EXAm 3

The the most common valvuloplasty procedure is a__________

commissurotomy

6. Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume: A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure

B. Preload C. Contractility D. Afterload

A patient has had cardiac surgery and is being monitored in the ICU. What complication should the nurse monitor for that is associated with an alteration in preload ? A. Cardiac tamponade B. Elevated central venous pressure C. Hypertension D. Hypothermia

A. Cardiac tamponade

4. A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility

B. increase, increasing preload

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply A. Polyruria B. Proteinuria C. White cell casts in the urine D. Hemoglobin of 12.8 g/dL E. Red blood cells in the urine

B. Proteinuria C. White cell casts in the urine E. Red blood cells in the urine

A patient with ESRD has developed anemia. What lab finding does the nurse understand to be significant in this stage of anemia? A. Potassium 5.2 B. Magnesium 2.5 C. Calcium 9.4 D. Creatitine 6

D. Creatitine 6

ACE Inhibitors and ARBs

-pril for ACE inhibitors and -sartan for ARBs block the RAAS. This lowers blood pressure and protects renal function, but it increases the risk for hyperkalemia as well as hypotension. Angioedema is a serious adverse effect.

During the admission assessment of a patient with hemolytic anemia, the nurse notesjaundice of the sclerae. The nurse will plan to check the laboratory results for a. the Schilling test .b. the bilirubin level. c. the stool occult blood test. d. the gastric analysis testing

.b. the bilirubin level. jaundice is caused by the elevation of bilirubin level associated with RBC hemolysis

21.Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? 1. Dehydration 2. Hypokalemia 3. Hypernatremia 4. BUN increases 5. Urine output increases 6. Serum creatinine increases

1. Dehydration 2. Hypokalemia 5. Urine output increases The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease

Typical candidates for a heart transplant have severe symptoms uncontrolled by medical therapy, no other surgical options, and a prognosis of less than__________ years to live

2

nurse is instruction a patient on dietary considerations while taking spironolactone (Aldactone). Which of the following statements made by the patient indicates that further teaching is necessary? A. "I should use a salt substitute instead of regular salt." B. "I should call my nurse practitioner if I have any significant adverse effects from my medications." C. "I should not eat foods high in potassium while taking this medication." D. "I should not take large amounts of potassium chloride supplements."

A. "I should use a salt substitute instead of regular salt."

A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty? A) "For some patients, valvuloplasty can be done in a cardiac catheterization laboratory." B) "Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well." C) "Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay." D) "It's prudent to get a second opinion before deciding to have valvuloplasty."

Ans: "For some patients, valvuloplasty can be done in a cardiac catheterization laboratory." Feedback: Some valvuloplasty procedures do not require general anesthesia or cardiopulmonary bypass and can be performed in a cardiac catheterization laboratory or hybrid room. Open heart surgery is not required and the procedure does not carry exceptional risks that would designate it as being dangerous. Normally there is no need for the nurse to advocate for a second opinion.

A patient with pericarditis has just been admitted to the CCU. The nurse planning the patient's care should prioritize what nursing diagnosis? A) Anxiety related to pericarditis B) Acute pain related to pericarditis C) Ineffective tissue perfusion related to pericarditis D) Ineffective breathing pattern related to pericarditis

Ans: Acute pain related to pericarditis Feedback: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Anxiety is highly plausible and should be addressed, but chest pain is a nearly certain accompaniment to the disease. Breathing and tissue perfusion are likely to be at risk, but pain is certain, especially in the early stages of treatment.

Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse? Select all that apply. A) Anxiety B) Fatigue C) Shoulder pain D) Tachypnea E) Palpitations

Ans: Anxiety, Fatigue, Palpitations Feedback: Most people who have mitral valve prolapse never have symptoms. A few have symptoms of fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, and anxiety. Hyperpnea and shoulder pain are not characteristic symptoms of mitral valve prolapse.

A patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder? A. Serial enzyme studies B. Phonocardiagram C. Echocardiogram D. Cardiac Catherization

C. Echocardiogram The structures and the functions of the ventricles can be easily observed with an ECHO

A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physician's choice of antibiotics would be primarily based on what diagnostic test? A) Echocardiography B) Blood cultures C) Cardiac aspiration D) Complete blood count

Ans: Blood cultures Feedback: To help determine the causative organisms and the most effective antibiotic treatment for the patient, blood cultures are taken. A CBC can help establish the degree and stage of infection, but not the causative microorganism. Echocardiography cannot indicate the microorganisms causing the infection. "Cardiac aspiration" is not a diagnostic test.

The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding? A) Decreased ejection fraction B) Decreased heart rate C) Ventricular hypertrophy D) Mitral valve regurgitation

Ans: Decreased ejection fraction Feedback: DCM is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in patients with DCM.

A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following? A) Exposure to immunocompromised individuals B) Future hospital admissions C) Dental procedures D) Live vaccinations

Ans: Dental procedures Feedback: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.

The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM? A) Dilated ventricles with atrophy of the ventricles B) Dilated ventricles without hypertrophy of the ventricles C) Dilation and hypertrophy of all four heart chambers D) Dilation of the atria and hypertrophy of the ventricles

Ans: Dilated ventricles without hypertrophy of the ventricles Feedback: DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.

The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should know that complications following this procedure include what? Select all that apply. A) Emboli B) Mitral valve damage C) Ventricular dysrhythmia D) Atrial-septal defect E) Plaque formation

Ans: Emboli, Mitral valve damage, Ventricular dysrhythmia Feedback: Possible complications include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, and bleeding from the catheter insertion sites. Atrial-septal defect and plaque formation are not complications of a balloon valvuloplasty.

A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patient's most recent laboratory results, the nurse should prioritize assessment of which of the following? A) Sodium B) AST, ALT, and bilirubin C) White blood cell differential D) BUN

Ans: Sodium Feedback: Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels. Consequently, sodium levels are followed more closely than other important laboratory values, including BUN, leukocytes, and liver function tests.

A vegetarian client was referred to a dietician for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: A. Adds dried fruit to cereal and baked goods B. Cooks tomato-based foods in iron pots C. Drinks coffee or tea with meals D. Adds vitamin C to all meal

C. Drinks coffee or tea with meals

The low tidal volume alarm on a client's ventilator keeps sounding. What is the nurse's first action? A) Manually ventilate the client. B) Put air into the endotracheal tube cuff. C) Check ventilator connections. D) Call the physician.

Answer: C- Check ventilator connections Rationale: Ventilator connections should be check initially and loose connections or disconnections should be fixed. If there is no immediate problem found, the client should be manually ventilated and another person should check the ventilator connections. Test Plan: Management of care

A client has just been intubated for placement on a mechanical ventilator. What is the first assessment of the tube placement? A) Chest X-Ray B) Auscultation of breath sounds C) Pulse oximetry reading of 95% D) End tidal CO2 monitoring

Answer: D- End tidal CO2 monitoring Rationale: End tidal CO2 monitoring is the first intervention to determine if the endotracheal tube is in place, but a chest x-ray is still needed to confirm proper placement.

The nurse is providing discharge teaching to a client with dilated cardiomyopathy. Which statement by the client indicates the need for further education? A. "I am at risk for blood clots because I have atrial fibrillation." B. "I need to take the diuretic on the days my feet are swollen." C. " I will take the ACE inhibitor every day so my heart doesn't work as hard." D. "Going to cardiac rehabilitaion may help me manage my activities better."

B. "I need to take the diuretic on the days my feet are swollen." Meds should be taken everyday.

8. A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime? A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." The answer is B. A patient with pernicious anemia cannot absorb vitamin B12 through the GI system. So, eating foods or taking supplements of vitamin B12 are pointless because the patient lacks intrinsic factor to absorb vitamin B12. Therefore, the typical regime for a patient with pernicious anemia is to receive vitamin B12 through intramuscular injections. Normally, the physician will order weekly injections and then monthly as maintenance, which is usually a lifelong treatment.

What valvular problem is characterized by a significantly widened pulse pressure? A. Mitral valve stenosis B .Mitral regurgitation C. Aortic regurgitation D. Aortic stenosis

C. Aortic regurgitation

A patient is admitted with suspected cardiomyopathy. What diagnosis test would be most helpful with the identification of this disorder ? A. Serial enzyme studies B. Cardiac catheterization C. ECHO D. Phonocardiogram

C. ECHO

A young athlete collapsed and died due to hypertrophic cardiomyopathy. The parents ask the nurse how it is possible that their child had no symptoms of this disorder before experiencing sudden cardiac death. What is the most appropriate response made by the nurse? A. "During exercise, the heart may not be able to meet the body's demands for blood and oxygen." B. "Cardiomyopathy results in destruction and scarring of cardiac muscle cells. As a result, the ventricle may rupture, causing sudden death." C. "Exercise causes the heart to contract more forcefully and can lead to changes in the heart's rhythm or outflow of blood." D. "It is likely that your child had symptoms of the disorder but may not have thought them important."

C. "Exercise causes the heart to contract more forcefully and can lead to changes in the heart's rhythm or outflow of blood." Rationale: In hypertrophic cardiomyopathy, symptoms may not develop until the demand for oxygen increases as with exercising. This type of cardiomyopathy is not a problem with filling the heart, but rather an obstruction of blood being ejected from the heart to meet the body's oxygen demand. It is not likely that the child had symptoms. The ventricle does not rupture due to scarring.

7. You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication? A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food

C. with a full glass of water The answer is C. Ibuprofen should be taken with a full glass of water to prevent GI problems, such as ulcers or bleeding.

The client is on CPAP for weaning from a mechanical ventilator. Assessment reveals a respiratory rate of 32/min, oxygen saturation of 88 percent, and use of accessory muscles. What should the nurse anticipate will occur? A. The FiO2 will be increased. B. Weaning will continue. C. The client will be placed back on full ventilatory support. D. The client will be extubated.

Correct Answer: C. The client will be placed back on full ventilatory support. Rationale: Weaning should be discontinued, as the client is showing signs of intolerance.

Erythropoietin sometimes is administered subcutaneously to treat which of the following? A. Clients with marrow suppression B. Clients with chronic liver disease C. Clients with Hodgkin's disease and non-Hodgkin's lymphoma D. Clients with anemia and fatigue related to non-myeloid cancers

D. Clients with anemia and fatigue related to non-myeloid cancers

16. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

D. Angiotensin-converting-enzyme inhibitors The answer is D. This is a description of ACE inhibitors (option D).

The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnosis for which disorder ? A. Mitral insufficiency B. Tricuspid insufficiency C. Tricuspid stenosis D. Aortic regurgitation

D. Aortic regurgitation

What is the most common cause of mitral stenosis A. Myocardial infraction B. Degenerative stenosis C. Congestive heart failure D. Infective endocarditis

D. Infective endocarditis

6. A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.

E. Options A and B are correct. The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation.

1. True or False: The pericardium layer consists of a fibrous layer that is made up of two layers called the parietal and visceral layers. True False

False False: The pericardium layer consists of a fibrous layer and SEROUS layer that is made up of two layers called that parietal and visceral layers.

8. True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage. True False

False The answer is FALSE. Some patients will skip the oliguric stage of AKI and progress to the diuresis stage.

1. True or False: Endocarditis only affects the atrioventricular and semi-lunar valves in the heart. True False

False This statement is FALSE. Endocarditis can affect not only the heart valves but the interventricular septum and chordae tendineae as well.

Blood flows back from the left ventricle into the left atrium during systole is called what?

Mitral regurgitation

(T/F) Mitral valve prolapse is a deformity that usually produces no symptoms

True

(T/F) Often the first and only sign of mitral valve prolapse is an extra heart sound, referred to as a diastolic click

True

Prevention of AKI is important because of high mortality rate. Which patient patients are at increased risk for AKI (select all that apply)? a. An 86 year old woman scheduled for a cardiac catheterization b. A 48 year old man with multiple injuries from a MVA c. A 32 year old woman following a c-section delivery for abruptio placentae d. A 64 year old woman with CHF admitted with bloody stools e. A 58 year old man with prostate cancer undergoing preoperative workup for prostatectomy

a. An 86 year old woman scheduled for a cardiac catheterization b. A 48 year old man with multiple injuries from a MVA c. A 32 year old woman following a c-section delivery for abruptio placentae d. A 64 year old woman with CHF admitted with bloody stools e. A 58 year old man with prostate cancer undergoing preoperative workup for prostatectomy . High-risk patients include those exposed to nephrotoxic agents and advanced age, massive trauma, prolonged hypovolemia or hypotension, obstetric complications, cardiac failure, preexisting chronic kidney disease, extensive burns or sepsis. Patients with prostate cancer may have obstruction of the outflow tract, which increases risk of postrenal AKI.

Two days after an acute MI, a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patient's temperature. c. Notify the HCP. d. Give the PRN acetaminophen (Tylenol).

a. Auscultate the heart sounds. -The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature and notifying the HCP are also appropriate but would not be done before listening for a rub. It is not stated for what symptoms (e.g., headache) or finding (e.g., increased temperature) the PRN acetaminophen is ordered.

A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's BP. c. Instruct the patient to avoid high-potassium foods. d. Call the lab and request a redraw of the lab to verify results.

a. Dysrhythmias may occur with an elevated potassium level and are potentially lethal. Monitor the rhythm while contacting physician or calling the rapid response team.

Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of a. ammonia synthesis b. excretion of sodium c. excretion of bicarbonate d. conservation of potassium

a. ammonia synthesis a. metabolic acidosis occurs in AKI because the kidneys cannot synthesize ammonia or excrete acid producgts of metabolism, resulting in an increased acid load. Bicarbonate is normally generated and reabsorbed by the functioning kidney to maintain acid-base balance.

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

a. increase the oxygen flow rate. Increasing oxygen flow rate usually will improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation. DIF: Cognitive Level: Application REF: 1747-1749 | 1754 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse suspects cardiac tamponade in a patient with acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should a. note when Korotkoff sounds are auscultated during both inspiration and expiration. b. subtract the diastolic blood pressure from the systolic blood pressure. c. check the ECG for variations in rate during the respiratory cycle. d. listen for pericardial friction rub that persists when the patient is instructed to stop breathing.

a. note when Korotkoff sounds are auscultated during both inspiration and expiration. -Pulsus paradoxus exists when there is a gap of greater than 10 mmHg between Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus.

Beta-blockers, alpha-1 adrenergic receptor blockers, and centrally-acting alpha adrenergics

all block the SNS but in different locations. Monitoring the pulse is necessary for both beta-blockers and centrally-acting alpha adrenergics. Blocking the SNS also results in lowered blood glucose and a masking of the symptoms of hypoglycemia.

In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. hematuria b. specific gravity fixed at 1.010 c. urine sodium of 12 mEq/l (12 mmol/L) d. osmolality of 1000 mOsm/kg (1000 mmol/kg)

b. A urine specific gravity that is consistently 1.010 and a urine osmolality of about 300 mOsm/kg is the same specific gravity and osmolality as plasma. This indicates that tubules are damaged and unable to concentrate urine.

A patient with AKI has a serum potassium level of 6.7 mEq/L and the following ABG results: ph 7.28, PaCo2 30, PaO2 86, HCO3- 18. the nurse recognizes that treatment of the acid-base problem with sodium bicarobnate would cause a decrease in with value? a. pH b. potassium level c. bicarbonate level d. carbon dixoide level

b. During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing the serum potassium level. Correction of the acidosis with sodium bicarbonate will help to shift the potassium back into the cells. A dcrease in pH and the bicarbonate and PaCo2 levels would indicate worsening acidosis.

Safe and Effective Care Environment 33. After receiving the following information about four patients during change-of-shift report, which patient should the nurse assess first? a. Patient with acute pericarditis who has a pericardial friction rub b. Patient who has just returned to the unit after balloon valvuloplasty c. Patient who has hypertrophic cardiomyopathy and a heart rate of 116 d. Patient with a mitral valve replacement who has an anticoagulant scheduled

b. Patient who has just returned to the unit after balloon valvuloplasty The patient who has just arrived after balloon valvuloplasty will need assessment for complications such as bleeding and hypotension. The information about the other patients is consistent with their diagnoses and does not indicate any complications or need for urgent assessment or intervention. DIF: Cognitive Level: Analyze (analysis) REF: 824 OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning MSC:

Physiological Integrity 32. After receiving report on the following patients, which patient should the nurse assess first? a. Patient with rheumatic fever who has sharp chest pain with a deep breath b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg c. Patient with infective endocarditis who has a murmur and splinter hemorrhages d. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse should immediately assess this patient for other findings such as dyspnea or chest pain. The findings in the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and intervention. DIF: Cognitive Level: Analyze (analysis) REF: 823 OBJ: Special Questions: Multiple Patients; Prioritization TOP: Nursing Process: Assessment MSC:

A patient is admitted to the hospital with idiopathic aplastic anemia. Which of thesecollaborative problems will the nurse include when developing the care plan? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema

b. Potential complication: infection the pt is at risk for infection and bleeding from aplastic anemia

The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia? a. BP 146/88 b. Respirations 28 shallow c. Weight gain of 10 pounds in 6 months d. Pink complexion

b. Respirations 28 shallow When there are fewer red blood cells, there is less hemoglobin and less oxygen. Therefore, the client is often short of breath. The client with anemia is often pale in color, has weight loss, and may be hypotensive.

A 68 year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2mEq/l (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3- is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. loop diuretics b. renal replacement therapy c. insulin and sodium bicarbonate d. sodium polystyrene sulfonate (Kayexalate)

b. This patient has a t least three of six common indications for RRT, including high potassium level, metabolic acidosis and changed mental status. The other indications are volume overload, resulting in compromised cardiac status (this patient has a history of HTN), BUN greater than 120 mg/dL, and pericarditis, pericardial effusion, or cardiac tamponade.

To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest. b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border. c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub. d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.

b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border. -Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. The nurse should ask the patient to hold his/her breath during auscultation to distinguish the sounds from a pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.

A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with a. administration of 100% oxygen by non-rebreather mask. b. endotracheal intubation and positive pressure ventilation. c. insertion of a mini-tracheostomy with frequent suctioning. d. initiation of bilevel positive pressure ventilation (BiPAP).

b. endotracheal intubation and positive pressure ventilation. The patient's lethargy, low respiratory rate, and SpO2 indicate the need for mechanical ventilation with ventilator-controlled respiratory rate. Administration of high flow oxygen will not be helpful because the patient's respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate removal of secretions, but it will not improve the patient's respiratory rate or oxygenation. BiPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange. DIF: Cognitive Level: Application REF: 1754-1756 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

13. A newborn infant has developed significant jaundice and has a positive Coombs test result resulting from high levels of bilirubin. What should a nurse be aware that these symptoms may indicate? a. Aplastic anemia b. Hemophilia c. Hemolytic anemia d. Sickle cell anemia

c. Hemolytic anemia Newborns can develop hemolytic anemias resulting from blood incompatibility to their mother. These are typical signs of hemolytic anemia in the newborn. DIF: Cognitive Level: Comprehension REF: p. 634-635 OBJ: 5 TOP: Hemolytic Anemia KEY: Nursing Process Step: Assessment MSC:

Prevention of aortic regurgitation is primarily based on prevention or and treatment for ___ infections.

bacterial

Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the HCP? a. Pulsus paradoxus 8 mmHg. b. Blood pressure of 168/94. c. Jugular venous distention to jaw level. d. Level 6 chest pain with a deep breath.

c. Jugular venous distention to jaw level. -The JVD indicates that the patient may have developed cardiac tamponade and may need rapid intervention to maintain adequate CO. Hypertension would not be associated with complications of pericarditis, and the BP is not high enough to indicate that there is any immediate need to call the HCP. A pulsus paradoxus of 8 mmHg is normal. Level 6/10 chest pain should be treated but is not unusual with pericarditis.

An 83 year old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in the patient(select all that apply)? a. anaphlyaxis b. renal calculi c. hypovolemia d. nephrotoxic drugs e. decreased cardiac output

c,e. Because the patient has had nothing to eat or drink for 2 days, she is probably dehydrated and hypovolemic. Decreased cardiac output is most likely because she is older and takes heart medicine, wich is probably for heart failure or HTN.

Physiological Integrity 30. Which statement by a patient with restrictive cardiomyopathy indicates that the nurse's discharge teaching about self-management has been most effective? a. "I will avoid taking aspirin or other antiinflammatory drugs." b. "I will need to limit my intake of salt and fluids even in hot weather." c. "I will take antibiotics when my teeth are cleaned at the dental office." d. "I should begin an exercise program that includes things like biking or swimming."

c. "I will take antibiotics when my teeth are cleaned at the dental office." Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use prophylactic antibiotics for any procedure that may cause bacteremia. The other statements indicate a need for more teaching by the nurse. Dehydration and vigorous exercise impair ventricular filling in patients with restrictive cardiomyopathy. There is no need to avoid salt (unless ordered), aspirin, or NSAIDs. DIF: Cognitive Level: Apply (application) REF: 830 | 813 TOP: Nursing Process: Evaluation MSC:

An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best indicator? a. Conjunctiva of the eye b. Soles of the feet c. Roof of the mouth d. Shins

c. Roof of the mouth The oral mucosa and hard palate (roof of the mouth) are the best indicators of jaundice in dark-skinned persons. Skin assessment of patients with dark skin should be done in natural light when possible in order to ascertain the condition; it may be necessary to check mucous membranes, sclera, lips, nail beds, palms, and soles of feet for accurate assessment.

28. What medical history information is significant to potential bleeding problems? (Select all that apply.) a. Drinks two glasses of wine a day b. Eats red meat three times a week c. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for the relief of arthritic pain four times a day d. Has hepatitis B e. Had a cardiac valve replaced 6 months earlier

c. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for the relief of arthritic pain four times a day d. Has hepatitis B e. Had a cardiac valve replaced 6 months earlier NSAIDs and liver disorders enhance the probability of bleeding. The valve replacement of a few months earlier suggests that the patient is using anticoagulant drugs. DIF: Cognitive Level: Comprehension REF: p. 625 OBJ: 2 TOP: Factors Predisposing to Bleeding Tendency KEY: Nursing Process Step: Assessment MSC:

What are intrarenal causes of AKI (select all that apply)? a. anaphylaxis b. renal stones c. bladder cancer d. nephrotoxic drugs e. acute glomerulonephritis f. tubular obstruction by myoglobin

d, e, f. Intrarenal causes of AKI includes conditions that cause direct damage to the kidney tissue, including nephrotoxic drugs, acute glomerulonephritis, and tubular obstruction by myoglobin, or prolonged ischemia.

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching thepatient about pernicious anemia, the nurse determines that the patient understands thedisorder when the patient states, a. "I need to start eating more red meat or liver." b. "I will stop having a glass of wine with dinner." c. "I will need to take a proton pump inhibitor like omeprazole (Prilosec)." d. "I would rather use the nasal spray than have to get injections of vitamin B12

d. "I would rather use the nasal spray than have to get injections of vitamin B12 Since pernicious anemia prevents the absorption of vitamin B12, this patient requiresinjections or intranasal administration of cobalamin. Alcohol use does not causecobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12.Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factorprevents absorption of the vitami

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. patient with DM. b. a patient with HTN crisis c. patient who tried to overdose on acetaminophen d. patient with major surgery who required a blood transfusion

d. ATN is primarily the result of ischemia, nephrotoxins, or sepsis. DM, HTN, and acetaminophen overdose will not contribute to ATN.

22. A nurse is helping prepare a nursing care plan for a 90-lb, 82-year-old woman with iron-deficiency anemia with a hemoglobin of 5.2. What is the most appropriate nursing diagnosis? a. Impaired tissue integrity related to immobility b. Disturbed body image related to weight loss c. Anxiety related to an unfamiliar hospital environment d. Activity intolerance related to fatigue

d. Activity intolerance related to fatigue Fatigue and activity intolerance are common complaints of patients with hematologic disorders. DIF: Cognitive Level: Application REF: p. 635 OBJ: 6 TOP: Hematologic Nursing Diagnosis KEY: Nursing Process Step: Nursing Diagnosis MSC:

A patient receiving a transfusion of packed red blood cells develops chills, fever,headache, and anxiety 30 minutes after the transfusion is started. After stopping thetransfusion, what is the first action that the nurse should take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Give the PRN diphenhydramine (Benadryl). d. Administer the PRN acetaminophen (Tylenol

d. Administer the PRN acetaminophen (Tylenol these are clinical manifestations of a febrile nonhemolytic reactionstop infusion and give antipyretics for fever

Safe and Effective Care Environment 34. Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG) technicians working on the cardiac unit? a. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome. b. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis. c. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy. d. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

d. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates. Under the supervision of registered nurses (RNs), UAP check the patient's cardiac monitor and obtain information about changes in heart rate and rhythm with exercise. Teaching and obtaining information about home medications (prescribed or complementary) and selecting the best leads for monitoring patients require more critical thinking and should be done by the RN. DIF: Cognitive Level: Apply (application) REF: 15 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC:

Physiological Integrity 20. A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder? a. A heart transplant should be scheduled as soon as possible. b. Elevating the legs above the heart will help relieve dyspnea. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

d. Notify the doctor about any symptoms of heart failure such as shortness of breath. The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation. DIF: Cognitive Level: Apply (application) REF: 828 TOP: Nursing Process: Planning MSC:

In caring for the patient with AKI, what should the nurse be aware of? a. The most common cause of death in AKI is irreversible metabolic acidosis. b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 ml plus the prior day's measured fluid loss c. dietary sodium and potassium during the oliguric phase of AKI are manage according to the patient's urinary output. d. One of the most important nursing measures in managing fluid balance in the patient with AKI in taking accurate daily weights

d. One of the most important nursing measures in managing fluid balance in the patient with AKI in taking accurate daily weights Measuring daily weights with the same scale at the same time each day allows for the evaluation and detection of excessive body fluid gains or losses.

What indicates to the nurse a patient with AKI is the recovery phase? a. a return to normal weight b. a urine output of 3700 ml/day c. decreasing sodium and potassium levels d. decreasing blood urea nitrogen and creatinine levels

d. The BUN and creatinine levels remain high during oliguric and diuretic phrases of AKI. The recovery phase begins when the glomerular filtration returns to a rate at which BUN and creatinine stabilize and then decrease. Urinary output of 305 L/day, decreasing sodium and potassium levels, and fluid weight loss are characteristic of the diuretic phase of AKI.

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The priority intervention by the nurse for this problem is to a. teach the patient to take deep, slow breaths to control the pain. b. force fluids to 3000 mL/day to decrease fever and inflammation. c. remind the patient to request opioid pain medication every 4 hours. d. place the patient in Fowler's position, leaning forward on the overbed table.

d. place the patient in Fowler's position, leaning forward on the overbed table. -Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend to increase pericardial pain. Opioids are not very effective at controlling pain caused by acute inflammatory conditions and are usually ordered PRN. The patient would receive scheduled doses of a non steroidal anti-inflammatory drug (NSAID).

While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the HCP? a. urine output is 300 ml/ b. edema occurs in the feet, legs, and sacral area c. cardiac monitor reveals a depressed T wave and elevated ST segment d. the patient experiences increasing muscle weakness and abdominal cramping

d. the patient experiences increasing muscle weakness and abdominal cramping d. Hyperkalemia is potentially life-threatening complication of AKI in the oliguric phase. Hyperkalemia can cause the cardiac conduction abnormalities of peaked T wave, prolonged PR interval, prolonged QRS interval, and depressed ST segment.

The first symptom of mitral stenosis often is _____ as a result of pulmonary venous hypertension.

dyspnea on exertion

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for ? A. Iron deficiency anemia B. Aplastic anemia C. Megablastic anemia D. Sickle cell disease.

C. Megablastic anemia

The client diagnosed with a iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? 1. Take Imodium, an antidiarrheal, OTC for diarrhea. 2. Limit exercise for several weeks until a tolerance is achieved 3. The stools may be very dark, and this can mask blood. 4. Eat only red meats and organ meats for protein.

3. The stools may be very dark, and this can mask blood.

7. When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? 1. Weigh patient three times weekly. 2. Increase dietary sodium and potassium. 3. Provide a low-protein, high-carbohydrate diet. 4. Restrict fluids according to previous daily loss.

4. Restrict fluids according to previous daily loss. Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week

The nurse is discussing treatment options and evaluating the goals of a client diagnosed with cardiomyopathy. Which client statement helps the nurse determine that teaching has been successful? A. "I am afraid to die and would like to talk about it with my pastor." B. "I just can't die yet; I am not ready." C. "This is just not possible; I am too young to die." D. "How will my family survive without me?"

A. "I am afraid to die and would like to talk about it with my pastor." Rationale: The client who admits fear but is willing to seek help and to talk about those fears has met the goal of verbalizing feelings about impending death. The client who verbalizes not being ready to die is not accepting the inevitable. Worrying about the family and stating that this is not possible are forms of denial that avoid discussion of fears and feelings.

1. You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." D. "A red, smooth tongue can be a sign of pernicious anemia."

A. "Pernicious anemia is caused by not consuming enough Vitamin B12." The answer is A. This statement is wrong because pernicious anemia is caused by the patient lacking intrinsic factor which helps with the absorption of vitamin B12. The patient can consume supplements or foods with vitamin B12, but they will not absorb B12 because they lack intrinsic factor. All the other statements are correct about pernicious anemia.

The nurse is discussing care with the parents of a 19-year-old client who has been diagnosed with end stage cardiomyopathy. The parents ask the nurse if it is helpful for family members and the client if the family is allowed to be present during resuscitation efforts. What is the best response by the nurse? A. "The family presence is a means of preserving the wholeness and integrity of the family unit." B. "The family can help until medical personnel arrive." C. "It is not allowed in this facility." D. "There are no benefits to the client or the family; it is a traumatic experience."

A. "The family presence is a means of preserving the wholeness and integrity of the family unit." Rationale: In 1995, nurses and doctors began to view the presence of family at resuscitations as beneficial for the family as well as a right of the family. Today, in cases where death is probable, the family is asked before the event if they wish to be present. The theory is that attendance preserves the wholeness and integrity of the family unit from birth to death, and most facilities today allow families to be present. The family is usually in the room but away from the client so the staff can work. The family does not participate in resuscitation; they may prevent medical personnel from getting to the client.

A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? A. "What activities were you able to do 6 months ago compared with the present? "B. "How long have you had this problem?" C. "Have you been able to keep up with all your usual activities?" D. "Are you more tired now than you used to be?"

A. "What activities were you able to do 6 months ago compared with the present? It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present.

2. The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has a. chest trauma and multiple rib fractures. b. carbon monoxide poisoning after a house fire. c. left-sided ventricular failure and acute pulmonary edema. d. tachypnea and acute respiratory distress syndrome (ARDS).

A. . chest trauma and multiple rib fractures. Rationale: Hypercapnia is caused by poor ventilatory effort, which occurs in chest trauma when rib fractures (or flail chest) decrease lung ventilation. Carbon monoxide poisoning, acute pulmonary edema, and ARDS are more commonly associated with hypoxemia. Cognitive Level: Application Text Reference: p. 1800 Nursing Process: Assessment NCLEX: Physiological Integrity

11. While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last? A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months

A. 1-2 weeks The answer is A. The oliguric stage can last 1-2 weeks. Regarding the other stages of AKI: Initiation: few hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more.

The nurse is caring for a client diagnosed with cardiomyopathy. Which assessment finding indicates that the client is experiencing heart​ failure, which is a clinical manifestation of​ cardiomyopathy? A. Nocturnal dyspnea B. Chest pain C. Dizziness D. Nausea

A. Nocturnal dyspnea RATIONALE: Nocturnal dyspnea indicates heart​ failure, which is a clinical manifestation of cardiomyopathy. Chest pain and nausea are clinical manifestations of angina. Dizziness is a clinical manifestation of syncope.

2. Which of the following patients are MOST at risk for developing endocarditis? Select-all-that-apply: A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. C. A 63 year old female who is newly diagnosed with hyperparathyroidism and is taking Aspirin. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever. Options A, B, and D are all risks for developing endocarditis. Remember that any thing that allows entry of bacteria into the system can potentially cause endocarditis. Option C is not relevant.

9. Which patient below with acute kidney injury is in the oliguric stage of AKI: A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.

3. Select the patient below who is at MOST risk for pernicious anemia: A. A 75 year old male who recently had surgery on the ileum. B. A 25 year old female who reports craving ice and clay. C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells. D. All the patients above are at risk for pernicious anemia.

A. A 75 year old male who recently had surgery on the ileum. The answer is A. Remember from the lecture that the elderly, patients who've had GI surgery (the ileum is part of the GI system), have endocrine disorders (like Addison's Disease, Diabetes Type 1 etc.), or GI disease are at risk for pernicious anemia. This reason is because as the person ages GI secretions decrease along with intrinsic factor and with GI surgery the parietal cells can be damaged (which are responsible for secreting intrinsic factor). So, the patient in option A is at most risk. Options B and C are risk factors for IRON-DEFICIENCY anemia (not pernicious anemia).

4. A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient's symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What is type of infective endocarditis this classified as based on the information listed? A. Acute Infective Endocarditis B. Subacute Infective Endocarditis C. Non-infective Endocarditis D. Pericarditis

A. Acute Infective Endocarditis The answer is A. This is acute infective endocarditis. The key clues in this question are patient has no significant health history and signs and symptoms were sudden/severe. In subacute infective endocarditis, the patient will have a pre-existing condition that caused them to develop the IE and the symptoms are gradual and subtle.

A patient who had coronary artery bypass graft (CABG) is exhibiting signs of cardiac failure. What nursing action should be appropriate for this patient ? Select all that apply A. Administration of furosemide B. Administration of digoxin C. Administration of milrinone D. Preparation of the patient for dialysis E. Administration of nitroprusside

A. Administration of furosemide B. Administration of digoxin C. Administration of milrinone

A patient who had a CABG is exhibiting signs of cardiac failure. What nursing actions would be appropriate for this patient? Select all that apply A. Administration of furosemide B. Administration of digoxin C. Preparation of the patient for dialysis D. Administration of nitroprusside E. Administration of milrinone

A. Administration of furosemide Diuretic is appropriate B. Administration of digoxin Increases force of contraction E. Administration of milrinone

A patient with chronic kidney failure experience decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this patient ? A. Anemia B. Acidosis C. Hyperkalemia D. Pericarditis

A. Anemia

A client is brought to the ER reporting fatigue, large amount of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia and thrombocytopenia. Based on the symptoms, what could be the diagnosis ? A. Aplastic anemia B. Sickle cell anemia C. Hemolytic anemia D. Iron deficiency anemia

A. Aplastic anemia Aplastic can be trigger by infection. Manifestation is usually symptoms of anemia including bruising, retinal hemorrhage, neutropenia, thrombocytopenia

A client is diagnosed with dilated cardiomyopathy. Which scheduled medication should the nurse clarify with the health care provider before administering​ it? A. Beta-blocker B. Diuretic C. Anticoagulant D. Antidysrhythmic

A. Beta-blocker RATIONALE: The nurse needs to question the health care provider about the​ beta-blocker, for this medication should be used with caution in clients with dilated cardiomyopathy.​ Anticoagulants, antidysrhythmics, and diuretics are often used in the treatment of dilated​ cardiomyopathy, and the nurse would not question these prescribed medications.

Orthostatic hypotension is a potential outcome for hypertensive drugs that places the elderly at risk for injury from falls. Instructions given to the patient to decrease this effect include which of the following? PLEASE SELECT ALL THAT APPLY A. Change position slowly when rising from bed or chair B. decrease dose until symptoms disappear C. Take the dose at bedtime D. increase fluid intake by 500mL/d

A. Change position slowly when rising from bed or chair C. Take the dose at bedtime CORRECT! Taking the dose at bedtime decreases the frequency of ambulation and the upright position. Changing position slowly decreases the occurrence of postural hypotension. A variety of lifestyle modifications to decrease the risk of falls should also be addressed by the nurse.

Which of the following interventions should the nurse perform when a patient with cardiomyopathy receiving diuretics ? A. Check for dependent edema frequently B. Unrestricted physical activities C. Administer Oxygen D. Maintain bedrest

A. Check for dependent edema frequently

A patient is placed on volume-cycled ventilation. The nurse plans care for this client based on which characteristic of this method of ventilation? A. Delivers a set volume, which will help overcome the client's airway resistance changes. B. The mechanism by which the phase of the breath switches from inspiration to expiration. C. Provides a consistent tidal volume. D. Delivers a preset volume of gas to the lungs to generate high pressures.

A. Delivers a set volume, which will help overcome the client's airway resistance changes. Rationale: Volume- cycled ventilation delivers a preset volume of gas to the lungs, making volume constant therefore, overcoming the changes in lung compliance and airway resistance.

The nurse hears the patient's ventilator alarm sound and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined? A. Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved. B. Suction the patient since the patient since the patient may be obstructed by secretions C. Stop the ventilator by pressing teh off button, wait 15 seconds, and then turn it on again to see if the alarm stops D. Cal respiratory therapy and wait until they arrive to determine what is happening

A. Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved.

You're assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?* A. Document your findings as normal. B. Assess for an air leak due to bubbling noted in the suction chamber. C. Notify the physician about the drainage. D. Milk the tubing to ensure patency of the tubes.

A. Document your findings as normal.

The nurse is planning care for a client with cardiomyopathy. Which nursing diagnoses are appropriate for the client? (Select all that apply.) A. Fear B. Risk for Electrolyte Imbalance C. Decisional Conflict D. Anticipatory Grieving E. Risk for Bleeding

A. Fear D. Anticipatory Grieving Rationale: Any type of cardiomyopathy has a very poor prognosis, so the client and family will likely experience anticipatory grieving of the loss of a loved one. The client will likely experience fear in confronting death. Risk for bleeding, decisional conflict, and risk for electrolyte imbalance are not priorities for this client.

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? A. Hematocrit B. Partial thromboplastin time C. Hemoglobin concentration D. Prothrombin time

A. Hematocrit Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked.Erythropoietin can be used to correct anemia by stimulating red blood cell production in the bone marrow in these conditions. The medication is known as epoetin alfa (Epogen, Procrit) or as darbepoietin alfa (Arnesp). It can be given as an injection intravenously or subQ.

The nurse is admitting a client with congenital cardiomyopathy. Which assessment finding is included in the health​ history? ​(Select all that​ apply.) A. History of hypertension B. Diet and activity C. Recent weight gain D. Presence of cough E. Vital signs

A. History of hypertension B. Diet and activity C. Recent weight gain D. Presence of cough RATIONALE: When admitting a client with congenital​ cardiomyopathy, the presence of​ cough, history of​ hypertension, recent weight​ gain, and diet and activity should be included in the health history. Vital signs are part of the physical examination.

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

A. Hypercapnic respiratory failure related to decreased ventilatory effort Rationale: The patient with an opioid overdose develops hypercapnic respiratory failure as a result of the decrease in respiratory rate and depth. Diffusion limitations, blood shunting, and increased airway resistance are not the primary pathophysiology causing the respiratory failure. Cognitive Level: Application Text Reference: p. 1800 Nursing Process: Diagnosis NCLEX: Physiological Integrity

6. Select-all-that-apply: What are the typical signs and symptoms of infective endocarditis? A. Hyperthermia B. S4 gallop C. Enlarged Spleen D. Hyperkalemia E. Substernal pain that radiates to the back F. Heart failure G. Cardiac Murmur

A. Hyperthermia C. Enlarged Spleen F. Heart failure G. Cardiac Murmur The answer is A, C, F, and G. These are classic signs and symptoms of IE.

2. A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply: A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level

A. Hypervolemia C. Increased BUN level The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.

The nurse is educating a patient about the care related to a new diagnosis of mitral valve prolapse. What statement made by the patient demonstrates understanding ? A. I will avoid caffein. alcohol and smoking B. I will take antibiotic prior to dental clean C. I shoulnd get tattoo but tounge pierced. D. This diorder will preogress and i will need a heart transplant.

A. I will avoid caffein. alcohol and smoking

A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?* A. Intermittent bubbling may be noted in the water seal chamber. B. 200 cc of drainage per hour is expected during recovery of a pneumothorax. C. The chest tube is positioned at the patient's chest level to facilitate drainage. D. All of these options are appropriate findings

A. Intermittent bubbling may be noted in the water seal chamber.

The nurse observes a coworker eating ice frequently. The nurse encourages the coworker to have an examination and diagnostic workup with the heatlhcare provider. What type of anemia is the nurse concerned the coworker may have ? A. Iron deficiency anemia B. Megaloblastic anemia C. Sickle cell disease D. Aplastic anemia

A. Iron deficiency anemia

When caring for a client newly diagnosed with​ cardiomyopathy, which type of treatment should the nurse anticipate will be​ initiated? A. Medications B. Surgical ventricular remodeling C. Left ventricular assist device​ (LVAD) D. Cardiac transplantation

A. Medications ( ACE Inhibitors) RATIONALE: Medications are used as the primary intervention to treat cardiomyopathy. The left ventricular assist​ device, cardiac​ transplantation, and surgical ventricular remodeling are treatment options when medications are not effective.

A patient at the clinic described SOB, period of feeling "lightheaded" and feeling fatigued despite a full night sleep. The nurse obtain vital signs and auscultates a systolic click. What does the nurse suspect from the assessment finding ? A. Mitral valve prolapse B. Mitral regurgitation C. Aortic stenosis D. Aortic regurgitation

A. Mitral valve prolapse

Which mitral valve condition generally produces no symptoms? A. Mitral valve prolapse B. Mitral valve regurgitation C. Mitral valve stenosis D. Mitral valve infection

A. Mitral valve prolapse Mitral valve stenosis usually cause progressive fatigue. Mitral valve regurgitation, in acute case, represent as severe heart failure. Mitral valve infection in severe case will represent as infection endocarditis.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for ? A. Aplastic anemia B. Iron deficiency anemia C. Sickle cell disease D. Pernicious anemia

D. Pernicious anemia

What are strategies to prevent Ventilator-associated Pneumonia? select all that apply A. Oral care every 4 hours, B. HOB elevated 30-45 degrees unless contraindicated by the patient's condition C. HOB elevated 10-15 degrees, unless contraindicated by the patient's condition D. Allow family to suction patient as needed to remove secretions

A. Oral care Q4h B. HOB elevated 30-45 degrees unless contraindicated by patients condition.

A client with adult respiratory distress syndrome (ARDS) is intubated, and mechanical ventilation has been initiated. His PaO2 is 60 mm Hg with a FiO2 of 100%. To increase his PaO2, what change would the nurse anticipate will be made to the ventilator settings? A. Positive end-expiratory pressure (PEEP B. Time-cycled ventilation C. Assist control cycled ventilation D. Blow-by pressure support

A. Positive end-expiratory pressure (PEEP PEEP has become an established therapy for clients with ARDS or flow limitation. It improves oxygenation, increases functional residual capacity, and increases respiratory system compliance at moderate levels, although at high levels, compliance may decrease. PEEP decreases intrapulmonary shunting and increases PO2 and facilitates a lower FiO2. The client is already on a volume cycled ventilator. Assist control ventilation may be used when the client is being weaned off the ventilator.

The nurse is for a client experiencing chronic heart failure. Which diagnostic test result require immediate follow up by the nurse? Select all that apply A. Potassium 3.3 mEq/L B. BUN 25 mg/dL C. Sodium 122 mEq/L D. Second degree heart block on ECG E. Magnesium 1.8 mEq/L F. Digoxin level 0.8 ng/ml

A. Potassium 3.3 mEq/L B. BUN 25 mg/dL C. Sodium 122 mEq/L D. Second degree heart block on ECG BUN L 7 to 20 mg/dl usually normal range Sodium Normal 135-145 Second degree heart block on ECG Dangerous heart block if second degree type 2

For the patient with AKI, which laboratory result would cause you the greatest concern? A. Potassium level of 5.9 mEq/L B. BUN level of 25 mg/dL C. Sodium level of 144 mEq/L D. pH of 7.5

A. Potassium level of 5.9 mEq/L Hyperkalemia is one of the most serious complications in AKI because it can cause life-threatening cardiac dysrhythmias.

What characterizes AKI (select all that apply)? A. Primary cause of death is infection. B. It usually affects older people. C. The disease course is potentially reversible. D. The most common cause is diabetic nephropathy. E. Cardiovascular disease is the most common cause of death.

A. Primary cause of death is infection. C. The disease course is potentially reversible. AKI is potentially reversible. It has a high mortality rate, and the primary cause of death is infection; the primary cause of death for chronic kidney failure is cardiovascular disease. AKI commonly follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Although it can occur at any age, the older adult is more susceptible to AKI because the number of functioning nephrons decreases with age.

Your plan for care of a patient with AKI includes which goal of dietary management? A. Provide sufficient calories while preventing nitrogen excess. B. Deliver adequate calories while restricting fat and protein intake. C. Replace protein intake with enough fat intake to sustain metabolism. D. Restrict fluids, increase potassium intake, and regulate sodium intake.

A. Provide sufficient calories while preventing nitrogen excess. The challenge of nutrition management in AKI is to provide adequate calories to prevent catabolism despite the restrictions required to prevent electrolyte and fluid disorders and azotemia (accumulation of nitrogen and wastes in blood).

How do you determine that a patient's oliguria is associated with acute renal failure (ARF)? A. Specific gravity of urine at 3 different times is 1.010. B. The serum creatinine level is normal. C. The blood urea nitrogen (BUN) level is normal or below. D. Hypokalemia is identified.

A. Specific gravity of urine at 3 different times is 1.010. A urinalysis may show casts, red blood cells (RBCs), white blood cells (WBCs), a specific gravity fixed at about 1.010, and urine osmolality at about 300 mOsm/kg.

A client with pneumonia has been receiving intravenous (IV) antibiotics for 24 hours. What nursing assessment would indicate the treatment is effective? A. Temperature is 99° F (37.2° C) and he is breathing comfortably B. Sputum is yellow and slightly blood tinged. C. Breath sounds are clear at the base of the left lung. D. White blood cell count is 20,000/μL (20 × 109/L).

A. Temperature is 99° F (37.2° C) and he is breathing comfortably The decrease in fever and the comfortable breathing is indicative of the treatment being effective. Yellow-tinged sputum and elevated white blood cell counts are common in clients with pneumonia. The breath sounds are clear in the base of only one lung; therefore the other lung may still contain consolidation.

The nurse is assessing the respiratory status of an older adult client with a diagnosis of pneumonia. What data would indicate the need for further nursing action at this time? A. The client's bronchovesicular breath sounds change with coughing. B. The client is coughing up blood-tinged sputum. C. The client's intake from 8:00 am to 4:00 pm has been 300 mL. D. There are decreased bilateral breath sounds

A. The client's bronchovesicular breath sounds change with coughing. The client with pneumonia needs a high fluid intake to liquefy the secretions and facilitate removal. An intake of only 300 mL for the past 8 hours is not adequate, and the nurse should begin to encourage increased fluids. Bronchovesicular breath sounds change as mucus moves out of the bronchioles, so this is expected; blood-tinged sputum should be monitored but does not require a nursing action. The client's breath sounds are decreased because of the pneumonia, and they should continue to be monitored.

Which patient has the greatest risk for prerenal AKI? A. The patient is hypovolemic because of hemorrhage. B. The patient relates a history of chronic urinary tract obstruction. C. The patient has vascular changes related to coagulopathies. D. The patient is receiving antibiotics such as gentamicin.

A. The patient is hypovolemic because of hemorrhage. Prerenal causes of AKI are factors external to the kidneys. These factors reduce systemic circulation, causing a reduction in renal blood flow, and they lead to decreased glomerular perfusion and filtration of the kidneys.

14. When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse? a. The patient is somnolent. b. The patient's SpO2 is 90%. c. The patient complains of weakness. d. The patient's blood pressure is 162/94.

A. The patient is somnolent. Rationale: Increasing somnolence will decrease the patient's respiratory rate and further increase the PaCO2 and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of possible impending respiratory arrest. Cognitive Level: Application Text Reference: p. 1804 Nursing Process: Assessment NCLEX: Physiological Integrity

9. What conditions below can result in an increased cardiac afterload? Select all that apply: A. Vasoconstriction B. Aortic stenosis C. Vasodilation D. Dehydration E. Pulmonary Hypertension

A. Vasoconstriction B. Aortic stenosis E. Pulmonary Hypertension The answers are A, B, and E. Vasoconstriction increases systemic vascular resistance which will increase cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve to get blood out of the heart....all of this increase cardiac afterload.

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

A. arterial blood gas (ABG) analysis. Rationale: ABG analysis is useful because it provides information about both oxygenation and ventilation and assists with determining possible etiologies and appropriate treatment. The other tests may also provide useful information about patient status but will not indicate whether the patient has hypoxemia, hypercapnia, or both. Cognitive Level: Comprehension Text Reference: p. 1805 Nursing Process: Assessment NCLEX: Physiological Integrity

patient being treated with an ACE inhibitor could take which of the following drugs? PLEASE SELECT ALL THAT APPLY A. beta adrenergic blockers B. diuretics C. potassium D. calcium

A. beta adrenergic blockers B. diuretics D. calcium

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? A. cardiac tamponade B. Decreased venous pressure C. Left ventricular hypertrophy D. Hypertension

A. cardiac tamponade

Important nursing interventions for the patient with AKI are (select all that apply) A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. D. increase intake of vitamin A and D. E. frequent mouth care.

A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. E. frequent mouth care. You have an important role in managing fluid and electrolyte balance during the oliguric and diuretic phases of AKI. Observing and recording accurate intake and output are essential. Measure daily weights with the same scale at the same time each day to assess excessive gains or losses of body fluids. Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membrane.

During the oliguric phase of AKI, you monitor the patient for (select all that apply) A. hypertension. B. electrocardiographic (ECG) changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity.

A. hypertension. B. electrocardiographic (ECG) changes. D. pulmonary edema. You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended and have a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions. The patient is monitored for hyponatremia. Damaged tubules cannot conserve sodium, and the urinary excretion of sodium may increase, resulting in normal or below-normal levels of serum sodium. Monitoring may reveal ECG changes and hyperkalemia. Initially, clinical signs of hyperkalemia are apparent on electrocardiogram, which demonstrate peaked T waves, widening of the QRS complex, and ST-segment depression. Urinary specific gravity is fixed at about 1.010.

"Several different groups of drugs function as antidysrhythmics. They are classified according to their mechanisms of action and effects on the conduction system, even though they differ in other respects. Some drugs have characteristics of more than one group. There are various types of antidysrhythmics: class I sodium channel blockers (quinidine, lidocaine), class II beta-adrenergic blockers (propranolol), class III potassium channel blockers (amiodarone), and class IV calcium channel blockers (diltiazem)" See pg. 528 Table 27.1 in The clinical uses of class III agents rather than class I agents is preferred for patients with heart disease because the class III agents are associated with: A. less ventricular fibrillation B. more sustained effects C. milder adverse effects D. increased mortality

A. less ventricular fibrillation

A 53 year old patient has had hypertension for 10 years and admits that she does not comply with her prescribed antihypertensive therapy. Recently, she has begun to experience shortness of breath and ankle swelling. A workup reveals the presence of chronic renal insufficiency. What classification of diuretic is the first drug of choice for the nurse practitioner to prescribe? A. loop B. thiazide C. potassium-sparing D. osmotic

A. loop

22. A patient with acute respiratory distress syndrome (ARDS) has progressed to the fibrotic phase. The patient's family members are anxious about the patient's condition and are continuously present at the hospital. In addressing the family's concerns, it is important for the nurse to a. support the family and help them understand the realistic expectation that the patient's chance for survival is poor. b. inform the family that home health nurses will be able to help them maintain the mechanical ventilation at home after patient discharge. c. refer the family to social support services and case management to plan for transfer of the patient to a long-term care facility. d. provide hope and encouragement to the family because the patient's disease process has started to resolve.

A. support the family and help them understand the realistic expectation that the patient's chance for survival is poor. Rationale: The chance for survival is poor when the patient progresses to the fibrotic stage because permanent damage to the alveoli has occurred. Because of continued severe hypoxemia, the patient is not a candidate for home health or long-term care. The fibrotic stage indicates a poor patient prognosis, not the resolution of the ARDS process. Cognitive Level: Application Text Reference: p. 1814 Nursing Process: Implementation NCLEX: Psychosocial Integrity

Which of the following is indicated for initial drug therapy in a patient newly diagnosed with uncomplicated hypertension (stage 1)? A. thiazide diuretic B. direct-acting vasodilator C. potassium- sparing diuretic D. calcium channel blocker

A. thiazide diuretic

23. A nurse is assessing a patient 20 minutes after a bone marrow biopsy. Which statement by the patient is cause for the most concern? a. "There is fresh blood on my dressing." b. "I am thirsty." c. "My hip feels bruised where they stuck the needle." d. "I had a sharp pain in my leg when they pulled the needle out."

ANS: A. "There is fresh blood on my dressing." Fresh blood on the pressure dressing 20 minutes after the aspiration needs to be addressed. Usually, redressing with a pressure dressing and an ice pack is sufficient. Feelings of bruising and pain on extraction are to be expected. Thirst is of no clinical significance. DIF: Cognitive Level: Application REF: p. 628 OBJ: 3 TOP: Diagnostic Tests KEY: Nursing Process Step: Implementation MSC:

10. Which foods should a nurse include in a nutrition teaching plan for a patient with iron-deficiency anemia? a. Beans and dried fruit b. Apples and white rice c. Yogurt and cooked carrots d. Yellow squash and tortillas

ANS: A. Beans and dried fruit Iron-rich foods include beans, dried fruit, liver, red meat, fish, and whole-grain breads. DIF: Cognitive Level: Comprehension REF: p. 635 OBJ: 6 TOP: Iron-Deficiency Anemia KEY: Nursing Process Step: Implementation MSC:

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse anticipate taking? a. Lower the positive end-expiratory pressure (PEEP). b. Increase the fraction of inspired oxygen (FIO2). c. Suction more frequently. d. Increase the tidal volume.

ANS: A. Lower the positive end-expiratory pressure (PEEP). Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased. The other actions will not decrease the risk for pneumothorax. DIF: Cognitive Level: Application REF: 1760-1761 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient with ARDS who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV) has settings of fraction of inspired oxygen (FIO2) 80%, tidal volume 500, rate 18, and positive end-expiratory pressure (PEEP) 5 cm. Which assessment finding is most important for the nurse to report to the health care provider? a. Oxygen saturation 99% b. Patient respiratory rate 22 breaths/min c. Crackles audible at lung bases d. Apical pulse rate 104 beats/min

ANS: A. Oxygen saturation 99% The FIO2 of 80% increases the risk for oxygen toxicity. Since the patient's O2 saturation is 99%, a decrease in FIO2 is indicated to avoid toxicity. The other patient data would be typical for a patient with ARDS and would not need to be urgently reported to the health care provider. DIF: Cognitive Level: Analysis REF: 1760 | 1761-1762 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased? a. The patient has subcutaneous emphysema. b. The patient has a sinus bradycardia with a rate of 52. c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%. d. The patient has bronchial breath sounds in both the lung fields.

ANS: A. The patient has subcutaneous emphysema. The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced. DIF: Cognitive Level: Application REF: 1760-1761 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective? a. The patient's PaO2 is 90 mm Hg, and the SaO2 is 92%. b. Endotracheal suctioning results in minimal mucous return. c. Sputum and blood cultures show no growth after 24 hours. d. The skin on the patient's back is intact and without redness.

ANS: A. The patient's PaO2 is 90 mm Hg, and the SaO2 is 92%. The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2. The other information will be collected but does not indicate whether prone positioning has been effective. DIF: Cognitive Level: Application REF: 1762-1763 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

2. Which is considered an approximate normal hematocrit value? a. Three times the hemoglobin value b. The same as the hemoglobin value c. Four times lower than the red blood cell count d. Same as the red blood cell count

ANS: A. Three times the hemoglobin value Hematocrit is approximately three times the hemoglobin value.

A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with a. inserting a pulmonary artery catheter. b. obtaining a ventilation-perfusion scan. c. drawing blood for arterial blood gases. d. positioning the patient for a chest radiograph.

ANS: A. inserting a pulmonary artery catheter. Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema. DIF: Cognitive Level: Application REF: 1753-1754 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

19. A nurse is completing an initial assessment on a new patient being seen in the hospital clinic. The presentation of this female patient includes vague symptoms of tiredness and large areas of ecchymosis. Which question is most important for the nurse to ask? a. "Are you allergic to anything?" b. "Do your gums easily bleed?" c. "How many hours do you sleep?" d. "How frequent are your periods?"

ANS: B. "Do your gums easily bleed?" Bleeding gums are indicative of general bleeding tendencies. Sleep and frequency of menstrual periods are not significant, but the heaviness of the period is significant. History can reveal information pertinent to assisting the physician in making a diagnosis. DIF: Cognitive Level: Application REF: p. 625 OBJ: 2 TOP: Assessment of Patients with Hematologic Disorders KEY: Nursing Process Step: Assessment MSC:

Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) can the RN delegate to an experienced LPN/LVN working in the intensive care unit? a. Assess breath sounds b. Insert a retention catheter c. Place patient in the prone position d. Monitor pulmonary artery pressures

ANS: B. Insert a retention catheter Insertion of retention catheters is included in LPN/LVN education and scope of practice and can be safely delegated to an LPN/LVN who is experienced in caring for critically ill patients. Placing a patient who is on a ventilator in the prone position requires multiple staff and should be supervised by an RN. Assessment of breath sounds and obtaining pulmonary artery pressures require advanced assessment skills and should be done by the RN caring for a critically ill patient. DIF: Cognitive Level: Application REF: 1761-1763 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment

A patient has a nursing diagnosis of ineffective airway clearance related to thick, secretions. Which action will be best for the nurse to include in the plan of care? a. Encourage use of the incentive spirometer. b. Offer the patient fluids at frequent intervals. c. Teach the patient the importance of coughing. d. Increase oxygen level to keep O2 saturation >95%.

ANS: B. Offer the patient fluids at frequent intervals. Since the reason for the poor airway clearance is the thick secretions, the best action will be to encourage the patient to improve oral fluid intake. The use of the incentive spirometer should be more frequent in order to facilitate the clearance of the secretions. The other actions also may be helpful in improving the patient's gas exchange, but they do not address the thick secretions that are causing the poor airway clearance. DIF: Cognitive Level: Application REF: 1755 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which of the following problems is a client with cardiomyopathy most likely to​ encounter? A. Risk of aspiration B. Ineffective tissue perfusion C. Fluid volume deficit D. Increased cardiac output

B. Ineffective tissue perfusion RATIONALE:Ineffective tissue perfusion is the result of the ineffective pumping action of the heart. Fluid volume​ deficit, increased cardiac​ output, and risk of aspiration are problems that a client with cardiomyopathy will likely not encounter.

28. When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

ANS: B. Place the patient on a cardiac monitor. Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output, but does not correct the cause of the renal failure.

9. What is the rationale for administering injections of vitamin B12 to patients with pernicious anemia? a. The patient's body does not normally manufacture enough vitamin B12. b. The patient may lack the intrinsic factor necessary for vitamin B12 absorption. c. Vitamin B12 is found in very small quantities in the patient's body. d. Vitamin B12 is a mineral necessary to aid in the formation of strong bones.

ANS: B. The patient may lack the intrinsic factor necessary for vitamin B12 absorption. The patient with pernicious anemia lacks the intrinsic factor, found in the stomach, which is essential for vitamin B12 absorption. DIF: Cognitive Level: Comprehension REF: p. 635 OBJ: 5 TOP: Pernicious Anemia KEY: Nursing Process Step: Evaluation MSC:

A patient with acute respiratory distress syndrome (ARDS) and acute renal failure has the following medications prescribed. Which medication should the nurse discuss with the health care provider before administration? a. ranitidine (Zantac) 50 mg IV b. gentamicin (Garamycin) 60 mg IV c. sucralfate (Carafate) 1 g per nasogastric tube d. methylprednisolone (Solu-Medrol) 40 mg IV

ANS: B. gentamicin (Garamycin) 60 mg IV Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS. DIF: Cognitive Level: Application REF: 1761-1762 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

25. A patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Obtain renal ultrasound. b. Insert retention catheter. c. Infuse normal saline at 50 mL/hour. d. Draw blood for complete blood count.

ANS: B.Insert retention catheter. The patients elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter.

18. A 52-year-old man has a diagnosis of aplastic anemia. What information in the patient history is pertinent to this diagnosis? a. Long family history of cancer b. Regular blood donor c. 25-year employee in a chemical plant d. Gain of 5 lb in the last 2 years

ANS: C. 25-year employee in a chemical plant Exposure to toxic chemicals can cause aplastic anemia. DIF: Cognitive Level: Analysis REF: p. 633 OBJ: 5 TOP: Aplastic Anemia KEY: Nursing Process Step: Assessment MSC:

The pulse oximetry for a patient with right lower lobe pneumonia indicates an oxygen saturation of 90%. The patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is best for the nurse to take? a. Position the patient on the right side. b. Place a humidifier in the patient's room. c. Assist the patient with staged coughing. d. Schedule a 2-hour rest period for the patient.

ANS: C. Assist the patient with staged coughing. The patient's assessment indicates that assisted coughing is needed to help remove secretions, which will improve oxygenation. A 2-hour rest period at this time may allow the oxygen saturation to drop further. Humidification will not be helpful unless the secretions can be mobilized. Positioning on the right side may cause a further decrease in oxygen saturation because perfusion will be directed more toward the more poorly ventilated lung. DIF: Cognitive Level: Application REF: 1754-1755 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

4. A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine output b. Calcium level c. Cardiac rhythm d. Neurologic status

ANS: C. Cardiac rhythm The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.

To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care for a patient who requires intubation and mechanical ventilation? a. Avoid use of positive end-expiratory pressure (PEEP). b. Suction every 2 hours. c. Elevate head of bed to 30 to 45 degrees. d. Give enteral feedings at no more than 10 mL/hr.

ANS: C. Elevate head of bed to 30 to 45 degrees. Elevation of the head decreases the risk for aspiration. PEEP is frequently needed to improve oxygenation in patients receiving mechanical ventilation. Suctioning should be done only when the patient assessment indicates that it is necessary. Enteral feedings should provide adequate calories for the patient's high energy needs. DIF: Cognitive Level: Application REF: 1760-1761 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The nurse obtains the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2° F, blood pressure 90/56 mm Hg, pulse 92, respirations 34. Which action should the nurse take next? a. Administer the scheduled IV antibiotic. b. Give the PRN acetaminophen (Tylenol) 650 mg. c. Obtain oxygen saturation using pulse oximetry. d. Notify the health care provider of the patient's vital signs.

ANS: C. Obtain oxygen saturation using pulse oximetry. The patient's increased respiratory rate in combination with the admission diagnosis of gram-negative sepsis indicates that acute respiratory distress syndrome (ARDS) may be developing. The nurse should check for hypoxemia, a hallmark of ARDS. The health care provider should be notified after further assessment of the patient. Administration of the scheduled antibiotic and administration of Tylenol also will be done, but they are not the highest priority for a patient who may be developing ARDS. DIF: Cognitive Level: Application REF: 1758 | 1760 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse is caring for a 22-year-old patient who came to the emergency department with acute respiratory distress. Which information about the patient requires the most rapid action by the nurse? a. Respiratory rate is 32 breaths/min. b. Pattern of breathing is shallow. c. The patient's PaO2 is 45 mm Hg. d. The patient's PaCO2 is 34 mm Hg.

ANS: C. The patient's PaO2 is 45 mm Hg. The PaO2 indicates severe hypoxemia and respiratory failure. Rapid action is needed to prevent further deterioration of the patient. Although the shallow breathing, rapid respiratory rate, and low PaCO2 also need to be addressed, the most urgent problem is the patient's poor oxygenation. DIF: Cognitive Level: Application REF: 1746-1747 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of shortness of breath and dyspnea. Which assessment finding by the nurse is most important to report to the health care provider? a. The patient has bibasilar lung crackles. b. The patient is sitting in the tripod position. c. The patient's respiratory rate has decreased from 30 to 10 breaths/min. d. The patient's pulse oximetry indicates an O2 saturation of 91%.

ANS: C. The patient's respiratory rate has decreased from 30 to 10 breaths/min. A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest. Therefore immediate action such as positive pressure ventilation is needed. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation. DIF: Cognitive Level: Application REF: 1751-1752 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

26. Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider? a. The blood urea nitrogen (BUN) level is 67 mg/dL. b. The creatinine level is 3.0 mg/dL. c. Urine output over an 8-hour period is 2500 mL. d. The glomerular filtration rate is <30 mL/min/1.73m2.

ANS: C. Urine output over an 8-hour period is 2500 mL. The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.

3. A patient with severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of a. replacing fluid volume. b. preventing hypertension. c. maintaining cardiac output. d. diluting nephrotoxic substances.

ANS: C. maintaining cardiac output. The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patients heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct? a. "PEEP will prevent fibrosis of the lung from occurring." b. "PEEP will push more air into the lungs during inhalation." c. "PEEP allows the ventilator to deliver 100% oxygen to the lungs." d. "PEEP prevents the lung air sacs from collapsing during exhalation."

ANS: D. "PEEP prevents the lung air sacs from collapsing during exhalation." By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation. PEEP will not prevent the fibrotic changes that occur with ARDS, push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the patient. DIF: Cognitive Level: Comprehension REF: 1761-1762 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

After receiving change-of-shift report, which patient will the nurse assess first? a. A patient with cystic fibrosis who has thick, green-colored sputum b. A patient with pneumonia who has coarse crackles in both lung bases c. A patient with emphysema who has an oxygen saturation of 91% to 92% d. A patient with septicemia who has intercostal and suprasternal retractions

ANS: D. A patient with septicemia who has intercostal and suprasternal retractions This patient's history of septicemia and labored breathing suggest the onset of ARDS, which will require rapid interventions such as administration of oxygen and use of positive pressure ventilation. The other patients also should be assessed as quickly as possible, but their assessment data are typical of their disease processes and do not suggest deterioration in their status. DIF: Cognitive Level: Analysis REF: 1758-1760 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first? a. Check pupil reaction to light. b. Notify the health care provider. c. Attempt to calm and reassure the patient. d. Assess oxygenation using pulse oximetry.

ANS: D. Assess oxygenation using pulse oximetry. Since agitation and confusion are frequently the initial indicators of hypoxemia, the nurse's initial action should be to assess oxygen saturation. The other actions also are appropriate, but assessment of oxygenation takes priority over other assessments and notification of the health care provider. DIF: Cognitive Level: Application REF: 1750-1751 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

11. Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)? a. Blood urea nitrogen (BUN) level b. Urine output c. Creatinine level d. Calculated glomerular filtration rate (GFR)

ANS: D. Calculated glomerular filtration rate (GFR) GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

A cardiac surgery patient's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? A) Prepare to assist with pericardiocentesis. B) Reposition the patient into a prone position. C) Administer a dose of metoprolol. D) Administer a bolus of normal saline.

Ans: Prepare to assist with pericardiocentesis. Feedback: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.

27. After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first? a. Document the QRS interval. b. Notify the patients health care provider. c. Look at the patients current blood urea nitrogen (BUN) and creatinine levels. d. Check the chart for the most recent blood potassium level.

ANS: D. Check the chart for the most recent blood potassium level. The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patients health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.

16. When a nurse is preparing to give ferrous sulfate (Feosol) to a home health care patient, what is the most appropriate nursing action to implement? a. Mix the drug with a high-protein milkshake. b. Give it undiluted with a small snack. c. Mix it with coffee or cola to disguise the bitter taste. d. Dilute it and offer through a straw and a few crackers.

ANS: D. Dilute it and offer through a straw and a few crackers. Patients should avoid taking iron with milk or caffeine because both inhibit drug absorption. The liquid form of the drug is offered with food in a diluted form through a straw to prevent staining the teeth. DIF: Cognitive Level: Application REF: p. 634 OBJ: 6 TOP: Administration of Feosol KEY: Nursing Process Step: Implementation MSC:

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. Cough that is productive of blood-tinged sputum b. Scattered crackles throughout the posterior lung bases c. Temperature of 101.5° F (38.6° C) after 2 days of IV antibiotic therapy d. Oxygen saturation 90% on 100% O2 by nonrebreather mask

ANS: D. Oxygen saturation 90% on 100% O2 by nonrebreather mask The patient's low SpO2 despite receiving a high fraction of inspired oxygen (FIO2) indicates the possibility of acute respiratory distress syndrome (ARDS). The patient's blood-tinged sputum and scattered crackles are not unusual in a patient with pneumonia, although they do require continued monitoring. The continued temperature elevation indicates a possible need to change antibiotics, but this is not as urgent a concern as the progression toward hypoxemia despite an increase in O2 flow rate. DIF: Cognitive Level: Application REF: 1760 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

8. What information should a nurse be sure to include when preparing discharge plans for a patient recently diagnosed with pernicious anemia? a. Adding daily high-fat, low-fiber supplements b. Adding a rigorous daily workout c. Avoiding prolonged exposure to direct sunlight d. Providing sufficient rest periods throughout the day

ANS: D. Providing sufficient rest periods throughout the day Fatigue and weakness are seen in all anemias. DIF: Cognitive Level: Application REF: p. 635 OBJ: 6 TOP: Pernicious Anemia KEY: Nursing Process Step: Planning MSC:

5. A patient receiving Epogen asks how soon an increase in the red blood cell count will occur. When should the nurse say that the initial increase in red blood cells should be seen? a. 2 days b. 1 week c. 10 days d. 2 weeks

ANS: d. 2 weeks Epoetin alfa (Epogen) stimulates the bone marrow to produce more red blood cells in approximately 2 weeks. DIF: Cognitive Level: Comprehension REF: p. 634 OBJ: 6 TOP: Colony-Stimulating Medication KEY: Nursing Process Step: Planning MSC:

2. A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

ANS: d. rapid respirations. Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

Human valves, obtained from cadaver tissue donations are used for aortic and pulmonic valve replacement, are called homographs or__________

Allografts

A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient? A) "Patients generally stay in the hospital for 6 to 8 days." B) "Patients are kept in the hospital until they are independent with all aspects of their care." C) "Patients need to stay in the hospital until they regain normal heart function for their age." D) "Patients usually remain at the hospital for 24 to 48 hours."

Ans: "Patients usually remain at the hospital for 24 to 48 hours." Feedback: After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.

A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurse's interview is most suggestive of this valvular disorder? A) "I get chest pain from time to time, but it usually resolves when I rest." B) "Sometimes when I'm resting, I can feel my heart skip a beat." C) "Whenever I do any form of exercise I get terribly short of breath." D) "My feet and ankles have gotten terribly puffy the last few weeks."

Ans: "Whenever I do any form of exercise I get terribly short of breath." Feedback: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some patients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.

A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs? A) Enoxaparin (Lovenox) B) Metoprolol (Lopressor) C) Azathioprine (Imuran) D) Amoxicillin (Amoxil)

Ans: Amoxicillin (Amoxil) Feedback: Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.

A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm? A) Ventricular fibrillation (VF) B) Ventricular tachycardia (VT) C) Atrial fibrillation D) Sinus bradycardia

Ans: Atrial fibrillation Feedback: In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.

A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patient's symptoms, the nurse should teach the patient to do which of the following? A) Eat a high-protein, low-carbohydrate diet. B) Avoid activities that cause an increased heart rate. C) Avoid large crowds and public events. D) Perform deep breathing and coughing exercises.

Ans: Avoid activities that cause an increased heart rate. Feedback: Patients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.

An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patient's echocardiogram? A) Blood to flow back from the aorta to the left ventricle B) Obstruction of blood flow from the left ventricle C) Blood to flow back from the left atrium to the left ventricle D) Obstruction of blood from the left atrium to left ventricle

Ans: Blood to flow back from the aorta to the left ventricle Feedback: Aortic regurgitation occurs when the aortic valve does not completely close, and blood flows back to the left ventricle from the aorta during diastole. Aortic regurgitation does not cause obstruction of blood flow from the left ventricle, blood to flow back from the left atrium to the left ventricle, or obstruction of blood from the left atrium to left ventricle.

A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurse's assessment findings is most consistent with myocarditis? A) Sudden changes in level of consciousness (LOC) B) Peripheral edema and pulmonary edema C) Pleuritic chest pain D) Flulike symptoms

Ans: Flulike symptoms Feedback: The most common symptoms of myocarditis are flulike. Chest pain, edema, and changes in LOC are not characteristic of myocarditis.

The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis? A) Wheezes B) Friction rub C) Fine crackles D) Coarse crackles

Ans: Friction rub Feedback: A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these occurs with pericarditis.

A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment? A) Heart transplantation B) Balloon valvuloplasty C) Cardiac catheterization D) Stent placement

Ans: Heart transplantation Feedback: When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Valvuloplasty, stent placement, and cardiac catheterization will not address the pathophysiology of cardiomyopathy.

The nurse on the hospital's infection control committee is looking into two cases of hospital-acquired infective endocarditis among a specific classification of patients. What classification of patients would be at greatest risk for hospital-acquired endocarditis? A) Hemodialysis patients B) Patients on immunoglobulins C) Patients who undergo intermittent urinary catheterization D) Children under the age of 12

Ans: Hemodialysis patients Feedback: Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis. Patients on immunoglobulins, those who need in and out catheterization, and children are not at increased risk for nosocomial infective endocarditis.

A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy? A) Dilated cardiomyopathy (DCM). B) Arrhythmogenic right ventricular cardiomyopathy (ARVC) C) Hypertrophic cardiomyopathy (HCM) D) Restrictive or constrictive cardiomyopathy (RCM)

Ans: Hypertrophic cardiomyopathy (HCM) Feedback: With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.

(T/F) The major cause of death in ARDS is nonpulmonary multiple organ dysfunction syndrome, often with sepsis.

True

The nurse is creating a plan of care for a patient with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this patient? A) Absence of complications B) Adherence to the self-care program C) Improved cardiac output D) Increased activity tolerance

Ans: Improved cardiac output Feedback: The priority nursing diagnosis of a patient with cardiomyopathy would include improved or maintained cardiac output. Regardless of the category and cause, cardiomyopathy may lead to severe heart failure, lethal dysrhythmias, and death. The pathophysiology of all cardiomyopathies is a series of progressive events that culminate in impaired cardiac output. Absence of complications, adherence to the self-care program, and increased activity tolerance should be included in the care plan, but they do not have the priority of improved cardiac output.

A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurse's admission interview, the patient states that she takes over-the-counter "water pills" on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics? A) Encourage the patient to drink at least 2 liters of fluid daily. B) Increase the patient's oral sodium intake. C) Inform the care provider because diuretics are contraindicated. D) Ensure that the patient's fluid balance is monitored vigilantly.

Ans: Inform the care provider because diuretics are contraindicated. Feedback: Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware. Adjusting the patient's sodium or fluid intake or fluid monitoring does not address this important contraindication.

.The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what? A) Cardiac tamponade B) Left ventricular hypertrophy C) Right-sided heart failure D) Ventricular insufficiency

Ans: Left ventricular hypertrophy Feedback: Aortic regurgitation eventually causes left ventricular hypertrophy. In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood. Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.

The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following? A) Use of patient-controlled analgesia B) Long-term anticoagulant therapy C) Steroid therapy D) Use of IV diuretics

Ans: Long-term anticoagulant therapy Feedback: Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and patient-controlled analgesia may or may be not be used in the immediate postoperative period.

A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient? A) Aortic regurgitation B) Mitral stenosis C) Mitral valve prolapse D) Aortic stenosis

Ans: Mitral stenosis Feedback: The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.

The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patient's diagnosis? A) Mitral valve regurgitation B) Aortic stenosis C) Aortic regurgitation D) Mitral valve stenosis

Ans: Mitral valve stenosis Feedback: Because no valve protects the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails. None of the other listed valvular disorders has this pathophysiological effect.

A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse? A) Arrange for an alternative bed. B) Measure the degree of the curvature. C) Notify the surgeon immediately. D) Note the scoliosis on the intake assessment.

Ans: Notify the surgeon immediately. Feedback: Most often used for mitral and aortic valve stenosis, balloon valvuloplasty is contraindicated for patients with left atrial or ventricular thrombus, severe aortic root dilation, significant mitral valve regurgitation, thoracolumbar scoliosis, rotation of the great vessels, and other cardiac conditions that require open heart surgery. Therefore notifying the physician would be the priority over further physical assessment. An alternative bed would be unnecessary and documentation is not a sufficient response.

The nurse is preparing a patient for cardiac surgery. During the procedure, the patient's heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo? A) Orthotopic transplant B) Xenograft C) Heterotropic transplant D) Homograft

Ans: Orthotopic transplant Feedback: Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipient's heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipient's heart, leaving a portion of the recipient's atria (with the vena cava and pulmonary veins) in place. Homografts, or allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not terms used to describe heart transplantation.

A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease? A) Recognizing and promptly treating streptococcal infections B) Prophylactic use of calcium channel blockers in high-risk populations C) Adhering closely to the recommended child immunization schedule D) Smoking cessation

Ans: Recognizing and promptly treating streptococcal infections Feedback: Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.

The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite? A) The procedure can be performed on an outpatient basis in a physician's office. B) Repaired valves tend to function longer than replaced valves. C) The procedure is not associated with a risk for infection. D) Lower doses of antirejection drugs are required than with valve replacement.

Ans: Repaired valves tend to function longer than replaced valves. Feedback: In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation. Valvuloplasty carries a risk of infection, like all surgical procedures, and it is not performed in a physician's office. Antirejection drugs are unnecessary because foreign tissue is not introduced.

The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what? A) A decrease in gamma globulins B) An insect bite C) Rheumatic heart disease and its sequelae D) Sepsis and its sequelae

Ans: Rheumatic heart disease and its sequelae Feedback: The most common cause of mitral valve regurgitation in developing countries is rheumatic heart disease and its sequelae.

A patient has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus. In light of this patient's medication regimen, what nursing diagnosis should be prioritized? A) Risk for injury B) Risk for infection C) Risk for peripheral neurovascular dysfunction D) Risk for unstable blood glucose

Ans: Risk for infection Feedback: Immunosuppressants decrease the body's ability to resist infections, and a satisfactory balance must be achieved between suppressing rejection and avoiding infection. These drugs do not create a heightened risk of injury, neurovascular dysfunction, or unstable blood glucose levels.

A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge? A) The need for long-term antibiotics B) The need for 7 to 10 days of bed rest C) Strategies for preventing atherosclerosis D) Strategies for infection prevention

Ans: Strategies for infection prevention Feedback: Patients with a mechanical valve prosthesis (including annuloplasty rings and other prosthetic materials used in valvuloplasty) require education to prevent infective endocarditis. Despite these infections risks, antibiotics are not used long term. Activity management is important, but extended bed rest is unnecessary. Valve replacement does not create a heightened risk for atherosclerosis.

.A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following? A) The need for regularly scheduled testing of the patient's International Normalized Ratio (INR) B) The need to learn to sleep in a semi-Fowler's position for the first 6 to 8 weeks to prevent emboli C) The need to avoid foods that contain vitamin K D) The need to take enteric-coated ASA on a daily basis

Ans: The need for regularly scheduled testing of the patient's International Normalized Ratio (INR) Feedback: Patients who take warfarin (Coumadin) after valve replacement have individualized target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement. Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping upright is unnecessary.

The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications? A) The nurse keeps the patient isolated to prevent nosocomial infections. B) The nurse encourages coughing and deep breathing. C) The nurse helps the patient with activities until the pain and fever subside. D) The nurse encourages increased fluid intake until the infection resolves.

Ans: The nurse helps the patient with activities until the pain and fever subside. Feedback: To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patient's condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated. Due to pain, coughing and deep breathing are not normally encouraged. An increase in fluid intake is not always necessary.

A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this? A) To prevent bacterial endocarditis B) To prevent hospital-acquired pneumonia C) To minimize the need for antibiotic use during the procedure D) To decrease the need for surgical asepsis

Ans: To prevent bacterial endocarditis Feedback: Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to decrease the need for surgical asepsis.

The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient? A) To eat a small meal before taking nitroglycerin B) To drink a glass of milk before taking nitroglycerin C) To engage in 15 minutes of light exercise before taking nitroglycerin D) To rest and relax before taking nitroglycerin

Ans: To rest and relax before taking nitroglycerin Feedback: The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.

(T/F) The most characteristic clinical manifestation of pericarditis is a creaky or scratchy friction rub that can be clearly heard during auscultation to the left lower sternal border

True

What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.* A. Mediastinal chest tube system B. Dry suction chest tube system C. Wet suction chest tube system D. Dry-Wet suction chest tube system

B. Dry suction chest tube system

A 24-year-old man with a history of asthma is admitted to the hospital with pneumonia. He is experiencing dyspnea with a respiratory rate of 34 breaths/min, O2 saturation of 86%, pulse of 124 beats/min, blood pressure (BP) of 146/82 mm Hg, and temperature of 101° F (38.3° C). The physician has ordered the following. Based on the physician's orders, what will be the priority of implementing these orders? Place all options in order of priority. 1. Oxygen 2 L via nasal cannula stat 2. 4 g of amoxicillin every 6 hours intravenous piggyback (IVPB) 3. 5 mg of albuterol via nebulizer stat and every 6 hours 4. Initiate IV of D5W at 75 mL/hr 5. Sputum for C & S A. 1,5,3,4,2 B. 1,3,5,4,2 C. 4,1,5,4,2 D. 4,1,3,5,2

B. 1,3,5,4,2 1. Oxygen 2 L via nasal cannula stat 3. 5 mg of albuterol via nebulizer stat and every 6 hours 5. Sputum for C & S 4. Initiate IV of D5W at 75 mL/hr 2. 4 g of amoxicillin every 6 hours intravenous piggyback (IVPB) First, oxygen is initiated immediately for low O2 saturation. Second, albuterol is administered as a fast-acting (5 to 15 minutes) bronchodilator. The nurse must wait 5 minutes before administration of longer-acting steroids. Third, a sputum specimen for C & S is obtained before administration of antibiotic therapy, which is started before receiving the results. Fourth, the nurse initiates IV therapy. Fifth, the nurse administers the antibiotic (amoxicillin).

The nurse is caring for a client in the intensive care unit who is receiving mechanical ventilation and begins to resist and cough against the ventilator, causing the alarms to sound. What are the appropriate nursing actions in order of priority? Start with the most important or first priority.1. 1. Assess the clients pulse ox reading. 2. Assess the ET tube for secretions 3. Disconnect the client from the ventilator 4. Assess the client for bilateral chest expansion. 5. Begin to mechanically ventilate with a bi-valve mask and 100% 02 A. 2,4,1,3,5 B. 2,1,4,3,5 C. 1,2,3,4,5 D. 1,3,2,54,

B. 2,1,4,3,5 2. Assess the ET tube for secretions 1. Assess the clients pulse ox reading. 4. Assess the client for bilateral chest expansion. 3. Disconnect the client from the ventilator 5. Begin to mechanically ventilate with a bi-valve mask and 100% 02 First, if secretions are present, the nurse should remove them by suctioning. The most frequent cause for a ventilated client to resist or fight the ventilator is an obstructed airway, most often because of excessive secretions in the airway. Second, if there are no secretions, the nurse assesses the client's pulse oximetry reading to see if he or she is getting enough oxygen. Third, the nurse assesses the client for bilateral chest expansion because mechanical ventilation may result in a pneumothorax, causing decreased oxygenation. Fourth, if the client is hypoxic, with clear airways, and/or there is abnormal chest expansion, the nurse should disconnect the client from the ventilator. Fifth, the nurse begins mechanical ventilation with a bi-valve mask with 100% oxygen because the ventilator may be malfunctioning. If this does not immediately resolve the problem, the physician should be notified and a code called if the client's condition deteriorates.

7. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation? A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.

B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.

19. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

B. A side effect of these drugs include bradycardia. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

A patient with restrictive cardiomyopathy is taking digoxin. Because of the risk for increasing sensitivities, the nurse should careful monitor patient for which of the manifestation ? A. Abdominal pain ad diarrhea B. Anorexia and confusion C. Tachypnea and dyspnea D. Edema and orthopnea

B. Anorexia and confusion

20. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

B. Assist the patient up slowing and gradually. The answer is B. The best answer for this particular question is option B. All the options are important for the nurse to perform. However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling.

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A. Eat animal protein and dark leafy vegetables each day B. Avoid exposure to others with acute infection C. Practice yoga and meditation to decrease stress and anxiety D. Get 8 hours of sleep at night and take naps during the day

B. Avoid exposure to others with acute infection Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection

8. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

B. BNP 820 The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe

16. Mrs. V is a client with oliguric acute renal failure. Which of the following clinical manifestations would be consistent with that diagnosis? a. Urine specific gravity of 1.001 b. BUN :Creatinine ratio of 30:1. c. Proteinuria d. Hematuria

B. BUN :Creatinine ratio of 30:1.

The nurse is caring for a client on a ventilator. The low-pressure alarm begins to sound. The nurse determines the ventilator is connected to the endotracheal (ET) tube and the ventilator tubing to the client is intact. What would be a priority nursing action? A. Check the client's vital signs. B. Begin administering manual mechanical ventilation. C. Administer high-flow oxygen. D. Begin cardiopulmonary resuscitation (CPR).

B. Begin administering manual mechanical ventilation. The priority is to ensure that the client is receiving adequate ventilation. Usually the low-pressure alarm sounds when the machine cannot deliver the tidal volume because of a leak or break in the system. Because this is a client safety issue, the nurse should begin manually ventilating the client and ask someone to check the client's vital signs. Cardiopulmonary resuscitation is not indicated.

A patient is administered with aortic regurgitation. Which of the following medications is contraindicated since it can cause bradycardia and decreased ventricular contractility ? A. Nitrates B. Calcium Channel blocker C. ACE Inhibitors D. Beta Blockers

B. Calcium Channel blocker

The nurse is reviewing the diagnostic tests for a client admitted for possible cardiomyopathy. Which test will evaluate coronary artery​ perfusion? A. Echocardiogram B. Cardiac catheterization C. Myocardial biopsy D. Radionuclear scan

B. Cardiac catheterization RATIONALE:A cardiac catheterization evaluates the​ client's coronary artery perfusion. An echocardiogram detects cardiac enlargement. A myocardial biopsy examines heart cells for​ infiltration, fibrosis, or inflammation. Radionuclear scans identify changes in ventricular volume and mass.

A patien has had a CABG and is being montiored in the ICU. What complications should the nurse monitor for that is associated with an alteration in preload? A. Hypertension B. Cardiac tamponade C. Elevated CVP D. Hypothermia

B. Cardiac tamponade The patient that has cardiac tamponade has a decreased blood pressure. Low preload.

The nurse determines that a patient has a characteristic symptoms of pericarditis. What symptoms does the nurse recognize as significant for this diagnosis ? A. Dyspnea B. Constant chest pain C. Fatigue D. Uncontrolled restlessness

B. Constant chest pain

3. You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min C. BUN 20 mg/dL D. Blood pH 7.40

B. Creatinine clearance 35 mL/min The answer is B. A normal creatinine clearance level in a female should be 85-125 mL/min (95-140 mL/min males). A creatinine clearance level indicates the amount of blood the kidneys can make per minute that contain no amounts of creatinine in it. Remember creatinine is a waste product of muscle breakdown. Therefore, the kidneys should be able to remove excessive amounts of it from the bloodstream. A patient who has experienced a myocardial infraction is at risk for pre-renal acute injury due to decreased cardiac output to the kidneys from a damaged heart muscle (the heart isn't able to pump as efficiently because of ischemia). All the other labs values are normal.

8. A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will? A. Decrease the patient's blood pressure and increase cardiac afterload B. Decrease the patient's blood pressure and decrease cardiac afterload C. Decrease the patient's blood pressure and increase cardiac preload D. Increase the patient's blood pressure but decrease cardiac output.

B. Decrease the patient's blood pressure and decrease cardiac afterload The answer is B. The patient has a high systemic vascular resistance...as evidence by the patient's blood blood....there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now, the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will go down (hence the systemic vascular resistance).

The nurse is assessing a client who is on a ventilator and has an endotracheal (ET) tube in place. What finding confirms that the tube has migrated too far into the trachea? A. Increased rhonchi are present at the lung bases bilaterally. B. Decreased breath sounds are heard over the left side of the chest. C. The client is able to speak and coughs excessively. D. The ventilator pressure alarm continues to sound.

B. Decreased breath sounds are heard over the left side of the chest. An ET tube that is inserted too far—beyond the carina—is most likely to enter the right main stem bronchus. The volume of air from the ventilator is only delivered to the right lung; breath sounds are decreased or absent over the left lung. The pressure alarm indicates that the current pressure is not adequate to deliver the tidal volume prescribed. This may occur but does not confirm tube migration.

A patient with chronic kidney disease is being examined by the nurse practioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? A. Increased mean corpuscular volume B. Decreased level of erythropoietin C. Decreased total iron-binding capacity D. Increased reticulocyte count

B. Decreased level of erythropoietin

The nurse assesses a client with oxygenation problems. Which findings indicate late onset of inadequate oxygenation? Select all that apply. A. Tachypnea B. Dyspnea at rest C. Dyspnea on exertion D. Use of accessory muscles E. Retraction of interspaces on inspiration F. Pause for breath between sentences and words

B. Dyspnea at rest D. Use of accessory muscles E. Retraction of interspaces on inspiration F. Pause for breath between sentences and words Dyspnea at rest, use of accessory muscles, retraction of interspaces on inspiration, and pausing for a breath between sentences and words indicate late onset of inadequate oxygenation. Tachypnea and dyspnea on exertion are early signs of inadequate oxygenation.

The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema? A. Elevated white blood count B. Elevated B-type natriuretic peptide (BNP) C. Elevated troponin levels D. Elevated myoglobin levels

B. Elevated B-type natriuretic peptide (BNP)

17. Which of the following is the most common overall sign of acute renal failure? a. Urine develops a fruity odor b. Expected urine output increases or decreases significantly c. Urine specific gravity is greater than 1.040 d. Urine develops a root beer color and consistency

B. Expected urine output increases or decreases significantly

Which of the following are manifestations of​ cardiomyopathy? Select all that apply A. Bounding peripheral pulses B. Fatigue C. Dizziness D. Restlessness E. Shortness of breath

B. Fatigue C. Dizziness E. Shortness of breath RATIONALE:Dizziness, shortness of​ breath, and fatigue are signs and symptoms of cardiomyopathy. Restlessness may result from a decrease of oxygen in the​ blood, but is not a common symptom of cardiomyopathy. Bounding peripheral pulses are not a manifestation of cardiomyopathy.

A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply:* A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed. B. Gather supplies needed which will include a petroleum gauze dressing per physician preference. C. Place the patient in Semi-Fowler's position. D. Have the patient take a deep breath, exhale, and bear down during removal of the tube. E. Pre-medicate prior to removal as ordered by the physician. F. Place the patient is prone position after removal.

B. Gather supplies needed which will include a petroleum gauze dressing per physician preference. C. Place the patient in Semi-Fowler's position. D. Have the patient take a deep breath, exhale, and bear down during removal of the tube. E. Pre-medicate prior to removal as ordered by the physician.

The nurse suspects a diagnosis of mitral valve regurgitation when what type of murmur is heard on auscultation ? A. Mitral click B. High- pitched blowing sound at the apex C. Low-pitched diastolic murmur at the apex D. Diastolic murmur at the left sternal border.

B. High- pitched blowing sound at the apex

Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia

B. Hyperkalemia In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased due to decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

In what type of cardiomyopathy, the heart size and mass is actually increase, especially along the septum ? A. Arrhythmogenic B. Hypertrophy C. Dilated D. Restrictive

B. Hypertrophy Restrictive cardiomyopathy is characterized as diastolic dysfunction caused by impaired rigid ventricular wall from diastole and filling. Arrhythmogenic caused by right ventricular tissues is replaced with scars and fat tissues.

7. A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply: A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR

B. Hypotension C. Low urine specific gravity D. Hypokalemia The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage.

7. A 36-year-old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply: A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR

B. Hypotension C. Low urine specific gravity D. Hypokalemia The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage.

3. Select-all-that-apply: Which of the following are NOT typical signs and symptoms of pericarditis? A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain

B. Increased pain when leaning forward C. ST segment depression F. Breathing in relieves the pain The answers are B, C, and F. These are findings NOT found in pericarditis. B is wrong because leaning forward actually helps relieve pain felt in pericarditis (supine position makes it worst). C is wrong because ST segment ELEVATION is seen not depression. F is wrong because inspiration (breathing in) increases the pain felt with pericarditis.

Anemia or insufficient hemoglobin content is common in older persons. The client's body compensates for the deficiency by: A. Decreasing the respiratory and heart rates. B. Increasing the heart and respiratory rates. C. Shunting blood away from vital organs and skin. D. Decreasing blood viscosity in order to supply oxygen to hypoxic tissues.

B. Increasing the heart and respiratory rates.

The nurse needs to monitor fluid volume for a client diagnosed with cardiomyopathy. What intervention should the nurse include in the​ client's plan of​ care? A. Auscultate heart sounds B. Monitor the​ client's weight daily C. Encourage rest periods throughout the day D. Administer supplemental oxygen

B. Monitor the​ client's weight daily RATIONALE:To monitor fluid​ volume, the nurse needs to monitor the​ client's weight daily. Auscultating heart sounds and administering supplemental oxygen will assist in monitoring cardiac output. Encouraging rest periods throughout the day will assist in monitoring the​ client's activity.

The nurse cares for a client with acute kidney injury. The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI ? A. Initiation B. Oliguria C. Recovery D. Diuresis

B. Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances that usually excreted by the kidneys. The initiation begins when the initial insults and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may takes 6-12 months.

5. Select ALL the signs and symptoms that can present in pernicious anemia: A. Erythema B. Paresthesia of hands and feet C. Racing thoughts D. Extreme hunger F. Unsteady gait G. Shortness of breath with activity

B. Paresthesia (tingling) of hands and feet F. Unsteady gait G. Shortness of breath with activity

A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.

A patient came into the emergency room complaint of chest pain that gets worse when taking deep breaths and laying down, after ruling out MI, the nurse should assess for what of the following ? A. Cardiomyopathy B. Pericarditis C. Mitral valve stenosis D. Rheumatic fever

B. Pericarditis

While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention?* A. Stay with the patient and monitor their vital signs while another nurse notifies the physician. B. Place a sterile dressing over the site and tape it on three sides and notify the physician. C. Attempt to re-insert the tube. D. Keep the site open to air and notify the physician.

B. Place a sterile dressing over the site and tape it on three sides and notify the physician.

An older adult patient presents to the healthcare provider reporting exhaustion. The nurse, aware of the most common hematologic condition affecting older adults, assesses for which laboratory values? A. Thrombocyte count B. RBC count C. Levels of plasma proteins D. WBC count

B. RBC count

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing ARDs. The nurse assess for which most common early sign of ARDs ? A. bilateral wheezing B. Rapid on set of severe dyspnea C. Cyanosis D. Inspiratory crackles.

B. Rapid on set of severe dyspnea

The nurse is assessing a client with a diagnosis of ARDS. What findings might the nurse anticipate? A. Lethargy, muscle cramping and shortness of breath B. Restlessness, confusion and agitation C. Bradycardia, hyperventilation, and nausea D. Hypotension, diaphoresis and anxiety

B. Restlessness, confusion and agitation

A 17-year-old client diagnosed with hypertrophic cardiomyopathy is about to be discharged from the hospital. The nurse-led topic is priority teaching for the client and parents? A. Increase sodium in the diet. B. Restrict strenuous physical exertion. C. Take medications when feeling pain. D. Report excess urine to the physician.

B. Restrict strenuous physical exertion. Rationale: Strenuous exertion is restricted because it may precipitate dysrhythmias and sudden death. Sodium in the diet is decreased. The client should report decreased urine output to the physician. Medications for this disorder are taken as prescribed, usually daily.

Which of the following symptoms occurs in patient diagnosed with mitral regurgitation when pulmonary congestion occurs ? A. Tachycardia B. Shortness of breath C. A loud, blowing murmur D. Hypertension

B. Shortness of breath

Mae​ Tashima, a​ 73-year-old woman, was recently diagnosed with dilated cardiomyopathy. She has a history of hypertension and chronic alcoholism. Which clinical manifestation does the nurse anticipate the client is​ experiencing? A. Ventricular tachyarrhythmia B. Syncope C. Weight loss D. Hypotension

B. Syncope A client diagnosed with dilated cardiomyopathy likely will experience syncope. A client diagnosed with arrhythmogenic right ventricular cardiomyopathy will likely experience ventricular tachyarrhythmias. A client with dilated cardiomyopathy will not experience the manifestations of hypotension or weight loss.

The nurse is administering albuterol via a metered dose inhaler (MDI) to a client who has a history of coronary artery disease and is now in heart failure. For what side effects will be it particularly important to observe when the client takes the medication? A. Tremors and central nervous system stimulation B. Tachycardia and presence of chest pain C. Development of oral candidiasis D. An increase in blood pressure (BP)

B. Tachycardia and presence of chest pain The side effects of tachycardia and chest pain are particularly important to watch for in a client who is receiving the beta2 agonist and has a history of cardiac problems. They are less common when the medication is administered via inhalation. Tremors also occur, but the tachycardia is more important with this client considering his cardiac history. Oral candidiasis may occur with the inhalation of the corticosteroids.

1. Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole. C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.

B. The amount the ventricles stretch at the end of diastole.

A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?* A. This is an expected finding. B. The lung may have re-expanded or there is a kink in the system. C. The system is broken and needs to be replaced. D. There is an air leak in the tubing.

B. The lung may have re-expanded or there is a kink in the system.

What assessment finding in a patient with heart failure receiving furosemide would indicate an improvement in fluid volume status? A. bounding radial pulse B. absence of crackles on auscultation of lungs C. complaints of proximal nocturnal dyspnea D. decrease in hematocrit

B. absence of crackles on auscultation of lungs

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?\ A. Schilling's test,elevated B. Intrinsic factor, absent. C. Sedimentation rate, 16 mm/hour D. RBCs 5.0 million

B. intrinsic factor absent The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs.

13. When the nurse is caring for an obese patient with left lower-lobe pneumonia, gas exchange will be best when the patient is positioned a. on the left side. b. on the right side. c. in the high-Fowler's position. d. in the tripod position.

B. on the right side. Rationale: The patient should be positioned with the "good" lung in the dependent position to improve the match between ventilation and perfusion. The obese patient's abdomen will limit respiratory excursion when sitting in the high-Fowler's or tripod positions. Cognitive Level: Comprehension Text Reference: pp. 1809-1810 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient receives intravenous (IV) furosemide 80mg for symptoms of severe heart failure. The nurse recognizes that administering the drug slowly by IV push reduces the likelihood of which of the following adverse effects of drug therapy? A. hyponatremia B. ototoxicity C. hypokalemia D. fluid volume deficit

B. ototoxicity Adverse effects of furosemide include fluid and electrolyte imbalances (hyponatremia, hypokalemia, fluid volume deficit) and ototoxicity. Ototoxicity, which is usually associated with high plasma drug levels (greater than 50mcg/mL), is the adverse effect that can usually be avoided by administering intravenous push orders slowly.

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

B. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. Rationale: The PaO2 indicates severe hypoxemia and that the nurse should take immediate action to correct this problem. Shallow breathing, rapid respiratory rate, and low PaCO2 can be caused by other factors, such as anxiety or pain. Cognitive Level: Application Text Reference: p. 1806 Nursing Process: Assessment NCLEX: Physiological Integrity

The primary purpose of the Schilling test is to measure the client's ability to: A. Store vitamin B12 B. Digest vitamin B12 C. Absorb vitamin B12 D. Produce vitamin B12

C. Absorb vitamin B12

(T/F) the pathophysiology of all cardiomyopathies is a series of events that culminates in impaired cardiac output.

True

A client is diagnosed with AKI has developed CHF. THe client has received 40mg IVP Laxis and 2 hours later, the nurse notes that there are 50 ml of fluid in the Foley bag. The client's vital are stable. Which health care order should the nurse anticipate ? A. normal saline bolus of 500ml B. Mannitol 12.5 IVP C. Laxis 80 mg IVP D. Chest X-Ray

C. Laxis 80 mg IVP Mannitol is only for cerebral edema. The initial dose is too low

. True or False: Intrinsic factor is a protein that plays a role in how the body absorbs Vitamin B12. True False

True

5. You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicates the patient did NOT understand the education you provided? A. "I can take this medication with or without food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take all my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."

C. "I like to take all my medications in the morning with grapefruit juice." The answer is C. Patients should not take Colchicine with grapefruit juice because it increases the amount of Colchicine the body absorbs (causing an increased chance of Colchicine toxicity). This medication can be taken WITH or WITHOUT food.

7. You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition? A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will only wash my hands with soap and water." C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats."

C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." The answer is C. Patients should finish all antibiotics doses and never stop taking them in the middle of treatment because this increases antibiotic resistances. Also, the patient should maintain good oral hygiene and should go to the dentist regularly for cleanings. However, it is very important the patient inform all other healthcare practitioners about their history of endocarditis because they will need prophylactic antibiotics therapy prior to any invasive procedures to prevent acquiring endocarditis again. Option D is incorrect.

A client with dilated cardiomyopathy has made the decision to undergo heart transplant. The client is concerned that severe ventricular dysrhythmias will affect the chances of surviving until a heart becomes available. What is the nurse's best response to the client about how the physician will support survival to transplant? A. "Your physician will perform a myocardial biopsy while you are waiting on the heart." B. "A coronary angiography will be performed prior to heart transplantation." C. "Prior to transplant you will have an implantation of a ventricular assistive device." D. "Prior to transplant you will have an aortic valve surgery."

C. "Prior to transplant you will have an implantation of a ventricular assistive device." Rationale: For the client awaiting a heart transplant, there are ventricular assistive devices, implantable cardioverter-defibrillator devices, and pacemakers that can be used to increase survival rates. Aortic valve surgery does not help dilated cardiomyopathy but is a treatment for obstructive hypertrophic cardiomyopathy. A myocardial biopsy and coronary angiography are tests for diagnosing heart disease.

16. When caring for a patient who developed acute respiratory distress syndrome (ARDS) as a result of a urinary tract infection (UTI), the nurse is asked by the patient's family how a urinary tract infection could cause lung damage. Which response by the nurse is appropriate? a. "The infection spread through the circulation from the urinary tract to the lungs." b. "The urinary tract infection produced toxins that damaged the lungs." c. "The infection caused generalized inflammation that damaged the lungs." d. "The fever associated with the infection led to scar tissue formation in the lungs."

C. "The infection caused generalized inflammation that damaged the lungs." Rationale: The pathophysiologic changes that occur in ARDS are thought to be caused by inflammatory and immune reactions that lead to changes at the alveolar-capillary membrane. ARDS is not directly caused by infection, toxins, or fever. Cognitive Level: Application Text Reference: p. 1813 Nursing Process: Implementation NCLEX: Physiological Integrity

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

C. . decreased transfer of oxygen into the blood because of thickening of the alveoli. Rationale: Pulmonary fibrosis causes the alveolar-capillary interface to become thicker, which increases the amount of time it takes for gas to diffuse across the membrane. Too-rapid pulmonary blood flow is another cause of shunt but does not describe the pathology of pulmonary fibrosis. Decrease in alveolar ventilation will cause hypercapnia. Ventilation and perfusion are matched in pulmonary fibrosis; the problem is with diffusion. Cognitive Level: Application Text Reference: p. 1802 Nursing Process: Implementation NCLEX: Physiological Integrity

1. It will be most important for the nurse to check pulse oximetry for which of these patients? a. A patient with emphysema and a respiratory rate of 16 b. A patient with massive obesity who is refusing to get out of bed c. A patient with pneumonia who has just been admitted to the unit d. A patient who has just received morphine sulfate for postoperative pain

C. A patient with pneumonia who has just been admitted to the unit Rationale: Hypoxemia and hypoxemic respiratory failure are caused by disorders that interfere with the transfer of oxygen into the blood, such as pneumonia. The other listed disorders are more likely to cause problems with hypercapnia because of ventilatory failure. Cognitive Level: Application Text Reference: pp. 1799-1800 Nursing Process: Assessment NCLEX: Physiological Integrity

24. Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) is most appropriate for the RN to delegate to an experienced LPN/LVN working in the intensive care unit? a. Placing the patient in the prone position b. Assessment of patient breath sounds c. Administration of enteral tube feedings d. Obtaining the pulmonary artery pressures

C. Administration of enteral tube feedings Rationale: Administration of tube feedings is included in LPN/LVN education and scope of practice and can be safely delegated to an LPN/LVN who is experienced in caring for critically ill patients. Placing a patient who is on a ventilator in the prone position requires multiple staff and should be supervised by an RN. Assessment of breath sounds and obtaining pulmonary artery pressures require advanced assessment skills and should be done by the RN caring for a critically ill patient. Cognitive Level: Application Text Reference: pp. 1816-1818 Nursing Process: Implementation NCLEX: Safe and Effective Care Environment

The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapsed. Which of the following is often the first and only manifestation ? A. Fatigue B. Syncope C. An extra heart sounds D. Dizziness

C. An extra heart sounds

What is a rare disease that is caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, or replacement of the marrow with fat? A. Pernicious Anemia B. Chronic Anemia C. Aplastic Anemia D. Thalassemia

C. Aplastic Anemia

The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the ECG? A. First degree atrioventricular block B. Ventricular tachycardia C. Atrial fibrillation D. Sinus dyshythmia

C. Atrial fibrillation

A patient describes numbness in the arms and hands with a tingling sensation and frequent stumbling when walking. What vitamin deficiency does the nurse determine may contribute to soem of these symptoms? A. Thiamine B. Folate C. B12 D. Iron

C. B12

The patient describes numbness in the arms and hands with a tingling sensation and frequent stumbling when walking. What vitamin deficiency does the nurse determine may contribute to some of these symptoms? A. Thiamine B. Folate C. B12 D. Iron

C. B12

The nurse is providing education to a client newly diagnosed with cardiomyopathy. Which statement should the nurse use to best describe cardiomyopathy to the​ client? A. Cardiomyopathy is another term for high blood pressure. B. Cardiomyopathy is an abnormal heart rate. C. Cardiomyopathy causes ineffective pumping pumping of the heart. D. Cardiomyopathy develops when the kidneys cannot regulate the blood pressure.

C. Cardiomyopathy causes ineffective pumping pumping of the heart. RATIONALE: Cardiomyopathy is a disease process in which the heart is​ weakened, which interferes with its ability to pump blood through the body. The other statements do not accurately describe cardiomyopathy.

2. A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis? A. Pericardial effusion B. Acute pericarditis C. Constrictive pericarditis D. Effusion-Constrictive pericarditis

C. Constrictive pericarditis The answer is C. This describes constrictive pericarditis. The key words in this question are: the patient's signs and symptoms which indicate heart failure (a common finding with patients who have constrictive pericarditis) and that the echo showed "thickening" of the pericardium.

A client has developed pulmonary edema secondary to many years of hypertension and congestive heart failure. He had been experiencing peripheral edema and paroxysmal nocturnal dyspnea before admission. The nurse has administered 40 mg of furosemide via an intravenous (IV) push. What would the nurse observe as the desired response to this medication? A. Urine output increases to 100 mL/hr for 3 hours B. Blood pressure (BP) goes from 160/100 to 150/94 mm Hg C. Decrease in respiratory rate and less difficulty breathing D. Peripheral edema begins to decrease in 24 hours

C. Decrease in respiratory rate and less difficulty breathing The decrease in respiratory rate and less difficulty breathing are secondary to a decrease in the fluid collecting in the lungs; this is the desired response to the diuretic. The decrease in BP is an expected response, but is not the desired response or primary objective in this client. The urine output increases, but if the output increases and the respiratory problem is not resolved, the desired response to the medication is not achieved. The peripheral edema may begin to decrease as a result of the diuretic, but the drug was given via IV push for the immediate action to decrease fluid precipitating respiratory distress.

14. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind No medication because this is a normal Digoxin level.

C. Digibind The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.

A client presents to the emergency department with symptoms of orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, and ascites. The physician suspects cardiomyopathy. The nurse suspects the client is experiencing which type of myopathy? A. Restrictive cardiomyopathy B. Hypotrophic cardiomyopathy C. Dilated cardiomyopathy D. Hypertrophic cardiomyopathy

C. Dilated cardiomyopathy Rationale: All cardiomyopathies have similar symptoms, but only dilated cardiomyopathy presents with orthopnea, nocturnal dyspnea, peripheral edema, and ascites. Hypertrophic and restrictive cardiomyopathy usually present with dyspnea on exertion. Hypotrophic cardiomyopathy is not a cardiomyopathy classification.

The nurse is teaching a client about to be discharged after undergoing detoxification from chronic alcohol abuse. The client asks the nurse about complications or risk for any heart problems related to alcoholism. The nurse teaches the client that which heart disease is likely for an alcoholic client? A. Restrictive cardiomyopathy B. Valve stenosis C. Dilated cardiomyopathy, reversible D. Mitral regurgitation, irreversible

C. Dilated cardiomyopathy, reversible Rationale: The client who abuses alcohol or cocaine is at risk for developing dilated cardiomyopathy that is reversible if the abuse is stopped. Alcoholism does not present a particular risk of valve disorders (stenosis, regurgitation) or restrictive cardiomyopathy.

A client with chronic bronchitis is receiving salmeterol, a beta2-adrenergic agonist. What is the best evidence that the drug is effective? A. Heart rate decreased from 120 beats/min to 90 beats/min B. Productive cough with increased amounts of clear sputum C. Diminished wheezing; decreased shortness of breath D. Decreased dyspnea for up to 4 hours after administration

C. Diminished wheezing; decreased shortness of breath Beta2-adrenergic agonists cause relaxation of bronchial smooth muscle, relieving bronchospasm and reducing airway resistance. Treating a client with a beta2-adrenergic agonist should cause a decrease in wheezing and prevent bronchospasm. Beta2-adrenergic agonists do not act as expectorants, so productive cough is incorrect. Beta2-adrenegic agonists have cardiac stimulant effects, which can lead to palpitations and tachycardia. The medication should have an effect of about 12 hours; it is not used for short-term relief.

Leo​ Alarcon, an​ 82-year-old man with a history of​ cardiomyopathy, is admitted with complaints of dyspnea. His breathing is​ labored, his respiratory rate is 34​ breaths/min, and he is very anxious. The nurse auscultates his heart and lungs. The nurse hears diffuse crackles and an S3 heart sound. Which treatment is anticipated for Mr.​ Alarcon? A. Benzodiazepine B. Vasoconstrictor C. Diuretic D. Intravenous normal saline fluid bolus

C. Diuretic Based on the​ client's symptoms, he is experiencing heart failure. The nurse should anticipate that the client will be treated with a diuretic because this medication will diurese the client and reduce the fluid overload. The client will not receive a​ vasoconstrictor, a​ benzodiazepine, or a fluid bolus.

A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What lab study does the nurse determine will have to be assessed at least monthly related to this medication ? A. Potassium B. Creatinine level C. Hemoglobin level D. Folate levels

C. Hemoglobin level

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy? A. Performing the test without contrast B. Administering gentamicin sulfate prophylactically C. Hydrating with saline intravenously before the test D. Administering sodium bicarbonate after the procedure

C. Hydrating with saline intravenously before the test

If a patient is in the diuretic phase of AKI, you must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia

C. Hypokalemia and hyponatremia In the diuretic phase of AKI, the kidneys have recovered their ability to excrete wastes but not to concentrate the urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

17. All the following medications are ordered for a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) and acute renal failure. Which medication should the nurse discuss with the health care provider before administration? a. IV ranitidine (Zantac) 50 mg IV b. sucralfate (Carafate) 1 g per nasogastric tube c. IV gentamicin (Garamycin) 60 mg d. IV methylprednisolone (Solu-Medrol) 40 mg

C. IV gentamicin (Garamycin) 60 mg Rationale: Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS. Cognitive Level: Application Text Reference: p. 1816 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse is caring for a client with adult respiratory distress syndrome (ARDS) is evaluating the plan of care. What is the priority safety goal that needs to be evaluated? A. Deep breathing and coughing on a regular basis to remove secretions B. Assess client's understanding of the diagnosis C. Identify and address potential causes of agitation D. Encourage adequate nutritional intake especially protein intake

C. Identify and address potential causes of agitation

The nurse is perfoming an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient ? A. It's part of the required assessment informaiton B. It's important for the nurse to determine what type of foods the patient will eat C. It may indicate deificiencies in essential nutrients D. It willl determine what type of anemia the patient has.

C. It may indicate deificiencies in essential nutrients

17. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

C. K+ 8.0 The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).

4. A doctor suspects pernicious anemia in a patient presenting with a beefy red tongue. The patient reports feeling extremely fatigued and numbness and tingling in the hands. The doctor orders a peripheral blood smear. From your nursing knowledge, how will the red blood cells appear in the peripheral blood smear if pernicious anemia is present? A. Round-shaped and hypochromic B. Oval-shaped and hyperchromic C. Large and oval-shaped D. Small and hyperchromic

C. Large and oval-shaped The answer is C. In pernicious anemia, the RBCs will appear very large (rather than normal size) and oval-shaped (rather than round).

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? A. Whole grains B. Green leafy vegetables C. Meats and dairy products D. Broccoli and Brussels sprouts

C. Meats and dairy products

7. Which treatments below would decrease cardiac preload? Select all that apply: A. IV fluid bolus B. Norepinephrine C. Nitroglycerin D. Furosemide

C. Nitroglycerin D. Furosemide The answers are C and D. Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys. This will decrease venous return to the heart and decrease preload. An IV fluid bolus and Norepinephrine (a vasoconstrictor) will increase venous return to the heart and increase preload.

3. A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as? A. Janeway Lesions B. Roth Spots D. Trousseau's Sign

C. Osler's Nodes Answer is C...Osler's Nodes. They are TENDER, red lesions on the hands and feet. Don't get this confused with Janeway Lesions which are NON-TENDER, red lesions on the PALMS of the hands and SOLES of the feet. Roth spots are retinal hemorrhages with white centers and Trousseau's Sign is found in hypocalcemia.

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? A. PCO2 B. HCO3 C. PaO2 D. pH

C. PaO2

Because older persons can have severe anemia for a long period of time without detection, when diagnosed, quick reversal is warranted. Which of the following orders most likely would be prescribed at this time? A. Platelet transfusion and osmotic diuretic B. Ferrous sulfate 325 mg orally three times a day C. Packed red blood cells followed by oral furosemide D. (Lasix)Erythropoietin (Procrit) injection twice per week

C. Packed red blood cells followed by oral furosemide

The most common cause of macrocytic anemia in the older person is B12 or folate deficiency. Failure to absorb vitamin B12 from the G.I. tract is called: A. Macrocytic anemia. B. Aplastic anemia. C. Pernicious anemia. D. Thalassemia anemia

C. Pernicious anemia.

4. You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient? A. Monitor the patient for complications of cardiac tamponade. B. Administer Ibuprofen as scheduled. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds.

C. Place the patient in supine position to relieve pain. The answer is C. Placing the patient in supine position is not a proper nursing intervention for a patient experiencing pericarditis because this increases pain. The high Fowler's position or leaning forward is the best position for a patient with pericarditis.

4. A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal

C. Pre-renal The answer is C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

9. A patient with endocarditis has listed in their medical history "Roth Spots". You know that this is a complication of infective endocarditis and presents as? A. Non-tender spots found on the feet and hands B. Red and tender lesions found in the eyes C. Retinal hemorrhages with white centers D. Purplish spots found on the forearms and groin

C. Retinal hemorrhages with white centers The answer is C. Roth spots are found in the eyes as retinal hemorrhages with white centers.

Mae​ Tashima, a​ 73-year-old woman, was recently diagnosed with dilated cardiomyopathy. She has a history of hypertension and chronic alcoholism. Which clinical manifestation does the nurse anticipate the client is​ experiencing? A. Ventricular tachyarrhythmia B. Weight loss C. Syncope D. Hypotension

C. Syncope RATIONALE:A client diagnosed with dilated cardiomyopathy likely will experience syncope. A client diagnosed with arrhythmogenic right ventricular cardiomyopathy will likely experience ventricular tachyarrhythmias. A client with dilated cardiomyopathy will not experience the manifestations of hypotension or weight loss.

Mr. Conley, who is 53 yrs. old is about to be discharged from the hospital after treatment for recurrent ventricular fibrillation. To prevent break through ventricular ectopy, his prescriber orders amiodarone, 1000mg PO daily as a loading dose for 2 weeks. What patient teaching implications are important regarding this loading dose? A. Males require large dosages because of their faster metabolic rate. B. Most of the drug is destroyed in the gastrointestinal tract and thus a large dose needs to be given. C. The drug has a long serum half-life. D. A history of bentricular dysrhythmia necessitates a higher dose

C. The drug has a long serum half-life. Amiodarone is highly lipid soluble, and the drug and it's metabolites accumulate in the liver, fat, skin, and other tissues. With IV administration, the onset of action usually is within several hours. With oral administration, the onset of action may be delayed from a few days up to a week or longer. However, because of the long serum half life of amiodarone, loading doses are often given; higher loading doses can reduce the time required for therapeutic effects. Low doses (100-200 mg/d) may prevent recurrence of atrial fibrillation with less toxicity than higher doses.

A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find?* A. The water in the chamber will increase during inspiration and decrease during expiration. B. There will be continuous bubbling noted in the chamber. C. The water in the chamber will decrease during inspiration and increase during expiration. D. The water in the chamber will not move.

C. The water in the chamber will decrease during inspiration and increase during expiration.

5. A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient's fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis? A. Abdominal ultrasound B. Heart catheterization C. Transesophageal echocardiogram D. White blood cell count

C. Transesophageal echocardiogram The answer is C. Transesophageal echocardiogram (TEE) is an ultrasound performed to look at the back side of the heart and assesses the valve structure. It is a test used to diagnose vegetations found on the valves. All the other options do not confirm endocarditis.

A patient with a history of hypertension come to the emergency department with double vision and blood pressure of 240/120 mm Hg. The physician on call orders sodium nitroprusside (Nitropress) by continuous infusion, with continual blood pressure monitoring. This drug's immediate action is to lower blood pressure by which of the following mechanisms? A. increasing peripheral vascular resistance B. increasing cardiac output C. dilating venous and arterial vessels D. decreasing heart rate

C. dilating venous and arterial vessels Niroprusside is a potent vasodilator that decreases peripheral vascular resistance. The drug is given by continuous intravenous (IV) infusion and requires continuous blood pressure monitoring, most effectively by intra-arterial monitoring.

In administering a newly initiated order for captopril, an ACE inhibitor, discharge instructions should indicate that which of the following adverse effects is most common? A. constipation B. muscle weakness C. dry, nonproductive, persistent cough D. tinnitus

C. dry, nonproductive, persistent cough All ACE-inhibitors can commonly cause a nonproductive cough and a tickling in the throat. Approximately 10-20% of clients experience this minor but annoying side effect. The cough resolves when the drug is discontinued.

A patient developed pericarditis complained of pain 6/10 which deep breathing which of the PRN order is most appropriate to administer ? A. Tylenol B. Morphine C. ibuprofen D. fentalny

C. ibuprofen Chest pain caused by pericarditis is normally cause by inflammation, NSAIDs is working in this case.

6. A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis

D. Pericardiocentesis The answer is D. The physician will probably order a pericardiocentesis. This is a procedure to remove excessive fluid from the pericardial sac.

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

D. "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths." Rationale: A pulmonary embolus limits blood flow but does not affect ventilation, leading to a ventilation-perfusion mismatch. The response beginning, "Oxygen transfer into your blood is slow because of thick membranes" describes a diffusion problem. The remaining two responses describe ventilation-perfusion mismatch with adequate blood flow but poor ventilation. Cognitive Level: Application Text Reference: p. 1802 Nursing Process: Implementation NCLEX: Physiological Integrity

6. When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first? a. Monitor the patient every 10 to 15 minutes. b. Notify the patient's health care provider immediately. c. Attempt to calm and reassure the patient. d. Assess vital signs and pulse oximetry.

D. Assess vital signs and pulse oximetry. Rationale: The nurse needs to collect additional clinical data to share with the health care provider and to start interventions quickly if appropriate (e.g., increased oxygen flow if hypoxic). The change in the patient's neurologic status may indicate deterioration in respiratory function, and the health care provider should be notified immediately but only after some additional information is obtained. Monitoring the patient and attempting to calm the patient are appropriate actions, but they will not prevent further deterioration of the patient's clinical status and may delay care. Cognitive Level: Application Text Reference: pp. 1804-1805 Nursing Process: Assessment NCLEX: Physiological Integrity

A Client has been intubated and placed on a volume-cycled mechanical ventilator. The nurse carefully assess the client for findings associated with a risk associated with this type of ventilator. What is the risk? A. Hypoventilation B. Hypercapnia C. Respiratory acidosis D. Barotrauma

D. Barotrauma rationale: the volume-cycled ventilator has the potential to increase pressure in order to deliver the set volume. barotrauma is a risk associated with this form of mechanical ventilation.

The nurse is caring for a patient following a CABG. Which of these finding required interventions? A. BP 110/68 B. HR 66 bpm C. Pain 5/10 D. CVP reading 1mmhg

D. CVP reading 1mmhg The CVP reading is low ( 2-6) indicated reduced right ventricular preload, common caused by hypovolemia after a cardiac surgery.

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Reposition the patient because the tubing is kinked. B. Continue to monitor the drainage system. C. Increase the suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak.

D. Check the drainage system for an air leak.

18. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin

D. Digoxin The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

A client is admitted to a medical unit for possible cardiomyopathy The client has a family history of​ cardiomyopathy, hypertension, and chronic alcohol and drug use. What type of cardiomyopathy is the client likely​ experiencing? A. Arrhythmogenic right ventricular cardiomyopathy B. Restrictive cardiomyopathy C. Hypertrophic cardiomyopathy D. Dilated cardiomyopathy

D. Dilated cardiomyopathy RATIONALE; The client is likely experiencing dilated cardiomyopathy. Dilated cardiomyopathy may be inherited and is secondary to​ hypertension, chronic​ alcoholism, and drug use. The other types of cardiomyopathy are not supported by the​ client's history.

Which clinical problem should the nurse include when planning care for a client with​ cardiomyopathy? A. Impaired gas exchange B. Fluid volume deficit C. Chronic pain D. Diminished cardiac output

D. Diminished cardiac output RATIONALE: The clinical problem that the nurse should include when planning care for a client with cardiomyopathy is diminished cardiac output. Excess fluid volume is a problem for a client with​ cardiomyopathy, not fluid volume deficit. Chronic pain and impaired gas exchange are not problems associated with cardiomyopathy.

The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY?* A. Place the patient in supine position and clamp the tubing. B. Notify the physician immediately. C. Disconnect the drainage system and get a new one. D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

The nurse has stopped the propofol drip for 15 minutes on a ventilated client. Which assessment findings indicate the client meets criteria for the weaning process? A. Elevated temperature that normalizes after acetaminophen administration B. Awake, restless, not following commands C. Suctioned for copious thick yellow sputum D. Fine crackles bilaterally that clear with coughing

D. Fine crackles bilaterally that clear with coughing By turning off the propofol for 15 minutes the nurse gives the client a sedation vacation for weaning assessment. If the client has an effective cough that clears fine crackles while intubated, then when extubated, the same should be true. Restlessness and not following commands may suggest hypoxia and/or an inability to cooperate after extubation. Copious secretions that require suction to remove would suggest the client will have difficulty if extubated. Temperature elevation suggests infection or worsening of the condition, which could include local or systemic infection. Even though the temperature responds to acetaminophen, this presents instability in the client's condition.

The nurse is providing education to a community group about cardiac disorders. When discussing​ cardiomyopathy, which risk factor should the nurse​ discuss? A. Hyperthyroidism B. Smoking C. Hypotension D. Heart failure

D. Heart failure RATIONALE: The nurse needs to include heart failure as a risk factor associated with cardiomyopathy.​ Alcoholism, not​ smoking, is a risk factor for cardiomyopathy.​ Hypertension, not​ hypotension, is a risk factor. Hyperthyroidism is not a risk factor for cardiomyopathy.

15. Mrs. K is in the diuretic phase of acute renal failure. During this phase, the client is assessed for signs of: a. Hyperkalemia b. Metabolic acidosis c. Hypertension d. Hypovolemia

D. Hypovolemia

What is the charateristic of the intrarenal category of AKI? A. Decreased CR B. High specific gravity C. Decreased urine sodium D. Increase BUN

D. Increase BUN

6. A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder? A. Intravenous B. Orally C. Through a central line D. Intramuscular

D. Intramuscular The answer is D. Remember patients with Vitamin B12 do NOT absorb vitamin B12 through the GI system due to lacking intrinsic factor (which helps with the absorption of vitamin B12)....therefore, you would not give it orally. The best route for administering vitamin B12 is via the muscle (intramuscular).

One of the most common cause of mitral regurgitation in developed countries is ? A. ischemic heart disease B. rheumatic fever C. myxomatous change D. Ischemia of the left ventricle

D. Ischemia of the left ventricle ischemia of the heart ventricle is the cause of mitral regurgitation for developed countries. rheumatic fever is for developing countries.

2. Select the statement below that best describes cardiac afterload: A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

What is used to decreased potassium level seen in acute renal failure? A. Sorbitol B. Calcium supplements C. IV dextrose D. Kayexalate

D. Kayexalate Normal BUN 3.6 to 5.2 millimoles per liter

When planning home care for a client with​ cardiomyopathy, which topic should the nurse include in client​ teaching? A. Record weight once a week B. Promote strenuous aerobic exercise C. Avoid resting throughout the day D. Maintain adequate fluid intake and output

D. Maintain adequate fluid intake and output RATIONALE:When planning home care for a client with​ cardiomyopathy, the nurse needs to educate the client to maintain adequate fluid intake and output. The nurse needs to educate the client to balance rest during the day with exercise. The client needs to record daily weights. The client needs to restrict strenuous physical exercise but adhere to a prescribed exercise program

10. The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

D. Maintaining cortisol production The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys.

Ms. Ferguson, age 58, is admitted to the coronary care unit for treatment of an acute anterior myocardial infarction. That evening, she experiences frequent episodes of ventricular tachycardia. The provider tells the nurse to prepare an IV bolus dose of lidocaine. Why is lidocaine administered intravenously at this time- and not orally? A. The onset of action for oral lidocaine is greater than 8 hours B. Lidocaine is inactivated by hydrochloric acid C. Lidocaine absorption is too erratic when administered orally D. Most of an absorbed oral dose of lidocaine undergoes first-pass metabolism in the liver

D. Most of an absorbed oral dose of lidocaine undergoes first-pass metabolism in the liver

A patient in the ICU after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance should the nurse assess the patient for? A. Magnesium B. Sodium C. Calcium D. Potassium

D. Potassium Signs and symptoms of hyperkalemia.

When caring for a patient during the oliguric phase of acute kidney injury, what would be an appropriate nursing intervention? A. Weigh patient three times weekly B. Increase dietary sodium and potassium C. Provide a low-protein, high-carbohydrate diet D. Restrict fluids according to the previous day's fluid loss

D. Restrict fluids according to the previous day's fluid loss Patients in the oliguric phase of acute kidney injury have fluid volume excess with potassium and sodium retention. They will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times per week.

the nurse is assessing a patient admitted with infective endocarditis. Which of the following manifestations would the nurse expect to find? A. Involuntary muscle movements B. Bruising on the palm of hand and sole of feet C. Raised red rash in trunk and face D. Small painful lesion on the pads of finger and toes

D. Small painful lesion on the pads of finger and toes Osler's nodes

8. A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding? A. Renal embolic event B. Pulmonary embolic event C. Central nervous system embolic event D. Splenic embolic event

D. Splenic embolic event The answer is D. These are classic signs and symptoms of a splenic embolic event. The patient with endocarditis is at risk for renal, pulmonary, central nervous system, or spleen emboli. Renal emboli would present with flank pain with pus or blood in the urine. Pulmonary emboli would present with dyspnea, chest pain, or shortness of breath, and CNS emboli would present with confusion or difficulty speaking.

5. ___________ is the amount of blood pumped by the left ventricle with each beat. A. Cardiac output B. Preload C. Afterload D. Stroke volume

D. Stroke volume

A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the healthcare provider will take now that the patient has been intubated for this length of time? A. The patient will be extubated and a nasotracheal tube will be inserted B. The patient will be extubated and another endotracheal tube will be inserted C. The patient will begin the weaning process D. The patient will have an insertion of a tracheostomy tube

D. The patient will have an insertion of a tracheostomy tube

26. A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? A. "Take the medication with an antacid." B. "Take the medication with a glass of milk." C. "Take the medication with cereal." D. "Take the medication on an empty stomach."

D. take on an empty stomach In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia). T-helper cell production doesn't decrease in aplastic anemia. Reed-Sternberg cells and lymph node enlargement occur with Hodgkin's disease.

15. The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. The patient has a cough that is productive of blood-tinged sputum. b. The patient has scattered crackles throughout the posterior lung bases. c. The patient's temperature is 101.5° F after 2 days of IV antibiotic therapy. d. The patient's SpO2 has dropped to 90%, although the O2 flow rate has been increased.

D. The patient's SpO2 has dropped to 90%, although the O2 flow rate has been increased. Rationale: The patient's dropping SpO2 despite having an increase in FIO2 indicates the possibility of acute respiratory distress syndrome (ARDS). The patient's blood-tinged sputum and scattered crackles are not unusual in a patient with pneumonia, although they do require continued monitoring. The continued temperature elevation indicates a possible need to change antibiotics, but this is not as urgent a concern as the progression toward hypoxemia despite an increase in O2 flow rate. Cognitive Level: Application Text Reference: p. 1815 Nursing Process: Assessment NCLEX: Physiological Integrity

7. A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of acute respiratory distress. When monitoring the patient, which assessment by the nurse will be of most concern? a. The patient is sitting in the tripod position. b. The patient has bibasilar lung crackles. c. The patient's pulse oximetry indicates an O2 saturation of 91%. d. The patient's respiratory rate has decreased from 30 to 10/min.

D. The patient's respiratory rate has decreased from 30 to 10/min. Rationale: A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest; therefore, the nurse will need to take immediate action. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation. Cognitive Level: Application Text Reference: p. 1804 Nursing Process: Assessment NCLEX: Physiological Integrity

The nurse is caring for a patient with suspected acute respiratory distress syndrome (ARDS) wiht a PO2 of 53. The patient is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS? A. Increased Pao2 B. Tachypnea C. Diminished alveolar dilation D. Unresponsive arterial hypoexemia

D. Unresponsive arterial hypoexemia

The patient admitted to the intensive care unit after a motor vehicle accident has been diagnosed with AKI. Which finding indicates the onset of oliguria resulting from AKI? A. Urine output less than 1000 mL for the past 24 hours B. Urine output less than 800 mL for the past 24 hours C. Urine output less than 600 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours

D. Urine output less than 400 mL for the past 24 hours The most common initial manifestation of AKI is oliguria, a reduction to urine output to less than 400 mL/day.

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

D. assist the patient with augmented coughing to remove respiratory secretions. Rationale: The patient's assessment indicates that assisted coughing is needed to help remove secretions, which will improve PaCO2 and will also help to correct fatigue. If the patient is allowed to rest, the PaCO2 will increase. Humidification may help loosen secretions, but the weak cough effort will prevent the secretions from being cleared. The patient should be positioned with the good lung down to improve gas exchange. Cognitive Level: Application Text Reference: p. 1809 Nursing Process: Planning NCLEX: Physiological Integrity

A client who is taking an oral hypoglycemic for management of this type 2 diabetes mellitus begins taking hydrochlorothiazide. The nurse should monitor for which of the following serum laboratory changes? A. hypercalcemia B. hypernatremia C. hypocalcemia D. hyperglycemia

D. hyperglycemia

Arterial blood gas analysis would reveal which value related to acute respiratory failure ? A. PaO2 80 B. PaCO2 32 C. pH. 7.35 d. pH 7.25

D. pH 7.25 ARF is defined as pAO2 lower than 60 (hypoxemia) increase arterial carbon dioxide tension PaCO2 > 50 ( hypercapnia) and an arterial pH less than 7.35

Single- drug therapy with an ARB would be least effective in which of the following groups? A. people of Caucasian descent B. people of Asian descent C. people of Hispanic descent D. people of African descent

D. people of African descent CORRECT! ARBs, ACE-I, and beta blockers are less effective as monotherapy in African Americans. Overall, African Americans are more likely to have severe hypertension and require multiple drugs as a result of having low circulating renin, increased salt sensitivity, and a higher incidence of obesity.

8. On physical assessment of a patient with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub

D. pericardial friction rub The answer is D. A common sign of pericarditis is being able to auscultate a pericardial friction rub.

A patient reports a drug allergy to sulfonamides. Which diuretic drug class should the nurse question if ordered for the patient? A. potassium-sparing diuretics B. osmotic diuretics C. loop diuretic D. thiazides

D. thiazides

Ms. Iokua is a​ 72-year-old woman with a history of​ hyperlipidemia, hypertension, and heart failure. She presents to the emergency department with fatigue and dyspnea on exertion. Which question should the nurse ask when obtaining Ms.​ Iokua's health​ history? ​A. "Are you able to care for your home as you​ like?" B. ​"Do you still drive a car to get​ groceries?" C. ​"Do your children visit you​ frequently?" D. ​"Are you able to perform all of your daily​ self-care?"

D. ​"Are you able to perform all of your daily​ self-care?" Since the client is experiencing fatigue and dyspnea on​ exertion, the nurse needs to identify whether the client can perform daily​ self-care. Therefore, this question needs to be asked when performing the health history. OK

1. ______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine. A. Urea B. Creatinine C. Potassium D. Magnesium

The answer is B. Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.

6. A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in? A. Initiation B. Diuresis C. Oliguric D. Recovery

The answer is D. This patient is in the recovery stage of AKI. The patient's labs and urinary output indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR (glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow waste levels and electrolyte levels to be maintained.

8. True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage.

The answer is FALSE. Some patients will skip the oliguric stage of AKI and progress to the diuresis stage.

10. True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload. True False

True The answer is True. If pulmonary vascular resistance or systemic vascular resistance is high, it will create an increased cardiac afterload. If pulmonary vascular resistance or systemic vascular resistance is low, it will create a decreased cardiac afterload.

A patient recovering from heart surgery develops pericarditis and complains of level 6 chest pain with deep breathing. Which ordered PRN medication will be the most appropriate for the nurse to give? a. Fentanyl 1 mg IV. b. IV morphine sulfate 4 mg. c. Oral ibuprofen (Motrin) 600 mg. d. Oral acetaminophen (Tylenol) 650 mg.

c. Oral ibuprofen (Motrin) 600 mg. -The pain associated with pericarditis is caused by inflammation, so NSAID's are most effective.

Physiological Integrity 21. The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which information obtained by the nurse is most important? a. The patient has a history of a recent upper respiratory infection. b. The patient has a family history of coronary artery disease (CAD). c. The patient reports using cocaine a "couple of times" as a teenager. d. The patient's 29-year-old brother died from a sudden cardiac arrest.

d. The patient's 29-year-old brother died from a sudden cardiac arrest. About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people. The information about the patient's brother will be helpful in planning care (such as an automatic implantable cardioverter-defibrillator [AICD]) for the patient and in counseling other family members. The patient should be counseled against the use of stimulant drugs, but the limited past history indicates that the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy, but not for HC. DIF: Cognitive Level: Apply (application) REF: 828 TOP: Nursing Process: Assessment MSC:

antihypertensive

may act by blocking the renin-angiotensin-aldosterone system (RAAS), by blocking the sympathetic nervous system (SNS), or by causing vasodilation.

When valves do not open completely, a condition called ________________________________________ occurs, and blood flow through the valve is reduced.

stenosis

Calcium channel blockers and direct-acting vasodilators

work by causing vasodilation. However, peripheral edema may be an adverse effect.