Midterm 131

1 point Digoxin (Lanoxin) is administered to a patient with heart failure primarily because the drug helps: dilate coronary arteries increase contractility decrease cardiac dysrhythmias decrease the electrical conductivity of the myocardium

B

1 point Nursing interventions for a burn patient with an intravascular fluid volume deficit would include all of the following except: placing the patient in the gupine position to maximize cerebral and renal blood flow teaching leg exercises to promote venous return and prevent postural hypotension when the patient stands monitoring urinary output to assess kidney perfusion IV fluids as ordered to expand intravascular compartment

B

1 point Oral potassium chloride is ordered. The nurse should schedule this drug to be given: Between meals With meals At bedtime Before meals

B

1 point The myocardial fiber length of the ventricle at end diastole is known as: cardiac index preload afterload contractility

B

1 point The order indicates to give K-Dur 20 mEq. bid. Your patient's potassium level is 7.5 mEq/L. What is the appropriate nursing intervention? Call the dialysis team. Hold the potassium and notify the physician immediately. Give the potassium as ordered. Hold the potassium, and leave a note on the patient's chart for the physician.

B

1 point To help maintain a normal blood level of potassium, the patient should be encouraged to include which of the following foods in their diet? hard cheeses beans and celery bananas and orange juice dairy products

C

1 point When administering Coumadin therapy, the nurse needs to monitor which test to make certain that it is within the therapeutic range: bleeding time clotting reaction time international normalized ratio (INR activated partial thromboplastin time (aPTT)

C

1 point When increased osmolarity causes the pituitary to release ADH, the kidney will: Be unaffected Eliminate water from the plasma Reabsorb water into the plasma Reabsorb potassium

C

1 point You are given the following parameters on your patient: Cardiac Output 6L/minute; HR 76 bpm; BP 150/68; Cardiac index 2.8L/minute/m2. What is the patient's stroke volume? 60 ml 100 ml 79 ml 82 ml

C

1 point Your patient had a sub-total thyroidectomy. What assessment would you make to determine if there has been any trauma to the parathyroid gland? Check for third spacing Check respiratory rate Check for Chvostek's sign Check for Babinski's sign

C

13 1 point Besides its responsibility for fluid balance, sodium is also responsible for: Good eyesight and vitamin balance Growth Impulse transmission Bone structure

C

15 1 point The best indicator of extracellular fluid volume deficit can be identified by assessing for: an elevated temperature a full and bounding pulse a drop in blood pressure pitting edema of the lower extremities

C

11 1 point After teaching a patient with congestive heart failure (CHF), the nurse assesses the patient's understanding. Which patient statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.) "I will drink at least 5 L of water each day: "A high salt diet will reduce the workload of my heart.: "I'll read the nutritional labels on food items for salt content." "I will eat oatmeal for breakfast instead of ham and eggs: "Substituting fresh vegetables for canned ones will lower my salt intake.

CDE

1 point A nurse assesses a patient after administering a prescribed beta-blocker. Which assessment would the nurse expect to find? Oxygen saturation increased from 88% to 96% Blood pressure increased from 98/42 to 132/60 mm Hg Respiratory rate decreased from 25 to 14 breaths/min Pulse decreased from 100 to 80 beats/min

D

1 point A nurse assesses a patient with mitral valve stenosis. What clinical manifestation would alert the nurse to the possibility that the patient's stenosis has progressed? Dyspnea on exertion Decreased CVP Upper extremity weakness Oxygen saturation of 92%

D

1 point A patient with heart failure has been prescribed enalapril (Vasotec). As the nurse, you know this drug will: Decrease HR Increase afterload Increase HR Decrease afterload

D

1 point As pulmonary edema increases, the lungs are unable to maintain adequate ventilation and the result is: Metabolic acidosis Metabolic alkalosis Respiratory alkalosis Respiratory acidosis

D

1 point The movement of molecules from an area of higher concentration to an area of lower concentration is called: Osmosis Oncotic pressure Hydrostatic pressure Diffusion

D

1 point The nurse can expect that because a patient has mitral stenosis, they will most likely demonstrate symptoms typical of those associated with congestion in the: aorta superior vena cava right atrium pulmonary circulation

D

1 point The nurse should be especially alert to assess for signs and symptoms of digitalis toxicity if laboratory blood findings indicate that the patient has a: high calcium level low sodium level high glucose level low potassium level

D

1 point Which of the following is a function of potassium? Osmotic pressure of the extracellular fluid Inhibit kidney function Regulate ADH Nerve impulse transmission

D

1 point Which of the following patients is at most risk for hypocalcemia? A hypertensive patient on diuretics A patient with coronary artery disease A patient with fluid volume deficit A thyroidectomy patient who had inadvertent removal of his parathyroid glands

D

1 point Your client is on a low-sodium diet. Which of the following items should they eliminate from their diet? Margarine Milk Canned tomato juicê Lamb

D

12 1 point Your patient had a sub-total thyroidectomy. What assessment would you make to determine if there has been any trauma to the parathyroid gland? Check respiratory rate Check for third spacing Check for Babinski's sign Check for Chvostek's sign

D

5 1 point Which of the following clients is most at risk for fluid volume deficit? A 90-year-old with frequent headaches A 2-year-old who can now drink from a cup A 12-year-old who is moderately active in 80° F weather • A 42-year-old with severe diarrhea

D

1 point Carpal pedal spasm could be interpreted as a: Positive Trousseau's sign Negative Chvostek's sign Negative Trousseau's sign Positive Chvostek's sign

A

1 point The acid-base imbalance in elderly persons is compounded because there is decreased respiratory ventilation and CO2 is retained. Which acid-base imbalance would this cause? Respiratory acidosis Metabolic alkalosis Metabolic acidosis Respiratory alkalosis

A

1 point The nurse assesses distended neck veins in a client sitting in a chair. What intervention is the nurse's priority? • Assess the pulse and blood pressure. Document the observation in the chart. Assess the client's deep tendon reflexes. Measure urine specific gravity and volume.

A

1 point The nurse would counsel a client who is to wear a Holter monitor to: Keep a record of daily activities Remove the electrodes when near water Exercise as much as possible while the monitor is in place Refrain from activities that cause chest pain

A

1 point The proportion of blood that is ejected during each ventricular contraction compared with the total ventricular filling volume is called the: Ejection fraction Cardiac index Stroke volume Cardiac output

A

1 point Which determination is essential to evaluate when caring for a patient who is considering mechanical valve replacement? Can the patient comply with the lifelong requirement for anticoagulant therapy? Is the patient able to cooperate fully and participate in a cardiac rehabilitation program? Will the patient experience body image problems? Does the patient require a high level of energy in their employment status?

A

1 point Which of the following will stimulate the release of ADH (antidiuretic hormone)? © Serum Osmolality of 340 mOsm/kg Serum Na+ of 130 mEg/L Serum K+ of 4.0 mEg/L Serum Osmolality of 270 mOsm/kg

A

1 point he acid-base imbalance in elderly persons is compounded because there is decreased respiratory ventilation and CO2 is retained. Which acid-base imbalance would this cause? Respiratory acidosis Metabolic alkalosis Metabolic acidosis Respiratory alkalosis

A

12 1 point Nursing interventions for patient with severe fluid overload would include all of the following except: assisting the patient to a low-Fowlers position to minimize his breathing efforts teaching dietary restriction of sodium to help decrease water retention inspecting for sacral edema to note the degree of fluid retention administering diuretics, as ordered, to help remove excess fluid

A

1 point A nurse is caring for a patient with a history of renal insufficiency who is scheduled for a cardiac catheterization. What actions would the nurse take prior to the catheterization? (Select all that apply.) Assess blood urea nitrogen (BUN) and creatinine results. Assess for allergies to iodine. Administer a prophylactic antibiotic. Insert a central venous catheter. Insert a Foley catheter. Establish IV access.

ABF

1 point After teaching a patient who is being discharged home after a mechanical mitral valve replacement surgery, the nurse assesses the patient's understanding. Which patient statement indicates a need for additional teaching? *I'm going to take some time off, but then I should be able to return to work in a few weeks. "I'm going to have my teeth cleaned by my dentist tomorrow" "I must keep my intake of vitamin K containing foods consistent.: "I must use an electric razor instead of a straight razor to shave.

B

1 point An 88-year-old male is suffering with congestive heart failure. He is admitted to the hospital with a diagnosis of extracellular fluid volume excess. He is frightened, slightly confused, and dyspneic on exertion. During the assessment process, the nurse would expect to identify all of the following except: A full pulse Decreased central venous pressure Edema Neck vein distention

B

1 point An Anion Gap of 20m Eq/L is: Indicative of respiratory acidosis Indicative of metabolic acidosis Indicative of metabolic alkalosis Indicative of respiratory alkalosis

B

1 point A 32-year-old male, has renal failure. He is admitted to the hospital because his symptoms are becoming progressively worse. The patient's serum potassium level is 6.9 mEq/L What is the priority nursing intervention? Measure urinary output Monitor the electrocardiogram (ECG, EKG) Obtain daily blood levels of potassium Assess Gl function

B

1 point A 73 year old client is being evaluated for the presence of heart failure. The nurse is palpating the precordium. Normally, the point of maximal intensity (PMI) should be noted in which position? At the level of the sternal manubrium The fifth intercostal space, medial to the left mid-clavicular line 2nd intercostal space left sternal border To the left of the Angle of Louis

B

1 point A frequent adverse effect of angiotensin-converting enzyme (ACE) inhibitors is: Hypokalemia Ticklish, dry cough Night sweats Bradycardia

B

1 point A nurse assesses a patient who has mitral valve regurgitation. Which type of murmur would the nurse expect? No murmur Systolic murmur Diastolic murmur Diastolic and systolic murmur

B

1 point A nurse teaches a patient with diabetes mellitus and a body mass index of 42 who is at high risk for coronary artery disease. Which statement related to nutrition would the nurse include in this patient's teaching? "A nutritionist will provide you with information about your new diet." There is a need to balance weight loss with the consumption of necessary nutrients. "If you exercise more frequently, you won't need to change your diet.I "The best way to lose weight is a high-protein, low-carbohydrate diet."

B

1 point A patient is diagnosed as having essential hypertension. She asks the nurse what causes this disease. Which is the most appropriate response? It is caused by a kidney problem. It is believed to be caused by a number of factors, not just one. It is caused by arteriosclerotic vessel disease. It is a result of a decrease in plasma renin levels.

B

1 point 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-angiotensin-aldosterone (RAA) decreases, AH decreases, urine output increases Renal blood flow decreases, renin-angiotensin-aldosterone (RAA) increases, urine output decreases Renal blood flow increases, aldosterone decreases, urine output increases Renal blood flow increases, renin-angiotensin-aldosterone RAA increases, AH decreases, urine output decreases

B

1 point Antihypertensive medications include agents from all of the following drug classes except: Calcium channel blockers Adrenergics Beta-Blockers * Angiotensin-converting enzyme inhibitors

B

1 point What produces the second heart sound (S2) and when does it occur? Closure of the Aortic Valve which occurs at the beginning of systole Closure of the Aortic Valve which occurs at the beginning of diastole Closure of the Mitral Valve which occurs at the beginning of systole Closure of the Mitral Valve which occurs at the beginning of diastole

B

1 point When caring for a patient with hyponatremia, the nurse is careful to restrict: sodium water chloride potassium

B

1 point Which coronary artery typically supplies the anterior wall of the left ventricle? circumflex artery left anterior descending artery pulmonary artery right coronary artery

B

1 point Which of the following compensating mechanisms is most likely to occur in the presence of respiratory acidosis? Hyperventilation to get as much oxygen as possible Retain HCO3 (bicarbonate) by the kidneys to increpse the pH level Hypoventilation to increase the CO2 levels Excrete HCO3 (bicarbonate) by the kidneys to decrease the pH level

B

1 point Your pt has the following labs: serum Na+ 160 mEq/L, urine specific gravity 1.040, BUN 36 mg/dI, Glucose 324 mg/dI, Hg 19 Gm/dI, and Het 55%. The patient's VS are: 130/78, 98 degrees F, HR 80, R 18. You would expect the MD to order: a kypertonic IV solution a hypotonic solution 3 % normal saline an isotonic IV solution

B

14 1 point The single best indicator of fluid status over a 24-hour period is the nurse's assessment of the client's: Intake and output Daily body weight Serum electrolyte levels Skin turgor

B

15 1 point Your patient has developed an excess amount of body fluid in the intravascular compartment. All of the following signs can be expected except: Engorged peripheral veins Peripheral edema A decreased hemoglobin level A bounding pulse

B

1 point A nurse assesses a patient who is scheduled for a cardiac catheterization. Which assessment is most important prior to this procedure? Patient's level of anxiety Ability to turn self in bed Allergies to iodine-based agents Patient's activity level

C

1 point A patient is admitted to the hospital to rule out a bowel obstruction. A NG (nasogastric tube) is placed and immediately suctions out 900cc's. The patient continues to have large amounts suctioned from the NG tube. The nurse knows that this patient is at risk for: Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

C

1 point A patient is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the patient to the bathroom and notes the patient's O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best? Administer oxygen at 2 L/min. Obtain a bedside commode. Allow continued bathroom privileges. Suggest the patient use a bedpan.

C

1 point If a person loses a large amount of blood following a gunshot wound, from what fluid compartment has the loss primarily occurred? Tissue Third space Vascular Intracellular

C

1 point If your patient is hemorrhaging, what is likely to happen? Renal blood flow increases; glomerular filtration rate increases; AH increases, and urine output decreases. Renal blood flow increases; glomerular filtration rate remains the same; ADH increases, and urine output decreases. • Renal blood flow decreases; glomerular filtration rate decreases; ADH increases, and urine output decreases. Renal blood flow decreases: glomerular filtration rate decreases; ADH decreases, and urine output decreases.

C

1 point The amount of blood pumped by the left ventricle in one minute divided by the body surface area is the: Cardiac output Stroke Volume Cardiac index Preload

C

1 point The best indicator of extracellular fluid volume deficit can be identified by assessing for: an elevated temperature a full and bounding pulse a drop in blood pressure pitting edema of the lower extremities

C

1 point The nurse is attempting to identify the timing of a murmur detected in a 40-year-old woman. The additional assessment necessary to make this assessment would be: Evaluation of peripheral pulses Assessment of blood pressure Identification of S1 and S2 Estimation of the client's fluid status

C