Music Final

The nurse is preparing to discharge a client with chronic kidney disease. The nurse is teaching the client and family about administering calcium acetate 2 tablets by mouth with each meal at home. Which explanation by the nurse is most appropriate? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps to neutralize your gastric acids." C) "The calcium acetate will help to stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."

A) "The calcium acetate will lower your serum phosphate levels." Rationale: The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.

The nurse in the ED is caring for a patient recently admitted with a likely myocardial infarction. The nurse understands that the patients heart is pumping an inadequate supply of oxygen to the tissues. Forwhathealth problem should the nurse assess? A) Dysrhythmias B) Increase in blood pressure C) Increase in heart rate D) Decrease in oxygen demands

A) Dysrhythmias Cardiogenic shock occurs when the hearts ability to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. Symptoms of cardiogenic shock include angina pain and dysrhythmias. Cardiogenic shock does not cause increased blood pressure, increased heart rate, or a decrease in oxygen demands.

One of the unique manifestations of sickle cell disease is ______, a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs.

Acute chest syndrome Explanation: Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion.

tissue plasminogen activator (tPA), alteplaseDose adult for Acute Ischemic Stroke (AIS)

Administer Activase as soon as possible but within 3 hours after onset of symptoms. The recommended dose is 0.9 mg/kg (not to exceed 90 mg total dose), with 10% of the total dose administered as an initial intravenous bolus over 1 minute and the remainder infused over 60 minutes. During and following Activase administration for the treatment of acute ischemic stroke, frequently monitor and control blood pressure. In patients without recent use of oral anticoagulants or heparin, Activase treatment can be initiated prior to the availability of coagulation study results. Discontinue Activase if the pretreatment International Normalized Ratio (INR) is greater than 1.7 or the activated partial thromboplastin time (aPTT) is elevated. Alteplase, a thrombolytic drug, is administered to treat ischemic stroke by dissolving the clot that is occluding blood flow to the brain. The goal is to administer alteplase to the client with no evidence of hemorrhagic stroke via a CT scan within 45 minutes or arrival in the emergency department. The recommended dose of alteplase is 0.9 mg/kg, with a maximum dose of 90 mg. Ten percent is administered intravenously (IV) over 1 minute; 90% is administered over 1 hour. Endovascular therapy is recommended for clients with ischemic stroke who have received thrombolytic therapy and have a National Institutes of Health Stroke Scale (NIHSS) score greater than or equal to 6.

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? A. Therapeutic paracentesis B. Platelet infusions C. Diuretic therapy D. Albumin infusion

Answer: Albumin infusion Rationale: Albumin infusions help to correct decreases in effective arterial blood volume that lead to sodium retention. The use of this colloid reduces the incidence of post-paracentesis circulatory dysfunction with renal dysfunction, hyponatremia, and rapid reaccumulation of ascites associated with decreased effective arterial volume.

A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?

Answer: IV administration of octreotide (Sandostatin) Rationale: Octreotide (Sandostatin)a synthetic analog of the hormone somatostatin is effective in decreasing bleeding from esophageal varices and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin are not administered, and heparin would exacerbate, not alleviate, bleeding.

A client with chronic lymphocytic leukemia (CLL) experiences frequent bacterial infections. Which medication will the nurse anticipate being prescribed for this client? Acyclovir Dasatinib Clotrimazole Asceniv

Asceniv Explanation: Virtually all clients with CLL have reduced levels of immunoglobulins, and bacterial infections are common, independent of treatment. Intravenous treatment with immunoglobulin (IVIG), such as ascenivc, may be given to clients with recurrent infection. Antivirals (acyclovir) and antifungals (clotrimazole) would be used if the client develops a viral or fungal infection. Tyrosine kinase inhibitors (dasatinib) are targeted therapies to treat certain types of cancer, and not to treat bacterial infection.

A patient arrives at the emergency department with symptoms of a stroke. Which diagnostic test should the nurse immediately prepare the patient for to further investigate the cause of the patient's symptoms? Cardiac marker levels Complete blood count (CBC) Computed tomography (CT) scan Transcranial doppler ultrasonography (TCD)

Computed tomography (CT) scanA CT scan can rapidly distinguish between ischemic and hemorrhagic stroke. This diagnostic test should be performed within 30 minutes of arriving in emergency department.

What does the nurse recognize as one of the best indicators of the patient's renal function?

Creatinine Creatinine is the end product of muscle metabolism. It is a better indicator of renal function than BUN because it does not vary with protein intake and metabolic state.

How often should neurologic assessments and vital signs be taken initially for the patient receiving tissue plasminogen activator (tPA)? Every 30 minutes Every 45 minutes Every 15 minutes Every hour

Every 15 minutes Explanation:Neurological assessment and vital signs (except temperature) should be taken every 15 minutes initially while the patient is receiving tPA infusion. The client receiving alteplase should have frequent neurologic assessments per facility policy, which can be as often as every 15 minutes, to determine the effectiveness of therapy and to detect any deterioration of neurologic status.

A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?

Folic acid deficiency Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell-derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4-5 g/dL, the leukocyte count 2,000-3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.

Heparin may increase/decreasethe platelet count, causing thrombocytopenia. This is called heparin-induced thrombocytopenia (HIT).

Heparin may decrease platelet count

Nurse Trish is caring for a female client with a history of GI bleeding, sickle cell disease, and a platelet count of 22,000/μl. The female client is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hr. The client complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. In administering the medication, Nurse Trish should avoid which route?

I.M With a platelet count of 22,000/μl, the clients tends to bleed easily. Therefore, the nurse should avoid using the I.M. route because the area is a highly vascular and can bleed readily when penetrated by a needle. The bleeding can be difficult to stop.

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?

Iron chelation therapy Explanation: Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.

This is used to treat and prevent angina or heart pain; it is in the class of drugs called nitrates.

Isosorbide Dinitrate

What type of cancer is the most common type of secondary malignancy in patients with Hodgkin's disease?

Lung Lung cancer is the most common type of secondary malignancy in patients with Hodgkin's disease, particularly following combination chemotherapy and radiation. Breast, colon, and bone are not the most common type of secondary malignancy.

Three of the four effects digitalis preparations have on the heart muscle (myocardium)

Positive inotropic action (increases heart contraction) Negative chronotropic Action (decreases heart rate) Negative dromotropic action (Decreases conduction of the heart cells) Increased stroke volume

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:

Renal calculi Usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor.

what is a sign that the heart is beginning to fail?

S3 heart sound and that increased blood volume fills the ventricle with each beat

1. Select-ALL-that-apply: In the pancreas, the acinar cells release: 1. Amylase 2. Somatostatin 3. Lipase 4. Protease

The answers are 1, 3, and 4. Acinar cells secrete digestive enzymes into the pancreatic ducts. These enzymes are: Amylase: breaks down carbs to glucose, Protease: breaks down proteins to amino acids, Lipase: breaks down fats

Ana has advanced kidney disease. As part of her routine lab work, her physician monitors her complete blood count to check the number of erythrocytes in her blood. The most recent test demonstrated that Ana had a much lower erythrocyte count than normal, leading her physician to diagnose her with anemia. What is the relationship between Ana's kidney disease and her anemia?

The kidneys produce the hormone erythropoietin, which stimulates the production and maturation of erythrocytes. When the kidneys are failing, erythropoietin production declines, which can result in anemia.

Tissue Plasminogen Activator Administration

The patient is weighed to determine the dose of t-PA. The dosage for t-PA is 0.9 mg/kg, with a maximum dose of 90 mg. Ten percent of the calculated dose is given as an IV bolus over 1 minute. The remaining dose (90%) is given IV over 1 hour via an infusion pump

other treatment they may have to get

Virtually all patients with CLL have reduced levels of immunoglobulins, and bacterial infections are common, independent of treatment. Intravenous treatment with immunoglobulin (IVIG) may be given to selected patients with recurrent infection. Patients with CLL should receive both pneumonia and flu vaccinations as indicated

A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? You Selected:Adventitious lung sounds Correct response:Diarrheal stools Explanation:Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.

You Selected:Adventitious lung sounds Correct response:Diarrheal stools Explanation:Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.

S3 heart sound

a sign that the heart is beginning to fail and that increased blood volume fills the ventricle with each beat

isosorbide dinitrate

in the class of drugs called nitrates, and it is used for treating and preventing angina or heart pain. Other nitrates include nitroglycerin

dilated cardiomyopathy

most common type of cardiomyopathy; causes diffuse myocyte necrosis and fibrosis, and commonly leads to progressive HF

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: weight loss. increased urine output. increased blood pressure. hematuria.

weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

How would the nurse explain to the patient with coronary artery disease (CAD) why chronically elevated levels of C-reactive protein (CRP) are a good predictor of CAD? 1) "Low-density lipoproteins represent oxidation and coronary artery disease." 2) "Low-density lipoproteins are only elevated when triglyceride levels are high." 3) "Chronically elevated CRP levels are associated with the immune response." 4) "Chronically elevated CRP levels are associated with plaque formation."

"Chronically elevated CRP levels are associated with plaque formation." - A chronically elevated CRP level is a marker of inflammation that can predict risk of cardiac disease and cardiac events, even in patients with normal lipid values.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: - hematuria. - weight loss. - increased urine output. - increased blood pressure.

- weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

Percutaneous coronary interventions

--PCIs to treat angina and CAD most commonly include balloon angioplasty with intracoronary stent implantation --The duration of oxygen deprivation is directly related to the number of cells that die, therefore, the time from the pts arrival in the ED to the time PCI is performed is critical and should be less than 60 minutes (time is muscle) (door to balloon time or time to device). --Nursing alert (know for exam): It is imperative that an accurate assessments of a pts peripheral vascular system is documented preprocedurally. This data will be used to evaluate postoperative vascular status. The assessment should include extremities color, sensation, temperature, capillary refill, and peripheral perfusion using the grading scale common to the nurse's institution. The affect extremity is assessed every 15 minutes for the first hour and then according to hospital protocol --Nursing alert: It is critical that an Allen Test is assessed pre-intervention to ensure ulnar arteria flow to the hand since adequacy will permit a radial artery approach for a PCI procedure. The radial approach provides direct access to the ascending aorta and allows for immediate mobilization following PCI

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Choose all that apply. -Clay-colored stools -Dark urine -Jaundice -Pruritis -Weight gain

-Clay-colored stools -Dark urine -Jaundice -Pruritis The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected.

Chronic Pancreatitis, Clinical Manifestations -__________ occurs late in the disease, when as little as 10% of pancreatic function remains-As a result, digestion, especially of __________ and __________, is impaired

-Malabsorption occurs late in the disease, when as little as 10% of pancreatic function remains -As a result, digestion, especially of proteins and fats, is impaired

Chronic pancreatitis is characterized by:

-recurring attacks of severe upper abdominal and back pain -vomiting -Weight loss >>>More than 80% of clients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack -Malabsorption occurs late in the disease when as little as 10% of pancreatic function remains >>>As a result, digestion, especially of proteins and fats, is impaired -Stools become frequent, frothy, and foul-smelling because of impaired fat digestion -Stools with a high-fat content referred to as steatorrhea

Creatinine: this is the end product of muscle metabolism; it's a better indicator of renal function than BUN because it does not vary with protein intake and metabolic state.

0.7-1.5 mg

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: renal calculi. interstitial cystitis. an overdistended bladder. acute prostatitis.

A. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? A. Clay-colored stools B. Straw-colored urine C. Reduced hematocrit D. Elevated urobilinogen in the urine

A. Clay-colored stools Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

Before a transesophageal echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes that he has no active gag reflex. In response, the nurse should: A. withhold food and fluids. B. position the client on his side. C. introduce a nasogastric (NG) tube. D. insert an oral airway.

A. withhold food and fluids. Rationale: Following a transesophageal echocardiogram in which the client's throat has been anesthetized, the nurse should withhold food and fluid until the client's gag reflex returns. There's no indication that oral airway placement would be appropriate. The client should be in the upright position, and the nurse needn't insert an NG tube.

1. The patient is admitted with a suspected acute myocardial infarction (AMI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction (MI)? a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels b. Depressed ST-segment on ECG and elevated total CPK c. Depressed ST-segment on ECG and normal cardiac enzymes d. Q wave on ECG with normal enzymes and troponin levels

ANS: A ST segment elevation and elevated cardiac enzymes are seen in Q wave MI.

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder? a. A heart transplant should be scheduled as soon as possible. b. Elevating the legs above the heart will help relieve dyspnea. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

ANS: D The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.

A patient with Hodgkin's disease had a bone marrow biopsy yesterday and is complaining of aching, rated at a 5 (on a 1-10 scale), at the biopsy site. After assessing the biopsy site, which of the following nursing interventions is most appropriate? Administer the ordered paracetamol 500 mg po Reposition the patient to a high Fowler's position and continue to monitor the pain Notify the physician Administer the ordered aspirin (ASA) 325 mg po

Administer the ordered paracetamol 500 mg po Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

Microalbumin (MA)

An albumin test checks urine for a protein called albumin. Albumin is normally found in the blood and filtered by the kidneys. When the kidneys are working as they should, there may be a very small amount of albumin in the urine. But when the kidneys are damaged, abnormal amounts of albumin leak into the urine. This is called albuminuria. If the amount of albumin is very small, but still abnormal, it is called microalbuminuria.

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

B-type natriuretic peptide (BNP) The client's symptoms suggest heart failure. BNP is a neurohormone that's released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure. A BNP level greater than 51 pg/ml is commonly associated with mild heart failure. As the BNP level increases, the severity of heart failure increases. Potassium levels aren't affected by heart failure. CRP is an indicator of inflammation. It's used to help predict the risk of coronary artery disease. There is no indication that the client has an increased CRP. There is no indication that the client is experiencing bleeding abnormalities, such as those seen with an abnormal platelet count.

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? A. Increase in blood pressure B. Decrease in erythropoietin C. Increase in serum phosphate levels D. Decrease in serum sodium concentration

B. Decrease in erythropoietin The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? A. Perforation of the colon caused by the liver biopsy B. Peritonitis from bleeding in the liver caused by the liver biopsy C. Normal post procedural pain, with a change in LOC resulting from pre-existing fever D. An allergic reaction to the contrast media used during the liver biopsy

B. Peritonitis from bleeding in the liver caused by the liver biopsy After any invasive procedure, the nurse must stay alert for complications in the affected region—in this case, the abdomen. This client exhibits classic signs and symptoms of peritonitis caused by blood or bile after the liver biopsy. There is a reason to suspect bleeding resulting from the liver biopsy.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? A. Perforation of the colon caused by the liver biopsy B. Peritonitis from bleeding in the liver caused by the liver biopsy C. Normal post procedural pain, with a change in LOC resulting from pre-existing fever D. An allergic reaction to the contrast media used during the liver biopsy

B. Peritonitis from bleeding in the liver caused by the liver biopsy After any invasive procedure, the nurse must stay alert for complications in the affected region—in this case, the abdomen. This client exhibits classic signs and symptoms of peritonitis caused by blood or bile after the liver biopsy. There is a reason to suspect bleeding resulting from the liver biopsy. I

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? A. Perforation of the colon caused by the liver biopsy B. Peritonitis from bleeding in the liver caused by the liver biopsy C. Normal post procedural pain, with a change in LOC resulting from pre-existing fever D. An allergic reaction to the contrast media used during the liver biopsy

B. Peritonitis from bleeding in the liver caused by the liver biopsy After any invasive procedure, the nurse must stay alert for complications in the affected region—in this case, the abdomen. This client exhibits classic signs and symptoms of peritonitis caused by blood or bile after the liver biopsy. There is a reason to suspect bleeding resulting from the liver biopsy. I

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client? A. Vaso-occlusive crisis B. Pneumocystis pneumonia C. Acute chest syndrome D. Acute muscular strain

C One of the unique manifestations of sickle cell disease is "acute chest syndrome," a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a) a decreased serum phosphate level secondary to kidney failure. b) an increased serum calcium level secondary to kidney failure. c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d) metabolic alkalosis secondary to retention of hydrogen ions.

C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

For which patient should synchronized cardioversion be considered to terminate ventricular tachyarrhythmias? A. A patient who has shown consistent hemodynamic stability B. A patient who is breathing at a rate of 12 breaths/min but has no pulse C. A patient who has a ventricular rate greater than 150 beats per minute D. A patient who has responded favorably to antiarrhythmic medications

C. A patient who has a ventricular rate greater than 150 beats per minute Rationale: Synchronized cardioversion is an electrical therapy used to terminate ventricular tachyarrhythmias. If a patient has no pulse, the AHA recommends defibrillation. A patient who is hemodynamically stable should be treated first with antiarrhythmic medications. A patient who has responded well to antiarrhythmic medications generally does not require cardioversion.

A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect which of the following sets of assessment findings? Headache, blood pressure 90/54, dry skinBlood pressure 188/120, nausea, vomitingConfusion, respiratory rate 8 breaths/min, dry skinClammy skin, blood pressure 86/46, headache

Clammy skin, blood pressure 86/46, headache Rationale: Metabolic acidosis, a common clinical disturbance, is characterized by decreased pH and plasma bicarbonate concentration. Common causes of metabolic acidosis include diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. The client will experience the following signs and symptoms: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Elevated urobilinogen in the urine b) Straw-colored urine c) Reduced hematocrit d) Clay-colored stools

Clay-colored stools Correct Explanation: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Elevated urobilinogen in the urine b) Straw-colored urine c) Reduced hematocrit d) Clay-colored stools

Clay-colored stoolsCorrect Explanation: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

A patient arrives at the emergency department with symptoms of a stroke. Which diagnostic test should the nurse immediately prepare the patient for to further investigate the cause of the patient's symptoms? Cardiac marker levels Complete blood count (CBC) Computed tomography (CT) scan Transcranial doppler ultrasonography (TCD

Computed tomography (CT) scanA CT scan can rapidly distinguish between ischemic and hemorrhagic stroke. This diagnostic test should be performed within 30 minutes of arriving in emergency department. The client with symptoms of an ischemic stroke requires prompt assessment (computed tomography [CT] scan within 25 minutes of arrival in the emergency department) and treatment with intravenous (IV) alteplase within 45 minutes for optimal results.

A nurse in the ICU is planning the care of a client who is being treated for shock. What statement best describes the pathophysiology of this client's health problem? Blood is shunted from vital organs to peripheral areas of the body .Hemorrhage occurs as a result of trauma, depriving vital organs of adequate perfusion. Cells lack an adequate blood supply and are deprived of oxygen and nutrients. Circulating blood volume is decreased with a resulting change in the osmotic pressure gradient.

Correct response: Cells lack an adequate blood supply and are deprived of oxygen and nutrients. Explanation: Shock is a life-threatening condition with a variety of underlying causes. Shock is caused when the cells have a lack of adequate blood supply and are deprived of oxygen and nutrients. In cases of shock, blood is shunted from peripheral areas of the body to the vital organs. Hemorrhage and decreased blood volume are associated with some, but not all, types of shock.

The ICU nurse is caring for a client with sepsis whose tissue perfusion is declining. What sign would indicate to the nurse that end-organ damage may be occurring? Urinary output increases Heart and respiratory rates are elevated Adventitious lung sounds occur in the upper airway Skin becomes warm and dry

Correct response: Heart and respiratory rates are elevated Explanation: As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the client begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., acute kidney injury, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs.

A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices? - Vasopressin (Pitressin) - Epinephrine - Octreotide (Sandostatin) - Glucagon

Correct response: Octreotide (Sandostatin) Explanation: Octreotide (Sandostatin), a synthetic analogue of the hormone somatostatin, is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding.

AML treatment A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive?

Correct response: Induction therapy Explanation: Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks

In actively bleeding patients with esophageal varices, the initial drug of therapy is usually: A. Pitressin B. Corgard C. Inderal D. Sandostatin

D. SandostatinIn an actively bleeding patient, medications are given initially because they can be obtained and given more quickly than other therapies. Sandostatin, a synthetic analog of the hormone somatostatin, is effective in decreasing bleeding from esophageal varices and lacks the vasoconstrictive effects of vasopressin.

- _________________ measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. - acidosis, an adverse reaction to spironolactone.

Daily weight

What pathophysiological concept related to sickle cell disease predisposes a client with sickle cell disease to pneumonia?

Damage to the spleen increases the risk for infection. -Sickle cell disease can damage the spleen by thrombosis and subsequent damage or necrosis of tissue. This damage to the spleen increases the risk for infection, predisposing the client to pneumonia and acute chest syndrome. Sequestration causes thrombosis, not infection.

What pathophysiological concept related to sickle cell disease predisposes a client with sickle cell disease to pneumonia? Damage to the lymphatic system increases the risk for infection. Damage to the spleen increases the risk for infection. Sequestration of sickled cells lead to infection in the area of sequestration. Sequestration of sickled cells lead to infection in the area distal to the sequestration.

Damage to the spleen increases the risk for infection. Explanation: Sickle cell disease can damage the spleen by thrombosis and subsequent damage or necrosis of tissue. This damage to the spleen increases the risk for infection, predisposing the client to pneumonia and acute chest syndrome. Sequestration causes thrombosis, not infection.

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart? Decrease the heart rate Increase the heart rate Prevent normal sinus rhythm Constrict the heart

Decrease the heart rate Explanation: Beta blockers decrease (not increase) heart rate and dilate blood vessels (not the heart itself). Beta blockers do not prevent normal sinus rhythm.

A client is receiving radiationtherapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? Adventitious lung sounds Hair loss Diarrheal stools Laryngeal edema

Diarrheal stools Explanation: Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.

A nurse is caring for a client with acute pancreatitis. His physical examination reveals that he has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, his lab results indicate that he is hypovolemic. Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity?

Diuretics• Albumin Diuretics are given if circulating fluid is excessive. IV albumin may be given to pull fluid trapped in the peritoneum back into the circulation. Sodium would not be used to treat excessive fluid accumulation. Blood glucose levels can be elevated in clients with acute pancreatitis; therefore, glucose solutions would not be administered nor would they be used to treat excessive fluid accumulation

he nurse monitors a client for side effects associated with furosemide, which is newly prescribed for the treatment of heart failure. Complete the following sentence by choosing from the lists of options. Due to the client's high risk for developing Dropdown Item 1as a result of the prescribed medication, the nurse focuses on monitoring the client for Dropdown Item 2. hypokalemia ventricular arrhythmia hyponatremia nausea hyperuricemia joint swelling

Due to the client's high risk for developing hypokalemia as a result of the prescribed medication, the nurse focuses on monitoring the client for ventricular arrhythmia Furosemide, a loop diurectic, is often prescribed for clients who experience fluid volume overload due to a diagnosis of heart failure (HF). The client who is newly prescribed furosemide for the treatment of hypervolemia due to HF is at a high risk for developing fluid and electrolyte abnormalites, with a high risk for hypokalemia. Hypokalemia is a potentially life-threatening complication of loop diuretic therapy due to the risk for cardiac arrhythmias. When assessing a client for hypokalemia, the nurse monitors the client for ventricular arrhythmias. This is a priority in the provision of care for a client who is prescribed furosemide for the treatment of heart failure. Although hyponatremia and hyperuricemia are both potential side effects associated with diuretic therapy, they are not high risks for the client who is prescribed furosemide. Although a symptom of hyponatremia is nausea and joint pain is a symptom of hyperuremia, these are not findings that are expected for a client who experiences hypokalemia due to furosemide therapy.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? Oral I.V. Subcutaneous (subQ) I.M.

I.M. Rationale: A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment? Iron overload Hypovolemia Vitamin B12 deficiency Thrombocytopenia

Iron overload Rationale: Clients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.

A client is admitted to the emergency department in ventricular fibrillation. The client is administered amiodarone hydrochloride (Cordarone). What is the major effect of this medication? It produces skeletal muscle relaxation. It slows the conduction through the AV node. It stimulates the sympathetic nervous system. It inhibits the increase of the refractory period of the cells.

It slows the conduction through the AV node.

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

Loss of 2.2 lb (1 kg) in 24 hours Rationale: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

Cardiogenic shock is most commonly seen in which patient population?Myocardial infarction Spinal cord injury Head injury Stroke

Myocardial infarction Explanation: Cardiogenic shock is seen most often in patient with myocardial infarction.

What is given to patient to dilate vessels and improve visualization; it also prevents coronary spasm that can mimic stenosis

Nitroglycerin

A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? a) Vasopressin (Pitressin) b) Vitamin K c) Epinephrine d) Octreotide (Sandostatin)

Octreotide (Sandostatin) Acute hemorrhage from esophageal varices is lifethreatening. Resuscitative measures include administration of IV fluids and blood products. IV octreotide (Sandostatin) is started as soon as possible. Sandostatin is preferred because of fewer side effects. Octreotide reduces pressure in the portal venous system and is preferred to the previously used agents, vasopressin (Pitressin) or terlipressin. Vitamin K promotes blood coagulation in bleeding conditions, resulting from liver disease.

A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? a) Vasopressin (Pitressin) b) Vitamin K c) Epinephrine d)Octreotide (Sandostatin)

Octreotide (Sandostatin) Acute hemorrhage from esophageal varices is lifethreatening. Resuscitative measures include administration of IV fluids and blood products. IV octreotide (Sandostatin) is started as soon as possible. Sandostatin is preferred because of fewer side effects. Octreotide reduces pressure in the portal venous system and is preferred to the previously used agents, vasopressin (Pitressin) or terlipressin. Vitamin K promotes blood coagulation in bleeding conditions, resulting from liver disease.

One of the unique manifestations of sickle cell disease is "________ ________ _______________," a type of pneumonia triggered by _____________ __________________.It is characterized by respiratory symptoms, such as ___________________, __________________, _________________, and _____________ __________.

One of the unique manifestations of sickle cell disease is "Acute Chest Syndrome," a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs.It is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? You Selected: "An x-ray will be done to view your kidneys, ureters, and bladder." Correct response: "You don't need to do any fasting before this noninvasive test." Explanation: Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client?

Respiratory assessment Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects. Consequently, the nurse should prioritize respiratory assessments over musculoskeletal or neurological assessments.

Which patient below is at MOST risk for CHRONIC pancreatitis? 1. A 25 year old female with a family history of gallstones. 2. A 35 year old male who reports social drinking of alcohol. 3. A 15 year old female with cystic fibrosis. 4. A 66 year old female with stomach cancer.

The answer is 2. Patients in options 1 and 2 are at slight risk for ACUTE pancreatitis not chronic. Remember the main causes of ACUTE pancreatitis are gallstones and alcohol consumption. In option 3, the patient with cystic fibrosis is at MAJOR risk for CHRONIC pancreatitis because they are lacking the protein CFTR which plays a role in the movement of chloride ions to help balance salt and water in the epithelial cells that line the ducts of the pancreas. There is a decreased production of bicarbonate secretion by the epithelial cells. Therefore, this leads to thick mucus in the pancreatic ducts that can lead to blockage of the pancreatic ducts which can cause the digestive enzymes to activate and damage the pancreas. Overtime, the pancreas will experience fibrosis of the pancreas' tissue and will no longer produce digestive enzyme to help with food digestion

A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is priority you? 1. Reassure the patient this is normal with pancreatitis 2. Check the patient's blood glucose 3. Assist the patient with drinking a simple sugar drink like orange juice 4. Provide a dark and calm environment

The answer is 2. Patients with acute pancreatitis are at risk for hyperglycemia (the signs and symptoms the patient are reporting are classic symptoms of hyperglycemia). Remember the endocrine function of the pancreas (which is to release insulin/glucagon etc. is insufficient) so the nurse must monitor the patient's blood glucose levels even if the patient is not diabetic.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply: Thrombocytopenia Vision changes Increased PT/INR Leukopenia

The answers are 1, 3, and 4. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival).

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply: Frothy light-colored urine Dark brown urine Yellowing of the sclera Dark brown stool Jaundice of the skin Bluish mucous membranes

The answers are 2, 3, and 5. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes ("jaundice") and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).

A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: 1. Hematuria 2. Weight loss 3. Increased urine output 4. Increased blood pressure

Weight loss; Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss.

A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: 1. Hematuria 2. Weight loss 3. Increased urine output 4. Increased blood pressure

Weight loss; Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss.

Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria. When the bladder contains 300 mL or more of urine, this is referred to as

a) functional capacity b) anuria. c) specific gravity d) renal clearance e) functional capacity

A patient with stage 2 hypertension who is taking chlorothiazide (Diuril) and lisinopril (Zestril) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention. b. Change position slowly and avoid prolonged standing. c. Use sugarless gum or candy to help relieve dry mouth. d. Take the pulse daily to note any slowing of the heart rate.

b. Change position slowly and avoid prolonged standing. Chlorothiazide is a thiazide diuretic that causes orthostatic hypotension. Prazosin is an α-adrenergic blocker that causes dilation of arterioles and veins and causes orthostatic hypotension. The patient may feel dizzy, weak, and faint when assuming an upright position after sitting or lying down and should be taught to change positions slowly, avoid standing for long periods, do leg exercises to increase venous return, and lie or sit down when dizziness occurs. Direct-acting vasodilators often cause fluid retention; dry mouth may occur with diuretic use, and centrally acting α-and β-blockers may cause bradycardia.

Creatinine is the end product of muscle metabolism. It is a better indicator of renal function than BUN. Why?

because it does not vary with protein intake and metabolic state.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? a) Oral b) Subcutaneous (subQ) c) I.M. d) I.V.

c) I.M. A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.

Dietary teaching that includes eating dietary sources of potassium is indicated for the hypertensive patient taking which drug? a. Enalapril b. Labetalol c. Spironolactone d. Hydrochlorothiazide

d. Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium loss through the kidneys. High-potassium foods should be included in the diet, or potassium supplements may be used to prevent hypokalemia. Enalapril and spironolactone may cause hyperkalemia by inhibiting the action of aldosterone, and potassium supplements should not be used by patients taking these drugs. As a combined α/β-blocker, labetalol does not affect potassium levels.

Heparin may ________ the platelet count, causing thrombocytopenia. This is called heparin-induced thrombocytopenia (HIT).

decrease Platelet counts may decrease with heparin therapy, and if your client's platelet count does decrease, the client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin.

The client with an overdistended bladder and interstitial cystitis presents with:

dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void.

The nurse monitors a client for side effects associated with furosemide, which is newly prescribed for the treatment of heart failure. Complete the following sentence by choosing from the lists of options. Due to the client's high risk for developing--------------as a result of the prescribed medication, the nurse focuses on monitoring the client fo--------

hypokalemia ventricular arrhythmia Explanation: Furosemide, a loop diurectic, is often prescribed for clients who experience fluid volume overload due to a diagnosis of heart failure (HF). The client who is newly prescribed furosemide for the treatment of hypervolemia due to HF is at a high risk for developing fluid and electrolyte abnormalites, with a high risk for hypokalemia. Hypokalemia is a potentially life-threatening complication of loop diuretic therapy due to the risk for cardiac arrhythmias. When assessing a client for hypokalemia, the nurse monitors the client for ventricular arrhythmias. This is a priority in the provision of care for a client who is prescribed furosemide for the treatment of heart failure. Although hyponatremia and hyperuricemia are both potential side effects associated with diuretic therapy, they are not high risks for the client who is prescribed furosemide. Although a symptom of hyponatremia is nausea and joint pain is a symptom of hyperuremia, these are not findings that are expected for a client who experiences hypokalemia due to furosemide therapy

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment? Iron overload Hypovolemia Vitamin B12 deficiency Thrombocytopenia

iron overload Rational: Clients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.

The emergency physician has contacted a cardiologist and the patient is scheduled for a percutaneous coronary intervention (PCI) in less than 60 minutes from the door-to-balloon time. Explain the reasoning for this action based upon evidence- based guidelines and considering the clinical manifestations and the pathophysiology of the STEMI.

o An immediate PCI is ordered to open the occluded coronary artery and permute reperfusion to the area that has been deprived of oxygen. The procedure treats the underlying atherosclerotic lesion. Because the duration of oxygen deprivation determines the number of myocardial cells that die, the time for the patients arrival in the ED to the time the PCI is performed should be less than 60 minutes. This is frequently referred to as door-to-balloon time. o Early PCI has been shown to be effective in patients of all ages, including those older than 75 years. o When a patient is going through STEMI manifestations include:Patient has ECG evidence of acute MI with characteristic changes in two contiguous leads on a 12-lead ECG. In this type of MI, there is significant damage to the myocardium.Chest pain that occurs suddenly and continues despite rest and medication. Shortness of breath Indigestion Nausea Anxiety Cool, pale, and moist skin Heart rate and respiratory rate may be faster than normal

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from:

perforation of the colon caused by the liver biopsy. Explanation: After any invasive procedure, the nurse must stay alert for complications in the affected region — in this case, the abdomen. This client exhibits classic signs and symptoms of a perforated colon — severe abdominal pain, fever, and a decreasing level of consciousness. After detecting these findings, the nurse must notify the physician immediately — the client is experiencing a medical emergency and requires abdominal surgery and bowel resection. There is no reason to suspect bleeding resulting from the liver biopsy, although this condition must be ruled out. Bleeding would cause hypotension and signs of decreasing perfusion to major organs, not severe pain. Liver biopsy doesn't involve the use of contrast media.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from:

perforation of the colon caused by the liver biopsy. Explanation: After any invasive procedure, the nurse must stay alert for complications in the affected region — in this case, the abdomen. This client exhibits classic signs and symptoms of a perforated colon — severe abdominal pain, fever, and a decreasing level of consciousness

The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates?

preload is reduced Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, thereby decreasing ischemia and relieving pain.

Malabsorption occurs late in the disease, when as little as 10% of pancreatic function remains. As a result, digestion, especially of ________ and _________ is impaired The stools become frequent, frothy, and foul smelling because of impaired fat digestion, which results in stools with a high fat content referred to as steatorrhea.

proteins and fats, is impaired - the stools become frequent, frothy, and foul smelling because of impaired fat digestion (steatorrhea)

cardiac natriuretic peptide markers (BNP)

released by the ventricles in response to prolonged fluid volume overload or elevated pressure- HIGHLY indication of heart failure

A client is diagnosed with dilated cardiomyopathy. Which scheduled medication should the nurse clarify with the health care provider before administering​ it?

​**Betablocker Diuretic Anticoagulant Antidysrhythmic RATIONALE: The nurse needs to question the health care provider about the​ beta-blocker, for this medication should be used with caution in clients with dilated cardiomyopathy.​ Anticoagulants, antidysrhythmics, and diuretics are often used in the treatment of dilated​ cardiomyopathy, and the nurse would not question these prescribed medications.

what is Hypertension?

• chronic high blood pressure is called hypertension • it increases the risk of angina, heart failure, kidney disease, stroke, heart disease, transient ischemic attacks, retinopathy, and myocardial infarction (MI.. heart attack) • it is quite common, and more common in elderly • can be asymptomatic, though it increases risk of developing other problems (The silent killer) • blood pressure classifications are subject to change. research and pharmaceutical companies want to change it • causes can vary, if it is the result of some other condition such as diabetes, pregnancy, it is called secondary hypertension, if the cause is unknown (genetic, unknown) => it is called primary hypertension or essential hypertension.