A&CI 2 Exam 2
A nurse is caring for a preschooler who has nephrotic syndrome. Which of the following findings should the nurse report to the provider? A - blood protein 5.0 g/dL B - hgb 14.5 g/dL C - hct 40% D - platelet 200,000 mm³
A - blood protein 5.0 g/dL
On an EKG strip what does the P wave represent? A - atrial depolarization B - atrial repolarization C - ventricular depolarization D - ventricular repolarization
B - atrial repolarization
A nurse is caring for a school age child who has acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A - BUN 8 mg/dL B - creatinine 1.3 mg/dL C - BP 100/74 mmHg D - urine output 550 mL in 34 hrs
B - creatinine 1.3 mg/dL
What type of infection usually precedes the onset of glomerulonephritis? A - herpes simplex B - pseudomonas C - beta-hemolytic streptococcus D - escherichia coli
C - beta-hemolytic streptococcus
Which of the following signs and symptoms are characteristic of minimal change nephrotic syndrome? A - gross hematuria, proteinuria, fever B - hypertension, edema, hematuria C - poor appetite, proteinuria, edema D - hypertension, edema, proteinuria
C - poor appetite, proteinuria, edema
Procedures performed on young children are usually done in the treatment room because: A - it is the most aseptic environment for the treatment B - children are less afraid in a different environment C - the child's room should be considered a safe haven D - the treatment room is soundproof
C - the child's room should be considered a safe haven
What is the main function that fetal heart structures such as the ductus arteriosus perform? A - to prevent fluid overload in the fetus B - to shunt blood toward fetal lungs C - to provide oxygenated blood to the fetal brain D - to allow a way for wastes to be removed.
C - to provide oxygenated blood to the fetal brain
A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction and reports that his dyspnea began two weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? A - CKMB B - troponin I C - troponin T D - myoglobin
C - troponin T
If a person is in left-sided heart failure, what would be the earliest signs to indicate this? A - pedal edema B - hepatomegaly C - jugular vein distention D - crackles or rales
D - crackles or rales
Which of the following conditions produces a hypovolemic shock state? A - carbon monoxide poisoning B - tension pneumothorax C - pulmonary emboli D - third spacing (movement of fluid from the vascular to the interstitial space)
D - third spacing (movement of fluid from the vascular to the interstitial space)
Which dysrhythmia is immediately life-threatening? A - premature ventricular contraction B - atrial fibrillation C - sinus rhythm D - ventricular fibrillation
D - ventricular fibrillation
A nurse is caring for a client who has a prescription for an after load reducing medication. The nurse should identify that this medication is administered for which of the following types of shock? A - cardiogenic B - obstructive C - hypovolemic D - distributive
A - cardiogenic
Which of the following is the best method to treat cardiomyopathy? A - heart transplantation B - CABG C - IABP D - coronary angioplasty
A - heart transplantation
A patient is in hypovolemic shock. Early signs of hypovolemic shock compensatory stage include what? (select all that apply) A - restlessness B - thirst C - increased heart rate D - decreased blood pressure E - apathy F - decreased respiratory rate G - unconsciousness
A, B, C
Following a coronary artery bypass graft (CABG) procedure, a client develops a temperature of 102°F (38.8°C). The nurse notifies the physician because elevated temperatures: A - may be a forerunner of hemorrhage B - cause diaphoresis and possible chilling C - increase the cardiac output D - may indicate cerebral edema
C - increase the cardiac output
The most common finding in people at risk for sudden cardiac death is A - aortic valve disease B - mitral valve disease C - left ventricular dysfunction D - atherosclerotic heart disease
C - left ventricular dysfunction
An advantage of using the internal mammary artery instead of the saphenous vein for myocardial revascularization is which of the following? A - dissection of the vessel is easier B - cardiopulmonary bypass time is decreased C - long term patency is greater D - risk of post operative bleeding is reduced
C - long term patency is greater
After the physician directs the nurse to add potassium to a child's IV fluid, the nurse should first: A - monitor apical pulse rate B - monitor blood pressure hourly C - monitor intake and output to assess kidney function D - monitor respiratory rate and depth
C - monitor intake and output to assess kidney function
What is the primary goal in treatment of all types of shock? A - increase blood pressure B - decrease acidosis. C - decrease heart rate D - increase perfusion of tissues
D - increase perfusion of tissues
Patient has a spinal cord injury at T4. Vital signs include falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing A - a relative hypovolemia B - an absolute hypovolemia C - neurogenic shock from low blood flow D - neurogenic shock from massive vasodilation
D - neurogenic shock from massive vasodilation
Which one of the following conditions is reversible? A - cardiomyopathy B - myocardial ischemia C - myocardial infarction D - heart muscle necrosis
B - myocardial ischemia
Drugs that block beta receptors (i.e. propanolol, esmolol, nadolol, etc.) will: A - decrease automaticity B - increase contractility C - increase conduction D - stimulate the atrioventricular (AV) node
A - decrease automaticity
What is the difference between angina and acute myocardial infarction (MI)? A - angina is a warning sign with no permanent damage, while an MI is actual damage to the heart muscle B - angina and an MI are the same only different terms used by health care providers C - angina is permanent damage while an MI is not D - angina occurs several days after an MI if it is not treated properly
A - angina is a warning sign with no permanent damage, while an MI is actual damage to the heart muscle
How does narrowing of coronary arteries due to athersclerosis affect the heart? A - blood flow to the myocardium is decreased B - electrolyte abnormalities occur due to atherosclerosis C - hardening of the chambers of the heart occurs D - increased amounts of blood are shunted to the lungs
A - blood flow to the myocardium is decreased
What is the most common early complication of cardiac catheterization? A - cardiac dysrhythmias B - infection C - fluid overload D - electrolyte imbalance
A - cardiac dysrhythmias
A patient with mitral regurgitation and severe left main coronary artery disease would be a candidate for: A - cardiac surgery B - percutaneous coronary intervention (PCI) C - percutaneous balloon valvuloplasty (PBV) D - Intra-aortic balloon pump counterpulsation
A - cardiac surgery
A transmural wall MI involves A - damage that extends through the entire ventricular wall B - scarring of the superficial inner lining of the ventricle C - disruption of delicate tissue lining the inner wall of the ventricle D - disturbance of the area around the Bundle of HIS
A - damage that extends through the entire ventricular wall
How do older infants generally perceive pain? A - they don't have a perception of pain since they have most likely not experienced pain B - their perceptions are influenced by previous perceptions and how the parent responded C - the are generally stoic and do not show emotions D - they may feel as though they are being punished
B - their perceptions are influenced by previous perceptions and how the parent responded
Which of the following phrases best describes acute glomerulonephritis? A - a syndrome involving a gain in nonvolatile acids or a loss of base B - a disorder occurring after an antecedent streptococcal infection C - a disorder resulting in massive urinary protein loss D - a disorder involving a defect in the kidneys' ability to concentrate urine
B - a disorder occurring after an antecedent streptococcal infection
A nurse is planning care for a client who has septic shock. Which of the following actions is the priority for the nurse to take? A - maintain adequate fluid volume with IV infusions B - administer antibiotic therapy C - monitor hemodynamic status D - administer vasopressor medication
B - administer antibiotic therapy
What is a common method of coping used by school-aged children during hospitalization? A - manipulation B - agitation C - decreased bonding D - rationalization
B - agitation
Which is true related to kidney function? A - the kidney receives approximately ¾ of the cardiac output B - an end product of protein metabolism is urea C - newborn infants are able to excrete water at rates similar to those of older persons D - protein is a normal finding in the urine because protein molecules are too big to be reabsorbed
B - an end product of protein metabolism is urea
A child has been admitted to the unit with nephrotic syndrome. The child's mother reports that a cousin had acute glomerulonephritis (AGN) last year and she asks a nurse how these two diseases compare, since they both affect the kidneys. The nurse's best response would include the information that both diseases: A - produce smoky colored urine B - cause a greatly reduced urine output C - demonstrate a genetic inheritance pattern D - involve antibiotic therapy for treatment
B - cause a greatly reduced urine output
When establishing a rapport, what is the best way to communicate a treatment plan to a school-aged child? A - provide minimal information in order to prevent anxiety B - explain treatment plan and encourage questions C - instruct parents to explain treatment plan to their child D - provide reassurance that they will not feel any discomfort
B - explain treatment plan and encourage questions
What is the most common manifestation of a myocardial infarction? A - pain across the shoulders B - decreased blood pressure C - crushing chest pain D - abdominal pain
C - crushing chest pain
Why is maintenance of fluid and electrolyte balance more critical in infants than in adults? A - renal function is immature in infants B - cellular metabolism is less stable than in adults C - the proportion of water in infants' bodies is less than that in adults D - the daily fluid requirement per unit of body weight is less than that in adults
A - renal function is immature in infants
A physiological response to impaired circulation and decreased peripheral perfusion can lead to which of the following acid-base disorders? A - metabolic acidosis B - metabolic alkalosis C - respiratory acidosis D - respiratory alkalosis
A - metabolic acidosis
When taking an admission history of a client with right ventricular heart failure, the nurse would expect the client most likely to complain of A - nausea, edema in legs, fatigue B - fatigue, vertigo, headache C - weakness, palpitations, nausea D - dyspnea, coughing, fatigue
A - nausea, edema in legs, fatigue
Assuming vascular volume is adequate, which medication would have the strongest effect on raising the blood pressure in a hypotensive patient? A - norepinephrine (Levophed) B - dobutamine (Dobutrex) C - epinephrine (Adrenalin) D - nitroglycerin (Tridil)
A - norepinephrine (Levophed)
Why is diastole so important to the functioning of heart muscle? A - perfusion of the coronary arteries occurs during diastole B - ventricular contraction occurs during diastole C - blood is ejected from the heart during diastole D - ventricular muscle depolarization occurs during diastole
A - perfusion of the coronary arteries occurs during diastole
How should the nurse manage family presence when dealing with children? A - provide parents and patient with necessary information regarding treatment plan B - include the entire family when discussing private information C - maintain strict visitation policies D - allow visitation for parents and siblings only
A - provide parents and patient with necessary information regarding treatment plan
A patient is given Lopressor, (metoprolol), a beta-blocking agent. What should the nurse include in the teaching plan for this patient related to this drug? A - take the pulse before each dose of Lopressor B - get up slowly because dizziness may occur C - be sure and take a potassium supplement daily D - report an increase in urine output
A - take the pulse before each dose of Lopressor
Deoxygenated blood flows from the right ventricle to the left ventricle. What defect does this most likely describe? A - tetralogy of Fallot B - coarctation of the aorta C - atrial septal defect D - ventricular septal defect
A - tetralogy of Fallot
The nurse is caring for a child with nephrotic syndrome. Which of the following is the best way to evaluate total fluid losses and gains while the child is hospitalized? A - weigh the child daily B - check the serum potassium level C - measure the abdominal girth D - ask the mother what the child weighed before she became ill
A - weigh the child daily
Common post-operative complications after a coronary artery bypass graft include what? (select all that apply) A - atelectasis B - hypotension C - dysrhythmias D - hemorrhage E - neurogenic shock F - diabetes G - wound infection
A, B, C, D, G
The nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? (select all that apply) A - urine dipstick +2 protein B - edema in the ankles C - hyperlipidemia D - polyuria E - anorexia
A, B, C, E
A child with periorbital edema, decreased urine output, pallor, & fatigue is admitted to the pediatric unit. The child is being examined for acute glomerulonephritis. Which of the following nursing measures would be considered? (select all that apply) A - upon examination there's usually a mild to moderate elevation in blood pressure compared w/ normal values for age, although severe HTN may be present B - urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity C - the primary objective is to reduce the excretion of urinary protein & maintain protein-free urine D - assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable & unpredictable E - because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors
A, B, D
A patient is admitted to the ICU with a diagnosis of NSTEMI. Which drugs will the nurse expect the patient to receive? (select all that apply) A - oral statin therapy B - anti-platelet therapy C - thrombolytic therapy D - prophylactic antibiotics E - intravenous nitroglycerin
A, B, E
Treatment modalities for the management of cardiogenic shock include (select all that apply) A - dobutamine to increase myocardial contractility B - vasopressors to increase systemic vascular resistance C - circulatory assist devices such as an intra-aortic balloon pump D - corticosteroids to stabilize the cell wall in the infarcted myocardium E - Trendelenburg positioning to facilitate venous return and increase preload
A, C
A nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. The child's mother asks about why this has occurred. The nurse knows that this is most likely the result of which of the following? A - poor appetite B - reduction of edema C - restriction to bed rest D - increased potassium intake
B - reduction of edema
Which of the following statements characterizes cardiogenic shock? A - increasing stroke volume in the face of decreasing cardiac output B - the heart failing to function as a pump C - increasing stroke volume in the face of increasing cardiac output D - massive loss of blood
B - the heart failing to function as a pump
Nuclear imaging with radioactive isotopes is scheduled for a patient with chest pain. The nurse explains to the patient that this test will: A - outline the blood flow through the chambers of the heart B - identify the areas of ischemia or infarction of the heart muscle C - identify abnormalities in heart wall motion and contraction D - evaluate the irritability of the heart and risk for arrhythmias
B - identify the areas of ischemia or infarction of the heart muscle
The nurse realizes that the pain associated with a coronary artery occlusion is caused primarily by: A - arterial spasm B - ischemia of the heart muscle C - blocking of the coronary veins D - irritation of nerve endings in the cardiac plexus
B - ischemia of the heart muscle
The nurse is caring for a patient who is two days post MI. The patient reports that she is experiencing chest pain when she takes a deep breath. Which action would be a priority? A - notify the provider STAT and obtain a 12 lead ECG B - obtain vital signs and auscultate for a pericardial friction rub C - apply high flow O2 by face mask and auscultate breath sounds D - medicate the patient with as needed analgesic and reevaluate in 30 minutes
B - obtain vital signs and auscultate for a pericardial friction rub
Defects associated with tetralogy of Fallot include: A - severe coarctation of the aorta, severe aortic valve stenosis, and severe mitral valve stenosis B - ventricular septal defect, overriding aorta, pulmonic stenosis, and right ventricular hypertrophy C - tricuspid valve atresia, atrial septal defect, and hyposplastic right ventricle D - origin of the aorta from the right ventricle and of the pulmonary artery form the left ventricle
B - ventricular septal defect, overriding aorta, pulmonic stenosis, and right ventricular hypertrophy
Which of the following are two benefits of an intra-aortic balloon pump? A - decreased preload and increased afterload B - increased contractility and afterload C - decreased afterload and increased coronary artery filling D - increased coronary artery filling and increased preload
C - decreased afterload and increased coronary artery filling
A 68-year-old female is admitted to your unit after a CABG. 8 hours following surgery, she is extubated and experiences only mild chest discomfort. Over the next hour, she begins to complain of vaguely increasing discomfort. Her pleural tube is bubbling in the water seal chamber. No drainage is present from the mediastinal tube. Her blood pressure fluctuates with respiration, decreasing by 20 mm Hg during inspiration. Her lung sounds are clear; heart sounds are normal but distant. Based on the preceding information, which condition is most likely to be developing? A - tension pneumothorax B - pneumonia C - left ventricular failure D - cardiac tamponade
D - cardiac tamponade
Cholesterol, frequently discussed in relation to atherosclerosis, is a substance that A - may be controlled entirely by eliminating food sources B - is found in many foods, both plant and animal sources C - persons would be better off without it because it causes cardiovascular disease process D - circulates in the blood, the level of which responds usually to dietary substitutions of unsaturated fats for saturated fats
D - circulates in the blood, the level of which responds usually to dietary substitutions of unsaturated fats for saturated fats
The nurse is assessing an infant who is admitted for congestive heart failure. Which sign would the nurse most likely find? A - pedal edema B - sudden weight loss C - unexplained bruising D - dyspnea
D - dyspnea
A nurse is admitting a client who has a suspected am I in a history of angina. Which of the following findings will help the nurse distinguish stable angina from an MI? A - stable angina can be relieved with rest & nitroglycerin B - the pain of an MI resolves in less than 15 minutes C - the type of activity that causes an MI can be identified D - stable angina can occur for longer than 30 minutes
A - stable angina can be relieved with rest & nitroglycerin
A nurse is caring for a child who has acute post streptococcal glomerulonephritis. Which of the following manifestations should the nurse expect? (select all that apply) A - pale urine B - periorbital edema C - ill appearance D - decreased creatinine E - hypertension
B, C, E
What are some common ineffective methods that parents use to assist their child in coping? (select all that apply) A - providing choices whenever possible B - encouraging digressive behavior C - promising gifts D - being present and supportive
B, C
The philosophy of family-centered care represents a paradigm shift for some pediatric nurses. Mark all of the following basic concepts included in the philosophy of family centered care. A - family dependence B - collaboration with family C - paraprofessional teams D - promotion of family strengths E - medical control of care
B, C, D
A nurse in the emergency department is completing an assessment on a client who's in shock. Which of the following findings should the nurse expect? (select all that apply) A - heart rate 60/minute B - seizure activity C - respiratory rate 42/minute D - increase urine output E - week, thready pulse
B, C, E
Therapeutic management in nephrotic syndrome includes the administration of prednisone. The nurse teaches which of the following as correct administration guidelines? A - corticosteriod therapy is begun after BUN and serum creatinine elevation B - prednisone is administered orally in a dosage of 4 mg/kg of body weight C - after a child is free of proteinuria and edema, the daily dose of prednisone is gradually tapered over several weeks to months D - the drug is discontinued as soon as the urine is free from protein
C - after a child is free of proteinuria and edema, the daily dose of prednisone is gradually tapered over several weeks to months
A 59-year-old male is admitted to your unit with the diagnosis "rule out myocardial infarction." He stated one hour ago that he was at work when he felt severe chest pain, became cool and clammy, and felt nauseated. He came immediately to the hospital. The ECG indicates ST segment elevation and a pathological Q wave. His troponin levels are elevated. He has not responded to nitrates in the emergency department. His vital signs are as follows: blood pressure 98/68 pulse 107 respiratory rate 32 Based on the preceding description, which initial treatment is indicated? A - fibrinolytic therapy B - CABG (coronary artery bypass graft) surgery C - emergent percutaneous coronary intervention (PCI) D - calcium channel blockers
C - emergent percutaneous coronary intervention (PCI)
A patient with angina who has episodes of ventricular tachycardia and ventricular fibrillation would be a good candidate for what? A - percutaneous transluminal coronary angioplasty B - coronary artery bypass surgery C - implantable cardioverter-defibrillator D - intra-aoric balloon pump counterpulsation
C - implantable cardioverter-defibrillator
A newborn infant is diagnosed as having a patent ductus arteriosus. The knowledgeable pediatric nurse understands that this congenital heart defect involves: A - narrowing of the aorta B - origination of the pulmonary artery from the left ventricle and origination of the aorta from the right ventricle C - persistence of the fetal opening between the pulmonary artery and the aorta D - obstruction of left ventricular outflow at the level of the aortic valve
C - persistence of the fetal opening between the pulmonary artery and the aorta
A nurse is caring for a group of clients. Which of the following clients is at risk for obstructive shock? A - a client who is having occasional PVCs on the ECG monitor B - a client who has been experiencing vomiting and diarrhea for several days C - a client who has a gram-negative bacterial infection D - a client who has a pulmonary arterial stenosis
D - a client who has a pulmonary arterial stenosis
For a child with recurring nephrotic syndrome, which of the following areas of potential disturbance should be a prime consideration when planning ongoing nursing care for this child? A - muscle coordination B - visual disturbances C - intellectual Development D - body Image
D - body Image
The nurse is planning care for a 3-year-old boy who has nephrotic syndrome and severe edema. Which nursing intervention is appropriate for the nursing diagnosis of impaired skin integrity? A - administer corticosteroids on time with careful monitoring for infections B - include daily weight, strict intake and output, daily checks for proteinuria C - enforce bedrest when his edema is the worst D - provide support for edematous areas such as legs, abdomen and even scrotum
D - provide support for edematous areas such as legs, abdomen and even scrotum
