406 E2 Practice
A client is prescribed cyanocobalamin for pernicious anemia. The nurse cautions the client about ingesting which substances as they can interfere with absorption of the cyanocobalamin? Select all that apply .A. neomycin B. colchicine C. phenytoin D. alcohol E. calcium
A. neomycin B. colchicine D. alcohol
A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea (Hydrea). What does the nurse inform the patient will be the benefits of treatment with this medication? (Select all that apply.) --Fewer painful episodes of sickle cell crisis -Lower incidence of acute chest syndrome -Decreased need for blood transfusions -Reverse damage to cells
--Fewer painful episodes of sickle cell crisis -Lower incidence of acute chest syndrome -Decreased need for blood transfusions
A 54-year-old client has been prescribed sublingual nitroglycerin. After the nurse has finished teaching the client about the medication, what statement could the client make to suggest that the client understands proper self-administration?
Answer: "I can take up to three tablets at five-minute intervals." The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply.
A student nurse prepares to assess a client for postural blood pressure changes. Which action indicates the student nurse needs further education?
Answer: letting 30 seconds elapse after each position change before measuring BP and HR
What is the primary cause of HF?
Atherosclerosis of coronary arteries
What lab value can indicate HF?
BNP
What is the definitive method of diagnosis for iron deficiency anemia?
Bone marrow aspiration The definitive method of diagnosis for iron deficiency anemia is bone marrow aspiration. The other answer choices may also be used to help with the diagnosis of the condition; however, these are not definitive diagnostic tests.
The nurse is caring for a patient who had a brush biopsy 12 hours ago. What will the nurse notify the physician of? A) Hematuria B) Renal colic C) Temperature 100.2°F orally D) Infiltration of the patient's intravenous catheter infusing dextrose 5% and .45 normal saline solution
C) Temperature 100.2°F orally Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the client's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary physician.
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.
C. Assist the patient into High Fowler's position. 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 nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply.
Changes in weight Cystic fibrosis Diabetes Obesity Risk factors for the development of gallstones (cholelithiasis) may include: changes in weight, obesity, cystic fibrosis, and diabetes. All of these conditions impact fat metabolism, increasing the risk of developing cholesterol gallstones. Sickle cell disease does not impact the development of gallstones.
In an OLDER ADULT, what might Early symptoms of UTI present like?
Confusion
The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult?
Correct response: Widening of the aorta Explanation: Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).
While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are:
Correct response: ● Severe headache and early change in level of consciousness Explanation: The main presenting symptoms for ischemic stroke are numbness or weakness of the face, arm, or leg, especially on one side of the body, confusion or change in mental status, and trouble speaking or understanding speech. Severe headache, vomiting, early change in level of consciousness, and seizures are early signs of a hemorrhagic stroke. Footdrop and external hip rotation can occur if a stroke victim is not turned or positioned correctly.
Taking Lasix can cause what SE?
Decreases blood volume
The nurse is teaching the client who will undergo surgery for the creation of a nephrostomy. Which of the images best depicts this type of cutaneous urinary diversion?
Explanation: A cutaneous diversion involves the creation of an opening through the abdominal wall and skin to allow urine to drain. A nephrostomy (Option D) allows urine to drain directly from the kidney through a percutaneous catheter through an opening in the flank. An ileal conduit (Option A) is the most common cutaneous diversion, whereby both ureters empty into an isolated section of the ileum. One end of the isolated segment is brought through the abdominal wall and allows urine to drain through a stoma. With a cutaneous ureterostomy (Option B), the ureter is detached from the bladder and brought through the abdominal wall and attached to an opening in the skin. The bladder is sutured to the abdominal wall and a stoma is created through the abdominal and bladder walls for drainage of urine in a vesicostomy (Option C).
Which client on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure?
A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas present Anemia, thrombocytopenia, and the presence of spider angiomas are characteristic of liver failure. High blood pressure, excessive clotting, fever, and cardiac arrhythmias are not common symptoms of liver failure, and AST and ALT levels would rise, not fall.
A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care? A) Cure of the disease B) Enhancing quality of life C) Controlling symptoms D) Palliation
A) Cure of the disease The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure the disease.
Age-related changes associated with the cardiac system include A) endocardial fibrosis B) decreased size of the left atrium C) increase in the number of SA node cells D) myocardial thinning
A) endocardial fibrosis Explanation: Age-related changes associated with the cardiac system include: endocardial fibrosis, increased size of the left atrium, decreasing number of SA node cells, and myocardial thickening
A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first? Can you explain your typical diet? Are you taking iron supplements? Have you experienced abdominal pain? How much alcohol do you drink?
Have you experienced abdominal pain? The laboratory data support that the client has iron-deficiency anemia. The most common cause of iron-deficiency anemia in men is bleeding from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal tumors. People who experience these problems may report abdominal pain. The nurse will make further assessments and may ask the other questions.
During the review of morning lab values on a patient complaining of severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which of the following findings? Elevated hematocrit level Elevated red blood cells (RBCs) Low ferritin level Enlarged mean corpuscular volume (MCV)
Low ferritin level The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin level.
Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration?
Monitor for edema at least once per shift Albumin is particularly important for the maintenance of fluid balance within the vascular system. Capillary walls are impermeable to albumin, so its presence in the plasma creates an osmotic force that keeps fluid within the vascular space. Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.
What is the B/P the target goals of the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure?
Over 60: 150/90 18-59, diabetic or CKD: 140/90
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. Which of the following is the most common complication of the pathology resulting from this process?
Pathologic fractures Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-Tube. Which finding during your assessment of the T-Tube requires immediate nursing intervention?
There is approximately 750 cc of drainage within the past 24 hours A T-Tube should not drain more than about 500 cc of drainage per day (within 24 hours). A T-Tube's drainage will go from bloody tinged (fresh post-op) to yellowish/green within 2-3 days. The drainage bag and tubing should be below the site of insertion (at or below the patient's waist so gravity can help drainage the bile), and the patient should be in Semi-Fowler's to Fowler's position to help with draining the bile.
A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test? Ultrasound Xray Computed tomography (CT) Nuclear scan
Ultrasound Feedback: Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure. Options B, C, and D are not used as initial diagnostic tests.
The thalassemias are a group of hereditary anemias characterized by which of the following? Select all that apply. a) Thrombocytopenia b) Hypochromia c) Hemolysis d) Anemia e) Extreme microcytosis
b) Hypochromia c) Hemolysis d) Anemia e) Extreme microcytosis
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? a) Unusually smooth skin b) Pruritus c) Increased alertness d) Hypoventilation
b) Pruritus
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. Correct response: a) Beta-blockers may cause sedation. b) With thiazide diuretics, monitor serum potassium levels. c) With adrenergic inhibitors, cough is a common side effect. d) With ACE inhibitors, assess for bradycardia. e) Direct vasodilators may cause headache and tachycardia.
b) With thiazide diuretics, monitor serum potassium levels. e) Direct vasodilators may cause headache and tachycardia. Explanation: Thiazide diuretics may deplete potassium; many clients will need potassium supplementation. Direct vasodilators may cause headache and increased heart rate. Adrenergic inhibitors can cause sedation and fatigue. Beta-blockers may induce decreased heart rate; pulse rate should be assessed before
A 74-year-old male client who is suffering a myocardial infarction is transported to the ED by ambulance. This client is at greatest risk for developing which type of shock? a) Distributive shock b) Hypovolemic shock c) Obstructive shock d) Cardiogenic shock
d) Cardiogenic shock Cardiogenic shock is caused by decreased force of ventricular contraction. Both myocardial infarction and cardiac dysrhythmia may cause cardiogenic shock. This type of shock is characterized by an impaired filling of heart with blood due to mechanical impediment, such as cardiac tamponade, dissecting aneurysm, or tension pneumothorax. This type of shock is caused by the enlargement of the vascular compartment and redistribution of intravascular fluid from arterial circulation to venous or capillary areas. Hypovolemic shock is caused by decreased blood volume with decreased filling of the circulatory system. Typical examples are hemorrhage, extreme dieresis, and third-spacing.
Which of the following terms is used to refer to inflammation of the renal pelvis? a) Urethritis b) Cystitis c) Interstitial nephritis d) Pyelonephritis
d) Pyelonephritis (Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.)
1. What are the s/s of Cardiomyopathy?
feel a sense of suffocation. Hands become cold and moist. Late sign cyanotic nails, skin turns ashen, pule is weak and rapid, neck veins distended, frothy foamy sputum, coughing may occur
What risk factors accompany prolonged jaundice?
hepatitis, blocked bile, cancer If bilirubin exceeds 20-25 mg may see severe jaundice and this poses risk for CNS damage
A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound? opening snap Graham Steell's murmur ejection click pericardial friction rub
pericardial friction rub A pericardial friction rub, which sounds like squeaky leather, may occur during the first week following an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other
The nurse is teaching a client who is undergoing diagnostic tests for multiple myeloma. What clinical findings support the client's diagnosis of multiple myeloma?
serum albumin level of 2.0 g/dL Albumin is a protein found in the blood and low levels can be seen in myeloma. Normal albumin level is 3.4 to 5.4 g/dL. Serum creatinine level may be increased (above 1.2 mg/dL in men and 0.9 mg/dL in women). Serum calcium levels exceed 10.2 mg/dL in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.
What is elevated after an MI?
with myocardial ischemia levels of CK, troponin t and troponin 1 typically rise because of cellular damage, myoglobin elevation is an early indicator of myocardial damage
What meds are given for systolic HF?
· ACE inhibitor · Beta blocker · Diuretic · Digoxin
What are the risk factors in developing Liver cancer?
· Cirrhosis · Hepatitis C · Metastasis from another site
What does urine testing include?
· casts, rbc, glucose, specific gravity and NOT BUN/CREATININE · bacteria, protein, ketones, WBCs
A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply.
● A ● D ● K ● Essential fatty acids Explanation:A low-fat diet should be supplemented with vitamins A, D, K, and essential fatty acids. These vitamins are fat-soluble and will need to be administered if the client does not have adequate fat intake. Folic acid is not a fat-soluble vitamin.
The nurse is providing care for a client who has sickle cell anemia and who is being treated with hydroxyurea. When providing health education, what topic should the nurse prioritize? A. Management of gastrointestinal irritation B. The importance of keeping immunizations up to date C. Dietary sources of iron D. Foods that are high in vitamin B12
A. Management of gastrointestinal irritation
A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient?
Beef tips and broccoli rabe Explanation: Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.
A nurse is caring for a client with mild acute pancreatitis. Which health care provider prescriptions will the nurse question as it relates to evidence based practices in the treatment of acute pancreatitis? Select all that apply.
● Full liquid diet as tolerated. ● Nasogastric tube to intermittent wall suction for removal of gastric secretions. ● Initiate parenteral feedings first and advance to enteral feedings as tolerated. Explanation: The nurse should question any order for clear liquid diet because oral intake should be held to inhibit pancreatic enzyme secretion. However, enteral feedings should be initiated as soon as possible, as the client tolerates them. The placement of a nasogastric tube to wall suction is recommended for the treatment of nausea, vomiting, or abdominal distention only; routine use of a nasogastric tube for removal of gastric secretions in order to limit pancreatic enzymes is not recommended. Enteral feedings should be tried first before parenteral feedings.
A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?
● IV administration of octreotide (Sandostatin) Explanation: Octreotide —a synthetic analog of the hormone somatostatin—is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding.
The nurse teaches the client with acute pancreatitis that the pain is caused by prematurely activated pancreatic enzymes that have leaked into surrounding tissues, causing which outcome? -Fatty deposits -Autodigestion -Abscess formation -Bowel obstruction
-Autodigestion Acute pancreatitis is associated with activated pancreatic enzymes inside the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. Acute pancreatitis also is associated with viral infections, abdominal and surgical trauma, and thiazide diuretics.
A client who has been taking acetaminophen 1000 mg every 4 hours presents to the Urgent Care Center with increased abdominal pain, elevated ALT, AST, and bilirubin levels. The nurse suspects the client is experiencing: -Direct hepatotoxic reaction -Idiosyncratic reaction -Chronic active hepatitis -Cholestatic reaction
-Direct hepatotoxic reaction Direct hepatotoxic reactions usually are a recognized characteristic of certain drugs. They usually result from drug metabolism and the generation of toxic metabolites from drugs like acetaminophen, isoniazid, and phenytoin. The condition is characterized by elevated ALT, AST, and bilirubin. Idiosyncratic reactions are unpredictable, not related to dose, and sometimes accompanied by features suggesting an allergic reaction. Cholestatic drug reactions result in decreased secretion of bile or obstruction of the biliary tree. The clinical features of chronic hepatitis are extremely variable and not predictive of outcome.
A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for: -Hepatitis C -Hepatitis B -Hepatitis A -Hepatitis D
-Hepatitis A Hepatitis A is normally transmitted through the fecal-oral route by drinking contaminated milk or water and eating shellfish from infected waters. Hepatitis B is transmitted through infected blood or serum. Hepatitis C is transmitted by recreational injection drug use. Hepatitis D occurs largely to persons at high risk for HBV infection.
A nurse reviewing the lab results of a client diagnosed with cholestasis would expect to find which abnormality? -Decreased plasma bile salts -Decreased serum bilirubin -Increased serum alkaline phosphate -Increased serum glucose level
-Increased serum alkaline phosphate A characteristic laboratory finding is elevated levels of serum ALP (alkaline phosphatase). Cholestasis results in materials normally transferred to the bile—such as bilirubin, cholesterol, and bile acids—accumulating (increasing) in the blood. Glucose may be altered for other conditions such as diabetes, stress, and infection.
A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis? -Jaundice and pruritus -Ascites and immunosuppression -Fatigue and depression -Nausea and diarrhea
-Jaundice and pruritus Jaundice and itching are the early manifestations of drug-induced cholestasis. Clients generally report no change in feelings of well-being. The symptoms subside when the drug is withdrawn.
When caring for the client with portal hypertension and ascites, which dietary intervention does the nurse suggest to prevent the progression of fluid accumulation? -Avoid dairy products. -Consume foods high in potassium. -Reduce protein intake. -Limit intake of sodium.
-Limit intake of sodium. Treatment of ascites usually focuses on dietary restriction of sodium, administration of diuretics, and possible fluid restriction.
The nurse is caring for a client with cholestasis. When planning care, which measure should the nurse include to promote comfort? -Increase the protein in the diet. -Provide skin care for itching. -Do not feed the client by mouth. -Elevate the head of the bed
-Provide skin care for itching. Pruritus is the most common presenting symptom in people with cholestasis, probably related to an elevation in plasma bile acids.
For a client diagnosed with idopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate? 1) Teaching coughing and deep-breathing techniques to prevent infection 2) Administering platelets, as ordered, to maintain an adequate platelet count 3) Giving Aspirin, as prescribed, to control body temperature 4) Administering stool softeners, as ordered to prevent straining during infection
4) Administering stool softeners, as ordered to prevent straining during infection The nurse should take measures to prevent bleeding because the client with ITP is at increased risk for bleeding. Straining at stool causes the Valsalva maneuver, which may raise intracranial pressure (ICP), thus increasing the risk for intracerebral bleeding. Therefore, the nurse should give stool softeners to prevent straining, which may result from constipation. Teaching coughing techniques would be inappropriate because coughing raises ICP. Platelets rarely are transfused prophylactically in clients with ITP because the cells are destroyed, providing little therapeutic benefit. Aspirin interferes with platelet function and is contraindicated in clients with ITP.
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A) Hematuria B) Precipituous drop in serum creatinine levels C) Hypotension unresolved by fluid administration D) Glucosuria
A) Hematuria The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.
There are three areas of the ureters that have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? A) In the ureteropelvic junction B) In the ureteral segment near the sacroiliac junction C) In the ureterovesical junction D) In the urethra
A) In the ureteropelvic junction There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter, so option D is incorrect.
A patient has been diagnosed with a lymphoid stem cell defect. This patient has the potential for a problem involving which of the following? A) Plasma cells B) Neutrophils C) Red blood cells D) Platelets
A) Plasma cells A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells (a more differentiated form of B lymphocyte), or natural killer (NK) cells.)
The nurse has attended morning report on a busy medical unit. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock? A. The patient admitted following a myocardial infarction (MI). B. The patient admitted following hypertensive urgency. C. The patient admitted with acute renal failure. D. The patient admitted following a stroke.
A. The patient admitted following a myocardial infarction (MI). Cardiogenic shock may occur following a MI when a large area of myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. While patients with acute renal failure are at risk for dysrhythmias, and patients experiencing a stroke are at risk for thrombus formation, the patient admitted following an MI is at the greatest risk for development of cardiogenic shock when compared to the other diagnoses.
When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority for the healthcare provider to monitor? A BUN and creatinine B Sodium, potassium, and calcium C Hemoglobin and hematocrit D PT and INR
B Sodium, potassium, and calcium BUN and creatinine levels are always important to monitor when giving any drug, not only antidysrhythmia drugs.The PT and INR will be important for patients who are on warfarin (Coumadin).Because abnormalities in sodium, potassium and calcium levels are likely to affect depolarization and repolarization of cardiac cells, it is most important for the healthcare provider to monitor these laboratory values.
The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about? A) Nitrous oxide B) Nitric oxide C) Betamethasone D) Terbutaline (Brethine)
B nitric oxide Inhaled nitric oxide—not nitrous oxide (laughing gas), a vasodilating agent—is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.
What chemical is injected intravenously during a nuclear stress test to allow the heart to be viewed on a special camera? A) Valium B) Radioactive tracer C) Digitalis D) Beta blocker
B) Radioactive tracer Explanation: In a nuclear stress test, the patient is injected intravenously with a stressing chemical. Then, before the stressing cycle is completed, a radioactive tracer is injected. As the chemical flows into the heart, the heart can be viewed using a special camera.
1. What are the complications that may occur to a patient with low platelet count?
Bleeding (spontaneous hemorrhage) o Usually happens if platelet count <10,000 (look at trends)
The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding? A. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B. Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury. C. This is an accurate indicator of myocardial injury. D. This result indicates muscle injury, but does not specify the source.
C. This is an accurate indicator of myocardial injury. Rationale: Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply.
Correct response: ● Let the tablet dissolve in the mouth and keep the tongue still. ● The tablet can be crushed between the teeth but not swallowed. ● Renew the supply every 6 months. ● Take the tablet in anticipation of any activity that can produce pain. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
The nurse is planning the care of a patient with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this patients health problem is due to what A) Production of inadequate quantities of RBCs B) Premature release of immature RBCs C) Injury to the RBCs in circulation D) Abnormalities in the structure and function RBCs
D) Abnormalities in the structure and function RBCs Vitamin B12 and folic acid deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia.
Which patient below is at MOST risk for developing cardiogenic shock? A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish. B. A 25-year-old female who has experienced an upper thoracic spinal cord injury. C. A 72-year-old male who is post-op from a liver transplant. D. A 49-year-old female who is experiencing an acute myocardial infarction.
D. A 49-year-old female who is experiencing an acute myocardial infarction. An acute MI (heart attack) is the main cause of cardiogenic shock. It happens because a coronary artery has become blocked. Coronary arteries supply the heart muscle's cells with oxygenated blood. If they don't receive this oxygenated blood they will die, which causes the heart muscle to quit working (hence pumping efficiently). When the heart muscle fails to pump efficiently, cardiac output fails and cardiogenic shock occur.
The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. When the nurse assesses the patient, the patient is found to be experiencing cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm? A. Ventricular fibrillation B. Ventricular tachycardia C. Pulseless electrical activity (PEA) D. Asystole
D. Asystole Cardiac arrest occurs when the heart ceases to produce an effective pulse and circulate blood. It may be caused by a cardiac electrical event such as ventricular fibrillation, ventricular tachycardia, profound bradycardia, or when there is no heart rhythm at all (asystole). Cardiac arrest may also occur when electrical activity is present but there is ineffective cardiac contraction or circulating volume, which is PEA. Asystole is the only condition that involves the absence of a heart rhythm.
If you think your pt might have dig toxicity what would you look for?
Early- anorexia, nausea, vomiting Late- visual disturbances (green/yellow halos), arrhythmias Monitor potassium levels, hypokalemia can enhance SE of Dig
The nursing instructor is teaching nursing students about myocardial contractility and ejection fractions. What diagnostic tests can determine client ejection fractions? Select all that apply.
Echocardiogram Cardiac catheterization Magnetic resonance imaging
A nurse cares for a client who is post op open cholecystectomy and has a T-tube in place. Which clinical situation will the nurse notify the health care provider about as a possible complication of the surgery? Absence of blood or serous fluid in the T-tube. Greater than 250 mL bile output from the T-tube in 24 hours. Significantly reduced bile output from the T-tube. Finding the T-tube placed below the level of the incision.
Significantly reduced bile output from the T-tube. A T-tube is placed after open cholecystectomy to drain excess bile. The T-tube should remain below the level of the incision in order to ensure proper drainage. The nurse should report an output of greater than 500 mL in 24 hours or a significantly reduced bile output from the T-tube. There should not be bloody or serous output from the T-tube.
A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? a) Creatinine clearance level b) Uric acid level c) Blood urea nitrogen level d) Serum potassium level
a) Creatinine clearance level Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypercalcemia b) Hypermagnesemia c) Hyperkalemia d) Hypernatremia
a) Hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
What medication order would the nurse question for a patient being treated for pericarditis? a) Indocin b) Prednisone c) Colchicine d) Ibuprofen
a) Indocin Explanation: Analgesic medications and NSAIDs such as aspirin or ibuprofen (Motrin) may be prescribed for pain relief during the acute phase of pericarditis. These agents also hasten reabsorption of fluid in patients with rheumatic pericarditis. Indomethacin (Indocin) is contraindicated because it may decrease coronary blood flow. Colchicine (Colcrys) or corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or if the patient does not respond to NSAIDs. Colchicine also may be used instead of NSAIDs during the acute phase.
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: a) The digestion of dietary and blood proteins. b) Excess potassium loss subsequent to prolonged use of diuretics. c) Excessive diuresis and dehydration. d) Severe infections and high fevers.
a) The digestion of dietary and blood proteins. Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.
Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? a) Vasopressin (Pitressin) b) Spironolactone (Aldactone) c) Cimetidine (Tagamet) d) Nitroglycerin
a) Vasopressin (Pitressin) Vasopressin may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Aldactone and Tagamet do not decrease portal hypertension.
The nurse is caring for a client with hypovolemic shock. Which of these does the nurse recognize is the liver's contribution to compensate for shock states? a. Stored blood in the liver can shift to the circulation to restore blood volume. b. The liver synthesizes ADH to retain water during periods of deficiency. c. The liver makes substances which constrict blood vessels to raise blood pressure. d d. Kuppfer cells are responsible for regulating blood volume and blood vessel tone
a. Stored blood in the liver can shift to the circulation to restore blood volume. The liver has the ability to store approximately 500 to 1000 mL of blood which can be shifted back into the general circulation during periods of hypovolemia and shock.
The patient was admitted with chest pain to rule out a myocardial infarction (MI). Which cardiac enzyme test is most indicative of an MI? a. Troponin b. Myoglobin c. CPK d. CK-MB
a. Troponin Elevated troponin levels are most indicative of an MI as these enzymes are specific to heart mus-cle damage. Elevated troponin, along with elevated CK-MB are the best diagnostic lab values when determining if an MI has occurred. CPK rises with injury to other muscles as well as car-diac muscle. Myoglobin levels rise with cardiac damage but are as indicative as other enzymes.
The patient receiving epoetin alfa (Procrit) asks the nurse why it has to be administered IV because he read that it could be self-administered subcutaneously. What is the nurse's best response? a. giving the drug IV reduces the risk of a potentially serious response to the drug b. giving the drug by the IV route makes it begin working sooner c. only patients with renal disease can receive the drug subcutaneously d. it is all determined by physician preference and this doctor prefers the IV route
a. giving the drug IV reduces the risk of a potentially serious response to the drug It is now recommended that patients receive Procrit and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or physician preference.
The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of the following? a. Reduction in acetylcholine receptors in the postsynaptic nerves b. Myelin degeneration in the spinal cord c. Destruction of myelin in peripheral nerves d. Altered function of neurons in the parietal lobe
b. Myelin degeneration in the spinal cord Effects on the nervous system can occur if a vitamin B12 deficiency causes the anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia (numbness), gait disturbances, extreme weakness, spasticity, and reflex abnormalities. This selection is the only option that accurately describes the cause of paresthesia in such anemias.
Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator? a) pH and HCO3 b) Blood pressure c) Serum glucose d) Urine protein
c) Serum glucose The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.
A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply.
• There is a 70% chance that jaundice will occur • Transmission of the virus is possible with oral-anal contact during sex • Typically there is a spontaneous recovery. The incubation period for hepatitis A is 15 to 50 days, with an average of 28 days. The risk of cirrhosis occurs with hepatitis B.
A patient's physician has ordered a "liver panel" in response to the patient's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.
● Alanine aminotransferase (ALT) ● Aspartate aminotransferase (AST) ● Gamma-glutamyl transferase (GGT) Explanation: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.
What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?
● Albumin infusion Explanation: Albumin infusions help to correct decreases in effective arterial blood volume (DEAV) that lead to sodium retention. The use of this colloid reduces incidence of post paracentesis circulatory dysfunction w/ renal dysfunction, hyponatremia, & rapid reaccumulation of ascites associated w/ DEAV.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
● Creatinine clearance Explanation: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
The nurse is instructing a health class of high school seniors on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.
● Excretes waste products ● Controls blood pressure ● Regulate calcium and the synthesis of vitamin D ● Activates growth hormone ● Regulates red blood cell production Explanation: The nurse is correct to highlight all of the options except regulates estrogen and progesterone. The pituitary gland controls hormone secretion.
A client in acute renal failure receives an IV infusion of 10 percent dextrose in water with 20 units of regular insulin. The nurse understands that the rationale for this therapy is to
● Force potassium into the cells to prevent arrhythmias. Explanation: Dextrose with insulin helps move potassium into cells and is immediate management therapy for hyperkalemia due to acute renal failure. An exchange resin may also be employed. This type of infusion is often administered before cardiac surgery to stabilize irritable cells and prevent arrhythmias; in this case KCl is also added to the infusion.
A client requires hemodialysis. Which type of drug should be withheld before this procedure? 1. Phosphate binders 2. Insulin 3. Antibiotics 4. Cardiac glycosides
4. Cardiac glycosides Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.