Exam 1 Sherpath studying

A patient with cerebral palsy has severe muscle spasticity that is being treated with a surgically implanted intrathecal port for delivery of baclofen. During each doctor visit, the nurse provides skin care to the implanted port pocket. Which antiseptic cleanser should the nurse use for this task?

10% Povidone-iodine solution When providing skin care for implanted intrathecal ports, the nurse should not use any solution that contains alcohol, because the alcohol could track along the catheter and cause nerve damage. A 10% povidone-iodine solution is preferred.

Which would be the approximate flow rates for a 22-gauge peripheral intravenous catheter?

38 mL/min The approximate flow rate of a 22-gauge catheter is 38 mL/min. A flow rate of 24 mL/min is appropriate for 24-26 gauge catheters. The flow rate of a 20-gauge catheter is 65 mL/min, while the flow rate for an 18-gauge catheter is 110 mL/min.

After receiving change-of-shift report, which patient does the RN assess first?

46-year-old receiving IV diuretics whose blood pressure is 95/52 mm Hg

Which disorder is associated with idiopathic hypoparathyroidism?

Adrenal insufficiency

The nurse who is starting the shift finds a patient with an IV that is leaking all over the bed linens. What does the nurse do initially?

Assess the insertion site.

A patient with hyperparathyroidism is being treated with cinacalcet. The primary health care provider wants the patient to discontinue cinacalcet and begin with furosemide. Which condition does the nurse suspect?

Mild hyperparathyroidism

A patient has had a total urine output of 200 mL in the past 24 hours. Which priority action does the nurse take?

Notify the primary health care provider.

A patient with cerebral edema was prescribed a hyperosmotic IV solution. What is the purpose of this intervention?

Pull excessive water from the interstitial volume through osmosis to reduce edema

A lab report for a 47-year-old patient shows the following results: pH 7.32; bicarbonate 24; Pao 2 77; Paco 2 48. These findings are consistent with which acid-base imbalance?

Respiratory acidosis

While assessing a patient with hypoparathyroidism, the nurse observes severe muscle cramps and elbow flexion. Which condition does the nurse suspect?

Severe hypocalcemia

What is hypodermoclysis?

Slow infusion of isotonic fluids into the subcutaneous tissues

A patient presents to the emergency department with hypertension and fatigue. The patient reports weight loss and vomiting over the past several days. The nurse suspects the patient may be experiencing an Addisonian crisis. What question by the nurse is priority?

"Have you recently been on steroids or pain medication?" Asking whether the patient has been on steroids or pain medication is priority because it may help to determine the cause of adrenal insufficiency if it is present.

The nurse is teaching a hospitalized patient who is being discharged about how to care for a peripherally inserted central catheter (PICC) line. Which patient statement indicates a need for further education?

"I can continue my 20-mile running schedule as I have for the past 10 years." Excessive physical activity can dislodge the PICC and should be avoided. Patients with PICCs should be able to perform normal activities of daily living. PICCs have low complication rates because the insertion site is in the upper extremity. The dry skin of the arm has fewer types and numbers of microorganisms, leading to lower rates of infection. PICC lines can be used long-term (months).

A patient scheduled for surgery is being assessed by the holding area nurse for identification and allergies. Which statement by the patient must be reported to the surgeon?

"I love seafood but I am allergic to shellfish."

The nursing student has been assigned to the hospital's Rapid Response Team (RRT). Which statement by the student indicates a correct understanding of the RRT member's purpose?

"I will be caring for patients in the hospital."

The nurse is teaching safety measures to an unlicensed assistive person (UAP) who is caring for a patient with a peripherally inserted central catheter in the right hand. Which statement made by the UAP shows ineffective learning?

"I will clean the insertion area on the right hand carefully when giving the patient a bath." The extremity that has an intravenous line should be covered with a plastic bag or wrap when giving a bath to keep the dressing dry and free from contamination.

The registered nurse is teaching a student nurse about the care plan for a patient with hypoparathyroidism. Which statement made by the student nurse indicates a need for further teaching?

"I will explain to the patient that hypocalcemia therapy is short-term."

The nurse is teaching a student nurse about caring for a patient receiving infusion therapy. Which statement made by the student nurse shows ineffective learning?

"I will infuse the fluids at a faster rate to complete the infusion."

The nurse is providing teaching to a patient scheduled for a unilateral adrenalectomy. What statement by the patient indicates that the teaching was effective?

"I will still have one adrenal gland left."

The registered nurse is teaching a student nurse about flushing the intravenous catheter to maintain patency of the lumens. Which statement made by the student nurse shows ineffective learning?

"I will stop the flushing procedure if the catheter lumen yields a blood return." A brisk blood return from the catheter is a positive sign that indicates that the operator has entered the vein without any dislocation. Therefore, the nurse should not stop the flushing procedure.

The registered nurse is teaching a student nurse about caring for a patient with hyperparathyroidism. Which statement made by the student nurse indicates a need for further teaching?

"I will teach the patient to eat foods high in calcium and low in phosphorous."

The nurse is inserting a peripheral intravenous (IV) catheter. Which patient statement is of greatest concern during this procedure?

"My hand tingles when you poke me." The patient's statement about a tingling feeling indicates possible nerve puncture. To avoid further nerve damage, the nurse should stop immediately, remove the IV catheter, and choose a new site.

The nurse is teaching a group of unlicensed assistive personnel (UAP) about fluid intake principles for older adults. What does the nurse tell them?

"Offer fluids that meet the patient's dietary restrictions on a regular schedule."

A patient who used to work as a nurse asks, "Why is the hospital using a 'fancy new IV' without a needle? That seems expensive." How does the nurse respond?

"They minimize health care workers' exposure to contaminated needles."

the nurse is assessing a patient prescribed an angiotensin-converting enzyme (ACE) inhibitor to treat blood pressure. The patient states, "This medication makes me urinate all the time. I didn't think it was a water pill." Which is the appropriate response by the nurse?

"This medication causes greater excretion of water and sodium in your urine."

A registered nurse and student nurse are monitoring a patient who has just received an intra-arterial infusion pump for fibrinolytic treatment of ischemic stroke. Which statement by the student nurse indicates a need for further teaching regarding intra-arterial infusion pumps?

"This patient would benefit from an implanted port rather than the external catheter." Intra-arterial fibrinolysis requires infusion over just a few hours. Therefore, an external catheter is a much better choice than an implanted port. If the student nurse indicates that an implanted port would be better, the student does not understand how intra-arterial infusion pumps work for ischemic stroke. Infusion pumps must have high pressure to overcome arterial pressure, and the administration set should be secured with Luer-Loks and the tubing should be secured to help prevent disconnection and subsequent hemorrhage.

A patient is having an arthroscopy of the left knee and has just been moved to the surgical holding area. Which statement by the nurse properly identifies the patient while the nurse checks the identification label?

"What is your name, and where were you born?"

The holding area nurse receives a patient for surgery. What question does the nurse ask to ensure the right patient has been brought to the surgical unit?

"When were you born?"

The nurse is providing care to a female patient who experienced an adverse reaction to a prescribed drug. The patient states, "My husband was on the same dose, and he didn't have any issues." Which response by the nurse is most appropriate?

"Women have more fat cells, which causes differences in drug responses."

The nurse is providing care to a patient diagnosed with dehydration. The patient asks, "Why is my urine so dark?" Which response by the nurse is most appropriate?

"Your kidneys are concentrating your urine to maintain fluid balance."

A patient who has been on long-term corticosteroid treatment calls the health care provider's office to report fatigue, nausea, and salt cravings. What question by the nurse is priority?

"have you stopped taking your corticosteroid?"

The nurse is providing instructions about dietary changes to a patient with hypoparathyroidism. Which statements made by the patient indicates effective learning?

- " i will avoid milk" - "i will avoid yogurt" - "i will avoid processed cheese

Which statements made by the student nurse shows effective learning about securing an intravenous (IV) catheter?

- "I will use strips of clean tape." - "I will use the tape from the IV starter kit."

When transferring a patient who was admitted with chest pain from the emergency department (ED), which information is essential for the ED nurse to communicate to the nurse on the medical-surgical unit?

- "The patient is being admitted for ongoing monitoring of pain and vital signs." - Nitroglycerin and morphine sulfate were given to relieve the pain." - "Frequent reassurance is needed because the patient has a high anxiety level." - "The patient has a family history of heart disease and hypertension." - A coronary arteriogram should be scheduled as soon as possible."

The nurse is instructing a patient who is being discharged with a diagnosis of congestive heart failure (CHF). Which patient statement indicates a correct understanding of CHF?

- "weighing myself daily can reveal increased fluid retention"

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). She is receiving lactated Ringer's solution IV for rehydration. What clinical manifestations does the nurse monitor during rehydration of the patient?

- BP - pulse rate and quality - urinary output - urine specific gravity levels

A patient has been poisoned by botulinum toxins. What assessment findings suggest the patient has acidosis?

- Confusion - Warm, flushed, dry skin

Which conditions and/or symptoms may be most likely responsible for this acid-base imbalance: pH 7.32, Pao 2 82 mm Hg, Paco 2 50 mm Hg, HCO 3 -18 mEq/L?

- RR of 8 - oliguria - dehydration The acid-base imbalance is a combined respiratory (Paco 2 50 mm Hg) and metabolic acidosis (HCO 3 -18 mEq/L). Conditions that may cause a combined acidosis are a decreased respiratory rate, kidney dysfunction (oliguria), and dehydration (dry mucous membranes).

A palliative care patient receiving home care is scheduled to start subcutaneous infusion therapy of 1,000 mL of isotonic fluids per day. What teaching points should the nurse use when teaching the patient and caregiver how to use the subcutaneous infusion set?

- The needle should be inserted in an area of skin free from infection, inflammation, and bruising. - If redness, warmth, swelling, leakage, bruising, or pain is seen around the infusion site, the infusion site should be changed.

The nurse delegates recording of a patient's vital signs to a patient care technician (PCT). What must the nurse ensure when delegating the selected nursing task to the PCT?

- The task is within the PCT's scope of practice and competence. - The patient care setting is appropriate for the delegation. - A clear explanation of the task is provided. When delegating and supervising a nursing task to a PCT, the nurse ensures the right task, right circumstances, and right communication.

Which manifestations would the nurse anticipate finding in a patient diagnosed with Cushing's disease?

- acne - moon face - hyperglycemia - elevated cortisol level

A patient taking exogenous glucocorticoids is to be discharged from the hospital. What does the nurse teach the patient and the caregiver?

- adhere to the drug regimen - make a point to receive a flu shot -use proper hygiene and avoid crowds The patient taking exogenous glucocorticoids must strictly adhere to the drug regimen because these drugs prevent the hypothalamus from secreting corticotropin-releasing hormone (CRH). The lack of CRH inhibits the secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary gland. Without normal levels of ACTH, the adrenal glands atrophy and completely stop the production of any of the corticosteroids. The patient is completely dependent on the exogenous drug. If the drug is stopped even for a day or two, the patient develops acute adrenal insufficiency, a life-threatening condition. The patient is prone to infection and should be encouraged to receive an influenza vaccination, use proper hygiene, and stay away from crowds. The patient must monitor weight daily and maintain a weight chart; a weight gain of 1-2 lb in a 24-hour period or more than 3 lb in a week must be reported to the health care provider.

An older adult patient with a history of renal failure is brought in to the emergency department with sudden onset of acute confusion, worsening muscle weakness in the extremities, abdominal cramps, and a weak, rapid, and thready pulse. What are the immediate nursing interventions to stabilize the patient?

- admin diuretics - admin 0.9% saline - admin 5% dextrose in 0.45% sodium chloride

Which will the nurse take into consideration when assessing a patient's fluid balance?

- age - body fat - gender

Which hormones play a role in the regulation of sodium balance by the kidneys?

- aldosterone - natriuretic peptide - ADH

A patient with adrenal insufficiency is placed on a low-potassium diet. What dietary selections by the patient indicate that nutritional teaching has been effective?

- apples -cabbage

What lab findings are consistent with a patient diagnosed with hyperaldosteronism?

- arterial ph 7.48 - serum sodium 148 Patients diagnosed with hyperaldosteronism usually are alkalotic and have hypernatremia

A 92-year-old woman is admitted from a long-term care facility for treatment of dehydration. The provider has ordered fall precautions. Which interventions does the nurse implement as part of fall precautions?

- asses for orthostatic hypotension - orient the patient frequently - place the bed in the lowest position with brakes - activate the bed alarm

The nurse is caring for a patient in the presurgical holding area. What interventions does the nurse perform before the patient is moved to the operating room (OR)?

- assess the patient's physical and emotional status - verify that operative consent forms are signed - review the medical record and preoperative checklist

The nurse is appointed to a hospital committee whose goal is to "improve the safety of nursing practice." Which areas of practice are included in the committee's task?

- attentiveness / surveillance of patients - mandatory reporting - medication admin - prevention of errors or complications

The nurse educator is instructing newly hired registered nurses about patient-centered care. Which competency categories are included in this content?

- attitudes - knowledge - skills

What foods should be avoided by a patient diagnosed with pheochromocytoma?

- bacon - cheddar cheese Patients diagnosed with pheochromocytoma should avoid foods high in tyramine. Bacon and cheddar cheese are both high in tyramine.

What manifestations of catheter-related complications does the nurse observe in a patient undergoing intraspinal infusion therapy?

- bleeding - infection

A patient receives intravenous (IV) fluids at a rate greater than the amount the patient's system can accommodate. The nurse expects what assessment findings?

- cough - edema - shortness of breath

Which signs does the nurse expect to find when assessing a patient with fluid overload?

- crackles in the lung - pitting edema in the ankles and feet - weight gain

The nurse is providing care to a patient who is experiencing severe nausea, vomiting, and diarrhea. Which is the patient at risk of developing?

- dehydration - hyperkalemia - hypernatremia

Which situation can cause a patient to experience "insensible water loss?"

- diarrhea - dry, hot weather - fever - increased resp. rate - mechanical ventilation

A nurse is assessing a patient suspected of having hyperparathyroidism. Which questions asked by the nurse would be helpful to assess the patient?

- do you have a history of fractures? - do you have a history of weight gain? - do you have a history of radiation therapy to the neck?

The Quality and Safety Education for Nurses (QSEN) initiative team has created specific knowledge, skills, and attitudes (KSAs) needed to develop each core competency. What do the KSAs for Informatics competence emphasize?

- documentation - electronic data access - data utilization

What laboratory findings are consistent with a diagnosis of Cushing's disease?

- elevated serum cortisol - increased serum sodium

Which will the nurse include when documenting a patient's fluid intake for the shift?

- enemas - oral fluids - irrigation fluids

Which will the nurse include in the documentation for a patient's measurable output at the end of the shift?

- feces - urine - emesis - chest tube drainage

When is intraosseous (IO) infusion therapy contraindicated?

- fracture - osteoporosis - osteogenesis imperfecta

What findings are consistent with a diagnosis of hyperaldosteronism?

- headache - muscle weakness - dehydration

The nurse admits a patient with dehydration. Which electrolyte imbalances does the nurse anticipate based on this diagnosis?

- hyperkalemia - hypernatremia

The nurse is providing care to a patient who is admitted with fluid volume overload. Which electrolyte imbalances does the nurse anticipate for this patient based on the admitting diagnosis?

- hyponatremia - hypokalemia - hypochloremia

A patient has been diagnosed with pheochromocytoma. Which factors can trigger a hypertensive crisis?

- increased abdominal pressure - foods high in tyramine - palpation of the abdomen

A tunneled central venous catheter (CVC) is used for lifetime parenteral nutrition. Which are commercial trade names of the catheters that are available?

- leonard - hickman CVCs were originally named for the physicians who designed them, including Leonard, Hickman, and Broviac catheters. The PreSep CVC is a non-tunneled CVC. Insyte BD and angiocath BD catheters are short peripheral catheters.

Which interventions does the nurse perform to prevent the risk of infection in an operating room (OR)?

- limiting the traffic in the operating room - reducing contaminants through air exchanges in the room - maintaining recommended temperature and humidity levels

The nurse is transfusing blood to a patient. Which components should the nurse be sure to check on the blood label?

- lot number - product code - ABO group and RH factor

Which assessment findings would indicate decreased tissue perfusion stimulating the secretion of renin from the kidney tubular system?

- low blood volume - low blood oxygen

Needleless connection devices are used for reducing the risk of exposure to contaminated needles. Which interventions can be included to reduce the risk of infection?

- maintaining hand hygiene - avoiding taped connections - cleaning the needleless devices

Which other conditions can be suspected in a patient with hypomagnesemia?

- malnutrition - chronic kidney disease - malabsorption syndrome

What nursing interventions are appropriate for a patient diagnosed with adrenal hypofunction? .

- monitor BUN levels - monitor hematocrit levels - admin steroid therapy

The nurse is attending to a patient receiving IV vancomycin. What actions does the nurse take for this patient during IV therapy?

- monitor the IV site continuously for manifestations of infiltration - discontinue the IV if swelling, cooling, or redness occurs - notify the infusion team of any adverse reactions

A patient reports swelling of the right foot and ankle. Upon assessing the patient, the health care provider confirms it as pitting edema and prescribes diuretic therapy. Which nursing interventions are necessary for this patient?

- monitoring the urine output of the patient - assessing the sodium and potassium levels - monitoring the ECG

What manifestations should the nurse expect to find in a patient with Cushing's syndrome?

- moon face - truncal obesity - loss of bone density

Which pharmacological interventions are best suited for a patient diagnosed with hypoparathyroidism?

- oral admin of calcitriol - IV admin of 10% calcium chloride - IV admin of 50% magnesium sulfate

The nurse is monitoring a trauma patient receiving fluids and pain medication via intraosseous therapy in the proximal tibia. During routine assessments, which complications should the nurse assess for related to the intraosseous therapy?

- osteomyelitis - compartment syndrome

The nurse observes that the serum calcium level for a patient with hyperparathyroidism is 12.5 mg/dL. Which other health problems can this condition lead to?

- osteoporosis - psychosis - peptic ulcer formation

What statements are true about minimally invasive and robotic surgery? .

- pain is less after surgery - reduced blood loss with the surgery - incisions are smaller in the surgical area

The nurse instructor is teaching nursing students about the knowledge, skills, and attitudes (KSAs) needed to develop core competencies based on the Institute of Medicine (IOM) and Quality and Safety Education for Nurses (QSEN) initiative. What KSAs are needed to develop the Quality Improvement competency?

- participate in root cause analyses of issues - implement activities to improve care processes

A patient diagnosed with malignant hyperthermia has a body temperature of 110° F. Which nursing interventions should be done to decrease the high body temperature?

- place a cooling blanket over the torso of the patient - place ice packs around the patient's axilla, groin, neck, and head - admin iced normal saline IV at 15 ml/ kg every 15 mins

What medications would the nurse plan to administer to a patient diagnosed with hyperaldosteronism?

- potassium - spironolactone Patients diagnosed with hyperaldosteronism often experience hypokalemia. Potassium and spironolactone (a potassium-sparing diuretic) are indicated for treatment of this.

The laboratory reports of a patient show the patient has metabolic alkalosis. What conditions may result in metabolic alkalosis?

- prolonged vomitting - nasogastric suctioning - blood transfusion - TPN

The nurse is administering sodium chloride 0.9% (normal saline) intravenously to a patient who is dehydrated. Which assessments does the nurse perform to evaluate the effectiveness of rehydration therapy?

- pulse - urinary output

Which parameters should be monitored to assess a patient's response to fluid replacement therapy?

- pulse - urine output - weight every 8 hours

Which assessment findings will indicate the need for continuation of prescribed fluid replacement therapy in a patient diagnosed with dehydration?

- pulse pressure of 28 nn hg - urine output of 400 ml per day

The scrub nurse performs a surgical scrub before entering the operating room (OR). How does the scrub nurse ensure an effective scrub?

- removes ornaments and wristwatch before scrubbing - rubs vigorously from finger tips to elbows - enters the OR with hands held higher than the elbows

The nurse is assessing a patient with a parathyroid disorder. Which laboratory values would be associated with a diagnosis of hypoparathyroidism?

- serum mag level of 1 - serum phos level of 6.5 - urine cAMP level of 17 A normal serum magnesium level is 1.3 to 2.1 mEq/L; this level is decreased in patients with hypoparathyroidism. A normal serum phosphorus level lies between 3.0 to 4.5 mg/dL; this level is increased in patients with hypoparathyroidism. Normal urine cAMP level is between 18.3 to 45.4 nmol/L; this level would be decreased in patients with hypoparathyroidism. Thus a urine cAMP level of 17 nmol/L, serum magnesium level of 1 mEq/L, and serum phosphorus level of 6.5 mg/dL help diagnose hypoparathyroidism.

Which clothing components are parts of the surgical attire?

- shirt - pants - cap - shoe coverings

The nurse has received a prescription for infusion therapy for a patient. What does the nurse look for in the prescription to determine its completeness?

- specific type of fluid - rate of admin - specific dose of drug to be added

What teaching should be provided for a patient diagnosed with Addison's disease who is going to be taking a cortisone replacement?

- take it twice a day - monitor weight daily take the medication with food

The nurse suspects that a patient has developed metabolic acidosis because of an overproduction of hydrogen ions. The nurse makes the conclusion based on what assessment findings?

- the patient has been fasting for 30 days - the patient has diabetic ketoacidosis - the patient has salicylate suctioning

What factors influence the way the nurse positions the patient on the operating table?

- the surgeon's preference - the age and size of the patient

The nurse is planning postoperative care for a patient who is undergoing spine surgery. What interventions does the nurse include in the plan, which will prevent harm to the patient?

- use pulsatile stockings for the patient's legs - get the patient out of bed as soon as possible

A physician suspects an autoimmune basis to be the cause of idiopathic hypoparathyroidism in a patient. From which other conditions is the patient likely to be already suffering?

- viltigo - hypothyroidism - adrenal insufficiency

The patient with fluid overload has been taking a diuretic for the past 2 days and now experiences these changes. Which changes indicate to the nurse that the diuretic resulted in overdiuresis?

- weight loss of 9 punds - reports of lightheadedness when first standing from a lying position - HR increase - reports of fatigue

A patient diagnosed with an Addisonian crisis has the following labs: potassium 5.4 mEq/L, sodium 130 mEq/L, calcium 8.0 mg/dL, and blood glucose 70 mg/dL. What medications does the nurse anticipate administering?

-insulin -dextrose -kayexalate The patient has hyperkalemia and will need IV insulin and kayexalate to reduce the potassium level. IV dextrose is given to prevent hypoglycemia.

What manifestation does the nurse expect to find during the assessment of a patient with pheochromocytoma?

-profuse sweating or diaphoresis -increased abdominal pressure -intermittent episodes of hypertension A pheochromocytomais is a tumor that produces, stores, and releases epinephrine and norepinephrine.These stimulate adrenergic receptors and have a wide range of adverse effects, mimicking the action of the sympathetic nervous system. Manifestations include profuse diaphoresis and increased abdominal pressure during intermittent episodes of hypertension.

Which manifestations would the nurse anticipate finding in a patient diagnosed with Addison's disease?

-vitiligo -hyperkalemia -hyperpigmentation

What is the pore size (in microns) of a filter for removing all particles and bacteria in infusion systems?

0.2 Filters are a part of an administration set used to remove particulate matter, microorganisms, and other contaminants from the infusion system. Filter sizes depend on the pore size, with common sizes being 0.2 microns intended to remove all particles and bacteria and 1.2 microns used to filter lipid-containing parenteral nutrition. Microaggregate filters used on blood administration sets have a pore size of 20, 40, or 80 microns and are used to remove degenerating platelets, white blood cells, and fibrin strands.

The prescription for a patient reads 3 L 5% D/0.45% NS to be infused over 30 hours. At what rate does the nurse administer the infusion?

100 mL/hr

What is the dosage of saline used for cooling the body when malignant hyperthermia has occurred in the patient? Record your answer using a whole number.

15 ml/kg Administering iced saline at a rate of 15 mL/kg is effective in treating malignant hypothermia. A higher dosage could be detrimental to the patient.

The health care provider instructs the nurse to administer 0.8 L of 5% dextrose over 5 hours. What would be the infusion rate in mL/hr? Record your answer using a whole number.

160 ml/hr

What is the minimum urine output to be maintained in a patient who was diagnosed with malignant hyperthermia? Record your answer using a whole number.

2 ml/kg/hr

A patient is suddenly diagnosed with malignant hyperthermia during surgery. How much dantrolene sodium is initially administered to the patient to treat this condition?

2 to 3 mg/kg

Following the administration of IV fluids, the patient reports peripheral edema and fluid overload. What might be the serum osmolarity of the infusate?

280 mOsm/L Normal serum osmolarity is 270 mOsm/L-300 mOsm/L. If the osmolarity of IV infusate is equal to the serum osmolarity, it is called isotonic. Administration of isotonic infusate will not create a concentration gradient, which may lead to peripheral edema and fluid overload. A solution with an osmolarity less than 270 mOsm/L (240 mOsm/L) is a hypotonic solution, and more than 300 mOsm/L (320 mOsm/L and 360 mOsm/L) is a hypertonic solution. Patients who receive infusions with hypotonic or hypertonic solutions are at a risk for phlebitis.

A patient is prescribed intravenous antibiotics for 4 weeks. How often should the nurse change the gauze dressing?

48 hours The gauze dressing of a midline catheter should be changed every 48 hours. The dressing is changed within 24 hours after a catheter insertion. Changing the dressing every 36 hours may not be necessary unless it is either saturated or soiled. Changing the gauze dressing every 72 hours can lead to an infection.

The charge nurse for a hospital operating room is making patient assignments for the day. Which patient is most appropriate to assign to the least-experienced circulating nurse?

52-year-old patient with stage I breast cancer who is having a tunneled central venous catheter placed

What would be the osmolarity of fluids and medications that are infused through a midline catheter?

575 mOsm/L The osmolarity of fluids and medications that are infused through a midline catheter should be less than 600 mOsm/L. Therefore, 575 mOsm/L is appropriate. If the osmolarity is greater than 600 mOsm/L, phlebitis and thrombosis may occur.

According to criteria of the Ramsay Sedation Scale (RSS) for assessing post-sedation consciousness, which grade indicates the absence of response to light or loud sound in the patient?

6

Which person attending an all-day outdoor festival on a hot August day is at greatest risk for dehydration?

72-year-old woman appearing to be at least 20 pounds overweight

What should be the optimum temperature maintained in an operating room (OR)?

72° F (22° C) A cool room temperature between 68° and 73° F (20° to 23° C) is optimal in the OR. Maintaining a cool temperature and low humidity prevents the spread of infection.

The primary health care provider prescribes oral ergocalciferol to a patient with hypoparathyroidism. What serum calcium level would the patient have to warrant this treatment?

8.5 mg/dL

Which nursing action demonstrates use of the principle of justice?

A 67-year-old patient with dementia is shown the same respect as his 47-year-old roommate with prostate cancer.

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with Addison's disease with a potassium level of 6.0 mEq/L and a sodium level of 127 mEq/L The patient with Addison's disease is likely experiencing Addisonian crisis because the potassium level is extremely high and sodium level is very low. Both imbalances can lead to cardiac dysrhythmias.

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with Conn's syndrome with a blood pressure of 210/106 mm Hg and tremors The patient with Conn's syndrome should be evaluated and treated for the elevated blood pressure. The patient is at risk for stroke or myocardial infarction (MI).

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with Cushing's syndrome who just returned from a bilateral adrenalectomy A patient who has just undergone a bilateral adrenalectomy should be assessed every 15 minutes and would be priority.

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with pheochromocytoma with a headache rated 10/10 The patient with pheochromocytoma with a headache rated 10/10 is likely experiencing an attack. The patient should be assessed, and the blood pressure should be evaluated for hypertension.

The nurse is providing care to several patients on a medical-surgical unit. Which patient is at an increased risk for insensible water loss?

A patient receiving continuous gastrointestinal suctioning postoperatively.

Which patient with parathyroid disorder is at risk of coma?

A patient with serum calcium levels of 14 mg/dL

The nurse is working in the intensive care unit. When does the nurse call the Rapid Response Team (RRT)?

A postoperative patient's blood pressure suddenly drops

A patient is brought in an unconscious state to the emergency department. The primary health care provider suspects dehydration and advises laboratory investigation to ascertain the cause. Which parameter in the laboratory investigations would indicate internal hemorrhage as a reason for dehydration?

Absence of hemoconcentration

When developing a standardized plan of care for patients with a diagnosis of pneumonia, how does the nurse find the best information about providing optimal nursing care?

Access a website that reports on randomized controlled studies on nursing care for patients with pneumonia.

A patient is admitted with chronic anemia. What physiologic imbalance does the nurse suspect the patient is at risk of developing?

Acidosis

What is the role of the certified registered nurse anesthetist (CRNA) in the operating room?

Administer anesthetic drugs under the supervision of the anesthesiologist.

A patient presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na 130 mEq/L, K 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates?

Administer insulin and dextrose in normal saline to shift potassium into cells. This patient is hyperkalemic. The nurse should anticipate a request to administer 20-50 units of insulin with 20-50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells. Spironolactone is a potassium-sparing diuretic that helps the body keep potassium, which the patient does not need.

Which prescribed intervention does the nurse implement first for a patient with metabolic acidosis from shock?

Administer intravenous fluids.

A patient who is receiving intravenous fluid replacement therapy has a bounding pulse, difficulty in breathing, and distended neck veins when sitting in the upright position. What is the most appropriate nursing intervention for the patient?

Administering diuretic drug therapy

After surgery to remove pancreatic cancer, the surgeon inserted an epidural catheter for patient-controlled opioid administration. Several hours after surgery during a routine nursing assessment, the patient indicated a pain level of 7 but had not yet self-administered pain medication. When the nurse asked why, the patient expressed concern about opioid addiction. What should the nurse tell the patient?

After surgery to remove pancreatic cancer, the surgeon inserted an epidural catheter for patient-controlled opioid administration. Several hours after surgery during a routine nursing assessment, the patient indicated a pain level of 7 but had not yet self-administered pain medication. When the nurse asked why, the patient expressed concern about opioid addiction. What should the nurse tell the patient?

What is the preferred diuretic used for patients with hypokalemia?

Amiloride

Which medication may affect the assessment of a patient's fluid balance after a surgical intervention?

Angiotensin-converting enzyme inhibitor twice a day Urine output is used as an indicator of perfusion adequacy after surgery or other procedures. Medications used to manage hypertension such angiotensin-converting enzyme (ACE) inhibitors disrupt the renin-angiotensin II pathway, resulting in greater excretion of water and sodium in the urine. This may make it harder to use urine output as a primary measure of perfusion.

Two days after intraperitoneal therapy for colorectal cancer, a patient complains of abdominal pain. Upon a physical assessment, the nurse finds that the patient has an oral temperature of 102.5 °F and abdominal rigidity. What follow-up treatment may the nurse need to administer to this patient?

Antibiotics

What would be the line of treatment for a female patient receiving chemotherapeutic agents for ovarian cancer through an implanted peritoneal catheter who has complications?

Antimicrobials

After a patient's intravenous (IV) infusion is discontinued, the nurse assesses the patient and observes swollen extremities, engorged peripheral veins of the ipsilateral chest, and tenderness and redness at the site of infusion. Which nursing intervention is appropriate for this patient?

Applying a cold compress Swollen extremities, engorged peripheral veins of the ipsilateral chest, and tenderness and redness at the site of infusion indicate thrombosis. The nurse applies a cold compress in order to decrease the blood flow and stabilize the clot.

The nurse is caring for a patient who is diagnosed with adrenal insufficiency. The patient has the following lab results: potassium 5.9 mEq/dL, sodium 128 mEq/dL, and calcium 8.0 mg/dL. The patient reports palpitations. What action by the nurse is priority?

Assess the patient's cardiac rhythm

The certified registered nurse anesthetist (CRNA) teaches a student nurse about the parameters to be assessed and monitored in a patient during surgery. Which action of the student nurse indicates the need for further teaching?

Assessing physical and emotional status

The nurse is attending to a patient with a double lumen midline catheter for fluid hydration. What action does the nurse take when providing infusion therapy for the patient?

Avoid simultaneous administration of incompatible drugs through both lumens.

The nurse is preparing to administer an IV solution to a patient who underwent a recent mastectomy. What must the nurse remember when choosing a site for placement of a short peripheral venous catheter?

Avoid the arm on the side of the mastectomy. The nurse should avoid the arm on the side of the mastectomy when choosing a site for placement of a short peripheral venous catheter. Similarly, the arm on the side of a lymph node dissection, arteriovenous shunt or fistula, or paralysis is not considered for placement of a short peripheral venous catheter, because they alter the normal pattern of blood flow through the arm.

Which type of anesthesia causes minimal disturbance to physiologic functions and is used in older and high-risk patients?

Balanced A balanced type of anesthesia is used in older and high-risk patients as it causes minimal disturbance to the physiologic function. Regional anesthesia is not used for extensive procedures. Inhalation anesthesia is used along with other agents; it may cause postoperative nausea and shivering. Intravenous anesthesia is contraindicated in high-risk groups.

Which type of anesthesia is associated with complications related to drug-drug interactions?

Balanced Drug-drug interactions are noticed when two or more types of drugs are administered together. A balanced type of anesthesia is a combination of many types of drugs including inhaled and intravenous drugs which may cause complications associated with drug-drug interactions.

A patient presents with dehydration. Which parameter should be considered when deciding isotonic fluid replacement therapy for the patient?

Body temperature of 40°C for more than 8 hrs

Which assessment finding requires priority nursing intervention in a patient with metabolic or respiratory acidosis?

Bradycardia with widened QRS complex

The lab values for a patient admitted for an exacerbation of chronic obstructive pulmonary disease (COPD) reveal a pH of 7.29 with a decreased Pao 2 and an elevated Paco 2. Which initial treatment does the nurse expect the provider to most likely order?

Bronchodilator therapy

What class of drugs is most appropriate for treating hyperparathyroidism?

Calcimimetics

What is the treatment modality for acute vitamin D deficiency?

Calcitriol 0.5-2 mg daily

Upon reviewing the medical reports of a patient with hypoparathyroidism, the nurse notices the serum calcium level as 8 mg/dL. What would be the appropriate long-term therapy in this patient?

Calcium In hypoparathyroidism, serum calcium levels are decreased. Thus the daily oral intake of 0.5 to 2 mg calcium is prescribed to manage hypocalcemia. Calcitriol is used to correct vitamin D deficiency. Calcitonin is preferred in patients with hyperparathyroidism. Cinacalcet is used to treat hypercalcemia related to parathyroid cancer.

What is the consequence of the action of the parathyroid hormone on the kidneys?

Calcium reabsorption and phosphorus excretion

As the nurse gives preoperative medication to a patient going into surgery, it is discovered that the surgical consent form is not signed. What does the nurse do?

Calls the surgeon

A patient undergoing hip replacement surgery suddenly develops unexplained bradycardia. The anesthetist administers epinephrine to the patient. Which complication is the anesthetist trying to prevent?

Cardiac arrest

A paraplegic patient is prescribed intravenous antibiotics for 6 weeks via a central venous catheter. Which complication might the patient develop?

Catheter dislodgement

Which method of administration should be used to prevent complications in a patient with cystic fibrosis who was prescribed an infusion of intravenous (IV) fluids with an osmolarity of 1200 mOsm/L and a pH of 4.3?

Central intravenous infusion When the osmolarity and pH are greater than normal ranges (osmolarity 270 to 300mOsm/L; pH 3.5 to 6.2), hypertonic fluids can cause vein damage. Fluids and medications with a pH value less than 5 and more than 9 and with an osmolarity greater than 600 mOsm/L are best if infused in the central circulation where greater blood flow provides adequate hemodilution.

A patient who is receiving intravenous antibiotic treatments every 6 hours has an intermittent IV set that was opened and begun 20 hours ago. What action does the nurse take?

Change the set in about 4 hours. Because both ends of the set are being manipulated with each dose, standards of practice dictate that the set should be changed every 24 hours, so the set should be changed in about 4 hours.

A patient has edema in both lower extremities. The patient's edema is due to which occurrence?

Changes in normal hydrostatic pressure

The nurse is caring for a patient who underwent knee replacement surgery the previous day. What early changes does the nurse observe for and document as indicators of a decline in the patient's clinical condition?

Changing mental status

What is the most appropriate nursing intervention in a patient with fluid overload and edema to prevent skin breakdown on pressure areas?

Changing position every 2 hours

The nurse is administering a drug to a patient through an implanted port. Before giving the medication, what does the nurse do to ensure safety?

Check for blood return. Before a drug is given through an implanted port, it is critical that the nurse check for blood return. If no blood return is observed, the drug should be held until patency is reestablished. Ports are flushed with heparin or saline after, rather than before, use.

A preoperative patient wears a hearing aid and is extremely hard of hearing without it. What does the nurse do to help reduce this patient's anxiety?

Check to see whether the operating room (OR) staff minds if the patient wears the hearing aid until anesthesia is given.

Which staff member will be best for the nurse manager to assign to update standard nursing care plans and policies for care of the patient in the operating room (OR)?

Circulating RN who has been employed in the hospital OR for 7 years

Which member of the surgical team is responsible for keeping track of the number of sponges used during surgery?

Circulating nurse

The nurse preparing a patient for infusion therapy follows aseptic skin preparation and technique before IV insertion. Which action does the nurse take to ensure aseptic skin preparation?

Clean the skin with 70% alcohol. The nurse should prepare clean skin with 70% alcohol or chlorhexidine before peripheral venous catheter insertion.

What is a common cause of hypoparathyroidism?

Congenital dysgenesis Congenital dysgenesis is one of the common causes of hypoparathyroidism. Neck trauma causes hyperparathyroidism.

What is a common cause of hyperparathyroidism?

Congenital hyperplasia

Which nursing action does the nurse include in the care of an alert older adult who is mildly dehydrated?

Considering dietary restrictions and ability to swallow, and offering oral fluids every 2 hours.

The nurse checking an IV fluid order questions its accuracy. What does the nurse do first?

Contacts the health care provider who ordered it

When inducing anesthesia, the anesthesiologist uses ice to reduce the surface temperature of the surgical site. What is this type of anesthesia called?

Cryothermia

What is the drug of choice for treating malignant hyperthermia?

Dantrolene sodium Malignant hyperthermia is a complication which can occur after general anesthesia. The drug of choice for treating this condition is dantrolene sodium, which is a skeletal muscle relaxant.

The nursing student asks the supervising nurse whether a certain fall protocol used on the nursing unit is effective. To demonstrate effectiveness, what does the supervising nurse identify?

Data about the number of falls after the protocol was introduced compared with previous rates

What should the nurse document after inserting a venous catheter?

Date and time of the insertion

A patient presents to the emergency room with confusion, altered level of consciousness, dry mouth, scaly skin, and very loose fitting shoes. Which finding in the patient's history is significant?

Decreased ingestion of solid foods such as gelati

What is the expected risk for a patient who had a total parenteral nutrition (TPN) solution with an osmolarity of 1500 mOsm/L infused peripherally?

Decreased perfusion Fluids and medications with an osmolarity more than 600 mOsm/L are best infused in the central circulation where greater blood flow provides adequate hemodilution. If TPN is infused peripherally, it damages blood cells and the endothelial lining of the veins, decreasing perfusion.

The primary health care provider prescribes 400,000 units of oral ergocalciferol to a patient with hypoparathyroidism. Which assessment findings support the intervention?

Decreased serum vitamin D levels Hypoparathyroidism is characterized by deficiency of calcium, magnesium, and vitamin D. Long-term therapy for vitamin D deficiency is 400,000 units of oral ergocalciferol. Decreased serum calcium levels are treated with intravenous administration of calcium chloride or calcium gluconate.

The nurse is assessing an older adult patient during a scheduled health maintenance visit. Which assessment finding, related to fluid balance, does the nurse anticipate?

Decreased turgor

Which of the following statements are accurate regarding RN delegation of nursing tasks?

Delegate turning and positioning tasks to a licensed vocational nurse (LVN).

According to the Institute of Healthcare Improvement (IHI), which is an intervention that the nurse makes to save patients' lives?

Deploy the Rapid Response Team (RRT).

Patient-centered care is about sharing the management of an illness between the patient and the health care provider. What is an example of knowledge needed to develop the Institute of Medicine (IOM)/Quality and Safety Education for Nurses (QSEN) initiative's Patient-Centered Care competency?

Describe how diverse backgrounds function as sources of patient, family, and community values.

A patient with a central venous catheter reports back pain between the shoulder blades. What should be the immediate nursing intervention in this situation?

Discontinuing all infusions and flushing the central venous line Back pain between the shoulder blades is a sign of catheter migration. The nurse should immediately stop the infusion and flush the catheter. The nurse should inform the primary health care provider after discontinuing the infusion.

Bedside computers are an example of informatics used in health care primarily for which purpose?

Documenting interdisciplinary care

A patient is scheduled for surgery. What factor plays an important role in determining the dose and type of anesthesia to be given?

Duration of the procedure

An elderly patient receiving intravenous steroid therapy reports swelling, pain, and tenderness at the insertion site. Which immediate complication may the patient develop?

Ecchymosis Swelling, pain, and tenderness at the intravenous insertion site are common signs of phlebitis, infiltration, ecchymosis, and thrombosis. However, the most common complication seen in older adults with steroid therapy is ecchymosis. In older patients, the nurse should refrain from using hard veins to prevent phlebitis. An infiltration is not an immediate possible complication. Thrombosis is seen due to damage of a vein after catheter insertion; however, it may not be an immediate complication.

The nurse leader is training a group of newly recruited licensed practical nurses (LPNs) about the standard hand-off communication strategies of the health care facility. This is an example of which targeted solution outlined in the SHARE acronym recommended by the Center for Transforming Health Care?

Educate and coach

A patient has been diagnosed with hyperaldosteronism. What laboratory finding is used to confirm this diagnosis?

Elevated blood pH In hyperaldosteronism, increased aldosterone levels affect the kidney tubules and cause loss of hydrogen ions. This leads to metabolic alkalemia or elevated blood pH level

A patient develops fluid overload while in the intensive care unit. Which nursing intervention does the nurse perform first?

Elevates the head of the bed

The surgeon is using a flexible tube on a patient that helps to view and manipulate internal body areas. What surgical device is the surgeon using?

Endoscope

The nurse is to administer a unit of whole blood to a postoperative patient. What does the nurse do to ensure the safety of the blood transfusion?

Ensures that another qualified health care professional checks the unit before administering

The nurse is caring for a patient with a peripherally inserted central catheter (PICC). What could cause this catheter to become dislodged?

Excessive physical activity

Which nursing activity is best for the charge nurse on the medical-surgical unit to delegate to unlicensed assistive personnel (UAP) staff members?

Feeding a patient whose hands are affected by rheumatoid arthritis.

Which is the least preferred site for peripherally inserted central catheters (PICC)?

Femoral vein Because there is a higher risk for infection, the femoral vein is the least preferred site for a PICC line insertion. The basilic vein is preferred because it offers the largest diameter of the blood vessels. The subclavian vein is also preferred because it is easy to access using bony landmarks, followed by an internal jugular vein. The basilic, subclavian, and internal jugular veins have a lower risk for infection than the femoral vein.

How is isotonic dehydration defined?

Fluids and electrolytes are lost from the body in equal amounts.

The scrub nurse takes special care to maintain the sterile environment in the operating room (OR). What action does the scrub nurse take when preparing for a surgery?

Handles surgical drapes and equipment only after donning the surgical gown.

A patient is taking fludrocortisone for adrenal hypofunction. The nurse instructs the patient to report which symptom while taking this drug?

Headache A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the patient's blood pressure should be monitored.

The nurse is assisting an older patient scheduled for cataract surgery in the operating room. What patient item does the nurse retain until the patient receives anesthesia?

Hearing aid

What finding does the nurse expect to see in a patient with hyperaldosteronism?

Hypernatremia Hyperaldosteronism, or increased aldosterone levels, affects the kidney tubules and causes sodium retention with excretion of potassium and hydrogen ions. As a result, hypernatremia, hypokalemia, and metabolic alkalosis result. The patient has elevated blood pressure, which may cause strokes, heart attacks, and kidney damage.

The nurse is providing care to a patient who is receiving diuretic therapy. Which electrolyte imbalance will the nurse monitor this patient for while providing care?

Hypokalemia

What type of parathyroid disorder would the nurse expect to find in patients with chronic kidney disease?

Hypomagnesemia Hypomagnesemia may cause hypoparathyroidism. Hypomagnesemia is seen in patients with chronic kidney disease, malabsorption syndrome, and malnutrition.

What parathyroid disorder is associated with a total thyroidectomy?

Iatrogenic hypoparathyroidism

A patient is scheduled for a cholecystectomy. What is the first step in the assessment and preparation of this patient for surgery?

Identifying the patient. During any surgery or procedure, the first and foremost step is to identify the patient. This can be done by asking the patient for his or her name and for verifying identification. Following identification, the nurse should obtain consent from the patient for the surgery. After obtaining consent, the nurse should assess the patient's perception about the procedure, such as asking the patient to elaborate on which operation he or she is having. Following this, the nurse can obtain the patient's medical history, including any allergies.

The nurse anesthetist notices that a surgical patient has an unexpected rise in the end-tidal carbon dioxide level, with a decrease in oxygen saturation and sinus tachycardia. What is the nurse's first action?

Immediately stop all inhalation anesthetic agents and succinylcholine.

What does the nurse teach a patient with hypoparathyroidism about treating hypocalcemia?

Include foods that are high in calcium.

The nurse is providing care to a patient who is experiencing tachypnea. Which intervention is most appropriate to maintain the patient's fluid balance?

Increase intravenous fluids.

What is the defense mechanism to combat the effects of isotonic dehydration and maintain blood flow to the vital organs?

Increased blood vessel constriction

What is the consequence of the action of parathyroid hormone on the bones?

Increased osteoblastic activity

The nurse knows to assess serum calcium levels for the patient with hyperparathyroidism because of which mechanism?

Increased reabsorption of calcium by the kidneys Increased levels of parathyroid hormone (PTH) cause the kidneys to reabsorb calcium, causing hypercalcemia. Hypercalcemia also occurs if there is decreased osteoblastic activity, or bone production. Similarly, an increased osteoclasticactivity, or bone destruction, also causes hypercalcemia. Increased reabsorption of phosphate by the kidneys causes hyperkalemia.

Which age-related change of the kidney increases an older adult patient's risk for dehydration?

Increased water loss

A patient receiving intrathecal therapy reports a headache, stiff neck, high grade fever, and swelling at the exit site. Based on these symptoms, what should the nurse suspect?

Infection

The nurse inserts an intravenous (IV) line in a patient requiring fluid infusion. Which condition would the nurse document if the IV solution leaks into tissues around the vein?

Infiltration

The nurse observes that a patient with intravenous (IV) fluids infusing via a peripheral catheter has developed skin tightening, tenderness, coolness of the skin, and fluid leaking from the insertion site. Which complication does the nurse suspect in this patient?

Infiltration

The critical care nurse uses a computerized decision support system to position a patient correctly to prevent ventilator-assisted pneumonia. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency?

Informatics

Before administering amoxicillin clavulanate to a patient with a sinus infection, the nurse checks the patient's electronic wristband. This is an example of which Quality and Safety Education for Nurses (QSEN) core competency?

Informatics The patient's wristband uses radio frequency identification that tracks any person or object electronically. The ability of the nurse to use and read this is an example of the Informatics competency.

Which nursing intervention takes priority for a patient admitted with severe metabolic acidosis?

Initiate cardiac monitoring.

A patient is undergoing minimally invasive splenectomy procedure. Which intervention is most important at the beginning of the surgery?

Injecting air into the abdominal cavity Air or gas should be injected into the abdominal cavity at the beginning of a minimally invasive splenectomy procedure to separate organs and improve visualization. This injection is known as insufflation and is an important factor in deciding whether to perform a traditional surgery or endoscopy.

The nurse has determined that a patient diagnosed with Cushing's disease is at risk for injury. What intervention is necessary??

Instruct patient to use an electric razor The patient should be encouraged to use an electric razor to prevent breaking the skin.

A patient who is suffering from chronic fluid overload asks the nurse to suggest necessary dietary changes. What dietary changes suggested by the nurse apart from restricting fluid intake would be effective to minimize fluid overload?

Intake of 2-4g/day of sodium

A patient presents with chronic pain resulting from a previous knee replacement surgery. The nurse expects that, prior to having a second corrective surgery on the knee, the anesthesia will be injected into which site?

Into the nerves or around the nerves present in the knee region

Which infusion therapy route is often used in the administration of chemotherapeutic agents into arterial blood flow?

Intra-arterial Intra-arterial therapy is used for infusing chemotherapeutic agents into the arterial blood flow. The radial, brachial, and femoral arteries are the sites of choice for this therapy.

A patient is brought to the emergency department with head trauma and requires immediate surgery. The patient has a history of chronic kidney disease and hepatic dysfunction. Which type of anesthesia would be contraindicated in this patient?

Intravenous

A patient with chronic kidney disease is scheduled for a hernia repair surgery. Which type of anesthesia would be contraindicated in the patient?

Intravenous

The nurse is providing education to a patient diagnosed with hypertension. Which statement by the nurse is most appropriate to help the patient maintain a normal fluid balance?

Limit your intake of sodium to decrease the water you are retaining."

Which anesthetic effect is most common with balanced and nerve block anesthesia?

Loss of sensory perception

Which is an age-related change that impacts fluid balance?

Loss of skin elasticity

The circulating nurse coordinates the patient's positioning during surgery and modifies positions according to safety and needs. What action does the nurse take to prevent peroneal nerve complications?

Maintain minimal external rotation of the hips.

Which is an inherited complication associated with general anesthesia?

Malignant hyperthermia Malignant hyperthermia is an inherited condition that involves drastic elevation of body temperature due to contraction of skeletal muscles. It is a life-threatening condition and associated with general anesthesia only.

An older patient with an elevated serum calcium level is receiving IV furosemide and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to unlicensed assistive personnel (UAP)?

Measure the patient's intake and output hourly

What is a post-operative complication associated with minimal invasive surgery (MIS)?

Mechanical trauma Minimal invasive surgery (MIS) is a common practice and now a preferred technique for many types of surgery. The complications associated with this type of surgery are mechanical trauma and thermal injury.

The nurse is preparing to administer a blood transfusion to a patient. Which vein is selected for a midline catheter?

Median antecubital The median antecubital vein is the preferred site for the administration of a midline catheter because it does not require vein transillumination for visualization. The basilic vein, which is the second choice for midline catheter administration, requires ultrasound visualization. The cephalic, subclavian, and internal jugular veins are not used for midline catheter placement. The cephalic vein is the site of placement for short peripheral catheters. The subclavian and internal jugular veins are used for placement of non-tunneled percutaneous central venous catheters.

A patient who takes corticosteroids daily for rheumatoid arthritis requires insertion of an IV catheter to receive IV antibiotics for 5 days. Which type of IV catheter does the nurse teach the new graduate nurse to use for this patient?

Midline catheter

While assessing a patient with hypoparathyroidism, the nurse observes tingling and numbness of the hands and feet. Which condition does the nurse suspect?

Moderate hypocalcemia

A patient is recovering from an acute episode of chronic obstructive pulmonary disease (COPD). Which nursing action is the greatest priority in the plan of care?

Monitor the respiratory rate and effort hourly.

A nursing student is preparing a care plan for preventing the risk of hypoventilation in an intraoperative patient during surgery. Which intervention would lead to complications in this patient?

Monitoring capnography every 5 minutes

The Center for Transforming Health Care recommends targeted solutions to enhance successful hand-off communication using the acronym SHARE. What describes the targeted solution "reinforce quality and measurement?"

Monitoring compliance with the use of standardized forms.

Which test sample is required in the caffeine halothane contracture test (CHCT) to evaluate an individual's risk for malignant hyperthermia?

Muscle The CHCT is the best way to determine if a person is at risk for developing malignant hyperthermia when undergoing anesthesia. A muscle biopsy is taken to perform this test. The test is not performed with sputum, blood, or urine.

A patient suspected of having Cushing's disease is scheduled for dexamethasone suppression testing. What statement by the patient indicates a need for further teaching?

My blood will be drawn over 3 days." The patient will not have blood drawn for this test. The urine will be collected over 24 hours. The test will determine if the patient has high cortisol levels. Dexamethasone suppression testing involves the administration of dexamethasone given over 3 hours.

The nurse is providing care to an edematous patient whose blood pressure is 190/110 mm Hg. Which hormone will be secreted in response to the patient's blood pressure in order to increase urine output?

Natriuretic peptides (NPs)

A patient is receiving long-term intra-arterial infusion therapy of methotrexate through the carotid artery. Which assessment is most important for the nurse to include?

Neurological assessment Because the carotid artery provides blood flow to the brain, it is important to conduct regular neurological assessments for patients who are receiving intra-arterial infusion therapy through the carotid artery.

When evaluating the laboratory results of a patient with diabetic ketoacidosis, which lab value indicates the body has fully compensated from this acid-base imbalance?

Normal pH on arterial blood gases

A patient diagnosed with pheochromocytoma has experienced two intermittent hypertensive attacks. What medication should the nurse assess for as a potential cause of the attack?

Nortriptyline Tricyclic antidepressants such as nortriptyline are potential causes of hypertensive attacks in patients with pheochromocytoma and should be avoided.

The RN is caring for a patient admitted with dehydration who requires a blood transfusion. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)?

Obtaining baseline vital signs before blood administration

The nurse is planning care for a 72-year-old resident of a long-term care facility who has a history of dehydration. Which action does the nurse delegate to unlicensed assistive personnel (UAP)?

Offering fluids to drink every hour

Which patient does the charge nurse on a medical-surgical unit assign to the LPN/LVN?

Older patient admitted for confusion who has a heparin lock that needs to be flushed every 8 hours

What complication could occur in a patient receiving intraosseous (IO) infusion therapy scheduled for 24 hours if the therapy is continued for longer than this time frame?

Osteomyelitis

An older adult patient is scheduled to undergo abdominal surgery. What measure does the nurse plan to implement in the operating room (OR) to prevent pressure ulcers in the patient?

Pad bony prominences.

Which intervention does the nurse implement for an older adult patient to minimize skin breakdown related to surgical positioning?

Pad bony prominences.

What would be the physiological findings if a patient is administered general anesthesia?

Pain is suppressed

Two patients sustained trauma in a motor vehicle collision, were admitted to the hospital reporting similar symptoms, and were prescribed different treatments. What could be the reason behind the different prescriptions?

Patient 2 has suffered a complication called compartment syndrome. Compartment syndrome is a condition in which increased tissue pressure in a confined anatomic space causes decreased perfusion that leads to hypoxia. Compartment syndrome presents with decreased perfusion, swelling, coolness, and discoloration to the extremity. When no improvement is observed, the leg must be amputated.

The RN is assessing a 70-year-old patient admitted to the unit with severe dehydration. Which finding requires immediate intervention by the nurse?

Patient behavior that changes from anxious and restless to lethargic and confused

The patient with hypoparathyroidism has bands on the teeth from loss of enamel because of hypocalcemia.

Patient who had a parathyroidectomy yesterday and has muscle twitching

After receiving a change-of-shift report about these four patients, which patient does the nurse attend to first?

Patient with acute adrenal insufficiency who has a blood glucose of 36 mg/dL

What type of anemia is associated with idiopathic hypoparathyroidism?

Pernicious anemia

The nurse has instructed unlicensed assistive personnel (UAP) to check the blood pressure of a patient who has a peripherally inserted central catheter (PICC) on the left arm. The UAP applied a blood pressure cuff on the left arm. Which complication may occur?

Phlebitis

What is the expected complication for a patient with an intra-abdominal infection is prescribed long-term treatment of antimicrobial agents to be infused via a peripheral intravenous catheter?

Phlebitis Antimicrobial drugs are venous irritants which have a pH of less than 5. Phlebitis occurs when patients require long-term infusion of these drugs in the peripheral circulation.

What is a possible complication of a patient receiving an intravenous infusion of a drug with a pH of 3 and an osmolarity of 500 mOsm/L through a short peripheral catheter?

Phlebitis For a short peripheral catheter, the pH of the intravenous infusion should be between 5 and 9 and the osmolarity should be between 270 to 300 mOsm/L. Infusions of a low pH and high osmolarity may cause chemical injury, which leads to vein irritation and phlebitis

If sterile gauze falls to the ground and hits the front of the surgeon's gown on the way down, what does the nurse do to ensure proper infection control?

Picks the gauze up without touching the surgeon

A patient's laboratory results show decreased hemoglobin levels, increased hematocrit, and serum protein levels leading to a diagnosis of fluid overload. What other changes support the diagnosis?

Pitting edema on the left foot and ankle.

What measure implemented in the operating room helps to prevent joint complications in the patient related to positioning during surgery?

Placing a pillow under bony prominences.

What would be the most appropriate intervention provided by the circulating nurse, to avoid pressure ulcers in a patient during surgery?

Placing gel pads over the operating bed

What post-operative assessment finding in a patient who underwent a parathyroidectomy indicates potential tetany?

Positive for Trousseau's test

What finding during the physical assessment of a patient does the nurse associate with hypoparathyroidism?

Presence of bands on the teeth The patient with hypoparathyroidism has bands on the teeth from loss of enamel because of hypocalcemia.

What changes does the nurse note in a patient with hypercortisolism upon physical assessment?

Presence of fat pads on the shoulders

What manifestation does the nurse expect to find in a patient with hyperparathyroidism?

Presence of renal calculi X-rays for the patient with hyperparathyroidism show the presence of renal calculi and deposits of calcium in the soft tissue of the kidney because of hypercalcemia.

Per the Institute of Healthcare Improvement (IHI) interventions, which is one of the nursing interventions that seek to save a patient's life?

Prevent ventilator-associated pneumonia (VAP

A patient presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this patient?

Providing isotonic fluids

The RN is caring for a patient who is severely dehydrated. Which nursing action can be delegated to unlicensed assistive personnel (UAP)?

Providing oral care every 1-2 hours

The nurse has been asked to start intraosseous therapy for a severely burned patient. Assuming that all the bones are intact, which site would be the preferred site for intraosseous therapy?

Proximal tibia The sites commonly used for intraosseous therapy are the proximal tibia, distal femur, medial malleolus, proximal humerus, and iliac crest. Of these, the proximal tibia is the most common.

The patient is a 69-year-old woman with uncontrolled diabetes, polyuria, and a blood pressure of 86/46 mm Hg. Which staff member is assigned to care for her?

RN who has floated from the intensive care unit The clinical manifestations suggest that the patient is experiencing hypovolemia and possible hypovolemic shock. The RN who floated from the intensive care unit will have extensive experience caring for patients with hypovolemia.

A severely dehydrated patient requires a rapid infusion of normal saline and needs a midline IV placed. Which staff member does the emergency department (ED) charge nurse assign to complete this task?

RN with certified registered nurse infusion (CRNI) certification who is assigned to the ED for the day

Nurses who are competent in Patient-Centered Care recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care. What is one of the attitudes needed to develop the Institute of Medicine (IOM)/Quality and Safety Education for Nurses (QSEN) initiative's Patient-Centered Care competency?

Recognize personally held values and beliefs about the management of pain and suffering.

A patient with a history of hypertension asks the nurse what dietary changes are necessary to make in order to control the blood pressure. What does the nurse include in the instruction?

Reduce the intake of sodium

Which cadre of nurses is trained and certified in administering infusion therapy?

Registered nurse (RN)

The nurse is caring for a patient with hypocalcemia due to hypoparathyroidism. What is the cause of iatrogenic hypoparathyroidism?

Removal of the parathyroid glands Iatrogenic hypoparathyroidism is caused by the removal of all parathyroid tissue during total thyroidectomy or by deliberate surgical removal of the parathyroid glands.

The nurse is monitoring a patient receiving morphine via subcutaneous infusion therapy. After three days of therapy, the nurse notices redness at the infusion site. Which is the appropriate immediate response by the nurse?

Remove the infusion needle and start the infusion at a new site with a new needle.

What action should the nurse take if the patient reports unusual pain during catheter use at the caval-atrial junction (CAJ)?

Repeat the chest x-ray.

Paramedics arrived to a 911 call to find the patient in cardiac arrest. After the patient was revived, the paramedics were unsuccessful in getting IV access, so they started intraosseous therapy for fluid administration and delivered the patient to the hospital. What is the priority action the nurse takes in regards to the intraosseous therapy when caring for the patient in the hospital?

Replacing the intraosseous therapy with traditional IV therapy within 24 hours Intraosseous therapy should not be used longer than 24 hours. Therefore, if fluids are still needed beyond the first 24 hours, the nurse should make replacement of the intraosseous therapy with traditional IV therapy a high priority within the first 24 hours. The intraosseous therapy should not be continued for 48 hours.

The nurse attends a patient in the acute care facility. What action does the nurse take to prevent the patient from medical harm?

Reposition the patient frequently.

Lab results for a 62-year-old patient show the following results: pH 7.48; bicarbonate 26; Pao 2 90; Paco 2 32. These findings are consistent with which acid-base imbalance?

Respiratory alkalosis

I-SBAR-R is a modification of the SBAR method of communication. What additional step has been included in the I-SBAR-R method compared to the SBAR method?

Response

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Her laboratory results include a potassium level of 7.0 mEq/L. What is the primary goal of drug therapy for this patient?

Restoring fluid balance by controlling the causes of dehydration

A patient with diabetes is undergoing abdominal surgery. In addition to regular sutures, which type of suture does the nurse expect the surgeon will likely use for this patient?

Retention sutures

What acronym is used for a popular procedure for hand-off communication provided by the Center for Transforming Health Care in 2010?

SHARE

In its report, Health Professions Education: A Bridge to Quality, the Institute of Medicine (IOM) identified five broad core competencies for health care professionals. Which core competency was later added in the Quality and Safety Education for Nurses (QSEN) initiative?

Safety

Which hospital team member should be restricted from entering the operating room (OR)?

Scrub nurse with a cold and cough

A surgical patient is given intravenous anesthesia for a minor procedure and is gradually feeling drowsy. What action is appropriate for the nurse to carry out at this stage?

Secure the patient with belts.

The nurse supports the patient and family in deciding on a "Do Not Resuscitate" order. Which ethical principle that guides nursing clinical decision making is demonstrated in this situation?

Self-determination Self-determination refers to the idea that patients are autonomous individuals capable of making informed decisions about their care. When the patient is not capable of self-determination, the nurse is ethically obligated to protect the patient as an advocate in the professional scope of practice.

What is the role of the scrub nurse in the operating room?

Set up a sterile table and drape the patient. For a smoothly functioning intraoperative setup, every person is given clearly defined roles and responsibilities. The scrub nurse sets up a sterile table and drapes the patient, taking care of all aseptic precautions. The scrub nurse is also responsible for handing out sterile equipment to the surgeon while performing surgery. The circulating nurse monitors the traffic in the room and records the blood and blood components given to the patient. The anesthesiologist is responsible for administering anesthesia.

Which statement is true about the special needs of older adults receiving IV therapy?

Skin integrity can be compromised easily by the application of tape or dressings.

Which assessment finding would cause the kidneys to secrete renin in order to increase blood pressure and maintain perfusion and fluid balance?

Sodium 130 mEq/L

What food is appropriate for the patient with hypoparathyroidism to include in the diet?

Soy milk

A patient with swollen arms and legs was brought to the emergency department. Which laboratory parameter would help in the diagnosis of peripheral edema?

Specific gravity of urine

A patient diagnosed with Cushing's disease has received teaching about nutrition. What food selection by the patient indicates effective teaching?

Spinach Spinach is a food choice that is high in potassium and is indicated for patients with Cushing's disease.

Which type of anesthesia would most likely be administered for a patient undergoing knee replacement surgery that allows the patient to remain conscious with an intact gag reflex?

Spinal Spinal anesthesia is a type of regional anesthesia used for knee surgery.

A patient with a central vascular access device (CVAD) reports unusual pain during an infusion. What assessment does the nurse perform for this patient?

Take an x-ray during the catheter use. A repeat x-ray should be taken during catheter use if the patient reports unusual pain. The nurse should be aware of the accurate tip location before beginning infusion through the catheter.

A patient has been ordered cortisone for hypofunction of the adrenal gland. What does the nurse instruct the patient about the administration of this drug?

Take the drug with meals or a snack.

One of the most successful initiatives of the Institute for Healthcare Improvement (IHI) was the creation of the Rapid Response Team (RRT). Which statement about the RRT is correct?

The RRT is also called the medical emergency team.

A student nurse was instructed by the primary health care provider to obtain a blood sample from a patient who is receiving peripheral infusion therapy. The student nurse draws blood from the venipuncture site, proximal to the catheter. What could be the result of this action?

The blood test results may be altered. If blood is drawn from the venipuncture site proximal to the catheter, the test results may become altered due the infusing fluid

What is taking place in the body when hyperventilation occurs?

The central nervous system is responding to a rise in carbon dioxide.

A patient with a body mass index of 42 is scheduled to receive hypodermoclysis. What consideration should the nurse take into account when administering hypodermoclysis to this patient?

The fluids from the treatment will be more readily absorbed because of the presence of large amounts of adipose tissue. Adipose tissue more readily absorbs fluids administered through subcutaneous infusion therapy. Therefore, the dose of fluids may need to be adjusted on a severely obese patient who has adipose tissue at every infusion site to prevent over-hydration and edema.

The nurse finds that a patient has dry skin, a heart rate of 115 beats per minute, a respiratory rate of 28 breaths per minute, and weight loss of 1 pound in 1 day. What does the nurse infer about the patient's condition?

The patient is suffering from dehydration.

The nurse assessing a patient's peripheral IV site obtains and documents information about it. Which assessment data indicate the need for immediate nursing intervention?

The vein feels hard and cordlike above the insertion site.

A patient has retention sutures after an abdominal surgery. What does the nurse inform the patient about retention sutures?

They are used in addition to standard sutures.

A patient receiving intravenous therapy has developed a swollen extremity and engorged peripheral veins of the ipsilateral chest. Which complication should the nurse suspect?

Thrombosis

After a central venous catheter is inserted, the patient reports chest pain and dyspnea. On further examination, the nurse finds the absence of vesicular breath sounds and a murmur with a flat sound over the location. Which reason does the nurse suspect for this condition?

Transection of the subclavian vein While a central venous catheter is being inserted, the subclavian vein may be transected, resulting in the placement of the catheter into the thoracic cavity. This leads to a complication called hydrothorax, which causes signs and symptoms such as chest pain, dyspnea, cyanosis, absence of vesicular breath sounds, and a murmur with a flat sound over the location.

Which intervention does the nurse include in caring for a patient with generalized edema who is receiving a loop diuretic?

Turning the patient every 2 hours. The patient with generalized edema/fluid overload is at risk for developing skin breakdown, especially at pressure points over bony prominences. Changing position frequently reduces this risk.

A patient has been prescribed divided doses of prednisone. How should the patient take this drug?

Two-thirds in the morning and one-third in the late afternoon Prednisone is an oral cortisol replacement drug. The patient should take two-thirds of the drug in the morning and one-third in the late afternoon. This mimics the normal release of cortisol. Dividing the drug in any other manner will not help the patient.

A patient has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention?

Unlicensed assistive personnel (UAP) pulling the patient up in bed by the shoulders

Which assessment finding is likely in a patient reporting diarrhea and vomiting with an elevated body temperature of 103° F for 2 days who is brought to the emergency department?

Urine output of 350 mL/day

A patient with hypercortisolism is at risk for bone fractures. What does the nurse instruct the unlicensed assistive personnel (UAP) to do when caring for this patient?

Use a gait belt to assist the patient when walking.

The circulating nurse is assisting a patient with a history of arthritis in the operating room (OR). What action does the nurse take to prevent joint complications?

Use pillows, trochanter rolls, or pads for support.

What could be the reason that a patient with a peripherally inserted central catheter (PICC) would have pain and numbness at the insertion site?

Venous spasm

A student nurse is demonstrating the actions to be performed during the surgical scrub. Which action by the student nurse indicates the need for further teaching?

Washing hands with an antimicrobial soap after using the surgical scrub

What is the reason for isotonic dehydration?

Water and sodium are lost from the body in proportionately equal amounts.

What integumentary change does the nurse expect while assessing the skin of a patient with hyperparathyroidism?

Waxy pallor

On the second day of caring for a patient with generalized edema, which change best reflects that the administered diuretic is effective?

Weight loss of 6 pounds

A patient with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the patient's care would be best to delegate to the unlicensed assistive personnel (UAP)?

assist with personal hygiene and skin care

Which precaution by the patient with hypercortisolism can prevent gastrointestinal (GI) bleeding?

avoid caffeine and alcohol

A patient with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment?

avoids palpating the abdomen The abdomen must not be palpated in a patient with pheochromocytoma because this action could cause a sudden release of catecholamines and severe hypertension.

A patient is suspected of having hyperparathyroidism. Which treatment strategy would be therapeutically effective in this patient?

calcitonin with glucocorticoids Calcitonin decreases the release of skeletal calcium and increases the kidney excretion of calcium. The therapeutic effects of calcitonin are greatly enhanced if it is given along with glucocorticoids. It is not effective when used alone because of its short duration of action.

Nurses plan, implement, and evaluate patient care together using an interdisciplinary plan of action. What term best describes this activity?

collaboration

Which finding does the nurse identify as contributing to the potential for infection in the patient with hypercortisolism?

decreased lymphocyte count

Which age-related change to fluid balance does the nurse anticipate when conducting a neurological assessment for an older adult patient?

decreased thirst reflex

An elderly patient who is prescribed diuretics and laxatives and has a history of diabetes mellitus is brought to the emergency room in an unconscious state. Which is the most likely reason for the patient's condition?

dehydration

Which medication classification does the nurse anticipate being prescribed to help a patient maintain an appropriate fluid balance?

diuretics

What is a local complication of intravenous therapy?

ecchymosis

A patient is seen in the emergency department (ED) with pain, redness, and warmth of the right lower arm. The patient was in the ED last week after an accident at work. On the day of the injury, the patient was in the ED for 12 hours receiving IV fluids. On close examination, the nurse notes the presence of a palpable cord 1 inch in length and streak formation. How does the nurse classify this patient's phlebitis?

grade 3 Grade 3 indicates pain at the access site with erythema and/or edema and streak formation with a palpable cord. Grade 1 indicates only erythema with or without pain; the patient has additional symptoms. Grade 2 indicates only pain at the access site with erythema and/or edema; the patient has additional symptoms. Grade 4 indicates pain at the access site with erythema and/or edema, streak formation, a palpable venous cord longer than 1 inch, and purulent drainage. No purulent drainage is present in this patient, and the palpable cord is 1 inch in length.

Which condition could be evident in laboratory reports of a hypervolemic patient?

hemodilution

A patient had a parathyroidectomy 18 hours ago. Which finding requires immediate attention?

hoarseness Hoarseness or stridor is an indication of respiratory distress and requires immediate attention.

Which electrolyte abnormality does the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis?

hyperkalemia

What clinical finding does the nurse expect in a patient with reduced aldosterone secretion?

hyperkalemia Reduced aldosterone secretion causes potassium, sodium, and water imbalances. Potassium excretion is decreased causing hyperkalemia. Insufficiency of adrenocortical steroids causes problems through the loss of aldosterone and cortisol steroids. Impaired secretion of cortisol results in hypoglycemia. There is an increased excretion of sodium and water causing hyponatremia and hypovolemia.

The nurse is providing care to a patient who is diagnosed with dehydration. Which laboratory finding supports the current diagnosis?

hypernatremia

Which condition should the nurse suspect in a patient who has undergone parathyroidectomy?

hypocalcemia

A patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with IV fluids and insulin. Which electrolyte imbalance does the nurse monitor for as the acid-base imbalance resolves?

hypokalemia

Which condition commonly occurs in patients who are on long-term furosemide therapy?

hyponatremia

Which condition triggers aldosterone secretion to maintain fluid balance within the body?

hyponatremia Aldosterone is a hormone secreted by the adrenal cortex whenever sodium levels in the extracellular fluid (ECF) are decreased in order to maintain fluid balance within the body.

A patient is prescribed an adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. What cortisol response should the nurse expect in secondary insufficiency?

increased An ACTH stimulation test involves administering ACTH intravenously to the patient, and plasma cortisol levels are obtained at 30-minute and 1-hour intervals. In secondary insufficiency, cortisol response is increased. Cortisol response is either absent or decreased in primary insufficiency. Plasma cortisol is not normal in a patient with adrenal insufficiency.

Which complication is common in both thrombophlebitis and phlebitis?

inflammation

A patient is to receive an IV solution of 5% dextrose and 0.45% normal saline at 125 mL/hr. Which system provides the safest method for the nurse to accurately administer this solution?

infusion pump

Which output source would the nurse exclude from the total output from the previous shift?

lung vaporization

A patient admitted with fluid overload from heart failure is treated with diuretic therapy. What laboratory test demonstrates effectiveness of the diuretic therapy?

natriuretic peptide

Which is a complication of intraosseous (IO) infusion therapy?

osteomylelitis

Which arterial blood gas result does the nurse anticipate in the care of a patient diagnosed with acute kidney failure?

pH 7.33, Pao 2 82 mm Hg, Paco 2 35 mm Hg, HCO 3 - 19 mEq/L

The health care provider prescribes IV ciprofloxacin to a patient who presents with a systemic infection via a peripheral intravenous catheter. Which complication would most likely occur in this patient?

phlebitis

Which parameters are elevated in a patient with adrenal insufficiency?

potassium level A patient with adrenal insufficiency will have decreased secretion of aldosterone. Aldosterone aids urinary potassium excretion; therefore, adrenal insufficiency results in hyperkalemia. The serum sodium level is low in patients with adrenal insufficiency because of its increased excretion. Glucose levels are normal or low in a patient with adrenal insufficiency. Serum cortisol levels are low in patients with adrenal insufficiency because of hypofunction of the adrenal gland.

What skin change does the nurse expect to find in a patient with hypercortisolism?

reddish-purple striae

The nurse is providing care for a patient who has hyperkalemia. Which disease process documented in the patient's medical record is the cause for this electrolyte imbalance?

renal failure

Which condition would stimulate the renin-angiotensin II to maintain fluid balance within the body?

shock The renin-angiotensin II pathway is highly stimulated whenever the patient is in shock or when the stress response occurs. This is why urine output is used as an indicator of perfusion adequacy after surgery or any time the patient has undergone an invasive procedure and is at risk for hemorrhage.

A patient with a diagnosis of Cushing's disease has been hospitalized. What care is priority for this patient?

treating fluid overload

What parameter does the nurse assess for in a postoperative patient to determine perfusion adequacy?

urine output

Which medication can be administered to mimic the effect of antidiuretic hormone (ADH) on the body?

vasopressin

A patient with Cushing's disease says that she has lost 1 lb. What does the nurse do next?

weighs the patient