Exam 1
A patient has been admitted with a C5-level spinal cord injury and has marked hypotension. What pharmacologic therapies would the nurse expect to be prescribed for this patient? Select all that apply. Nitrates Diuretics Beta blockers Anticoagulants Intravenous fluids
Answer: Anticoagulants Intravenous fluids Rationale: The spinal cord injury at the C5 level causes loss of sympathetic nervous system tone in peripheral vessels. This results in chronic low blood pressure with potential postural hypotension. Lack of muscle tone to aid venous return can result in sluggish blood flow, thus predisposing the patient to deep vein thrombosis. To treat hypotension, a vasopressor agent such as dopamine or norepinephrine should be administered. Fluid replacement also helps in maintaining optimal blood pressure. Nitrates are potent vasodilators and would worsen the hypotension if administered. Diuretics increase fluid loss from the body and may worsen hypotension. Beta blockers decrease the heart rate and cardiac output, which lower blood pressure and make the heart beat more slowly and with less force; this is inappropriate to treat hypotension. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient has been admitted with T2-level spinal cord injury and has abnormal cardiovascular signs and symptoms. Which drugs should the nurse administer to stabilize the condition of this patient? Select all that apply. Digoxin Atropine Metoclopramide Vasodilator drugs Vasopressor drugs
Answer: Atropine Vasopressor drugs Rationale: Due to the spinal cord injury at the T2 level, the patient may have abnormal cardiac signs and symptoms like bradycardia, peripheral vasodilation, and hypotension. Atropine should be administered to increase the heart rate and prevent hypoxemia. Hypotension should be treated by administering IV fluids or vasopressor drugs. Vasodilators would accentuate the peripheral pooling of blood, thereby worsening the condition. Digoxin is used to treat arrhythmias like ventricular tachycardia, and they act by reducing the heart rate. The patient has bradycardia, so digoxin administration would worsen the condition. Metoclopramide is not given for cardiac condition; it is used to treat delayed gastric emptying. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse reviews compensatory mechanisms associated with heart failure (HF). The nurse recalls that the sequence of events in the renin-angiotensin-aldosterone system (RAAS) occur in what order? Angiotensin I is converted to angiotensin II. Cardiac output falls. Vasoconstriction occurs. Renin is released. Angiotensinogen is activated.
Answer: Cardiac output falls. Renin is released. Angiotensinogen is activated. Angiotensin I is converted to angiotensin II. Vasoconstriction occurs. Rationale: In the RAAS, decreased cardiac output leads to release of renin from the kidneys. Renin causes activation of angiotensinogen, which is the enzyme that changes angiotensin I into angiotensin II, which is a potent vasoconstrictor. Test-Taking Tip: In this Question Type, you are asked to prioritize (put in order) the options presented. For example, you might be asked the steps of performing a nursing action or skill such as those involved in medication administration. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with heart failure is hospitalized with a diagnosis of digitalis toxicity. The nurse expects what assessment findings? Select all that apply. Depression Poor appetite Heart rate (HR) of 52 Distant heart sounds Seeing halos around lights Weight gain of 3 pounds in the past two days
Answer: Depression Poor appetite Heart rate (HR) of 52 Seeing halos around lights Rationale: Poor appetite (e.g., anorexia), decreased heart rate (due to digitalis preparations causing a decrease in HR), depression, and visual changes (e.g., seeing halos around lights) are all symptoms of digitalis toxicity. "Distant heart sounds" is not a correct answer; they are a symptom of pericarditis. Weight gain of 3 pounds in the past two days is not correct; it is a symptom of possible exacerbation of heart failure and fluid retention. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for the patient with pulmonary hypertension. Which treatment(s) are appropriate? Select all that apply. Diuretics Vasodilators Thrombolytics Anticoagulants
Answer: Diuretics Vasodilators Anticoagulants Rationale: Vasodilators, diuretics, and anticoagulants are correct because they are included in drug treatments for pulmonary hypertension. Vasodilators are especially important in the treatment of pulmonary hypertension because they will aid in reducing the right ventricular workload by dilating pulmonary vessels. Diuretics decrease plasma volume and thereby reduce myocardial workload. Anticoagulants also are used, especially if the case is severe, because they work to prevent in situ thrombus formation and venous thrombosis. Warfarin would be given to keep the international normalized ratio (INR) in the 2 to 3 range. Thrombolytic therapy is not an appropriate drug treatment and would be used if the condition caused right ventricle hypertrophy, resulting in cor pulmonale. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient presents with edema of the legs, dyspnea, and fatigue. The patient is diagnosed with acute decompensated heart failure (ADHF). The nurse expects that which medications will be included in the patient's immediate treatment plan? Select all that apply. Digitalis Dopamine Furosemide Morphine sulfate Sodium nitroprusside
Answer: Dopamine Furosemide Morphine sulfate Sodium nitroprusside Rationale: ADHF should be treated immediately to prevent complications. Furosemide is a loop diuretic used to promote sodium and water loss. Water loss decreases the preload and enhances the cardiac contractility. Sodium nitroprusside is a potent vasodilator and reduces both the preload and afterload. This results in improved cardiac contractility. Dopamine is a beta-adrenergic agonist and is used to dilate the renal vessels and promote water loss. Morphine sulfate reduces preload and afterload; it is frequently used in the treatment of HF and acute coronary syndrome. It dilates pulmonary and systemic blood vessels, resulting in decreased pulmonary pressure and increased gas exchange. Digitalis is a positive inotrope that improves the myocardial contractility. Because it requires a loading dose and time to work, it is not recommended for the initial treatment of ADHF. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient that is admitted to the emergency department is diagnosed with acute decompensated heart failure (ADHF), manifesting as pulmonary edema. The nurse expects to observe which clinical manifestations? Select all that apply. Dyspnea Dry, warm skin Rapid heart rate Decreased respiratory rate Frothy, blood-tinged sputum
Answer: Dyspnea Rapid heart rate Frothy, blood-tinged sputum Rationale: The clinical manifestations of pulmonary edema include dyspnea, rapid heart rate, and frothy, blood-tinged sputum. The skin usually becomes clammy and cold from the vasoconstriction caused by the stimulation of the sympathetic nervous system. The respiratory rate is often greater than 30 breaths per minute. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with a T1-level spinal cord injury is soon to be discharged from the hospital. The nurse has to plan the home care for neurogenic bowel management. What should the nurse include in the care plan? Select all that apply. Teach the Valsalva maneuver. Explain the use of stool softeners. Advise the patient to eat a high-fiber diet. Advise the patient to limit fluids in the diet. Teach the patient how to use suppositories for evacuation. Teach the patient to perform digital stimulation of the rectum.
Answer: Explain the use of stool softeners. Advise the patient to eat a high-fiber diet. Teach the patient how to use suppositories for evacuation. Teach the patient to perform digital stimulation of the rectum. Rationale: Careful management of bowel evacuation is necessary in the patient with spinal cord injury (SCI) because voluntary control of this function may be lost. This condition is called neurogenic bowel. A stool softener such as docusate sodium can be used to regulate stool consistency. A digital stimulation (performed 20 to 30 minutes after suppository insertion) by the nurse or patient may be necessary. In addition, suppositories (bisacodyl or glycerin) or small-volume enemas can be used. The usual measures for preventing constipation include a high-fiber diet and adequate fluid intake. However, these measures by themselves may not be adequate to stimulate evacuation. The Valsalva maneuver requires intact abdominal muscles, so it is used in those patients with injuries below T12. A high intake of fluid is advised for easier bowel evacuation. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
What are the most common causes for accumulation of fluid in the alveoli and interstitial spaces of the lungs? Select all that apply. Pregnancy Heart failure Oxygen toxicity Opioid overuse Muscular dystrophy
Answer: Heart failure Oxygen toxicity Opioid overuse Rationale: Pulmonary edema is an abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs. It is common during left-sided heart attack, respiratory distress syndrome due to oxygen toxicity, and opioid overdose. Therefore this life-threatening condition is considered to be a medical emergency. Pulmonary emboli are common in pregnant patients due to reduced mobility. Muscular dystrophy is a neuromuscular disorder that leads to pulmonary effusion. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient has been admitted to the hospital with a T3-level complete spinal cord injury. The nurse has to plan the home-based rehabilitation for this patient. When creating the care plan, the nurse considers the activities that the patient is able to do independently. What activities should the nurse consider to make maximum use of patient's abilities? Select all that apply. Independent self-care is possible. Independent wheelchair mobility is possible. Patient may be able to drive with hand controls. Patient will be able to climb stairs independently. Patient will be able to have effective coughing ability.
Answer: Independent self-care is possible. Independent wheelchair mobility is possible. Patient may be able to drive with hand controls. Rationale: The patient with a T3-level spinal cord injury will have full innervation of the upper extremities, back, essential intrinsic muscles of the hands, full strength and dexterity of grasp, decreased trunk stability, and decreased respiratory reserve. Therefore, the patient may have the following potentials: full independence in self-care and in a wheelchair, ability to drive a car with hand controls, independent standing in a standing frame. Abdominal muscles are affected, so the ability to cough is lost. The patient may also not be able to climb stars due to the injury. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient admitted to the intensive care unit with heart failure. The patient is prescribed IV sodium nitroprusside. Which actions should the nurse take when administering the medication? Select all that apply. Monitor arterial BP. Ensure a slow rate of administration. Place the patient in high Fowler's position. Monitor the IV site carefully since the patient is at high risk of extravasation. Record baseline blood pressure and continuously throughout administration.
Answer: Monitor arterial BP. Ensure a slow rate of administration. Record baseline blood pressure and continuously throughout administration. Rationale: Hypotension is the main adverse effect. When preparing to administer the vasodilator nitroprusside, the nurse should assess the patient's blood pressure before and during the administration. Arterial BP monitoring is also recommended during drug infusion. The nurse should ensure a slow rate of IV administration to prevent a sudden reduction in blood pressure. The patient is not at an increased risk of extravasation when receiving this medication. A patient with dyspnea is placed in high Fowler's position. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A nurse is assessing a patient with a T2-level spinal cord injury. The nurse notices that there is a kink in the catheter, the bladder is distended, and the blood pressure is 220/100 mm Hg. What nursing interventions would be appropriate for this patient if the nurse suspects autonomic dysreflexia? Select all that apply. Lower the head of the bed. Monitor blood pressure regularly. Make the patient lie flat on the bed. Notify the primary health care provider. Check for the presence of bowel impaction. Remove the kink in the catheter and drain the bladder.
Answer: Monitor blood pressure regularly. Notify the primary health care provider. Check for the presence of bowel impaction. Remove the kink in the catheter and drain the bladder. Rationale: A sudden rise in blood pressure for a spinal cord injury patient above the level of T6 is generally indicative of autonomic dysreflexia. Nursing interventions in a serious emergency like autonomic dysreflexia include notifying the primary health care provider and determining the cause. The blood pressure should be regularly monitored; administration of an alpha-adrenergic blocker or an arteriolar vasodilator is required. Contractions of the rectum are also a cause; therefore, the nurse should check for bowel impaction and treat it accordingly. The most common cause is bladder distension. If a catheter is present, the presence of any kinks or folds should be checked. However, the most important nursing intervention in this case is elevating the head of the bed 45 degrees or higher to make the patient sit upright; this would lower the blood pressure. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with spinal cord injury has poor nutritional intake. What measures should the nurse take to improve the patient's nutrition? Select all that apply. Provide adequate time to eat. Encourage intake of dietary fiber. Keep a calorie count of the food taken. Provide a pleasant eating environment. Provide a low-protein and low-calorie diet. Feed the patient only hospital-cooked food
Answer: Provide adequate time to eat. Encourage intake of dietary fiber. Keep a calorie count of the food taken. Provide a pleasant eating environment. Rationale: General measures such as providing a pleasant eating environment, allowing adequate time to eat (including any self-feeding the patient can achieve), encouraging the family to bring in special foods to avoid the patient becoming bored with institutional food, and planning social rewards for eating may be useful to improve nutrition of the patient. Keep a calorie count, and record the patient's daily weight to evaluate progress. If feasible, the patient should participate in recording caloric intake. Dietary supplements may be necessary to meet nutritional needs. Increased dietary fiber should be included to promote bowel function. Because there is severe catabolism taking place, a high-protein, high-calorie diet is necessary for energy and tissue repair. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient has been admitted to the hospital with a spinal cord injury. Following the assessment, the health care provider concludes that the injury is above T12. What signs and symptoms related to the gastrointestinal system would indicate an injury above T12? Select all that apply. The patient has an absence of bowel sounds. There is excess gastric distention, and the stomach is hard. The patient is constipated and is passing hard stools with straining. The sensation of a full bowel is perceived by the patient, and fecal incontinence is present. The sensation of a full bowel is not perceived by the patient, and fecal incontinence is present.
Answer: There is excess gastric distention, and the stomach is hard. The sensation of a full bowel is not perceived by the patient, and fecal incontinence is present. Rationale: An injury above T12 leads to development of a reflexic bowel, wherein nervous interactions between the colon (large intestine) and the brain are interrupted. As a result, the person may not feel the need to have a bowel movement. However, stool is still building up in the rectum. The build-up triggers a reflex, causing the rectum and colon to react, leading to a bowel movement without warning. When the sensation of a full bowel is perceived by the patient and the patient has fecal incontinence, it is a lower-level spinal cord injury (below T12). In spinal cord injury, it is usually incontinence that occurs. When the injury is above T5, paralytic ileus may be present and bowel sounds may be absent. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A nurse provides discharge instructions to a patient with chronic heart failure related to dietary restrictions. Which statement made by the patient indicates understanding of the teaching? "I should not use salt at the table." "I should increase the intake of milk." "I should avoid use of lemon juice and spices." "I can eat bread, processed meat, and cheese."
Answer: "I should not use salt at the table." Rationale: Patients with heart failure should avoid salt because it contains sodium. Sodium tends to absorb water and increase edema, which may worsen heart failure. Bread, processed meat, and cheese contain high levels of sodium and should be avoided. Intake of milk should be restricted to only two cups daily because it is rich in fat. Lemon juice and spices can be used instead of salt to flavor food. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
Which patient can be treated with a tissue plasminogen activator? A patient with atelectasis A patient with sarcoidosis A patient with right ventricular dysfunction A patient with idiopathic pulmonary fibrosis
Answer: A patient with right ventricular dysfunction Rationale: Tissue plasminogen activator is a fibrinolytic agent that dissolves the pulmonary embolus and thrombus in deep veins and can be used in the patient with right ventricular dysfunction. Atelectasis is treated with bronchodilators, and sarcoidosis can be effectively treated with antiinflammatory agents. Idiopathic pulmonary fibrosis is effectively treated with oxygen therapy and lung transplantation. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with a history of left-sided heart failure arrives in the emergency department reporting extreme shortness of breath and a persistent cough with pink, frothy sputum. On auscultation of the heart, the nurse notes an S3 gallop. The nurse recognizes those symptoms as being caused by what? Pneumonia An asthma attack A myocardial infarction Acute pulmonary edema
Answer: Acute pulmonary edema Rationale: Extreme shortness of breath and a persistent cough with pink, frothy sputum are symptoms of pulmonary edema. Pneumonia, an asthma attack, and a myocardial infarction are not correct because pink frothy sputum and an S3 gallop are not symptoms of any of these. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with New York Heart Association (NYHA) class III right-sided heart failure has an oxygen saturation of 75 percent. Which medication therapy would be beneficial to this patient? Diltiazem Adenosine Prednisolone Mycophenolatemofetil
Answer: Adenosine Rationale: Adenosine may be beneficial for a patient with New York Heart Association (NYHA) class III right-sided heart failure, whose oxygen saturation is 75 percent, because adenosine is a prostacyclin analog that promotes pulmonary vasodilation and reduces pulmonary vascular resistance. Diltiazem is a calcium channel blocker that should be used in a patient without right-sided heart failure because it may deteriorate the patient's condition. Prednisolone and mycophenolatemofetil are immunosuppressants that are used to prevent graft rejection in lung transplant patients. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with hypoxemia, sudden alterations in mental status, chest pain, and hemoptysis has a serum troponin level of 2.08 ng/mL and B type natriuretic peptide of 600 pg/mL. Which treatment is useful to control this patient's condition? Diuretics Anticoagulants Endothelin receptor antagonists Nonsteroidal anti-inflammatory agents
Answer: Anticoagulants Rationale: Hypoxemia, sudden alterations in mental status, chest pain, and hemoptysis are manifestations of pulmonary embolism. Serum troponin of 2.08 ng/mL (normal value: below 0.01 to 0.09 ng/mL) and B type natriuretic peptide of 600 pg/mL (normal value: below 100 pg/mL) indicates increased mortality. Therefore anticoagulants may provide relief from the symptoms by dissolving the embolus. Diuretics are beneficial in patients with pleural effusion and heart failure. Endothelin receptor antagonists are used in the treatment of pulmonary hypertension because they reduce pulmonary arterial pressure and pulmonary vascular resistance. Nonsteroidal anti-inflammatory agents are used in the treatment of pleurisy to reduce chest pain. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse compares the signs and symptoms of right-sided heart failure and left-sided heart failure. Which symptom is unique to right-sided heart failure? Fatigue Anxiety Depression Bilateral edema
Answer: Bilateral edema Rationale: Right-sided heart failure is manifested as bilateral edema in the patient. Fatigue, anxiety, and depression are symptoms of both right-sided and left-sided heart failure. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with cardiac failure is scheduled to receive sodium nitroprusside. The nurse should monitor what parameter while administering the drug to the patient? Blood pressure Body temperature Heart rate and pulse rate Central venous pressure
Answer: Blood pressure Rationale: Symptomatic hypotension is a major adverse effect of sodium nitroprusside; therefore, blood pressure is continuously monitored in patients taking sodium nitroprusside. Body temperature, heart rate, and central venous pressure are not altered due to administration of this drug. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The patient who had idiopathic pulmonary fibrosis had a bilateral lung transplantation. Now the patient is experiencing airflow obstruction that is progressing over time. It started with a gradual onset of exertional dyspnea, nonproductive cough, and wheezing. What are these manifestations signs of in the lung transplant patient? Pulmonary infarction Pulmonary hypertension Cytomegalovirus (CMV) Bronchiolitis obliterans (BOS)
Answer: Bronchiolitis obliterans (BOS) Rationale: BOS is a manifestation of chronic rejection and is characterized by airflow obstruction progressing over time with a gradual onset of exertional dyspnea, nonproductive cough, wheezing, or low-grade fever. Pulmonary infarction occurs with lack of blood flow to the bronchial tissue or preexisting lung disease. With pulmonary hypertension, the pulmonary pressures are elevated and can be idiopathic or secondarily caused by parenchymal lung disease that causes anatomic or vascular changes leading to pulmonary hypertension. CMV pneumonia is the most common opportunistic infection one to four months after lung transplant. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse provides medication education to a patient with heart failure. The nurse explains that the drug's mechanism of action is to reverse ventricular remodeling and to decrease cardiac workload by inhibiting catecholamines. Which drug is the nurse referring to? Digitalis Carvedilol Dopamine Furosemide
Answer: Carvedilol Rationale: Carvedilol is a β-adrenergic blocker that inhibits the sympathetic nervous system, preventing the release of catecholamines. (Catecholamines increase heart rate and myocardial contractility, which increases the workload of the heart.) Carvedilol also promotes reverse remodeling and decreases afterload. Furosemide is a diuretic and does not have those sympathetic nervous system (SNS)-blocking effects. Digitalis and dopamine are inotropic drugs that serve to increase contractility and do not block SNS stimulation. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
Which risk factor is an absolute contraindication to receiving lung transplantation? Skin cancer Former smoker Reversible renal failure Chronic active hepatitis B
Answer: Chronic active hepatitis B Rationale: Chronic active hepatitis, types B and C, are absolute contraindications for lung transplantation. Malignancy, with the exception of skin cancer, is an absolute contraindication. Skin cancer is not an absolute contraindication to receiving lung transplantation. Current smoking is an absolute contraindication. Former smoking is not, however, an absolute contraindication to lung transplantation. Untreatable advanced dysfunction of another major organ system, such as the kidneys, would be an absolute contraindication to lung transplantation. Reversible renal failure is not a contraindication. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
Which respiratory condition may have cor pulmonale as a complication? Kyphoscoliosis Pickwickian syndrome Chronic obstructive pulmonary disorder Secondary pulmonary arterial hypertension
Answer: Chronic obstructive pulmonary disorder Rationale: Cor pulmonale is a complication of pulmonary hypertension and respiratory disorders such as chronic obstructive pulmonary disorder. Kyphoscoliosis and Pickwickian syndrome cause extrapulmonary restrictive disease, in which the lung tissue is normal. Secondary pulmonary arterial hypertension develops due to parenchymal lung disease, left ventricular dysfunction, and intracardiac shunts. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify an incorrect answer. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). The nurse recognizes that this type of medication benefits patients with HF because it blocks what action? Secretion of aldosterone Conversion of pro-renin to renin Conversion of angiotensin I to angiotensin II Conversion of angiotensinogen to angiotensin I
Answer: Conversion of angiotensin I to angiotensin II Rationale: When renal blood flow is reduced, the juxtaglomerular cells secrete renin into circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to angiotensin II by the angiotensin-converting enzyme found in the lungs. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases blood pressure. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient diagnosed with heart failure is treated with an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what side effect? Cough Anemia Hyperpigmentation Increased body temperature
Answer: Cough Rationale: Patients treated with angiotensin-converting enzyme (ACE) inhibitors have an increased risk for medication-related cough. Methyldopa causes anemia. Beta blockers alter body temperature. Aspirin can increase melanin production and can cause hyperpigmentation. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse recalls that the decreased filling of the ventricles that is associated with diastolic failure results in what primary manifestation? Decreased afterload Decreased left ventricular ejection fraction Decreased left ventricular end-diastolic pressure Decreased stroke volume and cardiac output (CO)
Answer: Decreased stroke volume and cardiac output (CO) Rationale: Diastolic failure often is referred to as heart failure with normal ejection fraction. Decreased filling of the ventricles results in decreased stroke volume and CO. Diastolic failure is characterized by high filling pressures because of stiff ventricles. This results in venous engorgement in both the pulmonary and systemic vascular systems. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient states, "For my heart failure, I take hydrochlorothiazide. I take a second medication that helps improve my heart's contractility." The patient's assessment findings include hypokalemia, headache, and anorexia. The nurse suspects that the second medication the patient is referring to is what drug? Digoxin Captopril Carvedilol Metolazone
Answer: Digoxin Rationale: Digitalis preparations increase the force of cardiac contractility. Patients taking a digitalis preparation are at risk for digitalis toxicity. Early signs of toxicity include anorexia and headache. Hypokalemia, secondary to the use of potassium-depleting diuretics (e.g., thiazides), is one of the most common causes of digitalis toxicity. Severe hypotension and hypokalemia is seen with captopril. Carvedilol may cause profound bradycardia, hypotension, and cardiogenic shock. Metolazone causes severe reduction in potassium levels and inhibits sodium reabsorption. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse reviews the laboratory results of a patient with heart failure (HF) and notes an increased calcium level and decreased magnesium level. The nurse should notify the health care provider of the findings and withhold which scheduled medication? Digoxin Metoprolol Spironolactone Morphine sulfate
Answer: Digoxin Rationale: Hypercalcemia and hypomagnesemia can trigger digitalis toxicity. The dose should be held, and the health care provider should be notified. The lab findings are not indications to withhold morphine sulfate, metoprolol, or spironolactone. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse recognizes the need for more frequent monitoring of electrolytes when a patient that takes digitalis receives a prescription for what type of medication? Nitrate Diuretic β-adrenergic blocker Angiotensin-converting enzyme (ACE) inhibitor
Answer: Diuretic Rationale: Diuretics can either waste or spare potassium, causing hypokalemia or hyperkalemia, both of which can cause issues when occurring in the patient on digitalis. Nitroglycerin and ACE inhibitors are not correct answers; they do not impact the levels of electrolytes. The combination of a β-adrenergic blocker and digitalis can cause a decrease in heart rate but not an electrolyte imbalance. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by"—and three options might be: genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse recalls that which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)? Diuretics Narcotics Vasodilators Positive inotropes
Answer: Diuretics Rationale: Diuretics are used in patients with fluid overload, which helps them to decrease the sodium reabsorption at various sites within the nephrons. This helps with flushing out the sodium from the body and promotes water loss. Vasodilators improve coronary artery circulation by dilating the coronary artery. Narcotics, such as morphine sulfate, dilate both pulmonary and systematic blood vessels but may not help in fluid overload. Positive inotropes increase myocardial contractility and help in dilating renal blood vessels, enhancing renal output. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient is diagnosed with acute decompensated heart failure (ADHF). The nurse anticipates a prescription for which medication that is a selective β-agonist, does not increase systemic vascular resistance (SVR), and that is preferred for short-term treatment of ADHF? Milrinone Dobutamine Dopamine Procainamide
Answer: Dobutamine Rationale: Unlike dopamine, dobutamine is a selective β-agonist. It does not increase systemic vascular resistance (SVR) and is preferred for short-term treatment of ADHF. Milrinone and dopamine are also used to treat ADHF but are not preferred for short-term treatment. Procainamide is a class IA antidysrhythmic drug used to treat or prevent dysrhythmias. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient develops unexplained heart failure (HF) that remains unresponsive to usual therapy. For what diagnostic test does the nurse prepare the patient? Chest x-ray Echocardiogram Cardiac catheterization Electrocardiogram (ECG)
Answer: Echocardiogram Rationale: An echocardiogram provides information on the ejection fraction (EF). It also provides information on the structure and function of the heart valves. Heart chamber enlargement or stiffness can also be assessed. An ECG and chest x-ray are also useful but are not as specific. Heart catheterization, such as coronary angiography, is performed to determine ejection fraction (EF) and blockages. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
An acutely ill patient develops unexplained, new-onset heart failure (HF) that is unresponsive to usual care. The nurse anticipates a prescription for which diagnostic procedure that is commonly done as part of a heart catheterization?? Chest x-ray Intraarterial BP Endomyocardial biopsy (EMB) Multi-gated acquisition (MUGA) scan
Answer: Endomyocardial biopsy (EMB) Rationale: Endomyocardial biopsy is an investigation to find out the cause of new-onset heart failure that is unresponsive to routine care. Hemodynamic monitoring (e.g., intraarterial BP) is included in the care plan for a patient with acute decompensated heart failure (ADHF). A chest x-ray and MUGA scan are common diagnostic studies used for many types of patients suspected of having cardiac problems; they are not done as part of a cardiac catheterization. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
While assessing a patient with acute decompensated heart failure (ADHF), the nurse auscultates fine crackles bilaterally. The nurse recognizes that crackles are an indicator of what? Atelectasis Fluid in the alveoli Mucus in the alveoli Bronchoconstriction
Answer: Fluid in the alveoli Rationale: Fluid in the alveoli is the correct answer because crackles are made by the sound of air moving through fluid-filled alveoli. Atelectasis is the collapsing of alveoli and would not produce sound. Mucus in the airways sounds like rhonchi or would cause diminished lung sounds if there were consolidation. Bronchoconstriction results in wheezing. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
Which manifestations in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia? Headache and rising blood pressure Irregular respirations and shortness of breath Decreased level of consciousness or hallucinations Abdominal distention and absence of bowel sounds
Answer: Headache and rising blood pressure Rationale: Manifestations of autonomic dysreflexia are hypertension (up to 300 mm Hg systolic), a throbbing headache, bradycardia, and diaphoresis. Respiratory manifestations, decreased level of consciousness, and gastrointestinal manifestations are not characteristic manifestations. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with syncope and dyspnea has a systolic blood pressure of 70 mm Hg. The pulmonary artery pressure is 35 mm Hg after exercise. Which medication may worsen this patient's condition? Iloprost Tacrolimus Prednisolone Methotrexate
Answer: Iloprost Rationale: A patient with syncope, dyspnea, and a pulmonary artery pressure of 35 mm Hg after exercise may have pulmonary hypertension. Vasodilators, such as iloprost, may comfort the patient, but it should not be given when the systolic blood pressure is 70 mm Hg because it may lead to orthostatic hypotension. Tacrolimus and prednisolone are immunosuppressive agents that help prevent graft rejection in lung transplant patients. Methotrexate may be used to relieve the symptoms of idiopathic pulmonary fibrosis. Test-Taking Tip: The patient has a systolic blood pressure less than 85 mm Hg, which may result in hypotension. Select the correct medication that is not advised for this patient. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient that is diagnosed with heart failure experiences fatigue. The nurse suspects that the fatigue is caused by what? Increased cardiac output Increased hemoglobin levels Impaired perfusion to vital organs Increased oxygenation of the tissues
Answer: Immobilizing the affected extremity Rationale: Fatigue is one of the early signs of heart failure. Due to heart failure, there is inadequate blood circulation, leading to decreased perfusion to the vital organs. An impaired functioning of the vital organs may lead to fatigue. Cardiac output decreases in heart failure, depriving the body tissues of oxygen and nutrients, leading to fatigue. Inadequate blood supply results in inadequate oxygenation of the tissue and causes fatigue when the oxygen demands are not met. Hemoglobin levels are low in heart failure, leading to anemia. A decreased oxygen-carrying capacity of the blood also results in fatigue. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is educating a patient about diastolic failure and should include what characteristic feature? High pulmonary pressures Decrease in ejection fraction (EF) Inability of the ventricles to relax and fill Inability of the ventricles to pump blood effectively
Answer: Inability of the ventricles to relax and fill Rationale: Diastolic failure is the inability to relax and fill the ventricles during diastole. Systolic failure is the inability of the heart to pump blood effectively. Patients with mixed systolic and diastolic failure experience high pulmonary pressures. The EF is normal with diastolic failure. Test-Taking Tip: Identifying content and what is being asked about that content is critical to choosing the correct response. Be alert for words in the stem of the question that are the same or similar in nature to those in the options. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is receiving intravenous (IV) milrinone. The nurse recognizes that this medication is beneficial because of what effects it has on the body? Select all that apply. Increased diuresis Dilation of renal blood vessels Increased myocardial contractility Promotion of peripheral vasodilation Increased systemic vascular resistance
Answer: Increased myocardial contractility Promotion of peripheral vasodilation Rationale: Milrinone is a phosphodiesterase inhibitor (also known as an inodilator). It increases myocardial contractility (inotropic effect) and promotes peripheral vasodilation. Milrinone does not dilate renal blood vessels and promote diuresis, nor does it increase systemic vascular resistance. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
Epinephrine and norepinephrine are released in response to decreased cardiac output that occurs in patients with heart failure. These catecholamines can cause what physiologic change? Vasodilation Decreased heart rate Decreased blood pressure Increased myocardial oxygen demand
Answer: Increased myocardial oxygen demand Rationale: Catecholamines increase heart rate and contractility, which increase myocardial workload and oxygen demand. Catecholamines cause vasoconstriction (not vasodilation), an increased heart rate (not decreased), and an increase in blood pressure (not decrease). Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse expects to find which pathologic change in a patient with pulmonary arterial hypertension? Increased pulmonary vascular resistance Decreased pulmonary vascular resistance Respiratory acidosis with failure to compensate Increased crackles upon auscultation of the lower posterior and lateral lungs
Answer: Increased pulmonary vascular resistance Rationale: The most common cause of pulmonary arterial hypertension (PAH) is increased pulmonary vascular resistance due to primary disease or as a secondary complication of respiratory, cardiac, autoimmune, hepatic, or connective tissue disorders. Increased pulmonary vascular resistance is caused by vasoconstriction, remodeling (vessel wall thickening), and thrombosis. PAH causes right ventricular hypertrophy and eventually right-sided heart failure. PAH does not cause decreased pulmonary vascular resistance or respiratory acidosis. Increased crackles in any area of the lungs would be present in left-sided heart failure, not right-sided heart failure. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient with worsening heart failure (HF) that is hemodynamically unstable. What is likely to be included in the patient's treatment plan to increase coronary blood flow to the heart muscle? Vasodilators Ultrafiltration Intraaortic balloon pump (IABP) Ventricular assist device (VAD)
Answer: Intraaortic balloon pump (IABP)a Rationale: The IABP is a device that increases coronary blood flow to the heart muscle and decreases the heart's workload through a process called counterpulsation. Vasodilators improve the coronary artery circulation by dilating the coronary arteries. Ultrafiltration is the process of removing excess salt and water from the patient's blood. Ventricular assist devices (VADs) are used to maintain the pumping action of the blood, because the contracting ability of the heart decreases, thereby affecting its ability to function. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient is admitted with acute decompensated heart failure. Which part of the treatment plan will increase fatigue in this patient? A 2-g sodium diet Cardiac monitoring Oxygen at 2 L by nasal cannula Intravenous (IV) furosemide 40 mg every six hours
Answer: Intravenous (IV) furosemide 40 mg every six hours Rationale: Furosemide will cause diuresis and frequent trips to the bedside commode or bathroom, leading to fatigue. Oxygen will improve the patient's tolerance of activity. A cardiac monitor will monitor for electrolyte imbalances due to furosemide administration and will not affect fatigue. A 2-g sodium diet will help reduce the sodium load to the heart and reduce fatigue. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority? Ask the patient about the timing of the last meal. Offer the patient sips of water to prevent dehydration. Monitor the patient for any further episodes of nausea and vomiting. Notify the primary health care provider about the patient's condition.
Answer: Intravenous access is not available. Client is unconscious or unable to swallow. Deltoid muscle injection gives a faster response. Rationale: Vomitus with a "coffee ground" appearance is related to gastric bleeding, in which blood changes to dark brown as a result of its interaction with hydrochloric acid. The primary health care provider needs to be notified immediately about this change in the patient's condition. Asking the patient about the timing of the last meal and monitoring the patient are appropriate, but not the priority. The nurse should not offer water just in case the patient may have to have a diagnostic study that requires nothing by mouth (NPO) status. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is providing care to a patient who is paralyzed from the waist down. Which spinal vertebra injury would have caused this manifestation? Lumbar vertebra 1 Cervical vertebra 4 Cervical vertebra 6 Thoracic vertebra 6
Answer: Lumbar vertebra 1 Rationale: Injury to lumbar vertebra 1 results in paralysis below the waist. Injury to cervical vertebra 4 results in complete paralysis below the neck. Injury to cervical vertebra 6 results in partial paralysis of the hands and arms and of the lower body. Injury to thoracic vertebra 6 results in paralysis below the chest. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). What is the priority nursing assessment? Lung sounds Facial swelling Level of anxiety Intake and output
Answer: Lung sounds Rationale: The priority nursing assessment is auscultation of lung sounds. Excess fluid volume often leads to pulmonary congestion. ADHF can manifest as pulmonary edema. Facial swelling is a possible side effect with prescribed renin-angiotensin-aldosterone inhibitors for heart failure. It is important to assess the patient's anxiety, but it is not the priority. Assessing intake and output is important for right-sided heart failure. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse expects that which drug will be prescribed to a patient with heart failure (HF), to treat the compensatory increase in the heart rate and the renin release that occurs as a result of the failure? Digoxin Milrinone Metoprolol Dobutamine
Answer: Metoprolol Rationale: Metoprolol is a β-adrenergic blocker, which helps prevent an increase in the heart rate and renin release by inhibiting the sympathetic nervous system. Digoxin decreases the heart rate but does not decrease the renin release. Milrinone increases the heart's contractility and decreases the pulmonary vascular resistance. Dobutamine is a β-adrenergic agonist that increases cardiac contractility. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A 71-year-old patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing intervention is most appropriate during admission of this patient? Perform a comprehensive health history with the patient to review prior respiratory problems. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.
Answer: Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress. Rationale: Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed once the patient's acute respiratory distress is being managed. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient with right ventricular hypertrophy and a hematocrit of 70 percent. The nurse finds an increase in S2 upon auscultation. Which treatment strategy does the nurse anticipate will benefit this patient? Phlebotomy Embolectomy Lung transplantation Inferior vena cava filter
Answer: Phlebotomy Rationale: Right ventricular hypertrophy, hematocrit of 70 percent, and prominent S2 may indicate cor pulmonale. A patient with chronic cor pulmonale may have increased S2 and polycythemia due to a primary disorder of the respiratory system. This must be treated with phlebotomy. Embolectomy is used in the treatment of pulmonary embolism to remove the deep vein thrombus. Lung transplantation is indicated for patients with severe lung disorder. An inferior vena cava filter is used to filter out the large clots that block pulmonary circulation. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse reviews the laboratory results of a patient with heart failure (HF) who receives a prescription for digoxin. The nurse decides to withhold the medication based on abnormal findings of what blood study? Potassium Thyroid function tests White blood cells (WBCs) Blood urea nitrogen (B.U.N.)
Answer: Potassium Rationale: Low serum potassium enhances the actions of digitalis, causing a therapeutic dose to reach toxic levels. Similarly, hyperkalemia inhibits the actions of digitalis, resulting in subtherapeutic dose. Monitor serum potassium levels of all patients taking digitalis. The results of a B.U.N., WBCs, or thyroid function tests do not affect the nurse's decision to administer or to withhold digoxin. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse assesses that a patient with acute decompensated heart failure (ADHF) experiences dyspnea. What is the priority nursing action? Perform ultrafiltration Provide supplemental oxygen Provide mechanical ventilation Obtain arterial blood gases (ABGs)
Answer: Provide supplemental oxygen Rationale: Supplemental oxygen helps increase the percentage of oxygen in inspired air. Ultrafiltration is a process used to remove excess salt and water from the blood in case of volume overload. Mechanical ventilation is used in cases of pulmonary edema, to help decrease the preload. An ABG test will provide information about the amount of oxygen and carbon dioxide is in the blood, but it is not a priority. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient with left-sided heart failure and expects what assessment finding? Hepatomegaly Splenomegaly Pulmonary congestion Vascular congestion of gastrointestinal tract
Answer: Pulmonary congestion Rationale: Left-sided heart failure results from left ventricular dysfunction; this is manifested as pulmonary congestion and edema. Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A nurse reviews the medical record of a patient with pulmonary embolism and notes the presence of cor pulmonale. The nurse recalls that this refers to a disorder of the heart that is caused by what? Liver disease Renal disease Pulmonary disease Preexisting heart disease
Answer: Pulmonary disease Rationale: Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart diseases. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with a history of acute decompensated heart failure (ADHF) reports blood-tinged sputum, productive frothy cough, and rapid heart rate. The nurse suspects that which condition induced these clinical manifestations? Cerebral edema Peripheral edema Lymphatic edema Pulmonary edema
Answer: Pulmonary edema Rationale: Acute decompensated heart failure (ADHF) can manifest as pulmonary edema, which is an acute life-threatening condition. In this condition, the alveoli become filled with serosanguinous fluid, and the clinical manifestations include cough, blood-stained sputum, and rapid heart rate. Cerebral edema presents in the form of seizures, headache, and other neurologic symptoms. Peripheral edema presents as a swelling in the lower extremities. Lymphatic edema presents as hyperplasia and hyperkeratosis. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is assessing a patient with cor pulmonale, a distended neck vein, and an enlarged liver, whose computer tomography report reveals clear fluid accumulation in the pleural space. Which intervention by the nurse provides stabilization of this patient's condition? Restricting sodium diet Monitoring for infection Monitoring liver functioning Position the patient at a 45-degree angle
Answer: Restricting sodium diet Rationale: A patient with cor pulmonale, enlargement of the right ventricle, with distention of the neck vein, enlarged liver, and clear fluid accumulated in the pleural space may have heart failure. The patient with heart failure is treated with diuretics and a low sodium diet to decrease the incidence of pleural effusion and to reduce workload on the heart. The patient with a liver transplant should be monitored for infection that may lead to death. The patient on endothelin receptor antagonists to correct pulmonary hypertension should be monitored for liver functioning every month. Making the patient sit at a 45-degree angle may not benefit the patient; the patient may be treated with long-term oxygen therapy. This helps to reduce hypoxemia and vasoconstriction. Test-Taking Tip: A patient with cor pulmonale, enlargement of the right ventricle, with distention of the neck vein, enlarged liver, and clear fluid accumulated in the pleural space may have heart failure. Select the option that is commonly used to prevent this type of heart complication. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
Which condition is suspected in a patient with increased pulmonic and S4 heart sounds, and hepatomegaly? Pulmonary effusion Acute pulmonary embolism Idiopathic pulmonary fibrosis Secondary pulmonary arterial hypertension
Answer: Secondary pulmonary arterial hypertension Rationale: Secondary pulmonary arterial hypertension increases with chronic pulmonary arterial pressure and leads to right ventricular hypertrophy and failure. Increased pulmonic and S4 heart sounds and hepatomegaly are the pathologic signs of right-sided heart failure. Pulmonary effusion is indicated by decreased breath sounds. Acute pulmonary embolism is determined by accentuating pulmonic heart sound. Idiopathic pulmonary fibrosis is identified by crackles heard during inspiration. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A nurse is planning a bowel program for a patient with a T7 level spinal cord injury. What is the most suitable position for bowel evacuation for this patient? Prone position Sitting position Supine position Standing position
Answer: Sitting position Rationale: A patient with T7 level spinal injury will be able to sit; therefore it is best to position the patient upright for proper evacuation, because this position would ensure complete evacuation. The supine position does not facilitate evacuation of the bowels. If the patient is not able to sit upright, it could be done in the side-lying position. The prone position and standing are awkward for bowel evacuation. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with acute decompensated heart failure (ADHF) develops hypotension and thiocyanate toxicity after 48 hours of prescribed drug therapy. The nurse suspects that which medication is responsible for this condition? Nesiritide Milrinone Spironolactone Sodium nitroprusside
Answer: Sodium nitroprusside Rationale: Hypotension and thiocyanate toxicity are complications of sodium nitroprusside; they can develop after 48 hours of use. Nesiritide causes symptomatic hypotension. Milrinone complications include dysrhythmias, thrombocytopenia, and hepatotoxicity. Spironolactone complications include hyperkalemia and gynecomastia in males (with long-term use). Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following? Central cord syndrome Spinal shock syndrome Anterior cord syndrome Brown-Séquard syndrome
Answer: Spinal shock syndrome Rationale: About 50 percent of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as spinal shock. Central cord syndrome is manifested by motor and sensory loss that is greater in the upper extremities than in the lower extremities. Anterior cord syndrome results in motor and sensory loss but not reflexes. Brown-Séquard syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient is taking sildenafil for treatment of pulmonary hypertension. The nurse who is monitoring the patient finds that the patient's blood pressure has dropped to 80/60 mm Hg. The patient's current home medications include multivitamins, thyroxine, and nitroglycerin for comorbid conditions. The nurse contacts the primary health care provider and expects what change in the patient's treatment plan? Stopping sildenafil Stopping thyroxine Lung transplantation Administering intravenous fluids
Answer: Stopping sildenafil Rationale: Sildenafil should not be given to patients who are on nitroglycerin, because it can lead to refractory hypotension. Therefore sildenafil should be stopped immediately. Thyroxine does not interact with sildenafil and also does not cause hypotension. Lung transplantation is reserved for patients with pulmonary hypertension who do not respond to drug therapy. Administering intravenous fluids without correcting the cause will not help the patient. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with heart failure has a pulmonary arterial pressure of 28 mm Hg when at rest. Which intervention helps in comforting this patient? Supplying oxygen to the patient Infusing intravenous fluids to the patient Applying warm and cold compress to the patient Positioning the patient at an angle of 90 degrees
Answer: Supplying oxygen to the patient Rationale: A patient with heart failure and a pulmonary arterial pressure of 28 mm Hg when at rest may have pulmonary hypertension. This may lead to hypoxia; therefore, the patient must be supplied with low oxygen flow to provide symptomatic relief. Positioning the patient at an angle of 90 degrees indicates full Fowler's position, which may exacerbate symptoms in this patient. Intravenous fluid infusion may not relieve the patient's symptoms. Warm and cold compresses may benefit the patient with chest pain. Test-Taking Tip: A patient with vascular contraction and heart failure can readily supply blood to the tissues. Therefore select the intervention that may help to decrease the workload of the patient's heart. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient with chronic obstructive pulmonary disorder is considered for lung transplantation. The patient had melanoma and hepatitis A one year ago. The patient previously smoked three cigarettes per day but has not smoked in the past year. The nurse considers the patient's history and concludes what about the patient's eligibility for lung transplantation? The patient is eligible for lung transplantation. Because of the history of smoking, the patient is not eligible. Because of the history of hepatitis A, the patient is not eligible. Because of the history of cancer one year ago, the patient is not eligible.
Answer: The patient is eligible for lung transplantation. Rationale: Chronic obstructive pulmonary disease is one of the indications for lung transplantation. There are some absolute contraindications for lung transplantation, including but not limited to being a current smoker, chronic active hepatitis B or C, history of cancer except skin cancer, poor nutritional status, and HIV. This patient is eligible for lung transplantation. The patient is not a current smoker, has hepatitis A, and had melanoma, which is a skin cancer. Therefore there are no contraindications for lung cancer. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A patient has been admitted to the hospital with spinal cord injury at the upper thoracic level. The health care provider informs the caregiver that the patient is in a state of neurogenic shock. How should the nurse explain the term neurogenic shock to the caregivers? Select all that apply. Blood pressure and heart rate have increased. Blood vessels in the extremities have constricted. There is loss of nervous control of the blood vessels. The amount of blood pumped out of the heart reduces. There is pooling of blood in the veins of the extremities.
Answer: There is loss of nervous control of the blood vessels. The amount of blood pumped out of the heart reduces. There is pooling of blood in the veins of the extremities. Rationale: Neurogenic shock is due to the loss of vasomotor tone caused by spinal cord injury. Loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, and decreased cardiac output. It is chiefly characterized by hypotension and bradycardia, not increased blood pressure and heart rate. The blood vessels in the extremities dilate due to neurogenic shock. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
The nurse is caring for a patient with chest pain, dizziness, and an oxygen saturation level of 80 percent. The chest x-ray of the patient reveals right ventricular hypertrophy. Which medication may be beneficial to this patient? Warfarin Morphine Treprostinil Cyclosporine
Answer: Treprostinil Rationale: A patient with right ventricular hypertrophy, chest pain, dizziness, and an oxygen saturation level of 80 percent may have pulmonary hypertension. Therefore the patient must be treated with treprostinil because it acts by dilating the systemic and pulmonary arteries. Warfarin is administered in a patient with pulmonary embolism. Morphine helps relieve the patient's chest pain but will not completely control the patient's condition. Cyclosporine is an immunosuppressant that may provide comfort for the patient with idiopathic pulmonary fibrosis. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome
A nurse is caring for a patient who has sustained a spinal cord injury. To prevent autonomic dysreflexia, what should the nurse instruct the patient to avoid? Urine retention Emotional stress Smoking cigarettes People with upper respiratory infections
Answer: Urine retention Rationale: Autonomic dysreflexia is a medical emergency that occurs when sensory stimulation below the spinal injury triggers a reaction in the intact autonomic system, with resulting reflex arteriolar spasms that increase blood pressure to an extremely high level. A distended bladder is a common trigger of this condition. Profuse sweating below the level of injury and bradycardia are also seen. Although emotional stress, cigarette smoking, and exposure to upper respiratory infections should be avoided by the patient with a spinal cord injury, these factors are not triggers of autonomic dysreflexia. Source: Elsevier. (2019). Adaptive Quizzing. Retrieved from My evolve: https://eaq.elsevier.com/Resources/160224_selfstudy_0001/#/welcome