Complex Midterm Practice Qs

While assessing a term neonate on a home visit to a primiparous client 2 weeks a fter a vaginal delivery the nurse observes that the neoneate is slightly jaundiced and the stool is a pale light colour. the nurse notifies the physician because these findings should indicate which of the following? 1. biliary atresia 2. Rh isoimmunization 3. ABO incompatibility 4. esophageal varies

1

You're caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? 1. Asterixis 2. Chvostek's sign 3. Trousseau's sign 4. Hepatojugular reflex

1

a client has the following arterial blood gas values pH 7.52 Pa02 50 mmHg PaCO2 28 mmHg, HCO2 24 mEq/L. based upon the client's PaO2 which of the following conclusions would be accurate? 1. the client is severely hypoxic 2. the oxygen level is low but poses no risk for the client 3. the client's PaO2 level is within normal range 4. the client requires oxygen therapy with very low oxygen concentrations

1

a client has the following arterial blood gas values pH 7.52 Pa02 50 mmHg PaCO2 28 mmHg, HCO2 24 mEq/L. from the client's PaCO2 level the nurse determines that the client is experiencing which of the following conditions? 1. hypoxemia 2. hypoventilation 3. hyperventilation 4. oxygen toxicity

3

a client is admitted with complaints of severe abdominal pains and the diagnosis of acute pancreatitis. the plna of care during the acute phase of pancreatitis will involve interventions targeting which of the following problems? 1. drug and alcohol abuse 2. risk for injury 3. severe pain 4. ineffective airway clearance

3

a nurse is assessing a client with a hx of MI who is in the surgical unit following a gastric resection. the client complains of chest pain and nurse obtains ecg below. (ventricular fibrillation) what should the nurse do first? 1. administer oxygen 2. inspect the client's incision 3. call the rapid response team 4. reposition the ecg electroudes

3

the HCP has determinated that preterm labour client at 34 weeks gestation has fetal fibronectin present. the nurse should expect which of the following outcomes in the next week? 1. the ct will develop preeclampsia 2. the fetus will develop mature lungs 3. the client will not likely develop preterm labour 4. the fetus will not develop gestational diabetes

3

the nurse administers lactulose (duphalac) to a client with cirrhosis. what is the expected outcome from the administration of the lactulose? 1. stimulation of peristalsis of the bowel 2. reduced peripheral edema and ascites 3. reduced serum ammonia levels 4. prevention of hemorrhage

3

which of the following interventions should the nurse anticipate in a client who has been diagnosed with ARDS? 1. tracheostomy 2. use of a nasal cannula 3. mechanical ventilation 4. insertion of a chest tube

3

which of the following interventions would be the most appropriate for a client with chronic renal failure? 1. apply corticosteroid cream to relieve itching 2. achieve pain control with analgesics 3. maintain a low sodium diet 4. measure abdominal girth daily

3

a 17 year old client visits the clinic at 36 weeks gestation. the client's blood pressure is 130/90 mmHg. One previous visits, her BP ranged from 100 to 110 mmHg systolic, 70 to 80 mmHg diastolic. further assessment reveals slight edema of her hands and 1+ proteinuria. the nurse anticipates that the physician will most likely order which of the following? 1. IV magnesium sulfate 2. labetalol 3. bed rest with bathroom privileges 4. hourly blood pressure checks

3 IV magnesium sulfate and labetalol are given for severe preclampsia.

In the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. The nurse should suspect: a. Hypovolemia and/or shock. b. A nonneutral thermal environment. c. Central nervous system injury. d. Pending renal failure.

A (The nurse should suspect hypovolemia and/or shock. Other symptoms could include hypotension, prolonged capillary refill, and tachycardia followed by bradycardia. Intervention is necessary.)

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a. Notify the patient's health care provider. b. Document the QRS interval measurement. c. Review the chart for the patient's current creatinine level. d. Check the medical record for the most recent potassium level.

d

Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates? a. Biliary sludge b. Biliary atresia c. Pancreatic abscess d. Pancreatic pseudocyst

d

what nursing intervention is most important in preventing septic shock? a. administering IV fluid replacement therapy as ordered. b. obtaining VS every 4 hours for all clients c. monitoring RBC counts for elevation d. maintaining asepsis of indwelling urinary catheter

d

when preparing the room for admission of a multigravida client at 26 wees gestation diagnosed with severe preeclampsia which of the following would the nurse obtain? a. oxytocin infusion solution b. disposable tongue blades c. portable ultrasound machine d. padding for the side rails

d

which of the following nursing assessment findings indicates hypovolemic shock in a client who has had 15% blood loss? a. pulse rate <60 bpm b. RR of 4 bpm c. pupils unequally dilated d. systolic blood pressure less than 90 mmHg

d

DRUGS FOR HYPERTENSIVE DISORDERS OF PREGNANCY (HDP) MgSO4

-drug of choice for prevention & management of seizures & treatment for eclampsia, given IV by infusion pump • CNS depressant • Relaxes smooth muscle

which of the following goals would be most expected for a client with acute pancreatitis? 1. the client reports minimal abdominal pain 2. the client regains a normal pattern for bowel movements 3. the client limits alcohol intake to two or three drinks per meal 4. the client maintains normal liver function

1

Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include? 1. "You'll need to lie on your stomach during the test." 2. "You'll need to lie on your right side after the test." 3. "During the biopsy you'll be asked to exhale deeply and hold it." 4. "The biopsy is performed under general anesthesia."

2

Diruetic therapy with torsemide (Demadex) is started for a client heart failure. When calling the client 2 days after the drug therapy is started, the nurse evaulates the torsemide as effective when the client says she has experienced which of the following outcomes? 1. she has an improved appetite and is eating better 2. she weighs 6 pounds less than she did 2 days ago 3. she is less thirsty than she was before the drug therapy 4. she has clearer urine since starting torsemide

2

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2

a client has started taking amiodarone. the nurse should inform the client that period lab tests will be done to monitor the clients: 1. hemoglobin 2. liver enzymes 3. creatine kinase 4. renal function

2

Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? 1. There is no skin breakdown. 2. Her appetite improves. 3. She loses more than 10 lbs. 4. Stools are less fatty and decreased in frequency.

4 Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance

aPTT normal range

60 to 70 seconds - for heparin -antidote: protamine

A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for thenext 24 hours?

950 mL The general rule for calculating fluid restrictions is to add all fluid losses for the previous 24 hours, plus600 mL for insensible losses: (250 + 100 + 600 = 950 mL).

QRS complex represents what?

: ventricular depolarization/atrial repolarization

anticoagulants vs antiplatelets

Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of making clots. - blood THINNER Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot

Palmar erythema

in cirrhosis Red area on palms of bands that blanches with pressure

What clinical manifestations does Mr. Habib exhibit that support a diagnosis of ARDS?

increasing levels of FIO2 (refractory hypoxemia) and PEEP (PaO2 59 mm Hg, FIO2 100% [PaO2/FIO2 ratio <200]), respiratory acidosis on ABGs, sinus tachycardia with depressed ST segments (indicating myocardial ischemia), decreased oxygen saturation (SpO2 85%), fine crackles at the lung bases.

nursing responsibiliities for preclampsia: Assess fetal activity daily for decreased activity that is

move 5 times in 2 hours

systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg after 20 weeks with organ involvement

preclampsia - nonsevere/severe preclampsia -HELLP syndrome -eclampsia

anticoagulant

prevents blood clotting

Proteinuria in severe preeclampsia?

prsent +++

a client complains of a dull headache and dizziness and has an increased pulse rate. the results of arterial blood gas analysis are as follows: pH 7.26, CO2 50 mmHg, and bicarbonate 24 mEq/L. these findings indicate which of the following acid base imbalances?

respiratory acidosis

Spider angiomas

seen in cirrhosis Small dilated blood vessels with bright red centre and spider-like branches

hyperreflexia in eclampsia or severe preclamp?

severe

Antiplatelet drugs

substances that prevent platelet plugs from forming

t/f: post-Partum Hemorrhage is defined as the loss of 500 mL or more of blood after vaginal birth and 1000 mL or more after Caesarean birth. Either a 10% change in hematocrit between admission for labour and post-partum.

t

CHF (congestive heart failure) diuretic

thiazide #1 choice

Diuretics given for HF

thiazide diuretics = #1 choice mobilize edematous fluid, reduce pulmonary venous pressure and reduce preload

A 38-yr-old patient who had a kidney transplant 8 years ago is receiving theimmunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone . Which assessment data will be of most concern to the nurse? a. Skin is thin and fragile b. Blood pressure is 150/92. c. A nontender axillary lump. d. Blood glucose is 144 mg/dL.

c A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, skin change, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.

The client with cirrhosis has developed ascites. The nurse should recognize that the pathological basis for the development ascites in clients with cirrhosis is portable, hypertension, and: a. Increase serum sodium level b. an increase metabolism of aldosterone c. a decreased flow of hepatic lymph d. a decrease serum, albumin level

d

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take? a. Give the prescribed PRN lorazepam (Ativan). b. Encourage the patient to take deep slow breaths. c. Start the prescribed PRN oxygen at 2 to 4 L/min. d. Administer the prescribed normal saline bolus and insulin.

d

Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level

d The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters should also be monitored, but they are not directly associated with the patient's current symptoms.

systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg after 20 weeks without organ involvement

gestational hypertension

nonsevere HDP BP parameters

greater or equal to 140/90

ACE inhibitors (-pril) adverse effects are:

*symptomatic hypotension *chronic cough *angioedema

Sinus Bradycardia - treatment

- regular rhythm PQRST wave <60 bpm - Tx: atropine

TABLE 14-4 ASSESSING DEEP TENDON REFLEXES No response grade

0

INR normal range

0.81 to 1.2 - for warfarin antidote: vit k

A client with acute respiratory distress syndrome (ARDS) is on a ventilator. The client's peak inspiratory pressures and spontaneous respiratory rate are increasing and the PO2 is not imporving. Using the SBAR (Situation Background Assessment Recommendation) technique for communication, the nurse calls the healthcare provider (HCP) with the recommendation for: 1. initiating IV sedation. 2. starting a high-protein diet. 3. Providing pain medication. 4. increasing the ventilator rate.

1

A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client? Click on the exhibit button for additional information. Lab Results: Sodium 150 mEq/L Potassium 6.0 mEq/L Chloride 100 mEq/L Calcium 9.0 mg/dL Magnesium 2.0 mg/dL Phosphorus 5.8 mg/dL 1.Apple slices with caramel dip 2. Chips and avocado dip 3. Nonfat yogurt with orange slices 4. Vanilla pudding with strawberries

1

A client, diagnosed with acute pancreatitis 5 days ago, is experiencing respiratory distress. Which finding should the nurse report to the healthcare provider (HCP)? 1. arterial oxygen level of 46 mm Hg (6.1 kPa) 2. respirations of 12 breaths/min 3. lack of adventitious lung sounds 4. Oxygen saturation of 96% on room air

1

The dialysis solution is warmed before use in peritoneal dialysis primarily to: A. Encourage the removal of serum urea B. Force potassium back into the cells C. Add extra warmth into the body D. Promote abdominal muscle relaxation

1

The nurse assesses a client diagnosed with chronic kidney disease who had an internal arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow-up? 1. A bruit cannot be auscultated over the fistula site 2. Capillary refill of 2 seconds is assessed on the left hand 3. Client reports squeezing a rubber ball with the left hand several times daily 4. Incision is dry with no redness and has sterile skin closures in place

1

TABLE 14-4 ASSESSING DEEP TENDON REFLEXES Sluggish grade

1+

GDM pregnancy - asymptomatic between 1.8 to 2.5 mmol/L. what do you do?

1. 75 g of glucose 2. check either: i) FBG: > or equal to 5.3 mmol/L ii) 1 hr postprandial: > or equal 10.6 mmol/L iii) 2 hr postprandial: > or equal9.0 mmol/l if either is greater to or met = GDM confirmed

an infant with increased intracranial pressure on a regular diet vomits whiel eating dinner. which of the following should the nurse do next? 1. put the child on nothing by mouth NPO status for 4 hours 2. call to report this event to the physician 3. wait a few minutes then refeed the child 4. administer the prescribed antiemetic

3

A client with advanced kidney disease has serum potassium of 7.1 mEq/L (7.1 mmol/L) and creatinine of 4.5 mg/dL (398 µmol/L). What is the priority prescribed intervention? 1. Administer IV 50% dextrose and regular insulin 2. Administer IV furosemide 3. Administer oral sodium polystyrene sulfonate 4. Prepare the client for hemodialysis catheter placement

1 IV administration of 50 mL 50% dextrose with 10 units of regular insulin is the priority intervention as it is most effective in reducing the potassium level quickly. The insulin temporarily shifts the potassium from the extracellular fluid back into the intracellular fluid. The dextrose prevents hypoglycemia associated with the increase of insulin in the body and can be eliminated if the client has hyperglycemia (Option 1). If the client has ECG changes (eg, tall peaked T waves), calcium gluconate should be given before insulin/dextrose. This will stabilize the cardiac muscle until the potassium level can be reduced with insulin/dextrose.(Option 2) Furosemide (Lasix) increases the renal excretion of potassium and is usually prescribed for clients with fluid overload. However, administration of furosemide would take time to be effective and is not the priority.(Option 3) Sodium polystyrene sulfonate (Kayexalate) is administered by mouth or enema to remove potassium from the body by exchanging sodium for potassium ions in the intestines; these are then excreted in feces. This is not the priority due to the delayed onset of potassium removal.(Option 4) Hemodialysis is an invasive procedure that can be initiated if more conservative, noninvasive therapies are ineffective in reducing the potassium level. Placement of the catheter will delay treatment.Educational objective: Administration of IV 50% dextrose and regular insulin rapidly corrects an elevated serum potassium level by shifting potassium intracellularly. If the client has ECG changes from hyperkalemia, calcium gluconate should be given first to stabilize cardiac muscle.Physiological Adaptation

normal glomerular filtration rate (GFR)

120-130 mL/min

A patient arrives in the emergency department with acute abdominal pain related to acute pancreatitis. What does the nurse recognize may cause this disorder? Select all that apply. 1. Gallstones 2. Cystic fibrosis 3. Alcohol abuse 4. Isoniazid therapy 5. Food contaminated by feces

123

the nurse is caring for a hospitalized client who has chronic renal failure. which of the following nursing diagnoses are most appropriate for this client? sata a. excess fluid volume b. imbalanced nutrition: less than body requirements c. activity intolerance d. impaired gas exchange e. pain

123

a nurse is caring for a client with hepatic encephalopathy how should the nurse direct care for this client? select all that apply. 1. preventing constipation 2. administering lactulose 3. monitoring coordination while walking 4. checking the pupil reaction 5. providing food and fluids high in carb 6. encouraging physical activity

12345 constipation L/t increased ammonia production. lactulose is a hyperosmotic laxative that reduces blood ammonia by acidifying the colon contents which retard diffusion of nonionic ammonia from the colon to the blood while promoting its migration from the blood from the colon. hepatic encephalopathy is considered a toxic or metabolic condition that causes cerebral edema; it affects a person's coordination and pupil reaction to light and accommodation. food and fluids high in carbohydrates should be given bc the liver is not synthesizing and storing glucose. because exercise produces ammonia as a byproduct of metabolism physical activity should be limited not encouraged.

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a PaCO2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. 1. Nausea 2. Confusion 3. Bradypnea 4. Tachycardia 5. Hyperkalemia 6. Lightheadedness

1246 Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis.

The nurse is instituting seizure precautions for a client who is being admitted from the emergency department. Which measures should the nurse include in planning for the client's safety? Select all that apply. 1. Padding the side rails of the bed 2. Placing an airway at the bedside 3. Placing the bed in the high position 4. Putting a padded tongue blade at the head of the bed 5. Placing oxygen and suction equipment at the bedside 6. Flushing the intravenous catheter to ensure that the site is patent

1256

a nurse is caring for a client who is having a allergic reaction to a blood transfusion. in what order's what should he nurse provide care for this client? 1. stop the transfusion 2. send the blood bag and blood slip to the blood bank 3. keep the vein open with normal saline solution 4. administer an antihistamine as directed

1342

A client with ARDS has fine crackles at lung bases and the respirations are shallow at a rate of 28 bpm. The ct is restless and anxious. In addition to monitoring the arterial blood gas results, the nurse should do which of the following? SATA 1. monitor serum creatinine and BUN 2. administer a sedative 3. keep the head of the bed flat 4. administer humidified oxygen 5. auscultate the lungs

145

GFR (glomerular filtration rate) requiring transplant

15 mL/min

Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? 1. Calcium 2. Glucose 3. Magnesium 4. Potassium

2 Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of langerhans.

TABLE 14-4 ASSESSING DEEP TENDON REFLEXES Active or expected response

2+

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1. Respirations that are shallow 2. Respirations that are increased in rate 3. Respirations that are abnormally slow 4. Respirations that are abnormally deep 5. Respirations that cease for several seconds

2,4 Kussmaul's respirations are abnormally deep and increased in rate. These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds.

a toddler admitted in respiratry distress keeps pulling at the oxygen mask, trying to remove it. which action by the nurse is most appropriate? sata 1. restraining the child 2. having the parent read to the child 3. administering a sedative 4. encouraging the parent to hold the child 5. telling the child the mask will help him breathe better 6. asking the parent to leave the child's bedside

24

A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider? 1. 2+ pitting edema of the extremity with the arteriovenous fistula 2. Loud swooshing sound auscultated over the arteriovenous fistula 3. Pale skin of the hand of the arm with the arteriovenous fistula 4. Surgical site pain reported by the client as 3 on a scale of 0-10 during hand exercises

3

Aluminum hydroxide (Amphojel) is prescribed for the ct with CHF to take at home. what is the purpose of giving this drug to a client with chronic renal failure? 1. to relieve pain of gastric hyperacidity 2. to prevent curlings stress ulcers 3. to bind to phosphate in the intestine 4. to reverse metabolic acidosis

3

Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: 1. Continuous peritoneal lavage. 2. Regular diet with increased fat. 3. Nutritional support with TPN. 4. Insertion of a T tube to drain the pancreas.

3

Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? 1. Serum creatinine and BUN 2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 3. Serum amylase and lipase 4. Cardiac enzymes

3

Several pregnant clients are waiting to be seen in the triage area of the obstetrical unit. What client should the nurse see first? 1. a client at 13 weeks gestation experiencing nausea and vomiting three times a day with +1 ketones in her urine. 2. a client at 37 weeks gestation who is an insulin dependent diabetic and experiencing 3 to 4 fetal movements per day. 3. a client at 32 weeks gestation who has preeclampsia and +3 proteinuria who is returning for evaluating of epigastric pain 4. a primigravida at 17 weeks gestation complaining of not feeling fetal movement at this point in her pregnancy

3

The nurse is caring for a 29-yr-old man who was admitted 1 week ago with multiple rib fractures, pulmonary contusions, and a left femur fracture from a motor vehicle crash. The attending physician states the patient has developed sepsis, and the family members have many questions. Which information should the nurse include when explaining the early stage of sepsis? 1.Antibiotics are not useful when an infection has progressed to sepsis. 2. Weaning the patient away from the ventilator is the top priority in sepsis. 3. Large amounts of IV fluid are required in sepsis to fill dilated blood vessels. d.The patient has recovered from sepsis if he has warm skin and ruddy cheeks.

3

a client has been taking furosemide (lasix) for 2 days. the nurse realize that a possible adverse effect of this type of diuretic is: 1. an elevated BUN levels 2. a elevated K levels 3. a decreased K levels 4. a elevated Na level

3

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer? 1. Serum α-fetoprotein level 2. Ventilation/perfusion scan 3. Hepatic structure ultrasound 4. Abdominal girth measurement

3 Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer. Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans do not diagnose liver cancer. Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.

TABLE 14-4 ASSESSING DEEP TENDON REFLEXES slightly brisk, Hyperactive grade

3+ grade

A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention? 1. Administer antihypertensives that were held prior to dialysis 2. Administer PRN ondansetron to relieve nausea 3. Contact the health care provider 4. Place client in Trendelenburg position

3 For disequilibrium syndrome Dialysis disequilibrium syndrome (DDS) is a rare but potentially life-threatening complication that can occur in clients during the initial stages of hemodialysis (HD); it can be prevented by slowing the rate of dialysis. During HD, solutes (ie, urea) are removed more quickly from the blood than from the brain cells and cerebrospinal fluid, creating a concentration gradient that can lead to excess fluid in the brain cells and increased intracranial pressure. Characteristic neurologic manifestations include nausea and vomiting, headache, restlessness, change in mentation, and seizure activity. If DDS is suspected, the health care provider should be contacted immediately (Option 3). If severe, DDS can progress to coma and death. If DDS is identified during treatment, the rate of dialysis should be slowed or stopped. Treatment focuses on interventions to decrease cerebral edema and manage symptoms.(Option 1) Antihypertensives are withheld prior to HD to minimize the risk for hypotension. If the client is not hypotensive after HD, prescribed antihypertensives should be administered but are not the priority intervention for a client with DDS.(Option 2) Antiemetics should be administered to treat nausea associated with DDS, but they are not the priority intervention.(Option 4) Trendelenburg position may increase cerebral edema and would be inappropriate for a client with DDS.Educational objective: Dialysis disequilibrium syndrome (DDS) is a potentially life-threatening condition associated with cerebral edema. Characteristic neurologic manifestations include nausea and vomiting, headache, restlessness, change in mentation, and seizure activity. If DDS is suspected, the health care provider should be contacted immediately and dialysis should be slowed or stopped.49%Physiological Adaptation

normal potassium (K+) levels

3.5-5.0 mmol/L - very important to monitor for cardiac patients and those taking potassium sparing diuretics (spironolactone) -

a young adult is hospitalized with a seizure disorder. the client, who is in bed with padded side rails, has a tonic-clonic seizure. in what order should the nurse take the following actions? 1. loosen clothing around the client's neck 2. turn the client on his or her side 3. clear the area around the client 4. suction the airway

3124

A client with chronic kidney disease has a subcutaneous arteriovenous fistula (AVF) placed in the nondominant left wrist for hemodialysis. Which of the following statements indicate the client understands how to care for the fistula properly? Select all that apply. 1. "I don't need to call my health care provider (HCP) if I have numbness or tingling in my left arm." 2. "I will make sure I always have my blood pressure taken in my nondominant (left) arm." 3. "I will squeeze a small sponge with my left hand several times a day." 4. "I will touch the site and feel for a vibration several times a day." 5. "I will try not to sleep on my left arm."

345

A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply. 1.Administer subcutaneous heparin to decrease clotting during dialysis 2.Administer the client's morning doses of carvedilol and lisinopril 3.Check the client's medical records to determine the last post-dialysis weight 4.Obtain a set of client vital signs and the client's current weight 5.Palpate the fistula in the client's arm for a thrill and auscultate for a bruit

345 Prior to dialysis treatment, the nurse should assess the client's fluid status (weight, blood pressure, peripheral edema, lung and heart sounds), vascular access (arteriovenous fistula, arteriovenous grafts), and vital signs (Option 4). The amount of fluid removed (ultrafiltration) is determined by calculating the difference between the last post-dialysis weight and the client's current pre-dialysis weight (Option 3). After the client is connected to the dialysis machine, IV heparin is added to the blood from the client to prevent clotting that can occur when blood contacts a foreign substance. Giving subcutaneous heparin prior to initiation is not necessary (Option 1).(Option 2) During dialysis, excess fluid is removed, making the client prone to hypotension. In addition, medications are removed from the blood during hemodialysis, making them ineffective. Many medications that are taken once daily can be held until after the dialysis treatment to prevent their removal. If blood pressure medications are given prior to dialysis, the client can develop hypotension during the dialysis and then uncontrolled hypertension (decreased drug concentrations).(Option 5) Arteriovenous fistulas are created by anastomosing an artery to a vein; a thrill can be felt when palpating the fistula, and a bruit can be heard during auscultation when the fistula is functioning properly. Educational objective: The nurse is responsible for assessing the client diagnosed with end-stage renal disease for risks associated with dialysis. These risks include medication removal, hemodialysis access dysfunction, hypotension, and fluid and electrolyte imbalances.Physiological Adaptation

A client receiving digoxin for heart failure undergoes cardiac catheterization to evaluate his condition further. the procedure reveals a cardiac output of 2.2 L/min. How should the nurse evaluate this cardiac output? 1. high because of the effects of digoxin 2. within normal limits because of the effects of digoxin 3. within normal limits but not adequate to support strenuous activity 4. low requiring further medical intervention

4

A multigravid client at 34 weeks gestation who has type 1 diabetes is scheduled for a biophysical profile in the morning. the nurse explains to the client that which of the following is one of the fetal parameters to be assessed? 1. biparietal diameter 2. bilirubin levels 3. contraction stress test 4. breathing movements

4

a client had advanced cirrhosis of the liver. the client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. how should the nurse respond to provide the most accurate explanation of the disease process? 1. he must have been eating too many foods with salt in them salt pulls water with it 2. the welling in his ankles must have moved up closer to his heart so the fluid circulates better 3. he must have forgetten to take his daily water pill 4. blood is not able to flow readily through liver now and the liver cannot making protein to keep fluid inside the blood vessels

4

a client has the following arterial blood gas values pH 7.52 Pa02 50 mmHg PaCO2 28 mmHg, HCO2 24 mEq/L. The nurse determines that which of the following is a possible cause for these findings? 1. COPD 2. Diabetic ketoacidosis with kussmaul's respirations 3. myocardial infarction 4. pulmonary embolus

4

Although ARDS may result from direct lung injury or indirect lung injuryas a result of systemic inflammatory response syndrome (SIRS), the nurseis aware that ARDS is most likely to occur in the patient with a host insultresulting from A. Sepsis B. Oxygen toxicity C. Prolonged hypotension D. Cardiopulmonary bypass

A Although ARDS may occur in the patient who has virtually anysevere illness and may be both a cause and a result of systemic inflammatoryresponse syndrome (SIRS), the most common precipitating insults of ARDS aresepsis, gastric aspiration, and severe massive trauma.

A client with chronic kidney disease has a large pleural effusion. What findings characteristic of a pleural effusion does the nurse expect? Select all that apply. a. Chest pain during inhalation b. Diminished breath sounds c. Dyspnea d. Hyperresonance on percussion e. Wheezing

A pleural effusion is an abnormal collection of fluid (>15 mL) in the pleural space that prevents the lung from expanding fully, resulting in decreased lung volume, atelectasis, and ineffective gas exchange. It is usually secondary to another disease (eg, heart failure, pneumonia, nephrotic syndrome). Pleural effusions are diagnosed by chest x-ray or CT scan. Thoracentesis can be performed to remove fluid from the pleural space and resolve symptoms. a, b c Clients commonly report dyspnea with a nonproductive cough, as well as pleural chest pain with respirations (Options 1 and 3). On assessment, clients have diminished breath sounds, dullness to percussion, decreased tactile fremitus, and decreased movement over the affected lung (Option 2). (Option 4) Fluid outside the lung interrupts the transmission of sound, resulting in decreased fremitus and dullness with percussion in pleural effusion. Percussion is hyperresonant in clients with pneumothorax. (Option 5) Wheezing indicates an obstructive process (eg, asthma, chronic obstructive pulmonary disease) and is not typical in pleural effusion. Educational objective:A pleural effusion is an abnormal collection of fluid (>15 mL) in the pleural space that prevents the lung from expanding fully, resulting in decreased lung volume, atelectasis, and ineffective gas exchange. Clients report dyspnea and pain with respirations and have diminished breath sounds with dullness to percussion over the affected area.

T wave represents

T wave: ventricular repolarization - ventricular relaxation

What are the primary pathophysiologic changes that occur in the injury orexudative phase of ARDS (select all that apply)? A. Atelectasis B. Shortness of breath C. Interstitial and alveolar edema D. Hyaline membranes line the alveoli E. Influx of neutrophils, monocytes, and lymphocytes

ACD The injury or exudative phase is the early phase of ARDS whenatelectasis and interstitial and alveoli edema occur and hyaline membranes composedof necrotic cells, protein, and fibrin line the alveoli. Together, these decrease gasexchange capability and lung compliance. Shortness of breath occurs but it is not aphysiologic change. The increased inflammation and proliferation of fibroblastsoccurs in the reparative or proliferative phase of ARDS, which occurs 1 to 2 weeksafter the initial lung injury.

qSOFA criteria evaluates what 3 parameters?

Altered mental status Systolic BP <=100 mmHg Respiratory rate >= 22 breaths per minute or hypotension, altered mental state, and tachypnea for sepsis

the client who does not response adequately to fluid replacement has an order for an IV infusion of dopamine hydrochloride at 5 ug/kg/min. the desired effect of this drug is: a. increased renal and mesenteric blood flow b. increased cardiac output c. vasoconstriction d. reduced preload and afterload

b

During follow-up visits, a nurse finds that the patient is having an exacerbation of pancreatitis. Which action of the patient's caregiver is responsible for this condition? A. Giving Creon along with meals B. Giving three large meals a day C. Checking for fatty stools in the patient D. Giving omeprazole one hour after meals

B

A clients ammonia level is elevated and the doctor orders 30 ml of lactulose which of the following adverse effects of this drug would nurse see? a. Increase urine output, b. impaired level of consciousness, c. increased bowel movements, d. nausea and vomiting

c

The nurse suspects the early stage of ARDS in any seriously ill patientwho manifests what? A. Develops respiratory acidosis B. Has diffuse crackles and rhonchi C. Exhibits dyspnea and restlessness D. Has a decreased PaO2 and an increased PaCO2

C Rationale: Early signs of ARDS are insidious and difficult to detect but the nurse should be alert for any early signs of hypoxemia, such as dyspnea, restlessness, tachypnea, cough, and decreased mentation, in patients at risk forARDS. Abnormal findings on physical examination or diagnostic studies, such as adventitious lung sounds, signs of respiratory distress, respiratory alkalosis, or decreasing PaO2, are usually indications that ARDS has progressed beyond the initial stages.

During treatment of a patient with a Minnesota balloon tamponade for bleeding esophageal varices, which nursing action will be included in the plan of care? a. Encourage the patient to cough and deep breathe. b. Insert the tube and verify its position q4hr. c. Monitor the patient for shortness of breath. d. Deflate the gastric balloon q8-12hr.

C The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. The health care provider inserts the tube and verifies the position. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.Cognitive Level: Application Text Reference: p. 1114Nursing Process: Implementation NCLEX: Physiological Integrity

A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor a. prothrombin time. b. bilirubin levels. c. ammonia levels. d. potassium levels.

C The protein in the blood in the gastrointestinal (GI) tract will be absorbed and may result in an increase in the ammonia level because the liver cannot metabolize protein very well. The prothrombin time, bilirubin, and potassium levels should also be monitored, but they will not be affected by the bleeding episode.

nursing responsibilities for seizure

Call for assistance Keep airway patent: turn head to one side, place pillow under one shoulder or back Protect woman from injury during seizure (padded side rails raised and safely locked) Observe and record convulsion activity Give magnesium sulphate or anticonvulsant medication as ordered. Monitor vital signs Use suction as needed and administer oxygen via face mask at 10 L/min Start intravenous fluids and Insert indwelling urinary catheter and monitor ins and outs Observe for post-convulsion coma, incontinence Do not leave woman unattended until she is fully alert Monitor fetal and uterine status Lab work to monitor kidney and liver function, coagulation, and medication levels Provide hygiene and a quiet environment. Support woman and family and keep them informed. Be prepared to assist with birth when the woman is in stable condition.

Heart Failure Zones. (Heart Failure Zones Information Sheet) yellow zone

Call your HCP if you have any of the following: • You gain more than 4 lbs (2 kg) over 2 days in a row or 5 lbs (2.5 kg) in 1 week. • You have vomiting and/or diarrhea that lasts > 2 days. • You feel more SOB than usual. • You have increased swelling in your feet, ankles, legs, or stomach. • You have a dry hacking cough. • You feel more tired and don't have the energy to do daily activities. • You feel lightheaded or dizzy, and this is new for you. • You feel uneasy, like something does not feel right. • You find it harder for you to breathe when you are lying down. • You find it easier to sleep by adding pillows or sitting up in a chair

MgSO4 s/e

Common-lethargy, sensations of heat, H/A, N & V, blurred vision, constipation

A client with ascites and peripheral oedema is at risk for impaired skin integrity. Which of the following interventions should be implemented to prevent skin breakdown? a. Range of motion exercise every four hours b. Massage of the abdomen once a shift c. Use of alternating air pressure mattress d. Elevation of the lower extremities

D

A client with cirrhosis vomits, bright red blood in the position, suspects blood bleeding, oesophageal varices. The physician decides to insert a SENGSTAKEN - BLAKEMORE tube. The nurse should explained to the client the tube ask by: a. Providing a large diameter for a fact of gastric lavage b. Apply direct pressure to gastric bleeding sites c. Blocking blood flow to the stomach and oesophagus d. Applying direct pressure to the esophagus

D

During the assessment of a patient with acute abdominal pain, the nurse should: A. perform deep palpation before auscultation B. obtain pulse rate and blood pressure to determine hypovolemic changes C. auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus D. measure body temperature because an elevated temp may indicate an inflammatory or infectious process

D

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? A. Impaired skin integrity related to edema, ascites, and pruritus B. Imbalanced nutrition: less than body requirements related to anorexia C. Excess fluid volume related to portal hypertension and hyperaldosteronism D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D

Which of the following intervention should the nurse anticipate incorporating into the clients plan of care when hepatic encephalopathy initially develops? a. Starting a nasogastric tube b. restricting fluids to 1000 mL per day, c. administering IV salt poor albumin d. implementing a low protein diet

D

A nurse is assessing with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome? A. Bilateral wheezing B. Inspiratory crackles C. intercostal retractions D. Increased respiratory rate

D Rationale: The earliest detectable sign of ARDS is an increased respiratory rate,which can begin from 1-96 hours after the initial injury to the body. This is followedby increasing dyspnea., air hunger, retractions of accessory muscles, and cyanosis.Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarsecrackles.

Prone positioning is considered for a patient with ARDS who has not responded to other measures to increase PaO2. The nurse knows that this strategy will A. increase the mobilization of pulmonary secretions. B. decrease the workload of the diaphragm and intercostal muscles. C. promote opening of atelectatic alveoli in the upper portion of the lung. D. promote perfusion of nonatelectatic alveoli in the anterior portion of the lung.

D Rationale: When a patient with ARDS is supine, alveoli in the posterior areas ofthe lung are dependent and fluid-filled and the heart and mediastinal contents placemore pressure on the lungs, predisposing to atelectasis. If the patient is turned prone,air-filled nonatelectatic alveoli in the anterior portion of the lung receive more bloodand perfusion may be better matched to ventilation, causing less V/Q mismatch.Lateral rotation therapy is used to stimulate postural drainage and help mobilizepulmonary secretions.

when reviewing the prenatal records of a 16 yo primigravid client at 37 weeks gestation diagnosed with severe preeclampsia the nurse would interpret which of the following as most indicative of the client's diagnosis? a. blood pressure of 138/94 mmHg b. severe blurring of visions c. less than 2 g of protein in a 24 hour sample d. weight gain of 0.5 lb in 1 week

b

which of the following would be an essential nursing action for the client who is receiving dopamine hydrochloride for treatment of shock? a. administer pain medication concurrently b. monitor BP continuously c. evaluate arterial blood gasses at least every 2 hours d. monitor for signs of infection

b

which of the following assessment findings should lead the nurse to suspect that a client who had a Caesarean delivery 8 hours earlier is developing disseminated intravascular coagulation (DIC)? SATA 1. petechiae on the arm where the blood pressure was taken 2. heart rate of 126 bpm 3. abdominal incision dressing with bright red drainage 4. platelet count of 80,000/mm3 5. urine output of 350 mL in the past 8 hours 6. temperature of 36.9C

Disseminated intravascular coagulation is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. 1234 tachycardia and diaphoresis may also be noted

Turner's sign

Flank-greyish blue. (turn around to see your flanks or lateral positions - bc the pancreas tail is located there) - Seen with pancreatitis

ARF (Acute Renal Failure) diuretic

Furosemide Lasix

GDM pregnancy - symptomatic with glucose levels between 1.8 to 2.5 mmol/L. what do you do?

GDM confirmed!

Heart Failure Zones. (Heart Failure Zones Information Sheet) green zone

GREEN ZONE: our symptoms are under control. You have: • No SOB. • No chest discomfort, pressure, or pain. • No swelling or increase in swelling of your feet, ankles, legs, or stomach. • No weight gain of more than 4 lbs (2 kg) over 2 days in a row or 5 lbs (2.5 kg) in 1 week

A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes a: a. shallow breathing pattern. b. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. c. partial pressure of carbon dioxide in arterial gas (PaCO2) of 34 mm Hg. d. respiratory rate of 32/min.

b

Heart Failure Zones. (Heart Failure Zones Information Sheet) red zone

Go to ER or call 9-1-1 if you have any of the following: • You are struggling to breathe. • Your SOB does not go away while sitting still. • You have a fast heartbeat that does not slow down at rest. You have chest pain that does not go away with rest or with medicine. • You are having trouble thinking clearly or are feeling confused. • You have fainted

electrolytes imbalances in pancreatitis

HYPOkalemia, HYPOcalcemia, HYPERnatremia

The nurse would recognize which clinical manifestation as suggestive of sepsis? Sudden diuresis unrelated to drug therapy Hyperglycemia in the absence of diabetes Respiratory rate of seven breaths per minute Bradycardia with sudden increase in blood pressure

Hyperglycemia in the absence of diabetes hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachypnea and tachycardia.

First line oral hypertensive drugs for preclampsia in pregnancy

Labetolol Methyldopa Long acting nifedipine Other B-Blockers

acute respiratory distress syndrome (ARDS) diuretic

Lasix (add Mannitol)

priority intervention to improve Mr. Habib's respiratory status and hypoxemia?

Mechanical ventilation and PEEP are commonly used to keep the lungs partially expanded to prevent the alveoli from totally collapsing. Even with mechanical ventilation and PEEP, it may be necessary to increase the FIO2 >60% to maintain the PaO2 60 mm Hg. In this case, alternative modes of ventilation and respiratory therapies may be considered and include airway pressure release ventilation, pressure-control inverse ratio ventilation, high-frequency ventilation, and permissive hypercapnia. Continuous lateral rotation therapy/kinetic therapy and prone positioning of patients with ARDS may also be used to improve the PaO2. This may allow for a reduction in the FIO2 or amount of PEEP, when patients do not respond to other strategies to increase PaO2. Prone positioning may promote oxygenation by increasing perfusion to air-filled, nonatelectatic alveoli in the upper portion of the lung.

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse is the best indicator that these therapies have been effective? a. Bowel sounds are present. b. Abdominal pain is decreased. c. Electrolyte levels are normal. d. Grey Turner sign resolves.

b

Nursing Responsibilities for mothers taking MgSO4

Monitor BP closely and FHR Monitor Resp., urine output, and DTR q 1h or as per hospital policy Calcium gluconate at bedside

possible complications that Mr. Habib is at risk for developing secondary to ARDS?

Multiple complications can result from ARDS including oxygen toxicity, sepsis, pulmonary emboli, stress ulceration and hemorrhage, paralytic ileus, acute renal failure, myocardial infarction, dysrhythmias, decreased cardiac output, anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), and, finally, multiple organ dysfunction syndrome (MODS). Complications also occur as a result of treatment of ARDS and may include ventilator-associated pneumonia, pulmonary barotrauma, oxygen toxicity, catheter-related infection, pneumoperitoneum, and laryngeal and tracheal injury from endotracheal intubation

The nurse is caring for a 72-yr-old man in cardiogenic shock after an acute myocardial infarction. Which clinical manifestations would be most concerning? Restlessness, heart rate of 124 beats/min, and hypoactive bowel sounds Mean arterial pressure of 54 mm Hg; increased jaundice; and cold, clammy skin PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and puncture site bleeding Agitation, respiratory rate of 32 breaths/min, and serum creatinine of 2.6 mg/dL

PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and puncture site bleeding Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold and clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock.

An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. The nurse would expect which clinical manifestation? a. Pallor b. Edema c. Confusion d. Restlessness

b

During routine hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check the blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs

b

Abruptio Placentae:

Premature separation of the placenta is the detachment of part or all of the placenta from its implantation site.

Based on the assessment data presented, what are the priority nursing diagnoses?

Priority nursing diagnoses: impaired gas exchange, ineffective airway clearance, ineffective breathing pattern, anxiety, excess fluid volume, imbalanced nutrition: less than body requirements

Edmonton Symptom Assessment System (ESAS)

Provides a clinical profile of symptom severity over time Assess 10 common symptoms: pain, tiredness (lack of energy), drowsiness (feeling sleepy), nausea, lack of appetite, SOB, depression (feeling sad), anxiety (feeling nervous), well-being (overall feeling) and constipation. Scale of 1-10, measures severity only (not quality, impact, etc)

second line oral hypertensive drugs for preclampsia in pregnancy

Second line oral drugs Hydralazine (apresoline)—arterial vasodilator • effectively lowers BP without adverse fetal effects

Eclampsia Emergency: Tonic-Clonic Convulsion Signs

Stage of invasion—2 to 3 seconds: eyes are fixed; twitching of facial muscles occurs Stage of contraction—15 to 20 seconds: eyes protrude and are bloodshot; all body muscles are in tonic contraction Stage of convulsion—Muscles relax and contract alternately (clonic); respirations are halted and then begin again with long, deep, stertorous inhalation; coma ensues

Regular P wave: hidden QRS wave Wide and bizarre Interventions: CAB, immediate cardiopulmonary resuscitation (CPR) and defibrillation.

ventricular tachycardia

A client is receiving support through an intra-aor琀椀c balloon counterpulsa琀椀on. The catheter for the balloon is inserted in the right femoral artery. The nurse evaluates the following as a complica琀椀on of the therapy:

The right foot is cooler than the le昀琀 foot.

What are the possible causes of ARDS in Mr. Habib?

There is probably no one cause of ARDS in Mr. Habib, but rather a combination of insults, including multiple blood transfusions (transfusion-related acute lung injury), multiple traumas, hypovolemic shock, and sepsis caused by escaped bacteria from open bowel injuries.

PPS (Palliative Performance Scale)

Tool for measuring functional performance (level of functioning appears to be most important indicator of prognosis) 5 categories: ambulation, activity & evidence of disease, self-care, intake, conscious level

MgSO4 toxicity symptoms

Toxicity-sweating, nausea, warm, diplopia, slurred speech, depressed reflexes, muscular weakness, circulatory collapse & respiratory paralysis---cardiac arrest

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? a. Auscultate for a bruit at the fistula site. b. Assess the quality of the left radial pulse. c. Compare blood pressures in the left and right arms. d. Irrigate the fistula site with saline every 8 to 12 hours.

a The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

ØCare provided in the last days or weeks of life a. end of life care b. hospice palliative care c. palliative care

a end of life

the pregnant client with a chronic hypertensive disorder: an obese 36 year old multigravid ct at 12 weeks gestations has a history of chronic HTN. she was treated with Methyldopa (aldomet) before becoming pregnant. when counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when she states which of the following? a. i need to reduce caloric intake to 1200 calories a day b. a regular diet is recommended during pregnancy c. i should eat more frequent meals if i get heartburn d. i need to consume more fluids and fiber each day

a i need to reduce caloric intake to 1200 calories a day

Ventricular tachycardia (V-tach)

a very rapid heartbeat that begins within the ventricles Amiodarone, IV Mg, EPI

after completion of Peritonial dialysis the nurse should expect the client to exhbit which of the following? a. hematuria b. wt loss c. hypertension d. increased urine output

b

after instructing a multigravida client at 10 weeks gestation diagnosed with chronic hypertension about the need for frequent prenatal visits, the nurse determines that the instructions have been successful when the client states which of the following? a. i may develop hyperthyroidism because of my high blood pressure b. i need close monitoring because i may have a small for gestational infant c. its possible that i will have excess amniotic fluid and may need a c section d. i may develop placenta accreta, so i need to keep my clinic appointments

b

Risk factors associated with necrotizing enterocolitis (NEC) include (Select all that apply): a. Polycythemia. b. Anemia. c. Congenital heart disease. d. Bronchopulmonary dysphasia.e. Retinopathy.

abc (Risk factors for NEC include asphyxia, respiratory distress syndrome, umbilical artery catheterization, exchange transfusion, early enteral feedings, patent ductus arteriosus, congenital heart disease, polycythemia, anemia, shock, and gastrointestinal infection.Bronchopulmonary dysphasia and retinopathy are not associated with NEC.)

a teenager with acute renal failure has an arteriovenous shunt n place for hemodialysis. which of the following activities are appropriate for the client? sata a. video games b. jogging c. swimming d. roller blading e. soccer

abd

Asystole

absence of contractions of the heart (flat line) - Tx: IV access, EPI 1 mg q3-5 mins, advanced airway, capnography

proteinuria in mild preclampsia?

absent

A client with severe vomiting and diarrhea has a blood pressure of 90/70 mm Hg and pulse of 120/min. IV fluids of 2-liter normal saline were administered. Which parameters indicate that adequate rehydration has occurred? Select all that apply. a. Cap refill is less than 3 seconds b. Pulse pressure is narrowed c. SBP drops only when standing d. Urine output is 360 ml in 4 hours e. Urine specific gravity is 1.020

ade This client's initial vital signs show tachycardia and hypotension, which are classic signs of hypovolemia. Normal capillary refill is less than 3 seconds and is an indication of normal hydration and perfusion (Option 1). Obligatory urine output is 30 mL/hr, and this client has 90 mL/hr. Urine output is one of the best indicators of adequate rehydration (Option 4). The urine specific gravity is within a normal range (1.003 to 1.030), which can indicate normal hydration (Option 5). (Option 2) Narrowing pulse pressure (the difference between systolic and diastolic) is a sign of hypovolemic shock and would not indicate adequate rehydration. The client arrived with a narrow pulse pressure already. (Option 3) This is indicative of orthostatic vital signs. When a client stands, the body normally vasoconstricts to maintain the blood pressure from the effects of gravity. If a client is dehydrated, the body has already maximally vasoconstricted, and there is no compensatory mechanism left to adjust to the position change. Educational objective: Signs of adequate hydration are normal urine specific gravity (1.003 to 1.030), adequate volume of urine output (>30 mL/hr), and capillary refill of less than 3 seconds. Pulse pressure narrows in shock, and positive orthostatic vital signs (decreasing systolic blood pressure and rising heart rate) with position change indicate dehydration.

a client presents to the community health experiencing rapidly increasing symptoms of anaphylactic shock. which nursing action on would be completed first? obtain health history administer EPI obtain the name and information of the allergic substance call 911

administer EPI

Nursing management of the patient with acute pancreatitis includes (select all that apply) a. checking for signs of hypocalcemia. b. providing a diet low in carbohydrates. c. giving insulin based on a sliding scale. d. observing stools for signs of steatorrhea. e. monitoring for infection, particularly respiratory tract infection. (Lewis 1042)

ae

Asterixis

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

total absence of ventricular electrical activity prognosis poor Treatment: IV/IO access epinephrine 1 mg every 3 to 5 minutes consider advanced airway capnography

asystole

P wave represents

atrial depolarization (atrial contraction)

A patient is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate? a. "Is there any history of IV drug use?" b. "Are you taking corticosteroids for any reason?" c. "Do you use any over-the-counter (OTC) drugs?" d. "Have you recently traveled to a foreign country?"

c

The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Acetaminophen b. Calcium phosphate c. Magnesium hydroxide d. Multivitamin with iron

c

Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a. Start continuous pulse oximetry. b. Restrict physical activity to bed rest. c. Restrict the patient's oral protein intake. d. Discontinue the urethral retention catheter.

b. Restrict physical activity to bed rest. The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

The nurse is aware of potential complications related to cirrhosis. Which interventions would be included in a safe plan of care (select all that apply.)? A. Provide a high-protein, low-carbohydrate diet. B. Teach the patient to use soft-bristle toothbrush and electric razor. C. Teach the patient to avoid vigorous blowing of nose and coughing. D. Apply gentle pressure for the shortest possible time after venipuncture. E. Use the smallest gauge needle possible when giving injections or drawing blood. F. Instruct the patient to avoid aspirin and nonsteroidal antiinflammatory (NSAIDs).

bcef Using the smallest gauge needle for injections, using a soft bristle toothbrush and an electric razor will minimize the risk of bleeding into the tissues. (Liver cirrhosis also reduces absorption of VitK nd increases bleeding tendency) Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk ofbleeding. Aspirin and NSAIDs should not be used in patients with liver disease becausethey interfere with platelet aggregation, thus increasing the risk for bleeding. A low-salt, low-protein, high-carbohydrate diet may be recommended

A patient with cirrhosis has increased abdominal girth from ascites. Which items identify the pathophysiology related to ascites (select all that apply.)? A. Hepatocytes are unable to convert ammonia to urea. B. Osmoreceptors in the hypothalamus stimulate thirst. C. An enlarged spleen removes blood cells from the circulation. D. Portal hypertension causes leaking of protein and water into the peritoneal cavity. E. Aldosterone is released to stabilize intravascular volume by saving salt and water. F. Inability of the liver to synthesize albumin reducing intravascular oncotic pressure.

bdef

A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a. Urine volume b. Creatinine level c. Glomerular filtration rate (GFR) d. Blood urea nitrogen (BUN) level

c GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago? a. Dry palpebral and oral mucosa b. Crackles at bilateral lung bases c. Temperature 100.8° F (38.2° C) d. No bowel movement for 4 days

c Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions, but do not indicate a need for urgent action.

A patient in acute respiratory failure as a complication of COPD has a PaCO2 of 65 mm Hg, rhonchi audible in the right lung, and marked fatigue with a weak cough. The nurse will plan to: a. allow the patient to rest to help conserve energy. b. arrange for a humidifier to be placed in the patient's room. c. position the patient on the right side with the head of the bed elevated. d. assist the patient with augmented coughing to remove respiratory secretions.

d

A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive aprescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg

c. Hemoglobin level 13 g/dL High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when erythropoietin (EPO) is administered to a target hemoglobin of greater than 12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.

systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg before 20 weeks

chronic prepreg hypertension

Sinus bradycardia symptoms

dizziness hypotension SOB hypothermia angina syncope

Disseminated Intravascular Coagulation (DIC)

characterized by the profuse bleeding that results from the depletion of platelets and clotting factors that occurs as a result of an underlying disease or condition.

A patient complains of leg cramps during hemodialysis. The nurse should: a. massage the patient's legs. b. reposition the patient supine. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.

d

Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern? a. The patient's skin has multiple spider-shaped blood vessels on the abdomen. b. The patient has ascites and a 2-kg weight gain from the previous day. c. The patient complains of right upper-quadrant pain with abdominal palpation. d. The patient's hands flap back and forth when the arms are extended.

d The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper-quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurologic status.

during a home visit to a 16 year old client at a 34 week gestation diagnosed with mild preeclampsia assessment reveals that the client has gained 2 lb in the past week and her current BP is 130/86 mmHg which of the following assessment findings would provide further evidence to support the client's diagnosis? a. pounding headache after reading b. history of UTI c. frequent voiding in large amounts d. mild edema in hands and face

d - from fluid retention headache a more nonsevere form of preclampsia

Which nursing action is a priority when the nurse is caring for a patient with pancreatic cancer? a. Offer high-calorie, high-protein dietary choices. b. Offer psychologic support for anxiety or depression. c. Educate about the need to avoid scratching pruritic areas. d. Administer prescribed opioids to relieve pain as needed.

d Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to education, or manage anxiety or depression.

A client is being discharged after having a stent placed in the left anterior descending coronary artery. The client is prescribed clopidogrel. Which client data obtained by the nurse would be concerning in relation to this new medication? Select all that apply. a. BP of 140/84 mm Hg b. HR of 98 c. Platelet count of 200,000 d. Report of Ginkgo biloba use e. Report of peptic ulcer disease

de Antiplatelet agents (eg, clopidogrel, ticagrelor, prasugrel, aspirin) prevent platelet aggregation and are given to clients to prevent stent re-occlusion. They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage. Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding. This information should be reported to the prescribing health care provider before the client is discharged. (Option 1) This blood pressure is slightly elevated, but is unaffected by antiplatelet agents. (Option 2) Normal heart rate is between 60/min-100/min. (Option 3) This is a normal platelet count (150,000/mm3-400,000/mm3 [150-400 x 109/L]). Educational objective:If a client is prescribed clopidogrel, the nurse should be concerned about a history of peptic ulcer disease and Ginkgo biloba use. In this situation, the client would be at increased risk for bleeding. This data should be reported to the prescribing health care provider before the client is discharged.

A client is receiving a continuous heparin infusion and the most recent aPTT is 140 seconds. The nurse notices blood oozing at the surgical incision and IV insertion sites. What interventions should the nurse implement? Select all that apply. a. Continue heparin infusion and recheck aPTT in 6 hours b. Prepare to administer vitamin K c. Redraw blood for laboratory tests d. Review guidelines for administration of protamine e. Stop infusion of heparin and notify the HCP

de The nurse should stop the infusion of heparin when there is evidence of bleeding. The HCP should be notified immediately and the nurse should be prepared to give protamine if ordered.

At what point in shock does metabolic acidosis occur? Compensation Irreversible Early Decompensation (Progressive)

decompensation

Cullen's sign

ecchymosis in umbilical area, seen with pancreatitis

Creatinine in preclamp vs severe preclamp

elevated in severe preclampsia

HELLP syndrome

hemolysis, elevated liver enzymes, low platelets

ØCare aimed at improving the quality of life of clients with life-threatening illness and of their families through the relief of pain and suffering. a. end of life care b. hospice palliative care c. palliative care

hospice palliative care

The central venous pressure (CVP) reading in hypovolemic shock is typically which of the following high low normal unable to measure

low

reflexes in mild preclampsia?

normal

ØAn approach that improves the quality of life of clients and their families facing problems associated with life-threatening illness

palliative care

Gordon's functional assessment as part of nursing assessment in palliative care is used to evaluate:

patient's abilities, food and fluid intake, patterns of sleep and rest and response to stress of terminal state

If magnesium toxicity is suspected, then?

the infusion should be discontinued immediately. Calcium gluconate, the antidote for magnesium sulphate, may also be ordered (10 mL of a 10% solution, or 1 g) and given by slow IV push (usually by the physician) over at least 3 minutes to avoid undesirable reactions such as dysrhythmias, bradycardia, and ventricular fibrillation, or may be given as a mini-bag infusion over 15 to 30 minutes by the nurse.

Ventricular fibrillation

the rapid, irregular, and useless contractions of the ventricles CPR, defibrillator, and epi

What priority interven琀椀on can the nurse provide to decrease the incidence of sep琀椀c shock for pa琀椀ents who are at risk

use strict hand hygiene techniques

cirrhosis of the liver for the diuretic

spironolactone

How does the pathophysiology of ARDS predispose to the development of refractory hypoxemia?

- Initially, damage to the alveolar-capillary membrane results in increased capillary permeability, which leads to interstitial edema and eventually alveolar edema. - This creates an intrapulmonary shunt (severe V/Q mismatch) because the alveoli fill with fluid and the blood passing through them cannot be oxygenated, no matter what concentration of inspired oxygen is delivered. - In addition, alveolar type I and type II cells, which produce surfactant, are damaged by the changes caused by ARDS. Inactivation of surfactant by these changes of ARDS causes the alveoli to become unstable and collapse, resulting in atelectasis. - The widespread atelectasis creates a severe V/Q mismatch that contributes to hypoxemia because airflow to the alveoli is limited. Hyaline membrane formation of the alveolar membranes also contributes to the development of fibrosis and atelectasis, leading to a decrease in gas-exchange capability and lung compliance. - Overall, the severe V/Q mismatch and shunting of pulmonary capillary blood result in hypoxemia unresponsive to increasing concentrations of oxygen because oxygen can neither be delivered to the alveoli nor diffuse across the alveolar-capillary membrane.

the membranes of a multigravida client in active labour rupture spontaneously, revealing greenish coloured amniotic fluid. the nurse interprets this finding as related to which of the following? 1. passage of meconium by the fetus 2. maternal intrauterine infection 3. Rh incompatibility between mother and fetus 4. maternal sexually transmitted disease

1 greenish coloured amniotic fluid is caused by the passage of meconium usually secondary to a fetal insult during labour. meconium passage also may be related to an intact gastrointestinal system of the neonate, esp. those neonates who are full term or of postdate gestational age. amnioinfusion may be used to treat the condition dilute the fluid. cloudy amniotic fluid is associated with an infection caused by bacteria or a sexually transmitted disease. severe yellow coloured fluid is associated with incompatibility or erythoblastosis fetalis.

which of the following nursing diagnoses would be priority for a client with ARDS? 1. ineffective breathing pattern 2. pain 3. ineffective health maintenance 4. risk for infection

1 ineffective breathing patterns is a priority nursing diagnosis for the client with ARDS. the massive shift from the capillaries to the alveoli as well as the reduced surfactant greatly increases the work of breathing. the lungs becomes stiff and noncompliant and the client becomes severely hypoxic. the client with ards usually requires endotracheal intubation and mechanical ventilation. pain and ineffective health maintenance are not priority nursing dx for a ct with ards. although he client may be at risk for development of an infection, a higher nursing priority is maintaining an airway.

A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia? 1. Intravenous calcium gluconate 2. Intravenous regular insulin with dextrose 3. Oral sodium polystyrene sulfonate 4. Transport to hemodialysis unit

1 Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence. Once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis) (Option 1). (Option 2) Intravenous regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells. Dextrose is administered concurrently to prevent hypoglycemia. Although intravenous regular insulin will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. (Option 3) Sodium polystyrene sulfonate causes excretion of potassium from the body via the gastrointestinal tract. Although this will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. (Option 4) Although hemodialysis will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias.Educational objective: The priority in treatment of hyperkalemia with ECG changes (eg, peaked T waves) is administration of intravenous calcium gluconate to prevent life-threatening dysrhythmias. Once calcium gluconate is administered, prescriptions to correct serum potassium (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis) may be implemented. Physiological Adaptation

The nurse is preparing to administer morning medications to a client with type 2 diabetes mellitus and end-stage renal disease who is scheduled for dialysis today. Which medication should the nurse hold for clarification prior to administration? Click the exhibit button for more information. Allergies: None Medications + Time: Atenolol 50 mg by mouth daily, 0900 Calcium acetate 667 mg by mouth, With each mealInsulin lispro, high-dose sliding-scale SQ injection with meals and before bedtime, 0730Vitamin E 400 IU by mouth daily, 0900 1. Atenolol 2. Calcium acetate 3. Insulin lispro 4. Vitamin E

1 Medication administration may require modification on days that clients are scheduled to receive dialysis. The nurse should consider whether the medication will be dialyzed out of the client's system or may create adverse effects during dialysis. Fluid is removed during dialysis, which may cause hypotension. Typically, antihypertensives are held before dialysis to prevent hypotension. In addition, some medications are dialyzed out of the client's system and should therefore be held until after dialysis. C ommonly held medications are water-soluble vitamins (eg, vitamins B and C), antibiotics, and digoxin.(Option 2) Clients with chronic kidney disease have high phosphorus levels as the kidney is unable to filter the phosphate from the body; dialysis also does not filter it. Therefore, the client should still take phosphate binders prior to dialysis. Phosphate binders (eg, calcium containing [calcium carbonate and calcium acetate]) and non-calcium containing [sevelamer and lanthanum]) block absorption of ingested phosphate from the intestine and excrete it through feces.(Option 3) Lispro is a fast-acting insulin that should be given 15-30 minutes before meals. It is appropriate to give scheduled lispro with breakfast prior to dialysis.(Option 4) Vitamin E is a fat-soluble vitamin that is not affected by dialysis. It is given to some clients to prevent leg cramps that can be experienced by dialysis clients.Educational objective: Unless otherwise indicated by the health care provider, antihypertensives and other blood pressure-lowering medications (eg, furosemide), antibiotics, digoxin, and water-soluble vitamins (B, C, and folic acid) should be held prior to dialysis.Pharmacological and Parenteral Therapies

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, PaCO2 50 mm Hg (50 mm Hg) 2. pH 7.35, PaCO2 40 mm Hg (40 mm Hg) 3. pH 7.50, PaCO2 52 mm Hg (52 mm Hg) 4. pH 7.52, PaCO2 28 mm Hg (28 mm Hg)

1 Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal PaCO2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis, the pH is decreased and the PaCO2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition, and option 4 identifies respiratory alkalosis.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? 1. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." 2. "I need to take good care of my belly and ankle skin where it is swollen."" 3. A scrotal support may be more comfortable when I have scrotal edema." 4. "I can use pillows to support my head to help me breathe when I am in bed."

1 If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, as this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? 1. Milk thistle may affect liver enzymes and thus alter drug metabolism. 2. Milk thistle is generally safe in recommended doses for up to 10 years. 3. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. 4. Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

1 Milk thistle may affect liver enzymes and thus alter drug metabolism.There is good scientific evidence that there is no real benefit from using milk thistle to protect the liver cells from toxic damage in the treatment of cirrhosis. Milk thistle does affect liver enzymes and thus could alter drug metabolism. Therefore patients will need to be monitored for drug interactions. It is noted to be safe for up to 6 years, not 10 years, and it may lower, not elevate, blood glucose levels.

The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing base products

1 Rationale: Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis. The remaining options are incorrect. Respiratory alkalosis is associated with hyperventilation. There are no data in the question that indicate calcium loss or that the client is taking analgesics containing base products. Test-Taking Strategy: Focus on the data in the question . Think about the location of the ribs to determine that the client will have difficulty breathing adequately. This will assist in directing you to the correct option. Remembering that hypoventilation results in respiratory acidosis will direct you to the correct option

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)? 1. Use smallest gauge needle possible when giving injections or drawing blood. 2. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. 3. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. 4. Apply gentle pressure for the shortest possible time period after performing venipuncture. 5. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

1235 Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding.

The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? Select all that apply. 1. Assess for abdominal distention and constipation 2. Contact the client's health care provider 3. Examine the catheter for kinks and obstructions 4. Flush the tubing with 100 mL of dialysate 5. Place the client in a side-lying position

135 Peritoneal dialysis uses the abdominal lining (ie, peritoneum) as a semipermeable membrane to dialyze a client with insufficient renal function. A catheter is placed into the peritoneal cavity, and dialysate (ie, dialysis fluid) is infused. The tubing is clamped to allow the fluid to remain in the cavity, usually for 20-30 minutes (dwell phase). The catheter is then unclamped to allow dialysate to drain via gravity.Insufficient outflow results most often from constipation when distended intestines block the catheter's holes. If outflow becomes sluggish, the nurse should assess the client's bowel patterns and administer appropriate prescribed medications (eg, stool softeners) (Option 1). The nurse should also check the tubing for kinks and reposition the client to a side-lying position or assist with ambulation (Options 3 and 5). The drainage bag should be maintained below the abdomen to promote gravity flow. The nurse should assess for fibrin clots and milk the tubing to dislodge or administer fibrinolytics (eg, alteplase) as prescribed. If these measures are ineffective, an x-ray may be needed to check the catheter location. (Options 2 and 4) The nurse should identify the problem before instilling additional fluids and perform routine assistive measures before contacting the health care provider. Educational objective: Insufficient outflow from peritoneal dialysis commonly results from constipation; bowel movements should be monitored and stool softeners administered as prescribed. Additional nursing measures include checking the tubing for kinks or clots; maintaining the drainage bag below the abdomen; and placing clients in a side-lying position or assisting with ambulation.Physiological Adaptation

a nurse is analyzing a client's intake and output. the client has a temperature of 38.9C and is receiving IV fluid therapy because of his NPO due to acute pancreatitis. before planning nursing actions, the nurse should first consider which of the following details? 1. the client's body mass index 2. insensible fluid loss through the lungs and skin 3. when the client last ate 4. the number of bags of IV fluid for the client

2

signs and symptoms of which of the following is a priority when caring for a newly delivered term neonate diagnosed as small for gestational age? 1. iron deficiency anemia 2. birth asphyxia 3. persistent pulmonary hypertension 4. hyperglycemia

2

the nurse is assessing an adolescent who is in the oliguric stage of ARF. the child weighs 100 kg which of the following indicates that treatment is effective? 1. the child has gained 2 kg 2. the urine output is 300ml/hr 3. the respirattions are 14 4. the heart rate is 100

2

the nurse is planning care for a child with renal failure who is recieving epotein alfa (epogen). which of the following is an expected outcome of this drug? 1. increased gfr 2. increased rbc count 3. normal urinary output 4. normal potassium levels

2

You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? 1. Pruritus 2. Dyspnea 3. Jaundice 4. Peripheral Neuropathy

2 Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing. The others are signs of cirrhosis that aren't relieved by paracentesis.

A 64-yr-old woman is admitted to the emergency department vomiting bright red blood. The patient's vital signs are blood pressure of 78/58 mm Hg, pulse of 124 beats/min, respirations of 28 breaths/min, and temperature of 97.2°F (36.2°C). Which physician order should the nurse complete first? 1. Obtain a 12-lead ECG and arterial blood gases. 2. Rapidly administer 1000 mL normal saline solution IV. 3. Administer norepinephrine (Levophed) by continuous IV infusion. 4. Carefully insert a nasogastric tube and an indwelling bladder catheter.

2 Isotonic crystalloids, such as normal saline solution, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products. Other orders (e.g., insertion of nasogastric tube and indwelling bladder catheter and obtaining the diagnostic studies) can be initiated after fluid resuscitation is initiated.

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PaCO2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L (145 mmol/L) 2. Potassium level of 3.0 mEq/L (3.0 mmol/L) 3. Magnesium level of 1.3 mEq/L (0.65 mmol/L) 4. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

2 Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia. Test-Taking Strategy: Note the strategic words, most likely. Focus on the data in th e question and use knowledge about the interpretation of arterial blood gas values to determine that the client is experiencing respiratory alkalosis. Next, recall the manifestations that occur in this condition and the normal laboratory values. The only abnormal laboratory value is the potassium level, the correct option.

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PaCO2 of 30 mm Hg (30 mm Hg), and HCO3 À of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated

2 Rationale: The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the PaCO2. In this situation, the pH is at the high end of the normal value and the PCO2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred. Test-Taking Strategy: Focus on the subject, arterial blood gas results. Remember that in a respiratory imbalance you will find an opposite response between the pH and the PCO2 as indicated in the question. Therefore, you can eliminate the options reflective of a primary metabolic problem. Also, remember that the pH increases in an alkalotic condition and compensation can be evidenced by a normal pH. The correct option reflects a respiratory alkalotic condition and compensation and describes the blood gas values as indicated in the question. Review: The steps related to analyzing arterial blood gas results and the findings noted in respiratory alkalosis

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit? 1. Hematochezia 2. Left upper abdominal pain 3. Ascites and peripheral edema 4. Temperature over 102o F (38.9o C)

2 Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care? 1. Immediately start enteral feeding to prevent malnutrition. 2. Insert an NG and maintain NPO status to allow pancreas to rest. 3. Initiate early prophylactic antibiotic therapy to prevent infection. 4 Administer acetaminophen (Tylenol) every 4 hours for pain relief.

2 Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

the nurse interprets which of the following as an early sign of acute respiratory distress syndrome in a client at risk? 1. elevated carbon dioxide level 2. hypoxia not responsive to oxygen therapy 3. metabolic acidosis 4. severe unexplained electrolyte imbalance

2 a hallmark of early ARDS is hypoxia.

the nurse is assessing the extent of generalized edema for the child with arf. which of the following is the most effective wway to assess this child for edema? 1. document changes in vs 2. note swelling around the eyes 3. measure abdominal girth 4. track changes in daily weight

4

the nurse makes a home visit to a primiparous client and her neonate at 1 week after a vaginal delivery. which of the following findings should be reported to the physician? 1. a scant amount of maternal lochia serosa 2. the presence of a neonatal tonic neck reflex 3. a non-palpable maternal fundus 4. neonatal central cyanosis

4

which of the following is a major risk factor for having a low birth weight baby? 1. heredity 2. age 3. drug use during pregnancy 4. poor nutrition

4

The nurse prepares to instill dialysate for a client receiving peritoneal dialysis. Which nursing action is the priority? 1. Ensuring that the drainage collection bag is below the level of the abdomen 2. Placing the client in the semi-Fowler position 3. Recording the characteristics of output dialysate 4. Using sterile technique when spiking and attaching the bag of dialysate

4 In peritoneal dialysis (PD), the abdominal lining (peritoneum) is used as a semipermeable membrane to dialyze clients with decreased kidney function. A catheter is placed in the peritoneal cavity for infusing and draining dialysate (dialysis fluid). Dialysate is infused and dwells in the abdomen, which allows waste products and electrolytes to cross the peritoneum into the dialysate for removal. After the prescribed dwell time, the dialysate, electrolytes, and wastes are drained via gravity.When administering PD, it is essential to use sterile technique when spiking and attaching bags of dialysate to the client's PD catheter to prevent contamination and infection (Option 4). Bacterial peritonitis, an infection of the peritoneum, is a potential complication of PD that may lead to sepsis. Signs of peritonitis should be reported to the health care provider. (Options 1 and 2) Proper positioning of the catheter drainage bag (ie, below the abdomen) and the client (eg, Fowler or semi-Fowler position) promotes effluent outflow but is not a priority over infection prevention.(Option 3) Cloudy effluent may indicate infection, whereas bloody or brown effluent may indicate bowel perforation. Documenting effluent characteristics is important but not a priority over maintaining asepsis. Educational objective: Peritoneal dialysis (PD) uses the peritoneum as a semipermeable membrane to dialyze clients with decreased kidney function. Bacterial peritonitis is a potential complication of PD. Using sterile technique when spiking or changing bags of dialysate is a priority to avoid contamination and reduce the risk of peritonitis.Physiological Adaptation

which of the following interventions would be most likely to prevent development of acute respiratory distress syndrome? 1. teaching cigarette smoking cessation 2. maintaining adequate serum potassium levels 3. monitoring clients for signs of hypercapnia 4. replacing fluids adequately during hypovolemic states

4 hypovolemic shock is a major risk factor for ARDS.

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/ minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1. A decreased pH and an increased PaCO2 2. An increased pH and a decreased PaCO2 3. A decreased pH and a decreased HCO3 À 4. An increased pH and an increased HCO3 À

4 Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3 À to increase. Symptoms experienced by the client would include hypoventilation and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition.

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PaCO2 is 90 mm Hg (90 mm Hg), and HCO3 À is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation

4 The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal PaCO2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis the pH is decreased and the PCO2 is elevated. The normal bicarbonate (HCO3 À) level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acidbase disturbance. In addition, the pH is not within normal limits. Therefore, the condition is without compensation. The remaining options are incorrect interpretations.

A week after kidney transplantation, a client develops a temperature of 101 °F (38.3 °C), the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? 1. Antibiotic therapy 2. Peritoneal dialysis 3. Removal of the transplanted kidney 4. Increased immunosuppression therapy

4 Acute rejection most often occurs within 1 week after transplantation but can occur any time posttransplantation. Clinical manifestations include fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with hyperacute rejection, which occurs within 48 hours of the transplant surgery.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

4 Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome.

A client with advanced cirrhosis with ascites is short of breath and has an increased respiratory rate. Which of the following actions should the nurse implement? 1. Initiate oxygen therapy at 2 L/minute to increase gas exchange. 2. Notify the health care provider so a paracentesis can be performed. 3. Ask client to cough and deep breathe to clear respiratory secretions. 4. Place the client in Fowler's position to relieve pressure on the diaphragm.

4 Dyspnea is a frequent problem for the patient with ascites, and a semi-Fowler's or Fowler's position allows for maximal respiratory efficiency. Oxygen administration is not indicated; SpO2 level less than 90% would be an indication for oxygen. The respiratory distress is caused by ascites (not by respiratory secretions); coughing and deep breathing will not alleviate the respiratory distress. A paracentesis may be performed to remove ascitic fluid; however, this procedure is only a temporary measure and is reserved for severe respiratory distress or abdominal pain.

The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH 7.53, PaO2 72 mm Hg (72 mm Hg), PaCO2 32 mm Hg (32 mm Hg), and HCO3 28 mEq/L(28 mmol/L). Which conclusion about the client should the nurse make? 1. The client has acidotic blood. 2. The client is probably overreacting. 3. The client is fluid volume overloaded. 4. The client is probably hyperventilating.

4 The ABG values are abnormal, which supports a physiological problem. The ABGs indicate respiratory alkalosis as a result of hyperventilating, not acidosis. Concluding that the client is overreacting is an insufficient analysis. No conclusion can be made about a client's fluid volume status from the information provided

the. family of an elderly client with terminal cancer inquiries about hospice services. the nurse explains that hospice care: 1. focuses only on the needs of the client 2. can only be provided in the inpatient setting 3. is staffed exclusively by professional health care workers 4. focuses on supportive care for the client and family

4 hospice care focuses on supportive care for the client and family. care for the family may continue throughout the bereavement period. hospice care involves care of the client at home as well as in an inpatient setting. although professional care is provided in hospice, family members, volunteers and unlicensed nursing personnel also participate in the care ofthe client.

. The nurse has calculated a low PaO2 /FIO2 (P/F) ratio < 150 for a client with acute respiratory distress syndrome (ARDS). The nurse should place the client in which position to improve oxygenation, ventilation distribution, and drainage of secretions? 1. Supine. ■ 2. Semi-fowlers. ■ 3. Lateral side. ■ 4. Prone.

4 Prone positioning is used to improve oxy- genation in clients with acute respiratory distress syndrome (ARDS) who are receiving mechanical ventilation. The positioning allows for recruit- ment of collapsed alveolar units, improvement in ventilation, reduction in shunting, mobiliza- tion of secretions, and improvement in functional reserve capacity (FRC). When the client is supine, side-to-side repositioning should be done every 2 hours with the head of the bed elevated at least 30 degrees.

TABLE 14-4 ASSESSING DEEP TENDON REFLEXES Brisk, Hyperactive grade

4+

What Laboratory test is a key diagnostic indicator of heart failure?

BNP

severe HDP BP parameters

BP ≥ 160/110 - ↑ risk of maternal stroke in pregnancy

patho of HDP

Initially: placental ischemia (from any factor) → hypoperfusion → local vasospam (kidneys = glomerular damage, oliguria, proteinuria; retina = scotima, blurry flashing lights; liver = RUQ pain liver enzymes) → proinflammatory proteins (released into maternal circulation) → caues endotherlial cells dysfunction → L/t thrombi formation causes platelets used up, vasoconstriction, kidneys retention Na = HTN

The health care provider prescribes pancreatin (Viokase) for a patient with chronic pancreatitis. The nurse teaches the patient that the drug is considered effective if the patient experiences: a. normal-appearing stools. b. decreased jaundice. c. improved appetite. d. reduced abdominal pain.

a

Which of the following positions would be an appropriate for a client with severe ascites? a. Fowlers b. Side lying c. Reversed Tretenburg d. Sims

a

which of the following findings is the best indication that fluid replacement for the client in Hypovolemic shock is adequate? a. urine output greater than 30 mL/hour b. SBP greater than 110 mmHg c. DBP greater than 90 mmHg d. RR of 20 bpm

a

which of the following is a risk factor for hypovolemic shock? a. hemorrhage b. antigen-antibody reaction c. gram negative bacteria d. vasodilation

a

for the client who is receiving intravenous magnesium sulfate for severe preeclampsia which of the following assessment findings would alert the nurse to suspect hypermagnesiemia? a. decreased deep tendon reflexes b. cool skin temperature c. rapid pulse rate d. tingling in the toes

a Memorize these 3 sentences 1. Kalemias do the same as the prefix (hypo-, hyper-), except for HR and urine output which go opposite 2. Calcemias do the opposite as the prefix 3. Magnesemias do the opposite as the prefix 4. Natremias o HypoNatremia = Volume overload ... HyperNatremia = Dehydration

An infant with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which highly technical method of treatment may be necessary for an infant who does not respond to conventional treatment? a. Extracorporeal membrane oxygenation b. Respiratory support with a ventilator c. Insertion of a laryngoscope and suctioning of the trachea d. Insertion of an endotracheal tube

a Extracorporeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, thus allowing the infant's lungs to rest and recover. The infant is likely to have been first connected to a ventilator. Laryngoscope insertion and tracheal suctioning are performed after birth before the infant takes the first breath.An endotracheal tube will be in place to facilitate deep tracheal suctioning and ventilation.

wht diet should be implemented fora client who is in the early stages of cirrhosis? a. high cal high carb b. high protein low fat c. low fat low protein d. high carb low protein

a do not restrict Na, fat, or protein during early stages

A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient now has a serum sodium level of 127 mEq/L (127 mmol/L). Which prescribed therapy should the nurse question? a. Infuse 5% dextrose in water at 125 mL/hr. b. Administer 3% saline at 50 mL/hr for a total of 200 mL. c. Administer IV morphine sulfate 4 mg every 2 hours PRN. d. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for nausea.

a A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient now has a serum sodium level of 127 mEq/L (127 mmol/L). Which prescribed therapy should the nurse question?a. Infuse 5% dextrose in water at 125 mL/hr.b. Administer 3% saline at 50 mL/hr for a total of 200 mL.c. Administer IV morphine sulfate 4 mg every 2 hours PRN.d. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for nausea.

To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with: a. arterial blood gas (ABG) analysis. b. hemodynamic monitoring. c. chest x-rays. d. pulse oximetry.

a ABG analysis is useful because it provides information about both oxygenation and ventilation and assists with determining possible etiologies and appropriate treatment. The other tests may also provide useful information about patient status but will not indicate whether the patient has hypoxemia, hypercapnia, or both.

A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to: a. collect a stool specimen. b. prepare for colonoscopy. c. schedule a barium enema. d. have blood cultures drawn.

a Acute diarrhea is usually caused by an infectious process, and stool specimens are obtained for culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can accommodate larger needles. d. A fistula can be used sooner after surgery.

a Arteriovenous (AV) fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.

Nurse is preparing a client for a paracentesis which of the following activities would be appropriate before the procedure? a. HAVE The client void immediately before the procedure b. placed a client in a side lying position c. initiate an IV line to administer sedatives d. place the client and nothing by mouth or NPO status six hours before the procedure

a Immediately before a paracentesis, the client should empty the bladder to prevent perforation decline will be placed in a high Fowlers position or seated on the side of the bed for the procedure. IV sedatives are not usually administered. The client does not need to be NPO.

The nurse identifies the collaborative problem of potential complication: electrolyte imbalance for a patient with severe acute pancreatitis. Assessment findings that alert the nurse to electrolyte imbalances associated with acute pancreatitis include: a. muscle twitching and finger numbness. b. paralytic ileus and abdominal distention. c. hypotension. d. hyperglycemia.

a Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. The other data indicate other complications of acute pancreatitis but are not indicators of electrolyte imbalance.

Client with cirrhosis receives 100 ML of 25% serum albumin IV. which finding would best indicate that the albumin is having its desired effect? a. Increased, urine output b. Increase serum albumin level c. Decreased anorexia d. Increased ease of breathing

a Normal serum albumin is administered to reduce ascites. Hypoalbuminaemia a mechanism. Underlying ascites formation results in decreased colloid osmotic pressure. Administering serum albumin increase as a plasma colloidal osmotic pressure which causes fluid to flow from the tissues base into the plasma. Increased urine output is the best indication of the albumin is having the desired effect. An increase serum albumin level and increase is a breathing mean. Indirectly implied to the administration of albumin is effective in relieving the ascites. However, it is not a direct indicator as increase urine output. Anorexia is not affected by the administration of albumin.

In caring for the patient with ARDS, what is the most characteristic sign thenurse would expect the patient to exhibit? A. Refractory hypoxemia B. Bronchial breath sounds C. Progressive hypercapnia D. Increased pulmonary artery wedge pressure (PAWP)

a Rationale: Refractory hypoxemia, hypoxemia that does not respond to increasing concentrations of oxygenation by any route, is a hallmark of ARDS and is always present. Bronchial breath sounds may be associated with the progression of ARDS. PaCO2 levels may be normal until the patient is no longer able to compensate in response to the hypoxemia. Pulmonary artery wedge pressure (PAWP) that is normally elevated in cardiogenic pulmonary edema is normal in the pulmonary edema of ARDS.

Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern? a. The patient's hands flap back and forth when the arms are extended. b. The patient has ascites and a 2-kg weight gain from the previous day. c. The patient's skin has multiple spider-shaped blood vessels on the abdomen. d. The patient complains of right upper-quadrant pain with abdominal palpation.

a The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurologic status.

A patient is brought to the emergency department unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care? a. Hypercapnic respiratory failure related to decreased ventilatory effort b. Hypoxemic respiratory failure related to diffusion limitations c. Hypoxemic respiratory failure related to shunting of blood d. Hypercapnic respiratory failure related to increased airway resistance

a The patient with an opioid overdose develops hypercapnic respiratory failure as a result of the decrease in respiratory rate and depth. Diffusion limitations, blood shunting, and increased airway resistance are not the primary pathophysiology causing the respiratory failure.

The nurse is assessing a 31-year-old female patient with abdominal pain. Th nurse,who notes that there is ecchymosis around the area of umbilicus, will document this finding as a. Cullen sign. b. Rovsing sign. c. McBurney sign. d. Grey-Turner's sign

a cullen sign is ecchymosis around the umbilicus. Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower quadrant. Deep tenderness at McBurney's point (halfway between the umbilicus and the right iliac crest), known as McBurney's sign, is a sign of acute appendicitis.

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." b. "The drug keeps your baby from requiring too much sedation." c. "Surfactant is used to reduce episodes of periodic apnea." d. "Your baby needs this medication to fight a possible respiratory tract infection."

a (Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With administration of artificial surfactant, respiratory compliance is improved until the infant can generate enough surfactant on his or her own. Surfactant has no bearing on the sedation needs of the infant. Surfactant is used to improve respiratory compliance, including the exchange of oxygen and carbon dioxide. The goal of surfactant therapy in an infant with respiratory distress syndrome (RDS) is to stimulate production of surfactant in the type 2 cells of the alveoli. The clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started on broad-spectrum antibiotics to treat infection.)

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate: a. Meconium aspiration, hypoglycemia, and dry, cracked skin. b. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome. c. Golden yellow- to green stained-skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat. d. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance.

a Meconium aspiration, hypoglycemia, and dry, cracked skin.

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the: a. bowel sounds. b. blood glucose. c. blood urea nitrogen (BUN). d. level of consciousness (LOC).

a bowel sounds Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (asindicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.

The nurse is preparing to administer 40 mg of IV furosemide. Prior to administering the medication, the nurse should assess which parameters? Select all that apply. a. BP b. BUN c. Liver enzymes d. Potassium e. WBC

abd Loop diuretics (furosemide, torsemide, bumetanide) are used to treat fluid retention, such as that found in clients with heart failure or cirrhosis. When administering loop diuretics, the nurse can expect the client's kidneys to excrete a significant amount of water and potassium. When potassium is excreted at a fast rate, the client could develop hypokalemia, a medical emergency that can result in other life-threatening complications such as heart arrythmias, as well as muscle cramps and weakness (Option 4). Blood pressure should also be assessed prior to administration of loop diuretics as excess diuresis may cause intravascular volume depletion that results in low blood pressure. A client with baseline hypotension may develop a critically low blood pressure. Excess diuresis can also affect kidneys, and the blood urea nitrogen and creatinine levels can become elevated as well. Therefore, these levels should be assessed (Options 1 and 2). (Options 3 and 5) Loop diuretics typically do not cause abnormalities in white blood cell counts or liver function tests, so these do not need to be assessed routinely. Educational objective:When administering furosemide, it is important to closely monitor the client's vital signs, serum electrolytes (potassium), and kidney function tests (blood urea nitrogen, creatinine) prior to administration to prevent side effects such as hypokalemia, hypotension, and kidney injury.

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Restrict fluid intake to 1000 mL daily. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.

acd

a male client who has been taking warfarin has been admitted with severe acute rectal bleeding and the following lab results: INR 8 Hbg 11g/dL and Hmt 33%. which of the following physician orders would the nurse expect to implement initially? SATA a. administer intravenabcous dextrose 5% in 0.45% normal saline solution b. schedule patient for a sigmoidoscopy in the morning c. give 1 unit fresh frozen plasma d. administer vitamin K 2.5 mg po e. begin giving polyethylene glycol electrolyte solution in preparation for sigmoiddoscopy f. administer flet enema

acd

*Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? (Select all that apply.) A. Assessing the client's neurologic status every 2 hours B. Monitoring the client's hemoglobin and hematocrit levels C. Evaluating the client's serum ammonia level D. Monitoring the client's handwriting daily E. Preparing to insert an esophageal tamponade tube F. Making sure the client's fingernails are short

acd Hepatic encephalopathy results from an increased ammonia level due to the liver's inability to covert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should monitor the client's neurologic status, serum ammonia level, and handwriting. Monitoring the client's hemoglobin and hematocrit levels and insertion of an esophageal tamponade tube address esophageal bleeding. Keeping fingernails short address jaundice.

a client with acute respiratory distress syndrome has fine crackles at lung bases and the respirations are shallow at a rate of 28 breaths per min. the client is restless and anxious. in addition to monitoring the arterial blood gas results, the nurse should do which of the following? select all that apply. a. monitor serum creatinine and blood urea nitrogen levels b. administer a sedative c. keep the head of the bed flat d. administer humidified oxygen e. auscultate the lungs

ade ARDS may cause renal failure and superinfection so the nurse should monitor urine output and urine chemistries. treatment of hypoxemia can be complicated because changes in lung tissue leave less pulmonary tissue available for gas exchange, thereby causing inadequate perfusion. Humdified oxygen may be one means of promoting oxygenation. the client has crackles in the lung bases so the nurse should continue to assess breath sounds. sedatives should be used with caution in clients with ards. the nurse should try other measures to relieve the client's restlessness and anxiety. the head of bed should be elevated to 30 degrees to promote chest expansion and prevent atelectasis.

A client is to be discharged with a prescription for lactulose or CEPHULAC. The nurse teaches the client and the client spouse how to administer this medication. Which of the following statements would indicate the client has understood the information? a. Take it with Maalox b. ill mix it with apple juice c. I'll take it with a laxative. d. I'll mix it with crushed tablets in some gelatin.

b

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

b

The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be a. augmenting fluid volume. b. maintaining cardiac output. c. diluting nephrotoxic substances. d. preventing systemic hypertension.

b

the client with chronic renal failure complains of feeling nauseated at least part of everyday. the nurse should explain that the nausea is the result of: a. acidosis caused by the medications b. accumulation of waste products in the blood c. chronic anemia and fatigue d. excess fluid load

b

the nurse in the preoperative holding area keeps a client with gastric bleeding in a dimly lit environment with one fmaily member present. what is the primary rationale for these nursing interventions? a. to stabilize fluid and electrolyte balance b. to minimize oxygen consumption c. to increase client and fmaily comofrt d. to prevent infection

b

what is a priority assessment for the client in shock who is receiving an intravenous infusion of packed red blood cells and normal saline solution? a. fluid balance b. anaphylactic reaction c. pain d. altered level of consciousness

b

Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's: a. glucose. b. potassium. c. creatinine. d. phosphate.

b Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not.

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient's abdomen appears bloated after the inflow. d. The patient has abdominal pain during the inflow phase.

b Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: A. Meperidine provides a better, more prolonged analgesic effect. B. Morphine may cause spasms of Oddi's sphincter. C. Meperidine is less addictive than morphine. D. Morphine may cause hepatic dysfunction.

b For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn't associated with hepatic dysfunction.

A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take? a. Give both drugs as scheduled. b. Administer the spironolactone. c. Administer the furosemide and withhold the spironolactone. d. Withhold both drugs until talking with the health care provider.

b Spironolactone is a potassium-sparing diuretic and will help to increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.

A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor: a. bilirubin levels. b. ammonia levels. c. potassium levels. d. prothrombin time.

b The blood in the gastrointestinal (GI) tract will be absorbed as protein and may result in an increase in ammonia level because the liver cannot metabolize protein well. The prothrombin time, bilirubin, and potassium levels also should be monitored, but these will not be affected by the bleeding episode.

A patient with new-onset confusion and hyponatremia is being admitted. When making room assignments, the charge nurse should take which action? a. Assign the patient to a semi-private room. b. Assign the patient to a room near the nurse's station. c. Place the patient in a room nearest to the water fountain. d. Place the patient on telemetry to monitor for peaked T waves..

b The patient should be placed near the nurse's station if confused for the staff to closely monitor the patient. To help improve serum sodium levels, water intake is restricted. Therefore a confused patient should not be placed near a water fountain. Peaked T waves are a sign of hyperkalemia, not hyponatremia. A confused patient could be distracting and disruptive for another patient in a semiprivate room.

A portocaval shunt is considered for a patient with cirrhosis following an episode of bleeding esophageal varices. The nurse plans to teach the patient that this procedure a. is likely to improve the patient's life expectancy. b. will increase the risk of hepatic encephalopathy. c. will help to decrease the incidence of peritonitis. d. is a first-line therapy for portal hypertension.

b The risk for hepatic encephalopathy increases after shunt procedures because blood bypasses the portal system and ammonia is diverted past the liver and into the systemic circulation. Life expectancy is not improved. The risk for peritonitis is not decreased by a surgical procedure, which will increase infection risk. First-line procedures for portal hypertension are medications such as diuretics and albumin.

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? a. Necrotizing enterocolitis (NEC) b. Retinopathy of prematurity (ROP) c. Bronchopulmonary dysplasia (BPD) d. Intraventricular hemorrhage (IVH)

b (ROP is thought to occur as a result of high levels of oxygen in the blood. hyperoxic environment --> vasoconstriction -> retinal ischemia -> vascular endothelial growth factor creaters new weak BV -> abnormal BV fragile, hemmorhage l/t retinal distortion. NEC is caused by the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. BPD is caused by the use of positive pressure ventilation against the immature lung tissue. IVH results from rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.)

The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that: a. a lack of clotting factors promotes the collection of blood in the abdominal cavity. b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space. c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel. d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid. (Lewis 1042)

b Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity and is a common manifestation of cirrhosis. With portal hypertension, proteins shift from the blood vessels through the larger pores of the sinusoids (capillaries) into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, those substances leak through the liver capsule into the peritoneal cavity. Osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity. A second mechanism of ascites formation is hypoalbuminemia, which results from the inability of the liver to synthesize albumin. Hypoalbuminemia results in decreased colloidal oncotic pressure. A third mechanism is hyperaldosteronism, which occurs when aldosterone is not metabolized by damaged hepatocytes. The increased level of aldosterone causes increases in sodium reabsorption by the renal tubules. Sodium retention and an increase in antidiuretic hormone levels cause additional water retention.

A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria,anemia, and hyperkalemia. Which prescribed action should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

b Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor thecardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. Thecatheter allows monitoring of the urine output but does not correct the cause of the renal failure.

A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which assessment finding is the best indicator that the medication has been effective? a. The apical pulse rate is 68 beats/minute. b. Stools test negative for occult blood. c. The patient denies complaints of chest pain. d. Blood pressure is less than 140/90 mm Hg.

b Since the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury(AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a. The creatinine level is 3.0 mg/dL. b. Urine output over an 8-hour period is 2500 mL. c. The blood urea nitrogen (BUN) level is 67 mg/dL. d. The glomerular filtration rate is less than 30 mL/min/1.73 m2

b The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The otherinformation is typical of AKI and will not require a change in therapy.

A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.

b The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis.

b When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of: a. persistent skin tenting b. rapid, deep respirations. c. hot, flushed face and neck. d. bounding peripheral pulses.

b metabolic acidosis in AKI

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include: a. Hypertonia, tachycardia, and metabolic alkalosis. b. Abdominal distention, temperature instability, and grossly bloody stools. c. Hypertension, absence of apnea, and ruddy skin color. d. Scaphoid abdomen, no residual with feedings, and increased urinary output.

b (Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis.)

which of the following is an indication of a complication of septic shock? a. anaphylaxis b. acute respiratory distress syndrome c. COPD d. mitral valve prolapse

b - V/Q mismtach

when assessing a client for early septic shock, the nurse observes for which of the following? a. cool clammy skin b. warm flushed skin c. decreased SBP d. hemorrhage

b - early

When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of: a. persistent skin tenting b. rapid, deep respirations c. hot, flushed face and neck. d. bounding peripheral pulses.

b metabolic acidosis associated with kussmaul respirations

Before administration of Captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's: a. glucose. c. creatinine. b. potassium. d. phosphate.

b potassium Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore careful monitoring ofpotassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not. ACE inhibitors s/e: *chronic cough *angioedema

The nurse teaches the client taking atorvastatin to call the health care provider (HCP) if experiencing which symptom associated with a serious adverse effect of atorvastatin? a. Diarrhea b. Headache c. Muscle aches d. Numbness in the feet

c The client taking a statin such as atorvastatin or rosuvastatin should be taught to call the HCP if generalized muscle aches develop as this may be a symptom of myopathy, a serious adverse effect of this type of medication.

after reinforcing the danger sign to report with a gravida 2 client 32 weeks gestation with an elevated blood pressure which client statements would demonstrate her understanding of when to call the physicians office? sata a. if i get up in the morning and feel dizzy even if the dizziness goes away b. if i see any bleeding even if i have no pain c. if i have a pounding headache that doesnt go away d. if i notice the veins in the my legs getting bigger e. if i the leg cramps at night are waking me up f. if the baby seems to be more active than usual

bcf vaginal bleeding with or without pain could signify placenta previa or abruptio placentae. continuous or pounding headache could indicate elevated blood pressure, and change in the strength or frequency of fetal movements could indicate that the fetus is in distress. orthostatic hypotension can occur during pregnancy and can be alleviated by rrising slowly. leg veis may increase in size due to additional pressur efrom the increasing uterine size while leg cramps may also occur and can comonnly be decreased with calcuim supplements.

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Teach the patient about normal AVG function. b. Remind the patient to take a daily low-dose aspirin tablet. c. Report the patient's symptoms to the health care provider. d. Elevate the patient's arm on pillows to above the heart level.

c The patient's complaints suggest the development of distal ischemia (steal syndrome) and may requirerevision of the AVG. Elevation of the arm above the heart will further decrease perfusion. Pain andcoolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.

A client is in suspected shock state from major trauma. Which parameters best indicate the adequacy of peripheral perfusion? Select all that apply. a. Apical pulse b. Capillary refill c. Lung sounds d. Pupillary response e. Skin color and temperature

be Shock is a life-threatening syndrome characterized by decreased perfusion and impaired cellular metabolism. A lack of perfusion at both the tissue and cellular level (anaerobic metabolism) occurs due to decreased cardiac output, ineffective blood flow, and inability to meet the body's demand for increased oxygen. Sustained hypoperfusion activates compensatory mechanisms (eg, neural, hormonal, biochemical) to maintain homeostasis and reverse the consequences of anaerobic metabolism. Shock will progress through 4 stages (initial, compensatory, progressive, irreversible). Early identification and intervention help to prevent stage progression. Adequacy of tissue perfusion in a client with shock syndrome and possible organ dysfunction is assessed by the level of consciousness, urine output, capillary refill, peripheral sensation, skin color, extremity temperature, and peripheral pulses. Capillary refill indicates adequacy of blood flow to the peripheral tissues. It is measured by the time taken for color (pink) to return to an external capillary bed (nail bed) after pressure is applied to cause blanching. In an adult, color should return in less than 3 seconds. Normal skin color and temperature are indicators of the adequacy of peripheral blood flow; these are usually within normal limits during the initial and compensatory stages of shock. (Option 1) Apical pulse is a central pulse and does not indicate adequacy of peripheral tissue perfusion. (Option 3) Lung sounds indicate the adequacy of ventilation and gas exchange, not peripheral tissue perfusion. (Option 4) Pupillary response is an indicator of cerebral function, not peripheral tissue perfusion. Educational objective:The adequacy of blood flow to peripheral tissues is determined by measuring capillary refill and assessing skin color and temperature; these are usually within normal limits during the initial and compensatory stages of shock.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy

c

The nurse is providing discharge instructions for a client with cirrhosis, which of the following statements. Which of the following statements Best indicates of the client has understood the teaching? a. I should eat a high protein high carbohydrate diet to provide energy. b. It is safer for me to take acetaminophen Tylenol for pain instead of aspirin. c. I should avoid constipation to decrease chances of bleeding. d. If I get enough sleep and follow my diet it is possible for my services to be cured.

c

The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase) a. at bedtime. b. in the morning. c. with each meal. d. for abdominal pain.

c

The physician orders, oral neomycin, as well as a neomycin enema for a client with cirrhosis. The nurse understands the purpose of this therapy is to: a. Reduce abdominal pressure, b. prevent straining during defection block, c. reduce ammonia formation d. reduce bleeding within the intestine

c

When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of: a. too-rapid movement of blood flow through the pulmonary blood vessels. b. incomplete filling of the alveoli with air because of reduced respiratory ability. c. decreased transfer of oxygen into the blood because of thickening of the alveoli. d. mismatch between lung ventilation and blood flow through the blood vessels of the lung.

c

Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while taking a bath each day. d. The patient slows the inflow rate when experiencing abdominal pain.

c

Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? a. Split-pea soup, English muffin, and nonfat milk b. Oatmeal with cream, half a banana, and herbal tea c. Poached eggs, whole-wheat toast, and apple juice d. Cheese sandwich, tomato soup, and cranberry juice

c

a 32 year old multigravida returns to the clinic for a routine prenatal visit at 26 weeks gestation. she had had a prior pregnancy with pregnancy induced hypertension. the assessments during this visit BP 140/90 P80 and +2 edema of the ankles and fet. bsed on the client's past history and current assessment what further information should the nurse obtain to determinan if this client is becoming preclamptic? a. headaches b. blood glucose level c. proteinuria d. edema in lower extremities

c

when teaching a multigravid client diagnosed with mild preclampsia about nutritional needs which of the following types of diet should the nurse discuss? a. high residue b. low sodium diet c. regular diet d. high protein diet

c

which of the following is the most important goal of nursing care for a client who is in shock? a. manage fluid overload b. manage increased cardiac output c. manage inadequate tissue perfusion d. manage vasoconstriction of. vascular beds

c

the nurse is assessing a client who is in the early stages of cirrhosis of the liver. which sign should the nurse anticipate finding? a. peripheral edema b. ascites c. anorexia d. jaundice

c early signs of cirrhosis: n/v, anorexia, bowel pattern changes late: jaundice peripheral edema and ascites d/t portal hypertension

The nurse in the dialysis clinic is reviewing the home medications of a patient withchronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Acetaminophen c. Magnesium hydroxide b. Calcium phosphate d. Multivitamin w/ iron

c Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's a. blood glucose. b. urine osmolality. c. serum creatinine. d. serum potassium.

c When a patient at risk for chronic kidney disease (CKD) receives a potentially nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin.

A patient with severe cirrhosis has a new prescription for propranolol (Inderal). The nurse will teach the patient that the medication is ordered to: a. decrease systemic BP. b. prevent the development of ischemia. c. lower the risk for bleeding varices. d. reduce fluid retention and edema.

c -blockers have been shown to decrease the risk for bleeding in esophageal varices. Although propranolol will decrease BP and prevent cardiac ischemia, these are not the purposes for this patient. Propranolol will not decrease fluid retention or edema.

The nurse is caring for a client after percutaneous placement of a coronary stent for a myocardial infarction. The client rates lower back pain as 5 on a scale of 0-10 and has blood pressure of 140/92 mm Hg. The cardiac monitor shows normal sinus rhythm with occasional premature ventricular contractions. Which prescription should the nurse administer first? Click on the exhibit button for additional information. Laboratory results Potassium 3.3 mEq/L (3.3 mmol/L) Sodium 149 mEq/L (149 mmol/L) Glucose 157 mg/dL (8.7 mmol/L) a. Captopril PO every 8 hours b. Morphine IV prn for pain c. Potassium chloride IVPB once d. Regular insulin SQ with meals

c Clients with myocardial infarction (MI) are at risk for life-threatening dysrhythmias (eg, heart block, ventricular tachycardia, ventricular fibrillation) both during the MI and following reperfusion therapy (eg, coronary artery stenting). Myocardial ischemia damages cardiac muscle cells, causing electrical irritability (eg, premature ventricular contractions) that can be exacerbated by electrolyte imbalances (eg, hypokalemia). Hypokalemia hyperpolarizes cardiac electrical conduction pathways, increasing the risk for dysrhythmias. Therefore, prompt potassium replacement is the priority in these clients (Option 3). (Option 1) ACE inhibitors (eg, captopril, enalapril, lisinopril) help reduce the risk of future MIs by reducing blood pressure and cardiac workload and inhibiting ventricular remodeling. ACE inhibitors should be administered after MI; however, life-threatening dysrhythmias pose a higher risk to the client. (Option 2) Administering morphine is an appropriate intervention to address the client's back pain, but it is not the priority. (Option 4) Strict glycemic control in the resolution phase of an acute MI is associated with better long-term outcomes (eg, reduced morbidity/mortality), but it does not take priority. Educational objective: Prompt potassium replacement is the priority action for hypokalemic clients with myocardial infarction because they are at increased risk for life-threatening dysrhythmias (eg, heart block, ventricular tachycardia, ventricular fibrillation) and cardiac arrest.

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. The nurse explains to the patient that the major purpose of this treatment is: a. control of fluid and electrolyte imbalance. b. relief from nausea and vomiting. c. reduction of pancreatic enzymes. d. removal of the precipitating irritants.

c Pancreatic enzymes are released when the patient eats. NG suction and NPO status decrease the release of these enzymes. Fluid and electrolyte imbalances will be caused by NG suction and require that the patient receive IV fluids to prevent this. The patient's nausea and vomiting may decrease, but this is not the major reason for these treatments. The pancreatic enzymes that precipitate the pancreatitis are not removed by NG suction.

After a patient has had a transjugular intrahepatic portosystemic shunt (TIPS) placement, which finding indicates that the procedure has been effective? a. Lower indirect bilirubin level b. Increase in serum albumin level c. Decrease in episodes of variceal bleeding d. Improvement in alertness and orientation

c TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patient's hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level on the chart. d. Notify the health care provider immediately.

c The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection."

c The patient with end-stage renal disease is taught to measure urine output as a means of determining anappropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

a client with cirrhosis complains that his skin always feels itchy and that he scratches himself raw while he sleeps the nurse should recognize that the itching is th result of which abnormality associated with cirrhosis? a. folic acid deficiency b. prolong PT time c. increased bilirubin levels d. hypokalemia

c excess retained bilirubin produces an irritating effect on the peripheral nerves causing intense itching

An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant's mother asks the nurse whether her baby will meet developmental milestones on time, as did her son who was born at term. The nurse's most appropriate response is: a. "Your baby will develop exactly like your first child did." b. "Your baby does not appear to have any problems at the present time." c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing." d. "Your baby will need to be followed very closely."

c "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing." (The age of a preterm newborn is corrected by adding the gestational age and the postnatal age. The infant's responses are evaluated accordingly against the norm expected for the corrected age of the infant. Although it is impossible to predict with complete accuracy the growth and development potential of each preterm infant, certain measurable factors predict normal growth and development. The preterm infant experiences catch-up body growth during the first 2 to 3 years of life. The growth and developmental milestones are corrected for gestational age until the child is approximately 2.5 years old. Stating that the baby does not appear to have any problems at the present time is inaccurate. Development will need to be evaluated over time.)

The nurse is reviewing the physician's orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client's chart? A. NPO status B. Nasogastric tube insertion C. Morphine sulfate for pain D. An anticholinergic medication

c Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate interventions for the client with acute pancreatitis.

Which nursing action will be included in the plan of care for a patient with cirrhosis who has ascites and 4+ edema of the feet and legs? a. Restrict dietary protein intake. b. Reposition the patient every 4 hours. c. Use a pressure-relieving mattress. d. Perform passive range of motion qid.

c The pressure-relieving mattress will decrease the risk for skin breakdown for this patient. Adequate dietary protein intake is necessary in patients with ascites to improve oncotic pressure. Repositioning the patient every 4 hours will not be adequate to maintain skin integrity. Passive range of motion will not take pressure off areas like the sacrum that are vulnerable to breakdown.

During change-of-shift report, the nurse learns about the following four patients. Which patient requires the most rapid assessment? a. 50-year-old with chronic pancreatitis who has gnawing abdominal pain b. 48-year-old who has compensated cirrhosis and is complaining of anorexia c. 45-year-old with cirrhosis and severe ascites who has an oral temperature of 102° F (38.8° C) d. 56-year-old who is recovering from a laparoscopic cholecystectomy and has severe shoulder pain

c This patient's history and fever suggest spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

A client with newly diagnosed chronic heart failure is being discharged home. Which statement(s) by the client indicate a need for further teaching by the nurse? Select all that apply. a. I don't plan on eating any more frozen meals b. I plan to take my diuretic pill in the morning c. I will weigh myself at least every other day d. I'm going to look into joining a cardiac rehabilitation program e. Ibuprofen works best for me when I have pain

c e Client and family education is important for those with heart failure to prevent/minimize exacerbations, decrease symptoms, prevent target organ damage, and improve quality of life. The use of any nonsteroidal anti-inflammatory drugs (NSAIDS) is contraindicated as they contribute to sodium retention, and therefore fluid retention (Option 5). To monitor fluid status, clients are instructed to weigh themselves daily, at the same time, with the same amount of clothing, and on the same scale (Option 3). Weights should be recorded to allow for day-to-day comparisons to help identify early signs of fluid retention. (Option 1) Frozen meals are often high in sodium. Most heart failure clients are instructed to limit sodium intake. All foods high in sodium (>400 mg/serving) should be avoided. (Option 2) Diuretic medications cause clients to urinate more. Morning is the appropriate time to take this type of medication. Evening administration would cause nocturia and interrupted sleep. (Option 4) Exercise training, such as cardiac rehabilitation, improves symptoms of chronic heart failure. It has been found to be safe and improves the client's overall sense of well-being. It has also been correlated with reduction in mortality. Educational objective:Discharge education for the client with chronic heart failure should include daily weights, drug regimens, diet, and exercise plans. The use of any NSAIDS is contraindicated in heart failure as these contribute to sodium retention, and therefore fluid retention.

Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is hemorrhaging? A. Allowing the client to help insert the tube B. Beginning teaching for home care C. Maintaining the client's level of anxiety and alertness D. Obtaining cooperation and reducing fear

d An esophageal tamponade tube would be inserted in critical situations. Typically, the client is fearful and highly anxious. The nurse therefore explains about the placement to help obtain the client's cooperation and reduce his fear. This type of tube is used only short term and is not indicated for home use. The tube is large and uncomfortable. The client would not be helping to insert the tube. A client's anxiety should be decreased, not maintained, and depending on the degree of hemorrhage, the client may not be alert.

Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient. Which statement by the patient indicates that the teaching about this medication has been effective? a. "I will try to drink at least 8 glasses of water every day." b. "I will use a salt substitute to decrease my sodium intake." c. "I will increase my intake of potassium-containing foods." d. "I will drink apple juice instead of orange juice for breakfast."

d Because spironolactone is a potassium-sparing diuretic, patients should be taught to choose low-potassium foods (e.g., apple juice) rather than foods that have higher levels of potassium (e.g., citrus fruits). Because the patient is using spironolactone as a diuretic, the nurse would not encourage the patient to increase fluid intake. Teach patients to avoid salt substitutes, which are high in potassium.

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

d NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this occur to determine whether treatment was effective.

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Draw blood for hepatitis serology testing. c. Discuss the need to increase caloric intake. d. Review the patient's current medication list.

d Some medications can increase the risk for NAFLD and these should be eliminated. NAFLD is not associated with hepatitis, weight loss is usually indicated, and variceal bleeding would not be a concern in a patient with asymptomatic NAFLD.

What laboratory finding is consistent with a medical diagnosis of cardiogenic shock? 1. Decreased liver enzymes 2. Increased white blood cells 3. Decreased red blood cells, hemoglobin, and hematocrit 4. Increased blood urea nitrogen (BUN) and serum creatinine (Cr) levels

d The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, but white blood cell levels do not typically increase in cardiogenic shock. Red blood cell indices are typically normal because of relative hypovolemia.

A patient who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine (Zantac). Which response by the nurse is most appropriate? a. The medication will reduce the risk for aspiration. b. The medication will decrease nausea and anorexia. c. The medication will inhibit the development of gastric ulcers. d. The medication will prevent irritation to the esophageal varices

d The therapeutic action of H2 receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2 receptor blockade in this patient.

A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care? A. Measuring serum potassium for hyperkalemia B. Assessing the client for hypervolemia C. Measuring the client's weight weekly D. Documenting precise intake and output

d should be weighing the client daily, not weekly Hypokalemia, not hyperkalemia, commonly occurs with diuretic therapy. Because urine output increases, a client should be assessed for hypovolemia, not hypervolemia.

When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

d A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

When the nurse is caring for a patient with acute pancreatitis, which of these assessment data should be of most concern? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

d A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include? a. "Oxygen transfer into your blood is slow because of thick membranes between the small air sacs and the lung circulation." b. "Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs." c. "Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs." d. "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths."

d A pulmonary embolus limits blood flow but does not affect ventilation, leading to a ventilation-perfusion mismatch. The response beginning, "Oxygen transfer into your blood is slow because of thick membranes" describes a diffusion problem. The remaining two responses describe ventilation-perfusion mismatch with adequate blood flow but poor ventilation.

A client comes to the emergency department and reports headache, nausea, and shortness of breath after being stranded at home without electricity due to severe winter weather. While collecting a history, which question is most important for the nurse to ask? a. Are you up to date with your annual flu shot and other vaccinations? b. Have you had difficulty eating or drinking in the last few days c. How have you been keeping your house warm during this weather? d. Is there anything that you have found that relieves your symptoms?

d Carbon monoxide (CO) toxicity can occur when fuel-burning (eg, wood, coal) stoves or appliances are used in poorly ventilated settings. Clients with CO toxicity may have vague symptoms (eg, headache, dizziness, nausea), so it is important to assess for possible CO exposure to prevent delay of appropriate emergency care.

While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's arterial oxyhemoglobin saturation (SpO2) from 94% to 88%. The nurse will a. assist the patient to cough and deep-breathe. b. help the patient to sit in a more upright position. c. suction the patient's oropharynx. d. increase the oxygen flow rate.

d Increasing oxygen flow rate will usually improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation.

Which of these nursing actions included in the plan of care for a patient with cirrhosis can the nurse delegate to a nursing assistant? a. Assessing the patient for jaundice b. Assisting the patient in choosing the diet c. Palpating the abdomen for distention d. Providing oral hygiene before meals

d Providing oral hygiene is included in the education and scope of practice of nursing assistants. Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher-level nursing education and scope of practice and would be delegated to LPNs/LVNs or RNs.

After prolonged cardiopulmonary bypass, a patient develops increasing shortness of breath and hypoxemia. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with: a. positioning the patient for a chest radiograph. b. drawing blood for arterial blood gases. c. obtaining a ventilation-perfusion scan. d. inserting a pulmonary artery catheter.

d Pulmonary artery wedge pressure will remain at normal levels in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.

Loss of patellar reflexes, respiratory and muscular depression, oliguria, and a decreased level of consciousness are signs of?

magnesium toxicity.

increased ICP for the diuretic

mannitol

atrial fibrillation

rapid, random, ineffective contractions of the atrium. TREATMENT: anticoagulant warfarin Amiodarone Beta blocker Ca channel blocker Digoxin Cardioversion pacemaker

GDM pregnancy - asymptomatic with <2.6 mmol/L. what do you do?

reassess 24 to 28 weeks of gestation if test is done earlier

Morphine sulfate has which of the following effects on the body

reduces preload

Pancreatitis (acute) diruetics

spironolactone