210 Test 2

An emergency department nurse triages clients who present with chest discomfort. Which client would the nurse plan to assess first? a.) Client who describes intense squeezing pressure across the chest. b.) Client who reports moderate pain that is worse on inspiration. c.) Client who describes pain as a dull ache. d.) Client who reports cramping substernal pain.

A

Which principle related to angina pain is important for the nurse to remember? A) The administration of nitroglycerin (NTG) will improve oxygen supply. B) There will be an ST elevation noted on the ECG. C) The patient will have an increase in body temperature. D) Premature ventricular contractions (PVCs) accompany the pain

A

Which underlying physiologic problem is associated with cystic fibrosis (CF)? A) Thick, sticky mucus B) Airway hyperreactivity C) Interstitial lung pathology D) Reduced pulmonary airflow

A

The nurse discusses the importance of restricting sodium in the diet of a patient with heart failure (HF). Which statement made by the patient indicates the need for further teaching? A) "I should avoid eating homemade hamburgers." B) "I must cut out bacon and canned foods." C) "I shouldn't put the salt shaker on the table anymore." D) "I should avoid lunch meats but may cook my own turkey."

A

The nurse is counseling a patient whose parent has just been diagnosed with tuberculosis (TB). The patient tells the nurse that the parent was exposed several years ago but developed symptoms only recently. Which information would the nurse provide to the patient about the risk for contracting the disease? A) "People are infectious to others only when symptoms are present." B) "As soon as drug therapy is initiated, your parent will not be contagious." C) "Because you have had prolonged contact with your parent, you are most likely infected." D) "You will need to begin treatment for TB because you have been exposed to your parent."

A

Which interventions may help patients with cystic fibrosis (CF) avoid infections? A) Washing hands regularly and avoiding contact with body fluids B) Maintaining appropriate weight through nutrition management C) Maintaining pulmonary hygiene to clear mucus secretions from the airway D) Taking bi-level positive airway pressure as a daily therapy to avoid mechanical ventilation

A

1) Name two nursing interventions related to Transdermal Nitroglycerin.

-Clean, dry, hairless area -rotate sites -remove after 12-24 hours -remove before defibrillation

Which patient would be appropriate for the nurse to assign to the same room as a patient with cystic fibrosis (CF)? A) Patient with asthma B) Patient with bronchitis C) Patient with pneumonia D) Patient with tuberculosis

A

A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? a.) "I must stop halfway up the stairs to catch my breath." b.) "I am awakened by the need to urinate at night." c.) "I have been drinking more water than usual." d.) "I have experienced blurred vision on several occasions."

A

A patient who is taking isoniazid and rifampin to treat tuberculosis reports reddish-orange urine. Which action would the nurse take? A) Reassure the patient that this is an expected drug side effect. B) Encourage the patient to increase fluids to 2 L or more per day. C) Request a prescription to change the isoniazid to another antitubercular drug. D) Notify the health care provider, and request a prescription for creatinine clearance

A

A patient with active tuberculosis who is prescribed isoniazid, pyrazinamide (PZA), and rifampin (RIF) asks the nurse why it is necessary to take three antibiotics. Which response would the nurse provide? A) "Three antibiotics help prevent bacterial drug resistance." B) "You will have fewer drug side effects with multidrug therapy." C) "The dose of each drug can be reduced with multidrug therapy." D) "Taking three drugs decreases the risk for liver damage."

A

When planning care for a patient in the emergency department, the nurse understands that which intervention is needed in the acute phase of myocardial infarction (MI)? Select all that apply. One, some, or all responses may be correct. A) Morphine sulfate B) Oxygen C) Nitroglycerin D) Naloxone E) Acetaminophen F) Verapamil

A, B, C

A patient with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why so many medications are needed. Which information would the nurse provide in answering this question? Select all that apply. One, some, or all responses may be correct. A) Multiple drug regimens destroy organisms as quickly as possible. B) Combination drug therapy is effective in preventing transmission. C) Combination drug therapy is the most effective method of treating TB. D) The use of multiple drugs reduces the emergence of drug-resistant organisms. E) Combination drug therapy will decrease the length of required treatment to 2 months

A, B, C, D

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the primary HCP and prepares to implement which priority interventions. SATA A) Admin O2 B) Insert foley C) Admin furosemide D) Admin morphine sulfate IV E) transport client to coronary care unit F) place client in low fowlers side lying position

A, B, C, D

Which assessment finding would cause the nurse to suspect that a patient with cystic fibrosis is in need of exacerbation therapy? Select all that apply. One, some, or all responses may be correct. A) Decreased saturated peripheral oxygen (SpO2) B) Purulent sputum C) Increased appetite D) Increased chest congestion E) 3% decrease in forced expiratory volume

A, B, D

An 80-year-old female client was admitted to a telemetry unit with an exacerbation of heart failure. She has a medical history of osteoarthritis, chronic renal insufficiency, and coronary artery disease including a myocardial infarction and coronary artery bypass surgery 22 years ago. The client is scheduled to be discharged today and will move in with her daughter until she feels well enough to go home alone. Which of the following discharge instructions will the nurse provide the client and her daughter? Select all that apply. a.) "Weigh yourself each day at the same time on the same scale to monitor for fluid retention." b.) "Contact your primary health care provider if you experience cold symptoms lasting more than 3 days." c.) "Exertion can cause another episode of heart failure, so help your mother by performing daily activities for her." d.) "Notify your primary health care provider if you experience shortness of breath or chest pain while resting." e.) "Do not use table salt, avoid salty foods, and read labels on all food items to ensure your diet is low in sodium." f.) "Heart failure is a chronic condition, so you don't need to be alarmed when you experience heart palpitations."

A, B, D, E

Which diagnostic test aids in the diagnosis of cystic fibrosis (CF)? Select all that apply. One, some, or all responses may be correct. A) Stool for fat B) Bronchoscopy C) Stool for trypsin D) Sweat chloride analysis E) Biopsy of intestinal mucosa F) Gastric contents for hydrochloric acid levels

A, D

Which sign or symptom would the nurse anticipate in a patient diagnosed with tuberculosis? Select all that apply. One, some, or all responses may be correct. A) Lethargy B) Dyspnea C) Weight gain D) Night sweats E) Low-grade fever

A, D, E

Prompt pain management with myocardial infarction (MI) is essential for which reason? A) The discomfort will increase patient anxiety and reduce coping. B) Pain relief improves oxygen supply and decreases oxygen demand. C) Relief of pain indicates that the MI is resolving. D) Pain medication should not be used until a definitive diagnosis has been established.

B

Which action does the nurse take first when a patient with heart failure (HF) states, "I am tired and short of breath, and I gained 5 lb in the past 3 days"? A) Assess the patient for peripheral edema. B) Auscultate the patient's posterior breath sounds. C) Remind the patient about dietary sodium restrictions. D) Notify the health care provider about the patient's weight gain.

B

What is the first intervention for a client experiencing chest pain?

Administer Oxygen

In an acute care setting, what type of isolation is a patient with TB placed in?

Airborne

The nurse is caring for a patient admitted to the telemetry floor for possible myocardial infarction (MI). Which action would the nurse take when administering sublingual nitroglycerin to the patient? Select all that apply. One, some, or all responses may be correct. A) Monitor blood pressure. B) Monitor the patient for dizziness. C) Monitor the patient for a headache. D) Administer with the patient lying down. E) Administer every 5 minutes up to three times.

All

This drug class is contraindicated in client with known large esophageal varices.

Antiplatelets

A nurse assesses clients on a medical-surgical unit. Which client would the nurse identify as having the greatest risk for cardiovascular disease? a.) A 32-year-old man with colorectal cancer. b.) A 65-year-old woman with diabetes mellitus. c.) A 53-year-old postmenopausal woman who takes bisphosphonates.d.) An 86-year-old man with a history of asthma.

B

Which action would the nurse perform when caring for a patient with coronary artery disease (CAD) who has been prescribed metoprolol XR? A) Instruct the patient to not take sildenafil with this medication. B) Hold the medication if the heart rate is less than 50 to 60 beats/min. C) The medication can be crushed and mixed with pudding. D) Teach the patient to lie down on the bed 30 minutes after administration

B

Which immediate action would the nurse take when a patient presents to the emergency department with chest pain? A) Obtain a chest x-ray. B) Obtain a 12-lead ECG. C) Obtain an 18-lead ECG. D) Obtain troponins T and I.

B

Which information would the nurse include when teaching a patient newly diagnosed with tuberculosis (TB) about the treatment regimen? A) Most people can be effectively treated with one medication. B) Avoid alcohol while taking the medication. C) Do not participate in any exercise while taking medication. D) Have the skin test repeated periodically.

B

Which is the nurse's priority action when, after receiving enalapril for heart failure (HF), a patient reports dizziness and has a blood pressure (BP) of 82/46 mm Hg? A) Initiate cardiac monitoring. B) Place the patient flat in bed. C) Obtain a prescription for dopamine. D) Apply oxygen at 2 L via nasal cannula

B

A nurse assesses a client after administering a prescribed beta blocker. Which assessment would the nurse expect to find? a.) Blood pressure increased from 98/42 to 132/60 mm Hg.b.) Respiratory rate decreased from 25 to 14 breaths/min. c.) Pulse decreased from 100 to 80 beats/min. d.) Oxygen saturation increased from 88% to 96%.

C

After teaching a client with heart failure the nurse assesses the client's understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? Select all that apply. a.) "I will drink at lest 3 L of water each day." b.) "Substituting fresh vegetables for canned ones will lower my salt intake." c.) "I'll read the nutritional labels on food items for salt content." d.) "I will eat oatmeal for breakfast instead of ham and eggs." e.) "Using salt in moderation will reduce the workload of my heart." f.) "Salt substitutes are a good way to cut down on sodium in my diet."

B, C, D

Which is a common sign of right-sided heart failure? Select all that apply. One, some, or all responses may be correct. A) A hacking cough B) Dependent edema C) Increase in weight D) Nausea and anorexia E) Oliguria during the day

B, C, D

A client is being assessed for possible heart failure. Which laboratory result will support this diagnosis?

BNP

This class of drug is contraindicated in patients with Diabetes because it can mask hypoglycemia-induced tachycardia

Beta blockers

This class of drugs blocks the effects of catecholamines, thus improving survival after MI

Beta blockers

These drugs bind to bile acids then cannot be absorbed by the intestine and are excreted in the feces

Bile acid sequestrants

This class of drugs may interfere with digestion of fats and prevent absorption of fat-soluble vitamins (A, D, E, & K)

Bile acid sequestrants

A nurse admits a client who is experiencing an exacerbation of heart failure. What action would the nurse take first? a.) Administer intravenous furosemide. b.) Ask the client about current medications. c.) Assess the client's respiratory status. d.) Draw blood to assess the client's serum electrolytes.

C

What EKG change is indicative of a STEMI?

ST elevation

A nurse teaches a client who is prescribed digoxin therapy. Which statement would the nurse include in this client's teaching? a.) "Increase your intake of foods that are high in potassium."b.) "Hold this medication if your pulse rate is below 80 beats/min." c.) "Do not take this medication within 1 hour of taking an antacid." d.) "Avoid taking aspirin or aspirin-containing products."

C

The nurse expects a prescription for which test when a patient presents with indications of heart failure, including pedal edema, crackles on auscultation, and a 10-lb weight gain in 1 week? A) Serum electrolytes B) Arterial blood gases C) B-type natriuretic peptide (BNP) D) Ventilation perfusion (V/Q) scan

C

The nurse is caring for a client recently admitted with acute coronary syndrome. The client states that he is experiencing an increase in chest pain. What action should the nurse implement first? a.) Obtain a 12-lead electrocardiogram. b.) Administer prescribed pain medication. c.) Ensure client is receiving supplemental oxygen. d.) Notify the healthcare provider of the increase in pain.

C

Which benefit will chest physiotherapy have on a patient with cystic fibrosis (CF)? A) It increases vascular resistance in the lungs. B) It stops excess production of mucus in the lungs. C) It creates mini-coughs to dislodge the mucus from the lungs. D) It decreases the constriction of the bronchiolar smooth muscle

C

Which intervention does the nurse perform first after reviewing the prescriptions for a patient with acute heart failure who is experiencing severe dyspnea, pink and frothy sputum, and crackles? A) Administer heparin subcutaneously. B) Administer enalapril orally. C) Administer furosemide IV. D) Begin strict input and output (I&O) monitoring.

C

Which intervention does the nurse perform to decrease dyspnea in a patient with acute heart failure? A) Avoid waking the patient at night. B) Elevate swollen legs above heart level. C) Place the patient in the high-Fowler position. C) Assess for orthostatic hypotension and dizziness.

C

Which laboratory result may indicate the need for a change in a furosemide prescription in a patient with heart failure (HF)? A) Serum creatinine level of 1.0 mg/dL B) Serum sodium level of 135 mEq/L C) Serum potassium level of 2.8 mEq/L D) Serum magnesium level of 1.9 mEq/L

C

Which nursing intervention is best for a patient who has had a myocardial infarction and is speaking angrily to and finding fault with nurses, family members, and hospital employees? A) Request that the health care provider prescribe an antidepressant. B) Explain the harmful effects of noncompliance to the patient. C) Offer the patient the ability to make decisions related to care. D) Perform ADLs for the patient until the patient's previous disposition returns

C

Which medication instruction is important for the nurse to provide to a patient with heart failure who receives a prescription for enalapril? Select all that apply. One, some, or all responses may be correct A) "Avoid sodium intake." B) "Check your weight daily." C) "Avoid potassium-rich foods." D) "Side effects include a cough." E) "Move slowly while changing positions.

C, D, E

Which statement about cystic fibrosis (CF) is correct? Select all that apply. One, some, or all responses may be correct. A) CF is a genetic disease of the lungs that occurs equally in all ethnicities. B) CF is an autosomal dominant disorder occurring when both gene alleles are mutated. C) Nonpulmonary problems with CF include malnutrition and potential intestinal obstruction. D) Mucus changes in CF cause problems in the lungs, pancreas, liver, salivary glands, and testes. E) Problems in young adulthood associated with CF are osteoporosis and diabetes mellitus.

C, D, E

A patient who has recently been released from prison has just tested positive for tuberculosis (TB). Which teaching point would the community health nurse stress for this patient? Select all that apply. One, some, or all responses may be correct. A) These medications may cause kidney failure. B) These medications must be taken for 2 years. C) The medications may cause nausea. They should be taken at bedtime. D) The patient is generally not contagious after 2 weeks of treatment. E) Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance.

C, E

A client has been admitted to the cardiac unit with a diagnosis of Right-sided HF. Which of the flowing assessment findings would you expect to observe? a) Fatigue & hemoptysis b) Bradycardia & cyanosis c) Dyspnea & crackles d) Peripheral edema & JVD

D

A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client'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.) Obtain a bedside commode. c.) Suggest the client use a bedpan. d.) Allow continued bathroom privileges.

D

A nurse is teaching a client with heart failure who has been prescribed enalapril. Which statement would the nurse include in this client's teaching? a.) "Avoid using aspirin-containing products." b.) "Check your pulse daily." c.) "Take your medicine with food." d.) "Avoid using salt substitutes."

D

A patient with a dormant tuberculosis (TB) infection has experienced a reactivation of the disease. Which factor is likely to have contributed to the reactivation? A) Fracture of a rib 1 week ago B) Allergy testing 6 months ago C) Pneumonia vaccine 2 months ago D) Taking corticosteroids for the past 3 weeks

D

The nurse recognizes that which intervention will assist with energy conservation in a patient who is hospitalized with an exacerbation of heart failure (HF)? A) Ambulate in the hallway with use of a walker. B) Maintain bedrest if tachycardia is present. C) Monitor the pulse and blood pressure every 2 hours. D) Obtain a bedside commode before administering furosemide

D

The patient presents to the emergency department with severe chest pain. After administration of 2 sublingual nitroglycerin tablets, the patient is now reporting pain of 2 on a scale of 1 to 10. Which action by the nurse is a priority? A) Recheck cardiac enzymes. B) Repeat an ECG. C) Continue to monitor the patient. D) Prepare to administer a third nitroglycerin tablet

D

Which assessment finding takes precedence when a patient returns from percutaneous coronary intervention? A) The patient reports thirst. B) Distal pulses are graded as +1/4. C) The patient falls asleep after answering questions. D) The groin dressing has a 10-cm round bloodstain

D

Which disease process will a nurse suspect in a patient who has frequent respiratory infections, chronic chest congestion, and a sweat chloride level of 85 mEq/L? A) Asthma B) Bronchitis C) Emphysema D) Cystic fibrosis

D

Which instructions would the nurse provide to the family members of a patient being treated for tuberculosis (TB) at home? A) Use airborne precautions. B) Place used tissues in an open trash can. C) Wear a mask and shoe covers when you are in the home. D) Ensure that all household residents undergo TB testing

D

Which primary factor is responsible for the clinical manifestations of cystic fibrosis (CF)? A) Hyperactivity of the sweat glands B) Hypoactivity of the autonomic nervous system C) Atrophic changes in the mucosal wall of the intestines D) Mechanical obstruction by increased viscosity of secretions

D

Which values in the sweat chloride analysis for cystic fibrosis (CF) indicate a positive result for the disease? A) 10 mEq/L B) 20 mEq/L C) 30 mEq/L D) 80 mEq/L

D

A patient returns to the clinic to have the tuberculosis (TB) Mantoux test, which was administered 2 days ago, analyzed by the nurse. The patient's left forearm shows a red raised area, which measures 10 mm in diameter. Which interpretation of this finding would the nurse make? A) Positive reaction that indicates the presence of active TB infection B) Possible false-positive reading; the test will need to be read again at 72 hours C) Possible false-negative reading; the test will need to be administered again D) Positive reaction that indicates exposure to and possible presence of TB infection

D An area of induration (raised soft tissue) measuring 10 mm or greater in diameter at 48 to 72 hours after the injection indicates exposure to and possible infection with TB. A positive reaction does not in itself mean TB is present until that has been confirmed with a chest x-ray and sputum culture. There are no false-positive readings, but the incidence of false-negative readings is greater at 48 hours and will need to be read again at 72 hours to confirm. The test will not be administered again in this situation.

During your morning assessment of a client with HF, the client complains of sudden vision changes that include seeing yellowish-green halos around lights. Which medication do you suspect is causing this issue?

Digoxin

True or False: The majority of those infected with the organism will develop TB Disease.

False

This drug class of Antilipemics can cause changes in coagulation (decrease in platelets adhesiveness).

Fibrates

What PPE should you wear before entering the room with airborne precautions?

HEPA filter mask

This type of heart failure is when the ventricle is unable to properly fill with blood because it is too stiff

Left Sided diastolic HF

Many of the medications used for treating TB are metabolized in what organ?

Liver

What medication must be held prior to and 48hrs after heart catheterization?

Metformin (glucophage)

This medication can cause facial flushing

Niacin

A client is diagnosed with HF and is prescribed Digoxin (Lanoxin) and Furosemide (Lasix). Before administration of the furosemide to the client, which laboratory result should you review?

Potassium

Name the lab test most specific for myocardial damage

Troponin I

True or False. Clients with left-sided diastolic HF usually have a normal ejection fraction

True

True or False: A person who acquires TB from a person who is infected with a resistant strain will also have drug-resistant disease.

True

What food/drink must be avoided/limited when taking "statins"

grapefruit juice

One use of these drugs is for long-term prevention of angina episodes.

beta blockers

Use of the erectile dysfunction drugs is contraindicated with this drug class

nitrates

What is the most common side effect of ACE Inhibitors?

persistent dry cough

This class of drugs can cause rhabdomyolysis (skeletal muscle breakdown)

statins

This class of drugs decreases the rate of cholesterol production (inhibits enzyme production by the liver)

statins