406 E2 PRACTICE
16) When a chemical stress test is performed using Persantine, adenosine, or a similar chemical, how does the chemical affect the patient? A) It stimulates the patient so he or she can exercise longer. B) It changes the heart's rhythm from atrial fibrillation to normal sinus rhythm. C) It relaxes the heart .D) It mimics the stresses placed on the heart during exercise
.D) It mimics the stresses placed on the heart during exercise Answer: DExplanation: The chemical injected during a chemical stress test causes the heart to exercise artificially.
1. 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?
<140 SBP, <90 DBP, encourage lifestyle modifications
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- Feedback: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.)
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
You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12."
A. "Pernicious anemia is caused by not consuming enough Vitamin B12." lack of intrinsic factor keeps vitamin b12 from being absorbed, so the patient is consuming, just not absorbing.
Q. A client has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, the client has an inability to fight infection because bone marrow is unable to produce a sufficient amount of:
A. lymphocytes.
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? Notify the physician Administer aspirin (ASA) 325 mg po, as ordered Administer acetaminophen 500 mg po, as ordered Reposition the client to a high Fowler position and continue to monitor the pain
Administer acetaminophen 500 mg po, as ordered Explanation: After a marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., acetaminophen) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.
15) 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
Answer: 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.
Q: A very ill client with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which term? a. Cholecystostomy b. Cholecystectomy c. Choledochostomy d. Choledochoduodenostomy
Answer: C. choledochostomy Rationale: This procedure is reserved for the client with acute cholecystitis who may be too ill to undergo a surgical procedure. It involves making an incision in the common duct, usually to remove stones
Which condition most commonly results in coronary artery disease (CAD)?
Atherosclerosis
When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority for the healthcare provider to monitor? ABUN and creatinine BSodium, potassium, and calcium CHemoglobin and hematocrit DPT 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.
Because of the lack of mature and normal granulocytes that help fight infection, patients with leukemia are prone to infection. The likelihood of infection increases with the degree and duration of neutropenia; neutrophil counts that persist at less than 100/mm3 dramatically increase the risk of systemic infections
Because of the lack of mature and normal granulocytes that help fight infection, patients with leukemia are prone to infection. The likelihood of infection increases with the degree and duration of neutropenia; neutrophil counts that persist at less than 100/mm3 dramatically increase the risk of systemic infections
:Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's:
electrocardiogram (ECG) .Lidocaine is an antiarrhythmic and is given for the treatment of cardiac irritability and ventricular arrhythmias. The best indicator of its effectiveness is a reduction in or disappearance of ventricular arrhythmias as seen on an ECG. Urine output is an indicator of pump effectiveness; CK and troponin levels monitor myocardial damage. Blood pressure and heart rate measurements are too nonspecific to help determine the effectiveness of parenteral lidocaine.
Age-related changes associated with the cardiac system include
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
Digoxin toxicity symptoms
nausea vomiting loss of appetite bradycardia blurred vision altered color perception greenish-yellowish halos abdominal pain confusion delerium arrythmia MADVAN malaise, arrythmia, digoxin, vomiting, anorexia, nausea (professors slide) bradycardia and blurred vison, confusion too decrease dosage
Which of the following medications could be used to treat pericarditis? Choose all that apply.
• Colchicine• Motrin• Prednisone Explanation: Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Motrin), may be prescribed for pain relief during the acute phase. Indomethacin (Indocin) is contraindicated, because it may decrease coronary blood flow. Corticosteroids (eg, prednisone) may be prescribed if the pericarditis is severe or the patient does not respond to NSAIDs. Colchicine may also be used as alternative therapy.
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is:
"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."
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?
"I can take up to three tablets at five-minute intervals."
The nurse is educating a patient about the care related to a new diagnosis of mitral valve prolapse. What statement made by the patient demonstrates understanding?
"I will avoid caffeine, alcohol, and smoking. "In mitral valve prolapse, if dysrhythmias are documented and cause symptoms, the patient is advised to eliminate caffeine and alcohol from the diet and to stop the use of tobacco products. shit is not hereditary either.
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
Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve?-1 to 2 -3 to 5 -6 to 12 -13 to 18
-6 to 12 Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (eg, GI symptoms, pruritus, headache) is required during this time.
A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? Acute lymphocytic leukemia Chronic myelogenous leukemia Chronic lymphocytic leukemia Acute myelogenous leukemia
CLL RATIONALE:" Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age. Clients with AML have a decrease in all myeloid formed cells: monocytes, granulocytes, erythrocytes, and platelets. Clients with CML are similar to those with AML but greater number of normal cells than in acute form.
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
Cardiogenic shock Explanation: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.
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.
Correct response: a. 500-1000ml of Stored blood in the liver can shift to the circulation to restore blood volume. Explanation: 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 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
DAbnormalities in the structure and function RBCs Feedback: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. This pathologic process does not involve inadequate production, premature release, or injury to existing RBCs.)
During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?
Decreased cardiac output A primary nursing diagnosis for cardiomyopathy is decreased cardiac output related to structural disorders caused by cardiomyopathy or to dysrhythmia from the disease process and medical treatments. Dyspnea on exertion, fatigue, and fluid retention are related to poor cardiac output. Nausea is related to poor perfusion of the gastrointestinal system. Autonomic dysreflexia is related to a spinal cord injury. Ineffective airway clearance relates to the inability to clear secretions from the airway, which is not an initial problem with cardiomyopathy. Disturbed sensory perception is related to specific senses and not to initial cardiomyopathy.
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
What medication order would the nurse question for a patient being treated for pericarditis?
Indomethacin (Indocin) (NSAID) 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.
A febrile nonhemolytic reaction is caused by antibodies to donor leukocytes that remain in the unit of blood or blood component; it is the most common type of transfusion reaction. It occurs more frequently in patients who have had previous transfusions (exposure to multiple antigens from previous blood products) and in Rh-negative women who have borne Rh-positive children (exposure to an Rh-positive fetus raises antibody levels in the untreated mother).
It occurs more frequently in patients who have had previous transfusions (exposure to multiple antigens from previous blood products) in Rh-negative women who have borne Rh-positive children (exposure to an Rh-positive fetus raises antibody levels in the untreated mother). MOST COMMON
Failure to synthesize adequate amounts of normal DNA
Megaloblastic Anemias
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?
Rh-negative mother; Rh-positive child
A patient is exhibiting classic signs of a hemorrhagic stroke. What complaint from the patient would be an indicator of this type of stroke?
Severe headache
A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following?
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less
Which initial cardiac rhythm is most frequently found in clients who experience sudden cardiac arrest?
Ventricular fibrillation (V-fib)
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?
Vitamin B12 deficiency Explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.
The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which clients would receive the greatest benefit from this program? Select all that apply. a) A client with Crohn's disease b) A client who lives in a nursing home c) A client who is a vegetarian d) An older adult client on a fixed income e) A young female client with bulimia nervosa
a) a client with crohns disease d) an older adult client on a fixed income e) young female client with bulimia nervosa Those who consume a healthy diet absorb less than 10% of the iron in food. Clients whose nutrition is compromised by unhealthy dieting or who cannot afford to eat a healthy diet, lack knowledge about nutrition, or have malabsorption disorders are at great risk for iron-deficiency anemia. A pt with bulimia nervosa has an unhealthy diet. An older adult client on a fixed income may not have the funds to eat a healthy diet. A client with Crohn's disease has a malabsorption syndrome. A client who resides in a nursing home has prepared meals as well as available supplements if required. A client who is a vegetarian is still able to receive ample iron supplementation in the vegetables being eaten.
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.
During a blood transfusion with packed red blood cells (RBCs), a patient begins to complain of chills, low back pain, and nausea. What priority action should the nurse take? a) D/c the infusion STAT and maintain the IV line with normal saline solution using new IV tubing b) D/c the infusion STAT and notify the physician c)slow the infusion rate and continue to monitor the pt q15min d) Observe for additional symptoms and notify the physician
ans: Aa) D/c the infusion STAT and maintain the IV line with normal saline solution using new IV tubing The following steps are taken to determine the type and severity of the reaction: Stop the transfusion. Maintain the IV line with normal sailine solution through new IV tubing, administered at a slow rate. Assess the pt carefully. Notify Dr. Continue to monitor the pt's vital signs and resp, cardio, and renal status. Notify the blood bank that a suspected transfusion reaction has occurred and send the blood container and tubing to the blood bank for repeat typing and culture.
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. B,C,D,E. THROMBOCYTOPENIA IS NOT ASSOCIATED WITH THALASSEMIA.
A nurse assesses a client who is in cardiogenic shock. Which statement by the nurse best indicates an understanding of cardiogenic shock? a) "A decrease in cardiac output and evidence of inadequate circulating blood volume and movement of plasma into interstitial spaces" b) "It is due to severe hypersensitivity reaction resulting in massive systemic vasodilation." c) "Generally caused by decreased blood volume" d) "A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume"
d) A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume" Explanation: Shock may have different causes (e.g., hypovolemia, cardiogenic, septic), but always involves a decrease in blood pressure and failure of the peripheral circulation because of sympathetic nervous system involvement. Movement of plasma into the interstitial spaces could reflect dependent edema and sepsis. Decreased blood volume is an example of hypovolemia. A hypersensitivity reaction is an example of anaphylactic shock or distributive shock
A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for? a) Abdominal cramps b) Hypotension c) Seizure activity d) Infection
d) Infection Because of the lack of mature and normal granulocytes that help fight infection, patients with leukemia are prone to infection. The likelihood of infection increases with the degree and duration of neutropenia; neutrophil counts that persist at less than 100/mm3 dramatically increase the risk of systemic infections.
6. 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? a. Diuretic therapy b. Therapeutic paracentesis c. Platelet infusions d. Albumin infusion
d. Albumin infusion
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. Rationale: 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.