NUR 325 Exam 3

The three risk factors for nephropathy.

10-15 year history of diabetes mellitus, poor glucose control, and uncontrolled hypertension.

For a patient with diabetes, what level should they keep their LDL at, according to the American Diabetes Association?

100 mg/dL

BMI ranges

underweight= less than 18.5 normal= 18.5-24.9 overweight= 25-29.9 obese= 30-39.9 morbidly obese: >40

What medications are used for those undergoing stage 1 or stage 2 hypertension?

usually a thiazide type diuretic, and/or other medications: ACE Inhibitors, beta-blockers, calcium channel blockers, aldosterone-receptor blockers

A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is: a. Normal because of the increased blood flow through the leg b. Slightly deteriorating and should be monitored for another hour c. Moderately impaired, and the surgeon should be called. d. Adequate from the arterial approach, but venous complications are arising.

A

Which skin color change suggests pregangrene and should be reported immediately? a. Purple-black b. Black c. Bright red d. Blue

A

A nurse is admitting an older adult client who has diabetic neuropathy with painful, burning feet. Which of the following interventions should the nurse anticipate the health care provider to prescribe? a. Place a bed cradle on the client's bed b. Inspect the client's feet once weekly c. Apply graduated compression stocking to the client's lower extremities d. Put a heating pad on the client's feet.

A (A bed cradle can reduce pain for a client who has diabetic neuropathy by preventing sheets from touching hypersensitive skin. The nurse should inspect the client's feet daily to assess for ulcerations. Graduated compression stocking are used to promote venous return in clients who have venous insufficiency. A heating pad can cause burns on a client who has diabetic neuropathy because they cannot tell how hot the heating pad actually is.)

A nurse is planning care for a client who has COPD and is malnourished. Which of the following recommendations to promote nutritional intake should the nurse include in the plan? a. Eat high calorie foods first. b. Increase intake of water at meal times c. Perform ative ROM exercises before meals d. Keep saltine crackers nearby for snacking

A (A client who has COPD often experiences early satiety. Therefore, the client should eat calorie-dense foods first. The client should limit intake of water at mealtimes to reduce the felling of early satiety. The client should rest before meals to decrease dyspnea while eating. The client should keep foods on hand for snacking, but should avoid dry and salty foods, which can place the client at risk for aspiration and make the client's mouth dry.)

A nurse is caring for a client who had a myocardial infarction 5 days ago. The client has a sudden onset of shortness of breath and begins coughing frothy, pink sputum. The nurse auscultates loud, bubbly sounds on inspiration. Which of the following adventitious breath sounds should the nurse document? a. coarse crackles b. wheezes c. rhonchi d. friction rub

A (A patient who had a recent MI is at risk for left-sided heart failure. Crackles are breath sounds caused by movement of air through airways partially or intermittently occluded with fluid and are associated with heart failure and frothy sputum. Crackling sounds are heard at the end of inspiration and are not cleared by coughing)

Which of the following terms describes the force against which the ventricle must expel blood? a. Afterload b. Cardiac output c. Overload d. Preload

A (Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.)

A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse should first: a. Administer the morphine b. Obtain a 12-lead ECG c. Obtain the lab work d. Order the chest x-ray

A (Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.)

Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions? a. Changes in blood pressure b. Changes in arterial oxygen tension c. Changes in arterial carbon dioxide tension d. Changes in heart rate

A (Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.)

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: a. Headache b. High blood pressure c. Shortness of breath d. Stomach cramps

A (Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.)

While auscultating a client's heart sounds, the nurse hears turbulence between the S1 and S2 heart sounds. The nurse should document this finding as which of the following? a. A systolic murmur b. A third heart sound (S3) c. An expected heart sound d. A fourth heart sound (S4)

A (Cardiac murmurs are relatively loud, turbulent sounds the nurse can hear between the usual, expected heart sounds. They create a whooshing or a swishing sounds. Those between S1 and S2 are systolic murmurs. Those between S2 and the next S1 are diastolic murmurs.)

A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours? a. Creatine kinase (CK or CPK) b. Lactic dehydrogenase (LDH) c. LDH-1 d. LDH-2

A (Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream. Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.)

A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by: a. Decreased arterial blood flow secondary to vasoconstriction b. Decreased arterial blood flow leading to hyperemia c. Atherosclerotic obstruction of the arteries d. Trauma to the lower extremities

A (Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.)

A nurse on a medical-surgical unit is caring for a client who is postoperative following a hip replacement surgery. The client reports feeling apprehensive and restless. which of the following findings should the nurse recognize as an indication of pulmonary embolism? a. Sudden onset of dyspnea b. Tracheal deviation c. Bradycardia d. Difficulty swallowing

A (Dyspnea occurs due to reduced blood flow to the lungs. Tachycardia is a clinical manifestation of pulmonary embolism.)

A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? a. Review the intake and output records for the last 2 days b. Change the time of diuretic administration from morning to evening c. Request a sodium restriction of 1 g/day from the physician d. Order daily weights starting the following morning

A (Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.)

A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as the case of the client's low potassium level? a. Furosemide b. Nitroglycerin c. Metoprolol d. Spironolactone

A (Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis, which decreases potassium levels through excretion in the distal nephrons. Hypokalemia is an adverse effect of furosemide. Spironolactone is a potassium-sparing diuretic medication, therefore, hyperkalemia is an adverse effect of this medication.)(reg potassium=3.5-5.0)

Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of: a. Cerebrovascular accident b. Liver disease c. Myocardial infarction d. Pulmonary disease

A (Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA's can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.)

A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? a. 6.3% b. 7.8% c. 8.5% d. 10%

A (The client with DM needs to manage activity/diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecing such things as eyesight and kidney function. The goal for a client who has DM is to keep the HbA1c values at 6.5% or less)

The nurse observes that during morning care the patient is complaining of leg pain when ambulating to the bathroom. The nurse assists the patient back into bed and notices that the patient's leg pain is relieved. Further assessment reveals bilateral pedal edema. The nurse knows that the cause of the patient's leg pain is most likely which of the following: a. The pain indicates an inadequate amount of blood to transport oxygen to meet the demands of leg muscles. b. The pain indicates a muscle spasm. c. The patient is having a myocardial infarction. d. The pain is due to over-exertion during morning care.

A (Impaired perfusion often results in leg pain as related to peripheral arterial disease (PAD). PAD leg pain is often relieved with rest and worsens with walking. Leg pain that is relieved with rest is called intermittent claudication and means that there is an inadequate supply of blood being transported to the muscles. Edema also develops from the obstruction of venous blood flow.Although pain is common during a muscle spasm, it is usually not relieved with rest. During a myocardial infarction, pain is often felt in the chest and not in the lower extremities.Although pain may occur from exercise, acute leg pain with the presence of edema indicates a perfusion problem and warrants further investigation.)

A nurse is caring for a client who has peripheral vascular disease and reports difficulty sleeping because of cold feet. Which of the following nursing actions should the nurse take to promote the client's comfort? a. Obtain a pair of slipper-socks for the client b. Rub the client's feet briskly for several minutes c. Increase the client's oral fluid intake d. Place a moist heating pad under the client's feet

A (In cold weather or when the client's feet are cold, he should wear extra socks or slipper socks to help provide warmth and increase his level of comfort. Massaging the legs or feet can cause a clot to break loose in the bloodstream. Impairment of arterial or venous circulating to a lower extremity is a contraindication for massage and heating pads. If there is co-existing sensory involvement, the client might not be able to feel a burn and be prone to serious injury)

A nurse is caring for a client who has PAD. Which of the following symptoms should the nurse expect to find in the early stage of the disease? a. Intermittent claudication b. Dependent rubor c. Rest pain d. Foot ulcers

A (Intermittent claudication is ischemic pain that is precipitated by exercise, resolves with rest, and is reproducible. The pain associated with claudication arises when cellular oxygen demand exceeds supply. It occurs early in the disease course, and is typically the initial reason clients who have PAD seek medical attention. Dependent rubber, rest pain, and foot ulcers, are all manifestations that occur in later stages of PAD.)

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse instruct the patient to do? a. Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. b. Use the flow meter each morning after taking medications to evaluate their effectiveness. c. Increase the doses of the long-term control medication if the peak flow numbers decrease. d. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

A (It is important to keep track of peak flow readings daily, especially when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the physician based on personal peak flow numbers. Peak flow is measured by exhaling into the flow meter and should be assessed before and after medications to evaluate their effectiveness.)

A nurse is caring for a client who is diabetic and reports a headache, restlessness, fatigue, and hunger. The nurse should identify that the client is likely experiencing which of the following conditions? a. Hypoglycemia b. Hyperglycemia c. Neuropathy d. Hypokalemia

A (Manifestations of hypoglycemia include sweating, tremors, tachycardia, palpitations, headache, fatigue, nervousness, and hunger. Manifestation of hyperglycemia include dehydration, fruity breath odor, nausea, vomiting, and warm, moist skin. The nurse should recognize a prickling or burning sensation and numbness of the extremities as a manifestation of neuropathy. Symptoms of hypokalemia include fatigue, confusion, muscle weakness, hypotension, a weak pulse, hypoactive bowel sounds, and shallow respirations.)

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II

A (Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.)

A nurse is reviewing a client's repeat laboratory results 4 hrs after administering fresh frozen plasma, (FFP). Which of the following laboratory results should the nurse review? a. Prothrombin time b. WBC count c. Platelet count d. Hematocrit

A (Prothrombin time should be reviewed after administering FFP, which is plasma rich in clotting factors. FFP is administered to treat acute clotting disorders. The desired effect is a decrease in the prothrombin time)

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: a. Check the client status and lead placement b. Press the recorder button on the electrocardiogram console c. Call the physician d. Call a code blue

A (Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.)

A nurse has an order to begin administering warfarin sodium (coumadin) to a client. While implementing this order, the nurse ensures that which of the following medications is available on the nursing unit as the antidote for Coumadin? a. Vitamin K b. Aminocaproic acid c. Potassium chloride d. Protamine sulfate

A (The antidote to warfarin (Coumadin) is Vitamin K and should be readily available for use if excessive bleeding or hemorrhage should occur.)

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? (Select all that apply). a. Eat less meat and processed foods. b. Decrease intake of saturated fats. c. Increase daily fiber intake. d. Limit saturated fat intake to 15% of daily caloric intake. e. Include omega-3 fatty acids in the diet.

A B C E

A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis? a. Oral mucosa b. Conjuctivae c. Ear lobes d. Soles of the feet

A (The nurse should first monitor the client's tongue and lips for manifestations of central cyanosis because cyanosis is most evident in areas with minimal pigmentation. All of the other answers can be correct, but oral mucosa is the most optimal area to assess for cyanosis.)

A nurse is caring for a client who has a new diagnosis of essential hypertension. The nurse should monitor the client for which of the following findings that is consistent with this diagnosis? a. Vertigo b. Uremia c. Blurred vision d. Dyspnea

A (The nurse should monitor the client for findings such as *vertigo, headache, facial flushing, and fainting.* These manifestation are consistent with a new diagnosis of essential hypertension. A client who has malignant hypertension might manifest uremia, blurred vision, and dyspnea.)

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis? a. Work of breathing b. Fear of suffocation c. Effects of medications d. Anxiety and restlessness

A (When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are not etiologies for activity intolerance for a patient with asthma.)

While performing an admission assessment for a client, the nurse notes that the client has varicose veins with ulcerations and lower extremity edema with a report of a feeling of heaviness. Which of the following nursing diagnoses should the nurse identify as being the priority in the client's care? a. Impaired tissue perfusion b. Alteration in body image c. Alteration in activity tolerance d. Impaired skin integrity

A (When using the airway, breathing, and circulation priority framework, the nurse should identify impaired perfusion of tissues as the priority finding.)

A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? a. graham crackers b. 1 tsp sugar c. 4 oz diet soda d. 4 oz skim milk

A (after establishing that the client has hypoglycemia, the nurse should give the client about 15g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of sim milk, 3-4 tsp of sugar or 1 tsp of honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes

A nurse is auscultating a client's lung sounds and identifies crackles in the left lower lobe. Which of the following interventions should the nurse take? a. Repeat auscultation after asking the client to breathe deeply and cough b. Instruct the client to limit fluid intake to less than 2,000 mL/day c. Prepare to administer antibiotics d. Place the client on bed rest in semi-Fowler's position

A (although crackles often indicate fluid in the alveoli, they can also be the result of positioning or decreased ventilation. They sometimes clear after a deep breath or a cough) It's premature to restrict fluid or prepare for antibiotic treatment, and Fowler's will ease breathing but not resolve crackles

A nurse is caring for a client who has an abdominal aortic aneurism and is scheduled for surgery. The client's vital signs are blood pressure 160/98, HR 102/min, RR 22/min, SPO2 95%. Which of the following actions should the nurse take? a. administer antihypertensive medication for blood pressure b. monitor that urinary output is 20mL/hr c. withhold pain medication to prepare for surgery d. take vital signs every 2 hrs

A (antihypertensive medication should be administered for the elevated blood pressure because hypertension can cause sudden rupture of the aneurism due to pressure on the arterial wall)

A nurse is assessing a client who is 2 days postoperative and auscultates bilateral breath sounds, but absent breath sounds in the bases. The nurse should suspect which of the following postoperative complications? a. atelectasis b. pneumonia c. pulmonary embolism d. arterial thrombus

A (atelectasis is incomplete alveolar expansion or collapse. Breath sounds are dull or absent over areas of alveolar collapse)

A 45-yr-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? a. Anxiety b. Cyanosis c. Bradycardia d. Hypercapnia

A (decreased CO2 because hyperventilating)

The nurse is caring for a patient with an acute exacerbation of asthma. After initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? a. Wheezing becomes louder. b. Cough remains nonproductive. c. Vesicular breath sounds decrease. d. Aerosol bronchodilators stimulate coughing.

A (narrowing of the airway and diminished air exchange. As bronchi dilates, wheezing becomes louder)

A nurse is providing dietary teaching for a client who has just learned that she has type 2 diabetes mellitus. The nurse should explain that which of the following sweeteners will add calories to the client's carbohydrate count? a. sorbitol b. sucralose c. aspartame d. acesulfame potassium

A (this nutritive sweetener provides calories just as sucrose does. However, it can have benefits for clients who must restrict caloric intake because it causes less elevation in blood glucose than sucrose does. sucralose, aspartame, and acesulfame potassium are nonnutritive sweeteners; and therefore contain no calories and won't add to carbohydrate count

A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching? (Select all that apply.) a. Reduce cholesterol and saturated fat intake b. Increase physical activity and daily exercise c. Enroll in smoking-cessation program d. Sustain hyperglycemia to reduce deterioration of nerve cells e. Maintain optimal blood pressure to prevent kidney damage

A B C E

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers (select all that apply.)? a. Exercise b. Allergies c. Emotional stress d. Decreased humidity e. Upper respiratory infections

A B C E (Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD).)

A nurse is providing discharge teaching to a client who has experience diabetic ketoacidosis. Which of the following information should the nurse include in the teaching? (Select all that apply.) a. Drink 2 L of fluids daily b. Monitor BG every 4 hour when ill c. Administer insulin as prescribed when ill d. Notify the provider when BG is 200 mg/dL e. Report ketones in the urine after 24 hr of illness

A B C E (Drinking 2 L of fluids daily can prevent dehydration. BG tends to increase during illness, BG should be monitored every 4 hr. The provider should be notifies if there are ketones in the urine after 24 hr of illness.)

A nurse is providing discharge teaching to a client who has experienced diabetic ketoacidosis. Which of the following information should the nurse include in the teaching? (Select all that apply). a. Drink 2 L fluids daily. b. Monitor blood glucose every 4 hr when ill. c. Administer insulin as prescribed when ill. d. Notify the provider when BG is 200 mg/dL. e. Report ketones in the urine after 24 hr of illness.

A B C E (You should be drinking 2 L of fluids every day to prevent dehydration. You must monitor BG every 4 hours when ill. Definitely administer insulin as prescribed when ill. Its unnecessary to tell the provider that your BG is 200, you'll know how much insulin to give. You should report ketones in the urine because you have to monitor that every day when you're sick and if you do have ketones you should tell the provider.)

A nurse is assessing a client who has fluid volume overload from a cardiovascular disorder. Which of the following manifestations should the nurse expect? (select all that apply) a. jugular vein distention b. moist crackles c. postural hypotension d. increased heart rate e. fever

A B D Fluid volume excess would result in hypertension and tachycardia. Fever would be indicative in someone who is dehydrated. Dehydration may cause low blood pressure.

A nurse is reviewing a client's medication history. The client has an admission blood glucose of 260 mg/dL and no documented history of diabetes mellitus. Which of the following types of medication should alert the nurse to the possibility that the client has developed an adverse effect of pharmacological therapy? (select all that apply) a. diuretics b. corticosteroids c. oral anticoagulants d. opioid analgesics e. antipsychotics

A B E (diuretics can cause hyperglycemia, especially in those with DM, & can cause electrolyte imbalances; corticosteroids can cause hyperglycemia and glycosuria; anticoagulants can cause excessive bleeding during blood sampling for glucose testing but not hyperglycemia; opioid analgesics can cause respiratory depression but not hyperglycemia; antipsychotics can cause new-onset diabetes mellitus

A nurse is determining a client's ability to learn self-monitoring of blood glucose using a glucometer. Which of the following abilities should the nurse confirm that the client has before proceeding with instruction (select all that apply) a. finger dexterity b. visual acuity c. color vision d. basic literacy e. demonstration ability

A B E (patient need finger dexterity to cleanse/puncture his finger, visual acuity to read the digital results, and demonstration ability to verify understanding)

Which guidelines should be included when instructing a patient with high cholesterol and hypertension? Select all that apply. a. Avoid use of salt at the table b. Use prepared canned foods to reduce the need for added salt c. Gradually change from using regular milk, to low-fat milk, and eventually skim milk d. Eat low-fat, low-salt cheeses e. Eliminate 'junk food' snacks f. Increase protein in the diet by eating more red meat

A C D Canned foods are high in sodium Elimination of snacks is unrealistic Red meat is high in saturated fats

A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select all that apply.) a. Dyspnea b. Bradycardia c. Barrel chest d. Clubbing of the fingers e. Deep respirations

A C D (Dyspnea is seen in clients with emphysema as the lung try to increase the amount of O2 available to the tissues. With emphysema, the HR will increase as the heart tries to compensate for less oxygen to the tissues. Barrel chest is seen in people with COPD and emphysema. Clubbing result from chronic low arterial-oxygen levels. Clients with emphysema lose lung elasticity and have muscle fatigue; consequently, respirations become increasingly shallow.)

Pain is a common symptom of peripheral arterial disease (PAD) and PAD is generally characterized by leg pain that occurs in which of the following instances? Select all that apply. a. occurs with walking and is relieved with rest b. occurs with walking and is relieved by increasing the pace of walking c. occurs when lying down and is relieved with leg elevation d. occurs when lying down and is relieved by sitting or standing e. occurs in a predictable pattern or at a known level of exertion

A D E Walking (activity) increases oxygen demand in leg muscles. With peripheral arterial disease, this demand for oxygen cannot be met. Anaerobic metabolism in the affected area results in accumulation of lactic acid and pain in the affected muscle group. Rest decreases the need for oxygen, and generally alleviates pain. Elevating the legs would further impede arterial flow to extremities Sitting/standing/making the legs dependent improves arterial flow

A nurse is attending a social event when another guest coughs weakly once, grasps his throat with his hands, and cannot talk. Which of the following actions should the nurse take? a. observe the client before taking further action b. perform the Heimlich maneuver c. assist the client to the floor and begin mouth-to-mouth resuscitation d. slap the client on the back several times

B

A nurse is preparing to administer a morning dose of insulin apart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse implement? a. Check BG immediately before breakfast. b. Administer insulin when breakfast arrives. c. Hold breakfast for 1 hr after insulin administration. d. Clarify the prescription because insulin should not be administered at this time.

B

A nurse is teaching the parents of a child who is to start using a metered-dose inhaler (MDI) to treat asthma. Which of the following information should the nurse include in the teaching? a. "The spacer increases the amount of medication delivered to the oropharynx." b. "The spacer increases the amount of medication delivered to the lungs." c. "Inhale rapidly using the spacer with the MDI." d. "Cover exhalation slots of the spacer with lips when inhaling."

B

A patient is having the arterial blood gas (ABG) measured. What would the nurse identify as the parameters to be evaluated by this test? a. Ratio of hemoglobin and hematocrit b. Status of acid-base balance in arterial blood c. Adequacy of oxygen transport d. Presence of a pulmonary embolus

B

What is the most significant modifiable risk factor for the development of impaired gas exchange? a. Age b. Tobacco use c. Drug overdose d. Prolonged immobility

B

When evaluating the concept of gas exchange, how would the nurse best describe the movement of oxygen and carbon dioxide? a. Oxygen and carbon dioxide are exchanged across the capillary membrane to provide oxygen to hemoglobin. b. Gas moves from an area of high pressure to an area of low pressure across the alveolar membrane. c. The level of inspired oxygen must be sufficient to displace the carbon dioxide molecules in the alveoli. d. Gases are exchanged between the atmosphere and the blood based on the oxygen-carrying capacity of the hemoglobin.

B

Which assessment is indicated to evaluate a patients' leg circulation? a. Carotid arteries for bruits b. Pedal and tibial pulses for presence and quality c. Orthostatic blood pressure readings

B

Which technique is considered the gold standard for diagnosing DVT? a. Ultrasound imaging b. Venography c. MRI d. Doppler flow study

B

With peripheral arterial insufficiency, leg pain during rest can be reduced by: a. Elevating the limb above heart level b. Lowering the limb so it is dependent c. Massaging the limb after application of cold compresses d. Placing the limb in a plane horizontal to the body

B

A nurse is assessing a male client who has advanced PAD. Which of the following findings should the nurse expect? a. Thin, pliable toe nails b. Leg pain at rest c. Hairy legs d. Flushed, warm legs

B (A client who has PAD will have thickened toenails. In the initial stages of PAD, clients might experience intermittent claudication. As the disease progresses, the client will experience pain even at rest due to ischemia of the distal extremities. The client might describe this pain as a persistent burning or aching pain that often awakens the client at night. Because of the decreases perfusion the the lower extremities, the client who has PAD will have shiny, dry skin on the legs with sparse hair growth. The client who has PAD will have skin that is cool or cold to the touch because of the decreased arterial blood flow to the extremity. When the extremity is in a dependent position, such as when the client is dangling, the extremity develops dependent rubber, a dark red color. When the extremity is elevated above the heart, it will appear pale and cyanotic.)

A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: a. Call for the doctor b. Start an intravenous line c. Obtain a portable chest radiograph d. Draw blood for laboratory studies

B (Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.)

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? a. Order fruits and fruit juices to be offered between meals. b. Order a high-calorie, high-protein diet with six small meals a day. c. Teach the patient to use frozen meals at home that can be microwaved. d. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.

B (Because the patient with COPD needs to use greater energy to breathe, there is often decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat six small meals per day taking in a high-calorie, high-protein diet, with nonprotein calories divided evenly between fat and carbohydrate. The other interventions will not increase the patient's caloric intake.)

For all persons without a normal blood pressure, treatment recommendations vary by blood pressure classification. Blood pressure classification should be based on: a. an average of two or more blood pressure readings taken at one healthcare visit b. an average of two or more blood pressure readings taken at each of two healthcare visits c. the highest pressure over a week d. the lowest pressure over a week

B (Blood pressure classification should be made on the basis of average blood pressure readings (two or more) obtained at each of two separate healthcare visits.)

The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to: a. Open and dilate the blocked coronary arteries b. Assess the extent of arterial blockage c. Bypass obstructed vessels d. Assess the functional adequacy of the valves and heart muscle

B (Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.)

A nures is providing discharge teaching to a client who has peripheral arterial disease. Which of the following instructions should the nurse include in the teaching? a. Apply a heating pad on a low setting to help relieve leg pain. b. Adjust the thermostat so that the environment is warm. c. Wear anti embolic stocking during the day. d. Rest with the legs above heart level.

B (Clients who have PAD should not apply heat directly to a limb, because sensation is diminished and burns could result. The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will help prevent vasoconstriction. Clients who have PAD should not wear any constrictive clothing. Extreme elevation of the legs can slow the flow of arterial blood to the feet.)

A nurse is caring for an older adult client. The nurse informs the client that straining while defecating can cause which of the following? a. Dilated pupils b. Dysrhythmias c. Diarrhea d. Gastric ulcer

B (Dysrhythmias can result from straining while defecating. When the client contracts the abdominal muscles and holds their breath while bearing down then the client exhales, there is a sudden release of intraabdominal pressure against the closed airway, which can result in cardiac dysrhythmias and elevated blood pressure.)

A nurse is caring for a client who has hemophilia. The client reports pain and swelling in a joint following an injury. Which of the following actions should the nurse take? a. obtain blood samples to test platelet function b. prepare replacement of the missing clotting factor c. administer aspirin for the client's pain d. place the bleeding joint in the dependent position

B (Hemophilia is hereditary and causes blood to clot slowly causing abnormal bleeding. It is caused by a deficiency in the most common clotting factor, [factor VIII=hemophilia A]. Aggressive factor replacement is initiated to prevent hemarthrosis that can result in long term loss of range of motion in repeatedly affected joints) a is wrong because tests are used to diagnose, not treat. c is wrong b/c medications that interfere with clotting should be avoided with hemophilia, and d is wrong because the affected joint should be elevated to allow blood to drain away from the joint)

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? a. An overproduction of the antiprotease a1-antitrypsin b. Hyperinflation of alveoli and destruction of alveolar walls c. Hypertrophy and hyperplasia of goblet cells in the bronchi d. Collapse and hypoventilation of the terminal respiratory unit

B (In COPD, structural changes include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.)

A nurse is assessing a male client who has advanced peripheral artery disease (PAD). Which of the following findings should the nurse expect? a. Thin, pliable toe nails b. Leg pain at rest c. Hairy legs d. Flushed/ warm legs

B (In the initial stages of PAD, clients might experience intermittent claudication. As the disease progresses, the client will experience pain even at rest due to ischemia of the distal extremities. The client might describe this pain as a persistent burning or aching pain that often awakens the client at night. A client who has PAD will have thickened toenails. They will also have shiny, dry skin on the legs with sparse hair growth, and they will have skin that is cool or cold to the touch.)

A client comes to the outpatient clinic and tells the nurse that he has had legs pains that began when he walks but cease when he stops walking. Which of the following conditions would the nurse assess for? a. An acute obstruction in the vessels of the legs b. Peripheral vascular problems in both legs c. Diabetes d. Calcium deficiency

B (Intermittent claudication is a condition that indicates vascular deficiencies in the peripheral vascular system. If an obstruction were present, the leg pain would persist when the client stops walking. Low calcium levels may cause leg cramps but would not necessarily be related to walking.)

The nurse is evaluating if a patient understands how to safely determine whether a metered-dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler? a. Place it in water to see if it floats. b. Keep track of the number of inhalations used. c. Shake the canister while holding it next to the ear. d. Check the indicator line on the side of the canister.

B (It is no longer appropriate to see if a canister floats in water or not because this is not an accurate way to determine the remaining inhaler doses. The best method to determine when to replace an inhaler is by knowing the maximum puffs available per MDI and then replacing it after the number of days when those inhalations have been used (100 puffs/2 puffs each day = 50 days).)

After femoral angiography, the client must stay in bed with his leg straight, and pressure is applied at the puncture site. You advise Mr. Smith that these interventions are aimed at: a. increasing peripheral blood flow b. preventing bleeding at the puncture site c. preventing allergic reaction d. preventing blood clots

B (Limited leg movement and application of pressure at the puncture site are intended to prevent bleeding or hematoma at the puncture site.)

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs? a. Hypertension and pulmonary edema b. Oropharyngeal candidiasis and hoarseness c. Elevation of blood glucose and calcium levels d. Adrenocortical dysfunction and hyperglycemia

B (Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose.)

A patient is questioning the nurse about circulation and perfusion. What is the nurse's best response? a. Perfusion assists the body by preventing clots and increasing stamina. b. Perfusion assists the cell by delivering oxygen and removing waste products. c. Perfusion assists the heart by increasing the cardiac output. d. Perfusion assists the brain by increasing mental alertness.

B (Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.)

A nures is caring for an older adult clients who has COPD with pneumonia. The nurse should monitor the client for which of the following acid-base imbalances? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis

B (Respiratory acidosis is a common complication of COPD. This complication occurs because clients who have COPD are unable to exhale carbon dioxide due to a loss of elastic recoil in the lungs.)

A nurse is teaching a client who has COPD about ways to facilitate eating. Which of the following statements indicates a need for further teaching? a. "I will rest for at least 30 minutes before eating." b. "I will take my bronchodilators after meals." c. "I will eat five or six small meals each day." d. "I will choose foods that are not gas-forming."

B (Resting before meals decreases fatigue, providing more energy during meals. This is an appropriate statement by the client. Bronchodilators should be taken before meals, not after, in order to reduce shortness of breath. This statement by the client indicates a need for further teaching. Eating small, frequent meals decreases shortness of breath. This is an appropriate statement by the client. Abdominal bloating and a feeling of fullness often prevent clients from eating a full meal. They tire easily and tend to have anorexia. This is an appropriate statement by the client.)

A nurse is performing a cardiac assessment on a client and auscultates an S3 sound. The nurse should recognize that this sound represents which of the following heart conditions? a. Atrial gallop b. Ventricular gallop c. Closure of mitral valve d. Closure of the pulmonic valve

B (S3 indicates a ventricular gallop caused by a rush of blood into a ventricle that is stiff or dilates. This can be a finding of heart failure and hypertension.) An S4 sound represents an Atrial Gallop. Closure of the mitral valve is represented by the S1 sound, and closure of the pulmonic valve is represented by the S2 sound.

A nurse is providing instructions about pursed-lip breathing for a client who has COPD with emphysema. The nurse should explain that this breathing technique accomplishes which of the following? a. Increases oxygen intake b. Promotes CO2 elimination c. Uses intercostal muscles d. Strengthens the diaphragm

B (The client who has COPD with emphysema should use pursed-lip breathing when experiencing dyspnea. This is one of the simplest ways to control dyspnea. It slows the client's pace of breathing, making each breath more effective. Pursed-lip breathing releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. This improved breathing pattern moves CO2 out of the lungs more efficiently.)

In preparation for discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include: a. Walking several times each day as an exercise program. b. Keeping the heat up so that the environment is warm c. Wearing TED hose during the day d. Using hydrotherapy for increasing oxygenation

B (The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will also be useful when preventing vasoconstriction, but TED hose would not be therapeutic. Walking would most likely increase pain.)

A home health nurse visits a client who has COPD and receives oxygen at 2 L/min via nasal cannula. The nurse reports difficulty breathing. Which of the following actions is the nurse's priority? a. Increase the oxygen flow to 3 L/min b. Assess the client's respiratory status c. Call emergency services for the client d. Have the client cough and expectorate secretions

B (The first action the nurse should take using the nursing process is to collect data from the client. The nurse should immediately assess the client's respiratory status before determining the appropriate interventions.)

A nurse is administering a unit of packed red blood cells to a client who is postoperative. The client reports itching and has hives 30 mins after the infusion begins. Which of the following actions should the nurse take first? a. maintain the IV access with 0.9% sodium chloride b. stop the infusion of blood c. send the blood container and tubing to the blood bank d. obtain a urine sample

B (The nursing should use the urgent vs. nonurgent priority-setting framework. The nurse should stop the infusion of blood because the client is showing manifestations of an allergic reaction)

A 72-year-old man presents to the emergency room. The patient appears diaphoretic and anxious, and has noted peripheral edema. The patient's vital signs are blood pressure of 100/40, heart rate of 130 and irregular, and respiratory rate of 26. How does the nurse interpret these findings? a. The patient is having a myocardial infarction. b. The patient has impaired central perfusion. c. The patient has a virus. d. Pain medication should be administered to this patient.

B (This patient has the classic symptoms of impaired central perfusion. Central perfusion occurs when cardiac output is optimal and blood is pumped to all of the organs and tissues from the arteries, through the capillaries, and then back to the heart through the veins. The nurse needs to administer oxygen. Chest pain is often present with myocardial infarction, along with elevated blood pressure readings and electrocardiogram changes. Viral illness commonly presents with other symptoms such as body ache or gastrointestinal issues, and typically has little or no effect on the heart rate. Pain management is not indicated for patients who do not present with pain. Also, the question is asking what assessment the nurse has made, and is not asking about interventions.)

When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: a. Help keep him well hydrated b. Dissolve clots he may have c. Prevent kidney failure d. Treat potential cardiac arrhythmias

B (Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.)

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: A. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. B. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. C. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. D. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

B (Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited)

A nurse is transfusing a unit of 0-negative fresh frozen plasma to a client whose blood type is B positive. Which of the following actions should the nurse take? a. continue to monitor for manifestations of a transfusion reaction b. remove the unit of plasma immediately and start an IV infusion of normal saline solution c. continue the transfusion and repeat the type and crossmatch d. prepare to administer a dose of diphenhydramine IV

B (someone who receives FFP that is not compatible can experience a hemolytic transfusion reaction. The transfusion should be stopped and 0.9% sodium chloride should be administered immediately with a new tubing)

A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include? a. perform vigorous exercise when blood glucose is less than 100 mg/dL b. do not exercise if ketones are present in your urine c. avoid eating for 2 hr before exercise d examine your feet weekly

B (the client should be instructed not to exercise if ketones are present in their urine because this is an indication of inadequate insulin and increases the risk for hyperglycemia) vigorous exercise is instructed of blood glucose is between 100-250 client should eat a snack if it has been over 1 hr since their last meal feet should be examined daily, and after exercising to check for ulcers

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (Select all that apply). a. Weight gain b. Fruits odor of breath c. Abdominal pain d. Kussmaul respirations e. Metabolic acidosis

B C D E

A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.) a. Genetic predisposition b. Hypercholesterolemia c. Hypertension d. Obesity e. Smoking

B C D E

Which statements are true about femoral angiography? Select all that apply. a. The procedure is risk-free b. Diet restrictions apply c. The patient will be injected with an iodine-based dye d. The procedure generally takes 1-3 hours e. An IV is required f. Angiography will provide more detailed information about the circulation in a patient's leg, and identify areas of obstruction.

B C D E F angiography is an invasive procedure and is not risk free

Select the activity/positioning guidelines that are appropriate for a patient that is postoperative for a right femoral tibial bypass surgery when they are becoming more mobile?. Select all that apply. a. Use a straight-back, non-reclining chair when sitting out of bed b. When in bed, change position frequently c. Avoid extreme joint flexion at the hip and the knee d. Ambulate as much as possible e. Use an abduction pillow at all times when in bed.

B C E (Frequent position changes encourage blood flow and reduce the risk of thrombosis. Extreme joint flexion can cause graft occlusion or thrombosis, and should be avoided. Ambulation promotes circulation, and helps prevent thrombus formation. Long periods of standing should be avoided. Movement is important.)

You are teaching your patient with PAD about the importance of exercise. Which of the following are appropriate guidelines? Select all that apply. a. Exercise involving the legs should be avoided until testing is completed b. Walking should be done at least several times per week, preferably each day c. One long exercise period each day is preferred over several, brief exercise periods d. If leg pain occurs, stop exercising and resume exercise later in the day e. Exercise to the point of pain each session

B D E There is no reason to avoid leg exercise

A nurse is providing teaching to a client who has a new diagnosis of type 2 DM. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (select all that apply) a. polyuria b. blurred vision c. polydipsia d. tachycardia e moist, clammy skin

B D E (polydipsia and polyuria are signs of hyperglycemia)

A nurse is caring for a client who has a BG of 52. The client is lethargic by arousable. Which of the following actions should the nurse perform first? a. Recheck BG in 15 min. b. Provide a carbohydrate and protein food. c. Provide 4-8 oz grape juice. d. Report findings to the provider.

C

During an assessment of a 45-yr-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to what pathophysiologic change? a. Laryngospasm b. Pulmonary edema c. Narrowing of the airway d. Overdistention of the alveoli

C

Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? a. Take one tablet every 2 to 5 minutes until the pain stops. b. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. c. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets. d. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.

C

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? a. Temperature of 98.4°F b. Oxygen saturation 96% c. Pulse rate of 72 beats/min d. Respiratory rate of 18/ breaths/min

C

The pain that Mr. Smith (who has PAD) feels in his legs with exercise, which is relieved with rest, is called: a. peripheral angina b. thromboangiitis obliterans c. intermittent claudication d. Buerger's syndrome

C

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows not to expect therapeutic benefits for: a. At least 12 hours b. The first 24 hours c. 2-3 days d. 1 week

C

Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? a. Supine b. Lithotomy c. High Fowler's d. Reverse Trendelenburg

C

While auscultating a client's heart sounds, the nurse hears turbulence between S2 and the next S1 heart sound. The nurse should document this finding as which of the following? a. A systolic murmur b. A third heart sound (S3) c. A diastolic murmur d. A fourth heart sound (S4)

C

You read in Mr. Smith's medical record that he was diagnosed with stage 1 hypertension and started on a diuretic. Which statement defines stage 1 hypertension? a. A systolic reading of less than 120 mm Hg, and a diastolic reading of less than 80 mm Hg b. A systolic reading of 120-139 mm Hg, or a diastolic reading of 80-89 mm Hg c. A systolic reading of 140-159 mm Hg, or a diastolic reading of 90-99 mm Hg d. A systolic reading of 160 mm Hg or greater, or a diastolic reading of 100 mm Hg or greater

C

Which of the following factors can cause blood pressure to drop to normal levels? a. Kidneys' excretion of sodium only b. Kidneys' retention of sodium and water c. Kidneys' excretion of sodium and water d. Kidneys' retention of sodium and excretion of water

C (The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.)

Smoking cessation is critical for Mr. Smith. He tells you he's tried to stop smoking a number of times on his own without success, and he just doesn't think he can stop. Which approach is best? a. Reinforce with Mr. Smith the dangers associated with smoking so he will be more motivated to quit b. Commend Mr. Smith for trying and agree with him that some people will never be able to stop smoking c. Suggest to Mr. Smith that he try a more formalized smoking cessation program d. Tell Mr. Smith that he can use Nicotine patches to help him quit since he has smoked for so long.

C Group support helps many people who are unable to quit on their own Nicotine patches constrict blood vessels

A nurse is reviewing blood pressure classifications with a group of nurses at an in-service meeting. Which of the following should the nurse include as a risk factor for the development of hypertension? a. HDL level of 70 mg/dL b. A diet high in potassium c. Obstructive sleep apnea (OSA) d. Taking benazepril

C (A HDL level of 70 mg/dL is greater than the optimal range for men and women. HDLs should be greater than 45 mg/dL in men and 55 mg/dL in women. A diet high in potassium decreases blood pressure. A diet low in calcium, potassium, and magnesium can result in hypertension. A diet high in sodium may result in hypertension. OSA is a condition in which the client's airway becomes blocked by the relaxation of the tongue and muscle of the oropharynx, effectively obstructing the airway. The obstructed airway results in surges in both the systolic and diastolic pressure during sleep and, in some clients, through the waking hours even when breathing is normal. Benazepril is an ACEI, which lowers blood pressure. *Medications that increase BP may be glucocorticoids, mineralocorticoids, and sympathomimetics*.)

A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this? a. Aortic b. Mitral c. Pulmonic d. Tricuspid

C (Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.)

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with chronic obstructive pulmonary disease (COPD) are successful based on which finding? a. Absence of dyspnea b. Improved mental status c. Effective and productive coughing d. PaO2 within normal range for the patient

C (Airway clearance is most directly evaluated as successful if the patient can engage in effective and productive coughing. Absence of dyspnea, improved mental status, and PaO2 within normal range for the patient show improved respiratory status but do not evaluate airway clearance.)

A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? a. "Have you ever had this pain before?" b. "Can you describe the pain to me?" c. "Does the pain get worse when you breathe in?" d. "Can you rate the pain on a scale of 1-10, with 10 being the worst?"

C (Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.)

The most important long-term goal for a client with hypertension would be to: a. Learn how to avoid stress b. Explore a job change or early retirement c. Make a commitment to long-term therapy d. Control high blood pressure

C (Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.)

Which of the following characteristics is typical of the pain associated with DVT? a. Dull ache b. No pain c. Sudden onset d. Tingling

C (DVT is associated with deep leg pain of sudden onset, which occurs secondary to the occlusion. A dull ache is more commonly associated with varicose veins. A tingling sensation is associated with an alteration in arterial blood flow. If the thrombus is large enough, it will cause pain.)

A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority? a. Monitoring vital signs b. Completing a physical assessment c. Maintaining cardiac monitoring d. Maintaining at least one IV access site

C (Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished around the MI monitoring.)

The nurse is assessing a female patient at the neighborhood clinic. The patient is complaining of "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition? a. Ischemia b. Pneumonia c. Myocardial infarction d. Peptic ulcer disease

C (Fatigue is an atypical symptom of myocardial infarction in women. Ischemia is associated with pain. Pneumonia is associated with pain and shortness of breath. Peptic ulcer disease is associated with pain and intestinal discomfort.)

One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? a. Hypocalcemia b. Hypermagnesemia c. Hypokalemia d. Hypernatremia

C (Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.)

Direct-acting vasodilators have which of the following effects on the heart rate? a. Heart rate decreases b. Heart rate remains significantly unchanged c. Heart rate increases d. Heart rate becomes irregular

C (Heart rate increases in response to decreased blood pressure caused by vasodilation.)

A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions? a. Encourage the client to ambulate frequently b. Encourage coughing and deep breathing c. Encourage the client to increase fluid intake d. Encourage regular use of the incentive spirometer

C (Increasing fluid intake to 1,500 to 2,500 mL/day promotes liquefaction and thinning of pulmonary secretions, which improves the client's ability to cough and remove the secretions)

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a BF of 278. Which of the following actions should the nurse take? a. Draw up the regular insulin and then the glargine insulin in the same syringe. b. Draw up the glargine insulin then the regular insulin in the same syringe. c. Draw up and administer regular and glargine insulin in separate syringes. d. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.

C (Insulin Glargine is lantus, a long acting insulin, should not be mixed with other insulins)

A nurse is giving a presentation at a community center about chronic bronchitis. Which of the following information should the nurse include as effective for preventing this disorder? a. Maintenance of ideal weight b. Annual influenza immunization c. Smoking cessation d. Regular moderate exercise

C (Maintaining ideal weight is not a preventative strategy for chronic bronchitis. Getting a flu vaccine will not prevent the development of chronic bronchitis. Smoking is a major cause of chronic bronchitis; therefore, smoking cessation is an effective preventative strategy.)

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principal effects are produced by: a. Antispasmodic effect on the pericardium b. Causing an increased myocardial oxygen demand c. Vasodilation of peripheral vasculature d. Improved conductivity in the myocardium

C (Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.)

A nurse is providing teaching to a client who has diabetes mellitus about carbohydrate needs when exercising. Which of the following foods should the nurse include as containing a 15 g serving of carbohydrates? a. 2 slices bread b. 1 cup sugar free yogurt c. 1 cup milk d. 1 cup regular ice cream

C (One slice of bread contains 15 g of carbohydrates. 1/3 cup of sugar-free yogurt contains 15 g of carbohydrates. 1 cup of milk contains 15 g of carbohydrates. The nurse should instruct the client that 1/2 cup of regular ice cream contains 15 g of carbohydrates.)

To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse: a. In all extremities b. At the insertion site c. Distal to the catheter insertion d. Above the catheter insertion

C (Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.)

The nurse knows that primary prevention strategies to prevent impaired perfusion in the patient include which of the following recommendations by the American Heart Association (AHA): a. Routine blood pressure monitoring b. Administering furosemide (Lasix) to a patient with active congestive heart failure (CHF) symptoms c. Eating a healthy diet and exercising most days of the week d. Monitoring routine serum lipids

C (Primary prevention strategies include measures that promote health and prevent disease from developing. The American Heart Association recommends eating a heart-healthy diet, exercising most days of the week, taking a low-dose aspirin, and not smoking. Routine blood pressure monitoring is considered secondary prevention, which also includes screening and early diagnosis of health issues.Although administering a diuretic such as furosemide to a patient who presents with active CHF symptoms is considered an optimal treatment of symptoms, this is not considered a primary prevention strategy. Testing for routine serum lipids is considered secondary prevention.)

A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first? a. Monitor the apical pulse rate b. Instruct the client to take medication with food c. Question the physician about the order d. Caution the client to rise slowly when standing

C (Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.)

The nurse is caring for a 48-yr-old male patient admitted for exacerbation of chronic obstructive pulmonary disease. The patient develops severe dyspnea at rest, with a change in respiratory rate from 26 breaths/min to 44 breaths/min. Which action by the nurse would be the most appropriate? a. Have the patient perform huff coughing. b. Perform chest physiotherapy for 5 minutes. c. Teach the patient to use pursed-lip breathing. d. Instruct the patient in diaphragmatic breathing.

C (Pursed-lip breathing (PLB) prolongs exhalation and prevents bronchiolar collapse and air trapping. PLB is simple and easy to teach and learn. It also gives the patient more control over breathing. Evidence from controlled studies does not support the use of diaphragmatic breathing in patients with COPD. Diaphragmatic breathing results in hyperinflation because of increased fatigue and dyspnea and abdominal paradoxical breathing rather than with normal chest wall motion. Chest physiotherapy (percussion and vibration) is used primarily for patients with excessive bronchial secretions who have difficulty clearing them. Huff coughing is a technique that helps patients with COPD to use a forced expiratory technique to clear secretions.)

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a â-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? a. IV fluids b. Biofeedback therapy c. Systemic corticosteroids d. Pulmonary function testing

C (Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient. IV fluids may be used but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.)

A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? a. "I'll wear sandals in warm weather." b. "I'll put lotion between my toes after drying my feet." c. "I'll check my feet every day for sores and bruises." d. "I'll soak my feet in cool water every night before I go to bed."

C (The nurse should instruct the client to avoid shoes such as sandals that have an open toe or straps that rest between the toes to decrease the risk of foot injuries. The nurse should instruct the client that lotion is appropriate for dry areas of the feet but not to apply to it between the toes, because it creates a moist environment that promotes bacterial growth. The client should check his feet family to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see. The nurse should instruct the client not to soak his hands or feet for prolonged periods of time, as this can increase the risk of infection. When cleansing the feet, the client should use warm, soapy water.)

The nurse teaches pursed-lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism? a. Loosening secretions so that they may be coughed up more easily b. Promoting maximal inhalation for better oxygenation of the lungs c. Preventing bronchial collapse and air trapping in the lungs during exhalation Correct d. Increasing the respiratory rate and giving the patient control of respiratory patterns

C (The purpose of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. It does not affect secretions, inhalation, or increase the rate of breathing.)

Which of the following blood tests is most indicative of cardiac damage? a. Lactate dehydrogenase b. Complete blood count (CBC) c. Troponin I d. Creatine kinase (CK)

C (Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury.)

A nurse is teaching self-monitoring to a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? a. "I will check my urine once a day for ketones." b. I will notify my provider is pre-meal glucose is 120 mg/dL." c. "I will check my blood glucose every 4 hours when I am sick." d. I will check blood glucose every 5 minutes when lightheaded."

C (Urine testing for ketones is only advised for clients who have type 1 diabetes mellitus and have glycosuria, BG levels greater than 240 mg/dL for two testing periods in a row, and during illness. A pre-meal BG of 120 mg/dL is within the target reference rage of 70 to 130 mg/dL. The client should follow specific guidelines with sick. You should monitor BG every 3-4 hours and continue to take insulin or oral anti diabetic agents. The client should consume 4 oz of sugar free, non caffeinated liquid every 30 minutes to prevent dehydration. You should monitor ketones when sick.)

A nures in a clinic is assessing the lower extremities and ankles of a client who has a history of PAD. Which of the following findings should the nurse expect? a. Pitting edema b. Areas of reddish-brown pigmentation c. Dry, pale skin with minimal body hair d. Sunburned appearance with desquamation

C (Venous insufficiency causes edema. A client who has venous insufficiency can display areas of reddish-brown pigmentation because the valves of the veins are damaged from venous hypertension. A client who has PAD can display dry, scaly, pale or mottled skin with minimal body hair.)

A nurse is teaching a client who has a new diagnosis of Type 1 diabetes mellitus about self-administration of insulin. Which of the following instructions should the nurse include? a. "Pull back on the plunger after injecting the insulin." b. "Massage the injection site after removing the needle." c. "Store the current bottle of insulin at room temperature." d. "Use each syringe up to six times."

C (You do not aspirate with a SubQ injection. Massaging the area can increase the absorption of insulin. The nurse should instruct the client to keep the bottle of insulin she is currently using at room temperature to minimize painful injections. The client should refrigerate unused bottles of insulin to protect the quality of the medication. The nurse should instruct the client to use syringes no more than 3 times.)

A nurse is assessing for cardiac tamponade on a client who had coronary artery bypass grafts. Which of the following actions should the nurse take? a. check for hypertension b. auscultate for loud, bounding heart sounds c. auscultate blood pressure for pulses paradoxus d. check for a pulse deficit

C (a client who has cardiac tamponade will have pulses paradoxus when the systolic blood pressure is at least 10 mm Hg higher on expiration than on inspiration. This occurs because of the sudden decrease in cardiac output from the fluid compressing the atria and ventricles)

A nurse is assessing a client who has pericarditis. Which of the following manifestations should the nurse expect? a. Bradycardia with ST segment depression b. Relief of chest pain with deep inspiration c. Dyspnea with hiccups d. Chest pain that increases when sitting upright

C (a client with paricarditis will experience dyspnea, hiccups, and a nonproductive cough. These manifestations can indicate heart failure from pericardial compression due to constrictive pericarditis or cardiac tamponade)

A nurse in a clinic is assessing the lower extremities of and ankles of a client who has a history of peripheral arterial disease. Which of the following findings should the nurse expect? a. pitting edema b. areas of reddish-brown pigmentation c. dry, pale skin with minimal body hair d. sunburned appearance with desquamation

C (a client with peripheral arterial disease can display dry, scaly, pale, or mottled skin with minimal body hair because of narrowing of the arteries in the legs and feet. This causes a decrease in blood flow to the distal extremities, which leads to tissue damage. Common manifestations are intermittent claudication (leg pain with exercise) cold/numb feet at rest, loss of hair on lower legs, and weakened pulses)

A nurse is monitoring a patient who had a myocardial infarction. For which of the following complications should the nurse monitor in the first 24 hours? a. infectious endocarditis b. pericarditis c. ventricular dysrhythmias d. pulmonary emboli

C (after a MI, the the electrical conduction system of the heart can be irritable and prone to dysrhythmias. Ischemic tissue caused by the infarction can also interfere with the conduction of the hearts normal electrical system)

A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following recommendations should the nurse make to the client for a sweetener? a. corn syrup b. natural honey c. nonnutritive sugar substitute d. guava nectar

C (clients who have type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake)

A nurse is providing dietary teaching to a client who has nephropathy secondary to diabetes mellitus and plans to make dietary adjustments. Which of the following instructions should the nurse include? a. consume less than 45% of total calories from carbohydrates per day b. eat no more than 300 mg of cholesterol per day c. consume less than 0.8 g/kg of body weight of protein per day d. eat at least 45 g of fiber per day

C (clients with diabetes should adjust protein intake to less than 0.8 g/kg of body weight per day to delay renal injury) at intakes of below 45% for carbs for total calories means that fat intake is too high. Diabetics should consume between 45-65% of carbohydrates per day clients who have diabetes should limit cholesterol to less than 200 mg per day clients with diabetes should reach the goal of 25g of fiber for women and 38 g for men per day

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? a. ranitidine b. guaifenesin c. prednisone d. atorvastatin

C (corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication) ranitidine can alter serum creatinine levels, but not glucose guaifenesin can cause drowsiness and dizziness, but doesn't alter glucose levels atorvastatin can interfere with thyroid function tests, but not glucose

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? a. Allow time to calm the patient. b. Observe for signs of diaphoresis. c. Evaluate the use of intercostal muscles. d. Monitor the patient for bilateral chest expansion.

C (other options may occur but aren't primary reason to evaluate chest wall)

A nurse attempts to collect a capillary blood specimen via finger stick for a blood glucose monitoring from a client who has DM. The nurse is unable to obtain an adequate drop of blood for the reagent strip. Which of the following actions should the nurse take first? a. puncture another finger to obtain a capillary specimen b. test the urine with a urine reagent strip c. wrap the hand in a warm, moist cloth d. perform a venipuncture to obtain a venous sample

C (while providing client care, the nurse should first use the least restrictive intervention. The nurse should warm the client's finger with a with a warm, moist cloth to promote blood flow in preparation for the next finger stick)

A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (Select all that apply). a. Remove calluses using over-the-counter remedies. b. Apply lotion between toes. c. Perform nail care after bathing. d. Trim toenails straight across. e. Wear closed-toe shoes.

C D E

Which foot care interventions could help prevent the formation of arterial ulcers in a patient's lower extremities who is diagnosed with peripheral arterial disease (PAD)? Select all that apply. a. washing their legs and feet only when they are obviously dirty b. wearing knee-high support hose c. applying moisturizing cream after washing legs and feet d. wearing well-fitting, protective shoes e. using a bed cradle

C D E Leg hoses would restrict arterial flow to legs even more Clean/moist skin less prone to dryness/breaks in skin integrity. Moisturizing cream prevents dryness

A nurse is teaching self-monitoring of blood glucose (SMBG) to a client who has diabetes mellitus. Which of the following instructions should the nurse include? (select all that apply) a. perform SMBG once daily at bedtime b. wipe the hand with an alcohol swab c. Hold the hand in a dependent position prior to the puncture d. place the puncturing device perpendicular to the site e. prick the outer edge of the fingertip for the blood sample

C D E (The client can perform SMBG as often as before each meal and at bedtime, which generally correlates with their medication schedule, so monitoring once a day at bedtime does not provide enough to monitor blood glucose control effectively. Client should wash hands warm water/soap b/c alcohol can alter the reading. Holding hand in dependent position increases blood flow to fingers. Perpendicular puncture allows adequate puncture depth. Outer edge of the fingertip should be used)

A nurse is assessing a client who has hypoxia. Which of the following findings should the nurse expect? a. bradypnea b. somnolence c. pallor d. tachycardia

D

A nurse is caring for a client who is in hypovolemic shock. While waiting for a unit of blood, the nurse should administer which of the following IV solutions? a. 0.45% sodium chloride b. dextrose 5% in 0.9% sodium chloride c. dextrose 10% in water d. 0.9% sodium chloride

D (0.9% sodium chloride and lactated ringer's solutions are used for fluid volume replacement)

A nurse is assessing a female client who is at risk for developing type 2 diabetes mellitus. The nurse should identify that which of the following manifestations increases the client's risk for developing type 2 diabetes? a. Abdominal girth 32 inches b. Fasting BG 98 mg/dL c. Triglyceride level 100 mg/dL d. Blood pressure 138/98 mmHg

D (A female client who has a waist circumference of 35 inches or greater is at risk for type 2 diabetes. A female client who has a fasting BG of 100 mg/dL of greater is at risk for type 2 diabetes. A female client who has a triglyceride level of 150 mg/dL is at risk type 2 diabetes. A female client who has a blood pressure greater than 130 mmHg systolic and 85 mmHg diastolic is at risk for type 2 diabetes.)

A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan? a. Restrict the client's fluid intake to less than 2 L/day. b. Provide the client with a low-protein diet. c. Have the client use the early-morning hours for exercise and activity d. Instruct the client to use pursed-lip breathing.

D (A patient should drink 2-3 L of fluids each day. Clients who have COPD should consume a high-calorie, high-protein diet to prevent weight loss. Clients who have COPD have poor exercise tolerance in the early morning due to the pulmonary secretions that accumulate while the client has been recumbent during the night. Pursed-lip breathing lengthens the expiratory phase of respiration and also increases the pressure in the airway during exhalation. *This action reduces airway resistance and decreases trapped air for clients who have COPD*.)

A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? a. Seating the client with arm bared, supported, and at heart level. b. Measuring the blood pressure after the client has been seated quietly for 5 minutes. c. Using a cuff with a rubber bladder that encircles at least 80% of the limb. d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

D (BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.)

A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? a. "Eat foods high in potassium." b. "Take daily potassium supplements." c. "Discontinue sodium restrictions." d. "Avoid salt substitutes."

D (Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.)

A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes? a. Pigeon b. Funnel c. Kyphotic d. Barrel

D (Clients who have COPD use accessory muscles to assist with respiratory effort. The use of those accessory muscles causes the chest wall to eventually increase in anterior-posterior diameter, making it appear barrel shaped.)

A nurse is caring for a client who has asthma and is taking fluticasone. The nurse should minor the client for which of the following adverse effects? a. Hypoglycemia b. Hypertension c. Polyuria d. Oral candidiasis

D (Corticosteroids can cause hyperglycemia. They do not cause hypertension. They do not cause polyuria. They can cause oral candidiasis, or thrush; therefore, the client should rinse her mouth with water.)

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? a. Cancer b. Hypertension c. Liver disease d. Myocardial infarction

D (Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Note: less than 90 mg/L is normal).)

A nurse is caring for a client who has returned to the unit following a surgical procedure. The client's oxygen saturation is 85%. Which of the following actions should the nurse take first? a. administer oxygen at 2 L/min b. administer prescribed analgesic medication c. encourage coughing and deep breathing d. raise the head of the bed

D (Elevating the HOB uses gravity to reduce pressure on the diaphragm from abdominal organs and allows for increased lung expansion. This is the first action the nurse should take as it is the least invasive)

A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock? a. Decrease in RR from 20 to 16/min. b. Decrease in urinary output from 50 mL to 30mL per hour. c. Increase in the temp from 99.5 fahrenheit to 101.5 fahrenheit. d. Increase in the HR from 88 to 110/min.

D (Hypovolemic shock is a condition in which the heart is unable to supply enough blood to the body because of blood loss or inadequate blood volume. In an effort to compensate for this, the HR increases steadily. In the first stage of shock, the HR is >100/min. As shock progresses, the HR continues to accelerate to more than 150/min. Hyperthermia is seen in septic shock, one of the classic signs of shock is cool, moist skin. A client experiencing shock would have an increased RR.)

A nurse is assessing a client who has postoperative atelectasis and is hypoxic. Which of the following manifestations should the nurse expect? a. bradycardia b. bradypnea c. lethargy d. intercostal retractions

D (Hypoxia causes tissues to be oxygen-starved. If follows hypoxemia, (low oxygen in blood) and is manifested as substernal or intercostal retractions as the body works harder to draw more oxygen into the lungs)

A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can fell the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." Which of the following actions should the nurse take to help this client with tenacious bronchial secretions? a. Maintaining a semi-Fowler's position as often as possible b. Administering oxygen via nasal cannula at 2 L/min c. Helping the client select a low-salt diet d. Encouraging the client to drink 2 to 3 L of water daily

D (Maintaining hydration through the consumption of adequate fluids will help liquefy thick secretions and facilitate their expectoration)

Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? a. Cardiac catheterization b. Cardiac enzymes c. Echocardiogram d. Electrocardiogram (ECG)

D (The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.)

Intravenous heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? a. Vitamin K b. Aminocaproic acid c. Potassium chloride d. Protamine sulfate

D (The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur)

The nurse knows that including teaching on modifiable risk factors for impaired perfusion in the patient's plan of care includes which of the following: a. Impaired perfusion increases with age. b. Genetics play a role in impaired perfusion. c. Exercise should be kept at a minimum to prevent a myocardial infarction. d. A smoking cessation plan should be in place.

D (The importance of distinguishing between modifiable versus nonmodifiable risk factors is imperative when determining what sort of lifestyle changes can be discussed when formulating the patient's plan of care. Impaired perfusion can affect all people and age groups regardless of gender, race, or economic status. Smoking cessation is an example of a modifiable risk factor for impaired perfusion that can be included in the patient's plan of care. Modifiable risk factors can be changed by the patient through teaching from the nurse. Although impaired perfusion can increase with age, this is an example of an unmodifiable risk factor (something that the patient cannot change). Genetics is an example of an unmodifiable risk factor for impaired perfusion. A sedentary lifestyle can lead to obesity, which would then become a modifiable risk factor for impaired perfusion.)

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient tells the nurse he is having a "hard time breathing." His respiratory rate is 32 breaths per minute, his pulse is 120 beats per minute, and the oxygen saturation is 90%. What would be the best nursing intervention for this patient? a. Begin oxygen via a face mask at 60% FiO2 (fraction of inspired oxygen). b. Administer a PRN (as necessary) dose of an intranasal glucocorticoid. c. Encourage coughing and deep breathing to clear the airway. d. Initiate oxygen via a nasal cannula, and begin at a flow rate of 3 L/min.

D (The normal respiratory drive is a person's level of carbon dioxide (CO2) in the arterial blood. The COPD patient had compensated for his chronic high levels of CO2, and his respiratory drive is dependent on his oxygen levels, not his CO2 levels. If the COPD patient's oxygen level is rapidly increased to what would be considered a normal level, it would compensate for his respiratory drive. The patient with COPD who has difficulty breathing should be given low levels of oxygen and closely observed for the quality and rate of ventilation. A dose of glucocorticoids will not address his immediate needs, but it may provide decreased inflammation and better ventilation over an extended period of time. Encouraging coughing and deep breathing in a patient with COPD does not meet his needs as effectively as administration of low-level oxygen does.)

A nurse is assessing a client who has chronic respiratory insufficiency. Which of the following findings should the nurse expect as result of the long-term inadequate oxygenation? a. restlessness b. retractions c. dependent edema d. clubbing of the fingers

D (The nurse should expect a client who has chronic hypoxia or respiratory insufficiency to display clubbing of the fingers and toes)

Which of the following types of pain is most characteristic of angina? a. Knifelike b. Sharp c. Shooting d. Tightness

D (The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.)

Before discharge, the nurse discusses activity levels with a 61-yr-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness? a. Slightly increase activity over the current level. b. Swim for 10 min/day, gradually increasing to 30 min/day. Incorrect c. Limit exercise to activities of daily living to conserve energy. d. Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

D (The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 min/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220 - patient's age).)

Which of the following parameters is the major determinant of diastolic blood pressure? a. Baroreceptors b. Cardiac output c. Renal function d. Vascular resistance

D (Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.)

The nurse would anticipate that which of the following patients will need to be treated with insertion of a chest tube? a. A patient with asthma and severe shortness of breath b. A patient undergoing a bronchoscopy for a biopsy c. A patient with a pleural effusion requiring fluid removal d. A patient experiencing a problem with a pneumothorax

D (When air is allowed to enter the pleural space, the lung will collapse and a chest tube will be inserted to remove the air and reestablish negative pressure in the pleural space. Patients with asthma do not require a chest tube. A bronchoscopy is done to evaluate the bronchi and lungs and to obtain a biopsy. A thoracentesis may be done to remove fluid from the pleural space. A chest tube may be inserted if there are complications from the thoracentesis or for the bronchoscopy.)

A nurse is assessing a client who has right-sided heart failure. Which of the following findings should the nurse expect? a. decreased capillary refill b. dyspnea c. orthopnea d. dependent edema

D (blood return from the venous system to the right atrium is impaired by a weakened right heart. The subsequent systemic venous backup leads to development of dependent edema) decreased capillary refill occurs to ppl with decreased cardiac output from left sided heart failure when the left side of the heart fails, blood return from the lungs via pulmonary vein is slowed, causing fluid backup in the lungs that results in shortness of breath Dizziness/orthopnea occurs in ppl with decreased cardiac output from left sided heart failure

A nurse is providing education on how to check blood glucose levels to a client who has a new diagnosis of type 1 diabetes mellitus. The nurse should include which of the following instructions about transferring blood into the reagent portion of the test strip? a. smear the blood onto the strip b. squeeze the blood onto the strip c. touch the puncture to stimulate bleeding d. hold the test strip next to the blood on the fingertip

D (holding the pad of the strip next to the puncture allows the blood to flow until the amount on the strip is adequate. Too little blood can result in falsely low readings)

A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take? a. give the insulin at 0700 b. give the insulin when the breakfast tray arrives c. give the insulin 30 min after breakfast with the client's other routine medicines d. give the insulin at 0730

D (regular insulin has an onset of 30-60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin)

When assessing for possible signs of graft occlusion and subsequent limb ischemia it is helpful to remember the "5 P's". What are the 5 P's? (This is not a multiple choice question)

Pain, Pallor, Pulselessness, Paresthesias, Paralysis

Symptoms of Hyperglycemia

Polyuria, Polydipsia, Polyphagia, Dehydration, Fatigue, Fruity Odor to breath, Kussmaul breathing, Weight loss, hunger, poor wound healing

Symptoms of Hypoglycemia

Reduced cognition, tremors, diaphoresis, weakness, hunger, headache, irritability, seizure, tachycardia

A nurse is assessing a client who has an abdominal aortic aneurism. Which of the following manifestations should the nurse expect? a. midsternal chest pain b. thrill c. pitting edema in lower extremities d. lower back discomfort

d (abdominal aortic aneurism involves a widening/stretching/ballooning of the aorta. Back/abdominal pain can indicate that the aneurism is extending downward and pressing on lumbar spinal nerve roots, causing pain)

What is the systolic/diastolic range for prehypertension?

systolic 120-139 diastolic 80-89

What is the systolic/diastolic range for stage 1 hypertension?

systolic 140-159 diastolic 90-99

What is the systolic/diastolic range for stage 2 hypertension?

systolic 160 or higher diastolic 100 or higher

What is the systolic/diastolic range for normal blood pressure?

systolic less than 120 diastolic less than 80