Med-Surg Exam 2 (Soph 2)
normal phosphorus
2.4-4.4mg/dL (mostly extracellular anion)
normal potassium
3.5-5meq/L (intracellular cation)
normal calcium
8.6-10.2mg/dL (mostly extracellular cation)
To maximize arterial blood flow and minimize calf pain, you would instruct a patient with PAD to
a. Use elastic support stockings when she ambulates b. Apply warm, moist compresses to legs for 20 minutes every 2 hours c. Dangle her legs over the side of the bed Correct d. Elevate her legs to heart level when pain is present
The patient has a pulmonary embolus and the kidneys are spilling bicarb
respiratory alkalosis with metabolic compensation
pH 7.48, C02 33, HC03 20
respiratory alkalosis with metabolic compensation
concentration of plasma proteins are greater i the
vascular bed
normal sodium
135-145meq/L (extracellular cation)
When teaching a patient about antihypertensive drug therapy, which statement by the nurse is correct? Select all that apply
"You should try to have your blood pressure checked once a week and keep track of the readings.", "An exercise program may be helpful in treating hypertension, but let's check with your doctor first.", "Please continue the medication, even if you are feeling better.
plasma proteins...
-affect serum osmolarity -are the main negatively charged intravascular fluid anions -balance the positive charge of Na in osmolarity -pulls water into the vascular space and keeps it there
ADH
-made in the hypothalamus -stored in the post. pit. -acts on renal collecting tubules to regulate reabsorption or elimination of water
aldosterone
-produced by the adrenal cortex -released as part of the renin angiotensin aldosterone mechanism -acts on renal distal convoluted tubule -regulates water reabsorption by increasing sodium uptake from the tubular fluid into the blood
glucocorticoids (hydrocortisone, cortisol)
-regulate metabolism and increase BG -made in the adrenal gland -exert a weak mineralocorticoid (aldosterone) -promote resportption of Na and H2O by the kidney and therefore affect total blood volume
normal magnesium
1.5-2.5meq/L (mostly extracellular cation)
if water follows glucose out of the kidneys, total blood volume will then
A. decrease b. increase c. remain the same
glucose attracts water. it is an osmotic diuretic. so, if the blood sugar is high and the kidney filters out some of the excess sugar, what will be the result?
A. water will be eliminated b. water will be reabsorbed c. the kidney will fail
when thirst exists these events will occur
ADH secreted, renin angiotensin aldosterone activated, water and sodium retained, and urine output decreases
What assessment should the nurse do before giving a dose of digoxin?
Count an apical heart rate and hold the digoxin if it is less than 60 beats per min
Which of the following assessments would indicate that a patient's IV has infiltrated?
Edema of the extremity near the insertion site , Skin discolored or bruised in appearance, Skin cool to the touch, Numbness or loss of sensation
A patient with severe burns loses fluid from the vascular area to the interstitial space. How does the body attempt to improve blood volume?
Renal blood flow decreases, renin-angiotension-aldosterone (RAA) increases, urine output decreases.
The patient with hypovolemia (aka-fluid volume deficit) will exhibit:
Thirst, Decreased urine output, Tachycardia, Confusion, Hypotension
The nurse should ask which of the following questions to detect the risk factors for metabolic acidosis?
When did your kidneys stop working? CorrectRisk factors for metabolic acidosis include decreased excretion of metabolic acid from oliguria or anuria (kidneys are not working); excessive production of metabolic acid from starvation ketoacidosis (inappropriate weight loss diet); and loss of bicarbonate from diarrhea. Vomiting (loss of acid) causes metabolic alkalosis, as does overusing bicarbonate antacids. Shortness of breath might be related to a cause of respiratory acidosis. c. Which weight loss diet are you using? CorrectRisk factors for metabolic acidosis include decreased excretion of metabolic acid from oliguria or anuria (kidneys are not working); excessive production of metabolic acid from starvation ketoacidosis (inappropriate weight loss diet); and loss of bicarbonate from diarrhea. Vomiting (loss of acid) causes metabolic alkalosis, as does overusing bicarbonate antacids. Shortness of breath might be related to a cause of respiratory acidosis. f. How long have you had diarrhea? CorrectRisk factors for metabolic acidosis include decreased excretion of metabolic acid from oliguria or anuria (kidneys are not working); excessive production of metabolic acid from starvation ketoacidosis (inappropriate weight loss diet); and loss of bicarbonate from diarrhea. Vomiting (loss of acid) causes metabolic alkalosis, as does overusing bicarbonate antacids. Shortness of breath might be related to a cause of respiratory acidosis.
Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of diabetes mellitus?
a. 139/90 mm Hg b. 128/76 mm Hg CorrectThe goal for antihypertensive therapy for a patient with hypertension and diabetes mellitus is a BP <130/80 mm Hg. The BP of 102/60 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment. c. 136/82 mm Hg d. 102/60 mm Hg
A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse take next?
a. Auscultate breath sounds. CorrectThe patient's statement indicates that pleurisy or a pleural effusion may have developed and the nurse will need to listen for a pleural friction rub and/or decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider. b. Administer the PRN morphine. c. Notify the patient's health care provider. d. Have the patient cough forcefully.
A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which response by the nurse is accurate?
a. "The diseased portion of the artery in the brain is replaced with a synthetic graft." b. "A wire is threaded through an artery in the leg to the clots in the carotid artery and the clots are removed." c. "A catheter with a deflated balloon is positioned at the narrow area, and the balloon is inflated to flatten the plaque." d. "The obstructing plaque is surgically removed from an artery in the neck." CorrectIn a carotid endarterectomy, the carotid artery is incised and the plaque is removed. The response beginning, "The diseased portion of the artery in the brain is replaced" describes an arterial graft procedure. The answer beginning, "A catheter with a deflated balloon is positioned at the narrow area" describes an angioplasty. The final response beginning, "A wire is threaded through the artery" describes the mechanical embolus removal in cerebral ischemia (MERCI) procedure.
The nurse knows that teaching about medication administration has been effective when the patient states
a. "I should take my pulse before taking my medications every day." b. "I should adhere to the DASH diet to help control my blood pressure." c. "If my carotid pulse is below 60 per minute I should not take my digoxin." CorrectThe patient should take their pulse before taking digoxin, but more importantly should not take the digoxin if the pulse is below 60. The DASH diet may help blood pressure, but the question is about digoxin. Weight loss may help blood pressure but digoxin is not an antihypertensive.
A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask?
a. "Do you have any metal implants or prostheses?" b. "Have you taken any bronchodilators in the past 6 hours?" Correct c. "Are you claustrophobic?" d. "Are you allergic to shellfish?"
The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions?
a. "I will schedule two appointments for the pneumonia and influenza vaccines." b. "I'll cancel my chest x-ray appointment if I'm feeling better in a couple weeks." c. "I will continue to do the deep breathing and coughing exercises at home." Correct d. "I will call the doctor if I still feel tired after a week."
Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient. Which statement by the patient indicates that the teaching about this medication has been effective?
a. "I will use a salt substitute to decrease my sodium intake b. "I will increase my intake of potassium-containing foods." Incorrect c. "I will drink apple juice instead of orange juice for breakfast." (Aldosterone increases retention of sodium and water. Aldosterone also facilitates renal excretion of K+. Spironolactone (Aldactone) is a synthetic steroid that blocks aldosterone receptors. It is used in high dosages for the treatment of ascites, a condition commonly associated with cirrhosis of the liver. Monitor serum potassium levels frequently in patients who have impaired renal function or who are currently taking potassium supplements, because hyperkalemia is a common complication of spironolactone therapy. It is the potassium-sparing diuretic most commonly prescribed for children who have heart failure. Recently spironolactone has been shown to reduce morbidity and mortality in patients with severe heart failure when added to standard therapy. Of the three commonly used potassium-sparing diuretics, spironolactone has the greatest antihypertensive activity. It is available only in oral form. It also is available in combination with hydrochlorothiazide) d. "I will try to drink at least 8 glasses of water every day."
The patient had diarrhea for 5 days and developed an acid-base imbalance. Which statement would indicate that the nurse's teaching about the acid-base imbalance has been effective
a. "To prevent another problem, I should eat less sodium during diarrhea." b. "Diarrhea removes fluid from the body, so I should drink more ice water." c. My blood became too acidic because I lost some base in the diarrhea fluid." CorrectThis patient has lost base through diarrhea. Eating less sodium will not prevent the loss of base through stool. Ice water can upset the stomach and increase cramping. Having the patient try to modify respirations will not work and could be dangerous.
The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse
a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg Correct(The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible but do not require interventions as quickly as the 22-year-old.) b. 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg c. 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg
The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse?
a. 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg b. 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg c. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg Correct d. 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?
a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL d. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain CorrectThe patient with chest pain may be experiencing acute myocardial infarction, and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes.
Which diagnosis indicates that the nurse should assess the patient most carefully for development of metabolic acidosis?
a. A pancreatic fistula that is draining. CorrectThe pancreas secretes bicarbonate; a draining pancreatic fistula could cause metabolic acidosis from bicarbonate loss. Type B COPD and pneumonia cause respiratory acidosis by impairing carbonic acid excretion. Meningitis can stimulate hyperventilation, which causes respiratory alkalosis. Aldosterone facilitates renal excretion of hydrogen ions; hyperaldosteronism would cause metabolic alkalosis. b. Acute meningococcal meningitis. c. Severe hyperaldosteronism. d. Type B chronic obstructive pulmonary disease (COPD) and pneumonia.
The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first?
a. A patient who has a cough productive of thick, green mucus b. A patient with jugular venous distention and peripheral edema c. A patient with loud expiratory wheezes d. A patient with a respiratory rate of 38/minute Correct (A respiratory rate of 38/minute indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest)
Which of the following is an example of a patient with a central perfusion problem?
a. A patient with compartment syndrome b. A patient with a hemorrhage Correct c. A patient with a stroke
Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete immediately?
a. Abnormal serum potassium level b. Bleeding on the patient's dressing c. Decreased thyroid hormone level D. Presence of the Chvostek's sign Correct (The patient's symptoms indicate possible hypocalcemia, which can occur secondary to parathyroid injury/removal during thyroidectomy. There is no indication of a need to check the potassium level, the thyroid hormone level, or for bleeding)
A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient now has a serum sodium level of 127 mEq/L (127 mmol/L). Which prescribed therapy should the nurse question?
a. Administer 3% saline if serum sodium decreases to less than 128 mEq/L. b. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for nausea. c. Infuse 5% dextrose in water at 125 mL/hr.(Because the patient's gastric suction has been depleting electrolytes, the IV solution should include electrolyte replacement. Solutions such as lactated Ringer's solution would usually be ordered for this patient. The other orders are appropriate for a postoperative patient with gastric suction.) d. Administer IV morphine sulfate 4 mg every 2 hours PRN.
A newly admitted patient is diagnosed with hyponatremia. When making room assignments, the charge nurse should take which action?
a. Assign the patient to a room near the nurse's station. (The patient should be placed near the nurse's station if confused in order for the staff to closely monitor the patient. To help improve serum sodium levels, water intake is restricted. Therefore a confused patient should not be placed near a water fountain. Peaked T waves are a sign of hyperkalemia, not hyponatremia. A confused patient could be distracting and disruptive for another patient in a semiprivate room. This patient needs sodium replacement, not restrict) b. Place the patient on telemetry to monitor for peaked T waves. c. Assign the patient to a semi-private room and place an order for a low-salt diet d. place the patient in a room nearest the water fountain
The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?
a. Auscultate lung sounds every 4 hours. b. Maintain the patient on bed rest. c. Encourage fluid intake up to 4000 mL every day. Correct (To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mL daily. Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with hypercalcemia. Trousseau's and Chvostek's signs are monitored when there is a possibility of hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds, although these would be assessed every shift) d. Monitor for Trousseau's and Chvostek's signs.
Which set of assessment data is consistent for a patient with severe infection that could lead to system failure?
a. BP 152/90, P 52 beats/min, RR 12 breaths/min, urine output 4800 mL in past 24 hours b. Blood pressure (BP) 92/52, pulse (P) 56 beats/min, respiratory rate (RR) 10 breaths/min, urine output 1200 mL in past 24 hours c. BP 112/64, P 98 beats/min, RR 18 breaths/min, urine output 2400 mL in past 24 hours d. BP 90/48, P 112 beats/min, RR 26 breaths/min, urine output 240 mL in past 24 hours CorrectA low BP, associated with a high heart rate and a low urinary output is indicative of shock associated with sepsis.
The long-term care nurse is evaluating the effectiveness of protein supplements for an older resident who has a low serum total protein level. Which assessment finding indicates that the patient's condition has improved?
a. Blood pressure 110/72 mm Hg b. Absence of skin tenting c. Decreased peripheral edema Correct (Edema is caused by low oncotic pressure in individuals with low serum protein levels. The decrease in edema indicates an improvement in the patient's protein status. Good skin turgor is an indicator of fluid balance, not protein status. A low hematocrit could be caused by poor protein intake. Blood pressure does not provide a useful clinical tool for monitoring protein status.)
Which ABG value indicates that the patient is acidotic?
a. C02 of 33 b. bicarb of 20 CorrectRight. This bicarb is too low (under 22). This makes the patient acidotic. This could happen because of bicarb wasting through kidney failure or loss through diarrehea. c. pH of 7. 48
A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
a. Calcium channel blockers b. Beta-blockers c. Angiotensin-converting enzyme (ACE) inhibitors (ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough.)
A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication?
a. Change position slowly to help prevent dizziness and falls. CorrectThe angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the medication, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate. b. Increase fluid intake if dryness of the mouth is a problem. c. Check blood pressure (BP) in both arms before taking the medication.
A nurse in the outpatient clinic is caring for a patient who has a magnesium level of 1.3 mg/dL. Which assessment would be most important for the nurse to make?
a. Daily alcohol intake correct (Hypomagnesemia is associated with alcoholism. Protein intake would not have a significant effect on magnesium level. OTC laxatives (such as milk of magnesia) and use of multivitamin/mineral supplements would tend to increase magnesium levels.) b. Multivitamin/mineral use c. Intake of dietary protein d. Use of over-the-counter (OTC) laxatives
Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis?
a. Resting pulse oximetry (SpO2) of 85% b. Weak, nonproductive cough effort CorrectThe weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern. c. Respiratory rate of 28 breaths/minute d. Large amounts of greenish sputum
A patient is admitted for hypovolemia associated with multiple draining wounds. Which assessment would be the most accurate way for the nurse to evaluate fluid balance?
a. Hourly urine output b. Presence of edema c. Skin turgor d. Daily weight CorrectDaily weight is the most easily obtained and accurate means of assessing volume status. Skin turgor varies considerably with age. Considerable excess fluid volume may be present before fluid moves into the interstitial space and causes edema. Although very important, hourly urine outputs do not take account of fluid intake or of fluid loss through insensible loss, sweating, or loss from the gastrointestinal tract or wounds.
A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which nursing diagnosis is most appropriate?
a. Ineffective coping related to unknown outcome of illness b. Chronic low self-esteem related to increased physical dependence Correct c. Complicated grieving related to expectation of death d. Deficient knowledge related to lack of education about COPD
A patient with early septic shock is likely to exhibit all of the following signs EXCEPT
a. Low systemic vascular resistance b. Low blood pressure c. Cold, clammy skin Correct d. Increased heart rate
A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.0 mEq/L. The nurse should alert the health care provider immediately that the patient is on which medication?
a. Metoprolol (Lopressor) 12.5 mg orally daily b. Oral digoxin (Lanoxin) 0.25 mg daily Correct (Hypokalemia increases the risk for digoxin toxicity, which can cause serious dysrhythmias. The nurse will also need to do more assessment regarding the other medications, but they are not of as much concern with the potassium level.) c. Ibuprofen (Motrin) 400 mg every 6 hours d. Lantus insulin 24 U subcutaneously every evening
A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching?
a. Oxygen use can improve the patient's prognosis and quality of life. Correct b. Oxygen flow should be increased if the patient has more dyspnea. c. Travel opportunities will be limited because of the use of oxygen. d. Storage of oxygen tanks will require adequate space in the home.
A patient is admitted for hypovolemia associated with multiple draining wounds. Which assessment would be the most accurate way for the nurse to evaluate fluid balance?
a. Presence of edema b. Skin turgor c. Daily weight (Daily weight is the most easily obtained and accurate means of assessing volume status. Skin turgor varies considerably with age. Considerable excess fluid volume may be present before fluid moves into the interstitial space and causes edema. Although very important, hourly urine outputs do not take account of fluid intake or of fluid loss through insensible loss, sweating, or loss from the gastrointestinal tract or wounds.) d. Hourly urine output
The patient has severe metabolic alkalosis. Which intervention has the highest priority?
a. Raise the side rails on the patient's bed. CorrectSevere metabolic alkalosis causes a decreased level of consciousness; raising the side rails is a safety intervention in that situation. Safety interventions are a higher priority than teaching. An order to administer intravenous NaHCO3 to a patient with metabolic alkalosis should be questioned because it would make the alkalosis worse. Urine output and skin turgor are part of the assessment for extracellular fluid volume (ECV) deficit, but this is not a high priority in this situation. b. Administer intravenous NaHCO3 as ordered. c. Measure the urine output and skin turgor. d. Teach the family about metabolic alkalosis.
Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider?
a. Respiratory rate 28 breaths/minute while ambulating in hallway b. Cough productive of bloody, purulent mucus CorrectHemoptysis may indicate life-threatening hemorrhage and should be reported immediately to the health care provider. The other findings are frequently noted in patients with bronchiectasis and may need further assessment but are not indicators of life-threatening complications. c. Scattered rhonchi and wheezes heard bilaterally d. Complaint of sharp chest pain with deep breathing
A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding?
a. Serum hematocrit of 42% b. Serum sodium level of 120 mg/dL Correct c. Reported weight gain of 2.2 lb (1 kg) d. Urinary output of 280 mL during past 8 hours
The nurse assesses a patient who has been hospitalized for 2 days. The patient has been receiving normal saline IV at 100 mL/hr, has a nasogastric tube to low suction, and is NPO. Which assessment finding would be a priority for the nurse to report to the health care provider?
a. Serum sodium level of 138 mEq/L (138 mmol/L) b. Gradually decreasing level of consciousness (LOC) Correct c. Weight gain of 2 pounds (1 kg) above the admission weight d. Oral temperature of 100.1° F
A patient who is taking Lasix (furosimide) for treatment of hypertension complains of generalized weakness. It is most appropriate for the nurse to take which action?
a. Suggest that the patient avoid orange juice with meals. b. Assess for facial muscle spasms c. Ask the health care provider to order a basic metabolic panel. correct. (Generalized weakness is a manifestation of hypokalemia. After the health care provider orders the metabolic panel, the nurse should check the potassium level. Facial muscle spasms might occur with hypocalcemia. Orange juice is high in potassium and would be advisable to drink if the patient was hypokalemic. Loose stools are associated with hyperkalemia) d. Ask the patient about loose stools.
A patient has been diagnosed with possible white coat syndrome. Which action will the nurse take next?
a. Teach the patient about the medications he will have prescribed for him b. Schedule the patient for frequent blood pressure checks in the clinic c. Instruct the patient about the need to reduce stress levels d. Teach the patient how to self monitor and record blood pressures at home Correct Feedback
A patient with renal failure has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion. The patient arrives for outpatient hemodialysis and is unresponsive to questions and has decreased deep tendon reflexes. Which action should the dialysis nurse take first?
a. Teach the patient about the risk of magnesium-containing antacids b. Review the magnesium level on the patient's chart. c. Obtain an order to draw a potassium level d. notify the patient's healthcare provider. correct. (The health care provider should be notified immediately. The patient has a history and manifestations consistent with hypermagnesemia. The nurse should check the chart for a recent serum magnesium level and make sure that blood is sent to the laboratory for immediate electrolyte and chemistry determinations. Dialysis should correct the high magnesium levels. The patient needs teaching about the risks of taking magnesium-containing antacids. Monitoring of potassium levels also is important for patients with renal failure, but the patient's current symptoms are not consistent with hyperkalemia.)
After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective?
a. The patient has a glass of low-fat milk with each meal. CorrectFor the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet. b. The patient restricts intake of chicken and fish. c. The patient has two cups of coffee in the morning. d. The patient avoids eating nuts or nut butters
The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed?
a. The patient inhales slowly through the nose. b. The patient practices by blowing through a straw. c. The patient puffs up the cheeks while exhaling. CorrectThe patient should relax the facial muscles without puffing the cheeks while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing. d. The patient's ratio of inhalation to exhalation is 1:3.
The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?
a. The patient takes montelukast (Singulair) for peak flows in the red zone. b. The patient calls the health care provider when the peak flow is in the green zone. c. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone. CorrectReadings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting β2-adrenergic (SABA) medications. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow, and the patient should take a fast-acting bronchodilator and call the health care provider for further instructions. Singulair is not indicated for acute attacks but rather is used for maintenance therapy. d. The patient inhales rapidly through the peak flow meter mouthpiece.
A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse?
a. There are crackles audible throughout both lung fields. CorrectCrackles throughout both lungs suggest that the patient may be experiencing pulmonary edema, a life-threatening adverse effect of hypertonic solutions. The increased pulse rate and blood pressure and the appearance of the urine also should be reported, but they are not as dangerous as the presence of fluid in the alveoli. b. The blood pressure increases from 120/80 to 142/94. c. There is sediment and blood in the patient's urine. d. The patient's radial pulse is 105 beats/minute
A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately
a. apply a compression stocking to the leg. b. keep the patient in bed in the supine position. CorrectThe patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg. c. assist the patient in gently exercising the leg. d. elevate the leg above the level of the heart.
A patient is admitted to the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to
a. obtain the blood pressure. b. obtain a 12-lead electrocardiogram (ECG). c. check the level of consciousness. d. administer oxygen. CorrectThe initial actions of the nurse are focused on the ABCs—airway, breathing, and circulation—and administration of oxygen should be done first. The other actions should be accomplished as rapidly as possible after oxygen administration.
The patient has type B chronic obstructive pulmonary disease (COPD) exacerbated by an acute upper respiratory infection. Which blood gas values should the nurse expect to see?
a. pH low, PaCO2 high, HCO3 - normal b. pH high, PaCO2 high, HCO3 - high c. pH low, PaCO2 low, HCO3 - low d. pH low, PaCO2 high, HCO3 - high Correct In a patient with chronic respiratory acidosis who is suddenly worse because of an acute respiratory process (resulting in high PCO2), you will expect to see the acidosis compensated (HCO3 High) but not compensated enough (ph high)
Which of the following indicates a compensatory process?
a. pH of 7.32 with a HC03 of 28 CorrectYou got it. In this case the pH is low (acidotic) so the kidneys retain bicarb to try and buffer the acid retained by the lungs b. pH of 7.32 with C02 of 48 c. pH of 7.32 with HC03 of 20
The nurse would identify which patient as having a problem of impaired gas exchange secondary to a perfusion problem? A patient with
a. peripheral arterial disease of the lower extremities CorrectAlthough all these patients might have impaired gas exchange, the patient with peripheral artery is the only one with a perfusion problem. COPD and asthma are obstructive disorders and anemia is a transport problem b. chronic obstructive pulmonary disease (COPD) c. chronic asthma d. severe anemia secondary to chemotherapy
When teaching about clopidogrel (Plavix), the nurse will tell the patient with cerebral atherosclerosis
a. that Plavix will dissolve clots in the cerebral arteries. b. that Plavix will reduce cerebral artery plaque formation. c. to call the health care provider if stools are bloody or tarry. CorrectClopidogrel (Plavix) inhibits platelet function and increases the risk for gastrointestinal bleeding, so patients should be advised to notify the health care provider about any signs of bleeding. The medication does not lower blood pressure, decrease plaque formation, or dissolve clots
Which of the following patients most likely has respiratory alkalosis.
a. the patient is is overdosed on morphine b. the patient with failing kidneys c. the patient who is anxious and hyperventilating CorrectRight... because the pt is breathing out too much carbonic acid d. the patient with emphysema e. the patient with copious vomiting
A 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
a. there is an immediate danger of a stroke and hospitalization will be required. b. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed. CorrectA sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level. c. a BP recheck should be scheduled in a few weeks. d. dietary sodium and fat content should be decreased.
The nurse is assigned a group of patients. Which patient would the nurse identify as being at increased most at risk for impaired gas exchange? A patient
a. who has been on anticoagulants for 10 days b. with a heart rate of 100 beats/min and blood pressure of 100/60 c. with a blood glucose of 350 mg/dL d. with a hemoglobin of 8.5 g/dL CorrectA low hemoglobin indicates low carrying capacity for both oxygen and carbon dioxide.
three factors govern osmolarity
electrolytes, especially sodium, glucose and urea, and plasma proteins aka albumin
This patients kidneys are failing
hyperkalemia
A patient with this problem has decreased reflexes
hypermagnesemia
this patient has been getting enteral feeding with very little water
hypernatremia
5% dextrose and normal saline
hypertonic, commonly used after surgery to maintain intravascular volume
5% dextrose and lactated ringers (D5LR)
hypertonic- lots of calories. a good choice for a post-op patient who can't eat
the nurse set the wrong rate in the IV pump and this patient got excess fluid
hypervolemia
5% dextrose and water
hypo-isotonic. rarely used, provides some calories and could be used to maintain blood sugar
This patient with renal failure is secreting parathyroid hormone as a compensatory mechanism for what problem
hypocalcemia
the patient with this problem has chvostek sign
hypocalcemia
this patient had bowel surgery and is unable to eat. He now has weak crampy muscles and is developing an ileus
hypokalemia
this patient was diagnosed with bulimia and has been vomiting
hypomagnesemia
A patient has syndrome of inappropriate diuretic hormone
hyponatremia
0.45% normal saline (1/2NS)
hypotonic. rarely used. PT has cellular dehydration with elevated sodium
this patient was admitted to the ER with a GI bleed and low BP
hypovolemia
An increase in osmolarity indicates:
increased solute concentration
lactated ringers (LR)
isotonic solution with some calories, typically used in labor setting or surgery
normal saline 0.9% solution
isotonic- the only solution that is compatible with blood products
If increased osmolarity indicates increased solute concentration, how will increased osmolarity affect ADH output?
it will cause the pituitary to release ADH
The patient with renal failure has Kussmaul's respirations.
metabolic acidosis with respiratory compensation
pH 7.33, C02 33, HC03 20
metabolic acidosis with respiratory compensation
The patient has an NG tube sucking out stomach acid. The lungs are retaining acid.
metabolic alkalosis with respiratory compensation
pH 7.48, C02 48, HC03 29
metabolic alkalosis with respiratory compensation
when increased osmolarity causes the pituitary to release ADH, the kidney will
reabsorb water into the plasma
The patient has severe emphysema and can't get rid of carbon dioxide. The kidneys retain bicarbonate.
respiratory acidosis with metabolic compensation
pH 7.32, CO2 50, HC03 28
respiratory acidosis with metabolic compensation
