoresis Correct Nausea and vomiting Correct S3 or S4 heart sounds Correct

EVOLVE LEWIS 31-A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient (select all that apply.)? Assess for return of gag reflex. Assess groin for hematoma or bleeding. Monitor vital signs and oxygen saturation. Position patient supine with head of bed flat. Assess lower extremities for circulatory compromise.

Assess for return of gag reflex. Correct Monitor vital signs and oxygen saturation. Correct

EVOLVE LEWIS 35-The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? Reinforcing the pressure dressing as needed Encouraging range-of-motion exercises of the involved arm Assessing the incision for any redness, swelling, or discharge Applying wet-to-dry dressings every 4 hours to the insertion site

Assessing the incision for any redness, swelling, or discharge Correct

EVOLVE LEWIS 31-In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? Atherosclerosis Hyperthyroidism Arteriovenous fistula Cardiac dysrhythmias

Atherosclerosis Correct

VARACOLIS-The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is: a. Transcranial magnetic stimulation b. Deep brain stimulation c. Vagus nerve stimulation d. Electroconvulsive therapy

VARACOLIS-What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? a. The caregiver is a single male relative. b. The caregiver was neglected as a child. c. The caregiver is under the age of 30. d. The caregiver has little experience with the elderly.

VARCAROLIS 28-A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, Ive considered leaving, but I made a vow and I must keep it no matter what happens. Which outcome should be met before discharge? The patient will: a. facilitate counseling for the abuser. b. name two community resources for help. c. demonstrate insight into the abusive relationship. d. reexamine cultural beliefs about marital commitment.

VARACOLIS-When a nurse uses therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to: a. Meditate in the quiet environment b. Ask simple questions even if the patient will not answer c. Use the technique of making observations d. Simply sit quietly and leave when the patient falls asleep

. The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: a. Altered cerebral blood flow. c. Umbilical cord compression. b. Fetal hypoxemia. d. Fetal sleep cycles.

EVOLVE LEWIS 53-The patient at the clinic complains of abdominal bloating, depression, and irritability related to premenstrual syndrome. What should the nurse recommend initially (select all that apply.)? Take diuretics. Exercise regularly. Take antidepressants. Take antianxiety agents. Increase pork, chicken, and milk intake. Consider psychological counseling to resolve symptoms.

Exercise regularly. Correct Increase pork, chicken, and milk intake. Correct

EVOLVE LEWIS 33-A patient experienced sudden cardiac death (SCD) and survived. Which preventive treatment should the nurse expect to be implemented? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)

Implantable cardioverter-defibrillator (ICD)

EVOLVE LEWIS 31-The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy information is most important for the nurse to assess and document before this procedure? Iron Iodine Aspirin Penicillin

Iodine

EVOLVE LEWIS 33-When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? Oxygen, nitroglycerin, aspirin, and morphine Aspirin, nitroprusside, dopamine, and oxygen Oxygen, furosemide (Lasix), nitroglycerin, and meperidine Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)

Oxygen, nitroglycerin, aspirin, and morphine Correct

EVOLVE LEWIS 31-A patient is admitted with severe dyspnea, a history of heart failure, and chronic obstructive lung disease. Which diagnostic study would the nurse expect to be elevated if the cause of dyspnea was cardiac related? Serum potassium Serum homocysteine High-density lipoprotein b-type natriuretic peptide (BNP)

b-type natriuretic peptide (BNP) Correct

NCO-A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? 1 Sertraline 2 Fluoxetine 3 Amphetamine 4 Carbamazepine

NCOA mother and her three young children arrive at the mental health clinic. The woman says that she is seeking help in leaving her husband. She reports that he has been beating her for years but just started hitting the children. What is the best initial action by the nurse? 1Arranging for a staff member to watch the children so the mother and nurse can talk 2Calling a facility where the mother and her children will be safe until the crisis is resolved 3Determining whether the mother is ambivalent about this decision before making permanent plans 4Suggesting that the mother and her husband return for couples counseling so the marriage can be saved

NCO-A nurse providing care in a hospital witnesses a client's spouse shaking the client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with which party? 1The client 2The client's spouse 3The client's primary healthcare provider 4Adult Protective Services

NCO-A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1"Maybe it was your husband's fault, too." 2"I can't agree with that—no one should be beaten." 3"Tell me why you believe that you deserve to be beaten." 4"You say that it was your fault—help me understand that."

GIDDENS 18-The patient asks the nurse to explain the sinoatrial node in the heart. The nurses best response would be, The sinoatrial node a. provides the heart with the stimulation to beat in a normal rhythm. b. protects the heart from atherosclerotic changes. c. provides the heart with oxygenated blood. d. protects the heart from infection.

GIDDENS 22-A 55-year-old male patient postmyocardial infarction (MI) queries the nurse caring for him whether he will be healthy enough for sexual activity after discharge from the hospital. The patient has been prescribed anti-hypertensives and beta-blockers. While health teaching, the nurse understands that the three phases of the four-stage model of the human sexual response cycle that are of concern for this patient include a. excitement, plateau, and orgasmic. b. plateau, orgasmic, and resolution. c. excitement, orgasmic, and resolution. d. arousal, excitement, and plateau.

GIDDENS 22-Preventing infection remains the most effective way of reducing the adverse consequences of sexually transmitted infections, in particular those that are not readily curable. Nurses are often able to reassure the patient enough to open dialog regarding possible exposure, testing, and treatment options. When assessing high-risk behaviors, which question specifically identifies a blood-related risk? a. Have you ever received donor semen, eggs, or transplanted tissue? b. Have you ever exchanged sex for drugs, money, or shelter? c. How do you protect yourself from HIV and sexually transmitted infections? d. Have you ever injected drugs using shared equipment?

GIDDENS 33-As a nurse in the emergency department, you are caring for a patient who is exhibiting signs of depression. What is a priority nursing intervention you should perform for this patient? a. Assess for depression and ask directly about suicide thoughts. b. Ask the care provider to prescribe blood lab work to assess for depression. c. Focus on the presenting problems and refer the patient for a mental health evaluation. d. Interview the patients family to identify their concerns about the patients behaviors.

GIDDENS 38-The nurse is reviewing case files for children at risk for injury resulting in brain injury. Which child is at most risk for experiencing this type of violence? a. A Caucasian, six-month-old infant living with a single mother b. An African-American, 24-month-old child living with her grandmother c. A Mexican, three-year-old child living in an inner city apartment d. A Japanese, eight-year-old child living in a home with three generations of family

In assisting with the two factors that have an effect on fetal status (i.e., pushing and positioning), nurses should: a. Encourage the womans cooperation in avoiding the supine position. b. Advise the woman to avoid the semi-Fowler position. c. Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response. d. Instruct the woman to open her mouth and close her glottis, letting air escape after the push.

LEWIS 31-The nurse hears a murmur between the S1 and S2 heart sounds at the patients left fifth intercostal space and midclavicular line. How will the nurse record this information? a. Systolic murmur heard at mitral area b. Systolic murmur heard at Erbs point c. Diastolic murmur heard at aortic area d. Diastolic murmur heard at the point of maximal impulse

LEWIS 31-The standard policy on the cardiac unit states, Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg. The nurse will need to call the health care provider about the a. postoperative patient with a BP of 116/42. b. newly admitted patient with a BP of 150/87. c. patient with left ventricular failure who has a BP of 110/70. d. patient with a myocardial infarction who has a BP of 140/86.

LEWIS 31-To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the a. bell of the stethoscope with the patient in the left lateral position. b. diaphragm of the stethoscope with the patient in a supine position. c. bell of the stethoscope with the patient sitting and leaning forward. d. diaphragm of the stethoscope with the patient lying flat on the left side.

LEWIS 33-A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, I just had a little chest pain. As soon as I get out of here, Im going for my vacation as planned. Which reply would be most appropriate for the nurse to make? a. What do you think caused your chest pain? b. Where are you planning to go for your vacation? c. Sometimes plans need to change after a heart attack. d. Recovery from a heart attack takes at least a few weeks.

LEWIS 33-Three days after experiencing a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with hygiene activities, saying, I am too nervous to take care of myself. Based on this information, which nursing diagnosis is appropriate? a. Ineffective coping related to anxiety b. Activity intolerance related to weakness c. Denial related to lack of acceptance of the MI d. Disturbed personal identity related to understanding of illness

LEWIS 33-When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Give the scheduled aspirin and lipid-lowering medication. b. Perform the initial assessment of the catheter insertion site. c. Teach the patient about the usual postprocedure plan of care. d. Titrate the heparin infusion according to the agency protocol.

LEWIS 33-Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? a. No change in the patients chest pain b. An increase in troponin levels from baseline c. A large bruise at the patients IV insertion site d. A decrease in ST-segment elevation on the electrocardiogram

LEWIS 34-A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurses priority action will be to a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

LEWIS 34-After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

LEWIS 34-During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of feeling too tired to get out of bed. Based on these data, the bestnursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion.

LEWIS 34-Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide slowly before stopping. d. Teach patient about home use of the drug.

LEWIS 35-A 20-year-old has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54, and the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further diagnostic testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the students family health history.

LEWIS 35-A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about a. anticoagulant therapy. b. permanent pacemakers. c. electrical cardioversion. d. IV adenosine (Adenocard).

LEWIS 35-A patients cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? a. Perform immediate defibrillation. b. Give epinephrine (Adrenalin) IV. c. Prepare for endotracheal intubation. d. Give ventilations with a bag-valve-mask device.

LEWIS 35-To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patients a. P wave. b. Q wave. c. P-R interval. d. QRS complex.

LEWIS 35-Which action by a new registered nurse (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias? a. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia b. Obtains the defibrillator and quickly brings it to the bedside of a patient whose monitor shows asystole c. Turns the synchronizer switch to the on position before defibrillating a patient with ventricular fibrillation d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block

LEWIS 35-Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? a. Instruct the patient to call for assistance before getting out of bed. b. Explain the association between various dysrhythmias and syncope. c. Educate the patient about the need to avoid caffeine and other stimulants. d. Tell the patient about the benefits of implantable cardioverter-defibrillators.

LEWIS 35-Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? a. The nurse assists the patient to do active range of motion exercises for all extremities. b. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID. c. The nurse gives amiodarone (Cordarone) to the patient without first consulting with the health care provider. d. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.

LEWIS 53-A 28-year-old patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Ask the patient to keep track of her symptoms in a diary for 3 months. b. Suggest that the patient try aerobic exercise to decrease her symptoms. c. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. d. Advise the patient to use nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Advil) to control symptoms.

LEWIS 53-A 50-year-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan? a. The symptoms may decrease after the patient undergoes menopause. b. The tumor size is likely to increase throughout the patients lifetime. c. Aspirin or acetaminophen may be used to control mild to moderate pain. d. The patient will need frequent monitoring to detect any malignant changes.

LEWIS 53-A 56-year-old woman is concerned about having a moderate amount of vaginal bleeding after 4 years of menopause. The nurse will anticipate teaching the patient about a. endometrial biopsy. b. endometrial ablation. c. uterine balloon therapy. d. dilation and curettage (D&C).

VARACOLIS-Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."

VARACOLIS-Which patient has the greatest risk for suicide? a. A patient who expresses the inability to stop searching the internet for child pornography. b. A patient who reports having lost interest in having a sexual relationship with his wife. c. A patient with a history of exposing himself to female strangers on the bus. d. A patient whose attraction to prepubescent girls has increased.

VARACOLIS-Which statement describes a common sexual side effect of diazepam (Valium)? a. "I'm just not interested in sex as much." b. "I'm experiencing vaginal dryness." c. "I don't have organisms anymore." d. "My breasts have gotten larger."

VARCAROLIS 14-A patient became depressed after the last of the familys six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will: a. verbalize realistic positive characteristics about self by (date). b. agree to take an antidepressant medication regularly by (date). c. initiate social interaction with another person daily by (date). d. identify two personal behaviors that alienate others by (date).

VARCAROLIS 14-A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective? a. Make observations. b. Ask the patient direct questions. c. Phrase questions to require yes or no answers. d. Frequently reassure the patient to reduce guilt feelings.

VARCAROLIS 14-Which documentation for a patient diagnosed with major depression indicates the treatment plan was effective? a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. b. Slept 10 hours uninterrupted. Attended craft group; stated project was a failure, just like me. c. Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. d. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, I feel tired all the time.

VARCAROLIS 20-A man who regularly experiences premature ejaculation tells the nurse, I feel like such a failure. Its so awful for both me and my partner. Select the nurses most therapeutic response. a. I sense you are feeling frustrated and upset. b. Tell me more about feeling like a failure. c. You are too hard on yourself. d. What do you mean by awful?

VARCAROLIS 20-A nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patients sexual practices? a. Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern? b. Sexual health can reflect a number of medical problems, so Id like to ask if you have any sexual problems you think we should know about. c. Its your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please? d. I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment.

VARCAROLIS 20-A nurse is performing an assessment for a 59-year-old man who has hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment? a. Sexual dysfunction may result from use of prescription medications for management of hypertension. b. Such questions are an indirect way of learning about the patients medication adherence. c. These questions ease the transition to questions about sexual practices in general. d. Sexual dysfunction can cause stress and contribute to increased blood pressure.

VARCAROLIS 20-An adult experienced a myocardial infarction six months ago. At a follow-up visit, this adult says, I havent had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I dont know if my heart is strong enough. Which nursing diagnosis applies? a. Deficient knowledge related to faulty perception of health status b. Disturbed self-concept related to required lifestyle changes c. Disturbed body image related to treatment side effects d. Sexual dysfunction related to self-esteem disturbance

VARCAROLIS 28-A patient tells the nurse, My husband lost his job. Hes abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me. What risk factor was most predictive for the husband to become abusive? a. History of family violence c. Abuse of alcohol b. Loss of employment d. Poverty

VARCAROLIS 28-After treatment for a detached retina, a survivor of intimate partner abuse says, My partner only abuses me when I make mistakes. Ive considered leaving, but I was brought up to believe you stay together, no matter what happens. Which diagnosis should be the focus of the nurses initial actions? a. Risk for injury related to physical abuse from partner b. Social isolation related to lack of a community support system c. Ineffective coping related to uneven distribution of power within a relationship d. Deficient knowledge related to resources for escape from an abusive relationship

VARCAROLIS 28-An 11-year-old says, My parents dont like me. They call me stupid and say they wish I were never born. It doesnt matter what they think because I already know Im dumb. Which nursing diagnosis applies to this child? a. Chronic low self-esteem related to negative feedback from parents b. Deficient knowledge related to interpersonal skills with parents c. Disturbed personal identity related to negative self-evaluation d. Complicated grieving related to poor academic performance

EVOLVE LEWIS 34-A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritizewhen providing care for this patient? Taper the patient off his current medications. Continue education for the patient and his family. Pursue experimental therapies or surgical options. Choose interventions to promote comfort and prevent suffering.

Choose interventions to promote comfort and prevent suffering.

GIDDENS 22-Primary strategies are those that are implemented in order to avoid the development of disease. These strategies can be either population-based or individually-based. As a school nurse, you are developing a curriculum for a junior human sexuality class. In order to provide the most up-to-date information, you are aware that the single most effective primary prevention strategy for preventing sexually transmitted diseases is a. a vaccine to prevent HPV infection. b. HIV screening. c. education directed at high-risk behaviors. d. the male condom.

GIDDENS 33-A patient newly diagnosed with depression states, I have had other people in my family say that they have depression. Is this an inherited problem? What is the nurses best response? a. There are a lot of mood disorders that are caused by many different causes. Inheriting these disorders is not likely. b. Current research is focusing on fluid and electrolyte disorders as a cause for mood disorders. c. All of your family members raised in the same area have probably learned to respond to problems in the same way. d. Members of the same family may have the same biological predisposition to experiencing mood disorders.

GIDDENS 33-A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient? a. The medication dose needs to be decreased. b. Treatment is successful, and medication can be stopped. c. The patient is ready to return to work. d. Specific assessment for suicide plan must be evaluated.

LEWIS 31-After noting a pulse deficit when assessing a 74-year-old patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require a. emergent cardioversion. b. a cardiac catheterization. c. hourly blood pressure (BP) checks. d. electrocardiographic (ECG) monitoring.

LEWIS 31-During a physical examination of a 74-year-old patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to a. ask the patient about risk factors for atherosclerosis. b. document that the PMI is in the normal anatomic location. c. auscultate both the carotid arteries for the presence of a bruit. d. assess the patient for symptoms of left ventricular hypertrophy.

LEWIS 31-The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. connect the recorder to a computer once daily. b. exercise more than usual while the monitor is in place. c. remove the electrodes when taking a shower or tub bath. d. keep a diary of daily activities while the monitor is worn.

LEWIS 31-To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? a. Troponin b. Homocysteine (Hcy) c. Low-density lipoprotein (LDL) d. B-type natriuretic peptide (BNP)

LEWIS 31-When reviewing the 12-lead electrocardiograph (ECG) for a healthy 79-year-old patient who is having an annual physical examination, what will be of most concern to the nurse? a. The PR interval is 0.21 seconds. b. The QRS duration is 0.13 seconds. c. There is a right bundle-branch block. d. The heart rate (HR) is 42 beats/minute.

LEWIS 31-When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse? a. Patient complaint of feeling tired b. Pulse change from 87 to 101 beats/minute c. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg d. Newly inverted T waves on the electrocardiogram

LEWIS 31-While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next? a. Document this finding in the patients record. b. Obtain vital signs, including oxygen saturation. c. Have the patient perform the Valsalva maneuver. d. Observe for JVD with the patient upright at 45 degrees.

LEWIS 31-While doing the admission assessment for a thin 76-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? a. Teach the patient about aneurysms. b. Notify the hospital rapid response team. c. Instruct the patient to remain on bed rest. d. Document the finding in the patient chart.

LEWIS 33-A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI? a. Myoglobin b. Homocysteine c. C-reactive protein d. Cardiac-specific troponin

LEWIS 33-A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is mostappropriate when giving the medication? a. Have the patient take this medication with an aspirin. b. Administer the medication at the patients usual bedtime. c. Have the patient take the colesevelam with a sip of water. d. Give the patients other medications 2 hours after the colesevelam.

LEWIS 33-After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. 39-year-old with pericarditis who is complaining of sharp, stabbing chest pain b. 56-year-old with variant angina who is to receive a dose of nifedipine (Procardia) c. 65-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge d. 59-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

LEWIS 33-After reviewing a patients history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? a. Q waves on ECG b. Elevated troponin levels c. Fever and hyperglycemia d. Tachypnea and crackles in lungs

LEWIS 34-A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. Furosemide (Lasix) 60 mg b. Captopril (Capoten) 25 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg

LEWIS 34-Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. b. b-adrenergic blockers. c. calcium channel blockers. d. angiotensin-converting enzyme (ACE) inhibitors.

LEWIS 34-The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 pounds in 24 hours b. Hourly urine output greater than 60 mL c. Reduction in patient complaints of chest pain d. Reduced dyspnea with the head of bed at 30 degrees

LEWIS 34-When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. eggs and other high-protein foods. d. milk, yogurt, and other milk products.

LEWIS 35-. The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? a. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago b. A patient with new onset atrial fibrillation, rate 88, who has a first dose of warfarin (Coumadin) due c. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating d. A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due

LEWIS 35-A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next? a. Recheck the heart rhythm and BP in 5 minutes. b. Have the patient perform the Valsalva maneuver. c. Give the scheduled dose of diltiazem (Cardizem). d. Apply the transcutaneous pacemaker (TCP) pads.

LEWIS 35-A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the health care provider immediately. b. give atropine per agency dysrhythmia protocol. c. prepare the patient for temporary pacemaker insertion. d. document the finding and continue to monitor the patient.

LEWIS 35-A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next? a. Immediately notify the health care provider. b. Document the rhythm and continue to monitor the patient. c. Perform synchronized cardioversion per agency dysrhythmia protocol. d. Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.

LEWIS 35-A patients cardiac monitor shows sinus rhythm, rate 64. The P-R interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next? a. Place the transcutaneous pacemaker pads on the patient. b. Administer atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Document the patients rhythm and assess the patients response to the rhythm. d. Call the health care provider before giving the next dose of metoprolol (Lopressor).

LEWIS 35-After providing a patient with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the patient states a. I will avoid cooking with a microwave oven or being near one in use. b. It will be 1 month before I can take a bath or return to my usual activities. c. I will notify the airlines when I make a reservation that I have a pacemaker. d. I wont lift the arm on the pacemaker side up very high until I see the doctor.

LEWIS 35-The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Calculate the number of small squares between one QRS complex and the next and divide into 1500. d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.

LEWIS 35-The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patients cardiac rhythm as a. atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

LEWIS 35-Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is mostimportant for the nurse to communicate to the health care provider? a. Blood glucose 243 mg/dL b. Serum chloride 92 mEq/L c. Serum sodium 134 mEq/L d. Serum potassium 2.9 mEq/L

LEWIS 53-A 49-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which initial response by the nurse is most appropriate? a. A frequent cause of spotting is endometrial cancer. b. How long has it been since your last menstrual period? c. Breakthrough bleeding is not unusual in women your age. d. Are you using prescription hormone replacement therapy?

VARCAROLIS 14-A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? a. Dry mouth c. Nasal congestion b. Blurred vision d. Urinary retention

EVOLVE LEWIS 35-The patient has a potassium level of 2.9 mEq/L, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm, the P wave is 0.06 seconds (sec) and normal shape, the PR interval is 0.24 sec, and the QRS is 0.09 sec. How should the nurse document this rhythm? First-degree AV block Second-degree AV block Premature atrial contraction (PAC) Premature ventricular contraction (PVC)

First-degree AV block Correct

EVOLVE LEWIS 34-What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? Acute anxiety Hypotension and tachycardia Peripheral edema and weight gain Paroxysmal nocturnal dyspnea (PND)

Hypotension and tachycardia Correct

EVOLVE LEWIS 31-A patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? IV sedation may be administered to help the patient relax. Food and fluids are restricted for 2 hours before the procedure. Ambulation is restricted for up to 6 hours before the procedure. Contrast medium is injected into the esophagus to enhance images.

IV sedation may be administered to help the patient relax. Correct

EVOLVE LEWIS 33-The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact? Palpate the insertion site for induration. Assess peripheral pulses in the right leg. Inspect the patient's right side and back. Compare the color of the left and right legs.

Inspect the patient's right side and back. Correct

EVOLVE LEWIS 33-A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months, she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? Exercise almost every day. Avoid saturated fat intake. Limit calories to daily limit. Keep Hgb A1C (A1C) less than 7%.

Keep Hgb A1C (A1C) less than 7%. Correct

EVOLVE LEWIS 54-The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? Give the patient choices for penile implant surgery. Recommend counseling for the patient and his partner. Obtain a thorough sexual, health, and psychosocial history. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

Obtain a thorough sexual, health, and psychosocial history. Correct

EVOLVE LEWIS 34-A patient with a recent diagnosis of heart failure has been prescribed furosemide. What outcome does the nurse anticipate will occur that demonstrates medication effectiveness? Promote vasodilation. Reduction of preload. Decrease in afterload. Increase in contractility.

Reduction of preload. Correct

EVOLVE LEWIS 34-After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? ADHF Chronic HF Left-sided HF Right-sided HF

Right-sided HF

EVOLVE LEWIS 31-The nurse is caring for an older adult patient. What age-related cardiovascular changes should the nurse assess for when providing care for this patient (select all that apply.)? Systolic murmur Diminished pedal pulses Increased maximal heart rate Decreased maximal heart rate Increased recovery time from activity

Systolic murmur Correct Diminished pedal pulses Correct Decreased maximal heart rate Correct Increased recovery time from activity Correct

EVOLVE LEWIS 34-The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)? Take medications as prescribed. Use oxygen when feeling short of breath. Only ask the physician's office questions. Encourage most activity in the morning when rested.

Take medications as prescribed. Correct

EVOLVE LEWIS 35-The nurse determines there is artifact on the patient's telemetry monitor. Which factor should the nurse assess for that could correct this issue? Disabled automaticity Electrodes in the wrong lead Too much hair under the electrodes Stimulation of the vagus nerve fibers

Too much hair under the electrodes Correct

EVOLVE LEWIS 31-A patient presents to the emergency department with reports of chest pain for 3 hours. What component of his blood work is mostclearly indicative of a myocardial infarction (MI)? CK-MB Troponin Myoglobin C-reactive protein

Troponin Correct

EVOLVE LEWIS 31-The nurse is performing an assessment for a patient with fatigue and shortness of breath. Auscultation of the heart reveals the presence of a murmur. What is this assessment finding indicative of? Increased viscosity of the patient's blood Turbulent blood flow across a heart valve Friction between the heart and the myocardium A deficit in heart conductivity that impairs normal contractility

Turbulent blood flow across a heart valve Correct

EVOLVE LEWIS 35-The nurse prepares to defibrillate a patient. For which dysrhythmia has the nurse observed in this patient? Ventricular fibrillation Third-degree AV block Uncontrolled atrial fibrillation Ventricular tachycardia with a pulse

Ventricular fibrillation Correct

GIDDENS 38-The nurse working at a womens health clinic is seeing a teenage female patient who has come in for a refill on her birth control medication and with a complaint of abdominal pain. When the nurse enters the room, the patient is sitting in the chair with her head down, rocking back and forth, does not make eye contact, and answers questions with no expression on her face. What assessment question would be important for the nurse to ask the patient? a. What brings you to the clinic today? b. What can we do to help you today? c. Do you feel safe in your current relationship? d. Have you changed your diet lately?

LEWIS 35-A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patients vital signs including oxygen saturation.

LEWIS 35-Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter? a. The procedure will prevent or minimize the risk for sudden cardiac death. b. The procedure will use cold therapy to stop the formation of the flutter waves. c. The procedure will use electrical energy to destroy areas of the conduction system. d. The procedure will stimulate the growth of new conduction pathways between the atria.

VARCAROLIS 28-A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? Select all that apply. a.Keep a cell phone fully charged. b.Hide money with which to buy new clothes. c.Have the phone number for the nearest shelter. d.Take enough toys to amuse the children for 2 days. e.Secure a supply of current medications for self and children. f.Assemble birth certificates, Social Security cards, and licenses. g.Determine a code word to signal children when it is time to leave.

A, C, E, F, G

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply): a. The child spends an inordinate amount of time in the nurses office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his or her day.

A,B,C

VARCAROLIS 14-A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply. a. Offer laxatives if needed. b. Monitor food and fluid intake. c. Provide a quiet sleep environment. d. Eliminate all daily caffeine intake. e. Restrict intake of processed foods.

A,B,C

LEWIS 53-Which nonhormonal therapies will the nurse suggest for a healthy perimenopausal woman who prefers not to use hormone therapy (HT) (select all that apply)? a. Reduce coffee intake. b. Exercise several times a week. c. Take black cohosh supplements. d. Have a glass of wine in the evening. e. Increase intake of dietary soy products.

A,B,C,E

VARACOLIS-Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply. a. Phobias b. Low self-esteem c. Major depressive disorder d. Narcissistic personality disorder e. Posttraumatic stress disorder

A,B,C,E

GIDDENS 38-The nurse is admitting a child with a history of abuse. The nurse understands that the child may exhibit what behaviors that are consequences of being in an abusive environment? (Select all that apply.) a. Reliving abuse incidents b. Sleep disturbance c. Overeating d. Acting out behaviors e. Intermittent fever

A,B,D

VARACOLIS-Perpetrators of domestic violence tend to: Select all that apply. a. Have relatively poor social skills and to have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. c. Force their mates to work and expect them to handle the financial decisions. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

A,B,D,E

. Possible alternative and complementary therapies for postpartum depression (PPD) for breastfeeding mothers include (Select all that apply): a. Acupressure. d. Wine consumption. b. Aromatherapy. e. Yoga. c. St. Johns wort.

A,B,E

VARCAROLIS 14-A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, I took a few extra tablets earlier today and now I feel bad. Which assessments are most critical? Select all that apply. a. Vital signs b. Urinary frequency c. Psychomotor retardation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness

A,D,E

VARACOLIS-Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population? a. Conducting routine suicide screenings at a senior center. b. Identifying depression as a natural, but treatable result of aging. c. Identifying males as being at a greater risk for developing depression. d. Stressing that most individuals experience just a single episode of major depression in a lifetime.

EVOLVE LEWIS 33-For which problem is percutaneous coronary intervention (PCI) most clearly indicated? Chronic stable angina Left-sided heart failure Coronary artery disease Acute myocardial infarction

Acute myocardial infarction

EVOLVE LEWIS 35-A patient reports dizziness and shortness of breath and is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole? Digoxin Adenosine Metoprolol Atropine sulfate

Adenosine Correct

EVOLVE LEWIS 34-A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply.)? Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Position patient on left side with head of bed flat. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient.

Administer ordered morphine sulfate. Correct Position patient in a semi-Fowler's position. Correct Instruct patient on the use of relaxation techniques. Correct Use a calm, reassuring approach while talking to patient. Correct

EVOLVE LEWIS 34-A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? Perform a bladder scan to assess for urinary retention. Restrict the patient's oral fluid intake to 500 mL per day. Assist the patient to a sitting position with arms on the overbed table. Instruct the patient to use pursed-lip breathing until the dyspnea subsides.

Assist the patient to a sitting position with arms on the overbed table. Correct

EVOLVE LEWIS 33-Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which common complication? Dehydration Paralytic ileus Atrial dysrhythmias Acute respiratory distress syndrome

Atrial dysrhythmias Correct

EVOLVE LEWIS 35-The nurse observes no P waves on the patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. What does the nurse determine the rhythm to be? Sinus tachycardia Atrial fibrillation Ventricular fibrillation Ventricular tachycardia

Atrial fibrillation Correct

GIDDENS 22-A thorough assessment of sexual health includes laboratory and other diagnostic procedures. Tests are ordered at the providers discretion based upon gender and lifestyle of the patient. A 37-year-old heterosexual African-American man has come for his annual health screening. Which test must the nurse ensure is ordered for this patient? a. Human papilloma virus (HPV) b. Prostate-specific antigen (PSA) c. HIV d. Venereal disease research laboratory (VDRL)

GIDDENS 33-An older adult has experienced severe depression for many years and is unable to tolerate most antidepressant medications due to adverse effects of the medications. He is scheduled for electroconvulsive therapy (ECT) as a treatment for his depression. What teaching should the nurse give the patient regarding this treatment? a. There are no special preparations needed before this treatment. b. Common side effects include headache and short-term memory loss. c. One treatment will be needed to cure the depression. d. This treatment will leave you unconscious for several hours.

GIDDENS 38-A nurse is caring for a patient in the emergency department who has been a victim of intimate partner violence. What is most important for the nurse to include in the plan of care? a. Medication to calm the perpetrator of the violence b. A list of community resources c. A referral for self-defense training d. A referral to the victims religious advisor

GIDDENS 38-Critical Thinking: A crisis intervention nurse is training emergency department staff on treatment needs of persons in abusive relationships. What is a common difficulty staff encounter when caring for this population? a. There is not a good legal pathway to help persons in abusive relationships. b. The abused person may return to the abusive home setting. c. Hospital policies do not identify the legal care needed for abused persons. d. Because length of care is short in the emergency department, there is little staff can do for patients who have been abused.

GIDDENS 38-The nurse is seeing a patient who has been in the clinic eight times in the past 6 months for injuries from an abusive partner. The patient states, I dont see any way to get away from my partner, and I cant keep going on like this. What assessment question is most important for the nurse to ask? a. Do you have any family in the area that can help? b. Have you thought about hurting yourself or someone else? c. Have you thought about moving to a different city? d. Have you discussed this with anyone else?

LEWIS 31-A patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that a. it will be important to lie completely still during the procedure. b. a flushed feeling may be noted when the contrast dye is injected. c. monitored anesthesia care will be provided during the procedure. d. arterial pressure monitoring will be required for 24 hours after the test.

LEWIS 31-A registered nurse (RN) is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse a. presses on the skin over the tibia for 10 seconds to check for edema. b. palpates both carotid arteries simultaneously to compare pulse quality. c. documents a murmur heard along the right sternal border as a pulmonic murmur. d. places the patient in the left lateral position to check for the point of maximal impulse.

LEWIS 31-A transesophageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which action included in the standard TEE orders will the nurse need to accomplish first? a. Start an IV line. b. Place the patient on NPO status. c. Administer O2 per nasal cannula. d. Give lorazepam (Ativan) 1 mg IV.

LEWIS 31-The nurse and unlicensed assistive personnel (UAP) on the telemetry unit are caring for four patients. Which nursing action can be delegated to the UAP? a. Teaching a patient scheduled for exercise electrocardiography about the procedure b. Placing electrodes in the correct position for a patient who is to receive ECG monitoring c. Checking the catheter insertion site for a patient who is recovering from a coronary angiogram d. Monitoring a patient who has just returned to the unit after a transesophageal echocardiogram

LEWIS 31-When admitting a patient for a cardiac catheterization and coronary angiogram, which information about the patient is most important for the nurse to communicate to the health care provider? a. The patients pedal pulses are +1. b. The patient is allergic to shellfish. c. The patient had a heart attack a year ago. d. The patient has not eaten anything today.

LEWIS 31-When assessing a newly admitted patient, the nurse notes a murmur along the left sternal border. To document more information about the murmur, which action will the nurse take next? a. Find the point of maximal impulse. b. Determine the timing of the murmur. c. Compare the apical and radial pulse rates. d. Palpate the quality of the peripheral pulses.

LEWIS 33-A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about when sexual intercourse can be resumed. Which response by the nurse is best? a. Most patients are able to enjoy intercourse without any complications. b. Sexual activity uses about as much energy as climbing two flights of stairs. c. The doctor will provide sexual guidelines when your heart is strong enough. d. Holding and cuddling are good ways to maintain intimacy after a heart attack.

LEWIS 33-After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. Carvedilol will help my heart muscle work harder. b. It is important not to suddenly stop taking the carvedilol. c. I can expect to feel short of breath when taking carvedilol. d. Carvedilol will increase the blood flow to my heart muscle.

LEWIS 33-Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetals (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will a. reduce heart palpitations. b. decrease spasm of the coronary arteries. c. increase the force of the heart contractions. d. help prevent plaque from forming in the coronary arteries.

LEWIS 33-The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the a. patient is restless and agitated. b. blood pressure is 90/54 mm Hg. c. patient complains about feeling anxious. d. cardiac monitor shows a heart rate of 61 beats/minute.

LEWIS 33-To improve the physical activity level for a mildly obese 71-year-old patient, which action should the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity.

LEWIS 33-When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that a. sudden cardiac death events rarely reoccur. b. additional diagnostic testing will be required. c. long-term anticoagulation therapy will be needed. d. limited physical activity after discharge will be needed to prevent future events.

LEWIS 33-When titrating IV nitroglycerin (Tridil) for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? a. Monitor heart rate. b. Ask about chest pain. c. Check blood pressure. d. Observe for dysrhythmias.

LEWIS 33-Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms.

LEWIS 33-Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

LEWIS 34-A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most appropriate? a. Because you have diabetes, you would not be a candidate for a heart transplant. b. The choice of a patient for a heart transplant depends on many different factors. c. Your heart failure has not reached the stage in which heart transplants are needed. d. People who have heart transplants are at risk for multiple complications after surgery.

LEWIS 34-Patient who is taking carvedilol (Coreg) and has a heart rate of 58 Patient who is taking digoxin and has a potassium level of 3.1 mEq/L Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

LEWIS 35-A 19-year-old student comes to the student health center at the end of the semester complaining that, My heart is skipping beats. An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take next? a. Start supplemental O2 at 2 to 3 L/min via nasal cannula. b. Ask the patient about current stress level and caffeine use. c. Ask the patient about any history of coronary artery disease. d. Have the patient taken to the hospital emergency department (ED).

LEWIS 35-A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Administer atropine per agency dysrhythmia protocol. d. Provide supplemental oxygen via non-rebreather mask.

LEWIS 35-Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the off position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device.

LEWIS 53-A 34-year-old woman who is discussing contraceptive options with the nurse says, I want to have children, but not for a few years. Which response by the nurse is appropriate? a. If you do not become pregnant within the next few years, you never will. b. You may have more difficulty becoming pregnant after about age 35. c. You have many years of fertility left, so there is no rush to have children. d. You should plan to stop taking oral contraceptives several years before you want to become pregnant.

LEWIS 53-A 63-year-old woman undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan? a. Encourage a high-fiber diet. b. Perform indwelling catheter care. c. Repack the vagina with gauze daily. d. Teach the patient to insert a pessary.

LEWIS 54- A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask first to assess for possible etiologic factors? a. Do you experience an unusual amount of stress? b. Do you use any recreational drugs or drink alcohol? c. Do you have chronic cardiovascular or peripheral vascular disease? d. Do you have a history of an erection that lasted for 6 hours or more?

LEWIS 54-A 52-year-old man tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife is losing patience with the situation. The most appropriate nursing diagnosis for the patient is a. situational low self-esteem related to effects of ED. b. ineffective role performance related to effects of ED. c. anxiety related to inability to have sexual intercourse. d. ineffective sexuality patterns related to infrequent intercourse.

LEWIS 54-A 58-year-old man with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first? a. Assure the patient that ED is common with aging. b. Ask the patient about any prescription drugs he is taking. c. Tell the patient that Viagra does not always work for ED. d. Discuss the common adverse effects of erectogenic drugs.

LEWIS 54-The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first? a. A 48-year-old man who has perineal pain and a temperature of 100.4 F b. A 58-year-old man who has a painful erection that has lasted over 6 hours c. A 38-year-old man who states he had difficulty maintaining an erection last night d. A 68-year-old man who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago

LEWIS 54-The nurse performing a focused examination to determine possible causes of infertility will assess for a. hydrocele. b. varicocele. c. epididymitis. d. paraphimosis.

The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by: a. Altered fetal cerebral blood flow. c. Uteroplacental insufficiency. b. Umbilical cord compression. d. Fetal hypoxemia.

VARACOLIS-. Which statement made by a new mother should be explored further by the nurse? a. "I have three children, that's enough." b. "I think the baby cries just to make me angry." c. "I wish my husband could help more with the baby." d. "Babies are a blessing, but they are a lot of work."

VARACOLIS-An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: a. A decrease in family interaction so that there are fewer opportunities for abuse to occur. b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses. c. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy. d. A triad of treatment modalities, including medication, counseling, and role-playing opportunities.

VARACOLIS-Secondary effects of abuse often manifest as arrested development in children due to the fact that: a. Coping is easier than emotional growth b. Energy for development is diverted to coping c. Children cannot differentiate love from abuse d. Abuse fosters a sense of belonging, even if dysfunctional

VARACOLIS-The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and the elderly due to: a. The love they have for parents or children. b. Their limited options. c. The need to feel safe at home. d. Other relatives do not want them.

VARCAROLIS 14-. A patient diagnosed with major depression says, No one cares about me anymore. Im not worth anything. Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient? a. You look nice this morning. c. I like the shirt you are wearing. b. Youre wearing a new shirt. d. You must be feeling better today.

VARCAROLIS 14-A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. hypotensive shock. c. cardiac dysrhythmia. b. hypertensive crisis. d. cardiogenic shock.

VARCAROLIS 14-A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve? a. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee b. Mashed potatoes, ground beef patty, corn, green beans, apple pie c. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

VARCAROLIS 14-A patient diagnosed with depression repeatedly tells staff, I have cancer. Its my punishment for being a bad person. Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. a. Powerlessness c. Stress overload b. Risk for suicide d. Spiritual distress

VARCAROLIS 14-A patient diagnosed with major depression tells the nurse, Bad things that happen are always my fault. Which response by the nurse will best assist the patient to reframe this overgeneralization? a. I really doubt that one person can be blamed for all the bad things that happen. b. Lets look at one bad thing that happened to see if another explanation exists. c. You are being extremely hard on yourself. Try to have a positive focus. d. Are you saying that you dont have any good things happen?

VARCAROLIS 14-A patient says to the nurse, My life doesnt have any happiness in it anymore. I once enjoyed holidays, but now theyre just another day. The nurse documents this report as an example of: a. dysthymia. c. euphoria. b. anhedonia. d. anergia.

VARCAROLIS 14-During a psychiatric assessment, the nurse observes a patients facial expression is without emotion. The patient says, Life feels so hopeless to me. Ive been feeling sad for several months. How will the nurse document the patients affect and mood? a. Affect depressed; mood flat c. Affect labile; mood euphoric b. Affect flat; mood depressed d. Affect and mood are incongruent.

VARCAROLIS 14-Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include: a. distracting the patient from self-absorption. b. careful unobtrusive observation around the clock. c. allowing the patient to spend long periods alone in meditation. d. opportunities to assume a leadership role in the therapeutic milieu.

VARCAROLIS 14-Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depression. Which comment by the patient indicates teaching about the procedure was effective? a. They will put me to sleep during the procedure so I wont know what is happening. b. I might be a little dizzy or have a mild headache after each procedure. c. I will be unable to care for my children for about 2 months. d. I will avoid eating foods that contain tyramine.

VARCAROLIS 20-A man who reports frequently experiencing premature ejaculation tells the nurse, I feel like such a failure. Its so awful for both me and my partner. Can you help me? Select the nurses best response. a. Have you discussed this problem with your partner? b. I can refer you to a practitioner who can help you with this problem. c. Have you asked your health care provider for prescription medication? d. There are several techniques described in this pamphlet that might be helpful.

VARCAROLIS 28-What feelings are most commonly experienced by nurses working with abusive families? a. Outrage toward the victim and discouragement regarding the abuser b. Helplessness regarding the victim and anger toward the abuser c. Unconcern for the victim and dislike for the abuser d. Vulnerability for self and empathy with the abuser

VARCAROLIS 28-Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Self-awareness enhances the nurses advocacy role. b. Strong negative feelings interfere with assessment and judgment. c. Strong positive feelings lead to healthy transference with the victim. d. Positive feelings promote the development of sympathy for patients.

What correctly matches the type of deceleration with its likely cause? a. Early decelerationumbilical cord compression b. Late decelerationuteroplacental inefficiency c. Variable decelerationhead compression d. Prolonged decelerationcause unknown

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. a. Call the provider, reposition the mother, and perform a vaginal examination. b. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. c. Administer oxygen to the mother, increase IV fluid, and notify the care provider. d. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

Why is continuous electronic fetal monitoring usually used when oxytocin is administered? a. The mother may become hypotensive. b. Uteroplacental exchange may be compromised. c. Maternal fluid volume deficit may occur. d. Fetal chemoreceptors are stimulated.

VARACOLIS-Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply. a. "Do rules apply to you?" b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?" e. "Have you ever been arrested for committing a crime?"

B,C,D

A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. These categories include (Select all that apply): a. Reassuring. b. Category I. c. Category II. d. Nonreassuring. e. Category III.

B,C,E

VARACOLIS-Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply. a. Female b. 7 years old c. Comorbid autism diagnosis d. Outbursts occur at least once a week e. Temper tantrums occur at home and in school

B,C,E

GIDDENS 18-A patient was diagnosed with hypertension. The patient asks the nurse how this disease could have happened to them. The nurses best response is Hypertension a. happens to everyone sooner or later. Dont be concerned about it. b. can happen from eating a poor diet, so change what you are eating. c. can happen from arterial changes that impede the blood flow. d. happens when people do not exercise, so you should walk every day.

GIDDENS 22-Symptoms of sexual dysfunction and altered body image often coexist with prolapse of the female reproductive organs. Nursing care requires a great deal of sensitivity, because many women are embarrassed by their condition. Your patient is a 44-year-old married woman who is complaining of painful intercourse and incontinence. Clinical evaluation reveals that the patient has a cystocele. Which treatment option is most appropriate for this patient? a. Pelvic floor training b. Vaginal pessaries c. Surgical correction d. Lifestyle changes

GIDDENS 33-A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient? a. Serum blood levels must be regularly monitored to assess for toxicity. b. To prevent side effects, the medication should be administered as an intramuscular injection. c. Eating foods such as blue cheese or red wine will cause side effects. d. This medication class may only be used safely for a few days at a time.

GIDDENS 38-The nurse is counseling women at a crisis shelter about risk factors for increased intimate partner violence. What event is most likely to trigger an increase in abusive behaviors? a. Moving to a new community b. Starting a new job c. Becoming pregnant d. The death of a grandfather

LEWIS 31-The nurse is reviewing the laboratory results for newly admitted patients on the cardiovascular unit. Which patient laboratory result is most important to communicate as soon as possible to the health care provider? a. Patient whose triglyceride level is high b. Patient who has very low homocysteine level c. Patient with increase in troponin T and troponin I level d. Patient with elevated high-sensitivity C-reactive protein level

LEWIS 31-When the nurse is screening patients for possible peripheral arterial disease, indicate where the posterior tibial artery will be palpated. a.1 b.2 c.3 d.4

LEWIS 31-Which action will the nurse implement for a patient who arrives for a calcium-scoring CT scan? a. Insert an IV catheter. b. Administer oral sedative medications. c. Teach the patient about the procedure. d. Confirm that the patient has been fasting.

LEWIS 31-Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI? a. The patient has an allergy to shellfish. b. The patient has a history of atherosclerosis. c. The patient has a permanent ventricular pacemaker. d. The patient took all the prescribed cardiac medications today.

LEWIS 33-A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 and heart rate is 123. Based on this information, which nursing diagnosis is a priority for the patient? a. Acute pain related to myocardial infarction b. Anxiety related to perceived threat of death c. Stress overload related to acute change in health

LEWIS 33-A patient is recovering from a myocardial infarction (MI) and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? a. Assess the feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias.

LEWIS 33-A patient who has chest pain is admitted to the emergency department (ED) and all of the following are ordered. Which one should the nurse arrange to be completed first? a. Chest x-ray b. Troponin level c. Electrocardiogram (ECG) d. Insertion of a peripheral IV

LEWIS 33-A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. Do you have any allergies? b. Do you take aspirin on a daily basis? c. What time did your chest pain begin? d. Can you rate your chest pain using a 0 to 10 scale?

LEWIS 33-A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten). The nurse should teach the patient that the primary purpose of captopril is to a. lower heart rate. b. control blood glucose levels. c. prevent changes in heart muscle. d. reduce the frequency of chest pain.

LEWIS 33-After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. I can expect some nausea as a side effect of nitroglycerin. b. I should only take the nitroglycerin if I start to have chest pain. c. I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart. d. Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.

LEWIS 33-During the administration of the thrombolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. increase in blood pressure. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

LEWIS 33-Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patients response to the activity, which assessment data would indicate that the exercise level should be decreased? a. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg. b. Oxygen saturation drops from 99% to 95%. c. Heart rate increases from 66 to 92 beats/minute. d. Respiratory rate goes from 14 to 20 breaths/minute.

LEWIS 33-Heparin is ordered for a patient with a nonST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? a. Heparin enhances platelet aggregation. b. Heparin decreases coronary artery plaque size. c. Heparin prevents the development of new clots in the coronary arteries. d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.

LEWIS 33-In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? a. I will check my pulse rate before I take any nitroglycerin tablets. b. I will put the nitroglycerin patch on as soon as I get any chest pain. c. I will stop what I am doing and sit down before I put the nitroglycerin under my tongue. d. I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin.

LEWIS 33-The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies ever having a heart attack. c. Bilateral crackles are auscultated in the mid-lower lobes. d. The patient has occasional premature atrial contractions (PACs).

LEWIS 33-Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain? a. Inverted P wave b. Sinus tachycardia c. ST-segment elevation d. First-degree atrioventricular block

LEWIS 34-A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

LEWIS 34-A patient who has chronic heart failure tells the nurse, I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating! The nurse will document this assessment finding as a. orthopnea. b. pulsus alternans. c. paroxysmal nocturnal dyspnea. d. acute bilateral pleural effusion.

LEWIS 34-A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patients blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.

LEWIS 34-A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation.

LEWIS 34-A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurses priority action will be to a. have the patient recall the dietary intake for the last 3 days. b. ask the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of restricting dietary sodium.

LEWIS 34-A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. I will be sure to take the medication with food. b. I will need to eat more potassium-rich foods in my diet. c. I will call for help when I need to get up to use the bathroom. d. I will expect to feel more short of breath for the next few days.

LEWIS 34-An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue

LEWIS 34-IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

LEWIS 34-The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute.

LEWIS 34-The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is applied when any chest pain develops. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. d. an additional pillow can help her sleep if she is feeling short of breath at night.

LEWIS 34-Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

LEWIS 34-Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. Need to begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider

LEWIS 34-While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the water pill with the heart pill. When planning for the patients discharge the nurse will facilitate a a. consult with a psychologist. b. transfer to a long-term care facility. c. referral to a home health care agency. d. arrangements for around-the-clock care.

LEWIS 34-While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. increased right atrial pressure. d. incompetent jugular vein valves.

LEWIS 35-A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as a. junctional escape rhythm. b. accelerated idioventricular rhythm. c. third-degree atrioventricular (AV) block. d. sinus rhythm with premature atrial contractions (PACs).

LEWIS 35-A patient who is complaining of a racing heart and feeling anxious comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next? a. Prepare to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patients vital signs including oxygen saturation. d. Prepare to give a b-blocker medication to slow the heart rate.

LEWIS 35-Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as a telemetry technician on the cardiac care unit? a. Decide whether a patients heart rate of 116 requires urgent treatment. b. Monitor a patients level of consciousness during synchronized cardioversion. c. Observe cardiac rhythms for multiple patients who have telemetry monitoring. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.

LEWIS 53-A 27-year-old patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information is most important to communicate to the health care provider? a. Bilateral breast tenderness b. Frequent abdominal bloating c. History of migraine headaches d. Previous spontaneous abortion

The nurse caring for the woman in labor should understand that maternal hypotension can result in: a. Early decelerations. c. Uteroplacental insufficiency. b. Fetal dysrhythmias. d. Spontaneous rupture of membranes.

The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are the result of: a. Altered cerebral blood flow. c. Uteroplacental insufficiency. b. Umbilical cord compression. d. Meconium fluid.

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should: a. Notify the womans primary health care provider immediately. b. Prepare to administer an oxytocic to stimulate uterine activity. c. Document the findings because they reflect the expected contraction pattern for the active phase of labor. d. Prepare the woman for the onset of the second stage of labor.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features: a. Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist. b. Is more common among older, Caucasian women because they have higher expectations. c. Is distinguished by irritability, severe anxiety, and panic attacks. d. Will disappear on its own without outside help.

VARCAROLIS 14-A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse will advise the patient to: a. Go to the nearest emergency department immediately. b. Do not to be alarmed. Take two aspirin and drink plenty of fluids. c. Take a dose of your antidepressant now and come to the clinic to see the health care provider. d. Resume taking your antidepressants for 2 more weeks and then discontinue them again.

VARCAROLIS 14-A patient diagnosed with major depression received six electroconvulsive therapy sessions and aggressive doses of antidepressant medication. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. a. Antidepressant medications alter catecholamine levels, which impairs decision-making abilities. b. Antidepressant medications may cause confusion related to limitation of tyramine in the diet. c. Temporary memory impairments and confusion may occur with electroconvulsive therapy. d. The patient needs time to readjust to a pressured work schedule.

VARCAROLIS 14-Major depression resulted after a patients employment was terminated. The patient now says to the nurse, Im not worth the time you spend with me. I am the most useless person in the world. Which nursing diagnosis applies? a. Powerlessness c. Situational low self-esteem b. Defensive coping d. Disturbed personal identity

VARCAROLIS 14-When counseling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using: a. psychoanalytic therapy. b. desensitization therapy. c. cognitive behavioral therapy. d. alternative and complementary therapies.

VARCAROLIS 28-An 11-year-old reluctantly tells the nurse, My parents dont like me. They said they wish I was never born. Which type of abuse is likely? a. Sexual c. Emotional b. Physical d. Economic

VARCAROLIS 28-An adult tells the nurse, My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. Ive considered leaving but havent been able to bring myself to actually do it. Which phase in the cycle of violence prevents this adult from leaving? a. Tension-building c. Honeymoon b. Acute battering d. Stabilization

VARCAROLIS 28-An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? a. Psychological c. Physical b. Financial d. Sexual

VARCAROLIS 28-Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has: a. complaints of abdominal pain. c. bruises on extremities. b. repeated middle ear infections. d. diarrhea.

VARCAROLIS 28-What is a nurses legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the childs parent and health care provider. b. Document the observation and suspicion in the medical record. c. Report the suspicion according to state regulations. d. Continue the assessment.

VARCAROLIS 28-Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources? a. A support group c. A womens shelter b. A mental health center d. Vocational counseling

What is an advantage of external electronic fetal monitoring? a. The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the fetal heart rate. b. The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. d. Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions.

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may: a. Have outbursts of anger. c. Harm her infant. b. Neglect her hygiene. d. Lose interest in her husband.

NCO-When working with a client who is depressed, what should the nurse do initially? 1 Accept what the client says. 2 Attempt to keep the client occupied. 3 Keep the client's surroundings cheery. 4 Try to prevent the client from talking too much.

LEWIS 31-When auscultating over the patients abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a a. thrill. b. bruit. c. murmur. d. normal finding.

LEWIS 33-A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patients care? a. Sildenafil (Viagra) b. Furosemide (Lasix) c. Captopril (Capoten) d. Warfarin (Coumadin)

LEWIS 35A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/minute. a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100-

LEWIS 35-When analyzing the rhythm of a patients electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. P-R interval of 0.18 second. c. Q-T interval of 0.38 second. d. QRS interval of 0.14 second.

EVOLVE LEWIS 35-The nurse performs discharge teaching for a patient with an implantable cardioverter-defibrillator (ICD). Which statement by the patient indicates to the nurse that further teaching is needed? "The device may set off the metal detectors in an airport." "My family needs to keep up to date on how to perform CPR." "I should not stand next to antitheft devices at the exit of stores." "I can expect redness and swelling of the incision site for a few days."

"I can expect redness and swelling of the incision site for a few days."

EVOLVE LEWIS 33-After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? "I will replace my nitroglycerin supply every 6 months." "I can take up to five tablets every 3 minutes for relief of my chest pain." "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

"I can take up to five tablets every 3 minutes for relief of my chest pain." Correct

EVOLVE LEWIS 34-At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? "I will limit the amount of milk and cheese in my diet." "I can add salt when cooking foods but not at the table." "I will take an extra diuretic pill when I eat a lot of salt." "I can have unlimited amounts of foods labeled as reduced sodium."

"I will limit the amount of milk and cheese in my diet." Correct

EVOLVE LEWIS 33-In caring for the patient with angina, the patient said, "While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, then the pain went away." What further assessment data should the nurse obtain from the patient? "What precipitated the pain?" "Has the pain changed this time?" "In what areas did you feel this pain?" "What is your pain level on a 0 to 10 scale?"

"In what areas did you feel this pain?" Correct

EVOLVE LEWIS 31-The patient informs the nurse that he does not understand how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. What is the best response by the nurse? "The one vessel curves around from the left side to the right ventricle." "The LAD supplies blood to the left side of the heart and part of the right ventricle." "The right ventricle is supplied during systole primarily by the right coronary artery." "It is actually on your right side of the heart, but we call it the left anterior descending vessel."

"The LAD supplies blood to the left side of the heart and part of the right ventricle." Correct

NCO-Which symptoms of depression, often overlooked in the older adult client, should the nurse include in the assessment process? Select all that apply. 1 Anxiety 2 Insomnia 3 Weight loss 4 Weight gain 5 General fatigue

2, 5

NCO-What characteristics are commonly associated with adolescent depression? Select all that apply. 1 Exercising daily 2 Having suicidal ideation 3 Exhibiting tearfulness 4 Having poor muscle tone 5 Avoiding previously enjoyed activities and relationships

2,3,5

Which statement best describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

EVOLVE LEWIS 34-The nurse is administering a dose of digoxin to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom? Muscle aches Constipation Pounding headache Anorexia and nausea

Anorexia and nausea Correct

LEWIS 33-The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching for this patient would include a. when cardiac rehabilitation will begin. b. the typical emotional responses to AMI. c. information regarding discharge medications. d. the pathophysiology of coronary artery disease.

NCO-A client comes to the emergency department with pressure in the chest and shortness of breath. The client is admitted for observation after receiving a tentative diagnosis of a myocardial infarction. Which assessment finding should the nurse monitor for in this client that supports this diagnosis? 1 Vomiting 2 Bradycardia 3 Severe headache 4 Pain radiating to the abdomen

NCO-A client presents to the emergency department with weakness, dizziness, and difficulty breathing. The nurse performs an electrocardiogram (ECG) and notices this arrhythmia. Which arrhythmia is the client exhibiting? 1 Atrial fibrillation (AF) 2 Ventricular tachycardia (VT) 3 Junctional tachycardia 4 Supraventricular tachycardia (SVT)

NCO-A client comes to the clinic for a 6-week postpartum check-up. She confides that she is experiencing exhaustion that is not relieved by sleep and feelings of failure as a mother because the infant "cries all of the time." When asked whether she has a support system, she replies that she lives alone. Which response would provide the most accurate information? 1 Providing information about a local support group 2 Explaining that it is normal to feel depressed after childbirth 3 Asking the client questions, using a postpartum depression scale 4 Suggesting that the client find someone who can take care of the baby for 24 hours

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurses first priority is to: a. Change the womans position. c. Assist with amnioinfusion. b. Notify the care provider. d. Insert a scalp electrode.

EVOLVE LEWIS 33-Which patient is at greatest risk for sudden cardiac death (SCD)? A 42-yr-old white woman with hypertension and dyslipidemia A 52-yr-old African American man with left ventricular failure A 62-yr-old obese man with diabetes mellitus and high cholesterol A 72-yr-old Native American woman with a family history of heart disease

A 52-yr-old African American man with left ventricular failure Correct

EVOLVE LEWIS 35-The nurse is monitoring the electrocardiograms of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse, and all of the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action? A 62-yr-old man with a fever and sinus tachycardia with a rate of 110 beats/min A 72-yr-old woman with atrial fibrillation with 60 to 80 QRS complexes per minute A 52-yr-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute A 42-yr-old woman with first-degree AV block and sinus bradycardia at a rate of 56 beats/min

A 52-yr-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute Correct

VARCAROLIS 28-A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, My father doesnt like me. He calls me stupid all the time. The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? Select all that apply. a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care

A,B,C

VARCAROLIS 28-A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, Why are you such a stupid kid? The wife says, I have difficulty disciplining the children. Its so frustrating. Which comments by the nurse will facilitate an interview with these parents? Select all that apply. a.Tell me how you discipline your children. b.How do you stop your baby from crying? c.Caring for four small children must be difficult. d.Do you or your husband ever spank your children? e.Calling children stupid injures their self-esteem.

A,B,C

VARACOLIS-The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply. a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter e. The hospital emergency department

A,B,C,D

GIDDENS 18-The patient is brought to the emergency department after a motor vehicle accident. The patient is diagnosed with internal bleeding. The nurses primary concern is to monitor for a. mental alertness. b. perfusion. c. pain. d. reaction to medications.

EVOLVE LEWIS 33-The patient is being dismissed from the hospital after acute coronary syndrome and will be attending rehabilitation. What information would be taught in the early recovery phase of rehabilitation? Therapeutic lifestyle changes should become lifelong habits. Physical activity is always started in the hospital and continued at home. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications. Activity level is gradually increased under cardiac rehabilitation team supervision and with electrocardiographic (ECG) monitoring.

Activity level is gradually increased under cardiac rehabilitation team supervision and with electrocardiographic (ECG) monitoring.

EVOLVE LEWIS 34-The nurse is preparing to administer a nitroglycerin patch to a patient. When providing instructions regarding the use of the patch, what should the nurse include in the teaching? Avoid high-potassium foods Avoid drugs to treat erectile dysfunction Avoid over-the-counter H2-receptor blockers Avoid nonsteroidal antiinflammatory drugs (NSAIDS)

Avoid drugs to treat erectile dysfunction Correct

. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of intimate partner violence (IPV)? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. d. She avoids making eye contact and is hesitant to answer questions.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the babys heart rate should be. Your best response is: a. Dont worry about that machine; thats my job. b. The top line graphs the babys heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor. c. The top line graphs the babys heart rate, and the bottom line lets me know how strong the contractions are. d. Your doctor will explain all of that later.

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have: a. Bradycardia. c. Tachycardia. b. A normal baseline heart rate. d. Hypoxia.

During which phase of the cycle of violence does the batterer become contrite and remorseful? a. Battering phase c. Tension-building phase b. Honeymoon phase d. Increased drug-taking phase

LEWIS 33-When admitting a patient with a nonST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? a. Obtain the blood pressure. b. Attach the cardiac monitor. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

VARCAROLIS 20-A woman tells the nurse, My partner is frustrated with me. I dont have any natural lubrication when we have sex. What type of sexual disorder is evident? a. Genito-Pelvic Pain/Penetration Disorder b. Female Sexual Interest/Arousal Disorder c. Hypoactive Sexual Desire Disorder d. Female Orgasmic Disorder

VARCAROLIS 14-The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan? Select all that apply. a. Channeling excessive energy b. Reducing guilty ruminations c. Instilling a sense of hopefulness d. Assisting with self-care activities e. Accommodating psychomotor retardation

C, D, E

GIDDENS 22-Sexual dysfunction is a negative consequence of human sexuality manifested by any disturbance to the psycho-physiologic changes that occur during the sexual response cycle. Which statements related to sexual dysfunction are correct? (Select all that apply.) a. Biological factors play a more significant role than psychologic factors. b. Sexual dysfunction is more prevalent among men than women. c. The best predictor of sexual health is emotional well-being. d. The patient with sexual dysfunction is at risk for anxiety and depression. e. Sexual dysfunction remains uncommon.

C,D

GIDDENS 33-A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? (Select all that apply.) a. Risk for caregiver strain b. Impaired verbal communication c. Risk for injury d. Imbalanced nutrition, less than body requirements e. Ineffective coping f. Sleep deprivation

C,D,F

VARCAROLIS 20-While performing an assessment, the nurse says to a patient, While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now? The purpose of this question is to: a. identify areas of sexual dysfunction for treatment. b. determine possible homosexual urges. c. introduce the topic of masturbation. d. identify sexual misinformation.

VARCAROLIS 28-A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, My partner beat me, but it was because I did not do the laundry. What is the nurses next action? a. Call the police. c. Call the adult protective agency. b. Arrange for hospitalization. d. Document injuries with a body map.

Which fetal heart rate (FHR) finding would concern the nurse during labor? a. Accelerations with fetal movement c. An average FHR of 126 beats/min b. Early decelerations d. Late decelerations

EVOLVE LEWIS 35-The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer? Lidocaine and amiodarone Digoxin and procainamide Epinephrine and/or vasopressin β-adrenergic blockers and dopamine

Epinephrine and/or vasopressin Correct

EVOLVE LEWIS 31-The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? It is calculated by multiplying the patient's stroke volume by the heart rate. It is the average amount of blood ejected during one complete cardiac cycle. It is determined by measuring the electrical activity of the heart and the patient's heart rate. It is the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.

It is calculated by multiplying the patient's stroke volume by the heart rate. Correct

EVOLVE LEWIS 34-The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply.)? Left ventricular function is documented. Controlling dysrhythmias will eliminate HF. Prescription for digoxin (Lanoxin) at discharge Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

Left ventricular function is documented. Correct Prescription for angiotensin-converting enzyme inhibitor at discharge Correct Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen Correct

EVOLVE LEWIS 31-The blood pressure of an older adult patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? Stenosis of the heart valves Decreased adrenergic sensitivity Increased parasympathetic activity Loss of elasticity in arterial vessels

Loss of elasticity in arterial vessels

EVOLVE LEWIS 33-A 74-yr-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin? Administer morphine sulfate IV. Auscultate heart and lung sounds. Obtain a 12-lead electrocardiogram (ECG). Assess for coronary artery disease risk factors.

Obtain a 12-lead electrocardiogram (ECG). Correct

EVOLVE LEWIS 31-While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement in the assessment during auscultation? Position the patient supine. Ask the patient to hold his or her breath. Palpate the radial pulse while auscultating the apical pulse. Use the bell of the stethoscope when auscultating S1 and S2.

Palpate the radial pulse while auscultating the apical pulse. Correct

EVOLVE LEWIS 33-A 52-yr-old male patient has received a bolus dose and an infusion of alteplase (Activase) for an ST-segment elevation myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of the medication? Presence of chest pain Blood in the urine or stool Tachycardia with hypotension Decreased level of consciousness

Presence of chest pain Correct

EVOLVE LEWIS 34-The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? Prothrombin time Urine specific gravity Serum potassium level Hemoglobin and hematocrit

Serum potassium level Correct

EVOLVE LEWIS 31-The nurse is performing an assessment for a patient undergoing radiation treatment for breast cancer. What position should the nurse place the patient to best auscultate for signs of acute pericarditis? Supine without a pillow Sitting and leaning forward Left lateral side-lying position Head of bed at a 45-degree angle

Sitting and leaning forward Correct

EVOLVE LEWIS 35-The patient has atrial fibrillation with a rapid ventricular response. What electrical treatment option does the nurse prepare the patient for? Defibrillation Synchronized cardioversion Automatic external defibrillator (AED) Implantable cardioverter-defibrillator (ICD)

Synchronized cardioversion Correct

EVOLVE LEWIS 31-A patient with aortic valve stenosis is being admitted for valve replacement surgery. Which assessment finding documented by the nurse is indicative of this condition? Pulse deficit Systolic murmur Distended neck veins Splinter hemorrhages

Systolic murmur Correct

EVOLVE LEWIS 31-The nurse informs the patient that she must wear intermittent sequential compression stockings after a surgical procedure. What is an appropriate rationale for nurse to give to the patient for the use of the device? The socks keep the legs warm while the patient is not moving much. The socks maintain the blood flow to the legs while the patient is on bed rest. The socks keep the blood pressure down while the patient is stressed after surgery. The socks provide compression of the veins to keep the blood moving back to the heart.

The socks provide compression of the veins to keep the blood moving back to the heart.

EVOLVE LEWIS 31-While auscultating the patient's heart sounds with the bell of the stethoscope, the nurse hears these sounds. How should the nurse document what is heard? Diastolic murmur Third heart sound (S3) Fourth heart sound (S4) Normal heart sounds (S1, S2)

Third heart sound (S3) Correct

EVOLVE LEWIS 31-A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? Women are less likely to delay seeking treatment than men. Women are more likely to have noncardiac symptoms of heart disease. Women are often less ill when presenting for treatment of heart disease. Women experience more symptoms of heart disease at a younger age than men.

Women are more likely to have noncardiac symptoms of heart disease. Correct

EVOLVE LEWIS 35-Cardioversion is attempted for a patient with atrial flutter and a rapid ventricular response. After the delivering 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately? Administer 250 mL of 0.9% saline solution IV by rapid bolus. Assess the apical pulse, blood pressure, and bilateral neck vein distention. Turn the synchronizer switch to the "off" position and recharge the device. Tell the patient to report any chest pain or discomfort and administer morphine sulfate.

Turn the synchronizer switch to the "off" position and recharge the device. Correct

EVOLVE LEWIS 34-The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What is the priority action by the nurse? Withhold the daily dose until the following day. Withhold the dose and report the potassium level. Give the digoxin with a salty snack, such as crackers. Give the digoxin with extra fluids to dilute the sodium level.

Withhold the dose and report the potassium level. Correct

LEWIS 35-The nurse notes that a patients cardiac monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Multifocal premature ventricular contractions

GIDDENS 33-A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, This medication isnt working. I dont feel any different. What is the best response by the nurse? a. I will call your care provider. Perhaps you need a different medication. b. Dont worry. You can try taking it at a different time of day to help it work better. c. It usually takes a few weeks for you to notice improvement from this medication. d. Your life is much better now. You will feel better soon.

VARCAROLIS 14-A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patients symptoms be most acute? a. January c. June b. April d. September

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? a. Early decelerations b. Late decelerations c. Variable decelerations d. It is always a good idea to change the womans position.

VARCAROLIS 14-An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a. Social skills training c. Desensitization techniques b. Relaxation training classes d. Use of complementary therapy

NCO-Which ovulation stimulant is derived from the urine of postmenopausal women? 1 Oxytocin 2 Clomiphene 3 Menotropins 4 Dinoprostone

EVOLVE LEWIS 35-The nurse is doing discharge teaching with the patient who received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that further teaching is required? "I will call the cardiologist if my ICD fires." "I cannot fly because it will damage the ICD." "I cannot move my left arm until it is approved." "I cannot drive until my cardiologist says it is okay."

"I cannot fly because it will damage the ICD." Correct

EVOLVE LEWIS 35-A patient develops third-degree heart block and reports feeling chest pressure and shortness of breath. Which instructions should the nurse provide to the patient before initiating emergency transcutaneous pacing? "The device will convert your heart rate and rhythm back to normal." "The device uses overdrive pacing to slow the heart to a normal rate." "The device is inserted through a large vein and threaded into your heart." "The device delivers a current through your skin that can be uncomfortable.

"The device delivers a current through your skin that can be uncomfortable.

EVOLVE LEWIS 34-An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin has been prescribed to continue at home. What is the best response by the nurse? "The medication prevents blood clots from forming in your heart." "The medication dissolves clots that develop in your coronary arteries." "The medication reduces clotting by decreasing serum potassium levels." "The medication increases your heart rate so that clots do not form in your heart."

"The medication prevents blood clots from forming in your heart." Correct

EVOLVE LEWIS 31-Which instruction by the nurse is given to a patient who is about to undergo Holter monitoring is most appropriate? "You may remove the monitor only to shower or bathe." "You should connect the monitor whenever you feel symptoms." "You should refrain from exercising while wearing this monitor." "You will need to keep a diary of all your activities and symptoms."

"You will need to keep a diary of all your activities and symptoms."

NCO-A nurse identifies signs of electrolyte depletion in a client with heart failure who is receiving bumetanide and digoxin. What does the nurse determine is the cause of the depletion? 1 Diuretic therapy 2 Sodium restriction 3 Continuous dyspnea 4 Inadequate oral intake

NCO-A nurse in the clinic is conducting a routine assessment of a primigravida client. The nurse notes bruises on the client's upper arms. When questioned, the client responds that her boyfriend was upset and hit her. What is the priority nursing action? 1 Developing a safety plan with the client 2 Calling the nurse manager to inspect the bruises 3 Informing the client that her pregnancy is in danger 4 Notifying social services to monitor the home situation

NCO-An older client is treated in the emergency department for soft-tissue injuries that the medical team suspects might be caused by physical abuse. An adult child states that the client is forgetful and confused and falls all the time. A mini-mental examination indicates that the client is oriented to person, place, and time, and the client does not comment when asked directly how the bruises and abrasions occurred. What is the next appropriate nursing action? 1Interview the client without the presence of family members. 2Report the abuse to the appropriate state agency for investigation. 3Accept the adult child's explanation until more data can be collected. 4Refer the client's clinical record to the hospital ethics committee for review

NCO-The client reports a "fluttering in my chest." The nurse analyzes the client's heart rhythm and notices that there are three P waves for each QRS complex. The waves have a sawtooth appearance. The atrial rate is 240 beats per minute, but the ventricular rate is only 80 beats per minute. The nurse notifies the primary healthcare provider for which rhythm? 1 Atrial flutter 2 Atrial fibrillation 3 Ventricular fibrillation 4 Atrial flutter with rapid ventricular response

NCO-The parent of a 5-month-old infant with heart failure questions the necessity of weighing the baby every morning. What does the nurse say that this daily information is important in determining? 1 Fluid retention 2 Kidney function 3 Nutritional status 4 Medication dosage

NCO-The primary healthcare provider has prescribed a stat chest x-ray exam and electrocardiogram for a client with a history of heart failure. The pulse oximeter has changed from 90% to 86% oxygen saturation. Which immediate actions will the nurse take? Select all that apply. 1 Tell a staff member to get the electrocardiogram machine. 2 Notify the x-ray department that a chest x-ray exam must be done stat. 3 Have a staff member notify the nursing supervisor of the change in client status. 4 Notify the healthcare provider of the change in the oxygen saturation to ask what to do. 5 Tell the certified nursing assistant to get a prescription from the healthcare provider to increase the oxygen. 6 Increase the supplemental oxygen without a prescription from 2 L nasal cannula to 4 L nasal cannula and notify the healthcare provider.

1,2,3,6

NCO-When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes what important components? Select all that apply. 1Planning for future safety 2Normalizing victimization 3Validating the experiences 4Promoting access to community services 5Providing housing for the victim

1,3,4

NCO-A nurse is assessing a toddler and the dynamics of the child's family, in which abuse is suspected. What behaviors are expected? Select all that apply. 1The child cringes when approached. 2The child has unexplained healed injuries. 3The parents are overly affectionate toward the child. 4The child lies still while surveying the environment. 5The parents give detailed accounts of the child's injuries

1,2,4

NCO-Which nursing interventions may promote safe drug administration in a child diagnosed with heart failure who is receiving digoxin? Select all that apply. 1 Checking for compliance with the client's drug regimen 2 Monitoring the client's serum potassium and magnesium levels regularly 3 Administering digoxin only through the intramuscular route 4 Calculating the correct dosage form, prescribed amounts, and the prescriber's order 5 Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly

1,2,4,5

NCO-During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite 5 Long periods of sleep

1,2,3

NCO-The client is admitted with sinus tachycardia. To treat the dysrhythmia, the nurse will look for potential causes. Which causes will the nurse look for in this client? Select all that apply. 1 Anxiety 2 Caffeine 3 Exercise 4 Anemia 5 Hypothermia

1,2,3,4

NCO-A newly immigrated older Chinese adult is brought to a mental health clinic when family members become concerned that their parent is depressed. In an attempt to conduct a culturally competent assessment interview, the nurse asks certain questions. Which questions does the nurse ask? Select all that apply. 1"What brought you here for treatment today?" 2"What do you believe is the cause of your depression?" 3"Does religion have a role in your perception of health and wellness?" 4"Do you have insurance that includes coverage of mental health issues?" 5"Have you ever sought treatment for a mental health problem previously?

1,2,3,5

NCO-A nurse is assessing a 55-year-old client who is experiencing postmenopausal bleeding. The tentative diagnosis is endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply. 1 Obesity 2 Multiparity 3 Cigarette smoking 4 Early onset of menopause 5 Family history of endometrial cancer 6 Previous hormone replacement therapy

1,5,6

EVOLVE LEWIS 35-When computing a heart rate from the electrocardiography (ECG) tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. What does the nurse calculate the patient's heart rate to be? 60 beats/min 75 beats/min 100 beats/min 150 beats/min

100 beats/min Correct

NCO-A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? 1 Perform daily weights 2 Auscultate breath sounds 3 Monitor intake and output 4 Assess for dependent edema

NCO-A client who is suspected of having had a silent myocardial infarction has an electrocardiogram (ECG) prescribed by the primary healthcare provider. While the nurse prepares the client for this procedure, the client asks, "Why was this test prescribed?" Which is the best reply by the nurse? 1 "This test will detect your heart sounds." 2 "This test will reflect any heart damage." 3 "This procedure helps us change your heart's rhythm." 4 "The ECG will tell us how much stress your heart can tolerate."

NCO-A healthcare provider prescribes morphine for a client who had a myocardial infarction. What clinical response will be reduced if the client experiences the intended therapeutic effect of morphine? 1 Respiratory rate 2 Workload of the heart 3 Size of the clot blocking the coronary artery 4 Metabolites within the ischemic heart muscle

NCO-The nurse is caring for a client who is on a cardiac rhythm monitor. The nurse notes that the client's P waves are of normal configuration and that each P wave is followed by a QRS complex. All intervals are normal as well, but the client's heart rate is 112 beats per min. How will the nurse interpret this rhythm? 1 Sinus arrhythmia 2 Sinus tachycardia 3 Junctional tachycardia 4 Ventricular tachycardia

NCO-To therapeutically relate to parents who are known to have maltreated their child, what must the nurse do first? 1Develop a trusting relationship with the child. 2Identify personal feelings about child abusers. 3Recognize the emotional needs of the parents. 4Gather information about the child's home environment.

NCO-What is the nurse's priority responsibility when abuse of an 8-year-old child is suspected? 1 Treating the child's traumatic injuries 2 Protecting the child from future abuse 3 Confirming the child's suspected abuse 4 Having the child examined by the healthcare provide

NCO-A client is admitted to the cardiac care unit with a myocardial infarction. The cardiac monitor reveals several runs of ventricular tachycardia. The nurse anticipates that the client will be receiving a prescription for which drug? 1 Atropine 2 Epinephrine 3 Amiodarone 4 Sodium bicarbonate

NCO-A client with an inferior myocardial infarction has a heart rate of 120 beats per minute. Which goal achievements are priority? 1 Increase left ventricular filling and improve cardiac output 2 Decrease oxygen needs of the vital organs and prevent cardiac dysrhythmias 3 Decrease the workload on the heart and promote maximum coronary artery filling 4 Increase venous return to the right atrium and increase pulmonary arterial blood flow

NCO-A primary healthcare provider prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement? 1Complimenting the client's appearance 2Starting preparations for the client's discharge 3Arranging for constant supervision of the client 4Adding privileges to the client's plan of care as a reward

NCO-The family of a client with right ventricular heart failure expresses concern about the client's increasing abdominal girth. What physiologic change should the nurse consider when explaining the client's condition? 1 Loss of cellular constituents in blood 2 Rapid osmosis from tissue spaces to cells 3 Increased pressure within the circulatory system 4 Rapid diffusion of solutes and solvents into plasma

NCO-The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next? 1Ambulating the client to promote circulation 2Inserting two small-bore intravenous catheters 3Determining whether the client feels safe at home 4Ensuring that the client has her glasses to ambulate

NCO-A client with recurrent episodes of depression comes to the mental health clinic for a routine follow-up visit. The nurse suspects that the client is at increased risk for suicide. What is a contributing factor to the client's risk for suicide? 1 Psychomotor retardation 2 Decreased physical activity 3 Deliberate thoughtful behavior 4 Overwhelming feelings of guilt

NCO-An infant who has a congenital heart defect with left-to-right shunting of blood is admitted to the pediatric unit. What early sign of heart failure should the nurse identify? 1 Cyanosis 2 Restlessness 3 Decreased heart rate 4 Increased respiratory rate

NCO-On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding? 1 The client's feelings will pass after she has bonded with her infant. 2 The client is probably suffering from postpartum depression and needs special care. 3 A cesarean birth may be a traumatic experience, but most women know that it is a possible outcome. 4 A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this

NCO-The nurse instructs the client admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD) about the importance of assessing for right-sided heart failure after discharge. What does the nurse instruct the client to assess for? 1 Increased appetite 2 Clubbing of the nail beds 3 Hypertension 4 Weight gain

NCO-The nurse is conducting a nutrition class for a group of clients with heart failure (HF). Which information is most important for the nurse to share with the class? 1 Restricting fluid intake 2 Eating a low caloric diet to reduce weight 3 Recognizing which products are high in cholesterol 4 Choosing fresh or frozen vegetables instead of canned ones

NCO-A nurse administers an estrogen agonist to a client. Which nursing actions would be beneficial? Select all that apply. 1 Observing the client for signs of hypercalcemia 2 Ensuring that the client has a dental examination before starting the drug 3 Teaching the client about signs and symptoms of venous thromboembolism (VTE) 4 Monitoring the client's liver function tests (LFTs) in collaboration with the primary healthcare provider 5 Observing the client for central nervous system (CNS) adverse effects, such as drowsiness, anxiety, and agitation

3,4

NCO-A client takes isosorbide dinitrate daily. The client states, "I would like to start taking sildenafil for erectile dysfunction." The nurse explains that taking both of these medications concurrently may result in which complication? 1 Constipation 2 Protracted vomiting 3 Respiratory distress 4 Severe hypotension

NCO-A client with heart failure is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question? 1 Reduces edema 2 Increases cardiac conduction 3 Increases rate of ventricular contractions 4 Slows and strengthens cardiac contractions

Fetal well-being during labor is assessed by: a. The response of the fetal heart rate (FHR) to uterine contractions (UCs). b. Maternal pain control. c. Accelerations in the FHR. d. An FHR above 110 beats/min.

A normal uterine activity pattern in labor is characterized by: a. Contractions every 2 to 5 minutes. b. Contractions lasting about 2 minutes. c. Contractions about 1 minute apart. d. A contraction intensity of about 1000 mm Hg with relaxation at 50 mm Hg.

According to Becks studies, what risk factor for postpartum depression is likely to have the greatest effect on the womans condition? a. Prenatal depression c. Low socioeconomic status b. Single-mother status d. Unplanned or unwanted pregnancy

GIDDENS 18-The nurse is conducting a patient assessment. The patient tells the nurse that he has smoked two packs of cigarettes per day for 27 years. The nurse may find which data upon assessment? a. Blood pressure above the normal range b. Bounding pedal pulses c. Night blindness d. Reflux disease

LEWIS 34-Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

Perinatal nurses are legally responsible for: a. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. b. Greeting the client on arrival, assessing her, and starting an intravenous line. c. Applying the external fetal monitor and notifying the care provider. d. Making sure that the woman is comfortable.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: a. Change in position. c. Regional anesthesia. b. Oxytocin administration. d. Intravenous analgesic.

The nurse caring for the laboring woman should understand that early decelerations are caused by: a. Altered fetal cerebral blood flow. c. Uteroplacental insufficiency. b. Umbilical cord compression. d. Spontaneous rupture of membranes.

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: a. Over the uterine fundus. c. Inside the uterus. b. On the fetal scalp. d. Over the mothers lower abdomen.

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement: a. Are reassuring. b. Are caused by umbilical cord compression. c. Warrant close observation. d. Are caused by uteroplacental insufficiency.

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat: a. Variable decelerations. c. Fetal bradycardia. b. Late decelerations. d. Fetal tachycardia.

VARACOLIS-Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. Isocarboxazid (Marplan) c. Amitriptyline d. Duloxetine (Cymbalta)

VARACOLIS-The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: a. Establish trust and rapport b. Ask lots of questions c. Interrupt the patients' story to allow for decompression d. Utilize closed-ended questions

VARCAROLIS 14-A patient diagnosed with major depression refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient? a. Tomato juice c. Hot tea b. Orange juice d. Milk

VARACOLIS-Which chronic medical condition is a common trigger for major depressive disorder? a. Pain b. Hypertension c. Hypothyroidism d. Crohn's disease

VARCAROLIS 28-An adult has a history of physical violence against family when frustrated, followed by periods of remorse after each outburst. Which finding indicates a successful plan of care? The adult: a. expresses frustration verbally instead of physically. b. explains the rationale for behaviors to the victim. c. identifies three personal strengths. d. agrees to seek counseling.

VARCAROLIS 28-An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, My mother often wanders at night. Last night she fell down the stairs. Which nursing diagnosis has priority? a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night

VARCAROLIS 28-The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occur in adolescents who: a. have been abused. c. have eating disorders. b. are attention seeking. d. are developmentally delayed.

VARCAROLIS 28-Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a. You are feeling violated because you thought you could trust your partner. b. Im here for you. I want you to tell me about the bad things that happened to you. c. I was very worried about you. I knew you were living in a potentially violent situation. d. Abusers often target people who are passive. I will refer you to an assertiveness class.

When the nurse is alone with a battered patient, the patient seems extremely anxious and says, It was all my fault. The house was so messy when he got home and I know he hates that. The best response by the nurse is: a. No one deserves to be hurt. Its not your fault. How can I help you? b. What else do you do that makes him angry enough to hurt you? c. He will never find out what we talk about. Dont worry. Were here to help you. d. You have to remember that he is frustrated and angry so he takes it out on you.

Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes c. External monitors in current use b. Cervix dilated to 4 cm d. Fetus with a known heart defect

LEWIS 31-The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be a. myoglobin. b. low-density lipoprotein (LDL) cholesterol. c. troponins T and I. d. creatine kinase-MB (CK-MB).

LEWIS 34-Based on the Joint Commission Core Measures for patients with heart failure, which topics should the nurse include in the discharge teaching plan for a patient who has been hospitalized with chronic heart failure (select all that apply)? a. How to take and record daily weight b. Importance of limiting aerobic exercise c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

A, C, D, E

LEWIS 35-When preparing to defibrillate a patient. In which order will the nurse perform the following steps? (Put a comma and a space between each answer choice [A, B, C, D, E].) a. Turn the defibrillator on. b. Deliver the electrical charge. c. Select the appropriate energy level. d. Place the paddles on the patients chest. e. Check the location of other staff and call out all clear.

A, C, D, E, B

VARCAROLIS 14-A student nurse caring for a patient diagnosed with depression reads in the patients medical record, This patient shows vegetative signs of depression. Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply. a. Imbalanced nutrition: less than body requirements b. Chronic low self-esteem c. Sexual dysfunction d. Self-care deficit e. Powerlessness f. Insomnia

A, C, D, F

The transition phase during which ovarian function and hormone production decline is called: a. The climacteric. c. Menopause. b. Menarche. d. Puberty.

A. The climacteric is a transitional phase during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period. Puberty is a broad term that denotes the entire transitional stage between childhood and sexual maturity.

GIDDENS 18-The nurse is explaining to a student nurse about impaired central perfusion. The nurse knows the student understands this problem when the student states, Central perfusion a. is monitored only by the physician. b. involves the entire body. c. is decreased with hypertension. d. is toxic to the cardiac system.

LEWIS 35-A patient has ST segment changes that support an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient? a. I b. II c. V2 d. V6

VARCAROLIS 20-A new staff nurse tells the clinical nurse specialist, I am unsure about my role when patients bring up sexual problems. The clinical nurse specialist should give clarification by saying, All nurses: a. qualify as sexual counselors. Nurses have knowledge about the biopsychosocial aspects of sexuality throughout the life cycle. b. should be able to screen for sexual dysfunction and give basic information about sexual feelings, behaviors, and myths. c. should defer questions about sex to other health care professionals because of their limited knowledge of sexuality. d. who are interested in sexual dysfunction can provide sex therapy for individuals and couples.

VARCAROLIS 28-An older adult with Alzheimers disease lives with family in a rural area. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse? a. Multiple caregivers c. Living in a rural area b. Alzheimers disease d. Being part of a busy family

VARCAROLIS 28-An older woman diagnosed with Alzheimers disease lives with family and attends day care. After observing poor hygiene, the nurse talked with the caregiver. This caregiver became defensive and said, It takes all my energy to care for my mother. Shes awake all night. I never get any sleep. Which nursing intervention has priority? a. Teach the caregiver about the effects of sundowners syndrome. b. Secure additional resources for the mothers evening and night care. c. Support the caregiver to grieve the loss of the mothers cognitive abilities. d. Teach the family how to give physical care more effectively and efficiently.

EVOLVE LEWIS 34-An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first? Urine output Heart rhythm Breath sounds Blood pressure

EVOLVE LEWIS 34-What is the priority assessment by the nurse caring for a patient receiving IV nesiritide to treat heart failure? Urine output Lung sounds Blood pressure Respiratory rate

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR): a. Every 15 minutes in the active phase of the first stage of labor in the absence of risk factors. b. Every 20 minutes in the second stage, regardless of whether risk factors are present. c. Before and after ambulation and rupture of membranes. d. More often in a womans first pregnancy.

Fetal bradycardia is most common during: a. Intraamniotic infection. b. Fetal anemia. c. Prolonged umbilical cord compression. d. Tocolytic treatment using terbutaline.

GIDDENS 18-A nurse is explaining to a student nurse about perfusion. The nurse knows the student understands the concept of perfusion when the student states, Perfusion a. is a normal function of the body, and I dont have to be concerned about it. b. is monitored by the physician, and I just follow orders. c. is monitored by vital signs and capillary refill. d. varies as a person ages, so I would expect changes in the body.

LEWIS 53-A 47-year-old woman asks whether she is going into menopause if she has not had a menstrual period for 3 months. The best response by the nurse is which of the following? a. Have you thought about using hormone replacement therapy? b. Most women feel a little depressed about entering menopause. c. What was your menstrual pattern before your periods stopped? d. Since you are in your mid-40s, it is likely that you are menopausal.

LEWIS 53-A 49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT. b. Increased incidence of colon cancer in women taking HT requires more frequent colonoscopy. c. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

LEWIS 54-When obtaining the pertinent health history for a man who is being evaluated for infertility, which question is most important for the nurse to ask? a. Are you circumcised? b. Have you had surgery for phimosis? c. Do you use medications to improve muscle mass? d. Is there a history of prostate cancer in your family?

NCO-A woman who is older than 35 years may have difficulty achieving pregnancy primarily because: a. personal risk behaviors influence fertility. b. she has used contraceptives for an extended time. c. her ovaries may be affected by the aging process. d. prepregnancy medical attention is lacking.

The nurse caring for a woman in labor understands that prolonged decelerations: a. Are a continuing pattern of benign decelerations that do not require intervention. b. Constitute a baseline change when they last longer than 5 minutes. c. Usually are isolated events that end spontaneously. d. Require the usual fetal monitoring by the nurse.

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by: a. Narcotics. c. Methamphetamines. b. Barbiturates. d. Tranquilizers.

VARCAROLIS 14-A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about: a. restricting sodium intake to 1 gram daily. b. minimizing exposure to bright sunlight. c. reporting increased suicidal thoughts. d. maintaining a tyramine-free diet.

VARCAROLIS 14-A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, I dont think I can keep taking these pills. They make me so dizzy, especially when I stand up. The nurse will: a. limit the patients activities to those that can be performed in a sitting position. b. withhold the drug, force oral fluids, and notify the health care provider. c. teach the patient strategies to manage postural hypotension. d. update the patients mental status examination.

VARCAROLIS 14-A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, This medicine isnt working. The nurses best intervention would be to: a. discuss with the health care provider the need to increase the dose. b. reassure the patient that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. d. critically assess the patient for symptoms of improvement.

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patients most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration (Select all that apply)? a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the babys neck e. Maternal supine hypotension

C,E

Varacolis-The nurse should plan to educate the male patients prescribed a statin medication on the possible development of which commonly observed side effect? a. Impotence b. Gynecomastia c. Decreased libido d. Delayed ejaculation

EVOLVE LEWIS 33-When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food? Baked flounder Angel food cake Baked potato with margarine Canned chicken noodle soup

Canned chicken noodle soup Correct

EVOLVE LEWIS 33-A patient admitted to the emergency department 24 hours ago with complaints of chest pain was diagnosed with a ST-segment-elevation myocardial infarction (STEMI). What complication of myocardial infarction should the nurse anticipate? Unstable angina Cardiac tamponade Sudden cardiac death Cardiac dysrhythmias

Cardiac dysrhythmias

EVOLVE LEWIS 33-A patient returns after cardiac catheterization. Which nursing care would the registered nurse delegate to the licensed practical nurse? Monitor the electrocardiogram for dysrhythmias Check for bleeding at the catheter insertion site Prepare discharge teaching related to complications Take vital signs and report abnormal values

Check for bleeding at the catheter insertion site Correct

. To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features: a. Is more likely to occur in women with more than two children. b. Is rarely delusional and then is usually about someone trying to harm her (the mother). c. Although serious, is not likely to need psychiatric hospitalization. d. May include bipolar disorder (formerly called manic depression).

. While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: a. Change the womans position. b. Discontinue the oxytocin infusion. c. Insert an internal monitor. d. Document the finding in the clients record.

A nurse may be called on to stimulate the fetal scalp: a. As part of fetal scalp blood sampling. b. In response to tocolysis. c. In preparation for fetal oxygen saturation monitoring. d. To elicit an acceleration in the fetal heart rate (FHR).

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: a. Hypotension. c. Maternal drug use. b. Cord compression. d. Hypoxemia.

GIDDENS 18-A patients serum electrolytes are being monitored. The nurse notices that the potassium level is low. The nurse knows that the patient should be observed for a. tissue ischemia. b. brain malformations. c. intestinal blockage. d. cardiac dysthymia.

GIDDENS 22-In order to fully assess the patient and plan appropriate care including health teaching regarding sexuality, it is important for the nurse working in either a primary care or hospital setting to be cognizant that some groups of patients will have an increased risk for problems related to the concept of sexual health. Which patient is most at risk for sexual abuse? a. A recently divorced 50-year-old woman b. A Hispanic teenage girl c. A 30-year-old African-American male d. An individual with intellectual or developmental disabilities

LEWIS 33-Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and heart rate. b. fewer complaints of having cold hands and feet. c. improvement in the strength of the distal pulses. d. the ability to do daily activities without chest pain.

GIDDENS 33-A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient? a. 0 to 0.5 mEq/L b. 0.6 to 0.9 mEq/L c. 1.0 to 1.4 mEq/L d. 1.5 or higher mEq/L

LEWIS 33-Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? a. The patient states that the pain wakes me up at night. b. The patient rates the pain at a level 3 to 5 (0 to 10 scale). c. The patient states that the pain has increased in frequency over the last week. d. The patient states that the pain goes away with one sublingual nitroglycerin tablet.

VARACOLIS-Cabot has multiple symptoms of depression including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitor

VARACOLIS-Obtaining a sexual history can be embarrassing for the patient and practitioner. Experience with addressing the topic can help, as well as: a. Using informal language familiar to the patient's age b. Avoiding specifics and keeping the interview on general topics c. Avoiding eye contact d. Using a professional tone of voice and a relaxed posture

VARACOLIS-What safety-related responsibility does the nurse have in any situation of suspected of abuse? a. Protect the patient from future abuse by the abuser. b. Inform the suspected abuser that the authorities have been notified. c. Arrange for counseling for all involved parties but especially the patient. d. Report suspected abuse to the proper authorities.

VARCAROLIS 14-A disheveled patient with severe depression and psychomotor retardation has not showered for several days. The nurse will: a. bring up the issue at the community meeting. b. calmly tell the patient, You must bathe daily. c. avoid forcing the issue in order to minimize stress. d. firmly and neutrally assist the patient with showering.

VARCAROLIS 14-A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate from this patient? a. Arms crossed c. Smiling inappropriately b. Staring at the nurse d. Eyes pointed downward

VARCAROLIS 14-A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient: a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting. c. can identify foods with high selenium content that should be avoided. d. confers with a pharmacist when selecting over-the-counter medications.

VARCAROLIS 14-A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of: a. guilt and despair. c. interest and pleasure. b. over-involvement. d. ineffectiveness and frustration.

VARCAROLIS 14-A patient became severely depressed when the last of the familys six children moved out of the home 4 months ago. The patient repeatedly says, No one cares about me. Im not worth anything. Which response by the nurse would be the most helpful? a. Things will look brighter soon. Everyone feels down once in a while. b. Our staff members care about you and want to try to help you get better. c. It is difficult for others to care about you when you repeatedly say the same negative things. d. Ill sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you.

VARCAROLIS 20-Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should: a. develop an understanding of human sexual response. b. assess the patients sexual functioning and needs. c. acquire knowledge of the patients sexual roles. d. clarify own personal values about sexuality.

VARCAROLIS 28-An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurses priority assessment? a. Interpersonal relationships c. Socialization skills b. Work responsibilities d. Physical injuries

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both: a. Can be used when membranes are intact. b. Measure the frequency, duration, and intensity of uterine contractions. c. May need to rely on the woman to indicate when uterine activity (UA) is occurring. d. Can be used during the antepartum and intrapartum periods.

When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that: a. They can be expected to cover only two or three clients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with electronic fetal monitoring (EFM) when documenting results. c. If the heartbeat cannot be found immediately, a shift must be made to EFM. d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to: a. Stay home and avoid outside activities to ensure adequate rest. b. Be certain that you are the only caregiver for your baby, to facilitate infant attachment. c. Keep feelings of sadness and adjustment to your new role to yourself. d. Realize that this is a common occurrence that affects many women.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? a. Scream for help. b. Insert a Foley catheter. c. Start Pitocin. d. Notify the care provider immediately.

VARACOLIS- Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

VARCOLIS- Which patient statement suggests a concern over one's ability to perform sexually? a. "My partner and I aren't as close as we once were." b. "I'm not as desirable as I once was." c. "My personal life has changed a lot." d. "I'm not the partner I used to be."

EVOLVE LEWIS 53-Because of the risks, a 50-yr-old patient does not want hormone replacement therapy for perimenopausal symptoms. She asks the nurse how to minimize hot flashes and night sweats. What should the nurse recommend first? Increase warmth to avoid chills. Good nutrition to avoid osteoporosis Vitamin B complex and vaginal lubrication Decrease heat production and increase heat loss.

Decrease heat production and increase heat loss.

EVOLVE LEWIS 31-When looking at the electrocardiogram (ECG) of the patient, the nurse knows that the QRS complex recorded on the ECG represents which part of the heart's beat? Depolarization of the atria Repolarization of the ventricles Depolarization from atrioventricular (AV) node throughout ventricles The length of time it takes for the impulse to travel from the atria to the ventricles

Depolarization from atrioventricular (AV) node throughout ventricles Correct

EVOLVE LEWIS 33-The nurse is providing teaching to a patient recovering from a myocardial infarction. How should resumption of sexual activity be discussed? Delegated to the primary care provider Discussed along with other physical activities Avoided because it is embarrassing to the patient Accomplished by providing the patient with written material

Discussed along with other physical activities Correct

EVOLVE LEWIS 53-The nurse is providing teaching to a group of perimenopausal women. Which herbs and/or supplements would the nurse include in a discussion regarding effective alternative therapies for menopausal symptoms (select all that apply.)? Soy Garlic Gingko Vitamin A Cinnamon Black cohosh

Soy black cohosh

EVOLVE LEWIS 34-The home care nurse visits a patient with chronic heart failure. Which clinical manifestations, assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)? Fatigue, orthopnea, and dependent edema Severe dyspnea and blood-streaked, frothy sputum Temperature is 100.4oF and pulse is 102 beats/min Respirations 26 breaths/min despite oxygen by nasal cannula

Severe dyspnea and blood-streaked, frothy sputum Correct

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