Common - Test 1
HF Risk Factors
-Obesity -Diabetes -Renal Disease -HTN
HFrEF Meds
1) Angiotensin Receptor/ Neprilysin Inhibitor 2) Sodium Glucose Cotransporter 2 Inhibitor 3) Beta Blockers 4) ACEi (but not used with #1) 5) Mineralocorticoid Receptor Antagonist 6) Diuretics 7) Digoxin EU Guidelines: ARNI, ACEi/ ARB + SGLT2i + BB + MRA
Stages of PAD
1. Asymptomatic 2. Claudication - pain, commonly in legs, usually during exercise, caused by too little blood flow 3. Rest Pain 4. Necrosis/Gangrene
HF prognosis
50% in 5 years
Normal Ejection Fraction Range
55-70%
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg D. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg
A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg The nurse should expect a client who has renal failure to have metabolic acidosis, which is characterized by a low HCO3-, a low pH, and a low or normal PaCO2. Expected reference ranges for these laboratory values are as follows: pH 7.35 to 7.45, HCO3- 21 to 28 mEq/L, and PaCO2 35 to 45 mm Hg.
A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to the provider? A. "I drink at least 2 quarts of fluid every day." B. "The last time I voided it was painful and red-tinged." C. "My period ended 2 days ago." D. "I don't eat shellfish because it gives me hives."
D. "I don't eat shellfish because it gives me hives." The client says she experiences hives after eating shellfish, which indicates a sensitivity. The contrast dye typically used for an IVP is an iodine derivative, and the client with a shellfish sensitivity may have cross-sensitivity to iodine and a serious iodine allergy. This nurse should report these finding to the client's provider.
Most common cause of right-sided HF
Left-sided HF
Hypertensive Crisis (Malignant Hypertension)
Medical emergency Symptoms include morning headaches, blurred vision, dyspnea, uremia Systolic may be > 200 mm Hg Diastolic may be > 150 mm Hg
PAD clinical manifestations
Pain: Intermittent claudication (during exercise) Pulses**--bruit over femoral and aortic arteries; dec. cap refill Rubor Color** Numbness in feet while lying down Hair loss--- Skin Toenails Pain: Relieved with dependent position Severe arterial disease: temperature-cold, color, position, atrophy Critical Limb ischemia: extreme rest pain, ulcers, gangrene
Types of Thrombi
Red Thrombus (Vein): Rate of formation Fast Composition RBCs in fibrin mesh Consistency Soft Mechanism Forms in areas of low pressure or stagnation Association with native circulation Venous system Mechanistic treatment Anticoagulation White Thrombus (Artery): Rate of formation Slow Composition Platelets and amorphous debris in fibrin mesh Consistency Firm or hard Mechanism Shear activation of platelets by turbulence Association with native circulation Arterial system Mechanistic treatment Antiplatelet agent
DVT: Nonsurgical Management
Rest, preventive measures Drug therapy ◦Unfractionated heparin ◦Low-molecular-weight heparin ◦Warfarin ◦Thrombolytics ◦Novel oral anticoagulants (NOACs)
Heart Failure:
The clinical syndrome resulting from the inability of the heart to meet the perfusion demands of the body. Systolic Failure: Ineffective pumping HFrEF (EF ≤ 40%) (Systole: contraction of ventricles) Diastolic Failure: Ineffective filling HFpEF (EF ≥ 50%) (Diastole: relaxing of ventricles for filling) NEW SUBGROUP: HF c ̅ mildly reduced EF (EF 40-49%)
DVT: Surgical Management
Thrombectomy Inferior vena caval interruption Ligation or external clips
Venous Insufficiency
•A result of prolonged venous hypertension •Interferes with adequate return of blood return from extremities to heart •Occurs secondary to incompetent valves in deeper veins in lower extremities •(Varicose veins = enlarged, twisted, superficial veins)
Venous Insufficiency Interventions
•Ideally - non-surgical management •Wound Care Team (Wound, ostomy, and continence nurse) •Specialty Dressings •Dietary supplements to promote healing (zinc, vitamins A & C, high protein foods) •Compression stockings
Desired blood pressure
◦For people over 60: Below 150/90 ◦For people younger than 60: Below 140/90
Signs and Symptoms of HTN: Physical Assessment
◦May have no symptoms ◦Fundoscopic examination ◦Abdominal bruits ◦Headache ◦Chest pain ◦Epistaxis ◦Decreased exercise tolerance
Arteriosclerosis
◦Thickening or hardening of arterial wall ◦Often associated with aging
Atherosclerosis
◦Type of arteriosclerosis involving formation of plaque within arterial wall ◦Leading risk factor for cardiovascular disease
Rheumatoid Arthritis characteristics
- Autoimmune - Symmetry - DIP spared (Distal interphalangeal joints) - Symptoms worse in the morning - Movement eases pain - Warmth/ redness in affected joints - Twisting shape changes to joints - Random or Cyclical onset (flare ups) - May experience fever, malaise, vasculitis, cysts in joints
HF signs and symptoms
- Dyspnea (SOB) - Orthopnea (SOB while lying flat) - Paroxysmal nocturnal dyspnea (SOB at night) - JVD - Right hypochondrial pain (RUQ pain) - Pitting edema - Lung crackles - Extra heart sounds (S3 or S4)
Complications of HTN
- Left ventricular hypertrophy, myocardial ischemia, heart failure - Myocardial ischemia, myocardial infarction, sudden death - Glomerulosclerosis and decreased glomerular filtration, end-stage renal disease - Transient ischemic attacks, cerebral thrombosis, aneurysm, hemorrhage, acute brain infarction - Hypertensive retinopathy, retinal exudates and hemorrhage - Dissecting aneurysm - Intermittent claudication, gangrene
HF Diagnostic Labs
- NT pro BNP (N terminal, brain natriuretic peptide) * BNP released by ventricles and atria during stretch Some studies suggest: if BNP > 5,000pg/ml = 22.5% mortality during that hospital stay
Osteoarthritis characteristics
- Overuse - No symmetry - DIP not spared - Symptoms worse at the end of the day - no warmth or redness at affected joints - enlargement of joints, but not twisting necessarily - Slow/ gradual progression - No constitutional symptoms
Abdominal Aortic Aneurysm (AAA): Assessment
-Pain related to AAA is usually steady with a gnawing quality, unaffected by movement, may last for hours or days -Pain in abdomen, flank, back -Abdominal mass is pulsatile -Rupture is most frequent complication and is life threatening Assess for ◦Back pain ◦Manifestation of compression of aneurysm on adjacent structures ◦Assess for shortness of breath ◦Hoarseness ◦Difficulty swallowing ◦Mass may be visible above suprasternal notch Sudden excruciating back or chest pain symptomatic of thoracic rupture
A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make? A. "A low-protein diet reduces the risk for uremia." B. "A low-protein diet reduces the risk for edema." C. "A low -protein diet will reduce the risk for hyperkalemia." D. "A low-protein diet will increase the nitrogenous wastes in the blood."
A. "A low-protein diet reduces the risk for uremia." Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.
A nurse is teaching a client who has a new diagnosis of urge incontinence. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. "Your provider might prescribe anticholinergic medications." B. "You should limit fluids in the evening." C. "You should restrict your intake of caffeine." D. "You might require intermittent urinary catheterization." E. "You might require an anterior vaginal repair."
A. "Your provider might prescribe anticholinergic medications." B. "You should limit fluids in the evening." C. "You should restrict your intake of caffeine." "Your provider might prescribe anticholinergic medications" is correct. Anticholinergic medications suppress bladder contractions and increase bladder capacity.
A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following data should the nurse identify as the priority to monitor? A. Airway patency B. Temperature C. Urination D. Pain control
A. Airway patency When using the airway, breathing, circulation approach to client care, the nurse should determine it is the priority to monitor the client's airway. Nerve damage, hypocalcemia induced tetany, and edema can all impair the airway following thyroidectomy.
Arteriosclerosis and Atherosclerosis: Assessment
Assess blood pressure in both arms Palpate carotid arteries separately Capillary refill Bruits Cholesterol and triglycerides
A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client? A. Chvostek's sign B. Babibski's sign C. Brudzinski's sign D. Kernig's sign
A. Chvostek's sign The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia.
A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention? A. Daily weight B. Sodium level C. Tissue turgor D. Intake and output
A. Daily weight Obtaining a client's daily weight and comparing it to previous weights is a reliable method for measuring a client's fluid volume over time.
A nurse is assessing a client who has Graves' disease. The nurse should expect which of the following laboratory results? A. Decreased thyroid-stimulating hormone (TSH) level B. Decreased triiodothyronine (T3) level C. Decreased thyroxine (T4) level D. Decreased thyroid-stimulating immunoglobulins (TSI) percentage
A. Decreased thyroid-stimulating hormone (TSH) level The nurse should expect a TSH level below the expected reference range in a client who has Graves' disease.
A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? A. Dehydration B. Polyphagia C. Hyperglycemia D. Bradycardia
A. Dehydration Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.
A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose? A. Insomnia B. Constipation C. Drowsiness D. Hypo-active deep-tendon reflexes
A. Insomnia Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia.
A nurse is providing dietary teaching to a client who has chronic kidney disease (CKD).The nurse should instruct the client to limit which of the following nutrients? (Select all that apply.) A. Protein B. Calcium C. Calories D. Phosphorous E. Sodium
A. Protein D. Phosphorous E. Sodium Protein is correct. A client who has CKD should restrict protein intake to prevent uremia that can develop as a result of the kidneys' inability to remove the waste products of protein. Calcium is incorrect. A client who has CKD is at risk for hypocalcemia due to an alteration in the conversion of vitamin D by the kidneys. Calories is incorrect. A client who has CKD requires adequate calories to meet metabolic needs. Phosphorous is correct. A client who has CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys. Sodium is correct. A client who has CKD is at risk for hypernatremia, edema, and hypertension due to sodium retention.
A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply). A. Slurred speech B. Bone pain C. Bradypnea D. Pruritus E. Hypotension
A. Slurred speech B. Bone pain D. Pruritus
A nurse is caring for a patient who has newly diagnosed Addison's disease. Which of the following actions should the nurse take? A. Teach the patient about cortisol replacement therapy. B. Place the patient on a low-sodium diet. C. Monitor the patient for fluid volume excess. D. Discuss the manifestations of hyperglycemia with the patient.
A. Teach the patient about cortisol replacement therapy.
A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload? A. The client has a 5 lb weight gain since yesterday B. Flattened neck veins C. Oxygen saturation 93% D. Return of skin to previous position when the client's shin is palpated
A. The client has a 5 lb weight gain since yesterday The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.
A nurse is caring for a client and observes that the client's urine is dark amber, cloudy, and has an unpleasant odor. The nurse should recognize that these findings are associated with which of the following? A. Urinary tract infection B. Urinary incontinence C. Urinary frequency D. Urinary retention
A. Urinary tract infection A client who has a urinary tract infection has urine that appears cloudy and concentrated because of the presence of WBCs, RBCs and bacteria. The urine often has an unpleasant odor.
A nurse is educating a group of older adults in a community center on weight management using the BMI scale. Using the client's height and weight to calculate BMI, which of the following clients has a healthy BMI? A. A client with a weight of 128 lb and height of 70 inches B. A client with a weight of 150 lb and height of 68 inches C. A client with a weight of 200 lb and height of 72 inches D. A client with a weight of 133 lb and a height of 60 inches
B. A client with a weight of 150 lb and height of 68 inches The formula for calculating BMI is weight in kilograms divided by the height in meters squared. The formula to convert pounds to kilograms is to divide the weight in pounds by 2.2 kilograms. The formula for converting inches to meters is to multiply the total inches times 0.0254 meters. 150 pounds divided by 2.2 equals 68.18 kilograms. 68 inches multiplied times 0.0254 inches equals 1.7272 meters. 1.7272 meters (squared) is 2.983 meters. 68.18 kilograms divided by 2.983 meters equals a BMI of 22.85. A BMI of 18.5-24.9 is considered a healthy weight.
A client receives Alteplase (tPA), a fibrinolytic drug for thrombotic stroke. Eight hours after the dose is administered, the primary nurse notices the client has decreasing level of consciousness. The nurse is concerned about: A. An anaphylactic reaction to Alteplase B. A possible intracranial hemorrhage C. The normal progression of the stroke D. An expected improvement in the client's condition following thrombolysis
B. A possible intracranial hemorrhage When caring for a client who received Alteplase, know the signs and symptoms of intracerebral hemorrhage: any acute neurological deterioration, new HA, N/V, sudden HTN, mental status change.
A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion
B. Adrenocortical insufficiency Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.
A nurse is caring for a client who has an indwelling urinary catheter. Which of the following actions should the nurse take to prevent infection? A. Replace the catheter every 3 days B. Check the catheter tubing for kinks or twisting C. Irrigate the catheter once each shift D. Clean the perineal area with an antiseptic solution daily
B. Check the catheter tubing for kinks or twisting The nurse should check the catheter for twisting or kinks in the tubing. These obstructions can affect the flow of urine causing pooling in the tubing that could backflow into the bladder.
A nurse is caring for a client who is 5 hr postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first? A. Notify the provider B. Check the tubing for kinks C. Adjust the rate of the bladder irrigant D. Irrigate the catheter
B. Check the tubing for kinks When providing client care, the nurse should first use the least restrictive intervention; therefore, the nurse should check the catheter tubing for kinks. The nurse must ensure constant flow of the bladder irrigant into the catheter and outward drainage from the catheter to prevent clotting, which could occlude the catheter lumen.
A nurse is teaching a client following a cystoscopy about his new prescription for tamsulosin. Which of the following adverse effects should the nurse include in the teaching? A. Temporary loss of libido B. Dizziness C. Bradycardia D. Burning with urination
B. Dizziness Lightheadedness or dizziness is likely with the first several doses. Clients should be taught to rise slowly and carefully from lying or sitting positions until the sensation disappears.
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following medications should the nurse plan to administer? A. Danazol B. Finasteride C. Fluoxymesterone D. Methyltestosterone
B. Finasteride Finasteride, a 5-alpha-reductase inhibitor, is used in the treatment of BPH to prevent the conversion of testosterone and to decrease prostate size.
A nursing is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should nurse include in the teaching? A nursing is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should nurse include in the teaching? A. Limit intake of potassium-rich foods B. Restrict sodium intake C. Increase carbohydrate intake D. Decrease protein intake
B. Restrict sodium intake The nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no-added-salt" to table foods to a restriction of 2 g/day.
A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury? A. BUN 15 mg/dL B. Serum Creatinine 6 mg/dL C. Hemoglobin 16 g/dL D. Serum potassium 4.5 mEq/L
B. Serum Creatinine 6 mg/dL This finding is above the expected reference range. The expected reference range for creatinine is 0.5 mg/dL to 1.3 mg/dL depending on the client's gender and age. An elevated serum creatinine is a manifestation of impaired kidney function, such as with acute kidney injury.
Mrs. Liz Lemon is an 80-year-old woman brought into the emergency department 5 hours after being 'last known to be well' (LKW). Thrombolysis (tPA) will not be given to this patient. Which of the following best describes the rationale for this decision? A. The medication is too expensive to be used in this setting. B. The medication must be administered within 3 - 4.5 hours of symptom onset or LKW. C. This medication is not known to be effective in persons older than 65 years. D. The medication has not been approved by the FDA for the treatment of ischemic stroke.
B. The medication must be administered within 3 - 4.5 hours of symptom onset or LKW.
Select 3 findings from a client's medical record that increase their risk for peptic ulcer disease: A. family history B. smoking history C. alcohol use D. NSAID use E. Positive for Helicobacter pylori
B. smoking history D. NSAID use E. Positive for Helicobacter pylori
A nurse is caring for a client who is 1 day postoperative following a transurethral resection of the prostate (TURP) and has a continuous bladder irrigation in place. Which of the following actions should the nurse take? (Select all that apply.) A. Add the amount of bladder irrigation to the total output. B. Use sterile technique when preparing the irrigation solution. C. Ensure the drainage tubing is patent and without obstruction. D. Contact the surgeon if the client reports a continual need to void. E. Notify the surgeon if the urine is bright red in appearance or has large clots.
B. Use sterile technique when preparing the irrigation solution. C. Ensure the drainage tubing is patent and without obstruction. E. Notify the surgeon if the urine is bright red in appearance or has large clots. Add the amount of bladder irrigation to the total output is incorrect. The irrigation solution that should be used is sterile normal saline, unless otherwise directed by the surgeon. The amount of solution should be subtracted from the total output amount. For example, if the total drainage output is 2,500 mL and the amount of irrigation is 1,000 mL, subtract 1,000 from 2,500 and record 1,500 mL as the total urine output.Use sterile technique when preparing the irrigation solution is correct. Using sterile technique decreases the risk of contamination with micro-organisms and reduces the possibility of infection. Many clients who undergo a TURP are older adults who may have other chronic diseases that increase their susceptibility to infection. These clients should also be observed closely for manifestations of infection, such as fever and elevated WBC.Ensure the drainage tubing is patent and without obstruction or kinks is correct. For continuous drainage, the nurse should be sure that the clamp on the drainage tubing is open and check the volume of fluid in the drainage bag. It prevents accumulation of solution in the bladder, which can cause bladder distention and possible injury.Contact the surgeon if the client reports a continual need to void is incorrect. The catheter used following a TURP is large and is pulled taut and secured to the client's leg. This provides traction that holds the catheter balloon against the internal sphincter of the bladder. As a result, the client may experience a continual need to void.Notify the surgeon if the urine is bright red in appearance or has large clots is correct. It is normal to see a few small blood clots and pink tinged drainage, but urine that is bright red, ketchup-like, or has large clots is an indication of bleeding and should be reported to the surgeon.
A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? A. Omeprazole B. Vancomycin C. Ondansetron D. Diphenhydramine
B. Vancomycin
A nurse is developing a plan of care for a client who is to begin receiving peritoneal dialysis. Which of the following interventions should the nurse implement to ensure proper dialysate exchange? A. Monitor vital signs every 2 hr during the procedure. B. Warm the dialysate solution prior to instillation. C. Place the drainage bag above the level of the client's abdomen. D. Maintain the client in a left lateral position during dialysis.
B. Warm the dialysate solution prior to instillation. The nurse should monitor the client's vital signs every 15 to 30 min during the procedure. The drainage bag should be kept lower than the client's abdomen to promote drainage by gravity and prevent movement of fluid back into the peritoneal cavity. Having the client in a supine low-Fowler's position reduces abdominal pressure and facilitates the flow of dialysate into the abdomen.
A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH? A. osteoarthritis B. lung cancer C. liver cirrhosis D. dyspepsia
B. lung cancer The nurse should ask the client if he has a history of lung cancer because some of the treatment options for small cell lung cancer can cause secretion of antidiuretic hormone. This results in the body retaining water and can cause the syndrome of inappropriate antidiuretic hormone (SIADH).
HTN Drug Therapies
Beta-adrenergic blockers Renin inhibitors Central alpha agonists Alpha-adrenergic agonists Diuretics Calcium channel blockers ACE inhibitors Angiotensin II receptor antagonists Aldosterone receptor antagonists
Venous Thromboembolism
Deep Vein Thrombosis (most common type of thrombophlebitis) Thrombus formation associated with stasis of blood flow, endothelial injury, and/or hypercoagulability Virchow's triad
A nurse is providing teaching for a client who has gastroesophageal reflux disease (GERD) about ways to manage his condition. Which of the following instructions should the nurse include? A. "sleep on your left side" B. "drink milk to soothe your stomach" C. "eat four small meals each day" D. "wait to go to bed 1 hour after eating"
C. "eat four small meals each day" The client should avoid eating large meals because of the pressure it places on the stomach. Instead, he should eat four to six small meals per day.
A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective? A. A decrease in blood sugar B. A decrease in blood pressure C. A decrease in urine output D. A decrease in specific gravity
C. A decrease in urine output The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.
A nurse is reviewing a client's laboratory values and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate? A. Initiating an IV potassium infusion B. Encouraging the client to eat bananas C. Administering sodium polystyrene sulfonate. D. Administering a potassium-sparing diuretic.
C. Administering sodium polystyrene sulfonate. The nurse should expect to administer sodium polystyrene sulfonate, which absorbs excessive potassium and excretes it through the stool. Other treatments include hemodialysis and IV glucose and insulin.
A nurse is caring for a client who has a new arteriovenous (AV) graft in his left forearm. Which of the following techniques should the nurse use to assess the patency of this graft? A. Measure the client's blood pressure to ensure it is higher in the left arm than the right. B. Check the brachial and radial pulses of the left arm simultaneously. C. Auscultate the site for a bruit. D. Auscultate the antecubital fossa using a Doppler stethoscope.
C. Auscultate the site for a bruit. The nurse should auscultate the AV graft site for the presence of a bruit or palpate the site for a thrill every 4 hr to assess for blood flow.
A nurse is teaching a client who has gastroesophageal reflux disease about managing his illness. Which of the following recommendations should the nurse include in the teaching? A. Limit fluid intake not related to meals B. Chew on mint leaves to relieve indigestion C. Avoid eating within 3 hours of bedtime D. Season foods with black pepper
C. Avoid eating within 3 hours of bedtime The nurse should instruct the client to eat small, frequent meals but to avoid eating with 3 hr of bedtime.
To reduce the risk of bleeding during the first 24 hours after tPA (tissue plasminogen activator) administration for acute ischemic stroke the primary goal of the health care team is to control the clients: A. Pulse B. Respirations C. Blood Pressure D. Temperature
C. Blood Pressure Blood pressure should be lowered from >180 systolic or > 105 diastolic prior to and following administration of tPA. You need to maintain optimal cerebral blood flow to facilitate reperfusion to the ischemic area while balancing the risk of hemorrhage. This requires careful monitoring.
A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching? A. CAPD filters the client's blood through an artificial device called a dialyzer. B. CAPD is the dialysis treatment of choice for clients who have a history of abdominal surgery. C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires. D. CAPD requires a rigid schedule of exchange times.
C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires. CAPD's advantages include fewer dietary and fluid restrictions as compared to hemodialysis
A patient who experienced a stroke had difficulty communicating with the staff and her daughter. The patient's daughter frequently answers for her mother when she thinks her mother is too slow to respond to the nurse. What action should the nurse implement to address this situation? A. Praise the daughter for trying to help her mother. B. Inform the daughter that her mother will start physical therapy (PT) soon. C. Collaborate with Speech Therapy to obtain a pointing board for use by the patient and her daughter. D. Explain to the daughter the patient's speech will improve over time.
C. Collaborate with Speech Therapy to obtain a pointing board for use by the patient and her daughter. The best answer is for the RN to collaborate with Speech to get a pointing board or other communication aid for the patient to help with communication with her daughter and her health care team.
A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor? A. Hypocalcemia B. BMI less than 25 C. Family history D. Diuretic use
C. Family history Family history is strongly correlated with the formation of urolithiasis. A nurse should assess a client who has kidney stones for familial tendencies toward stone formation.
A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations? A. Sensitivity to cold B. Constipation C. Frequent mood changes D. Weight gain of 4.5 kg (10 lb) in 3 weeks
C. Frequent mood changes Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones that regulate the metabolic rate. Clients experience emotional lability that fluctuates between emotional hyperexcitability and irritability. They often cannot sit quietly.
A nurse is assisting a client who has hypothyroidism with meal planning. Which of the following foods should the nurse recommend that the client add to her diet? A. Ripe bananas B. Poached eggs C. Whole grains D. Baked chicken
C. Whole grains Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fluid and fiber intake. Whole grains provide ample amounts of fiber.
A nurse is performing gastric lavage on a client using a large-bore NG tube. Which of the following actions should the nurse take? A. Instill 500mL of sterile saline B. Position the client on her right side C. Withdraw the fluid until it is clear D. Connect the NGT to intermittent suction
C. Withdraw the fluid until it is clear
HFrEF
Causes: 1) Decreased Contractility Coronary artery disease Volume overload -valvular disease, etc Dilated cardiomyopathy 2) Increased Afterload Chronic HTN Aortic stenosis
HFpEF
Causes: 1) Left ventricular hypertrophy 2) Restrictive cardiomyopathy 3) Myocardial fibrosis 4) Pericardial constriction
A nurse is preparing a client for a kidney biopsy. Which of the following client conditions should the nurse identify as a contraindication for this diagnostic test? A. Elevated creatinine level B. Flank pain C. Urinary retention D. Bleeding tendencies
D. Bleeding tendencies One of the risks of a kidney biopsy is bleeding from the biopsy site. Therefore, a history of bleeding tendencies or coagulation disorders is a contraindication for a kidney biopsy.
A nurse is caring for an older adult client who has a urinary tract infection (UTI). Which of the following manifestations should the nurse identify as a finding specifically associated with this client? A. Urinary retention B. Low back pain C. Incontinence D. Confusion
D. Confusion Confusion is a clinical finding of UTIs specifically associated with older adult clients.
A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication? A. Decrease in level of thyroxine (T4) B. Increase in weight C. Increase in hours of sleep at night D. Decrease in level of thyroid stimulating hormone (TSH)
D. Decrease in level of thyroid stimulating hormone (TSH) In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.
A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take? A. Apply cold compress to the client's flank area B. Restrict protein intake to 2 servings per day C. Discourage ambulation D. Encourage intake of at least 3 L of fluids/day
D. Encourage intake of at least 3 L of fluids/day The nurse should encourage the client to consume at least 3,000 mL of fluids per day to dilute the urine, increase hydrostatic pressure behind the stone, and move the calculi down the urinary tract.
A nurse is assessing an adolescent who has an exacerbation of Graves' disease. Which of the following findings should the nurse expect? A. Weight gain B. Bradycardia C. Lethargy D. Heat intolerance
D. Heat intolerance An exacerbation of Graves' disease can cause heat intolerance due to an increased metabolic rate, which leads to warm flushed moist skin and extreme diaphoresis.
Peripheral Arterial Disease
Disorders that alter the natural flow of blood through the arteries of the peripheral circulation (venous often occurs as well) DECREASED PERFUSION Atherosclerosis most common cause of chronic PAD *Affects legs more than arms *PAD implies chronic occlusion
Arteriosclerosis and Atherosclerosis: Drug Therapies
HMG-CoA reductase inhibitors (statins) Ezetimibe Combination drugs (e.g., ezetimibe with simvastatin) PCSK9 inhibitors
HTN Assessment: Diagnostic Cues
◦Urinalysis for protein, RBC, BUN, creatinine ◦Chest x-ray (cardiomegaly) ◦ECG shows degree of cardiac involvement
