Med Surg Exam 3 practice Questions
A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response? "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." "You have no need to worry. Your pressure is probably elevated because you are being tested."
"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made."
The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? "Take this medication before going to bed." "Increase the amount of fruits and vegetables you eat." "You may develop nasal congestion or depression while taking this medication." "You may drink alcohol while taking this medication."
"Increase the amount of fruits and vegetables you eat."
A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client.
"Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7."
A client is being evaluated for possible lung cancer. Which client statement most likely indicates lung cancer?
"My cough has changed from a dry cough to one with lots of sputum production."
A 13-year-old soccer player presents to the emergency room with a fractured nose. The patient's mother is given which of the following post-discharge instructions? Select all that apply.
- Check for any unusual changes in breathing during the first 48 hours. - Observe for any clear drainage from either nostril. - Elevate the head of the bed for sleeping during the first week. - Restrict from sports activities for 6 weeks.
A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication?
0 to 4 mm
High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States? 1 in 3 adults 1 in 6 adults 1 in 7 adults 1 in 10 adults
1 in 3 adults
The client is to receive cephalexin (Ancef) 500 mg in 50 mL of normal saline intravenous piggyback. The medication is to infuse over 30 minutes. How many mL/hr would the nurse set the intravenous pump? Enter the correct number ONLY.
100
A nurse is assisting with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? A 16-year-old girl A 40-year-old African-American man A 50-year-old Caucasian woman An Asian adult man
A 40-year-old African-American man
The nurse is caring for a respiratory client who uses a noninvasive positive pressure device. Which medical equipment does the nurse anticipate to find in the client's room?
A face mask
Doppler Ultrasound Flow Studies
A handheld continuous wave (CW) doppler ultrasound device used to detect the blood flow in vessels Used when pulses cannot be reliably palpated
A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that:
A permanent tracheal stoma would be necessary.
Which of the following is accurate regarding status asthmaticus?
A severe asthma episode that is refractory to initial therapy
Varicose Vains
Abnormally dilated, tortuous, superficial veins called by incompetent venous valves Pathophysiology ~Reflux of venous blood results in venous stasis Manifestations ~Dull aches, Muscle cramps, increased muscle fatigue in the lower legs, ankle edema, and a feeling of heaviness of the legs ~Nocturnal cramps common ~May develop s/sx of chronic venous insufficiency Assessment ~Duplex ultrasound
The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?
Acute respiratory distress syndrome
A homeless client with streptococcal pharyngitis is being seen in a clinic. The nurse is concerned that the client will not continue treatment after leaving the clinic. Which of the following measures is the highest priority?
Administer one intramuscular injection of penicillin.
Which is a potential complication of a low pressure in the endotracheal tube cuff?
Aspiration pneumonia
A client with acute viral rhinosinusitis is being seen in a clinic. The nurse is providing discharge instructions and includes the following information:
Avoid air travel.
The nurse is providing discharge instructions to a client who has nasal packing in place following nasal surgery. Which discharge instructions would be most appropriate for the client?
Avoid sports activities for 6 weeks.
After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?
Bleeding
Pulmonary Embolism
Blood clot in the lungs ~Obstruction of the pulmonary artery or one of its branches Pathophysiology ~Most commonly it is due to a dislodged or fragmented DVT ~Occludes the outflow tract of the main pulmonary artery ~Impairs gas exchange! ~Hemodynamic instability (instability in the blood)- If sever, right ventricular failure occurs, which leads to hypotension, and shock
The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective?
Classes at community centers to teach about smoking cessation strategies
Capillaries
Connect arteries and veins Exchange area
Which medication is contraindicated in acute asthma exacerbations?
Cromolyn sodium
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.)
Decreases hypoxemia Sustains positive end expiratory pressure (PEEP) Decreases patient anxiety
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.
Decreases the production of neurotransmitters that constrict peripheral arterioles.
Ischemia!
Deficient blood supply
Veins
Deoxygenated blood
Wound drains, inserted during the laryngectomy, stay in place until what criteria are met?
Drainage is <30 mL/day for 2 consecutive days.
A client has been diagnosed as being prehypertensive. What should the nurse encourage this client to do to aid in preventing a progression to a hypertensive state? Avoid excessive potassium intake. Exercise on a regular basis. Eat less protein and more vegetables. Limit morning activity.
Exercise on a regular basis.
The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client
Exhales hard and fast with a single blow
Which exposure accounts for most cases of COPD?
Exposure to tobacco smoke
In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted?
I
A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Administer I.V. fluids as ordered. Administer an isosorbide as ordered. Insert an indwelling urinary catheter as ordered. Instruct the client to sit for several minutes before standing.
Instruct the client to sit for several minutes before standing.
Duplex Ultrasonography
Involves B-mode grayscale imaging of the tissues, organs, and blood vessels (arterial and venous) and permits estimation of velocity changes by use of a pulsed doppler
The nurse is assessing a client new to the clinic. Records brought to the clinic show that the client's hypertension has not improved. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? Progressive target organ damage Possibility of medication interactions Lack of adherence to prescribed drug therapy Possible heavy alcohol use or use of recreational drugs
Lack of adherence to prescribed drug therapy
Leg Ulcers Medical/Nursing Management
Medical ~Pharmacologic therapy ~Compression therapy ~Cleansing and debridement ~Topical therapy ~Wound dressing ~Stimulated healing such as Hyperbaric Oxygenation, Magot Therapy, Negative Pressure Wound Healing (wound vac- increases circulation) Nursing ~Assessment of skin/wound/pain ~Diagnosis ~Planning and goals ~Nursing interventions- Positinoning of the leg depends on if it is venous or arterial ~Activity/walking ~Restoring skin integrity ~Improving mobility ~!!!Promoting nutrition- High in protein (building blocks help heal), Vitamin C and A, Iron, Zinc
The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids?
Noisy breathing
Arteries
Oxygenated blood
A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? Magnesium level Potassium level Calcium level Sodium level
Potassium level
A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? Hypertensive Normal Slightly hypertensive Prehypertensive
Prehypertensive
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
Respiratory acidosis
A nurse is weaning a client from mechanical ventilation. Which nursing assessment finding indicates the weaning process should be stopped?
Runs of ventricular tachycardia
Which term describes high blood pressure from an identified cause, such as renal disease? Primary hypertension Secondary hypertension Rebound hypertension Hypertensive emergency
Secondary hypertension
A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what? Secondary hypertension has a specific cause. Secondary hypertension has a more gradual onset than primary hypertension. Secondary hypertension does not cause target organ damage. Secondary hypertension does not respond to antihypertensive drug therapy.
Secondary hypertension has a specific cause.
A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to
Seek medical help if he experiences inability to swallow
The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?
The patient should take the medication an hour before meals or 2 hours after a meal.
The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? The results will be falsely decreased. The results will be falsely elevated. It will give an accurate reading. It will be significantly different with each reading.
The results will be falsely elevated.
A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:
atelectasis
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.
decreases the production of neurotransmitters that constrict peripheral arterioles.
A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:
diminished or absent breath sounds on the affected side.
A blood pressure (BP) of 140/90 mm Hg is considered to be normal. prehypertension. hypertension. a hypertensive emergency.
hypertension
What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. hypertension diabetes obesity lowered triglyceride levels active lifestyle family history of early cardiovascular events
hypertension diabetes obesity family history of early cardiovascular events
A client is being seen by the physician because of an unrelenting headache, facial tenderness, low-grade fever, and dark yellow nasal discharge. The client reports seeming to develop sinus infections "all the time." Which factor may predispose the client to sinusitis?
interference with sinus drainage
An older male client with a history of chronic laryngitis reports a persistent hoarseness. What condition is the client at risk to develop?
laryngeal cancer
The classification of grade I COPD is defined as
mild COPD.
Raynaud's Disease
~Intermittent arterial vasocclusion, usually of the fingertips or toes ~This phenomenon is associated with other underlying disease such as scleroderma Manifestations ~Sudden vasoconstriction results in color changes, numbness, tingling, and burning pain Triggered by ~Cold and Stress ~Vasoconstriction ~Not permanent ~Ineffective circulation
Lymphatic Disorders
~Lymphangitis- Inflammation or infection of the lymphatic channels ~Lymphadenitis- Inflammation or infection of the lymph nodes ~Lymphedema- Tissues swelling related to obstruction of lymphatic flow. Primary- Congenital Secondary- Acquired obstruction Medical ~Pharmacologic therapy ~Surgery Nursing ~Antibiotics ~Elevation ~Educate-avoid heating pads
Upper Extremity Arterial Disease
~Occurs less frequently than lower extremities Clinical Manifestations ~Arm fatigue, pain with exercise, inability to hold or grasp objects, difficulty driving, subclavian steal Assessment/Diagnostic ~Coolness and pallor in the affected extremity ~Decreased capillary refill ~Difference in bp of more than 20mm hg Nursing Management ~Check bp in both arms ~Postoperative -> Keep arm above heart level, protect from cold, no venipunctures, no tape or constrictive dressings
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? "Your blood pressure is fine. Just keep doing what you're doing." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."
"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:
"Have you tried to quit smoking before?"
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension often causes no symptoms." "Hypertension often kills early in the disease process." "Hypertension often causes no pain." "Hypertension is difficult to diagnose."
"Hypertension often causes no symptoms."
The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?
"I can't use a spacer or holding chamber with the MDI."
A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?
"I do not need to rinse my mouth with this type of inhaler."
The nurse is obtaining a health history from a client with laryngitis. Which causative factor, stated by the client, is least likely?
"I was chewing ice chips all day long."
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "A glass of red wine each day will lower my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure."
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? "Eat a banana every day because this medication causes moderate hyperkalemia." "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." "This medication increases sodium levels in your blood, so cut down on your salt."
"This medication can cause low blood pressure and dizziness, especially when you get up suddenly."
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 145/95 or lower 130/80 or lower 150/95 or lower 125/85 or lower
130/80 or lower
The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of
2 to 12 days
A 73-year-old client is admitted to the pulmonology unit of the hospital. She was admitted with pleural effusion and was "tapped" to drain the fluid to reduce her mediastinal pressure. How much fluid is typically present between the pleurae, which surround the lungs, to prevent friction rub?
20 mL or less
According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8
4 or 5
The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.
60 mm Hg; 90%
A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? A cuff that is too small will give a false high blood pressure. A cuff that is too small will give a false low blood pressure. A cuff that is too large will give a false high blood pressure. The size of the cuff does not matter as long as it fits snugly around the arm.
A cuff that is too small will give a false high blood pressure.
Which statement describes emphysema?
A disease of the airways characterized by destruction of the walls of overdistended alveoli
A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a client with hypertension, the nurse learns that the client has a family history of hypertension and she herself has high cholesterol and lipid levels. The client says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? Hyperlipidemia Excessive alcohol intake A family history of hypertension Closer adherence to medical regimen
A family history of hypertension
A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem? Acute kidney injury Right ventricular hypertrophy Glaucoma Anemia
Acute kidney injury
Which action should the nurse take first when providing care for a client during an acute asthma attack?
Administer prescribed short-acting bronchodilator.
A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs?
Administer the salmeterol and then administer the triamcinolone.
Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)?
Amoxicillin
The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as
Atelectasis
A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply.
Atelectasis Respiratory failure Status asthmaticus
The nurse is providing care for a client with a diagnosis of hypertension. The nurse should consequently assess the client for signs and symptoms of which other health problem? Migraines Atrial-septal defect Atherosclerosis Thrombocytopenia
Atherosclerosis
A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this client's care, what desired outcome should the nurse identify? Client takes medication as prescribed and reports any adverse effects. Client's BP remains consistently below 140/90 mm Hg. Client denies signs and symptoms of hypertensive urgency. Client is able to describe modifiable risk factors for hypertension.
Client takes medication as prescribed and reports any adverse effects.
The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include? Client will reduce Na+ intake to no more than 2.4 g daily. Client will have a stable BUN and serum creatinine levels. Client will abstain from fat intake and reduce calorie intake. Client will maintain a normal body weight.
Client will reduce Na+ intake to no more than 2.4 g daily.
PAD Clinical Manifestations and Assessment/Diagnostic
Clinical Manifestations ~!Hallmark sign is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest ~As the disease progresses may have decreased ability to walk and pain at rest Assessment/Diagnostic ~A sensation of coldness or numbness in the extremities, skin, and nail changes, bruits (different kinds of blood flow), decreased peripheral pulses ~Exam peripheral pulses ~May use CW Doppler and ABI's (ankle brachial inspection- testing RN DOES NOT DO) treadmill testing for claudication, duplex ultrasonography
A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse?
Collects sputum for culture and sensitivity
Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply.
Compromised gas exchange Decreased airflow Wheezes
A nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer?
Cough or change in chronic cough
A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations?
Cromolyn sodium
The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care?
Develop an alternate method of communication.
A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client?
Developing a list of people with whom the client has had contact
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. With ACE inhibitors, assess for bradycardia. Beta-blockers may cause sedation. Direct vasodilators may cause headache and tachycardia. Cough is a common side effect of adrenergic inhibitors. With thiazide diuretics, monitor serum potassium concentration.
Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? dizziness persistent cough blurred vision tremor
Dizziness
What is the reason for chest tubes after thoracic surgery?
Draining secretions, air, and blood from the thoracic cavity is necessary.
A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis?
Group A, beta-hemolytic streptococci
Asthma is cause by which type of response?
IgE-mediated
A client reports nasal congestion, sneezing, sore throat, and coughing up of yellow mucus. The nurse assesses the client's temperature as 100.2°F. The client states this is the third episode this season. The highest priority nursing diagnosis is
Ineffective airway clearance related to excess mucus production
PAD Medical/Nursing Managments
Medical ~Walking program ~Pharmacologic therapy ~Endovascular management (balloon, stent, ect) ~Surgical management Nursing ~Nursing care of the postoperative patient after procedure -> Maintain circulation!!!, monitor and manage complications, promote home care, community-based and transitional care
Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply.
Mucus secretions block airways. Overinflated alveoli impair gas exchange. Inflamed airways obstruct airflow.
A client has acute bacterial rhinosinusitis for several weeks despite treatment. The nurse observes for a possible complication of the infection by assessing for
Nuchal rigidity
The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS?
Rapid onset of severe dyspnea
A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the client will not suffer a stroke. Reduce the blood pressure by 50% within the first hour of treatment.
Reduce the blood pressure by 20% to 25% within the first hour of treatment.
A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? Renal failure Right ventricular hypertrophy Glaucoma Anemia
Renal failure
The nurse is caring for a client with an endotracheal tube. Which client data does the nurse interpret as a life-threatening situation?
Sudden restlessness
The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for:
Symmetry of the client's chest expansion
A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply.
Take a slow, deep inhalation from the device. The device may increase delivery of the MDI medication. Activate the MDI once
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?
Take ordered medications as scheduled.
DVT Complications
Valvular destruction: •Chronic venous insufficiency •Increased venous pressure •Varicosities •Venous ulcers Venous obstruction: •Edema •Fluid stasis •Increased distal pressure •Venous gangrene
Most cases of acute pharyngitis are caused by which of the following?
Viral infection
Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?
Vitamin B6
Which type of ventilator has a preset volume of air to be delivered with each inspiration?
Volume-controlled
A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan?
Wearing a disposable particulate respirator that fits snugly around the face
A client with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed?
With meals
Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy?
impaired verbal communication
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes
implementing measures to clear pulmonary secretions.
The nurse is reviewing the diet of a client who has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine because caffeine: increases the heart rate and causes vasoconstriction. reduces the heart rate and leads to a coronary artery disease. reduces the heart rate and causes low blood pressure. increases the heart rate and causes angina.
increases the heart rate and causes vasoconstriction.
A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should:
instruct the client to drink at least 2 L of fluid daily.
The classification of Stage II of COPD is defined as
moderate COPD.
The nurse is caring for a client following a tonsillectomy and adenoidectomy. Two hours after the procedure, the client begins to vomit large amounts of dark blood at frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse
obtains a light, mirror, gauze, and curved hemostats.
Arterial blood gas analysis would reveal which value related to acute respiratory failure?
pH 7.28
A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as
pleural effusion.
The classification of Stage III of COPD is defined as
severe COPD.
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:
sit upright, leaning slightly forward.
Arterial Embolism and Arterial Thrombosis (Clots)
~Acute vascular occlusion may be caused by an embolus or acute thrombosis Pathophysiology ~ Aortic dissections (separations) are commonly associated with poorly controlled hypertension, blunt chest trauma, and cocaine use Clinical Manifestation ~Depends on size organ involvement, and state of collateral circulation ~ 6 P's- Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia (coldness), and Paralysis (not all have to be present) Assessment/Diagnostic ~Usually diagnosed on the basis of the sudden nature of the onset of symptoms and the apparent source of the embolus
Leg Ulcers
~An excavation of the skin surface that occurs when inflamed necrotic tissue sloughs off Pathophysiology ~Inadequate exchange of oxygen and other nutrients in the tissue ~When cellular metabolism cannot maintain energy balance, cell death (necrosis) results ~Severity depends on extent and duration ~Comes with comorbidities
Arterial Disorders
~Cause ischemia (restricted blood supply) and tissue necrosis ~May occur because of chronically progressive pathologic changes to the arterial vasculature (ex-Atherosclerotic changes) or due to an acute loss of blood flow to tissues (ex-aneurysm rupture) Arteriosclerosis and Atherosclerosis Peripheral Arterial Occlusive Disease Upper Extremity Arterial Occlusive Disease Aortoiliac Disease Arterial Embolism and Arterial Thrombosis Raynaud's Phenomenon and other Acrosyndromes
Other Diagnostic Evaluations and Nursing Implications
~Computed Tomography Scanning ~Angiography ~Magnetic Resonance Angiography ~Contrast Phlebography (Venography) ~Lymphoscintigraphy On procedures includes education on process, special dyes to be used and after procedure instructions
A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?
"Delay self-care activities for 1 hour."
A client exhibits a sudden and complete loss of voice and is coughing. The nurse states
"Do not smoke and avoid being around others who are smoking."
A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family?
"Family members should continue to talk to the client."
A client with newly diagnosed hypertension has come to the clinic for a follow-up visit. The client asks the nurse why she has to come in so often. What would be the nurse's best response? "We do this so we can identify any of the early symptoms of a stroke." "We do this to determine how your blood pressure changes throughout the day." "We do this to see how often you should change your medication dose." "We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."
"We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."
A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care?
"You must consume a diet rich in protein, such as chicken, fish, and beans."
A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? Pacific Islanders African-Americans Asians Hispanics
African-Americans
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Age Obesity Inactivity Dyslipidemia
Age
A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?
Albuterol
A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client?
Albuterol
In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply.
Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first?
An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection?
An antiviral agent such as acyclovir
A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?
An inhaled beta2-adrenergic agonist
Anatomy and Function of the Vascular System
Anatomy ~Arteries, Arterioles, Capillaries, Veins, Venules, Lymphatic Vessels Function ~Circulatory needs of tissues ~Blood flow- One way system ~Blood pressure ~Peripheral vascular regulating mechanisms
A client has been diagnosed as experiencing "white-coat hypertension." This refers to: anxiety insomnia depression loss of consciousness
Anxiety
A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?
Anxiety
The nurse is caring for a client admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been put in place. Which intervention should the nurse include in the client's care?
Apply an ice pack.
A client comes into the Emergency Department with epistaxis. What intervention should you perform when caring for a client with epistaxis?
Apply direct continuous pressure.
A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis?
Apply direct continuous pressure.
A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks?
Applying nasal packing
Arteriosclerosis and Atherosclerosis
Arteriosclerosis- Hardening of the arteries. Is the most common disease of the arteries Atherosclerosis- Affects the intima of large and medium-sized arteries. ~Accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery (atheromas or plaques) ~Can be used interchangeable because one rarely occurs without the other
A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take?
Assesses fasting blood glucose levels
DVT Assessment/Prevention
Assessment ~Careful assessment, history collection, obesity, oral contraceptive use ~Ask about limb pain, feeling of heaviness, functional impairment, areas of tenderness ~Compare extremities Prevention ~Graduated compression stockings ~Use of intermittent pneumatic compression devices ~Early ambulation ~Leg exercises ~Administration of subcutaneous unfractionated heparin or low-molecular-weight heparin (LMWH) ~Weight loss ~Smoking cessation
The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised?
Auscultate lung sounds.
A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned?
Auscultate the lung for adventitious sounds.
An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? C-reactive protein (CRP) levels Sodium, chloride, and potassium levels Arterial blood gas (ABG) results Blood urea nitrogen (BUN) and creatinine levels
Blood urea nitrogen (BUN) and creatinine levels
Which statement is true about both lung transplant and bullectomy?
Both procedures improve the overall quality of life of a client with COPD.
The nurse is caring for a client status post adenoidectomy. The nurse finds the client in severe respiratory distress when entering the room. What does the nurse suspect?
Edema of the upper airway
Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require?
Emotional support
A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder?
Emphysema
A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care?
Encouraging increased fluid intake
The nurse assesses a client who is bleeding profusely from the nose. The nurse documents this finding as which condition?
Epistaxis
A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates?
Flail chest
The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.
Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.
A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension: has a specific cause. has a more gradual onset than primary hypertension. does not normally cause target organ damage. does not normally respond to antihypertensive drug therapy. TAKE ANOTHER QUIZ
Has a specific cause
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client
Has wheezes in the right lung lobes
The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? Screen the client for visual disturbances regularly. Have the client participate in monitoring his or her own BP. Emphasize the dire health outcomes associated with inadequate BP control. Encourage the client to lose weight and exercise regularly.
Have the client participate in monitoring her or her own BP.
Assessment of the Vascular System
Health History ~Obtain description from the patient with PVD (Peripheral Arterial Disease) of any pain and its precipitating factors ~Intermittent claudication (arterial) ~"rest pain" and location of pain Physical Assessment ~Skin- Appearance- Cool, pallor, rubor, loss of hair, brittle nails, dry or scaling skin, atrophy, or ulcerations
The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) Heart rate Respiratory rate Heart rhythm Character of apical and peripheral pulses Lung sounds
Heart rate Heart rhythm Character of apical and peripheral pulses
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?
High-protein
The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention?
Hoarseness for 2 weeks
A nurse takes the initial history of a patient who is being examined for cancer of the larynx. Select the sign that is considered an early clinical indicator.
Hoarseness of more than 2 week's duration
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems?
Hypercapnia, hypoventilation, and hypoxemia
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? The BP is always higher in a hypertensive emergency. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. Hypertensive urgency is treated with rest and benzodiazepines to lower BP. Hypertensive emergencies are associated with evidence of target organ damage.
Hypertensive emergencies are associated with evidence of target organ damage
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? Hypertensive emergency Hypertensive urgency Primary hypertension Secondary hypertension
Hypertensive emergency
The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result?
Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing
Arteriosclerosis and Atherosclerosis Nursing Management
Improve peripheral arterial circulation ~Positioning ~Walking/exercise Promoting Vasodilation and Preventing Vascular Compression ~Application of warmth-hot water bottle or heating pad may be applied to the abdomen causing vasodilation of the lower extremities ~Don't use nicotine products Relive Pain Maintain Tissue Integrity ~Healing avoid trauma, nutrition
Which measure may increase complications for a client with COPD?
Increased oxygen supply
A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? Drowsiness or lethargy Increased urine output Decreased heart rate Mild agitation
Increased urine output
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. decreases circulating blood volume.
Increases the heart rate, constricts arterioles, and reduces the heart's ability t eject blood.
Which is the priority nursing diagnosis for a client undergoing a laryngectomy?
Ineffective airway clearance
A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be:
Ineffective airway clearance.
A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects?
Ineffective coping related to anxiety
A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.
Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange
Which of the following is the key underlying feature of asthma?
Inflammation
A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse? Inform the client that this is why hypertension is known as "the silent killer." Inform the client that remaining unmedicated is all right in conjunction with routine follow-up. Suggest that the client try an herbal supplement instead. Inform the client there should be no problems as long as she a low sodium diet is maintained.
Inform the client that this is why hypertension is known as "the silent killer."
The nurse is caring for a client who underwent a laryngectomy. Which intervention will the nurse initially complete in an effort to meet the client's nutritional needs?
Initiate enteral feedings.
A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first?
Initiate oxygen therapy.
The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal? Less than 140/90 mm Hg Less than 130/90 mm Hg Less than 129/89 mm Hg Less than 120/80 mm Hg
Less than 120/80 mm Hg
The nurse is developing a teaching plan for a client diagnosed with hypertension. What would be important for the nurse to emphasize as part of the plan of care? Limiting sodium intake in the diet Limiting cigarette smoking to 1 pack a week Limiting alcohol to a can of beer to four times a day to thin the blood Limiting activity to prevent over exertion
Limiting sodium intake in the diet
The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? Lowering and controlling the blood pressure without adverse effects and without undue cost Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence
Lowering and controlling the blood pressure without adverse effects and without undue cost
A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess?
Lung sounds
Leg Ulcers Manifestations/Assessments
Manifestations Arterial ~Intermittent claudication (comes with comorbidities) ~Pain (unrelenting not relieved from opioids) ~Ulcers are small, circular, deep ulcerations Venous ~Aching, heavy sensation ~May have edema ~Ulcers are large, superficial, and highly exudative (moist/wet) Assessments ~Identify cause ~History and pulses ~Doppler and duplex ultrasound, arteriography, venography
PE Manifestations/Assessments
Manifestations ~Dyspnea (difficulty breathing) ~Chest pain ~Anxiety, fear, apprehension (appending doom feeling) ~Tachycardia (high BP) ~Cough ~Diaphoresis (sweating) ~Hemoptysis (coughing up blood) Assessment ~Chest x-ray ~ECG ~Pulse ox ~ABG's ~D-dimer ~Pulmonary arteriogram or V/Q scan
Cellulitis
Manifestations ~Localized swelling or redness, warmth, pain, and systemic signs such as fever, chills, sweating Medical ~Treat with oral or IV antibiotics based on severity Nursing ~Elevate ~Warm, moist packs to site every 2-4 hr ~Educate regarding prevention of recurrence ~Reinforce education about skin and foot care
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside?
Manual resuscitation bag
What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?
Mast cells
Arterial Embolism and Arterial Thrombosis (Clots) Medical/Nursing Managements
Medical ~Depends on the cause ~Heparin ~Endovascular management ~Pharmacologic therapy Nursing ~Bed rest with affected extremity level or slightly elevated ~Vital signs, continuous monitoring, monitor for hemorrhage ~Post op care ~TPA- Clot buster (time frame to use)
Raynaud's Disease Medical/Nursing Management
Medical ~Protect from cold and other triggers (tobacco) ~Avoid injury to hands and fingers -won't be able to heal Nursing ~Avoid stress ~Layer clothing ~Wear gloves during the cold
PE Medical/Nursing Management
Medical ~Unstable- Stabilize cardiopulmonary, May need emergency measures ~Stable- Cardiovascular stability, immediate anticoagulation is indicated Nursing ~Managing Oxygen Therapy!!! ~Monitoring thrombolytic therapy ~Managing pain ~Relieving anxiety ~Post op care ~Transition home care
DVT Medical/Nursing Management
Medical ~Preventing thrombus from growing and fragmenting ~Pharmacologic therapy- Heparin and Warfarin ~Cannot dissolve a thrombus that has already formed ~May need to combine anticoagulation with endovascular management ~Endovascular management- Done when contraindications for anticoagulation therapy, danger of PE is extreme, or permanent damage is highly likely Nursing ~Educate on watching for signs of excessive bruising, gum bleeding, bloody stool ~Monitor lab values for anticoagulation therapy- PTT (partial thromboplastin time), PT (Prothrombin time), INR (International normalized ratio- Therapeutic range 2-3.5!!!), ACT (activated clotting time), Hemoglobin and hematocrit, platelet, fibrinogen levels ~Monitor for complications- Bleeding, thrombocytopenia (low platelet levels), drug interactions (herbals) ~Reduce discomfort- Elevate, providing compression therapy, analgesics ~Positioning the body and promoting exercise ~Home care
A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?
Oxygen through nasal cannula at 2 L/minute
A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing this client with flail chest?
Paradoxical chest movement
A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following?
Partial laryngectomy
A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education?
Partial laryngectomy
Deep Vein Thrombosis Pathophysiology/Manifestations
Pathophysiology ~Formation may frequently accompany phlebitis (inflimation/infection) ~Can occur in any vein but more commonly in the lower extremities ~Deep veins of the thighs or calf Manifestations ~Deep veins- Edema, swelling of the extremity, affected extremity may feel warmer than unaffected extremity, tenderness ~Superficial veins- Pain or tenderness, redness, warmth ~SCD, Moving, Walking- Used to help prevent DVT
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension? Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.
Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.
The nurse is preparing to perform tracheostomy care for a client with a newly inserted tracheostomy tube. Which action, if performed by the nurse, indicates the need for further review of the procedure?
Places clean tracheostomy ties then removes soiled ties after the new ties are in place without a second nurse assisting
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? Postural hypertension and resulting injury Rebound hypertension Sexual dysfunction Postural hypotension and resulting injury
Postural hypertension and resulting injury
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?
Providing sufficient oxygen to improve oxygenation
A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic control
Purchasing a self-monitoring BP cuff
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?
Respiratory acidosis
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?
Respiratory acidosis
The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?
Respiratory alkalosis
A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?
Respiratory rate of 22 breaths/minute
Which finding indicates that hypertension is progressing to target organ damage? Retinal blood vessel damage Urine output of 60 mL over 2 hours Blood urea nitrogen concentration of 12 mg/dL Chest x-ray showing pneumonia
Retinal blood vessel damage
Arteriosclerosis and Atherosclerosis Risk Factors and Preventions
Risk Factors ~Modifiable- Smoking (most important), Diabetes (increases overall risk of PAD), Hypertension, Hyperlipidemia, Diet, Stress, Sedentary lifestyle, Elevated C-reactive protein (can detect inflammation) ~Non-modifiable- Age, Genetics Preventions ~Diet- AHA recommends reduce the amount of fat in a diet, eat unsaturated fats rather than saturated fats, and decrease cholesterol intake ~Exercise ~Medications ~Decrease Hypertension ~Stop using tobacco products
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. Gallbladder disease Smoking Diabetes mellitus Physical inactivity Frequent upper respiratory infections
Smoking Diabetes mellitus Physical inactivity
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? Furosemide Spironolactone Chlorothiazide Chlorthalidone
Spironolactone
A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?
Sputum and a productive cough
A client comes to the walk-in clinic complaining of frequent headaches. While assessing the client's vital signs, the nurse notes the BP is 161/101 mm Hg. How would this client's BP be defined? Elevated Normal Stage 1 hypertensive Stage 2 hypertensive
Stage 2 hypertensive
Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. The incidence and prevalence of hypertension increase with age. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.
The incidence and prevalence of hypertension increase with age.
Hemodynamic Resistance
The most important factor that determines resistance in the vascular system is the vessel radius. Small changes in vessel radius lead to large changes in resistance. Veins dilate = fight-or-fight
The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient?
The patient is hypoxic from suctioning.
A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?
The system has an air leak.
A commonly prescribed methylxanthine used as a bronchodilator is which of the following?
Theophylline
A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less To stop smoking and increase physical activity to 30 minutes/day most days of the week To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less
A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client? Quitting smoking will cause the client's hypertension to resolve. Tobacco use increases the client's concurrent risk of heart disease. Tobacco use is associated with a sedentary lifestyle. Tobacco use causes ventricular hypertrophy.
Tobacco use increases the client's concurrent risk of heart disease.
The nurse is caring for a client in the physician's office with a potential sinus infection. The physician orders a diagnostic test to identify if fluid is found in the sinus cavity. Which diagnostic test, written by the physician, is specifically ordered for this purpose?
Transillumination of the sinus
A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following? Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Drank adequate fluids during the day prior Avoided drinking coffee for 12 hours before the visit
Tried o rest quietly for 5 minutes before the reading is taken
A patient has come to the clinic for a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has: Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Been NPO for at least 2 hours Avoided drinking coffee for 12 hours before the visit
Tried to rest quietly for 5 minutes before the reading is taken
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. What should the nurse include in health education? Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker Maintaining a diet high in dairy to increase protein necessary to prevent organ damage Use of strategies to prevent falls stemming from postural hypotension Limiting exercise to avoid injury that can be caused by increased intracranial pressure
Use of strategies to prevent falls stemming from postural hypotension
Exercise Testing
Used to determine how long a patient can walk and to measure the ankle systolic bp in response to walking
For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
Using a Venturi mask to deliver oxygen as ordered
The nurse is providing discharge instructions for a client following laryngeal surgery. The nurse instructs the client to avoid
swimming.
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:
uses the sternocleidomastoid muscles.
The classification of Stage IV of COPD is defined as
very severe COPD.
Varicose Veins Prevention and Medical/Nursing Management
~ ~Prevention (is key) ~Avoid activities that cause venous stasis (wearing socks that are too tight at the top or that leave marks on the skin, crossing the legs at the thighs, and sitting or standing for long periods) ~Elevate the legs 3-6 inches higher than heart level ~Walk for several minutes of every hour to promote circulation and 1 or 2 miles each day if no contraindications ~Wear graduated compression stockings ~Overweight patients should be encouraged to begin weight loss ~Thermal ablation Medical ~Microphlebectomy ~Sclerotherapy ~Ligation and Stripping Nursing ~Promoting comfort and understanding ~Promoting home, community-based, transitional care
Arteriosclerosis and Atherosclerosis Pathophysiology
~Direct results-narrowing (stenosis) of the lumen, obstruction by thrombosis, aneurysm, ulceration and rupture ~Indirect results-malnutrition and the subsequent fibrosis of the organs that the sclerotic arteries supply with blood ~All actively functioning tissue cells require an abundant supply of nutrients and oxygen and are sensitive to any reduction in the supply of these nutrients ~Ischemic necrosis can occur if blood supply is reduced ~Collateral circulation (unintended redirected blood flow) ~Two types- Fatty streaks and Fibrous plaque
Adequate Perfusion
~Ensures oxygenation and nourishment of body tissues, and it depends in part on a properly functioning cardiovascular system ~Depends on the efficiency of the heart as a pump, the patency (how open) and responsiveness (the sending back) of the blood vessels, and the adequacy of circulating blood volume
Peripheral Artery Disease
~Occurs most often in men, common cause of disability ~Age and onset ~Obstructive lesions are predominantly confined to segments of the arterial system extending from the aorta below the renal arteries to the popliteal artery
Aortoiliac Disease
~Patents with a stenosis or occlusion of the aortoiliac segment may be asymptomatic, may have pain in the buttocks, or low back discomfort when walking, especially if collateral circulation Medical Management ~Same for atherosclerotic PAD Nursing Management ~Pre-op and Post op assessments
Pathophysiology of the Vascular System
~Pump failure ~Alterations in blood (ex. thinner blood affects even good blood vessels) and lymphatic vessels ~Circulatory insufficiency of the extremities ~Aging produces changes in the walls of the blood vessels that affect the transport of oxygen and nutrients to the tissues
Venous Thromboembolism
~The blockage of a blood vessel by a thrombus carried through the bloodstream from its site of formation Pathophysiology ~Virchow triad- Endothelial change (caused by smoking), Venous stasis (immobility after surgery or sickness), Altered coagulation (caused by smoking) ~Trauma, anticoagulation medications, oral contraceptives, elevated CRP levels (inflammation), blood dyscrasias, pregnancy (because of increased blood flow)
Chronic Venous Insufficiency/Post thrombotic Syndrome
~Venous insufficiency results from obstruction of the venous valves in the legs or a reflux of blood through the valves Manifestations ~Chronic venous stasis resulting in edema ~Altered pigmentation ~Pain ~Stasis dermatitis- notice more in the evening and less in morning ~Develop stasis ulcers ~Can happen on its own or after a thrombus Management ~Prevent ulceration and reduce venous stasis ~Provide compression therapy- Stocking (placed correctly) Gerontologic considerations (educate) ~External compression ~Intermittent pneumatic compression devices
