NUR2261: Study Guide Unit 4

At what age does menopause typically begin

51

(powerpoints) First drug choice to convert PSVT to normal sinus rhyme A. IV adenosine B. IV β-blockers C. Amiodarone D. Calcium channel blockers

A. IV adenosine

What factors can cause premature menopause A. smoking B. autoimmune disorders C. a women mother had early D. menopause E. all of the above

E. all of the above

True or False: The SA node is located in the Left atrium

False

A pt is thinking about using HRT during menopause. which statement is correct by the nurse A. Vaginal estrogen creams are as effective as oral estrogen B. Increased risk of colon cancer in women taking HRT C. HRT decreases osteoporosis risk but increases breast cancer risk D. Use of HRT up to 10 years helps symptoms with no

HRT decreases osteoporosis risk but increases breast cancer risk

Treatment of choice for Dressler syndrome?

High-dose aspirin is the treatment of choice. Nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids are avoided in the first 4 weeks following MI because they can interfere with myocardial scar formation.

What are Amiodarone and ibutilide

Most common antidysrhythmic drugs used for conversion to and maintenance of sinus rhythm

A nurse is caring for a client with right-sided heart failure. Which assessment findings are key features of right-sided heart failure? Select all that apply. A. Collapsed neck veins B. Distended abdomen C. Dependent edema D. Urinating at night E. Cool extremities

Right-sided heart failure is associated with increased systemic venous pressures and congestion, as manifested by a distended abdomen, dependent edema, and urinating at night. Distended, not collapsed, neck veins occur in right-sided heart failure. Cool extremities are key features of left-sided heart failure.

What area of the heart's electrical conduction is known as the "pacemaker" of the heart? A. Bundle of His B. AV node C. SA node D. Purknije Fibers

C. SA node

Ventricular remodeling is changes in (select all that apply) A. size of the ventricle B. only the right ventricle C. shape of the ventricle D. mechanical performance of the ventricle

A. size C. shape D. mechanical performance of the ventricle

A normal PR interval how many seconds and how many boxes A. less than 12 seconds (2 boxes) B. 0.12-0.2 seconds (3-5 boxes) C. Greater than 20 seconds 6-8 boxes

B. 0.12-0.2 seconds (3-5 boxes)

4 hours after a difficult labor and birth, the patient refer uses to feed her baby, stating she needs to rest. the nurse should A. Tell the women she can rest after she feeds her baby B. Reorganize this as a behavior as postpartum C. Recognize the behavior as ineffective material-newborn attachment D. Take the baby back to the nurse, reassure the patient that her rest is priority

D. Take the baby back to the nurse, reassure the patient that her rest is priority

a women is considered to be in menopause after she missed how many menstrual cycles

12

Which of the drug therapy would NOT be included typically in the treatment of a pt with ACS/MI A. Calcium chanel blockers B. Morphine C. Stool softeners D. Lipid-lowering drugs

A. Calcium chanel blockers

A patient is dx with left side systolic heart failure. What is the expected findings ? A. EF 38% B. EF 65 % C. EF 20% D. jugular vein distension

A. EF 38%

When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes what important components? Select all that apply. A. Planning for future safety B. Normalizing victimization C. Validating the experiences D. Promoting access to community services E. Providing housing for the victim

A. Planning for future safety C. Validating the experiences D. Promoting access to community services Planning for the client's future safety needs, validating the client's experiences by letting the victim know that he or she is not alone, and promoting access to community services are all important roles of the nurse advocate. An advocate would not normalize the victimization by seeing the abuse as normal in the victim's relationship and failing to respond to the disclosure of the abuse. The advocate role would include information and resources for housing if needed, but not necessarily provide it.

How do ACE-inhibitors, such as enalapril work to reduce HF? A. Prevent the conversion of angiotensin I to II B. Cause systemic vasodilation C. Promote the excretion of sodium and water D. Block the sympathetic nervous system stimulation of the heart E. Increase cardiac contractility F. Reduce preload and afterload

A. Prevent the conversion of angiotensin I to II B. Cause systemic vasodilation D. Block the sympathetic nervous system stimulation of the heart F. Reduce preload and afterload

What is the correct sequence of electrical conduction of the heart? A. SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers B. None of the options are correct C. SA node, internodal pathways, AV node, Purkinje Fibers, Right and Left Bundle Branch, Bundle of His D. AV node, internodal pathways, SA node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers

A. SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers

Which are vasodilators ? (select all that apply) A. nitroglycerin B. Sodium nitroprusside(Nipride) C. Nesiritide (Natrecor) D. Milirinone

A. nitroglycerin B. Sodium nitroprusside(Nipride) C. Nesiritide (Natrecor)

30 y/o female with depression, poor eating habits, and who is underweight comes to the clinic and expresses suicidal ideations. Which nursing diagnosis should be the nurses first priority A. risk for suicide B. chronic low self-esteem C. imbalanced nutrition D. constipation

A. risk for suicide Nursing diagnoses are numerous. Risk for suicide is always the priority diagnosis when suicidal ideation is present. Other common nursing diagnoses are chronic low self-esteem, imbalanced nutrition, constipation, disturbed sleep pattern, ineffective coping, and disabled family coping.

The nurse understands that patients with which dysrhythmia constitute the largest group of those hospitalized with dysrhythmias? A.Atrial fibrillation B.Sinus tachycardia C.Sinus bradycardia Ventricular fibrillation

A.Atrial fibrillation Rationale: Atrial fibrillation (AF) is the most common dysrhythmia seen in clinical practice. It is responsible for a third of hospitalizations for cardiac rhythm disturbances. Patients can live with this dysrhythmia, but most are treated with anticoagulation therapy to avoid possible blood clots.

(powerpoints) What is an early symptom of ADHF? What is an early symptom of chronic HF?

ADHF--> increased RR Chronic--> fatigue

select all statements that at true about IV nitroglycerine A. Vasodilator that reduces blood volume B. Improves coronary artery circulation C. Reduces preload D. Slightly reduces after-load E. Increases myocardial oxygen supply)

ALL are correct statements

The nurse is preparing to examine a client who is experiencing menopause. What information should the nurse obtain when performing a health​ history?​(Select all that​ apply.) a Posture b Menstrual history c Medications d Sleep pattern e Vital signs

B, C, D (When performing a health history on a client experiencing​ menopause, the nurse should obtain information on the client​'s menstrual​ history, medications, and sleep pattern. Posture and vital signs are assessments that the nurse will include when completing the physical examination.)

Women taking estrogen replacement therapy need how much calcium a day A. 500mg B. 1000mg C. 1250 mg C. 1500mg

B. 1000mg

What area of the heart forms the QRS part on an EKG? A. SA node B. Purkinje fibers C. Left and right bundles D. AV node

B. Purkinje fibers

The SA node fires at a rate of? A. 80-90 bpm B. 60-80 bpm C. 40-60 bpm D. 60-100 bpm

D. 60-100 bpm

True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.*

True

What are the clinical manifestations of​ menopause?​(Select all that ​apply.) a Vaginal dryness b Thinning hair c Headaches d Hot flashes e Cold intolerance

a Vaginal dryness b Thinning hair c Headaches d Hot flashes

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

b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?"

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

b. Energy for development is diverted to coping

During the examination portion of her annual checkup, a 55-year-old client has several new complaints. Which subjective symptoms of menopause would the nurse expect to find during data collection? a Hair growth on the upper lip b Decreased skin elasticity c Night sweats d Rise in vaginal Ph

c. Night sweats is the only symptom that is subjective, reported by the client. Facial hair, decreased skin elasticity, and a rise in vaginal pH are all objective signs that can be observed by the nurse. )

When using a 5-electrode lead ECG monitoring system, the nurse recognizes which lead is most optimal for detecting dysrhythmias? A.III B.V1 C.V5 aVR

•Answer: B Rationale: Five-electrode ECG monitoring systems use four electrode leads to provide six limb lead tracings (leads I, II, III,aVR,aVL, oraVF) and the fifth electrode lead is a chest electrode that can be placed in any of the standard V1to V6locations. But in general, V1is selected because of its value in detecting dysrhythmias (e.g., arrhythmia monitoring).

The client with erectile dysfunction is being evaluated for the use of sildenafil (Viagra). Which of the following questions should the nurse ask before initiating therapy with sildenafil? 1) Are you currently taking medication for angina? 2) Do you have a history of diabetes? 3) Have you ever had an allergic reaction to dairy products? 4) Have you ever been treated for migraine headaches?

1) Are you currently taking medication for angina? 1 (life threatening hypotension is an adverse effect in clients taking sildenafil and organic nitrates

You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?* A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

B. Assist the patient up slowing and gradually.

After a child's visit to a healthcare provider, the parent tells the nurse, "I'm so upset! The doctor prescribed an antidepressant!" What is the best response by the nurse? A. "Tell me more about what's bothering you." B. "Weren't you told why your child needs an antidepressant?" C. "You need to speak with the healthcare provider about your concerns." D. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?"

A. "Tell me more about what's bothering you." "Tell me more about what's bothering you" provides an opportunity to explore the parent's feelings. It is the nurse's responsibility, not the healthcare provider's, to assess the parent's concerns before planning further interventions. "Weren't you told why your child needs an antidepressant?" is a confrontational response that may put the parent on the defensive. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?" is a judgmental, nontherapeutic response that may worsen the parent's concerns.

Which blood test can help confirm if a mown is beginning menopause A. FSH B. Testosterone C. Progesterone D. Cholesterol

A. FSH

You dx STEMI with W.R the closest hospital with cardiac cath lab is 4 hours away. you... A. Transfer the patient to the cath lab 4 hours away B. Forego re-perfusion tx as chest pain began 6 hours ago C. Begin administering a fibrotic agent D. Start heparin drop

C. Begin administering a fibrotic agent

(powerpoint) Most common reason for hospital admission in adults over 65 A. HF B. MI C. Dysrhythmias D. Depression

A. HF

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. A. Lethargy B. Ambivalence C. Emotional lability D. Increased appetite E. Long periods of sleep

A. Lethargy B. Ambivalence C. Emotional lability Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is also associated with postpartum depression.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation

A. Reduce preload. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

A patient with heart failure has +1 ankle edema and feeling too tires to go to the BR. Which nursing dx is correct Fluid volume excess r/t edema B. Activity intolerance r/t altered preload C. Alterations in gas exchange r/t imbalance between oxygen D. Knowledge deficit r/t subjective data

B. Activity intolerance r/t altered preload

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

B. Auscultate breath sounds Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kilogram) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is most important.

Which of the following are physical signs that a child was abused physically A. Withdrawing behavior in class B. Cigarette burns on arms C. Acting out sexual interactions when playing D. poor hygiene and dirty clothes

B. Cigarette burns on arms

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? A. High-potassium foods B. Drugs to treat erectile dysfunction C. Nonsteroidal antiinflammatory drugs D. Over-the-counter H2-receptor blockers

B. Drugs to treat erectile dysfunction

What is the hallmark for left sided HF with systolic dysfunction A. Pitting edema B. EF less than 45% C. Distended neck veins D. EF greater than 50%

B. EF less than 45%

Priority labs/diagnostics suspect for acute MI A. CBC B. EKG C. troponin, CK, CKMB D. Coronary angiography E. BMP

B. EKG C. troponin, CK, CKMB D. Coronary angiography

Which of the following is a common side effect of Spironolactone?* A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

B. Hyperkalemia

(Kahoot) You initially suspect he has an ACS, which symptom is not a typical manifestation ? A. Pressure-like chest pain B. Palpitations C. Dyspnea D. Nausea

B. Palpitations

The pt was dx with MI yesterday. Which of the data would be most important to report A. Hyperglycemia B. bilateral crackles C. Q waves on EKG D. elevated troponin

B. bilateral crackles

Most characteristic symptom of menopause ? A. hot flahses B. it varies from woman to woman C. Mood swings D. Vaginal dryness and painful intercourse

B. it varies from woman to woman

(Kahoot) Which assessment data suggest that his chest pain is caused by an acute MI? A. pain increases with deep breathing B. pain last lasted longer than 30 minutes C. pain is relieved after the patient take Nitro D. pain resolved when patient raises his arm

B. pain last lasted longer than 30 minutes

The nurse knows that cardiac specific troponin will increase ____ hours after onset of MI A. Immediately B. 2-3 C. 4-6 D. 10-12

C. 4-6

Which drug is used to prevent development of HR in its who had a MI and also used as 1st line tx in HR A. beta adrenergic blockers B. Beta adrenergic agonist C. Ace- inhibitors D. Calcium channel blockers

C. Ace- inhibitors

(Kahoot) W.R is recovering from an uncomplicated MI. Which rehabilitation guideline should be included A. Refrain from sexual activity for a minimum of 3 weeks B. Plan a diet that aims for 1-2 lb weight loss/week C. Begin an exercise program aiming at least 5-30 minutes session D. Consider using erectile agents and prophylactic NTG before sex

C. Begin an exercise program aiming at least 5-30 minutes session

An older adult presents with a fx arm, multiple bruises, which action should the RN do first A. Notify elder protective services B. Make a referral for a nursing home assessment C. Have the family member stay in the waiting room when the RN assesses the patient D. Ask the patient how injury occurred and watch the family's response

C. Have the family member stay in the waiting room when the RN assesses the patient

A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action?* A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.

C. Hold the dose and notify the physician of the digoxin level.

Which of the following would be the best recommendation for osteoporosis prevention A. Taking vitamin E B. cycling every day C. Include more dairy and green leafy vegetables D. Limit caffeine

C. Include more dairy and green leafy vegetables

Which information for a patient taking prednisone 40 mg daily x3 weeks is most important to report A. BP 130/90 B. +1 bilateral ankle edema C. Pt stopped the medication 2 days ago D. Pt has not been taking prescribed vitamin D

C. Pt stopped the medication 2 days ago

The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?* A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

D. Hold the dose and notify the physician about the potassium level

During the administration of the thrombolytic, the nurse should stop the transfusion if that pt has A. Bleeding gums B. increased BP C. a decrease in LOC D. a non-sustained arrhythmia

C. a decrease in LOC

A patient is taking digoxin, apical pulse 61, digoxin is 5. Which is correct a. hold dose now and administer the dose in the evening B. administer the dose as ordered C. hold the dose and notify the Dr. of the digoxin level D. Administer the dose and repeat a digoxin level in 6 hours

C. hold the dose and notify the Dr. of the digoxin level

A pt dx with ACS is on Nitro drip. Which nursing action could the RN delegate to the LPN A. teach the pt about nitro B. change the peripheral IV site C. monitor the patient BP every hour D. titrate the drip as ordered

C. monitor the patient BP every hour

What can a women do to decrease the vasomotor effect of menopause A. Perform aerobic exercise B. increase the amount of calcium and vitamin D in the diet C. Increase caffeinated beverages D. Dress in layers of cotton clothing

D. Dress in layers of cotton clothing

To determine whether there is a delay in condition through the ventricles, the nurse would measure A. P wave B. PR interval C. Q wave D. QRS complex

D. QRS complex

Which psychosocial nursing diagnosis is most relevant for a patient experiencing an acute MI A. Decreased cardiac output B. Hopelessness C. Activity intolerance D. Anxiety

D. Anxiety

A pt with heart failure after a week of tx with metoprolol. What is most important to report A. Mild bilateral pedal edema B. HR 56 bpm C. complaints of increased fatigue D. BP of 84/42

D. BP of 84/42

(Kahoot) which are W.R's modifiable risk factors for MI A. Age B. HTN C. Smoking D. Both B and C

D. Both B and C

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?* A. Lisinopril B. Losartan C. Lasix D. Digoxin

D. Digoxin The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

During a therapy group session, after several members relate traumatic incidents that happened during the week, a client says with a smile, "Things haven't gone well in my life this week either." It is most appropriate for the nurse to: A. Ask the client to share what has happened this week. B. Make a note of the incongruity of the client's message but remain silent. C. Comment, "This seems to have been a bad week for several of our members." D. Say to the client, "You say things have been bad this week, but you're smiling."

D. Say to the client, "You say things have been bad this week, but you're smiling." Say to the client, "You say things have been bad this week, but you're smiling.""You say things have been bad this week, but you're smiling" is an open-ended, nonjudgmental response that points out incongruity between the client's verbal and nonverbal communication. Asking the client to share, remaining silent but making a note of the incongruity, or noting that it has been a bad week for several of the group's members will not help the client recognize the incongruity.

On a telemetry monitor, the nurse observes that a patient's heart rhythm is sustained ventricular tachycardia (VT). Upon assessment, the patient is alert and oriented with no reports of chest pain, but expresses feeling slightly short of breath. His blood pressure is 108/70. What is the nurse's first action? A.Synchronized cardioversion B.CPR and immediate defibrillation C.Administration of IV amiodarone (Cordarone) and dextrose D.Administration of oxygen and observation of the heart rhythm

D.Administration of oxygen and observation of the heart rhythm Rationale: Current advanced cardiac life support (ACLS) guidelines recommend administration of oxygen and observation of heart rhythm first, followed by administration of an IV antidysrhythmic agent such as amiodarone mixed with dextrose 5%. Synchronized cardioversion would be the next step. CPR and immediate defibrillation would be used only to treat unstable VT.

A 13-year-old boy who recently was suspended from school for consistently bullying other children is brought to the pediatric mental health clinic by his mother. The child is assessed by the psychiatrist and referred to a psychologist for psychological testing. The day after the tests are completed, the mother returns to the clinic and asks the nurse for results of the tests. The nurse should: Refer the mother to the psychiatrist. Explain to the mother the results of the tests. Suggest that the mother call the psychologist. Teach the mother about the tests that were administered.

Refer the mother to the psychiatrist. It is the responsibility of the psychiatrist, who is the primary care provider, to discuss the test results with the mother. Explaining to the mother the results of the tests is beyond the scope of the nurse's role. The mother should be referred to the psychiatrist, not the psychologist, because the psychiatrist is the leader of this health team. Teaching about the tests should have been done before, not after, the tests were administered.

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings?* A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).

These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?* A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

The answer is D. This is a description of ACE inhibitors (option D).

A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?* A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.

The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation.

Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure:* A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

The answers are B and D.

The nurse is discussing menopause with a​ 40-year-old client. During this​ discussion, the nurse identified which factor that determines when perimenopause may​ occur? a Genetics b Age of menarche c Being sexually active d Alcohol use

a Genetics (RationaleThe age of perimenopause is genetically programmed and unrelated to the age of menarche. Cigarette smoking and living at high altitudes can lead to earlier menopause. Alcohol use and being sexually active does not influence perimenopause.)

Which medication is used​ off-label to reduce the occurrence of hot flashes associated with​ menopause? a Raloxifene​ (Evista) b Venlafaxine​ (Effexor) c Levothyroxine​ (Synthroid) d Triphenylethylene​ (Tamoxifen)

b Venlafaxine​ (Effexor)

A​ 52-year-old woman complains of hot​ flashes, night​ sweats, irritability, decreased vaginal​ lubrication, and no menstrual period in the past 15 months. Over the past several​ weeks, the hot flashes and night sweats have increased in​ frequency, and she has noticed that she is more irritable. Laboratory values reveal increased​ follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse​ initiate?​(Select all that​ apply.) a Asking​ open-ended questions about the​ client's body image b Instructing the client to avoid​ over-the-counter vaginal lubricants c Explaining such physiological manifestations of menopause as hot flashes and night sweats d Providing information about medications that might be prescribed to help with menopausal symptoms e Encouraging discussion of how menopausal symptoms are affecting sexual functioning

a,c,d,e(RationaleThe client is undergoing menopause. The client with menopause may have problems understanding the natural female aging​ process, sexual​ dysfunction, low​ self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiological manifestations of​ menopause; providing information about medications that might be prescribed to help with menopausal​ symptoms; encouraging discussion of how menopausal symptoms are affecting sexual​ functioning; and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking​ open-ended questions will further explore the client​'s thoughts and feelings about body image in a therapeutic manner.)

(med surg) A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do (select all that apply)? a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate. c. Keep an accurate measure of intake and output. d. Teach the patient about dietary restriction of potassium. e. Withhold digitalis and notify health care provider if pulse is irregular.

a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate.

(med surg) The nurse recognizes that primary manifestations of systolic failure include a. ↓ EF and ↑ PAWP. b. ↓ PAWP and ↑ EF. c. ↓ pulmonary hypertension associated with normal EF. d. ↓ afterload and ↓ left ventricular end-diastolic pressure.

a. ↓ EF and ↑ PAWP (pressure within the pulmonary arterial system)

The nurse is providing education to a client who has been diagnosed with menopause. Which health promotion intervention should the nurse discuss with the​ client?​(Select all that​ apply.) a Wearing tight clothing b Eating a balanced diet that includes​ fruits, vegetables, and​ high-fiber foods c Doing Kegel exercises d Avoiding alcohol and cigarette use e Participating in yoga classes

b,c,d,e (RationaleExercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Keeping the bedroom cool will help control and provide comfort during night sweats. Caffeine intake should be decreased during perimenopause because it can trigger hot flashes. Sexual intercourse does not have to be avoided during​ perimenopause, but lubricants may be used to decrease discomfort from vaginal dryness.)

(med surg) Patients with a heart transplantation are at risk for which complications in the first year after transplantation (select all that apply)? a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden cardiac death

b. Infection c. Rejection e. Sudden cardiac death

(med surg) In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) a. diffuse involvement of plaque formation in coronary veins. b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle. e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm

b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle.

The HCP ordered Sertaline (zoloft) after 3 days, says the med is not working. The RN should respond a. cheer up, you have so much to be happy about b. sometimes its takes 4-6 weeks to see improvements in symptoms C. Give it 2 days and you should see improvements in your symptoms D. I'll call the HCP and get an order to change the medication

b. sometimes its takes 4-6 weeks to see improvements in symptoms

A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia a. will always progress to myocardial infarction. b. will be relieved by rest, nitroglycerin, or both. c. indicates that irreversible myocardial damage is occurring. d. is frequently associated with vomiting and extreme fatigue.

b. will be relieved by rest, nitroglycerin, or both.

(med surg) You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (select all that apply) a. increases SVR. b. produces diuresis. c. improves contractility. d. dilates renal blood vessels. e. works on the β1-receptors in the heart.

c. improves contractility. e. works on the β1-receptors in the heart.

(med surg) A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is a. ventricular dilation. b. ventricular hypertrophy. c. neurohormonal response. d. sympathetic nervous system activation.

c. neurohormonal response

The nurse is interviewing Melinda Britt during her annual gynecologic exam. Which statement by Melinda would cause you to believe she is experiencing​ perimenopause? a ​"I am so cold​ lately." b ​"I feel that my appetite is really​ increasing."​ c "I have problems with​ constipation."​ d "I often experience sweating at​ night."

d "I often experience sweating at​ night." Sweating at night is a manifestation during perimenopause. Cold​ intolerance, increased​ appetite, and constipation are not symptoms manifested with perimenopause.

A​ 34-year-old client presents to the family practice clinic with complaints of not having a menstrual period in the past 14 months. What data should the nurse obtain when performing a physical examination on the​ client? a Drug and alcohol use b Sexual history c Menstrual history d Weight and height

d Weight and height Rationale: When performing a physical examination on a perimenopausal​ client, the nurse needs to obtain the client​'s weight and height. The client​'s sexual and menstrual history and use of alcohol and drugs are data obtained when performing the health history.

You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?* A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."

.The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.

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

a. "Depression often begins after a major loss. Losing dad was a major loss."

(Powerpoints) Label each as either Normal (reassuring) or abnormal (non reassuring) 1. Late deceleration 2.Acceleration 3. Sinusoidal variability 4. Early deceleration 5. Decreased variability 6. Monderate variability 7. Variable deceleration

1. abnormal (non reassuring) 2.Normal (reassuring) 3. abnormal (nonreassuring) 4. Normal (reassuring) 5. abnormal (nonreassuring) 6. Normal (reassuring) 7. abnormal (non reassuring)

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

a. Conducting routine suicide screenings at a senior center.

A nurse begins to develop a plan of care with a client who has left ventricular heart failure that resulted from a myocardial infarction (MI). Which goal is priority during the acute phase of recovery? A. Promote pain relief B. Increase activity tolerance C.Prevent cardiac dysrhythmias D. Maintain potassium and sodium intake

The major goal is to manage pain. Pain relief helps increase the oxygen supply and decrease myocardial oxygen demand, decreasing the workload of the heart. Increasing activity tolerance is the primary focus during the rehabilitative phase after an MI, not during the acute phase. While preventing dysrhythmia is important, it is not the priority. Although maintaining potassium intake is important, sodium should be limited to minimize fluid retention, which increases the workload on the heart

The nurse is providing instructions to a client who is on isocarboxazid for depression. Which statements made by the client indicate effective learning? Select all that apply. A. "I will include yogurt in my diet." B. "I will avoid soy sauce in my diet." C. "I will avoid pepperoni in my diet." D. "I will include cream cheese in my diet." E. "I will avoid fermented bean curds in my diet.

A. "I will include yogurt in my diet." D. "I will include cream cheese in my diet." E. "I will avoid fermented bean curds in my diet. Isocarboxazid is a monoamine oxidase (MAO) inhibitor used to treat depression. Clients on MAOIs should avoid foods containing high amounts of tyramine. Yogurt and cream cheese are foods containing low to no tyramine content. Fermented bean curds are high tyramine-containing foods that should be avoided. Soy sauce and pepperoni are high tyramine foods that should be avoided.

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

A. "What brought you here for treatment today?" B. "What do you believe is the cause of your depression?" C. "Does religion have a role in your perception of health and wellness?" E. "Have you ever sought treatment for a mental health problem previously? Determining the client's perception of the problem is an appropriate question that allows cultural factors to be included. Encouraging the client to discuss the problems will facilitate a clearer understanding of the factors involved. Religion often plays a significant role in a client's view of health, wellness, and recovery. Knowing whether a client has ever undergone treatment for a mental health problem reveals mental health history and how previous issues were addressed. Insurance coverage is not pertinent to the issue and is an inappropriate topic of questioning by the nurse.

Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:* A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza. The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza)

When working with a client who is depressed, what should the nurse do initially? A. Accept what the client says. B. Attempt to keep the client occupied. C. Keep the client's surroundings cheery. D. Try to prevent the client from talking too much

A. Accept what the client says. Because clients cannot be argued out of their feelings, it is best to initially accept what they say; it also encourages communication. Attempting to keep the client occupied delays discussing the client's feelings, and the client's low energy level may prevent involvement in activities. Keeping the client's surroundings cheery has little effect on the depressed client; it can increase depression. The depressed client does very little talking and needs to be encouraged to communicate.

A nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome? A. Allows excess tissue fluid to be excreted B. Helps to control the volume of food intake and thus weight C. Aids the weakened heart muscle to contract and improves cardiac output D. Assists in reducing potassium accumulation that occurs when sodium intake is high

A. Allows excess tissue fluid to be excreted A decreased concentration of extracellular sodium causes a decrease in the release of antidiuretic hormone (ADH); this leads to increased excretion of urine. Sodium restriction does not control the volume of food intake; weight is controlled by a low-calorie diet and exercise (if permitted). The resulting elimination of excess fluid reduces the workload of the heart but does not improve contractility. Potassium is retained inefficiently by the body; an adequate intake of potassium is needed.

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

A. Arranging for a staff member to watch the children so the mother and nurse can talk This emotionally charged topic should be discussed with the client in a confidential session; after the nurse has assessed the situation, the woman and the nurse can plan the family's future. Although a safe facility may be called, a determination of the client's ambivalence may be made, and couples counseling may be recommended eventually, all three actions are premature if a thorough assessment of the situation has not been made.

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

A. Checking for compliance with the client's drug regimen B. Monitoring the client's serum potassium and magnesium levels regularly D. Calculating the correct dosage form, prescribed amounts, and the prescriber's order E. Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly Digoxin may alter the serum potassium and serum magnesium levels, which affects heart function. Calculating the correct dose according to the healthcare provider's orders helps to prevent drug toxicity. Checking for compliance with the client's drug regimen is important so that the child does not have drug to drug interactions. Monitoring and recording drug intake and output, heart rate, blood pressure, daily weight, and respiration rate is a part of general nursing care. Administering digoxin through the intramuscular route is not advised because this method is very painful.

A female client is admitted to the hospital after attempting suicide. She reveals that her desire for sex has diminished since her child's birth 3 years ago. What is most directly related to the client's loss of interest in sex? A. Depression B. Dependency C. Marital stress D. Identity confusion

A. Depression Decreased sexual desire is a major symptom of clinical depression. Other vegetative signs of depression include changes in bowel elimination, eating habits, and sleeping patterns. Although depression is often related to unmet dependency needs, the decreased sexual desire is associated with the depression, not the unmet dependency needs. The sexual difficulties are associated with the depression, and the depression, not the sexual difficulties, may be the major cause of marital stress. Also, there are no data indicating marital stress. Role confusion, not identity confusion, is usually associated with depression.

Margaret, age 68, is a widow of 6 months. Since her husband dies, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with major depressive disorder. The PRIORITY nursing diagnosis for Margaret would be: A. Imbalanced nutrition: less than body requirements B. Complicated grieving C. Risk for suicide D social isolation

C. Risk for suicide This client is indicating thoughts of suicide. Safety should always be considered the priority with the other diagnoses being addressed after the initial threat has passed.

A client with a history of heart failure and atrial fibrillation reports a nine-pound (four kilogram) weight gain in the last two weeks. Which factor does the nurse consider as the most likely cause of this sudden weight gain? A. Fluid retention B. Urinary retention C. Renal insufficiency D. Abdominal distention

A. Fluid retention With the client's history and the large weight gain, fluid retention is the most likely cause of the increase in weight. Urinary retention occurs in the bladder, not the tissues, and does not account for the large weight gain. Renal insufficiency can occur with heart failure, but it is not the primary etiological factor of the sudden weight gain. Abdominal distention usually is caused by gas in the intestine and should not contribute to this large a weight gain. If the abdomen is enlarged, assessment by ballottement should be done to determine whether enlargement is caused by fluid in the peritoneal cavity (ascites).

A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity? Select all that apply . A. Nausea B. Yellow vision C. Irregular pulse D. Increased urine output E. Heart rate of 64 beats per minute

A. Nausea B. Yellow vision C. Irregular pulse Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision). In addition, ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse. Increased urine output is an expected effect of the diuretic furosemide; a pulse rate of 64 beats per minute is an acceptable rate when a client is receiving digoxin.

A client with a history of heart failure is experiencing dyspnea with a respiratory rate of 32. Crackles are noted bilaterally. The client is in Sims position, receiving oxygen at 2 L/min via nasal cannula. Which action should the nurse take first? A. Raise the client to high-Fowler position B. Obtain the apical pulse and blood pressure C. Call the primary healthcare provider immediately D. Monitor the pulse oximeter to ascertain the oxygen level

A. Raise the client to high-Fowler position Raising the client to high-Fowler position will decrease orthopnea by using gravity to keep fluid in lower extremities, putting less stress on the heart. Obtaining a full set of vital signs would be the next priority after changing the client position. Calling the primary healthcare provider immediately would not be useful without having a full set of vital signs. The vital signs should include the oxygen saturation, which the healthcare provider would expect the nurse to provide.

When the nurse is managing the care of an acutely depressed client, which intervention demonstrates that the nurse recognizes the client's fundamental mental health need? A. Role modeling a hopeful attitude regarding life and the future B. Sharing that life has presented depressing situations for all of us at times C. Devoting time with the client and trying to focus on happy, positive memories D. Identifying the client's personal weaknesses and designing interventions to strengthen them

A. Role modeling a hopeful attitude regarding life and the future Role modeling has been shown to be an excellent tool in molding adaptive behavior. Depression affects the individual's ability to see hope in the future, and role modeling will help provide adaptation to similar feelings. Affirming that everyone has depressive situations in their lives does not foster a positive response in the depressed client. Reminiscing about happier times and events is likely to highlight the client's current loss of happiness rather than foster positive feelings. The depressed client generally has low self-esteem and is often too tired to engage in physical activities. When a client is depressed, the nurse should identify the client's personal strengths, not weaknesses, and focus on interventions to reinforce those strengths. Focusing on a client's weaknesses when the client is already depressed may initiate a deeper depression.

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? A. Sertraline B. Fluoxetine C. Amphetamine D. Carbamazepine

A. Sertraline Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.

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

A. Tell a staff member to get the electrocardiogram machine. B. Notify the x-ray department that a chest x-ray exam must be done stat. C. Have a staff member notify the nursing supervisor of the change in client status F. Increase the supplemental oxygen without a prescription from 2 L nasal cannula to 4 L nasal cannula and notify the healthcare provider. A staff member can get the electrocardiogram machine and start the procedure. Ancillary personnel are trained to do electrocardiograms even if they are not able to interpret the results. Anyone can notify the x-ray department that the chest x-ray exam must be done. It is important to delegate the tasks to a specific person. Increasing the oxygen without a prescription is appropriate in the short term, but the nurse must obtain a prescription when notifying the healthcare provider. Notifying the healthcare provider of the change in oxygen saturation is appropriate, but it would be expected that nursing judgment had taken place and the oxygen already was increased from 2 L/min. Telling the certified nursing assistant (CNA) to get a prescription is an inappropriate action as a CNA is not allowed to take medical prescriptions. Taking a medical prescription is a nursing role.

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

A. The child cringes when approached. B. The child has unexplained healed injuries. D. The child lies still while surveying the environment. The child cringes when approached because past experiences with adults have resulted in pain rather than comfort. Evidence of past injuries may exist, but the parents do not discuss it, because this would be an admission of child abuse. Abused children are always on the alert for potential abuse. Lying motionless is an attempt to avoid attention; also, in the past the abused child's attempts to resist abuse have often precipitated more abuse. Abusive parents are unable to provide any emotional support and will not exhibit overly affectionate behavior. Because abusive parents try to hide the fact of abuse, explanations about injuries are usually fabricated, inconsistent, and vague.

A hospitalized, depressed, suicidal client has been taking a mood-elevating medication for several weeks. The client's energy is returning, and the client no longer talks about suicide. What should the nurse do in response to this client's behavior? A.Keep the client under close observation. B. Arrange for the client to have more visitors. C. Engage the client in preliminary discharge planning. D. Observe the client for side effects of the medication

A.Keep the client under close observation. As the client's motivation and energy return, the likelihood that suicidal ideation will be acted out increases. There are no data regarding visitation rights; the priority concern is the greater risk for suicide. Although engaging the client in preliminary discharge planning eventually will be done, the priority is determining the potential for suicide. Although the client should be observed for side effects of the medication, the greater risk of suicide takes precedence.

A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? A. "My ankles are swollen." B. "I am tired at the end of the day." C. "When I eat a large meal, I feel bloated." D. "I have trouble breathing when I walk rapidly." Dyspnea on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity. The statement "My ankles are swollen" is more likely with right ventricular heart failure. The statement "I am tired at the end of the day" is not specific to left ventricular heart failure. The statement "When I eat a large meal, I feel bloated" is not specific to left ventricular heart failure.

B. "I am tired at the end of the day."

What area of the heart is responsible for the delay of conduction between the artrium and ventricles? A. Bachmann's Bundle B. AV node C. Right bundle branch D. Bundle of His

B. AV node

When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first? A. Interview the client for a health history. B. Assess the client's heart and lung sounds. C. Monitor the client's pulse and temperature. D.Obtain the client's blood specimen for electrolytes.

B. Assess the client's heart and lung sounds. With heart failure, the left ventricle is not functioning effectively, which is evidenced by an increased heart rate and crackles associated with pulmonary edema. The health history interview is done after vital signs and breath sounds are obtained and the client is stabilized. Although an infection would complicate heart failure, there are no signs that indicate this client has an infection. Obtaining the client's blood specimen for electrolytes is inappropriate for immediate monitoring; it should be done after vital signs and clinical assessments have been completed.

What characteristics are commonly associated with adolescent depression? Select all that apply. A. Exercising daily B. Having suicidal ideation C. Exhibiting tearfulness D. Having poor muscle tone E. Avoiding previously enjoyed activities and relationships

B. Having suicidal ideation C. Exhibiting tearfulness E. Avoiding previously enjoyed activities and relationships Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.

On an EKG the P-wave represents what area of the heart? A. Left bundle branch B. AV node C. SA node D. Bachmann's Bundle

C. SA node

A nurse is concerned when an 11-month-old infant is brought to the pediatric clinic weighing 9 lb 3 oz (4167 g). The nurse suspects that the infant is suffering from physical and emotional neglect. What observations lead the nurse to suspect maltreatment? Select all that apply. A. Stranger anxiety B. Inappropriate clothing C. Social unresponsiveness D. Frequent rocking motions E. Adequate personal hygiene

B. Inappropriate clothing C. Social unresponsiveness D. Frequent rocking motions Stranger anxiety begins around 5 to 6 months, when infants become responsive to the caregivers who have met both physical and emotional needs. When strangers speak to them or reach out to hold them they seem fearful, cling to the caregiver, and cry. Infants whose needs have not been met adequately have no reason to be fearful of others. A typical sign of physical neglect is the wearing of dirty clothes or clothing that is not suitable to the environment. The infant who has not experienced social responsiveness from the caregiver has not learned how to be socially responsive to others. Infants who experience emotional deprivation resort to self-stimulating behaviors in an effort to meet their emotional needs. Infants who experience physical neglect are more likely to be unclean, with signs of unattended skin lesions such as diaper rash or bruises.

A nurse teaches the parents of an infant with a cardiac defect how to detect impending heart failure. What should the parents be taught to identify as an early sign? A. Slowed respiration B. Increased heart rate C. Distended neck veins D. Increased urine output

B. Increased heart rate Tachycardia results from sympathetic stimulation in the setting of heart failure; it is the body's attempt to increase cardiac output and increase oxygen supply to the body's cells. The respirations will increase, not decrease, when heart failure occurs. Distended neck veins occur only in adults when heart failure has progressed to systemic congestion. Urinary output is decreased as a result of sodium and water retention.

Which symptoms of depression, often overlooked in the older adult client, should the nurse include in the assessment process? Select all that apply. A. Anxiety B. Insomnia C. Weight loss D. Weight gain E. General fatigue

B. Insomnia E. General fatigue Insomnia and general fatigue are symptoms of depression that are often overlooked for the older adult client. Anxiety, weight loss and weight gain are all symptoms of depression; however, these symptoms are not often overlooked for the older adult client.

Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply:* A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

B. Persistent cough D. Crackles F. Orthopnea The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.

(powerpoints) What is the treatment of choice for atrial flutter A. Antidysrhythmia drugs B. Radiofrequency catheter ablation is the treatment of choice for atrial flutter C. Calcium channel blockers D. β-blocker

B. Radiofrequency catheter ablation is the treatment of choice for atrial flutter

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

B. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.

Incidents of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation? A.Isolation B.Repression C.Regression D.Introjection

B.Repression Repression is a coping mechanism in which unacceptable feelings are kept out of conscious awareness; later, under stress or anxiety, thoughts or feelings surface and come into one's conscious awareness.

What part of the heart's electrical system is known as the "gatekeeper"? A. SA node B. Tetany C. AV node D. Gap Junction

C. AV node

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

C. Arranging for constant supervision of the client A change in behavior that seems positive may actually indicate that the client has worked out a plan for suicide; the potential for suicide increases when physical energy returns. Increased supervision is needed. Complimenting the client's appearance may increase the client's feelings of inadequacy, because it implies that the client did not look good before. It is inappropriate to consider discharge simply because of a change in behavior. Many factors should be considered in the decision to discharge a client. The addition of privileges is not indicated at this time.

A nurse discovers lower extremity pitting edema in a client with right ventricular heart failure. Which information should the nurse consider when planning care? A. Client has decreased plasma colloid osmotic pressure. B. Client has increased tissue colloid osmotic pressure. C. Client has increased plasma hydrostatic pressure. D. Client has decreased tissue hydrostatic pressure.

C. Client has increased plasma hydrostatic pressure. In right ventricular heart failure, blood backs up in the systemic capillary beds; the increase in plasma hydrostatic pressure shifts fluid from the intravascular compartment to the interstitial spaces, causing edema. Increase in tissue (interstitial) colloid osmotic pressure occurs with crushing injuries or if proteins pathologically shift from the intravascular compartment to the interstitial spaces, pulling fluid and causing edema. In right ventricular heart failure, increased fluid pressure in the intravascular compartment causes fluid to shift to the tissues; the tissue hydrostatic pressure does not decrease. Although a decrease in colloid osmotic (oncotic) pressure can cause edema, it results from lack of protein intake, not increased hydrostatic pressure associated with right ventricular heart failure.

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

C. Determining whether the client feels safe at home Bruising on the backs of both shoulders and both wrists indicates potential abuse; asking the client whether she feels safe at home will open a dialogue to discuss the possible physical abuse. Whether or not the client admits abuse, the nurse is required to report the finding. A client in preterm labor should have a large-bore intravenous catheter. Ambulation is not appropriate for a client in preterm labor, and bed rest should be maintained. Reporting should not be delayed

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

C. Increased pressure within the circulatory system Failure of the right ventricle causes an increase in pressure in the systemic circulation. To equalize this pressure, fluid moves into the tissues, causing edema, and into the abdominal cavity, causing ascites; ascites leads to an increased abdominal girth. There is no loss of the cellular constituents in blood with right ventricular heart failure. Ascites is the accumulation of fluid in an extracellular space, not intracellular. The opposite of rapid diffusion of solutes and solvents into plasma results when there is a pressure increase in the systemic circulation.

A nurse spends time in individual sessions helping a depressed, suicidal client verbalize feelings. For what themes should the nurse particularly listen? Select all that apply. A. Anger B. Control C. Isolation D. Dominance E. Hopelessness F. Indecisiveness

C. Isolation E. Hopelessness Feelings of isolation compound feelings of hopelessness and helplessness and may provide the client with the impetus to act on suicide ideation. The main factor leading to acting on suicidal impulses is the feeling of hopelessness, that there is nothing to live for. Anger may be associated with depression; however, a depressed person usually does not have the energy to act out suicidal ideation. The struggle for control or dominance is not an important risk factor for suicide. Indecisiveness may be associated with depression, but an indecisive individual is usually unable to make the decision to commit suicide.

A nurse working on a mental health unit is caring for several clients who are at risk for suicide. Which client is at the greatest risk for successful suicide? A. Young adult who is acutely psychotic B. Adolescent who was recently sexually abused C. Older single man just found to have pancreatic cancer D. Middle-age woman experiencing dysfunctional grieving

C. Older single man just found to have pancreatic cancer Older single men with chronic health problems are at the highest risk of suicide. This is because men have fewer social supports than women do. (Men are less social then women in general.) Less social support at times of stress can increase the risk of suicide. Also, chronic health problems can lead to learned helplessness, which can lead to depression. People who are acutely psychotic as a group are at higher risk for suicide, but they do not have the suicide rate of older single adult men with chronic health problems. An adolescent who was recently sexually abused, although severely traumatized, does not have the risk of suicide of an older single man with chronic health problems. Dysfunctional grieving is prolonged grieving that is characterized by greater disability and dysfunctional patterns of behavior. Although people with complicated dysfunctional grieving may be at risk for self-directed violence, they do not have the suicide risk of older single men with chronic health problems.

A 6-year-old child with a leg fracture of suspicious origin is brought into the emergency department by the mother and the mother's boyfriend. It is the child's first visit to this hospital. After assessing the child, a nurse anticipates that the healthcare provider will order a skeletal survey. Why is a skeletal survey the preferred diagnostic tool? A. The exact location and extent of the fracture will be pinpointed. B. Three separate x-ray films of the leg and hip should be ordered, making it more cost-effective. C. The skeletal history of the current fracture and any previous healing or healed fractures are identified. D. It is the first step toward a complete assessment before computed tomography and magnetic resonance imaging are done.

C. The skeletal history of the current fracture and any previous healing or healed fractures are identified. Abusive parents may "shop" for hospitals that do not have a previous record of their child; the skeletal survey will provide a revealing injury history if abuse has occurred. Pinpointing the exact location of a fracture is necessary to plan appropriate treatment and can be done with a single x-ray film of the area; a skeletal survey is more extensive and helpful when abuse is suspected. Cost-effectiveness is not the primary concern if abuse is suspected. Computed tomography and magnetic resonance imaging are not required unless internal injuries are suspected.

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

C.Asking the client questions, using a postpartum depression scale A postpartum depression scale is a validated tool for identifying women who might be experiencing postpartum depression. The most widely used and validated tools are the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale. Although providing community resources of a local support group may be helpful, it is not useful in assessing the client's current emotional status. Although postpartum blues caused by hormonal changes soon after pregnancy might be common, feelings of depression and fatigue 6 weeks after childbirth is a matter of concern. The client may not have anyone else who can provide child care, or the client may not follow through on the recommendation. In addition, this intervention does not provide any information on the client's current emotional status.

An older client who lost a spouse 20 years ago comes to the community health center with a vague list of complaints and a brief life history. The couple's only child died at birth. The client lives alone and is able to perform all the activities of daily living. The client has had an active social life in the past but has outlived many friends and family members. What is an important question for the nurse to ask when taking this client's health history? A. "Are you all alone?" B. "How did your son die?" C. "Do you still miss your spouse?" D. "How do you feel about your life now?"

D. "How do you feel about your life now?" The answer to "How do you feel about your life now?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Are you all alone?" is probing and provides little information for the nurse to use in planning care. "How did your son die?" and "Do you still miss your spouse?" are both probing, disregard the client's present situation, and provide little information for the nurse to use in planning care.

A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition?* A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema." Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.

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

D. "You say that it was your fault—help me understand that." Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. "Maybe it was your husband's fault, too" is a declarative statement that is closed, will limit dialog, and is not therapeutic. When the nurse voices her opinion saying, "I can't agree with that—no one should be beaten", the nurse is shutting off communication with the client. Nurses are to be nonjudgmental and not offer an opinion, and should ask open-ended questions to facilitate communication with the client. Asking a "why" question is generally not therapeutic because most clients cannot respond to these questions with logical explanations.

What score on the EPDS would promote the to suspect possible depression and need further assessment A. 2 B. 5 C. 10 D. 15

D. 15 A maximum score 30 Scores of 12 or higher → possible depression and need further assessment.

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

D. A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this. The client's response is appropriate to the situation, reflecting disappointment in not achieving her goal; in addition, this is the time when "postpartum blues" occurs. The client's feelings may or may not pass after she has bonded with her infant; there is no indication that the feeling will pass or that bonding is involved. The client's statement is not indicative of depression. With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment a client may feel over not reaching her goal.

What area of the heart forms the PR segment on the EKG? A. Apex of heart B. Purkinje fibers C. Bundle of His D. AV node and Right and Left Bundles

D. AV node and Right and Left Bundles

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

D. Adult Protective Services The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified.

A teacher's aide in a kindergarten class informs the school nurse that a male student said that his mother beat him and that he has bruises on the back and shoulders. What is the priority nursing action? A. Notifying Child Protective Services B. Reporting this information to the principal C. Calling the parents to arrange a conference D. Assessing the child for the presence of bruises

D. Assessing the child for the presence of bruises The nurse must validate the presence of physical injury and potential abuse before initiating other interventions. Child Protective Services, the school principal, and the parents should not be notified until signs of possible abuse are verified.

The registered nurse instructed the nursing student to care for a client who suffers from depression. During a follow up visit, the registered nurse finds that the client's symptoms have not improved. Which activity of the nursing student would the registered nurse relate this to? A. Modifying the environment B. Limiting the client's choices of diet and clothing C. Encouraging fluid intake D. Discouraging social interaction to avoid the client's distraction from outside environment

D. Discouraging social interaction to avoid the client's distraction from outside environment The nursing student's act of discouraging interactions due to fear of the client's distraction may result in a lack of improvement. Social interactions should be encouraged instead. Modifying the environment may help to provide better healthcare. The nurse should limit the client's choices of food and clothing to relieve any decision-making stress. The nurse should also encourage fluid intake.

A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? A. Repression B. Manipulation C. Transference D. Displacement

D. Displacement Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on those who are less threatening. Repression is the unintentional putting out of the mind unacceptable or troubling thoughts, desires, or experiences. Transference is a mechanism by which affects or emotional tones are shifted from one individual to another; it is unrelated to child abuse. Manipulation is a mechanism by which individuals attempt to manage, control, or use others to suit their own purpose or to gain an advantage; it is unrelated to child abuse.

What is the best room assignment for a 5-year-old child admitted with injuries that may be related to abuse? A. In an isolation room B. With a friendly older child C. With a child of the same age D. In a room near the nurses' desk

D. In a room near the nurses' desk A child who exhibits signs of abuse needs close supervision, especially when members of the family visit. The child requires close monitoring and should not be left alone. There is no indication that this child needs to be placed in an isolation room for the sake of infection control. An older child who exhibits signs of friendliness may be threatening to this child. Placement with a child of the same age may be desirable from a developmental level, but it does not meet the child's safety needs.

The husband of a woman who gave birth to a baby 2 weeks ago calls the postpartum unit at the hospital, seeking assistance for his wife. He reports that he found his wife in bed and that the baby was wet, dirty, and crying in the crib. He says, "She says she just can't do it." What is the best response by the nurse? A. Encouraging him to express his feelings about the situation B. Telling him to schedule an appointment with the gynecologist C. Asking whether he can afford a home health aide for several weeks D. Informing him that he should seek emergency intervention for his wife

D. Informing him that he should seek emergency intervention for his wife The inability to care for herself or her infant is a significant sign that the wife is depressed and in need of immediate intervention. The wife, not the husband, is the priority at this time. The wife has an emotional, not physiologic, problem at this time. Asking whether the family can afford a home health aide for several weeks is not the priority at this time; the wife's emotional condition is the priority.

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

D. Overwhelming feelings of guilt Overwhelming feelings of guilt contribute to the client's risk for suicide. The client may ruminate over past or current failings, and extreme guilt can assume psychotic proportions. Psychomotor retardation and decreased physical activity are clinical findings associated with depression and usually do not lead to suicide because the client does not have the energy for self-harm. Impulsive behaviors, not deliberate thoughtful behaviors, contribute to the client's risk for suicide.

A young female client admitted to the trauma center after being sexually assaulted continues to talk about the rape. Toward what goal should the primary nursing intervention be directed? A. Getting her involved with a rape therapy group B. Remaining available and supportive to limit destructive anger C. Exploring her feelings about men to promote future relationships D. Providing a safe environment that permits the ventilation of feelings

D. Providing a safe environment that permits the ventilation of feelings

An 8-year-old girl visits the school nurse frequently with vague ailments. The nurse spends time listening to the girl, takes her temperature, and always sends her back to class. One Thursday the girl tells the nurse that she no longer wants to visit her grandfather in his home because he "hugs me too tight and touches me down there" (pointing to her genitals). She has told her mother that she does not want to spend the weekend with her grandparents, but her mother says that she has no choice. What is the most appropriate action by the nurse? A. Planning a home visit to discuss with the mother what her child has shared with the nurse B. Advising the child to tell her mother why she does not want to go to her grandfather's house C. Arranging a meeting with the principal and the mother to discuss the possibility of child molestation D. Reporting the alleged abuse to the local child protective agency and encouraging an investigation before the weekend visit

D. Reporting the alleged abuse to the local child protective agency and encouraging an investigation before the weekend visit

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

D. The child asks to go to the nurse's office frequently with vague complaints.

Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?* A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.

Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.

A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?* A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.

The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier

A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?* A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.

The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.

A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition?* A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.

Which of the following tests/procedures are NOT used to diagnose heart failure?* A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring

The answer is D. Options A, B, and C are all used to diagnose heart failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm.

Which of the following is a late sign of heart failure?* A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?* A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe

Select all the correct statements about educating the patient with heart failure:* A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.

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

a. Establish trust and rapport

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

a) Phobias b) Low-self esteem c) Major depressive disorder e) PTSD

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

a. Fluoxetine (Prozac)

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

a. Have relatively poor social skills and to have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

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

a. Pain

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

a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter

A woman who was sexually assaulted by a stranger in the elevator of her apartment building is brought by her husband to the emergency department. What is the priority nursing intervention? a.Obtaining information about her perception of the incident b.Notifying legal authorities that a sexual assault has occurred c.Talking with the husband about his feelings concerning sexual assault d. Teaching the client how to obtain a midstream clean-catch urine specimen

a.Obtaining information about her perception of the incident In a crisis situation it is important for the individual to talk about the situation to enable her to move past shock and disbelief. Notifying the legal authorities that a sexual assault has occurred is the client's decision ( if a minor nurse must report). Although the nurse might talk with the husband, the priority is the woman not the husband. Teaching the client how to obtain a midstream clean-catch urine specimen is contraindicated because the use of water or an antiseptic solution during the procedure will wash away sperm or blood evidence.

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

b. "I think the baby cries just to make me angry."

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

b. 7 years old c. Comorbid autism diagnosis e. Temper tantrums occur at home and in school The basic symptoms of disruptive mood dysregulation disorder are constant and severe irritability and anger in individuals between the ages of 6 and 18. Onset is before age 10. Temper tantrums with verbal or behavioral outbursts out of proportion to the situation occur at least three times a week. Sometimes children and adolescents with this problem can maintain control in certain settings such as school. To be diagnosed with disruptive mood dysregulation disorder, individuals need to exhibit the irritability, anger, and temper tantrums in at least two of these settings: home, school, and with peers. It is more common in males than females

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

b. Deep brain stimulation

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

b. The caregiver was neglected as a child.

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

b. Their limited options.

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

d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep.

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

c. Use the technique of making observations

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

d. Monoamine oxidase inhibitor

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

d) Report suspected abuse to the proper authorities.

True or False: Bachmann's bundle is located in the left artrium.

true

True or False: Depolarization of the heart muscle is when the muscle contracts and repolarization is when the heart muscle rests.

true