Review Q: Adult health Lecture #2
A nurse is assessing a patient with peripheral artery disease (PAD). The patient states that walking five blocks is possible without pain. What question asked next by the nurse will give the best information?
"Could you walk further than that a few months ago?
In which location in the illustration shown below would the nurse auscultate to best hear a cardiac murmur related to aortic regurgitation?
at the aortic spot of the heart assessment
A patient is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the patient to the bathroom and notes the patient's O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best? a.Administer oxygen at 2 L/min b. Allow continued bathroom privileges. c. Obtain a bedside commode. d. Suggest the patient use a bedpan.
b
A patient is undergoing diagnostic testing for reports of chest pain. Which test is done to determine the location and extent of CAD ?A. Electrocardiogram B. Echocardiogram C. cardiac catheterization D. chest X ray
??
After teaching a patient who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the patient's understanding. Which statement by the patient indicates a correct understanding of the teaching?
"I will avoid sources of strong electromagnetic fields."
An older patient with peripheral vascular disease (PVD) is explaining the daily foot care regimen to the family practice clinic nurse. What statement by the patient may indicate a barrier to proper foot care?
"My hands shake when I try to do things requiring coordination."
A nurse cares for a patient who is recovering from a myocardial infarction. The patient states, "I will need to stop eating so much chili to keep that indigestion pain from returning." What is the nurse's best response?
"What do you understand about what happened to you?"
matching a. Total Cholesterol b. Triglycerides c. Plasma high-density lipoproteins (HDL) d. Plasma low-density lipoproteins (LDL) ___ <70 mg/dl in high risk, <100 mg/dl in moderate risk factors, <130 mg/dl in no risk factors. ___ < 150 mg/dl ___ 122-120mg/dl; older adults 144-280 ___ > 45 mg/dl
1.D 2.B 3.A 4.C
A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description?• A. venous ulcer• B. arterial ulcer• C. diabetic ulcer
A
A patient is being discharged with a prescription for warfarin (Coumadin). Which test does the nurse instruct the patient to routinely have done for follow up monitoring? A. Prothrombin time (PT) and international normalized ratio (INR) B. partial thromboplastin time C. complete blood count and platelet count D. sodium and potassium levels
A
A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication? A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5
A
Magnesium is absorbed by what system of the body? •A. GI B. Hepatic C. Renal D. Lymphatic
A
Which patient below is considered hypernatremic? •A. A patient with a sodium level of 155 mEq/L B. A patient with a sodium level of 145 mEq/L C. A patient with a sodium level of 120 mEq/L D. A patient with a sodium level of 136 mEq/L
A
You're educating a patient's family member about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the family member require you to re-educate them about how this medication works? Select all that apply: A. "This medication will help dissolve the blood clot."• B. "This medication will prevent another blood clot from forming."• C. "This medication will help prevent the blood clot from becoming bigger in size."• D. "This medication starts working immediately after the first dose."
A and D
What is the most significant laboratory cardiac marker in the patient who has had an MI? A. A presence of Troponin T and Troponin I B. elevation of myoglobin levels C. Creatinine kinase levels D. Elevation of white count
A?
What nonpharmacologic comfort measures would the nurse include in the plan of care for a patient with severe varicose veins? (Select all that apply.)
Applying elastic compression stockings Elevating the legs when sitting or lying Reminding the patient to do leg exercises
A nurse is working with a patient who takes atorvastatin (Lipitor). The patient's recent laboratory results include : blood urea nitrogen (BUN) of 33 mg/dL and creatinine of 2.8 mg/dL. What action by the nurse is best?
Ask if the patient eats grapefruit.
The nurse is assessing a patient on admission to the hospital. The patient's leg appears as shown below: (gangrene on big toe, red, shiny) What action by the nurse is best?
Assess the patient's ankle-brachial index.
A patient is scheduled to take a dose of Warfarin (Coumadin) at 1800. The patient's INR level is 6. As the nurse you will? A. Administer the dose as scheduled B. Hold the dose and notify the physician C. Double the dose D. Hold today's dose but administer tomorrow's dose as scheduled.
B
Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia is known as? •A. Trousseau's Sign B. Chvostek's Sign C. Homan's Sign D. Goodell's Sign
B
What is considered a normal INR level in a person who is NOT taking Warfarin (Coumadin)?• A. 10-12 seconds B. 0.75-1.25 C. 2-3 D. 5-7
B
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 daya 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.
B,C,D
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,D,F
A patient had an acute myocardial infarction. What assessment finding indicates to the nurse that a significant complication has occurred? a. Blood pressure that is 20 mm Hg below baseline b. Oxygen saturation of 94% on room air c. Poor peripheral pulses and cool skin d. Urine output of 1.2 mL/kg/hr for 4 hour
C
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.
C
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
C
Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the?• A. Dependent position• B. Horizontal position• C. Elevated position above heart level• D. Knee-flexed position
C
A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply:• A. Pregnancy• B. Being Female• C. High Cholesterol• D. Diabetes Mellitus• E. Uncontrolled hypertension• F. Varicose veins• G. Smoking
C,D,E and G
A patient has a Magnesium level of 1.3 mg/dL. Which of the following is NOT a sign or symptom of this condition? A. Hypertension B. Torsades de pointes C. Positive Trousseau's Sign D. Absent deep tendon reflexes
D
A patient has a potassium level of 1.5 mEq/L. Which of the following is NOT typically a sign with this condition? •A. None, this is a normal potassium level. B. Decreased respirations C. Decreased deep tendon reflexes D. Tall T-waves
D
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
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
D
What is the antidote for Warfarin (Coumadin)? A. Flumazenil B. Narcan C. Protamine Sulfate D. Vitamin K
D
Which of the following patients is MOST at risk for hypermagnesemia? • A. A patient with alcoholism B. A patient taking a proton-pump inhibitor C. A patient suffering from Crohn's Disease D. A patient with a magnesium level of 0.6 mg/dL receiving IV magnesium sulfate
D
Which statement below BEST describes how Warfarin (Coumadin) works as an anticoagulant?• A. "It inhibits the formation of thrombin and fibrin in the clotting process."• B. "It increases the production of Factor Xa, which blocks thrombin and decreases the clotting process."• C. "It binds to antithrombin and reverses the clotting process."• D. "It stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form."
D
What is the purpose of the angiogram? A. Determine the size, silhouette, and position of the heart B. identify abnormal structures and calcifications of the heart by fluoroscopy C. assess cardiovascular response to an increased workload D. determine arterial obstruction, narrowing, or aneurysm in specific locations
D??
A nurse cares for a patient with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations would the nurse assess? (Select all that apply.)
Decrease in cardiac output Increase in blood pressure Decrease in urine output
A nurse is caring for patients with electrolyte imbalances on a medical-surgical unit. Which clinical manifestations are correctly paired with the contributing electrolyte imbalance?
Hypokalemia—Flaccid paralysis with respiratory depression Hyponatremia—Decreased level of consciousness
A telemetry nurse assesses a patient who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor.
Level of consciousness
A patient is receiving an infusion of alteplase (Activase) for an intra-arterial clot. The patient begins to mumble and is disoriented. What action by the nurse takes priority?
Notify the Rapid Response Team.
The nurse is caring for a patient with a chest tube after a coronary artery bypass graft. The drainage slows significantly. What action by the nurse is most important?
Notify the provider immediately
A nurse is caring for a patient with a deep vein thrombosis (DVT). What nursing assessment indicates that a priority outcome has been met?
Oxygen saturation of 98%
A nurse is caring for four patients. Which patient would the nurse assess first?
Patient who is 1 hour post-angioplasty, and has tongue swelling and anxiety
what would you see in a pt. with an insufficient aldosterone system
Serum potassium level of 5.4 mEq/L (5.4 mmol/L) blood osmolarity of 250
A nurse assists with the cardioversion (shock them) of a patient experiencing acute atrial fibrillation. What action would the nurse take prior to the initiation of cardioversion?
Turn off oxygen therapy
A nurse assesses a patient's electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How would the nurse interpret this observation?
Ventricular and atrial depolarizations are initiated from different sites.
A nurse admits a patient who is experiencing an exacerbation of heart failure. What action would the nurse take first? • a. Assess the patient's respiratory status. • b. Draw blood to assess the patient's serum electrolytes. • c. Administer intravenous furosemide (Lasix). • d. Ask the patient about current medications.
a
An older adult is on cardiac monitoring after a myocardial infarction. The patient shows frequent dysrhythmias. What action by the nurse is most appropriate? a. assess for any hemodynamic effects of the rhythm b. prepare to administer antidysrhythmic medication c. notify the provider or call the rapid response team d. turn the alarms off the cardiac monitor
a
The nurse is caring for four hypertensive patients. Which drug-laboratory value combination would the nurse report immediately to the healthcare provider? a. Furosemide (Lasix)/potassium: 2.1 mEq/L b. Hydrochlorothiazide (Hydrodiuril)/potassium: 4.2 mEq/L c. Spironolactone (Aldactone)/potassium: 5.1 mEq/L d. Torsemide (Demadex)/sodium: 142 mEq/L
a
A nurse is assessing a patient with peripheral artery disease (PAD). The patient states that walking five blocks is possible without pain. What question asked next by the nurse will give the best information? a. "Could you walk further than that a few months ago?" b. "Do you walk mostly uphill, downhill, or on flat surfaces?" c. "Have you ever considered swimming instead of walking?" d. "How much pain medication do you take each day?"
a.
A patient received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin. The patient's spouse asks why the patient needs this medication. What response by the nurse is best? a. "The t-PA didn't dissolve the entire coronary clot." b. "The heparin keeps that artery from getting blocked again." c. "Heparin keeps the blood as thin as possible for a longer time." d. "The heparin prevents a stroke from occurring as the t-PA wears off."
a?
While assessing a patient on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next?
assess for symptoms of left sided heart failure
A nurse assesses a patient 2 hours after a cardiac angiography via the left femoral artery. The nurse notes that the left pedal pulse is weak.
assess the color and temperature of the left leg
A patient with coronary artery disease (CAD) asks the nurse about taking fish oil supplements. What response by the nurse is best?• a. "Fish oil is contraindicated with most drugs for CAD."• b. "The best source is fish, but pills have benefits too."• c. "There is no evidence to support fish oil use with CAD."• d. "You can reverse CAD totally with diet and supplements."
b
A nurse teaches a patient with heart failure about energy conservation. Which statement would the nurse include in this patient's teaching? a. "Walk until you become short of breath, and then walk back home." b. "Gather everything you need for a chore before you begin." c. "Pull rather than push or carry items heavier than 5 lbs (2.2 kg)." d. "Take a walk after dinner every day to build up your strength."
b?
A patient in the cardiac stepdown unit reports severe, crushing chest pain accompanied by nausea and vomiting. What action by the nurse takes priority? a. administer an aspirin b. call for an ECG c. maintain airway patency d. notify the provider
c
The nurse is preparing to change a patient's sternal dressing. What action by the nurse is most important? a. assess vital signs b. don a mask and gown c. gather needed supplies d. Perform hand hygiene
d
The nurse is reviewing the lipid panel of a male patient who has atherosclerosis. Which finding is most concerning? a. Cholesterol: 126 mg/dL b. High-density lipoprotein cholesterol (HDL-C): 48 mg/dL c. Low-density lipoprotein cholesterol (LDL-C): 122 mg/dL d. Triglycerides: 198 mg/dL
d
in older adults, an MI can cause symptoms of....
disorientation or confusion
which patient is at greatest risk for hypokalemia?
nasogastric suctioning
what cardiac condition do you give IV adenosine?
supraventricular tachycardia
