MIDTERM SHAREPATH
A patient is diagnosed with obstructive sleep apnea and provided with a CPAP mask and device to use. The patient returns a month later and reports no reduction in symptoms. Which question by the nurse would elicit the most appropriate additional information from the patient? "Are you using the CPAP device every night?" "Are you experiencing problems with your mask?" "Do you take your medication before using the CPAP device?" "Did you make a follow-up appointment with your health care provider?"
"Are you experiencing problems with your mask?"
The nurse examines the patient's ECG and notices that there is a junctional rhythm. Which area of the heart is controlling the heart rate? SA node AV node Ventricles Purkinje fibers
AV node
Which medication for PD is often used by all patient?
carbidopa/levodopa
For a patient with PD, which prescribed intervention would the nurse anticipate when the patient developed a medication intolerance?
change the medication and the frequency
A patient with obstructive sleep apnea is still experiencing daytime sleepiness and cognitive problems after using continuous positive airway pressure (CPAP) during sleep. What is the next step in this patient's treatment? Fit the patient for a mouth guard Obtain an order for a Polysomnography Provide instructions for weight loss education Obtain a consult for an uvulopalatopharyngoplasty
Obtain a consult for an uvulopalatopharyngoplasty
Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? Metabolic alkalosis caused by excessive production of acid metabolites Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation
Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
Two months after being diagnosed with myocardial infarction, a patient returns for a checkup. A routine ECG shows a 2:1 then 3:1 ratio (indicating two P waves to one QRS complex, then three P waves to one QRS complex). The nurse anticipates educating the patient about which dysrhythmia? First-degree heart block Third-degree heart block Second-degree heart block type I Second-degree heart block type II
Second-degree heart block type II
Neurogenic VS Spinal Shock
Spinal Shock- decreased reflexes, loss of sensation, absent thermoregulation, and flaccid paralysis below the level of injury Neurogenic Shock- Cervical or high thoracic injuries lead to loss of sympathetic nervous system innervation, causing peripheral vasodilation, venous pooling, and decreased cardiac output -3 Ds• Decreased BP• Dependent edema• Dysregulation of Temp
Parkinson's Stages
Stage 1 : (initial) Slight tremors, one side. Symptoms are mild include changes in walking, posture, facial expressions Stage 2: (mild) Symptoms worsen, both sides. Changes in waling and moving make daily tasks more difficult Stage 3: (moderate) Loss of balance, slowness of movement, risk of falls. Symptoms significantly impair ADL Stage 4: (severe) Symptoms are severe and limit the ability to live alone. Walkers used. Stage 5: Confined to wheelchair. 24 caregiver, hallucinations, end of disease
To decrease dysrhythmia's, which food does the nurse suggest for a patient who is at risk for potassium imbalance? a. grapes b. apples c. turnips d. strawberries
d. strawberries
Why should the patient with a history of myocardial infarction (MI) be monitored closely when premature ventricular contractions (PVCs) are seen on the electrocardiogram (ECG) strip? PVCs may develop into atrial fibrillation. PVCs may develop into a junctional rhythm. PVCs may develop into ventricular tachycardia. PVCs may develop into a first-degree heart block.
PVCs may develop into ventricular tachycardia.
For patients diagnosed with PD, which stage for bilateral limb involvement, mask-like face, and low, shuffling, gait?
Stage 2
The nurse is caring for several patients. To which patient would the nurse expect to administer atropine? Patient with first-degree heart block Patient with third-degree heart block Patient with second-degree heart block type I Patient with second-degree heart block type II
Patient with second-degree heart block type I
A patient with a history of hypertension presents with chest tightness and discomfort, dyspnea, and dizziness. The ECG is shown. Which process is the primary goal when treating this patient? Increase AV block Treat the patient's pain Restore loss of atrial kick Improve cardiac contractility
Increase AV block
For which reasons may the nurse confuse ventricular fibrillation for asystole? Select all that apply. Patients are unresponsive in ventricular fibrillation and asystole. Patients are usually apneic with ventricular fibrillation and asystole. The prognosis for patients in both ventricular fibrillation and asystole is very poor. The irregularly shaped waves of ventricular fibrillation look similar to occasional P waves in asystole. Patients experiencing ventricular fibrillation and systole have a second-degree AV block prior to the event.
Patients are unresponsive in ventricular fibrillation and asystole. Patients are usually apneic with ventricular fibrillation and asystole The irregularly shaped waves of ventricular fibrillation look similar to occasional P waves in asystole.
A patient undergoes a genioglossal advancement and hyoid myotomy. Which nursing education topic is appropriate to discuss with this patient following surgery? Use of CPAP Potential complications Use of polysomnography Long-term effects of sleep apnea
Potential complications
The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis report. Which urinary finding indicates the need to notify the primary health care provider? Acidic pH Glucose negative Bacteria negative Presence of large proteins
Presence of large protein
What does the nurse consider to be the priority nursing intervention for a client on diuretic therapy who has developed metabolic alkalosis? Preventing falls Monitoring electrolytes Administering antiemetics Adjusting the diuretic therapy
Preventing falls
After cataract surgery, a client reports feeling nauseated. How can the nurse prevent vomiting? Administer the prescribed antiemetic medication. Provide some dry crackers for the client to eat. Explain that this is expected after surgery. Teach how to breathe deeply until the nausea subsides
Administer the prescribed antiemetic medication.
The nurse reviews the polysomnogram report of a patient not previously treated for sleep apnea. The patient experienced 23 apnea/hypopnea events per hour for most of the night. What treatment would the nurse anticipate being prescribed for this patient? Weight loss referral Uvulopalatopharyngoplasty Provision of a mouth guard Continuous positive airway pressure (CPAP)
Continuous positive airway pressure (CPAP)
A 39-year-old female patient presents to the emergency department with chest discomfort for the past 2 days. In obtaining the patient history, the nurse discovers the patient has a history of coronary artery disease. The patient's ECG shows a normal P wave, prolonged PR interval widened QRS complex, and an irregular ventricular rhythm. The nurse knows that these symptoms are indicative of which heart rhythm? First-degree AV block Third-degree AV block Type I second-degree AV block Type II second-degree AV block
Type II second-degree AV block
Which risk factors is known to contribute to AF?
Advancing age High BP Use of ARB's
Which condition is a result of hypereffective heart in a well-conditioned athlete?
Bradycardia
which electrolyte excess results in cellular irritability and severe cellular dehydration? a. sodium b. calcium c. phosphorus d. magnesium
a. sodium excitable tissues to over respond to stimuli, resulting in irritability and severe cellular dehydration.
The nurse identifies that which medication will be given to a patient who presents to the ER with CP, SOB, Hypotension, and HR of 56? a. Digoxin b. Atropine c. verapamil d. propanolol
b. atropine
which electrolyte imbalance should be anticipated in a patient with hyperphosphatemia? a. hypokalemia b. hypocalcemia c. hypernatremia d. hypermagnesemia
b. hypocalcemia phosphorus and calcium have an inverse or reciprocal relationship. when one is increased, the other is usually decreased.
which ECG finding is consistent with hyperkalemia? a. absent T waves b. elevated P waves c. prolonged PR intervals d. shortened QRS complexes
c. prolonged PR intervals hyperkalemai, absent p waves, tall t waves, prolonged pr intervals, widened QRS
The nurse monitors for which adverse effects when administering acebutolol to a patient? a. tremors b. insomnia c. blurred vision d. bronchospasm
d. bronchospasm
Which statement by the patient demonstrates an understanding of treatment for obstructive sleep apnea? "I will sleep with the head of bed flat." "CPAP can improve my concentration." "I will take my sleeping pill 1 hour before I go to sleep." "I don't have to wear the mouth guard when I take a nap."
"CPAP can improve my concentration."
How does the nurse correctly explain the pathophysiology behind an apneic patient with asystole? "Altered innervation of the diaphragm." "Depolarization of the ventricles does not occur." "The sinoatrial node is not functioning correctly." "The atrioventricular node is functioning properly."
"Depolarization of the ventricles does not occur."
What is an appropriate response to a patient with a history of heart failure who asks why it is important to treat sleep apnea? "Treating sleep apnea can cure heart failure." "Chronic sleep loss can lead to heart failure." "Untreated sleep apnea can worsen heart failure." "The CPAP machine for sleep apnea administers heart failure medication."
"Untreated sleep apnea can worsen heart failure."
Which device would the nurse apply to a patient who has arrived in the emergency department unconscious and in respiratory arrest (is not breathing)? Venturi mask Ambu bag Nasal cannula CPAP device
Ambu bag
When the nurse is reviewing a client's arterial blood gas results, which finding is consistent with respiratory alkalosis? An elevated pH, elevated partial pressure of carbon dioxide (PCO ) 2 A decreased pH, elevated PCO 2 An elevated pH, decreased PCO 2 A decreased pH, decreased PCO 2
An elevated pH, decreased PCO 2
The nurse assesses the electrocardiogram (ECG) strip shown here and notes the patient has a palpable peripheral pulse. Which action should the nurse take first? Initiate CPR and ACLS protocol. Provide electrolyte replacement. Obtain an order for an IV β-blocker. Apply 100% oxygen via non-rebreather.
Apply 100% oxygen via non-rebreather.
What happens to the patient physiologically during an apneic period? Dyspnea Hemoptysis Blood carbon dioxide levels rise Inhibition of breathing for 2 minutes
Blood carbon dioxide levels rise
Which laboratory results support the nurse ' s suspicion that a client diagnosed with type 1 diabetes is experiencing ketoacidosis? Blood glucose of 40 mg/100 mL (2.2 mmol/L), blood pH of 7.37 Blood glucose of 130 mg/100 mL (7.2 mmol/L), blood pH of 7.35 Blood glucose of 650 mg/100 mL (36.1 mmol/L), blood pH of 7.42 Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20
Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20
Spinal Cord Injury
Cervical Injury: paralysis below neck (level of injury) Quadriplegia: 4 limbs paralyzed Quad means 4 diplegia= sounds like paralyzed• BREATHING impaired - Life threatening Happens to a lot of sports figures Thoracic Injury - think T for trunk of body Parapalegic (2 legs) Legs, pelvic organs Lumbar Injury - think of double L's Legs & Leaky bladder
Which signs and symptoms are clinical manifestations of obstructive sleep apnea? Select all that apply. Changes in mood Evening headaches Craniofacial abnormalities Falling asleep during work Waking up several times per night
Changes in mood Falling asleep during work Waking up several times per night
A nurse sees an asystolic rhythm on a patient's heart monitor. What should the nurse do next? Notify the patient's family. Call for help and begin CPR. Call the rapid response team. Determine level of consciousness.
Determine level of consciousness.
When a client who has had a thoracotomy develops respiratory acidosis, which action would the nurse take? Administer oral fluids. Encourage deep breathing. Increase the oxygen flow rate. Perform nasotracheal suctioning.
Encourage deep breathing.
Which nutrient causes elevated ketones in diabetic acidosis by incomplete oxidation? Fats Protein Potassium Carbohydrates
Fats
The nurse is working with a patient who has a atrial rate of 500 beats per minute (bpm). The nurse expects which characteristic ECG abnormality? Absent P wave Fibrillatory P wave Extended PR interval Flattened QRS interval
Fibrillatory P wave
Which complication is the most serious for a client with kidney failure? Anemia Weight loss Uremic frost Hyperkalemia
Hyperkalemia
The clinic nurse is taking the sexual health history of an adolescent when the adolescent begins to perspire and hyperventilate. The client reports feeling dizzy and short of breath. Which condition would the nurse identify? Metabolic alkalosis Respiratory acidosis Pulmonary hypertension Hyperventilation syndrome
Hyperventilation syndrome
When assessing a patient's respiratory system, which alteration may require supplemental oxygen therapy? Select all that apply. Increased respiratory rate Decreased heart rate Low oxygen saturation Cyanosis Elevated hemoglobin
Increased respiratory rate Low oxygen saturation Cyanosis
A pathology report states a client's urinary calculus is composed of uric acid. Which food item would the nurse instruct the client to avoid? Milk Liver Cheese Vegetables
Liver
An arterial blood gas report indicates the client's pH is 7.25, PCO is 35 mm Hg, and HCO is 20 mEq/L. Which disturbance would the nurse identify based on these results? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Metabolic acidosis
The nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client' s arterial blood gas results, which response would the nurse expect? Hypokalemia Metabolic acidosis Respiratory alkalosis Decreased carbon dioxide level
Metabolic acidosis
Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? Monitoring for signs of hypoglycemia resulting from treatment Withholding glucose in any form until the situation is corrected Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally Regulating insulin dosage according to the client's urinary ketone levels
Monitoring for signs of hypoglycemia resulting from treatment
Which action is priority for the nurse caring for a patient with this electrocardiogram (ECG) tracing? Call for help and initiate CPR. Palpate the patient's carotid pulse. Call the primary health care provider. Auscultate the patient's respiratory sounds.
Palpate the patient's carotid pulse.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and Pco of 60 mm Hg. These blood gas results require nursing attention because they indicate which condition? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Respiratory acidosis
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO ) of 60 mm Hg. Which complication would the nurse suspect the client is experiencing? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Respiratory acidosis
A patient with a history of third-degree heart block comes to the ED with severe chest pain and bradycardia. Which serious medical complication does the nursing team need to prepare for in caring for this patient? Shock Digoxin toxicity Diabetes mellitus Cerebralvascular accident
Shock
A patient has the ECG strip shown here as most current in the chart and has been experiencing very low blood pressures. The nurse should expect to collaborate with the care team on which procedure for this patient? Administration of atropine Administer diltiazem Temporary pacemaker placement Monitor the patient, no treatment necessary
Temporary pacemaker placement
Why might a patient with atrial flutter be prescribed warfarin? To increase atrial rate To reverse hypotension To decrease stroke risk To decrease risk of bleeding
To decrease stroke risk
In which type of AV block will a nurse expect to see a gradual lengthening of the PR interval? First-degree heart block Third-degree heart block Type I second-degree heart block Type II second-degree heart block
Type I second-degree heart block
which patient condition is associated with a lower thoracic spinal cord injury? a. Paraplegia b. Tetraplegia c. Hemiplegia d. Quadriplegia
a. Paraplegia
The nurse should monitor for CV complications in patients with spinal cord injuries at which level? a. above L1 b. above T6 c. above C4 d. above T10
a. above T6 Above
Which arterial blood gas results are associated with diabetic ketoacidosis? pH: 7.28; Pco 2 : 28; HCO 3 : 18 pH: 7.30; Pco 2 : 54; HCO 3 : 28 pH: 7.50; Pco 2 : 49; HCO 3 : 32 pH: 7.52; Pco 2 : 26; HCO 3 : 20
pH: 7.28; Pco 2 : 28; HCO 3 : 18
Select the risk factors that increase the likelihood of obstructive sleep apnea. Select all that apply. Age Smoking Facial fracture Morning headaches Daytime drowsiness
Age Smoking Facial fracture
If a patient's sleep apnea is left untreated, which serious consequences may develop? Select all that apply. Death Liver disease Marital problems Difficulty holding a job Congenital abnormalities
Death Marital problems Difficulty holding a job
A patient who is otherwise healthy is experiencing premature atrial contractions (PACs). The patient asks what could be causing the PACs. Which is the best response by the nurse? "Your low-protein diet." "Your coffee and cigarette use." "Your family history of diabetes." "Your sedentary lifestyle and high-fat diet."
"Your coffee and cigarette use."
A client is in a state of uncompensated acidosis. Which approximate arterial blood pH does the nurse expect the client to have? 7.20 7.35 7.45 7.48
7.20
Which pH value of amniotic fluid is indicated by a Nitrazine test strip that turns deep blue? 4.5 5.5 6.5 7.5
7.5
A high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate, and complains of dizziness and tingling of the hands. Which would the nurse instruct the student to do? Breathe into cupped hands. Pant using rapid, shallow breaths. Use a rapid deep-breathing pattern. Hold the breath for as long as possible
Breathe into cupped hands.
A patient reports feeling palpitations and chest heaviness after several days of gastroenteritis. The nurse notes a serum potassium level of 3.1, and the patient's ECG shows no visible P waves, a normal QRS complex, and an immeasurable PR interval. The nurse expects the health care provider to order which medication class for this patient? Diuretic ACE inhibitor Antihistamine Calcium channel blocker
Calcium channel blocker
A patient in the cardiac unit has an ECG reading showing a regular rhythm, normal P wave, prolonged PR interval (greater than 0.20 second), and normal QRS complex. What is the next step in nursing management for this patient? Give atropine IV push Continue to monitor the patient Prepare for transcutaneous pacing Teach the patient about second-s-degree heart block
Continue to monitor the patient
The nurse is caring for a patient whose recent lab results show higher than therapeutic levels of digitalis. The patient has normal vital signs, denies chest pain, and has no physical abnormalities. The nurse notes an idioventricular rhythm on the ECG tracing. Which intervention is most appropriate? Administer atropine Administer amiodarone Prepare for cardioversion Continue to monitor the patient
Continue to monitor the patient
An ECG is performed on a 25-year-old patient with no significant medical history. The patient reports that he has been up all night "drinking tons of coffee to stay awake." The ECG shows an inverted P wave that occurs just before the QRS complex. The patient reports palpitations and has mild hypertension. How does the nursing team manage the plan of care of this patient? Encourage the patient to decrease daily caffeine intake Talk to the patient about the need for an implanted pacemaker Talk to the patient about the need for an emergency electrical cardioversion Educate the patient in measuring the radial pulse prior to taking a beta-blocker
Encourage the patient to decrease daily caffeine intake
Obstructive sleep apnea is associated with which pathologic conditions? Select all that apply. Hypopnea Hypoxemia Deep breathing Decreased airflow Narrowing of air passages
Hypopnea Hypoxemia Decreased airflow Narrowing of air passages
Which statement explains why metabolic acidosis develops with kidney failure? Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention Inability of the renal tubules to reabsorb water to dilute the acid contents of blood Impaired glomerular filtration, causing retention of sodium and metabolic waste products
Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? Ketones Glucose Lactic acid Glutamic acid
Ketones
A patient is diagnosed with ventricular fibrillation. Upon review of the patient history, the nurse expects which medical history from the patient? Hypokalemia Myocardial ischemia Prolonged QT interval Deep vein thrombus (DVT)
Myocardial ischemia
While caring for a patient with pneumonia, the nurse receives an order for a common low-flow system to deliver continuous oxygen at 2 L/min. The nurse anticipates using which system? Non-rebreather mask BiPAP Nasal cannula Ambu bag
Nasal cannula
A patient with a history of HF reports chest pain. An ECG shows a prolonged PR interval that remains constant on conducted beats. The QRS complex is 0.14 seconds. Which action does the nurse take for management of this patient? Monitor the patient Prepare the patient for insertion of a temporary pacemaker Prepare to administer dopamine Advise the patient to discontinue anticoagulants
Prepare the patient for insertion of a temporary pacemaker
A patient in ventricular fibrillation (VF) is receiving CPR. What is the priority intervention? Prepare to defibrillate. Administer IV epinephrine. Administer IV potassium bolus. Notify family members of the change in patient status.
Prepare to defibrillate.
A patient reports daytime sleepiness and indicates that he thinks he has sleep apnea. What is the initial assessment performed to evaluate this patient's suspicion? Electrocardiography Sleep history review Polysomnography Measurement of oxygen saturation
Sleep history review
Which statement describes a patient who has an ECG reading with a ventricular rate of 120 and loss of the atrial kick? The patient experiences a decrease in cardiac output because of ineffective atrial contractions. The patient experiences no symptoms associated with a ventricular rate of 120 and loss of atrial kick. The patient experiences loss of consciousness and requires CPR because the heart is not perfusing the body. The patient experiences an increase in cardiac output because the increase ventricular rate supports the loss of atrial kick
The patient experiences a decrease in cardiac output because of ineffective atrial contractions.
The nurse is providing care for a patient which a SCI and C6. What nursing action should the nurse perform to reduce the patient's risk of autonomic hyperreflexia? a. reposition the patient every 2 hours b. assess the patients bladder volume frequently c. assess for dependent edema and monitor fluid balance d. encourage deep breathing and coughing exercises
b. assess the patients bladder volume frequently
of the diagnoses documented in a patients health record, which condition would the nurse attribute to the cause of the patients sodium level of 130? a. diarrhea b. heart failure c. Cushing syndrome d. fever unknown origin
b. heart failure causes of hyponatremia include heart failure, being NPO, and excess diaphoresis
A nurse is caring for a patient with a low cervical spinal cord injury. When assessing the patient, the nurse notices a blood pressure-volume of 98/54. Why might turning or suctioning this patient result in a cardiac arrest? a. turning can lead to reduced CO due to gravities effect on the heart b. increase in vagal stimulation can lead to cardiac arrhythmia and cardiac arrest c. suctioning may lead to desaturation and respiratory arrest and then to cardiac arrest d. pain from turning or suctioning can cause decreased respiratory and cardiac arrest
b. increase in vagal stimulation can lead to cardiac arrhythmia and cardiac arrest
A new patient with a spinal cord injury at C4 experience a decrease in BP to 60/44 and HR 48. Which condition would the nurse suspect? a. spinal shock b. neurogenic shock c. autonomic dysreflexia d. brown sequard
b. neurogenic shock
Which blood gas result would the nurse expect an adolescent with diabetic ketoacidosis to exhibit? pH 7.30, CO 40 mm Hg, HCO 20 mEq/L (20 mmol/L) 2 3 - pH 7.35, CO 47 mm Hg, HCO 24 mEq/L (24 mmol/L) 2 3 - pH 7.46, CO 30 mm Hg, HCO 24 mEq/L (24 mmol/L) 2 3 - pH 7.50, CO 50 mm Hg, HCO 22 mEq/L (22 mmol/L)
pH 7.30, CO 40 mm Hg, HCO 20 mEq/L (20 mmol/L) 23
ICP, late sign of herniation of brainstem?
Brainstem herniated and sustained period of apnea
The nurse is caring for a patient with shortness of breath, dizziness, and chest pressure. The nurse notes a thready, irregular pulse, and an ECG that indicates atrial fibrillation. Which action would the nurse take first? Cardiovert at 360 joules Give narcotic pain medicine Administer a dose of warfarin Obtain STAT chest radiograph
Administer a dose of warfarin
A patient has blood pressure 88/56 and heart rate 33 bpm with the ECG strip shown here. After the appropriate care team members are notified, which intervention should be performed first? Administer dopamine Prepare for electrical cardioversion Place a temporary transvenous pacemaker Place a temporary transcutaneous pacemaker
Administer dopamine
A client appears anxious, exhibiting 40 shallow respirations per minute. The client reports dizziness, light-headedness, and tingling sensations of the fingertips and around the lips. The nurse concludes that the client' s symptoms are most likely related to which condition? Eupnea Hyperventilation Kussmaul respirations Carbon dioxide intoxication
Hyperventilation
Which conditions are cardiovascular manifestations of alkalosis? Select all that apply. One, some, or all responses may be correct. Increased heart rate Decreased heart rate Widened QRS complex Increased digitalis toxicity Prolonged PR interval
Increased heart rate Increased digitalis toxicity
Which is the regulator of extracellular osmolarity? Sodium Potassium Chloride Calcium
Sodium
Thrombotic VS Embolic Stroke
Thrombotic Stroke •Most common cause of stroke •Men > Women •Occurs from an injury to a blood vessel wall and formation of a blood clot •Progression: stepwise; s/s develop slowly and may progress in the first 72 hrs as infarction and cerebral edema increase, usually some improvement, recurrence in 20-25% of survivors Embolic Stroke •2nd most common cause of stroke (approx. 24%) •Occurs when an embolus lodges in and occludes a cerebral artery •Men > Women •Treat underlying disease to prevent recurrence •Clinical symptoms occur suddenly •Most patient remain conscious, although a headache may develop.
The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaO 80 mm Hg (10.64 kPa), PaCO 55 mm Hg (7.32 kPa), and HCO 23 mEq/L (23 mmol/L). How would the nurse interpret these findings? Hypoxemia Hypocapnia Compensated metabolic acidosis Uncompensated respiratory acidosis
Uncompensated respiratory acidosis
A patient who was injured when diving has no pain response from his nipple line to his feet and is unable to move his hips or legs. What type of spinal cord injury does the nurse suspect? a. anterior cord b. cauda equina c. posterior cord d. brown-sequarb
a. anterior cord
which electrolyte deficiency results in reduced excitable membrane depolarization and increased cellular swelling? a. sodium b. calcium c. potassium d. magnesium
a. sodium low calcium levels lead to muscle cramping and cardiac arrhythmias
which body system would the nurse reassess if a patients laboratory result indicates a serum potassium level of 5.9 ? a. respiratory b. genitourinary c. cardiovascular d. integumentary
c. cardiovascular
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with chest pain and signs of atrial flutter. The patient's vital signs are blood pressure 65/40, temperature 99.0 °F, heart rate 135 beats per minute, and respiratory rate 25 respirations per minute. Which actions would the nurse take? Administer warfarin according to orders Prepare the patient for an echocardiogram Prepare the patient for an electrical cardioversion Administer a dose of IV narcotic pain medication
Administer warfarin according to orders Prepare the patient for an electrical cardioversion Administer a dose of IV narcotic pain medication
Match the type of atrial dysrhythmia with its ECG characteristics. Atrial rate of 300 bpm and ventricular rate of 150 bpm Irregular rhythm and indiscernible P wave QRS complex appears normal, but PR interval is indiscernible
Atrial rate of 300 bpm and ventricular rate of 150 bpm Atrial fibrillation Irregular rhythm and indiscernible P wave Premature atrial contraction QRS complex appears normal, but PR interval is indiscernible Atrial flutter
A patient is diagnosed with atrial fibrillation. Which ECG findings does the nurse expect? Atrial rate 80 bpm/regular ventricular rhythm Atrial rate 400 bpm/consistent ventricular rate Atrial rate 200 bpm/ventricular rate irregular and variable Atrial rate of 580 bpm/variable and irregular ventricular rate
Atrial rate of 580 bpm/variable and irregular ventricular rate
When caring for a client in late hypovolemic shock, which complication will the nurse anticipate? Hypokalemia Metabolic acidosis Respiratory alkalosis Decreased Pco levels
Metabolic acidosis
Which initial change in acid-base balance will the nurse expect when a client is in the progressive stage of shock? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Metabolic acidosis
Which secondary spinal cord injury typically results from the decreased amount of circulating blood? a. ischemia b. hemorrhage c. local edema d. hypovolemia
a. hypovolemia
which secondary spinal cord injury typically result from reduced or absent blood Flow? a. ischemia b. hemorrhage c. local edema d. hypovolemia
a. ischemia
A patient is in sinus rhythm with multifocal PVCs. The patient's heart rate is 90 bpm with 2+ radial pulses and SpO2 of 85%. Which treatment should be most appropriate for this patient? Call for help and initiate CPR. Prepare for tracheal intubation. Activate the rapid response team. Start O2 at 2 L/minutes by nasal cannula.
Start O2 at 2 L/minutes by nasal cannula.
Which pathological occurrence explains why this electrocardiogram (ECG) strip is concerning? Absence of ventricular electrical activity Increased excitability of myocardial cells Myocardial cells with decreased irritability PVC is firing during a depolarization phase
Increased excitability of myocardial cells
Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin aspart Insulin detemir
Insulin aspart
When arterial blood gases done on a client who is being resuscitated after cardiac arrest show a low pH, which factor is the likely cause of the laboratory result? Ketoacidosis Irregular heartbeat Lactic acid production Sodium bicarbonate administration
Lactic acid production
The nurse teaches a client about the dangers of using sodium bicarbonate regularly. Which effect of sodium bicarbonate is the nurse trying to prevent? Gastric distention Metabolic alkalosis Chronic constipation Cardiac dysrhythmias
Metabolic alkalosis
Which situation associated with the physiological finding of ketones in the blood and urine would be the nurse ' s focus when collecting additional data about a client? Starvation Alcoholism Bone healing Positive nitrogen balance
Starvation
Match the type of oxygen mask to its description. No reservoir bag; 1 L/min increase O2 equal to 5% increase O2 concentration Reservoir bag present; room air is inspired with O2 delivered Reservoir bag present; one-way valve prevents entry of exhaled air No reservoir bag; ensures accuracy of O2 concentration; uses adaptors/dials
No reservoir bag; 1 L/min increase O2 equal to 5% increase O2 concentration Simple face mask Reservoir bag present; room air is inspired with O2 delivered Partial rebreather mask Reservoir bag present; one-way valve prevents entry of exhaled air Non-rebreather mask No reservoir bag; ensures accuracy of O2 concentration; uses adaptors/dials Venturi mask
Why is the heart rate undetermined for a patient in ventricular fibrillation (VF)? QRS interval is irregular. P waves are visible but irregular. Hyperkalemia causes atrial fibrillation. P-to-P intervals and QRS complexes are not measurable.
P-to-P intervals and QRS complexes are not measurable.
A 59-year-old patient arrives at the emergency department and with chest discomfort for the past 24 hours. An ECG reading shows a heart rate of 58, a regular rhythm with a normal QRS complex, and an inverted P wave on the fourth beat. Which conclusion can be made about the intrinsic pacemaker in this patient's heart? The SA node is functioning normally as the pacemaker of the heart. The impulse is coming from the AV node, because the SA node is either not functioning or the impulse is blocked. The AV node is not functioning properly as the primary pacemaker of the heart. The impulse is coming from the SA node. Neither the SA node or the AV node are functioning as the pacemaker of the heart. The impulse is coming from random areas of the heart.
The impulse is coming from the AV node, because the SA node is either not functioning or the impulse is blocked.
A 65-year-old patient with a 20-year history of CAD receives an ECG that shows a variable PR interval with no relationship between the P wave and the QRS complex. The nurse notes which type of heart block? First-degree heart block Third-degree heart block Second-degree heart block type I Second-degree heart block type II
Third-degree heart block
which electrolyte deficiency would the nurse expect to find when reviewing the laboratory data for a patient who presents with seizure activity, decreased deep tendon reflexes, and diarrhea? a. sodium b. calcium c. potassium d. magnesium
a. sodium hyponatremia can cause mental status change, lethargy, coma, seizure activity.
which condition is the major cause of death in patients with hypokalemia? a. stroke b. renal failure c. cardiac arrest d. respiratory insufficiency
d. respiratory insufficiency respiratory muscles weakness, shallow respirations