Chapter 35

C) Serum potassium Rationale: Furosemide is a loop diuretic that promotes loss of potassium and thereby increases the risk of digoxin-induced dysrhythmias. When digoxin and furosemide are used concurrently, serum potassium levels must be monitored and maintained within a normal range (3.5 to 5 mEq/L).

A patient is prescribed digoxin and furosemide. It is most important for the nurse to assess which value before administering these medications? A) Serum sodium B) Blood urea nitrogen C) Serum potassium D) Plasma B-natriuretic peptide

A) Activated partial thromboplastin time (aPTT)

A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value witll the nurse monitor to evaluate treatment with this medication? A) Activated partial thromboplastin time (aPTT) B) Prothrombin time (PT) C) Platelet count D) Hemoglobin and hematocrit (H&H)

C) Wait 1 minute between puffs from the inhaler. Rationale: Patients should be taught to wait at least 1 minute between puffs. Extra doses should not be taken unless prescribed by the health care provider. Glucocorticoid inhalation requires oral rinses to prevent the development of dysphonia and oropharyngeal candidiasis. Patients should take adequate amounts of calcium and vitamin D with glucocorticoid therapy.

A patient with asthma is prescribed albuterol [Proventil], two puffs 3 times per day. The nurse should teach the patient to do what? A) Rinse the mouth after taking the prescribed dose. B) Take an extra dose if breathing is compromised. C) Wait 1 minute between puffs from the inhaler. D) Take adequate amounts of calcium and vitamin D.

B) Stimulation of the parasympathetic nervous system Rationale: Heart rate can be slowed by two simultaneous events that begin in the cardiovascular control center: (1) inhibition of sympathetic stimulation of the SA node and (2) activation of parasympathetic stimulation of the SA node.

A person's heart rate is reduced. What is happening physiologically? A) Activation of the sympathetic nervous system B) Stimulation of the parasympathetic nervous system C) Stimulation of the cardioexcitatory system D) Reduction in blood pressure, detected by the baroreceptors

C) PR interval Rationale: The PR interval is a measure of time from the onset of atrial activation to the onset of ventricular activation; it normally ranges from 0.12 to 0.20 second. The PR interval represents the time necessary to travel from the sinus node through the atrium, AV node, and His-Purkinje system to activate ventricular myocardial cells.

A nurse is looking at an ECG and is measuring the time interval from the onset of atrial electrical activity to the onset of ventricular electrical activity. What is the nurse measuring? A) QRS complex B) QT interval C) PR interval D) Width of the P wave

A) Technetium scanning Rationale: Technetium pyrophosphate (99mTcPYP) is injected intravenously into a resting individual during a "hot spot" imaging examination. Two hours after injection the distribution pattern of the radioactive solution is recorded by nuclear scan.

A nurse observes a "hot spot" from the injection of a radioactive solution. Which test is the nurse reviewing? A) Technetium scanning B) Coronary angiography C) Doppler study D) Echocardiogram

C) Alveolar ducts Rationale: The gas-exchange airways are made up of respiratory bronchioles, alveolar ducts, and alveoli. These structures together are sometimes called the acinus and all of them participate in gas exchange.

A nurse recalls that the acinus contains: A) Ciliated cells B) Goblet cells C) Alveolar ducts D) Striated muscle

C) Fluticasone [Flonase] Rationale: Glucocorticoids (fluticasone [Flonase]) are the most effective agents used to treat allergic rhinitis.

A patient asks what medication would be most effective in the treatment of seasonal hay fever. The nurse will teach the patient about the use of which drug? A) Azelastine [Astelin] B) Chlorpheniramine [Chlor-Trimeton] C) Fluticasone [Flonase] D) Pseudoephedrine [Sudafed]

A) Respiratory depression Rationale: Codeine is an opioid that can suppress respiration.

A patient is prescribed codeine as an antitussive. Which symptom will the nurse observe for as an adverse effect of this medication? A) Respiratory depression B) Increased heart rate C) Productive cough D) Restlessness

C) Decreasing level of consciousness

A 52-year-old male presents to the emergency department with symptoms of acute myocardial infarction. After diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (t-PA) followed by 50 mg infused over 30 minutes. In monitoring this patient, the nurse understands that which symptom, if present, indicates the most likely adverse reaction to this drug? A) Urticaria, itching, and flushing B) Blood pressure = 90/50 C) Decreasing level of consciousness D) Potassium level = 5.5 mEq/L

C) Discolored urine

A 63-year-old male patient has been receiving a heparin infusion for 2 days for treatment of pulmonary embolism. Which symptom most clearly relates to an adverse effect of heparin? A) Heart rate = 60 beats/min B) Blood pressure = 160/88 C) Discolored urine D) Wheezing

B) Chronic inflammatory disorder, causing mucosal edema and reversible airflow obstruction Rationale: Asthma is a chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyperresponsiveness, constriction of the airways, and variable airflow obstruction that is reversible. Episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucus production occur in asthma.

A child has asthma. Which pathophysiologic process occurs in this disease? A) Acute injury to the alveolocapillary membrane, producing severe pulmonary edema and shunting B) Chronic inflammatory disorder, causing mucosal edema and reversible airflow obstruction C) Airway obstruction, increasing resistance to airflow and decreasing flow rates, especially inspiratory flow D) IL-17 impairs mucociliary clearance and contributes to bronchoconstriction

C) Left ventricle will be required to pump harder. Rationale: The left ventricle is responsible for pumping against pressures in the systemic vessels. When there is increased systemic vascular resistance, the left ventricle will be required to pump harder. Normally, there is little resistance to flow from the atria to the ventricles, so the atria will not be affected by increased systemic vascular resistance. The right ventricle pumps blood to the pulmonary system. It would become ineffective if there was an increase in pulmonary vascular system.

A client is diagnosed with increased systemic vascular resistance. What will be the effect on the heart? A) Left atrium will be required to pump harder. B) Right atrium chamber will become enlarged. C) Left ventricle will be required to pump harder. D) Right ventricle will become ineffective because of increased pressure.

B) "I should report any muscle weakness or nausea."

A nurse instructs a patient about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement? A) "If my heart is racing, the dose may be too high." B) "I should report any muscle weakness or nausea." C) "My doctor should be notified if diarrhea occurs." D) "The dose will be reduced if I develop memory loss."

B) Teach the patient to use a spacer to prevent a fungal infection. Rationale: Acetonide is an inhaled glucocorticoid. Spacers disperse the medication into the lungs, leaving less in the oropharyngeal mucosa; this reduces the incidence of fungal infection. Beta2-adrenergic agonists may cause tachycardia and are used to abort acute asthma attacks. Patients taking glucocorticoids should engage in weight-bearing activities to prevent osteoporosis. This drug should not be used to treat an acute attack.

A patient with asthma is prescribed triamcinolone acetonide [Azmacort]. What should the nurse do? A) Take the patient's pulse before administering the medication. B) Teach the patient to use a spacer to prevent a fungal infection. C) Instruct the patient to use this drug to treat an acute attack. D) Encourage the patient to avoid weight-bearing activity.

B) It suppresses coagulation by helping antithrombin to perform its natural functions.

A patient with deep vein thrombosis is receiving an intravenous heparin infusion. He asks the nurse how this medication will help him. The nurse's response is accurately based on which concept? A) It prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B) It suppresses coagulation by helping antithrombin to perform its natural functions. C) It works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D) It inhibits the enzyme responsible for platelet activation and aggregation within vessels.

D) It is within normal limits

A patient with early heart failur has an average heart rate of 90 beats per minute and a stroke volume of 55 mL. Whit is true about this patient's per minute cardiac output? A) It is extremely low B) It is low C) It is high D) It is within normal limits

C) Weakness Rationale: Weakness is a sign of hyperkalemia

A patient with heart failure is prescribed spironolactone and enalapril. It would be a priority to consult the prescriber regarding evaluation of the patient's potassium levels if the patient exhibited: A) Confusion B) Constipation C) Weakness D) Shallow respirations

B) Fail to shut completely, permitting the backflow of blood to continue. Rationale: In valvular regurgitation (also called insufficiency or incompetence) the valve leaflets, or cusps, fail to shut completely, permitting blood flow to continue even when the valve is supposed to be closed.

A person has a diagnosis of valvular regurgitation. What pathophysiologic process is the person experiencing? The valves: A) Are constricted and narrowed, impeding the forward flow of blood. B) Fail to shut completely, permitting the backflow of blood to continue. C) Have an inherited defect, such as thickening of the septal wall. D) Cause acute pericarditis and filling of the pericardial sac.

C) Sudden pleuritic chest pain, dyspnea, unexplained anxiety Rationale: An individual with Pulmonary embolism usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety.

A person has a pulmonary embolism. What will the nurse find upon assessment? A) Positive PPD skin test, night sweats, weight loss B) Productive cough, fever, pain behind the sternum C) Sudden pleuritic chest pain, dyspnea, unexplained anxiety D) Barrel chest, hyperresonant chest sounds, very little sputum

B) Macrophages release enzymes and toxic oxygen radicals that create oxidative stress. Rationale: Macropages adhere to the injured vessels wall. These macrophages then release enzymes and toxic oxygen radicals that create oxidative stress, oxidize LDL, and further injure the vessel wall.

A person has atherosclerosis. Which pathophysiologic process has occurred? A) Fatty streaks produce foam cells that accumulate and block the flow of blood in the vessel. B) Macrophages release enzymes and toxic oxygen radicals that create oxidative stress. C) Vasospasm in the small arteries from an imbalance between vasodilation and vasoconstriction produce fibrous plaque. D) Significant T-cell activation and a lack of endothelial precursor cells affect blood vessel linings.

D) Inflammatory cytokines cause alveolar edema, which creates a medium for microorganisms that leads to consolidation. Rationale: In pneumococcal pneumonia, inflammatory cytokines and cells are released that cause alveolar edema. Edema creates a medium for the multiplication of bacteria and aids in the spread of infection into adjacent portions of the lung. The involved lobe undergoes consolidation.

A person has pneumococcal pneumonia. Which pathophysiologic process has occurred? A) Progressive airflow limitation is associated with an abnormal inflammatory response and is not fully reversible. B) Continual bronchial inflammation causes bronchial edema and increases the size and number of mucous glands and goblet cells. C) Abnormal permanent enlargement of the acini is accompanied by the destruction of alveolar walls without obvious fibrosis. D) Inflammatory cytokines cause alveolar edema, which creates a medium for microorganisms that leads to consolidation.

A) Inhaled inorganic dust particles, resulting in a change in the lungs Rationale: Pneumoconiosis represents any change in the lung caused by inhalation of inorganic dust particles, which usually occurs in the workplace. Pneumoconiosis is caused by long-term inhalation of dust particles. Dust particles that produce this disorder include coal, asbestos, silica, talc, fiberglass, and mica.

A person has pneumoconiosis. Which information would the nurse find in the history of this person? A) Inhaled inorganic dust particles, resulting in a change in the lungs B) Fractured ribs, causing paradoxical movement of the chest with breathing C) Ruptured visceral pleura, which allows air or gas into the pleural space D) Bronchial inflammation with a persistent abnormal dilation of the bronchi

B) Counterproductive; it causes the heart to work harder. Rationale: Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of MI in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility.

A person with an MI is releasing angiotensin II. How should the nurse interpret this finding? Releasing angiotensin II is: A) Beneficial; it helps the heart pump effectively. B) Counterproductive; it causes the heart to work harder. C) Beneficial; it decreases the release of catecholamines. D) Counterproductive; it causes myocardial stunning.

C) ACE inhibitors Rationale: Individuals with heart failure, have chronic kidney disease, are postmyocardial infarction, or have had recurrent stroke should begin antihypertensive treatment with an ACE inhibitor, angiotensin receptor blocker (ARB), or aldosterone antagonist.

An individual has primary hypertension and recurrent strokes. Which drug should the nurse prepare to administer? A) Aldosterone agonists B) Beta activators C) ACE inhibitors D) Osmotic diuretics

B) Left atrium Rationale: Oxygenated blood from the lungs enters the left atrium through the four pulmonary veins (two from the left lung and two from the right lung).

Blood flows from the pulmonary veins into the: A) Right atrium B) Left atrium C) Right ventricle D) Left ventricle

C) Apply direct pressure over the puncture site.

During administration of alteplase, the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate? A) Discontinue the infusion of alteplase. B) Assess the patient's vital signs. C) Apply direct pressure over the puncture site. D) Administer aminocaproic acid.

D) Sensitive to alterations in the pulmonary capillary pressure. Rationale: They are sensitive to increased pulmonary capillary pressure, which stimulates them to initiate rapid, shallow breathing laryngeal constriction on expiration and mucus secretion; hypotension; and bradycardia.

J receptors are: A) Sensitive to noxious aerosols. B) Located in the smooth muscle of airways. C) Stimulated by increases in volume. D) Sensitive to alterations in the pulmonary capillary pressure.

B) Rise in blood pressure

Individuals who have plaque lining their arteries experience an increase in vessel resistance. The nurse should assess for which reaction that is the body's attempt to compensate? A) Peripheral edema B) Rise in blood pressure C) Shifting of point of maximal impulse (PMI) D) Slowing of heart rate

C) Potassium 3.0 mEq/L Rationale: Hypokalemia increases the risk of digoxin-induced dysrhythmias.

It is a priority to assess for digitalis toxicity if a patient is receiving digoxin, the digoxin level is 1.3 ng/mL, and the patient has which other laboratory result? A) BNP 1813 picograms/mL B) INR 1.5 C) Potassium 3.0 mEq/L D) Sodium 150 mEq/L

C) Renin-angiotensin-aldosterone system (RAAS) Rationale: Activation of the RAAS causes not only increases in preload and afterload but also direct toxicity to the myocardium. Ang II mediates remodeling of the ventricular wall, contributing to sarcomere death, loss of the normal collagen matrix, and interstitial fibrosis. This leads to decreased contractility, changes in myocardial compliance, and ventricular dilation.

Systolic heart failure is associated with the activation of the: A) Parasympathetic nervous system B) Hypothalamic pituitary adrenal axis C) Renin-angiotensin-aldosterone system (RAAS) D) Antidiuretic hormone (ADH) vasopressin aldosterone system

A) Call the healthcare provider to discuss the reduction or withdrawal of heparin.

The laboratory calls the nursing unit to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A) Call the healthcare provider to discuss the reduction or withdrawal of heparin. B) Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C) Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D) Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

C) Ventilation-perfusion mismatch Rationale: An abnormal ventilation-perfusion ratio (V•/Q•) is the most common cause of hypoxemia. Hypoxemia can be caused by inadequate ventilation of well-perfused areas of the lung (low V•/Q•). Hypoxemia also can be caused by poor perfusion of well-ventilated portions of the lung (high V•/Q•), resulting in wasted ventilation.

The most common cause of hypoxemia is: A) Reduced diffusion distance B) Hyperventilation with hypocapnia C) Ventilation-perfusion mismatch D) Reduced diffusion distance

A) Improved cardiac output

The nurse cares for a patient receiving digoxin. What indicates to the nurse that treatment with this medication is effective? A) Improved cardiac output B) Reduced exercise tolerance C) Increased body weight D) Decreased cardiac contractility

A) Start continuous heart monitoring. Rationale: The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL; levels higher than 2 ng/mL usually are associated with toxic symptoms. A priority action is to assess for dysrhythmias; the nurse should immediately initiate continuous heart monitoring. Serum creatinine indicates renal function, and digoxin is eliminated primarily by renal excretion. Renal impairment can lead to toxic accumulation, and the dosage must be reduced if kidney function declines. Digoxin should not be given to a patient suspected of having digoxin toxicity. If a severe digoxin overdose is responsible for dysrhythmias, digoxin levels can be lowered using Fab antibody fragments.

The nurse cares for a patient with a digoxin level of 1.9 mg/mL. Which action would be most appropriate for the nurse to take initially? A) Start continuous heart monitoring. B) Check the patient's serum creatinine. C) Administer digoxin as prescribed. D) Give Fab antibody fragments (Digibind).

A) Cough with frothy sputum Rationale: A cough that produces frothy sputum that may be tinged with blood is an indication of pulmonary edema.

The nurse is assessing a patient who is receiving medicaion for acute heart failure. Which assessment would be a priority to report to the prescriber? A) Cough with frothy sputum B) Expiratory wheezes of bronchi and bronchioles C) Pulse 100 beats per minute D) Respirations 25 per minute

B) 70

The nurse is beginning a heparin infusion for a patient with evolving stroke. The baseline aPTT is 40 seconds. Which aPTT level will indicate a therapeutic dose has been achieved? A) 50 B) 70 C) 90 D) 110

B) Omeprazole (Prilosec)

The nurse is caring for a patient receiving clopidogrel (Plavix) to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A) Aspirin (Bayer) B) Omeprazole (Prilosec) C) Acetaminophen (Tylenol) D) Warfarin (Coumadin)

D) Call the healthcare provider to increase the dose.

The nurse is caring for a patient receiving warfarin (Coumadin) for the prevention of deep vein thrombosis who has an international normalized ratio (INR) value of 1.2. Which action by the nurse is the most appropriate? A) Prepare to administer protamine sulfate. B) Continue with the current prescription. C) Prepare to administer vitamin K. D) Call the healthcare provider to increase the dose.

D) Urine output Rationale: Dopamine is administered by continuous infusion. Constant monitoring of blood pressure, the EKG, and urine output is required. Low blood pressure would result in low urine output.

What is a priority assessment when administering dopamine? A) Bowel sounds B) Capillary refill C) Temperature D) Urine output

C) Protamine sulfate

What is the antidote for heparin overdose? A) Ferrous sulfate B) Atropine sulfate C) Protamine sulfate D) Magnesium sulfate

B) High pH and hypocapnia Rationale: The curve is shifted to the left by alkalosis (high pH) and hypocapnia (decreased PaCO2). A shift to the left depicts hemoglobin's increased affinity for oxygen, which promotes association in the lungs and inhibits dissociation in the tissues.

Which conditions will cause a shift to the left in the oxyhemoglobin dissociation curve? A) Acidosis and increased PaCO2 B) High pH and hypocapnia C) Hyperthermia and increased 2,3-diphosphoglycerate (2,3-DPG) D) Decreased hila and gluconeogenesis

D) Increased blood viscosity Rationale: According to Poiseuille's law, resistance is proportional to vessel length and blood viscosity. The longer the vessel, the greater the resistance and as blood viscosity increases, resistance increases. Resistance is inversely proportion to the vessel radius; thus, as the radius decreases, resistance increases. Thick fluids move more slowly and cause greater resistance to flow than thin fluids.

Which finding will cause the resistance in blood vessels to be increased? A) Short length of the vessel B) Increased radial lumen C) Parallel vessel system D) Increased blood viscosity

A) Inhaled glucocorticoids have many significant adverse effects.

Which information should the nurse include when teaching a patient about inhaled glucocorticoids? A) Inhaled glucocorticoids have many significant adverse effects. B) The principal side effects of inhaled glucocorticoids include hypertension and weight gain. C) Use of a spacer can minimize side effects. D) Patients should rinse the mouth and gargle before administering inhaled glucocorticoids.

C) Hypoglycemia Rationale: Serious adverse effects include adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression.

Which of the following is NOT a serious adverse effect of long-term oral glucocorticoid therapy? A) Adrenal suppression B) Osteoporosis C) Hypoglycemia D) Peptic ulcer disease

D) Cardiac fibers have only one nucleus, and skeletal muscle fibers have many nuclei. Rationale: Cardiac fibers have only one nucleus. The fibers are branched, whereas skeletal muscle has parallel fibers. There is rapid transmission and abundant mitochondria in the cardiac muscle because cardiac muscle cannot rest and therefore needs a superabundance of mitochondria for energy supply.

Which of the following is TRUE with regard to cardiac and skeletal muscle fibers? A) Cardiac fibers have fewer mitochondria than skeletal muscle fibers. B) Cardiac fibers are parallel, and skeletal muscle fibers are branched. C) Cardiac fibers have a slower transmission than skeletal muscle fibers. D) Cardiac fibers have only one nucleus, and skeletal muscle fibers have many nuclei.

C) Blood flows from the right ventricle through the pulmonary semilunar valve. Rationale: The correct blood flow is from the right atrium through the tricuspid valve to the right ventricle. Blood then travels from the right ventricle through the pulmonic semilunar valve to the pulmonary circulation. Once in the pulmonary circulation, it is oxygenated and travels to the left atrium, through the bicuspid valve, and to the left ventricle. Blood leaves the left ventricle through the aortic valve and enters the systemic circulation.

Which of the following is an accurate statement regarding blood flow through the heart? A) Blood flows from the left ventricle through the bicuspid valve. B) Blood flows from the right atrium through the aortic valve to the right ventricle. C) Blood flows from the right ventricle through the pulmonary semilunar valve. D) Blood flows from the left atrium through the tricuspid valve to the left ventricle.

C) Patient taking oral contraceptives to prevent pregnancy

Which patient does the nurse identify as most likely needing an increased dose of warfarin [Coumadin] to have the same anticoagulant effect? A) Patient taking acetaminophen for back pain. B) Patient taking cimetidine (Tagamet) to prevent gastric ulcers C) Patient taking oral contraceptives to prevent pregnancy D) Patient taking prednisone for rhreumatoid arthritis

C) Reduces surface tension. Rationale: Type I alveolar cells provide structure, and type II alveolar cells secrete surfactant, a lipoprotein that coats the inner surface of the alveolus and facilitates its expansion during inspiration, lowers alveolar surface tension at end-expiration, and, thereby, prevents lung collapse.

Which statement indicates the nurse has a correct understanding of surfactant? Surfactant: A) Is found in the bronchi. B) Is produced by type 1 alveolar cells. C) Reduces surface tension. D) Promotes phagocytosis.