Final Exam - Module 5-7 (Exam, Quiz, ATI, TestBank)

Systolic heart failure is? Inadequate filling Inadequate pumping

Inadequate pumping

The nurse is interpreting a patients complete blood count. What does the CBC give an overall indication of? Coagulation cascade Cardiac output and index Bone marrow health Overall immune status

Bone marrow health

A patient in the CCU is recovering from coronary artery bypass graft (CABG) surgery. He has had multiple graft surgeries in the past. For this latest surgery, the patients radial artery was used in the graft. What complication should the nurse most expect to observe in this patient? Occlusion Infection Arterial spasm Internal hemorrhaging

Arterial spasm

Which of the following are paramount procedures that the critical care nurse ensures are complete during the preoperative phase for the patient undergoing organ transplantation? ECG Complete dialysis within 48 hours CT of the head without contrast Venogram and arteriogram

ECG

An immunocomprised patient presents with the following: chills, tachycardia, tachypnea, and hypotension. The critical care nurse suspects which of the following? Early septic shock Acute pancreatitis AIDS HIV

Early septic shock

A patient who underwent carotid endarterectomy is being discharged from the CCU. Which of the following instructions should the nurse give to the patient? Avoid rotating your head Bruising and discoloration of the neck are not normal and should be reported immediately Eat a low-fat diet Avoid washing the incision site

Eat a low-fat diet

When performing a physical examination of a hematological or immunocompromised patient, the critical care nurse focuses on which of the following major areas? Skin, liver, spleen, lymph nodes Skin, respiratory, cardiac, spleen Skin, liver, cardiac, lymph nodes Respiratory, kidney function, liver, spleen

Skin, liver, spleen, lymph nodes

A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply. Hypertension Arteriosclerotic disease Traumatic injury Type 2 diabetes mellitus Preeclampsia Type 1 diabetes mellitus

Hypertension Arteriosclerotic disease Type 2 diabetes mellitus Preeclampsia

A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching? "I should place the tablet under my tongue." "I should have my clotting time checked weekly." "I will report any ringing in my ears." "I will call my doctor if my pulse rate is less than 60."

"I will call my doctor if my pulse rate is less than 60." *The client is advised to notify the provider if bradycardia (pulse rate less than 60) occurs. Corrections: Metoprolol is administered orally, not sublingually. Metoprolol does not affect bleeding or clotting time. The client should have CBC and blood glucose checked periodically. Ringing in the ears is not an adverse effect of the medication. Dry mouth and mucous membranes can occur.

A nurse is caring for a client who asks why the provider prescribed a daily aspirin. Which of the following responses should the nurse make? "Aspirin reduces the formation of blood clots that could cause a heart attack." "Aspirin relieves the pain due to myocardial ischemia." "Aspirin dissolves clots that are forming in your coronary arteries." "Aspirin relieves headaches that are caused by other medications."

"Aspirin reduces the formation of blood clots that could cause a heart attack." *Aspirin decreases platelet aggregation that can cause a myocardial infarction. Corrections: One aspirin per day is not sufficient to alleviate ischemic pain. Aspirin does NOT dissolve clots. Other medications can cause headaches, but one aspirin per day is not administered as an analgesic.

The patient with Chronic Kidney Disease (CKD) is being discharged. Which of the following statements by the patient indicates a knowledge DEFICIT regarding care after discharge? "I will weigh myself daily and report a sudden increase in weight." "Because of dialysis, I can now drink as much as I want." "As my disease progresses, I may need continuous renal replacement." "I will do my best to follow the diet prescribed by the dietician."

"Because of dialysis, I can now drink as much as I want." Rationale: Fluid and protein management is an important approach to optimal health for the person with CKD. See p. 597, Box 31-7.

A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statements by the client indicates understanding of the teaching? "I will be glad to get back to my exercise routine right away." "I will have my prothrombin time checked on a regular basis." "I will talk to my dentist about no longer needing antibiotics before dental exams." "I will continue to limit my intake of foods containing potassium."

"I will have my prothrombin time checked on a regular basis." *Anticoagulant therapy with warfarin is necessary for the client following placement of a mechanical heart valve; the client's prothrombin time will be checked on a regular basis. Corrections: The client will be on activity limitation for 6 weeks following surgery for a heart valve replacement. Antibiotic therapy is recommended prior to dental work following placement of a heart valve. Dietary recommendations include limiting foods containing sodium

A nurse educator is reviewing the use of cardiopulmonary bypass during surgery for coronary artery bypass grafting with a group of nurses. Which of the following statements should the nurse include in the discussion? (Select all that apply.) "The client's demand for oxygen is lowered." "Motion of the heart ceases." "Rewarming of the client takes place." "The client's metabolic rate is increased." "Blood flow to the heart is stopped."

"The client's demand for oxygen is lowered." *The use of cardiopulmonary bypass reduces the client's demand for oxygen, which reduces the risk of inadequate oxygenation of vital organs. "Motion of the heart ceases." *Motion of the heart ceases during cardiopulmonary bypass to allow for placement of the graft near the affected coronary artery. "Rewarming of the client takes place." *The core body temperature is lowered for the procedure, and rewarming then occurs through heat exchanges on the cardiopulmonary bypass machine. Corrections: Blood flow to the heart is maintained by the action of the cardiopulmonary bypass machine. The use of cardiopulmonary bypass decreases the rate of metabolism.

A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching? "You will receive contrast dye during the procedure." "An enema is necessary before the procedure." "You will need to lie in a prone position during the procedure." "The procedure determines whether you have a kidney stone."

"The procedure determines whether you have a kidney stone." *Explain to the client that a KUB can identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system Corrections: Clients do not receive any contrast media for this procedure, as they would for excretory urography. Clients do not receive an enema before this procedure, because it does not affect the gastrointestinal system. The client will lie supine, not prone.

A nurse is caring for an older adult client who is to undergo a percutaneous balloon valvuloplasty. The client's family member asks the nurse to explain the expected outcome of this procedure. Which of the following responses should the nurse give? "This will improve blood flow of the coronary arteries." "This will assist with the ability to perform activities of daily living." "This will prolong the life span of living with this valve disorder." "This will reverse the effects to the damaged area."

"This will assist with the ability to perform activities of daily living." *Surgery is indicated for older adult clients when manifestations interfere with activities of daily living. Corrections: A valvuloplasty improves blood flow through a heart valve by opening the fused commissures and allowing valve leaflets greater mobility. It does not improve blood flow in the coronary arteries. Surgical interventions can improve the client's quality of life, but they will not necessarily prolong life. A valvuloplasty improves blood flow through a heart valve by opening the fused commissures and allowing valve leaflets greater mobility. It does not reverse the damage that has already occurred to the valve.

Mr. J is being prepared for a renal implant. The nurse attempts to determine the precise amount of daily urine excreted. Mr. J. asks why the nurse needs to know this when he is about to receive another kidney. The MOST relevant response is which of the following: "We will compare the amount excreted before and after surgery to identify how the kidney is functioning." "It is a part of the documentation needed to prove you need a donor kidney." "It's always possible you won't receive a kidney and we'll need to take care of your own." "It is a part of the history we need to complete your records."

"We will compare the amount excreted before and after surgery to identify how the kidney is functioning." Rationale: Part of the nurse's post-operative role is to observe transplanted kidney function. Comparing pre- and post-urine output will provide some information as to how well the transplanted kidney is functioning. See p. 926.

The patient is receiving maintenance IV fluids, has no active fluid loss site, and has normal renal function. Based on the physiology of fluid volume balance, what IV fluid use does the nurse anticipate? Dextrose 5% in water 0.9% saline 0.45% saline 3% saline

0.45% saline

The patient has very low serum potassium and is to receive an IV bolus of potassium mixed 20 mEq in 50 mL. To give a total dose of 60 mEq potassium at the highest recommended rate, what is the maximum intravenous rate in mL per hour? (Round your answer to the nearest whole number.)

100 mL per hour

A nurse is caring for a patient with a diagnosis of hypocalcemia. This patient likely has a corrected serum calcium level above which of the following? 11 mg/dL 5 mg/dL 25 mg/dL 2 mg/dL

11 mg/dL

A patient is severely hyponatremic. What would be the best nursing action? Put the patient on dialysis Administer 3% saline Administer 0.33% saline solution Administer 5% dextrose in water

Administer 3% saline

A patient is scheduled to have Captopril and Furosemide administered in the afternoon. The nurse notices that the patient's potassium levels have increased earlier than expected. The nurse should? Administer the medications Administer Furosemide and hold Captopril Hold off on administering the medications Set up dextrose IV infusion

Administer Furosemide and hold Captopril *Captopril = ACE inhibitor *Furosemide = Diuretic

Patient has a 158/62 BP and is coughing up pink frothy sputum. The nurse should? Administer IV Lasix Recheck BP Call HCP Give SubQ insulin

Administer IV Lasix

A patient in the CCU has severe angina pectoris and is undergoing ECG assessment. The nurse knows that this patient had a previous myocardial infarction (MI) 10 years ago and that this old MI is likely to show up on the ECG. Which of the following would show that the patient had a previous MI but is not having one now? Abnormal Q waves accompanied by ST-segment elevation Abnormal Q waves accompanied by a normal ST segment Normal Q waves accompanied by a ST-segment elevation Normal Q waves accompanied by ST-segment depression

Abnormal Q waves accompanied by a normal ST segment

Which of the following would be of highest priority post surgery? Absent pedal pulses Absent brachial pulses Absent radial pulses Absent femoral pulses

Absent pedal pulses

In preparation for a Percutaneous Coronary Intervention (PCI), the nurse checks the patient's serum lab values. Which of the following values may increase the risk for dysrhythmias during the procedure? An elevated BUN A low potassium level A low platelet count An elevated PT/INR

A low potassium level Rationale: Low potassium levels may cause life-threatening dysrhythmias due to increased sensitivity of the myocardial fibers. Threading a catheter through the vasculature decreasing oxygen supply also may enhance the risk of triggering dysrhythmias. See p. 276.

The patient has been diagnosed with mitral valve insufficiency and left ventricular hypertrophy. What effect would the nurse expect from the left ventricular hypertrophy? Improved cardiac output from increased left ventricular contractility No appreciable signs or symptoms or effects until late in the disease process A more obvious and easier-to-auscultate mitral valve regurgitant murmur Early onset of pulmonary edema and right-sided congestive heart failure

A more obvious and easier-to-auscultate mitral valve regurgitant murmur

A patient with severe coronary artery disease is scheduled for coronary artery bypass graft surgery. As part of the preoperative teaching, the nurse explains the surgery. Which of the following statements about this procedure is true? The diseased artery will be removed and replaced with a graft from another artery A piece of the saphenous vein will be used to go around the diseased part of the artery After removal of the diseased artery, the remaining ends will be anastomosed The wall of the heart will be incised to create a new pathway for blood flow

A piece of the saphenous vein will be used to go around the diseased part of the artery

The patient is being evaluated for compatibility for a solid organ transplant. What congruency between donor and recipient is the primary requirement? B and DR locus HLA matching ABO blood grouping White blood cell (WBC) match

ABO blood grouping

The critical care nurse knows that determination of compatibility in transplantation involves the evaluation of two major antigen systems. A mismatch in compatibility may cause an immediate reaction leading to organ loss. The primary determinant for solid organ transplantation is which of the following? ABO grouping HBO grouping A and B antigen matching HLA grouping

ABO grouping

Which of the following organ-specific criteria for transplantation are taken into consideration? (Select all that apply) ABO typing Transfusion history Gynecological examination Eye examination

ABO typing Transfusion history Gynecological examination

Why does the management of an AMI include ACE inhibitors? ACE inhibitors reduce preload and afterload National studies show that ACE inhibitors will eliminate post-infarct angina ACE inhibitors help the myocardium adjust to ventricular remodeling ACE inhibitors act as a loop diuretic

ACE inhibitors reduce preload and afterload Rationale: ACEIs dilate both arteries and veins thereby decreasing both preload and afterload. This reduces workload of the impaired myocardium.

Which of the following are used in emergency dialysis? Dual-lumen catheters Femoral venous catheters Internal jugular venous catheters Subclavian venous catheters

ALL OF THESE ARE CORRECT

A patient 30 days postoperative after allogeneic hematpoietic stem cell transplant presents with adenovirus and Candida infection. The critical care nurse suspects which of the following? Acute graft-versus-host disease Chronic graft-versus-host disease Neutropenia Stem cell rejection

Acute graft-versus-host disease

A patient who received a kidney transplant 2 months ago is having an episode of acute rejection. The patient expresses fear that his new kidney will not survive. What is the best rationale for the nurses response? Cytotoxic T cells damage the donor organ by secreting lysosomal enzymes Acute rejection is the most common type of rejection Acute rejection is the type most likely to respond to immune suppression Acute rejection occurs when donor organ antigens trigger helper T cells

Acute rejection is the type most likely to respond to immune suppression

Radiology results come back on a 44-year-old male cancer patient with a significant pleural effusion. He is breathing at a rate of 60 breaths per minute and has already had thoracentesis in the past to remove fluid. Current intervention should include which of the following? IV antibiotics IV antiviral agents Additional thoracentesis to reduce the fluid again Bag/mask ventilation

Additional thoracentesis to reduce the fluid again

Which of the following medications are administered to supraventricular tachycardia patients? Prilosec Adenosine Atropine Dopamine

Adenosine

The patient has been diagnosed with severely compromised immune function. What nursing intervention is most important? Antibiotic therapy Adequate protein Coughing and deep breathing Restricted visits from family

Adequate protein

A nurse is caring for a client who is 4 hr postoperative following coronary artery bypass grafting (CABG) surgery. The client is able to inspire 200 mL with the incentive spirometer, then declines to try to cough because of fatigue and pain. Which of the following actions should the nurse take? Allow the client to rest, and return in 1 hr Administer IV bolus analgesic, and return in 15 min Document the 200 mL as an appropriate inspired volume Tell the client coughing after incentive spirometry is required

Administer IV bolus analgesic, and return in 15 min *Providing adequate analgesia and returning in 15 min will reduce pain and improve coughing effectiveness. *Turning, coughing, and deep breathing should be performed every 2 hr to promote oxygenation and circulation.

A patient is recovering in the CCU following a myocardial infarction 24 hours ago. She is now pain free and is beginning to eat solid foods. To prevent the Valsalva maneuver from occurring in this patient, what intervention should the nurse take? Administer fibrinolytic therapy Administer a stool softener Administer sublingual nitroglycerin Administer aspirin

Administer a stool softener

The initial management of a MI with an elevated ST segment (STEMI) includes all of the following EXCEPT: Administer beta-blocker Administer sublingual nitroglycerin Administer morphine sulfate Administer coumadin

Administer coumadin Rationale: The initial management of an AMI includes the use of aspirin to prevent extension of a thrombus/emboli, and heparin to prevent new thrombi. Coumadin may be utilized prior to and post discharge. See Box 21-6, p. 385.

The patient is scheduled to receive hemodialysis for 4 hours this morning, and several medications for chronic diseases are scheduled to be given now. All of the medications will be at least partially removed by dialysis. What is the best nursing action? Give all medications as scheduled Give double doses of all medications Withhold medications for today only Administer medications after dialysis

Administer medications after dialysis

A patient with chronic kidney disease has a serum potassium level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention? Administer sodium polystyrene as an enema Administer IV calcium gluconate Administer IV insulin and dextrose Begin dialysis

Administer sodium polystyrene as an enema

A patient with acute leukemia is also anemic and is to receive packed red blood cells. What is the most important nursing action when giving the blood? Give intravenous diuretics before the blood Administer the blood with normal saline volume Ensure administration of bronchodilators Prepare for continuous renal replacement therapy (CRRT)

Administer the blood with normal saline volume

A patient is recovering in the CCU following off-pump coronary artery bypass graft (OPCABG) surgery involving the internal mammary artery graft. What nursing intervention is most important for the first 48 hours following surgery for this patient? Administration of anticoagulant therapy Administration of calcium channel blockers Assessment for hematoma

Administration of anticoagulant therapy

A patient in the CCU is experiencing premature atrial contractions following coronary artery bypass graft surgery. Which of the following would be the most appropriate nursing intervention? Administration of anticoagulants Administration of potassium and magnesium Administration of dopamine Administration of epinephrine

Administration of potassium and magnesium

Which of the following general assessment criteria guide the selection for transplantation? Select all that apply. Age Presence of infection Presence of malignancy Health insurance

Age Presence of infection Presence of malignancy

In teaching the patient the difference between angina and an infarction, the nurse correctly states the following: There is no real difference between angina and an infarction Angina is a temporary condition; an infarction is permanent. There are several types of angina, there is only one type of infarction. There is no treatment for angina, there are treatments for an infarction

Angina is a temporary condition; an infarction is permanent. Rationale: Angina pectoris is caused by transient, reversible myocardial ischemia precipitated by an imbalance between myocardial oxygen demand and myocardial oxygen supply (p. 373). Prolonged ischemia caused by an imbalance between oxygen supply and oxygen demand causes MI. The prolonged ischemia causes irreversible cell damage and muscle death (p. 377).

Which of the following is a correct medication regimen for a patient receiving liver transplant? Antibiotics Antibodies Immunosuppressants Single therapy Triple therapy Increased steroids

Antibiotics Antibodies Immunosuppressants Triple therapy *A single medication therapy usually cannot accomplish this effectively *Triple, "3 drug" therapy is a low dose combination of: prednisone azathioprine or mycophenolate mofetil (MMF) cyclosporine A or tacrolimus *Steroids can still be taken, but should be decreased

What medications might be administered for a patient with engraftment syndrome? (Select all that apply) Antibiotics Corticosteroids Dextrose Phenylephrine Furosemide Norepinephrine Methylprednisolone

Antibiotics Corticosteroids Phenylephrine Norepinephrine Methylprednisolone Engraftment syndrome, also known as: Peri-engraftment syndrome Cytokine release syndrome Cytokine storm Hemophagocytic syndrome Macrophage activation syndrome Engraftment syndrome is a recently identified disorder that occurs infrequently prior to or in association with the return of bone marrow growth after treatment of hematologic malignancies and hematopoietic stem-cell transplantation. Common features include: Fever, sudden onset, often high and continuous Sudden symptom onset over 24 to 48 hour near engraftment period Erythema with or without pruritic total-body rash Dyspnea; bilateral diffuse alveolar infiltrates on chest radiography Gastrointestinal bleeding Unprecipitated oliguria, elevated creatinine, hematuria Unprecipitated hepatomegaly, elevated aminotransferases

A patient with anginal chest pain is given a low-dose chewable aspirin tablet. In explaining the rationale for this medication to the patient and family, what information does the nurse include? Aspirin will help control the pain Reduction of low-grade fever is important Anticoagulation effects will reduce clot formation Aspirin is less toxic to the liver than Tylenol

Anticoagulation effects will reduce clot formation

An adult patient with a heart transplant develops severe bradycardia. The patient also had worsening hypotension and a deteriorating level of consciousness. What is the priority nursing action? Administer intravenous atropine Administer intravenous epinephrine Apply a transcutaneous pacemaker Place the patient in reverse Trendelenburg position

Apply a transcutaneous pacemaker

Upon completion of hemodialysis, the nurse removes the needle and catheter from the AV fistula. The site begins to bleed. What is the most appropriate INITIAL nursing action? Apply gentle pressure providing time for the blood to clot. Apply enough pressure proximal to the fistula to occlude the vessel. Inject the patient with protamine sulfate. Increase IV replacement fluids.

Apply gentle pressure providing time for the blood to clot. Rationale: A small amount of bleeding is not unusual following disconnection of the needle from the fistula site. Applying gentle pressure will slow blood flow allowing the clotting factors to coagulate. If bleeding does not stop and the aPTT is excessively high, protamine sulfate may be needed, but there is presently no indication of uncontrolled bleeding. It is inappropriate to occlude the fistula vessel potentiating permanent damage. See pp. 561-562.

A patient in the CCU is recovering from a repeat Coronary Artery Bypass Graft (CABG) surgery. For this latest surgery, the patient's radial artery was used in the graft. What complication should the nurse MOST expect to observe in this patient? Internal hemorrhaging Occlusion Arterial spasm Infection

Arterial spasm Rationale: The disadvantage of using the radial artery as a conduit is the tendency to spasm. Table 22-1, p. 395.

The nurse is preparing a teaching plan for the patient who just underwent placement of an Arterio-Venous (AV) fistula for future dialysis. Which of the following instructions should NOT be included in the teaching plan? Ask the dialysis nurse to use the same puncture site each time to reduce the extent of injury. Examine the skin for pimples around the access site, and report to the dialysis nurse. Check blood flow daily by feeling for a vibration around the fistula. Inform healthcare providers to assess blood pressure in the other arm.

Ask the dialysis nurse to use the same puncture site each time to reduce the extent of injury. Rationale: It is appropriate to rotate insertion points to reduce the risk of infection, stenosis from scar tissue, and an enlarged puncture site. See Teaching Guide Box 30-2 on p. 562.

A patient who recently underwent carotid endarterectomy is exhibiting signs of stroke. Which intervention or interventions should the nurse take to assess this patients neurological function? Select all that apply. Measure chest tube output Assess eye movement Monitor level of consciousness Assess urine output

Assess eye movement Monitor level of consciousness

A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) Assess for jugular vein distention. Provide frequent mouth rinses. Auscultate for a pleural friction rub. Provide a high-sodium diet. Monitor for dysrhythmias.

Assess for jugular vein distention. *Assess for jugular vein distention, which can indicate fluid overload and heart failure. Provide frequent mouth rinses. *Provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood. Auscultate for a pleural friction rub. *Auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. Monitor for dysrhythmias. *Monitor for dysrhythmias related to increased blood potassium caused by Stage 4 chronic kidney disease. Corrections: Monitor blood sodium and reduce the client's dietary sodium intake.

The patient with leukemia has received a hematopoietic stem cell transplant (HSCT) for lymphoma. During bedside rounds, the nurse receives report of elevated WBCs, and notes the patient appears dyspneic with a diffuse, red rash. What is the MOST appropriate action by the nurse? Assess for manifestations of Engraftment Syndrome. Initiate sepsis bundle protocols. Call the oncologist immediately. Assess for manifestations of acute contact dermatitis.

Assess for manifestations of Engraftment Syndrome. Rationale: "Engraftment syndrome often begins with fever, total-body erythema or rash, fluid retention, and symptoms of respiratory distress, and these symptoms may be the only manifestations. However, many patients exhibit additional signs or symptoms of cytokine effects, such as oliguria or hematuria with elevated creatinine, abdominal discomfort with elevated aminotransferases, and gastrointestinal bleeding. The Spitzer criteria for diagnosis includes these symptoms and the presence of the inflammatory marker of increased C-reactive protein. The onset of symptoms is rapid, usually occurring over 24 to 48 hours, and symptoms dissipate after the neutrophils engraft and the WBC count reaches about 2,500 to 3,000/mm. Newer literature describes this peri-transplantation syndrome as occurring as early as 4 days after transplant or as late as 14 days, and it may precede or coincide with engraftment. Box 48-5 outlines key clinical manifestations that distinguish sepsis and engraftment syndrome." (page 964-965??)

Which of the following are essential nursing actions for the patient receiving peritoneal dialysis? Select All that apply. Assess for signs of infection. Observe the characteristics of dialysate output. Check fistula for thrill and bruit. Monitor for signs of profusion to extremities. Monitor for the prescribed dialysate dwell time.

Assess for signs of infection. Observe the characteristics of dialysate output. Monitor for the prescribed dialysate dwell time. Rationale: Dwell time reflects the amount of time the blood comes in contact with the dialysate which along with the concentration factor, determines the degree of osmosis and diffusion; and therefore, water and waste excretion. The peritoneum may become infected and therefore the characteristics of the output should be monitored; the insertion site is at risk for infection as well. The profusion of extremities and monitoring of a fistula is unrelated to peritoneal dialysis. See pp. 573-574, and p. 597, Box 31-7.

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? Administer an opioid medication. Monitor for hypertension. Assess level of consciousness. Increase the dialysis exchange rate.

Assess level of consciousness. *Assess the client's level of consciousness. A change in urea levels can cause increased intracranial pressure. Subsequently, the client's level of consciousness decreases. Corrections: Do not administer an opioid medication because it could worsen the client's condition. The provider can prescribe medication to decrease seizure activity. Monitor for hypotension due to rapid change in fluids and electrolytes causing disequilibrium syndrome. Decrease the dialysis exchange rate to slow the rapid changes in fluid and electrolyte status when a client develops disequilibrium syndrome.

A patient is recovering in the CCU following carotid endarterectomy. What intervention should the nurse make to ensure that a hematoma is not forming in the patients neck? Assess neck size by comparing operative side with nonoperative side Monitor pupil reactivity Assess hand grip Monitor blood pressure

Assess neck size by comparing operative side with nonoperative side

A young patient who seems perfectly healthy is displaying symptoms of angina pectoris. Which of the following are possible underlying causes of the patients condition? Select all that apply. Atherosclerotic narrowing of the coronary arteries Hemophilia Use of aspirin Spasm of a coronary artery Arterial inflammation Tachycardia

Atherosclerotic narrowing of the coronary arteries Spasm of a coronary artery Arterial inflammation Tachycardia

Cardioversion may be used to treat patients with supraventricular dysrhythmias, such as? (Select all that apply) Atrial fibrillation Atrial flutter Ventricular tachycardia Systolic bradycardia

Atrial fibrillation Atrial flutter

Because of an immune disorder, the patient is to undergo evaluation of bone marrow function. For what test does the nurse prepare the patient? Computed tomography (CT) Intradermal skin testing Bone marrow aspiration Magnetic resonance imaging (MRI)

Bone marrow aspiration

What lab results are used to distinguish between pulmonary related and heart failure related causes of dyspnea in the emergency department? Sodium BNP Creatinine Potassium

B-type natriuretic peptides (BNP)

A patient with severe mitral stenosis is exhibiting signs of pulmonary hypertension. The nurse knows the patient may be a candidate for which of the following procedures: Greenfield filter placement Coronary artery graft Balloon valvuloplasty Percutaneous coronary intervention

Balloon valvuloplasty Rationale: The treatment for severe mitral valve stenosis may be balloon valvuloplasty or surgical repair (commissurotomy). See p. 396-399.

A patient on peritoneal dialysis develops a low-grade fever and complains of abdominal pain when fluid is being inserted. The nurse also observes that the peritoneal drainage fluid is cloudy. What intervention should the nurse make? Measure the patients blood pressure Begin the patient on antibiotic therapy Assess the patient for signs of pulmonary congestion Turn the patient from side to side

Begin the patient on antibiotic therapy

A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse suspect? Retroperitoneal bleeding Cardiac tamponade Bleeding from the incisional site Heart failure

Bleeding from the incisional site *Bleeding is occurring from the incision site and then draining under the client. The nurse should assess the incision for hematoma, apply pressure, monitor the client, and notify the provider. Corrections: Retroperitoneal bleeding is internal bleeding. Cardiac tamponade includes manifestations of bleeding in the pericardial sac, which is internal. Heart failure does not including findings of blood underneath the client's lower back.

A patient with an acute myocardial infarction has been started on daily enalapril (Vasotec), an ACE inhibitor, to preserve ejection fraction. What is the most important nursing assessment before giving this medication? Intake and output Daily weight Blood pressure Pulse oximetry

Blood pressure

The nurse is planning care for the patient with a subclavian central line being treated for lung cancer. The plan includes teaching the patient the risks of Superior Vena Cava Syndrome (SVCS). Which of the following should be included in the teaching plan specific to SVCS? Go to the emergency room immediately if you have pain when elevating your leg when lying down. Seek emergency help for a unilateral headache and/or blurred vision. Call your doctor if you notice malodorous phlegm. Call your doctor if you notice puffiness around the eyes, face, and/or neck.

Call your doctor if you notice puffiness around the eyes, face, and/or neck. Rationale: SVCS occurs when the vessel is occluded. Common causes include impingement by from congested lymph vessels, malignancies, or thrombus (e.g. from a central catheter). Fluid "backs-up" in the head and neck causing periorbital edema especially in the morning. Pain experienced when lifting the leg may indicate a spinal cord impingement, and a unilateral headache and blurred vision may occur with a carotid hemorrhage. Start on p. 971.

A patient with end-stage organ failure is being evaluated for an organ transplant. What factor is most likely to be a contraindication for transplant? Age 30 to 55 years Absence of acute or chronic infection Cannot afford the cost of medications after transplant Is receiving maximum doses of organ support medications

Cannot afford the cost of medications after transplant

A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern? (Select all that apply.) Trace of bloody drainage on dressing Capillary refill of affected limb of 6 seconds Mottled appearance of the limb Throbbing pain of affected limb that is decreased following IV bolus analgesic Pulse of 2+ in the affected limb

Capillary refill of affected limb of 6 seconds *Capillary refill greater than 3 seconds is outside the expected reference range and should be reported to the provider. Mottled appearance of the limb *Mottled appearance of the affected extremity is an unexpected finding and should be reported to the provider.

The patient has been diagnosed with an acute anterior myocardial infarction. What complication does the nurse most anticipate? Second-degree AV block, Mobitz 1 Few or no complications Cardiac failure or cardiogenic shock Intractable nausea and vomiting

Cardiac failure or cardiogenic shock

The nurse is caring for a patient who has just had coronary artery bypass grafting. As part of the admission procedure to the critical care unit immediately after surgery, what nursing assessment has the highest priority? Urine output Cardiac index measurement Chest tube drainage measurement Core body temperature

Cardiac index measurement

A patient is admitted to the ICU with the following symptoms: weak pulse, distant heart sounds, pulsus paradoxis, and distended neck veins. What is the likely diagnosis for this patient? Cardiac tamponade Pneumocystis pneumonia Pleural effusion Cardiac artery rupture

Cardiac tamponade

A patient in the CCU is recovering from a myocardial infarction. He complains of new chest pain and trouble breathing. The nurse observes that he has cool, moist skin and is breathing rapidly. On taking his pulse, she finds that it is rapid and thready. She takes his blood pressure and finds it to be 80/60 mm Hg. What complication is this patient most likely experiencing? Recurrent myocardial ischemia Ventricular septal wall rupture Cardiogenic shock Pericarditis

Cardiogenic shock

A 65-year-old man is admitted to the cardiovascular intensive care unit (CVICU) after an Acute Myocardial Infarction (AMI). During an assessment, the nurse notes the following findings: a rapid, thready pulse, dyspnea, jugular venous distention, and oliguria. Which of the following is a complication of an AMI and MOST likely to be the cause of these findings? Pneumothorax Hypervolemia Impaired renal perfusion Cardiogenic shock

Cardiogenic shock Rationale: The risk of ischemia post-MI increases the risk of recurrent infarctions. This increases the risk of cardiogenic shock secondary to damage of the left ventricle by a variety of insults. Clinical manifestations of cardiogenic shock include a rapid, thready pulse; a narrow pulse pressure; dyspnea; tachypnea; inspiratory crackles; distended neck veins; chest pain; cool, moist skin; oliguria; and decreased mentation. Arterial blood gas analysis reveals a decreased PaO2 and respiratory alkalosis. Hemodynamic findings include a systolic blood pressure less than 85 mm Hg, a mean arterial blood pressure less than 65 mm Hg, a cardiac index less than 2.2 L/min/m2, and a PAOP greater than 18 mm Hg. Cardiac enzymes may show an additional rise or a delay in reaching peak values. See p. 389.

Which of the following are indications for IABP? (Select all that apply) Cardiogenic shock Hypotension Severe peripheral vascular occlusive disease Decreased CO Mitral valve incompetence Aortic valve incompetence

Cardiogenic shock Hypotension Decreased CO Mitral valve incompetence *Occlusive disease would make insertion of the catheter difficult and possibly interrupt blood flow to the distal extremity or cause dislodgment of plaque formation along the vessel wall, resulting in potential emboli *A competent aortic valve is necessary if the patient is to benefit from IABP therapy

Which of the following are complications of Myocardial Infarction? (Select all that apply) Cardiogenic shock Pulmonary congestion Hypotension Atrial tachycardia

Cardiogenic shock Pulmonary congestion Hypotension *Ventricular tachycardia or fibrillation NOT Atrial

After receiving a bone marrow transplant, a cancer patient suffers a cardiopulmonary arrest and needs mechanical ventilation. The family asks the nurse about the patients chances of survival. What is the most accurate information for the nurse to base the answer on? Cardiopulmonary arrest and mechanical ventilation are associated with low survival rates in patients with cancer The hospital has a generally low incidence of death after cardiopulmonary arrest compared to national averages Every patient and every situation must be evaluated individually, and no prediction of survival is possible at this time The family should be referred to the physician and the chaplain to discuss their concerns about survival

Cardiopulmonary arrest and mechanical ventilation are associated with low survival rates in patients with cancer

A nurse is planning post-procedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) Check BUN and blood creatinine. Administer medications the nurse withheld prior to dialysis. Observe for findings of hypovolemia. Assess the access site for bleeding. Evaluate blood pressure on the arm with AV access.

Check BUN and blood creatinine. *Check the BUN and blood creatinine to determine the presence and degree of uremia or waste products that remain following dialysis. Administer medications the nurse withheld prior to dialysis. *Withhold medications the treatment can partially dialyze. After the treatment, the nurse should administer the medications. Antihypertensive medications might need to be withheld until the next day if the client is hypotensive. Observe for findings of hypovolemia. *A client who is post-dialysis is at risk for hypovolemia due to a rapid decease in fluid volume. Assess the access site for bleeding. *Assess the access site for bleeding because the client receives heparin during the procedure to prevent clotting of blood. Corrections: Never measure blood pressure on the extremity that has the AV access site because it can cause collapse of the AV fistula or graft.

During assessment the patient's ECG alarm is beeping. What is the priority action the nurse should take? Check vital signs Ensure the monitor is plugged in Restart monitor assessment Call code

Check vital signs

The nurse is caring for a patient who has just had coronary artery bypass grafting and is experiencing significant hypotension. What nursing assessment would best confirm that the hypotension is related to blood loss? Low hemoglobin and hematocrit, with high central venous pressure Chest tube drainage in excess of 200 mL/hr Urine output 40 to 50 mL/hr Chest tube drainage less than 30 mL/hr

Chest tube drainage in excess of 200 mL/hr

A patient receiving a blood transfusion in the ICU has developed relative hypocalcemia. What is the most likely cause for the hypocalcemia? Citrate binding to calcium Loop diuretics Malabsorption syndrome Lack of vitamin D

Citrate binding to calcium

A patient has had an arteriovenous fistula placed for access for long-term hemodialysis. What nursing assessment result indicates a patent and functional fistula? Diminished intensity of palpated fistula thrill Clearly auscultated bruit over fistula Ability to draw blood from proximal vessel Full range of motion of joints below fistula

Clearly auscultated bruit over fistula

A patient with moderate mitral stenosis with minimal calcification and regurgitation is preparing to have surgery. Which procedure would be most appropriate to restore normal function to this patient? Annuloplasty Valve replacement with biological valve Valve replacement with caged ball valve Commissurotomy

Commissurotomy

The unlicensed assistive personnel (UAP) reports the patient in renal failure has vital signs as follows: B/P of 165/100, T of 99° F, HR of 110, RR of 28, and a PaO2 of 89% via pulse oximetry. The UAP also reports a urine output of 120 mL over the past six hours. What is the MOST appropriate INITIAL response? Call the physician of record. Continue monitoring vital signs and urinary output. Complete a respiratory assessment. Review the patient's current orders.

Complete a respiratory assessment. Rationale: The patient is exhibiting manifestations of pulmonary edema. It is appropriate to determine if there are adventitious lung sounds, and whether he/she is dyspneic prior to administering medication and/or calling the physician.

A patient with acute kidney injury (AKI) demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:Creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit with these findings? Congestive heart failure Nephrotoxicity due to aminoglycoside antibiotics Hypertension Retroperitoneal tumor

Congestive heart failure

A patient with thyroid cancer is at high risk for rupture of a carotid artery and has had a carotid artery stent placed. The nurse notices a trickle of blood from the surgical site. What is the first nursing action? Application of a vascular clamp after digital pressure Insertion of two large-bore intravenous lines Constant digital pressure until reaching the operating room Immediate notification of the surgeon and oncologist

Constant digital pressure until reaching the operating room

As part of treatment for acute myocardial infarction, a patient is receiving an infusion of tissue plasminogen activator (tPA). Two hours after the initiation of the infusion, the patient has a short run of accelerated idioventricular rhythm. During the arrhythmia, the patients blood pressure is 110/78 but he denies any other change in symptoms. What is the best nursing action? Discontinue the tPA Initiate an intravenous lidocaine drip Assess for pulmonary adventitious sounds Continue close observation of the patient

Continue close observation of the patient

A patient in the ICU with severe hypotension is experiencing acute renal failure and uremia and needs dialysis. She requires a large infusion of intravenous fluids regularly. The nurse recognizes that which method of dialysis would be best for this patient? Continuous venovenous hemofiltration (CVVH) Continuous venovenous hemofiltration with dialysis (CVVH/D) Intermittent hemodialysis Peritoneal dialysis

Continuous venovenous hemofiltration with dialysis (CVVH/D)

What is necessary treatment for patients with Abdominal (Stable) Aortic Aneurism smaller than 5.5 cm? Control of hypertension Elimination of smoking Ultrasonography CT scans

Control of hypertension *Small abdominal (stable) aneurysms rarely rupture. And, they can often be treated with medicines to lower blood pressure and reduce stress on the aortic wall. Routine ultrasound or CT scans can show if the aneurysm is growing. Larger or expanding aneurysms will need surgery.

The patient is scheduled to undergo a percutaneous cardiac intervention (PCI). What patient history would the nurse least expect to find? Poor left ventricular function and ejection fraction Coronary artery lesions less than 70% narrowing Extreme old age with fragility Unstable angina with activity and at rest

Coronary artery lesions less than 70% narrowing

A patient has been diagnosed with unstable angina. Unstable angina may be described as what? Occurring with exercise Crescendo pattern Predictable pattern Relieved by rest

Crescendo pattern

A patient receiving continuous renal replacement therapy (CRRT) is placed on low-dose heparin for anticoagulation of the CRRT circuit. What laboratory result would cause the nurse to question the use of heparin? Normal total platelet count Partial thromboplastin time two times control Partial thromboplastin time normal Critically low total platelet count

Critically low total platelet count

During the immediate postoperative phase, the critical care nurse focuses on hemodynamic stability. Blood products should be leukocyte reduced to avoid introduction of CMV. CMV causes which of the following? Death Hyperkalemia Shift of oxyhemoglobin curve to the right Immunoadsorbent assays

Death

Calcium channel blocker medications? Decrease afterload Increase afterload

Decrease afterload Calcium Channel Blockers: Amlodipine (Norvasc) Diltiazem (Cardizem, Tiazac) Felodipine Isradipine Nicardipine Nifedipine (Adalat CC, Procardia) Nisoldipine (Sular) Verapamil (Calan, Verelan)

A patient on continuous venovenous hemofiltration with dialysis experiences a significant decrease in blood pressure. Which intervention would be most appropriate for the nurse to carry out? Decrease the amount of fluid removal Decrease the infusion rate of replacement fluid Administer heparin Use a blood warmer to warm the dialysis lines

Decrease the amount of fluid removal

Antidiuretic hormone is for? Dehydration Fluid overload

Dehydration

The purpose of the induction phase of immunosuppressive therapy is to: Respond to solid organ or HSCT rejection with corticosteroids. Deplete and prevent activation of T-cells with antibodies to prevent early cellular rejection. Suppress the immune response with a combination of complementary medications. Promote the immune system's sensitivity to foreign substance with the infusion of plasma.

Deplete and prevent activation of T-cells with antibodies to prevent early cellular rejection. Rationale: The three phases of immunosuppressive therapy are 1. Induction, 2. Maintenance, and 3. Rescue. The induction phase is characterized by using antibodies to inhibit T-cells to prevent early cellular rejection. Maintenance phase includes the use of multiple drugs to suppress the immune system, and the rescue phase is initiated if there is active rejection. See pp. 935-936.

The nurse is explaining the underlying principles of dialysis to a patient who is starting peritoneal dialysis for the management of chronic renal failure. As part of the teaching, what physiologic process does the nurse explain produces the most waste product removal? Water molecule movement by osmosis Diffusion to a less concentrated area Active transport by an energy-driven process Increased osmotic gradient from the abdomen

Diffusion to a less concentrated area

Which of the following medications is administered for a patient with hypokalemia? Insulin Digoxin Aspirin Corticosteroid

Digoxin

After an acute myocardial infarction, the patient is receiving tissue plasminogen activator (tPA) and initially on nitroglycerin for chest pain at 10 on 0/10 scale. The patient has rare premature ventricular contractions (PVCs) and a blood pressure of 82/55 mm Hg. What is the most important nursing action? Discontinue the nitroglycerin infusion rate Increase the tPA infusion rate Administer a bolus of amioderone Obtain a 12-lead electrocardiogram

Discontinue the nitroglycerin infusion rate

The patient with acute renal injury requires urgent dialysis. The physician will most likely prepare the patient for which of the following types of therapy: Dual-lumen central catheter for intermittent hemodialysis. Triple-lumen catheter for Continuous Renal Replacement Therapy (CRRT). Arterio-Venous (AV) fistula for immediate hemodialysis. Dual-lumen subclavian catheter for peritoneal dialysis.

Dual-lumen central catheter for intermittent hemodialysis. Rationale: Immediate hemodialysis is provided through a dual-lumen catheter placed in large (central) blood vessels such as subclavian, or femoral vessels. This is considered intermittent (versus continuous). An AV fistula is ideally created 6 months prior to use, and peritoneal dialysis requires access through the peritoneum via the abdomen. See pp. 560-562.

A nurse educator is reviewing expected findings in a client who has right-sided valvular heart disease with a group of nurses. Which of the following findings should the nurse include in the discussion? (Select all that apply.) Dyspnea Client report of fatigue Bradycardia Pleural friction rub Peripheral edema

Dyspnea Client report of fatigue Peripheral edema Corrections: A normal or rapid pulse and an irregular rhythm are manifestations of right-sided valvular heart disease. A pleural friction rub is a manifestation of pleurisy or pneumonia.

The patient has developed acute aortic valve insufficiency after experiencing blunt chest trauma. What symptom, if found by the nurse, is indicative of a counterproductive compensatory mechanism that should be treated? Low cardiac output Pulmonary edema Elevated blood pressure Aortic insufficiency murmur

Elevated blood pressure

Which of the following is an indication of Chronic Heart Failure? Elevated CVP Decreased CVP

Elevated central venous pressure (CVP)

A patient who has received an allogenic stem cell transplant has developed graft-versus-host disease. What symptoms does the nurse most expect? Diminished lymphocytes Elevated liver function tests Absence of active T cells Very high fever

Elevated liver function tests

A patient who developed chronic renal failure after a severe hypotensive episode has just been told that dialysis will be necessary for the rest of her life. She and her family are very upset and crying. What is the best nursing intervention? Ask the family to leave, as they are upsetting the patient Administer intravenous sedation to the patient Encourage patient and family to express their feelings Begin dialysis education immediately

Encourage patient and family to express their feelings

A patient is being evaluated for a solid organ transplant. If the patient is found to be eligible for a transplant, which of the following would the nurse expect to find? Age less than 65 years Presence of active inflammatory process End-stage organ disease refractory to other treatments Able to reach full life span without transplant

End-stage organ disease refractory to other treatments

A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patients question, what should the nurse most consider? The patient most likely has preexisting chronic anemia Erythropoietin is primarily produced in the kidney The patient is receiving low-dose aspirin therapy Chronic renal failure results in persistent uremia

Erythropoietin is primarily produced in the kidney

A patient who has received a solid organ transplant is experiencing chronic rejection. What symptoms does the nurse most expect? Lack of T-cell activity or increase Evidence of deteriorating organ function Evidence of immune suppression Negative antigenantibody reactions

Evidence of deteriorating organ function

A patient with coronary artery disease experiences exertional angina and shortness of breath with exercising. Which of the following is the MOST important indicator of the appropriateness of a Coronary Artery Bypass Graft (CABG)? Extensive stenosis of the left main coronary artery Adequate length and diameter of the donor conduit Exertional angina and shortness of breath Preference of the patient to undergo surgery

Extensive stenosis of the left main coronary artery Rationale: To decrease the mortality associated with bypass surgery, it is necessary to consider several factors: urgency of operation, age, previous heart surgery, sex, left ventricular ejection fraction, percentage stenosis of the left main coronary artery, and number of major coronary arteries with greater than 70% stenosis. The desired characteristics for a graft or conduit are (1) diameter similar to the coronary arteries, (2) no disease or vessel wall abnormalities, and (3) adequate length. Commonly used grafts include saphenous vein grafts and internal mammary artery grafts. Although a healthy conduit is important, it would not indicate the need for bypass surgery.

A patient newly diagnosed with atherosclerosis wants to know what the plaque building up in his arteries actually consists of. Which of the following should the nurse mention? Select all that apply. Fatty substances Osteocytes Epithelial tissue Cholesterol Cellular waste products Collagen and elastic fibers

Fatty substances Cholesterol Cellular waste products Collagen and elastic fibers

Some degree of postoperative renal dysfunction is common due either to hepatorenal syndrome or hypotension during surgery. In addition, some immunosuppressive medications are nephrotoxic. This can affect which of the following? Fluid and electrolyte balance Increased cardiac output Amount of dialysis treatments Retransplantation

Fluid and electrolyte balance

What is the PRIORITY nursing focus for the patient with Tumor Lysis Syndrome directly related to the pathophysiology? Monitoring for signs of infection, and nutritional support. Fluid and electrolyte monitoring, and aggressive fluid therapy. Monitoring for manifestations of rejection and managing temperature. Neurologic monitoring, and seizure precautions.

Fluid and electrolyte monitoring, and aggressive fluid therapy. Rationale: Tumor Lysis Syndrome occurs when therapies designed to destroy malignant cells cause a rapid release of cell contents. This can result in a sudden increase in electrolytes. If renal function is intact, the body may be able to adequately excrete excess electrolytes. If not, aggressive fluid therapy may support renal excretion. "The focus of nursing care is on careful monitoring of fluid therapy, intake and output, and electrolyte balance. The use of prophylactic allopurinol, aggressive hydration, and early intervention with CRRT has reduced the incidence and severity of tumor lysis syndrome." (page 980)

A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor? Blood pressure Fluid volume recovery Urine output Cardiac dysrhythmias

Fluid volume recovery

A patient with an acute myocardial infarction has received three nitroglycerin tablets, oxygen, and aspirin and is still complaining of severe crushing chest pain. What is the best nursing action? Give 5 mg intravenous morphine Assess for drug-seeking behavior Give intravenous benzodiazepine Use anxiety reduction measures

Give 5 mg intravenous morphine

A critically ill cancer patient has severe hypercalcemia. What treatment should the nurse initiate first? Administer high doses of phosphorus Withhold antineoplastics Give high-volume intravenous saline Maintain complete bed rest

Give high-volume intravenous saline

A female patient has just undergone a percutaneous coronary intervention (PCI). What symptom, if found by the nurse, requires immediate intervention? Three premature ventricular complexes Frank bleeding from the femoral insertion site Serum potassium level 4.8 mEq/L Hemoglobin 11.7 g/dL

Frank bleeding from the femoral insertion site

A nurse is reviewing client laboratory data. Which of the following findings is expected for a client who has Stage 4 chronic kidney disease? Blood urea nitrogen (BUN) 15 mg/dL Glomerular filtration rate (GFR) 20 mL/min Blood creatinine 1.1 mg/dL Blood potassium 5.0 mEq/L

Glomerular filtration rate (GFR) 20 mL/min Corrections: Expect the BUN to be above the expected reference range, about 10 to 20 times the BUN finding. In stage 4 chronic kidney disease, a blood creatinine level can be as high as 15 to 30 mg/dL. A client in stage 4 chronic kidney disease would have a blood potassium level greater than 5.0 mEq/L.

The patient with leukemia has received an allogenic stem cell transplant. The nursing diagnosis of Impaired Skin Integrity is primarily a concern related to which of the following complications: Graft Versus Host Disease Immobility secondary to surgery Chronic Inflammatory Response Syndrome Side effects of immunosuppressive drugs

Graft Versus Host Disease Rationale: GVHD occurs when the donor cells attack the host. Symptoms of the attack may present as itching, rashes, erythema. See pp. 931-935; 942-944.

If the vasculature isn't ready? Graft instead of fistula Fistula instead of graft

Graft instead of fistula

A patient with left main coronary artery disease (CAD) experiences persistent angina. She would like to exercise more, but is limited by shortness of breath and angina. Her physician believes that she is a good candidate for coronary artery bypass graft. The nurse recognizes that which of the following are indications for coronary artery bypass graft (CABG) surgery in this situation? (Select all that apply) Having left main CAD Being a good candidate for angioplasty and stenting Having persistent angina Availability of new effective CAD medication Limited exercise tolerance The patients spouse was successfully treated with CABG

Having left main CAD Having persistent angina Limited exercise tolerance

Which of the following complications would a patient in the cardiac unit with hyperkalemia be expected to have? Peripheral edema Heart block DVT Dysphasia

Heart block

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? Hemodialysis restores kidney function. Hemodialysis replaces hormonal function of the renal system. Hemodialysis allows an unrestricted diet. Hemodialysis returns a balance to blood electrolytes.

Hemodialysis returns a balance to blood electrolytes. *Explain to the client that hemodialysis restores electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid-base balance. Corrections: Hemodialysis does not restore kidney function, but it sustains the life of a client who has kidney disease. Hemodialysis does not replace hormonal function of the renal system due to tissue damage causing dysfunction of the renin-angiotensin-aldosterone system. Hemodialysis does not allow an unrestricted diet. It requires a diet high in folate and more protein than pre-dialysis restrictions allowed, and low in sodium, potassium, and phosphorus.

A patient returns from the OR to the CCU following cardiac surgery. What nursing responsibility is MOST important upon arrival? Pain management Calcium channel blockers administration Coagulation assessment Hemodynamic monitoring

Hemodynamic monitoring Rationale: Performing an assessment to ascertain hemodynamic stability is essential upon arrival to the unit. Once an assessment indicates the patient to be hemodynamically stable, the nurse proceeds to assess See Box 22-3, p. 402.

A nurse is monitoring a client who had a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client? Infection Hemorrhage Hematuria Pain

Hemorrhage *The greatest risk to the client following a kidney biopsy is hemorrhage due to a lack of clotting at the puncture site. Report this finding to the provider immediately. Corrections: The client is at risk for infection of the kidney because a biopsy is an invasive procedure. However, another complication is the priority. The client is at risk for hematuria, which is a common complication the first 48 to 72 hr after the biopsy. However, another complication is the priority. The client is at risk for pain after a kidney biopsy because blood in and around the kidney causes pressure on the nerves in the area; however, another complication is the priority.

A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient? Hypokalemia Hyperkalemia Hypermagnesemia Hypomagnesemia

Hypomagnesemia

Which of the following are included in the management of a patient with hypocalcemia? Select all that apply. IV fluids for hydration Medication to enhance renal excretion of calcium Dialysis Glucose

IV fluids for hydration Medication to enhance renal excretion of calcium Dialysis

A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? (Select all that apply.) Identify an allergy to seafood. Withhold metformin for 24 hr. Administer an enema. Obtain a blood coagulation profile. Assess for asthma.

Identify an allergy to seafood. *Clients who have an allergy to seafood are at higher risk for an allergic reaction to the contrast media they will receive during the procedure. Withhold metformin for 24 hr. *Clients who take metformin are at risk for lactic acidosis from the contrast media with iodine they will receive during the procedure. Administer an enema. *Clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization. Corrections: A blood coagulation profile is essential for a client prior to a kidney biopsy because of the risk of hemorrhage from the procedure.

When conditioning the patient to receive a stem cell transplant, what is the primary difference between conditioning for an autologous transplant versus an allogenic transplant? Bone marrow aplasia Immunosuppressive therapy Eradication of malignancy Clearing chemotherapy

Immunosuppressive therapy Rationale: "The goal of the conditioning regimen depends in part on whether the transplant is autologous or allogeneic, and on the nature of the recipient's underlying disease. In allogeneic transplantation, the purpose of conditioning is to eradicate any malignant disease, eliminate the bone marrow to create a space for the new donor stem cells, and provide sufficient immunosuppression to allow engraftment of the transplanted stem cells. In autologous transplantation, immunosuppression is not required because the recipient of the hematopoietic stem cells is also the donor, and therefore, there is no tissue incompatibility. However, the high-dose therapy is still needed to eradicate malignant disease. The stem cell recipient is allowed 1 to 2 rest days to clear the chemotherapeutic agents from the system before the infusion of stem cells. Bone marrow aplasia occurs within days after the conditioning regimen is completed." See p. 930

Diastolic heart failure is? Inadequate filling Inadequate pumping

Inadequate filling

A patient who is immunosuppressed after organ transplant has acquired an infection. What symptoms does the nurse most expect? Fever above 101 F Increase in the percentage of WBC bands Subnormal core body temperature Decline in absolute neutrophil count

Increase in the percentage of WBC bands

A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patients laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate? Increased fluids Renal stent placement Irrigation of urinary catheter Diuretic therapy

Increased fluids

The patient is seriously ill and has developed a fever, a cough productive of thick, yellow sputum, and respiratory insufficiency. What changes in the white blood cell differential count does the nurse expect to find? Increased neutrophils and bands Increased eosinophils and blasts Decreased neutrophils with bands Decreased lymphocytes and neutrophils

Increased neutrophils and bands

After a liver transplant, what nursing assessment best indicates that the transplanted liver is functioning? Increased INR ratio Increased aminotransferase levels Unstable serum glucose levels Increasing bile drainage

Increasing bile drainage

When planning care for the post stem-cell transplant patient, which of the following nursing diagnoses is MOST directly related to complications of both immunosuppressive therapy and chemotherapy? Ineffective Breathing Pattern secondary to infection or injury. Decreased Cardiac Tissue Perfusion secondary to hemorrhage or hypovolemia.

Ineffective Breathing Pattern secondary to infection or injury. Rationale: Immunosuppressive therapy places a patient at risk for infection which includes infection of the lung. Chemotherapy places a patient at risk for direct injury related to toxins. Both increase the risk for breathing impairment. Immunosuppressive therapy or chemotherapy may place a patient at risk for hemorrhage or hypovolemia but are less likely, and much less direct relationships. For example, if therapies indirectly lead to SIADH, or Septic Shock Syndrome or significant alterations in coagulation, then perhaps the patient might be at risk. Evaluate the relevancy of risk factors and nursing diagnoses in Box 47-4.

A female patient is in intensive care recovering from a severe illness and has these laboratory results: total white blood cells 2,000 cells/mm3, neutrophils 40%, lymphocytes 35%, monocytes 11%, eosinophils 4%, basophils 0%, red blood cell count 4.2 106 cells/mm3, hemoglobin 11.7 g/dL, hematocrit 38%, serum sodium 140 mEq/L, serum potassium 4.0 mEq/L. Based on the laboratory results, what is the highest-priority nursing action? Monitor cardiac rhythm closely Measure intake and output carefully Institute protective isolation Obtain an order for antibiotic therapy

Institute protective isolation

A patient is admitted to the critical care unit with pneumocystis pneumonia. Which of the following will the nurse likely need to manage for this patient? Select all that apply. Intravenous (IV) trimethoprim and sulfamethoxazole (Bactrim, Septra) and corticosteroids Dialysis Bloodborne pathogen isolation Ultrasound

Intravenous (IV) trimethoprim and sulfamethoxazole (Bactrim, Septra) and corticosteroids Bloodborne pathogen isolation

The critical care nurse promotes iron intake in the hematologic or immunocompromised patient to prevent which of the following? Iron deficiency anemia Acute cholecystitis Uremic frost Hyperspleenism

Iron deficiency anemia

A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process? It lowers the level of blood glucose It prevents nephron hyperfiltration It increases the urine output It filters waste from the blood

It prevents nephron hyperfiltration

Pulse oximetry may be inaccurate due to? Jaundice Peripheral edema

Jaundice

A patient who has received a bone marrow transplant is suspected to have either engraftment syndrome or sepsis and is undergoing evaluation. If the complication turns out to be engraftment syndrome, what is the most likely differentiating criterion? High fever, especially in the evening Pruritic total body rash Leukocytes less than 2,500/mm3 Dyspnea with pulmonary infiltrates

Leukocytes less than 2,500/mm3

Filtrate (urine) becomes highly concentrated in? Loop of Henley Glomerulus

Loop of Henley

The patient is 24 hours post acute myocardial infarction and may have developed a ventricular septum rupture. What nursing assessment would best indicate this complication? Loud holosystolic murmur Dyspnea and basal crackles Sinus tachycardia Pain unrelieved by nitroglycerin

Loud holosystolic murmur

After coronary artery bypass surgery, the patient experiences significant fluid volume shifts and losses. What nursing assessment would be most indicative of fluid volume deficit? Low central venous pressure Urine output 40 mL/hr Brisk capillary refill Diminished core body temperature

Low central venous pressure

The patient has had coronary artery bypass surgery involving the cardiopulmonary bypass pump, systemic hypothermia, topical cardiac hypothermia, and cold cardioplegia. As a result of the various hypothermic therapies, numerous postoperative complications may ensue. What collaborative postoperative intervention is specifically directed at ameliorating one or more of these complications? Use of intravenous pain and sedation medications Mechanical ventilation and supplemental oxygen therapy Vital signs every hour until stable or transferred to step-down unit Management of mediastinal chest tube drainage

Mechanical ventilation and supplemental oxygen therapy

When obtaining a history for a patient who is being admitted for hematological or immune disorders, the nurse first inquires about the chief complaint and history of present illness. The nurse next inquires about which of the following? Medical history Surgical history Last pap smear Recent CD4 count

Medical history

Long-term care focuses on monitoring the patients progress and adherence to the health care regimen. In solid organ transplant recipients, a major cause of graft loss in the long term is failure of patients to adhere to which of the following? Medication regimen Dietary requirements Follow-up appointments Financial requirements

Medication regimen

A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI? Fluid overload Anemia Metabolic acidosis Pericarditis

Metabolic acidosis

The physician orders an Arterial Blood Gas (ABG) to be drawn from the patient with Chronic Kidney Disease (CKD) who is complaining of headache, nausea, and difficulty breathing; and appears confused. The nurse knows the physician MOST likely suspects which of the following: Metabolic alkalosis secondary to the retention of CO2. Respiratory alkalosis from severe dehydration. Metabolic acidosis due to poor retention of bicarbonate. Respiratory acidosis due to fluid overload.

Metabolic acidosis due to poor retention of bicarbonate. Metabolic acidosis is a complication of renal failure as the kidneys struggle to adequately filter hydrogen ions and bicarbonate ions. "Clinical manifestations of metabolic acidosis include headaches, nausea and vomiting, deep and rapid respirations (Kussmaul respirations), altered mental status, hyperkalemia, and tachycardia. In severe metabolic acidosis, bradycardia and hypotension may manifest because of myocardial depression and vasodilation. There is also a dramatic depression of the patient's level of consciousness, often resulting in stupor or coma." (LeMone, p. 599)

A critically ill patient has developed acute renal failure and needs dialysis. Under what circumstance would the nurse question the use of continuous renal replacement therapy (CRRT)? Patient requires large amounts of hourly intravenous fluids Metabolic imbalances can be corrected with 3 hours of dialysis per day High risk of hemodynamic instability with dialysis Unlikely to tolerate rapid fluid shifts without destabilizing

Metabolic imbalances can be corrected with 3 hours of dialysis per day

Which of the following steps should NOT be taken? Evaluate fluid balance before dialysis Use pulmonary artery catheter to estimate fluid overload Add at the rate of 1,000 mL/h Obtain custom-mixed dialysate from the pharmacy Microwave prior to administering

Microwave prior to administering

The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included? Calorie restriction based on ideal body weight is necessary Sodium and potassium should be supplemented while on dialysis Renal diet restrictions take the place of those for diabetes mellitus Moderate protein restriction is recommended while otherwise healthy

Moderate protein restriction is recommended while otherwise healthy

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply.) Monitor blood glucose levels. Report cloudy dialysate return. Warm the dialysate in a microwave oven. Assess for shortness of breath. Check the access site dressing for wetness. Maintain medical asepsis when accessing the catheter insertion site.

Monitor blood glucose levels. *Monitor blood glucose levels because the dialysate solution contains glucose. Report cloudy dialysate return. *Monitor for cloudy dialysate return, which indicates an infection. Clear, light-yellow solution is typical during the outflow process. Assess for shortness of breath. *Assess for shortness of breath, which can indicate inability to tolerate a large volume of dialysate. Check the access site dressing for wetness. *Check the access site dressing for wetness and look for kinking, pulling, clamping, or twisting of the tubing, which can increase the risk for exit-site infections. Corrections: Avoid warming the dialysate in a microwave oven, which causes uneven heating of the solution. Maintain surgical, not medical, asepsis when accessing the catheter insertion site to prevent infection from contamination.

A nurse administered captopril to a client during a renal scan. Which of the following actions should the nurse take? Assess for hypertension. Limit the client's fluid intake. Monitor for orthostatic hypotension. Encourage early ambulation.

Monitor for orthostatic hypotension. *Monitor for orthostatic hypotension because this is an adverse effect of captopril. This results in a change in blood flow to the kidneys after the initial dose. Corrections: Captopril is an antihypertensive medication. Assess the client for hypotensive effects. Increasing the client's fluid intake can help resolve hypotensive effects following the administration of captopril. The client is at risk for falls when ambulating due to the hypotensive effects of captopril. Encourage the client to remain in bed.

In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure? Restrict fluid intake Monitor serum potassium De-emphasize dialysis Monitor serum creatinine

Monitor serum potassium

A patient with cancer has developed probable cardiac tamponade. The patient most likely presents with which of the following symptoms? Flat jugular veins when erect Muffled or distant heart sounds Bradycardia and heart block Generalized erythematous rash

Muffled or distant heart sounds

Selecting the ideal candidate for transplantation is an intricate process. To evaluate a patients suitability for transplantation, a comprehensive analysis on the patient is performed that includes which of the following types of assessments? Select all that apply. Multisystem Physiological Psychosocial Single donor system

Multisystem Physiological Psychosocial

A 78-year-old woman in the CCU complains of shortness of breath, along with prolonged chest pain unrelieved by rest or sublingual nitroglycerin. The nurse recognizes that this patient is most likely experiencing which condition? Stable angina pectoris Atherosclerosis Classic angina Myocardial infarction

Myocardial infarction

What is an antioxidant and a potent vasodilator that is part of the protocol in many hospitals to prevent contrast induced nephropathy based on clinical trials demonstrating its renoprotective effects in patients receiving IV contrast media? N-Acetylcysteine Iodinated contrast Gadodiamide

N-Acetylcysteine

A nurse is completing the admission physical assessment of a client who has mitral valve insufficiency. Which of the following findings should the nurse expect? S4 heart sound Petechiae Neck vein distention Splenomegaly

Neck vein distention *Neck vein distention is an expected finding in a client who has pulmonary congestion due to mitral valve insufficiency. Corrections: An S3 heart sound is an expected finding in a client who has mitral valve insufficiency. An S4 heart sound is an expected finding for a client who has aortic stenosis. Petechiae is an expected finding in a client who has infective endocarditis. Hepatomegaly, not splenomegaly, is an expected finding in a client who has left-sided heart valve damage.

Intradermal skin testing using a variety of antigens can be done to evaluate cell-mediated immunity. If the patient has a defect in cellular immunity, what test result does the nurse expect? Erythema and induration Itching and pain No change in skin assessment Increased B lymphocytes

No change in skin assessment

What treatment is necessary for a patient showing an EKG strip with premature ventricular contractions? Defibrillation Synchronized defibrillation CPR No treatment

No treatment

A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as this condition progresses beyond the onset phase? Normal potassium levels Duration of 7 to 14 days Normal urine concentrating function Normal urine volume

Normal urine volume

The nurse is caring for a patient who has received a liver transplant. The patients blood pressure is dropping and there is increased bloody drainage from the Jackson-Pratt drains at the abdominal incision. What is the most important nursing action? Administer intravenous fluid bolus Continue close observation and monitoring Notify the surgeon Milk the Jackson-Pratt drainage tubes

Notify the surgeon

Which of the following are important to assess in the immunocompromised patient? Select all that apply. Nutritional status Body temperature White blood cell count Skin assessment

Nutritional status Body temperature White blood cell count

An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patients acute kidney injury? Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells Obstruction of the flow of urine due to benign prostatic hypertrophy Lack of perfusion due to congestive heart failure Hypotension due to systemic inflammatory response to sepsis

Obstruction of the flow of urine due to benign prostatic hypertrophy

The patient is complaining of midsternal chest pain that feels like constant severe pressure. The pain is not relieved by rest or three nitroglycerin tablets and is different than the pain the patient has had in the past. What is the priority nursing action? Administer another nitroglycerin tablet Obtain a 12-lead electrocardiogram Use anxiety reduction techniques Teach risk reduction strategies

Obtain a 12-lead electrocardiogram

A nurse is reviewing the results of a client's urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrites. Which of the following actions should the nurse take? Repeat the test early the next morning. Start a 24-hr urine collection for creatinine clearance. Obtain a clean-catch urine specimen for culture and sensitivity. Insert an indwelling catheter urinary catheter to collect a urine specimen.

Obtain a clean-catch urine specimen for culture and sensitivity. Obtain a clean-catch urine specimen for culture and sensitivity. This test will identify which antibiotic will be most effective for treating the client's urinary tract infection. Corrections: Repeating the test early the next morning will not change the urinalysis results. A 24-hr urine collection for creatinine helps to determine kidney function. Insert a urinary catheter to collect urine when a client cannot empty their bladder.

A 48-year-old patient is admitted with hepatic veno-occlusive disease. Which of the following are likely assessments and interventions for this patient? Select all that apply. Observe and assess for dehydration Obtain serum bilirubin Prepare for a liver biopsy Prepare for a surgical intervention

Obtain serum bilirubin Prepare for a liver biopsy

A patient with chronic renal failure has an arteriovenous fistula in her forearm for dialysis access. What intervention or interventions should the nurse make in working with this patient? Select all that apply. Take the patients blood pressure on the forearm containing the fistula Palpate the fistula for thrill every 8 hours Draw blood samples from the vein that forms the fistula Avoid placing any restraints on the access arm Check access patency less frequently in hypotensive patients Occlude the fistula vein using firm pressure in the event of post dialysis bleeding from the needle site.

Palpate the fistula for thrill every 8 hours Avoid placing any restraints on the access arm

A patient who has had a myocardial infarction is started on a cardiac rehabilitation program. The patient asks the nurse why he must participate in this program. What is the most important information for the nurse to include in answering the patients question? This program has been ordered by the physician and is required Participation has been shown to decrease the risk of subsequent coronary events The program includes monitored exercise and risk reduction counseling Participation will improve the patients quality of life and emotional stability

Participation has been shown to decrease the risk of subsequent coronary events

Which of the following are types of acute kidney injuries? (Select all that apply) Prerenal AKI Intrarenal AKI Interrenal AKI Postrenal AKI

Prerenal AKI Intrarenal AKI Postrenal AKI

What type of dialysis uses temporary or Tenckhoff (permanent) catheters? Hemodialysis Continuous Renal Replacement Therapy Peritoneal dialysis

Peritoneal dialysis

A patient is admitted to the ICU with decompensated heart failure and is effectively diuresed with large doses of the loop diuretic furosemide (Lasix), and a thiazide diuretic (HCTZ). The nurse knows to monitor electrolytes and BUN/Cr for a related potential renal complication known as which of the following: Chronic Kidney Injury Intra-renal kidney injury Acute peritonitis Pre-renal kidney injury

Pre-renal kidney injury Rationale: A potential complication of diuresis is dehydration, which may be identified by an increase in serum sodium, abnormalities in other electrolytes, and an increase in BUN/Cr ratio. Although sodium may be excreted in diuresis, more water than sodium remains in the bloodstream resulting in an increase in sodium concentrations (or hypernatremia). Dehydration is a reduction in blood volume (hypovolemia) causing hypo-perfusion to the kidneys resulting in an inability to clear wastes; therefore, urea nitrogen will build in the blood, elevating the ratio of urea nitrogen in the blood (BUN) to creatinine in the blood. Hypo-perfusion is a pre-renal injury. (See Pre-renal, p. 585; electrolytes & dehydration, p. 579-580; BUN, p. 592, & diuretics, p. 576.)

What medication is the mainstay of rescue therapy for episodes of organ rejection? Prednisone Benadryl Alemtuzumab Mycophenolate mofetil

Prednisone (corticosteroids) High dose corticosteroids are the mainstay of rescue therapy for episodes of organ rejection. For rejection episodes that are refractory to high-dose corticosteroids. Other treatment options include: antithymocyte globulin monoclonal antibodies, including muromonab-CD3, basiliximab, or daclizumab for rejection episodes that are refractory to high-dose corticosteroids.

A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should expect which of the following interventions? Prepare the client for a CT scan with contrast dye. Plan to administer nitroprusside. Prepare to administer a fluid challenge. Plan to position the client in Trendelenburg.

Prepare to administer a fluid challenge. Plan to administer a fluid challenge for hypovolemia, which is indicated by the client's low urinary output and blood pressure. Corrections: Do not plan for a CT scan. Contrast dye is contraindicated for a client who has possible acute kidney injury. Nitroprusside is a rapid-acting vasodilator used to rapidly reduce blood pressure for clients who have hypertensive crisis. It is contraindicated for clients who have hypotension. Position the client in reverse Trendelenburg, with the head down and feet up, if a client becomes hypotensive.

Strict intake and output should be carried out for which of the following? Prerenal AKI Intrarenal AKI Postrenal AKI

Prerenal AKI

The patient presents with chest pain in the Emergency Department. A 12-lead ECG reveals an elevated ST segment. Which of the following serum lab values also contributes to the diagnosis of an acute myocardial infarction (AMI)? Decreased CK-MB Elevated ALT and AST Presence of Troponin T Elevated C-reactive protein

Presence of Troponin T Rationale: Troponin subtypes T and I are the most sensitive marker of myocardial damage. Troponin is not found in the patient with a healthy heart; therefore, it's presence may indicate a myocardial infarction. See p. 375.

A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task? Restricting the patients protein intake Monitoring the patients potassium level Evaluating the patient for signs of nephrotoxicity Preventing fluid overload

Preventing fluid overload

The patient has been diagnosed with severe mitral valve stenosis. What physical changes would the nurse expect to find as a result of the stenosis? Prolonged capillary refill Normal left atrial and ventricular pressures Clear lung sounds Angina pectoris

Prolonged capillary refill

A patient is admitted to the ICU to rule out necrotizing enterocolitis. Management of this patient may include which of the following initial therapies? Vasopressin Prophylactic hematopoietic growth factors Regular diet NG feedings

Prophylactic hematopoietic growth factors

Patient with prolonged urination is most likely dealing with what issue? Diuresis Prostate hypertrophy AKI Pancreatic edema

Prostate hypertrophy

When a patient is experiencing chest pain what is the priority action to be taken by the nurse? Administer aspirin Provide O2 Auscultate heart sounds Raise head of bed

Provide O2

A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a blood creatinine of 5 mg/dL (0.84 to 1.21 mg/dL is normal). Which of the following interventions should the nurse include in the plan? (Select all that apply.) Provide a high-protein diet. Assess the urine for blood. Monitor for intermittent anuria. Weight the client once per week. Provide NSAIDs for pain.

Provide a high-protein diet. *Provide a high-protein diet due to the high rate of protein breakdown that occurs with acute kidney injury. Assess the urine for blood. Assess urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney. Monitor for intermittent anuria. Assess for intermittent anuria due to obstruction or damage to kidneys or urinary structures. Corrections: Weigh the client daily to monitor for fluid retention due to acute kidney injury. Do not administer NSAIDs, which are toxic to the nephrons in the kidney.

In distinguishing between the management of pre-renal acute kidney injury versus chronic kidney disease, the nurse knows the fundamental difference is which of the following: Monitoring for fluid and electrolyte imbalance Providing intravascular fluid resuscitation Correcting acid-base balance Administering drugs to increase myocardial contractility

Providing intravascular fluid resuscitation Rationale: Pre-renal AKI may be caused by decreased intravascular fluid (e.g. dehydration); whereas CKD is characterized by damaged nephrons unable to filter fluid. Fluid is restricted in CKD. See p. 596.

A patient with severe vascular fluid loss from third spacing is being treated with intravenous hypertonic saline in an attempt to pull fluid from the extravascular space to the vascular space. What nursing assessment result is most indicative of a serious complication of the use of intravenous hypertonic saline? Increased urine output Decreased peripheral edema Slightly elevated blood pressure Pulmonary adventitious sounds

Pulmonary adventitious sounds

A patient who has just has coronary artery bypass surgery has developed tachycardia, a low-grade fever, and an elevated total white blood cell count. What additional sign or symptom would support the nurses suspicion of a postoperative infection? Purulent drainage from the chest incision Chest incision edges are red and swollen Elevated immature neutrophils or bands Severe incisional pain with cough

Purulent drainage from the chest incision

A patient recovering in the CCU following coronary artery bypass graft (CABG) surgery complains of pain in his chest. The patient underwent a sternotomy incision during the surgery. Which of the following types of pain would indicate angina which may indicate graft failure as opposed to typical pain resulting from the sternotomy? Radiates to arms Is worse with deep breathing Is worse with movement Is sharp

Radiates to arms

During assessment the patient is gasping for air. What is the priority action the nurse should take? Auscultate lungs for wheezing Call HCP immediately Have assistant nurse call code Raise the head of bed

Raise the head of bed

What is the management of choice if ventricular fibrillation occurs?

Rapid defibrillation The patient should be supported with cardiopulmonary resuscitation and drugs if there is no response to defibrillation. An ICD may be indicated for long-term management of VF

What is included in a liver transplant? (Select all that apply) Rapid infusion system Cell saver Venovenous bypass pump Median sternotomy incision

Rapid infusion system Cell saver Venovenous bypass pump *Median sternotomy incision for orthotopic transplantation

A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? (Select all that apply.) Reduced BUN Elevated cardiac enzymes Reduced urine output Elevated blood creatinine Elevated blood calcium

Reduced urine output Elevated blood creatinine Corrections: A manifestation of prerenal AKI is an elevated BUN caused by the retention of nitrogenous wastes in the blood. Elevated cardiac enzymes is a manifestation of cardiac tissue injury, not AKI. A manifestation of prerenal AKI is reduced calcium level.

The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect? Improvement in renal perfusion secondary to improved blood pressure Reduction in urine output secondary to constriction of renal arteries Augmentation of water reabsorption from distal tubular fluid Decrease in urine sodium concentration to critically low levels

Reduction in urine output secondary to constriction of renal arteries

A patient with severe coronary artery disease has persistent angina that is refractory to medical management at maximum drug doses and has severe compromise of activities of daily living from the angina. The patient has had several coronary artery bypass surgeries and has been told that he is not a candidate for any further surgeries or percutaneous interventions such as stents. In discussing options for further therapy, what should the nurse include that would offer the patient the most hope? Unless a new medication is invented, there is nothing that can be done Discussion of hospice and palliative support for end-of-life care Referral to the social worker for financial assistance Referral to the transmyocardial laser revascularization program for evaluation

Referral to the transmyocardial laser revascularization program for evaluation

A patient has experienced brain death after a head injury and the family has consented to organ donation. In this situation, who does the nurse now recognize as managing the care of that donor? Attending physician Intensive care physician team Registered nurse from organ procurement organization Pathophysiologist from the medical examiners office

Registered nurse from organ procurement organization

The patient with DM is being considered for a renal transplant. Which of the following factors is MOST relevant to determine candidacy? Bone marrow function Pancreatic function Renal disease severity Glucose dysregulation severity

Renal disease severity Rationale: End-stage disease is the primary reason for solid organ transplant. Hyperglycemia associated with DM may damage nephrons, and cause other pathologic processes resulting in renal failure. Bone marrow dysfunction from various causes is the primary reason for hematopoietic stem cell transplant (HSCT), not renal transplant. See pp. 917-918.

A critically ill patient is receiving continuous renal replacement therapy (CCRT) by continuous venovenous hemofiltration with dialysis (CVVHD) or continuous venovenous hemofiltration (CVVH). What difference in care of this patient does the nurse anticipate when compared with other methods of CCRT? Filtrate lost is equal to patient weight loss Differences are in brands of machines used Produced ultrafiltrate is not replaced Replacement fluid is necessary to maintain fluid balance

Replacement fluid is necessary to maintain fluid balance

A nurse is completing the admission assessment of a client who will undergo peripheral bypass graft surgery on the left leg. Which of the following findings should the nurse expect? Rubor of the affected leg when elevated 3+ dorsal pedal pulse in left foot Thin, peeling toenails of left foot Report of intermittent claudication in the affected leg

Report of intermittent claudication in the affected leg *A client who has peripheral artery disease might report that numbness or burning pain in the extremity ceases with rest (intermittent claudication). Corrections: Reddening (rubor) of a leg affected by peripheral artery disease occurs when it is placed in a dependent position. Pulses are decreased or absent in the feet in cases of peripheral artery disease. Toenails are thickened in cases of peripheral artery disease.

The nurse is teaching several patients how to reduce their risk for coronary artery disease or atherosclerosis. What risk factors should the nurse most emphasize? Serum cholesterol, high stress, and anger management Male gender, increased age, and hypertension Serum cholesterol, hypertension, and cigarette smoking Cigarette smoking, smokeless tobacco, and ethnicity

Serum cholesterol, hypertension, and cigarette smoking

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? (Select all that apply.) Review the medications the client currently takes. Assess the AV fistula for a bruit. Calculate the client's hourly urine output. Measure the client's weight. Check blood electrolytes. Use the access site area for venipuncture.

Review the medications the client currently takes. *Reviewing the medications the client currently takes can help determine which medications to withhold until after dialysis. Assess the AV fistula for a bruit. *Assessing the AV fistula for a bruit determines the patency of the fistula for dialysis. Measure the client's weight. *Measuring the client's weight before dialysis is essential for comparing it with the client's weight after dialysis. Check blood electrolytes. *Checking the blood electrolytes determines the need for dialysis. Corrections: The client's hourly urine output can vary with the remaining kidney function and does not determine the need for dialysis. Never use the access site area for venipuncture because compression from the tourniquet can cause loss of the vascular access.

The patient has been diagnosed with multiple myeloma. What abnormality on a laboratory test would the nurse most expect? Rouleaux formations on peripheral smear Reduced hemoglobin and hematocrit Nucleated red cells on peripheral smear Spherocytes on peripheral smear

Rouleaux formations on peripheral smear

The patient has been diagnosed with an acute inferior myocardial infarction. What 12-lead ECG changes does the nurse expect to find after several hours? ST segment elevation and large Q wave in leads II, III and aVF ST segment depression and wide QRS in leads II, III, and aVR ST segment elevation and large Q wave in leads V1V4 ST segment depression and large S wave in leads V2V4

ST segment elevation and large Q wave in leads II, III and aVF

The patient is experiencing severe chest pain after a stressful incident at work. On the 12-lead ECG, the nurse notices ST segment depression in the anterior leads that resolves as the patients pain resolves. What is the most appropriate nursing action? Send the patient home, since the symptoms have resolved Implement a risk reduction teaching plan Schedule the patient for immediate further diagnostic tests Refer the patient for psychological evaluation and treatment

Schedule the patient for immediate further diagnostic tests

Which of the following are used for distinguishing the types of AKI? (Select all that apply) Sediment Sodium concentration Albuminuria Osmolality Specific gravity

Sediment Sodium concentration Osmolality Specific gravity

A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority? Daily weights Intake and output Serum potassium Blood urea nitrogen

Serum potassium

A patient with end-stage liver failure has received a liver transplant. During the postoperative care phase, the nurse monitors the patients oxygen status closely. What condition may interfere with the use of peripheral pulse oximetry in this patient? Metabolic acidosis Severe jaundice Normal body temperature Clubbing

Severe jaundice

A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation? Toxic levels of medications Poststreptococcal glomerulonephritis Severe sepsis and shock Benign prostatic hypertrophy

Severe sepsis and shock

A patient recovering from cardiopulmonary bypass surgery is shivering. For what reason should the nurse be concerned about the shivering? Shivering is a sign of cardiogenic shock Shivering is a sign that the patient has a fever Shivering increases myocardial workload Shivering can cause sutures to rupture

Shivering increases myocardial workload

A patient is awaiting a stem cell transplant. What donor is most likely to have the best HLA and MLC matching? Not related, with same ABO group Sibling of same gender Any blood relative Nonrelated donor of either gender

Sibling of same gender

When examining a patients eyes for complaints of visual changes, which of the following indicates hyperviscosity from polycythemia or retinal infarcts? Sickle cell anemia Retinal hamartoma Stage one hypertension Iron deficiency anemia

Sickle cell anemia

The presence of what on an EKG indicates a MI? Significant Q waves Significant TPR intervals

Significant Q waves

What is showing on EKG strip for 1st degree block? Sinus rhythm with a long QT Widened T wave Sinus bradycardia with shortened QT Peaked QRS

Sinus rhythm with a long QT

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? Diet modification Relaxation exercises Smoking cessation Taking omega-3 capsules

Smoking cessation *According to the airway, breathing, and circulation (ABC) priority-setting framework, the first step is to recommend the clients to stop smoking. Nicotine causes vasoconstriction, elevates blood pressure, and narrows coronary arteries. *All answers correct, but smoking cessation is the highest priority

A patient with atherosclerosis acknowledges that he is a smoker but does not understand how this contributes to his atherosclerosis. Which response would be best for the nurse to give him? Smoking causes stress, which increases his lipid levels Smoking triggers in him a craving for high-cholesterol foods Smoking injures the inner layer of his arteries, facilitating plaque buildup Smoking causes vasoconstriction

Smoking injures the inner layer of his arteries, facilitating plaque buildup

A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate? IV sodium bicarbonate Reduction of respiratory rate Sodium citrate and citric acid (Bicitra) Massive IV fluids

Sodium citrate and citric acid (Bicitra)

A patient with leukemia has been admitted with possible leukostasis. What sign or symptom does the nurse most expect? Critical neutropenia High and persistent fever SpO2 82% to 90% Diffuse erythematous rash

SpO2 82% to 90%

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish stable angina from an MI? Stable angina can be relieved with rest and nitroglycerin The pain of an MI resolves in less than 15 min The type of activity that causes an MI can be identified Stable angina can occur for longer than 30 min

Stable angina can be relieved with rest and nitroglycerin Corrections: Pain associated with an MI usually lasts longer than 30 min and requires opioid analgesics for relief. There is no specific type of activity that causes an MI. It can occur following rest. The pain of stable angina usually occurs for 15 min or less.

During hemodialysis, the nurse observes the patient to be restless, and mildly confused. The patient begins to complain of nausea and is determined to be hypertensive. Due to the likely pathophysiology of this complication, what is the MOST appropriate response? Maintain dialysate flow and titrate anticoagulants. Stop dialysis and report the complication to the physician. Increase the rate of dialysis to remove wastes faster. Provide urgent hypotonic IV fluid resuscitation.

Stop dialysis and report the complication to the physician. Rationale: Disequilibrium Syndrome occurs when shifts in solutes in the body happen too quickly, leaving higher concentrations in the cerebral vasculature (the blood-brain barrier slows down the removal of wastes). This leads to cerebral edema. Due to the seriousness of cerebral edema, dialysis should be halted, and the physician engaged. To avoid this complication, blood should be dialyzed slowly enough to avoid this sudden disparity between the solute concentrations of blood in the body and the brain. Treatment will likely include an osmotic diuretic such as mannitol to reduce cerebral edema. See p. 566.

A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal? Distended bladder Edema Strep throat infection Kinked Foley catheter

Strep throat infection

A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells? Monitoring glycosylated hemoglobin every 3 months Strict adherence to prescribed weight-loss diet Restriction of sodium-containing beverages and food Strict control of serum glucose levels with diet and medication

Strict control of serum glucose levels with diet and medication

The nurse is caring for a patient who has just received a kidney transplant. What nursing assessment finding would be most indicative of development of urinary drainage blockage? Swelling over the graft site Decrease in serum creatinine Sudden drop in hourly urine drainage Increase in serum sodium

Sudden drop in hourly urine drainage

What is necessary treatment for patients with Abdominal (Stable) Aortic Aneurism larger than 5.5 cm? Surgery Dialysis Medication therapy

Surgery *In addition to surgery, AAAs larger than 5.5 cm may be repaired by a minimally invasive approach using an endovascular graft

A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? (Select all that apply.) Surgical repair of an atrial septal defect at age 2 Measles infection during childhood Hypertension for 5 years Weight gain of 10 lb in past year Diastolic murmur present

Surgical repair of an atrial septal defect at age 2 *A history of congenital malformations is a risk factor for valvular heart disease. Hypertension for 5 years *Hypertension places a client at risk for valvular heart disease. Diastolic murmur present *A murmur indicates turbulent blood flow, which is often due to valvular heart disease. Corrections: Having a streptococcal infection or rheumatic fever during childhood is a risk factor for valvular heart disease. A sudden weight gain of 10 lb could indicate fluid collection related to left-sided valvular heart disease.

A patient has been found to be at high risk for cardiovascular disease after a highly sensitive C-reactive protein (hs-CRP) blood test indicated a value of 3.0 mg/dL. The patient would like to know what this test measures. What would be the best answer for the nurse to give? Systemic inflammation related to atherosclerosis Cardiac output following myocardial infarction Blood pressure related to congestive heart failure Lipid levels in connection with stress response

Systemic inflammation related to atherosclerosis

A patient with stable angina is being treated with a beta-blocker. What assessment finding would most cause the nurse to question the use of this medication? Heart rate 60 at rest, denies dizziness when standing Systolic blood pressure 82, complains of chronic fatigue Sinus rhythm with rare premature atrial complexes (PACs) Diastolic blood pressure 80 with normal pulse pressure

Systolic blood pressure 82, complains of chronic fatigue

A patient is being discharged from the CCU following a myocardial infarction (MI). He will be participating in cardiac rehabilitation following discharge. His wife is wondering what she can do to help her husband during rehabilitation. What instructions should the nurse include in the discharge teaching plan? Select all that apply. Take cardiopulmonary resuscitation training Learn to interpret ECG readings Encourage her husband to stop smoking Exercise with her husband Prepare heart-healthy meals Perform a stress test on her husband monthly.

Take cardiopulmonary resuscitation training Encourage her husband to stop smoking Exercise with her husband Prepare heart-healthy meals

The patient has been diagnosed with severe aortic valve stenosis. Considering the most common symptoms caused by aortic valve stenosis, what is the most important nursing intervention? Document characteristics of the aortic stenosis murmur Teach patient to rise slowly from a supine position Assess peripheral circulation more frequently Assess for and document pulmonary adventitious sounds

Teach patient to rise slowly from a supine position

The nurse is explaining the process of atherosclerosis to a patient and family. What information should the nurse include? This disease is purely genetic in nature and cannot be prevented The central process involves the formation of lipid-filled arterial plaques Alterations in lifestyle have no effect on the formation of plaques Anginal chest pain occurs when a coronary artery is 100% occluded

The central process involves the formation of lipid-filled arterial plaques

During evaluation for compatibility with the donor, a potential organ transplant recipient undergoes HLA matching. When explaining the importance of this test to the patient, what is the best rationale for the nurse to use? This is simply a routine part of compatibility testing for all organs The higher the number of matching antigens, the lower the risk of rejection This test is used to ensure that the donor does not have an active infection HLA testing is part of the ongoing research into organ transplant success

The higher the number of matching antigens, the lower the risk of rejection

The patient is scheduled for coronary artery bypass surgery using the off-pump technique. During preoperative teaching, the nurse explains that using the off-pump procedure has what advantage over the on-pump procedure? There is a lower risk of a cerebral embolus The patient can anticipate a shorter hospital stay There will be less need for anticoagulation therapy The procedure will be less painful

The patient can anticipate a shorter hospital stay

An elderly patient in the ICU with chronic renal failure has just undergone surgery for a synthetic arteriovenous graft in her left forearm for dialysis access. The nurse recognizes that the most likely reason this patient received a graft instead of a fistula is which of the following? Thrombosis is less likely to occur with grafts than with fistulas Fistulas are more prone to infection than are grafts The patients own blood vessels were not adequate for fistula formation An aneurysm is more likely to occur in a fistula than in a graft

The patients own blood vessels were not adequate for fistula formation

A patient in the ICU is scheduled to begin peritoneal dialysis for acute renal failure. The patient tells the nurse that he understands hemodialysis but is not familiar with peritoneal dialysis. He asks her what the difference between them is. The nurse explains that the biggest difference between these two approaches is which of the following? Peritoneal dialysis relies on diffusion whereas hemodialysis relies on active transport The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis Hemodialysis uses a Tenckhoff catheter, whereas peritoneal dialysis uses a venous catheter Hemodialysis uses machines called cyclers to cycle the infusion and removal of blood, whereas peritoneal dialysis uses the body's own vascular system to do this.

The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis

The patient has been diagnosed with leukostasis. What definitive medical treatment does the nurse anticipate? Supplemental oxygen Magnetic resonance imaging (MRI) Serial arterial blood gases Therapeutic leukapheresis

Therapeutic leukapheresis

The patient has undergone a percutaneous coronary intervention (PCI) for relief of coronary stenosis secondary to arteriosclerotic heart disease. During discharge teaching, what patient statement most indicates the need for reteaching? This procedure means that my heart disease is cured I should continue to take my antilipidemic If I have any chest pain, I will call my doctor I will start a walking program after my doctor agrees

This procedure means that my heart disease is cured

The patient has developed a large pleural effusion as a complication from lung cancer. The patients life expectancy is short. What medical treatment does the nurse anticipate? Observation Thoracentesis Diuretic therapy Pneumonectomy

Thoracentesis

A critically ill patient has an elevated platelet count. What potential complication does the nurse assess for? Dehydration Thrombosis Hepatic impairment Disseminated intravascular coagulation

Thrombosis

The patient is being prepared for a liver transplant and is tested for antibodies for cytomegalovirus (CMV). What is the rationale for this test? Seronegative hosts may only receive seropositive donor's tissue and blood products. To identify the compatibility of the host's blood products to the donor's blood to plan treatment. To determine the host's immune response to known exposure. Seropositive hosts may only receive seronegative donor's tissue and blood products.

To identify the compatibility of the host's blood products to the donor's blood to plan treatment. Rationale: "After the first month, the most common infection in all transplant recipients is CMV. The consequences of CMV infection include enteritis, retinitis, pneumonitis, and marrow suppression. Current recommendations are to treat solid organ transplant recipients, who are CMV negative and who receive a CMV-positive organ, prophylactically with oral valacyclovir (Valtrex) for 3 to 6 months after transplantation." (page 940).

A nurse is caring for a patient with a tracheobronchial obstruction. The nurse should assess the patient frequently and watch for which of the following major complications? Pleural effusion and tachycardia Total airway occlusion and hemorrhage Total airway occlusion and vomiting Hemorrhage and decreased level of consciousness

Total airway occlusion and hemorrhage

A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider? The family is in crisis and unable to respond rationally Toxic acute tubular necrosis has a higher likelihood of complete healing Since the patient is currently oliguric, renal replacement therapy is indicated The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue

Toxic acute tubular necrosis has a higher likelihood of complete healing

The patient is being evaluated for acute myocardial infarction. Elevation in what laboratory value would confirm an acute MI? Troponin I or T CK-MB or CK-MM Myoglobin after 12 hours Leukocyte count

Troponin I or T

A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? CK-MB Troponin I Troponin T Myoglobin

Troponin T *The Troponin T level will still be evident 10 to 14 days following an MI. Corrections: The creatinine kinase MB levels are no longer evident after 3 days. Troponin I levels are no longer evident after 7 to 10 days. Myoglobin levels are no longer evident after 24 hr.

A nurse is caring for a patient with spinal cord compression from a tumor. The family asks the nurse why this happens. Which of the following is the nurses best response? There is not enough data to answer that question Tumors arising within the epidural space through vertebral or lymphatic spread may cause spinal cord compression More than 75% of cases are secondary to small cell or squamous cell lung cancers, and 10% to 15% are secondary to mediastinal lymphomas This occurs because of a large amount of fluid in the spinal space.

Tumors arising within the epidural space through vertebral or lymphatic spread may cause spinal cord compression

A patient has had a heart transplant using the standard atrial cuff technique. Based on the use of this surgical technique, what cardiac monitor reading does the nurse most expect? Third-degree heart block with ventricular rate 80 Two P waves for each QRS complex with one in disassociation Two independently rhythmic QRS complexes Ventricular pacing stimulus followed by a QRS complex

Two P waves for each QRS complex with one in disassociation

The patient is receiving continuous renal replacement therapy (CRRT). The rate of ultrafiltration shows a downward trend and coagulation of the filter is suspected. What is the most appropriate first nursing action? Immediately disconnect circuit from the patient Decrease the rate of blood flow by pump Use a saline bolus to diagnosis clot location and extent Raise the ultrafiltration collection device

Use a saline bolus to diagnosis clot location and extent

A patient in the CCU complains of pain and a squeezing sensation in his chest. He says that it typically affects him in the middle of the night, waking him from sleep. The nurse recognizes that this patient is most likely experiencing which of the following? Stable angina Unstable angina Classic angina Variant angina

Variant angina

The patient requires urgent hemodialysis or continuous renal replacement therapy after a suicide attempt with a variety of antidepressants. What access route for the dialysis does the nurse anticipate? Vascular catheter Arteriovenous fistula Synthetic vascular graft Peritoneal dialysis catheter

Vascular catheter

A patient has just had a dual-lumen venous catheter inserted in his subclavian vein for hemodialysis for acute renal failure. What intervention or interventions should the nurse make in working with this patient? (Select all that apply) Verify central line catheter placement radiographically before use Inject all medications directly into the catheter Leave the catheter unclamped to prevent clotting Maintain sterile technique in handling vascular access Observe catheter exit site for signs of inflammation

Verify central line catheter placement radiographically before use Maintain sterile technique in handling vascular access Observe catheter exit site for signs of inflammation

The nurse assesses a kidney transplant patient in the ICU immediately following surgery. Which of the following assessments are paramount in the care of the patient? Select all that apply. Vital signs Central venous pressure Patency of urinary catheters Blood sugars

Vital signs Central venous pressure Patency of urinary catheters

A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention? When your urine albumin-to-creatinine ratio is greater than 25 mg/g When your urine output is less than 0.5 mL/kg/h 6 h When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2 When your urine osmolality is greater than 500 mOsm/kg H2O

When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2

How should a complete heart block be explained to the patient? Your ventricles don't receive signals from SA node Your ventricles don't receive signals from AV node

Your ventricles don't receive signals from SA node

During the first month, the predominant fungal infections in recipients of HSCT are Aspergillus species and Candida species, for which what medications may be used prophylactically? (Select all that apply) amphotericin B fluconazole Prilosec furosemide

amphotericin B fluconazole