Final

An older adult visits the clinic for a BP check. The client's hypertension is not well controlled, and a new blood pressure medication is prescribed. What is important for the nurse to teach this client about blood

"A possible adverse side effect of BP medication is dizziness when you stand."

. The nurse is volunteering at a community blood pressure screening. A client never diagnosed with HTN presents with a BP of 158/90. Which assessment questions asked by the nurse are appropriate?

"DO YOU SMOKE?"

The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at the home?

"I cut back on going up the stairs during the day."

A patient has been placed on telemetry following treatment for a NON-STEMI, which of the patient's following statements indicates that the nurse should perform further patient teaching?

"If I get chest pain or shortness of breath, it will show up on my cardiac monitor."

1. A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?

"The condition is likely caused by a vitamin B12 deficiency."

The registered nurse and the LPN are preparing an educational program for a client who may be at risk for the development of iron-deficiency anemia. Which clients would receive the greatest benefit from this program? SATA

- young female client with bullimia nervosa - a client with a malabsportion disorder like Crohn's

The nurse should assess the patient for signs of lethargy, increasing Intercranial pressure, and seizures. When the serum sodium level reaches?

115

A nurse is assigning beds to four new clients being admitted to the cardiac floor which client should she assign to the bed at the end of the hallway away from the nurses station?

24/yo client with unstable hyperthyroidism with sinus tachycardia

. A nurse is preparing to infuse a 250 mL bag of PRBC over 2 hours. The drop factor of the manual IV tubing is 15 gtts per mL. The nurse should adjust the flow rate to deliver how many drops per minute?

31 gtts/min

A client is receiving nitro to treat angina. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's responses and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitro?

A BP of 84/52. BP drops and they get a HEADACHE (because nitro is a vasodilator, opens up the vessels)

The nurse assesses a patient and records the data collected. What would lead the nurse to anticipate that the patient will experience a decrease in cardiac output?

A heart rate of 54 BPM

The nurse is aware of the central role that erythropoietin plays in the initiation of erythropoiesis. Which of the following individuals would be likely to require the administration of erythropoietin?

A man with a diagnosis of acute renal failure secondary to diabetes. (Erythropoietin is made in the kidney. If the kidneys aren't functioning, erythropoietin can't be made effectively.)

A patient with megaloblastic anemia is being treated in an inpatient setting, and has daily bloodwork ordered. This morning's bloodwork has become available and the patient's hemoglobin and hematocrit are continuing to trend down. The nurse has contacted the patient's HCP to determine whether the HCP wants to order a transfusion of RBC. When considering the efficiency of this treatment the nurse should understand that:

A transfusion of packed red blood cells may have the potential to cause fluid volume overload and pulmonary edema.

A nurse understand that for the parathyroid hormone to exert its effect what must be present?

Adequate Vit D

A patient has been diagnosed with congestive heart failure. The nurse anticipates the physician to order what medication to enhance cardiac contractility?

DIGOXIN

The nurse is caring for a client prescribed oral warfarin. The nurse reviews the client's PT levels to evaluate the effectiveness of the medication. Which lab value would the nurse also investigate

INR

The nurse's primary role in the care of the patient with polycythemia vera (overproduction of RBC, thickens blood) is that of an educator. Choose the best advice that the nurse could give...

PHLEBOTOMY

A client's wound has begun to heal, and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?

PLASMIN...plasmin digests fibrin

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

Pallor, tachycardia, and a red, beefy, sore tongue

A hospital patient's most recent blood work calcium level of 14.2, phosphorus level of 1.4. What hormone has the potential to cause this alteration in the patient's electrolyte levels?

Parathyroid

1. While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?

Use an electric razor when assisting client with shaving.

When caring for a client, the nurse notices petechiae on the trunk and lower extremities. What precautions will the nurse take when caring for this client?

Use an electric razor when assisting the client with shaving (petechiae can indicate thrombocytopenia, so we need to use bleeding precautions. Use an electric razor instead of a real razor to prevent risk of bleeding)

The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance?

Weigh yourself at the same time everyday - notify doctor if you have gained 5lbs in a week

Which of the following would lead a nurse to suspect that a client is experiencing acute prostatitis?

frequency, dysuria, perineal discomfort, above norm. body temperature

A 72 y/o woman with a diagnosis of angina has presented to her nurse practitioner because her chest pain on exertion has become more frequent and longer lasting in recent days. The nurse should understand that this woman's chest pain is directly attributable to which of the following pathophysiological processes?

ischemia of the cardiac muscle cells

After teaching a class about the endocrine system the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland?

kidney's

A patient has developed pulmonary edema during an exacerbation of heart failure. The patient is experiencing dyspnea primarily from the accumulation of pressure in the patient's?

left atrium

A 66 year old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary care provider and bloodwork completed. The results of the man's bloodwork indicated anemia. The nurse who is contributing to the patient's care must recognize that the patient's anemia may be contributable to what factor?

loss of parietal cells decreasing the absorption of Vit. B12

Which cells are white blood cells with immune functions?

lymphocytes

During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's red beefy tongue. The nurse is aware that this is a sign of what kind of anemia?

megaloblastic/pernicious/vit. B12 deficient (all the same)

The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease. What are the modifiable risk factors?

-physical activity -alcohol use -obesity

The nurse is planning the care of a complex elderly patient who has been admitted to the medical ward for the treatment of cellulitis. The nurse knows that the patient has a long-standing history of chronic COPD. What assessment findings would most clearly indicate the need for oxygen therapy?

02 sat at 86%

A nurse is checking laboratory values on a patient who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which lab value does the nurse expect to be abnormal?

BNP - this patient has HF

The most common cause of iron-deficiency anemia in older adults is:

Blood loss (GI bleeding)

A 56 y/o man has been brought to the emergency department by emergency medical services and has been diagnosed with a myocardial infarction. Based on his presentation and his ECG the patient has been identified as a candidate for a PCT. The nurse providing care for this patient should recognize that the extent of cardiac damage will primarily depend on.

Duration of oxygen deprivation

A nurse is caring for a client with a history of GI bleed, sickle cell anemia, and a platelet count of 22,000. The client, who is dehydrated and is receiving dextrose 5% and 1/2NS solution at 150 mL/hr complains of severe bone pain, and is scheduled to receive a scheduled dose of morphine. Which administration route should the nurse question?

IM (we're not giving an IM injection because she has such low platelets and is at risk for bleeding.)

A client is admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia, asks the nurse about the benefits of a splenectomy. Which statement best explains the expected effect of a splenectomy?

It will remove the major cite of RBC DESTRUCTION - this is the function of the spleen

The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs and symptoms of the common compilation of?

Kidney stones

A 50 year old patient's ECG and presentation are suggestive of myocardial infarction and treatment has been promptly initiated. The nurse in charge of the patient's care should anticipate and facilitate which of the following interventions?

MONA protocol. Give oxygen, nitrates, morphine, Aspirin. DO NOT GIVE ORAL COUMADIN IF ITS AN OPTION, this is a maintenance drug, not an emergent one.

During a routine assessment of a patient diagnosed with anemia the nurse observes a patient's beefy red tongue. This is a sign of what kind of anemia?

Megoblastic

The nurse is assessing a client and notes a BP of 205/115. The client has had BPs within normal limits up until this time. The client reports a sudden onset, severe headache. The nurse recognizes this as a probable malignant hypertension. What would be the nurse's FIRST action?

NOTIFY THE PROVIDER. (because this is a change in condition for this patient. Any time there is ANY change in patient condition, you're going to notify the provider)

The nursing instructor is teaching students about myocardial contractility and ejection fraction. What diagnostic tests can determine client ejection fraction?

ONLY AN ECHO CAN MEASURE EF

A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling that is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. What other client report increases the likelihood of a cardiovascular disorder?

Shortness of breath - left sided HF

A 56 year old man has been brought to the emergency department by emergency medical services and has been diagnosed with a myocardial infarction. based on his presentation and ECG. The patient has been identified as a candidate for a percutaneous transluminal coronary angioplasty. The nurse who is providing care for this patient should recognize that the extent of cardiac damage will primarily depend on:

The duration of oxygen being deprived from the patient's cardiac cells

A community mental health nurse who works in an impoverished neighborhood has witnessed an increase in the incidents and prevalence of syphilis among underprivileged and homeless members of the community. The nurse is aware that syphilis often goes untreated because of what characteristic of the disease?

The lesions that accompany initial infection disappears spontaneously within several weeks

A nurse will identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which behavior?

The nurse puts on a second pair of gloves OVER soiled gloves when performing a bloody procedure.

What findings should a nurse expect to assess in a client with Hashimoto's thyroiditis?

Weight gain, decreased appetite, constipation

A patient is admitted to the ICU with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment?

weight gain (THIS HAPPENS IN LEFT AND RIGHT SIDED HF) -dyspnea -pulmonary crackles -YOU WILL NOT SEE JUGULAR VEINOUS DISTENTION OR ASCITES (those are in Right sided HF)

A detailed history and assessment of a 59 year old male patient....the nurse to suspect masked hypertension?

you tend to have a normotensive BP during your health assessments, and a high blood pressure during other times.

A patient has rung her call bell complaining of a severe headache and the nurse has completed a rapid assessment of the patient. The assessment reveals tachycardia, and a BP reading of 198/144. The nurse would recognize the need to treat this patient for what?

- hypertensive URGENCY (know the difference between hypertensive EMERGENCY and hypertensive URGENCY. A hypertensive EMERGENCY has target organ damage involved, examples would be a confused patient/slurring their words, or saying they're having the worst headache of their life, could have bleeding in their eyes bc BP is so high)

A young adult has just been diagnosed with atonic seizures. The nurse practitioner explains the patient that this type of seizure is usually characterized by?

Sudden loss of muscle tone usually with a fall

A detailed history and assessment of a 59 y/o male patient leads a nurse to suspect that the patient may have masked hypertension. A patient who has masked hypertension...

Tends to have normotensive blood pressures during health assessments and high blood pressure at other times

The nurse is providing care for a hemodynamically unstable patient in the critical care setting. The nurse has read in the patient's chart that his most recent echo prior to admission indicates a low stroke volume, which the nurse recognizes as being a function of preload, afterload and contractility. Which of the following statements best describes afterload?

The amount of resistance to the ejection of blood from the ventricles

A 60 year old woman has been brought to the emergency department by ambulance after she experienced a sudden onset of dyspnea and phoned 911. The woman is obese but claims an unremarkable medical history, and denies chest pain. When assessing this patient, the nurse in the ED should be aware that:

Women often present with an MI much differently than men.

1. A nurse is caring for a client who was found to have a hemoglobin (Hgb) level of 11.0 g/dL and a hematocrit (Hct) level of 34%. Which clinical manifestations correlate with these laboratory findings? Select all that apply.

a. REPORTS OF NOT FEELING HUNGRY OR EATING b. SLEEPING ONLY 3-5 HOURS PER NIGHT c. POOR ACTIVITY TOLERANCE d. PROGRESSIVE FATIGUE e. PALLOR

A nurse is preparing an IV dose of Hydro Cortisone to be administered to the adult patient on the acute medical unit. The endocrine disorder for which this treatment is most clearly indicated?

addison's disease

The nurse is assessing a client with heart failure. What breath sound is commonly auscultated in client's with left-sided heart failure?

crackles

1. A patient has asked the nurse about the clotting cascade, and the nurse explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present?

all body fluids

APPLY): A nurse is planning the care for a patient at risk for developing a pulmonary embolism, What nursing interventions should be included in the patient's care? SELECT ALL THAT APPLY

apply sequential compression devices, use elastic stockings, assisting the patient to do leg elevation and exersizes abouve the level of the heart, encourse a liberal amount of fluid intake

A client with Cushing's syndrome is admitted to the MedSurg unit during the admission The nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite and appears disheveled these findings are consistent with?

depression

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron-deficiency anemia?

dyspnea (because low hemoglobin=low oxygen) -tachycardia (heart is trying to work hard to circulate blood since it doesn't have enough) -pallor

A nurse is teaching nitro to a hospitalized patient with coronary artery disease that is being discharged the nurse tells the client that nitro has which of the following actions?

relieves pain, decreases ischemia, dilates blood vessels, reduces myocardial oxygen consumption

The nurse is reviewing the admission bloodwork of an adult woman who has presented with complaints of progressive fatigue over the past several weeks. This woman's subsequent bloodwork is indicative of iron-deficiency anemia. What assessment question by the nurse most directly addresses the potential cause of the woman's iron deficiency?

-"Have you seen any blood when you have had a bowel movement in recent weeks?"

The nurse is working with a patient who has a hematological disorder. The nurse is aware that in the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what broad cell types do myeloid stem cells differenciate?

-Erythrocytes -Leukocytes -Platelets (Lymphoid breaks into lymphocytes)

The nurse caring for a client in the Emergency room with a severe nosebleed becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black-looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action?

notify the physician!!!

1. A nurse cares for a client with iron-deficiency anemia. Which treatment will the nurse anticipate the client receiving?

oral iron supplementation

A child has suffered a laceration in a playground accident. When the human body receives an injury that causes blood loss several processes are involved in maintaining homeostasis when a blood clot is no longer needed what digest the fibrinogen to fibrin?

plasmin

Urinalysis has been ordered as part of a patient's diagnostic work up and the nurse has obtained and submitted a sample assessment of this patient's urine osmolality may be taken to diagnose dysfunction of the patients

posterior pituitary

The nurse is observing the skin of a client who is taking medications that suppress the hematopoietic system and notices multiple areas of ecchymosis on the arms, bleeding for a prolonged period after an IV was started, and reports of black tarry stool. What does the nurse understand may be a side effect of this medication that the client displays?

thrombocytopenia (low platelets)