NUR 351 Exam 2 Quizizz & Kahoots
Pt asks nurse what is considered a normal BP
<120/80
What neurotransmitter level is decreased by as much as 90% in people with severe Alzheimer's?
Acetylcholine
Pt has been prescribed ipatropium. Nurse is concerned about a history of: smoking, glaucoma, COPD, hypertension
Glaucoma
What physiologic abnormality is characteristic of emphysema? Collapse of the proximal airways, trapping of air in the distal air sacs, widespread occurrence of bronchial plugs, extensive inflammation of the lower airways
Trapping in the distal air sacs
A pt diagnosed with Alzheimers disease is aphasic. The nurse observes the following: difficulty swallowing, unable to recognize objects, unable to speak, difficulty with motor function
Unable to speak
Patient asks why we can't just use albuterol whenever he feels shortness of breath. The RN says: "Albuterol does not prevent mast cell activation" "It's better to prevent rather than to treat attacks" "Albuterol does not prevent bronchoconstriction"; "IT's better to treat attacks with Fluticasone"
"it's better to prevent rather than treat attacks"
Pt with Parkinson's asks the nurse how the medications will affect his symptoms. Nurse replies: "medications can prevent degeneration of neurons", "medications will control the disease but not symptoms", "medications can improve the balance of neurochemicals", "medications will prevent symptoms for as long as you take them".
"medications can improve the balance of neurochemicals"
Which medications could be used to treat hypertension in a diabetic patient?
ACE inhibitor or ARB (angiotensin II receptor blocker)
The pt reports a highly productive cough that lasts about 4 months of every year. The RN first asks: about allergies to dust, about exercise tolerance, about tobacco use, about sweats and chills
About tobacco use
Which neurotransmitter has been implicated in the development of Alzheimer's disease? Acetylcholine, dopamine, epinephrine, serotonin
Acetylcholine
An acetylcholinesterase inhibitor is beneficial in dementia because it? Acetylcholine increases norepinephrine activity, decreased levels of acetylcholine decrease anxiety, inhibition of Acetylcholineesterase improves motor function, Acetylcholine is needed for memory and problem solving
Acetylcholine is needed for memory and problem solving
High BP increases the workload of the left ventricle by increasing ____? Stroke volume, blood volume, preload, afterload
Afterload
What is a pathophysiologic change consistent with Alzheimer disease? Amyloid plaques, focal cerebral infarct, atherosclerotic plaques, platelet aggregation
Amyloid plaques
Dyspnea on exertion is associated with what disease? HF and emphysema, HF and chronic bronchitis, asthma
HF and chronic bronchitis
Cardiac output is measured by? (Equation)
HR x stroke volume
The nurse monitoring a patient on a heparin infusion is most concerned by? Bleeding gums with brushing, aPTT slightly above goal, blood pressure of 123/75, headache and faintness
Headache and faintness. Bleeding gums is common and not very worrisome. Headache and faintness could be a sign of internal bleeding.
The client asks the nurse which result on his lipid profile is most indicative of ASCVD (atherosclerosis) risk. The nurse says: HDL, LDL, Apolipoprotein B-100, Very LDL
High LDL and low HDL are both bad
The nurse anticipates administering this drug to a patient with acute asthma exacerbation? Flucitasone propionate (Flovent) metered dose inhaler, High-dose albuterol (Proventil) via nebulizer treatment, tiotropium (Spiriva) Handi-halerl DPI, albuterol (Proventil) MDI
High-dose albuterol (Proventil) via nebulizer tx. Albuterol MDI is good to prevent an attack from escalating, but once in a full-blown asthma attack, high-dose albuterol via neb is best.
What is the cause of Atherosclerosis? age over 65, heredity, HTN, hyperlipidemia
Hyperlipidemia
Which is not a risk of oral glucocorticoids? Hypoglycemia, peptic ulcer, risk for infection, adrenal suppression
Hypoglycemia
Beneficial effects that can be derived from statins include all, except? Elevation of HDLs, reduction of risk of cardiovascular events, reduction of LDLs, improvement of liver function
Improvement of liver function
RN knows pt with chronic bronchitis is at risk for cor pulmonale (R heart failure). Why? Due to an increase in the work of the L ventricle, reduced R ventricular preload, due to an increase in pressure in the pulmonary arteries, due to air trapping in the distal alveoli.
Increase in pressure in pulmonary arteries
Poorly controlled HTN will eventually lead to HF secondary to? Increased myocardial workload, pulmonary congestion, reduced renal perfusion, coronary atherosclerosis
Increased myocardial workload.
The chest x-ray of the pt with pneumonia shows a pleural effusion. The RN recognizes that: Inflammation of the pleural membrane increases permeability, blood has collected in the pleural space, pulmonary vascular pressure has increased, air trapping has resulted in increased fluid production
Inflammation of the pleural membrane increases permeability.
In assessment of a pt with chronic HF, what manifestation is expected? Expiratory wheezing, asymmetrical chest expansion, subcutaneous crepitus, inspiratory crackles
Inspiratory crackles (fluid in alveoli). Like rice krispies
Asthma that causes symptoms less than 2 days a week is? Mild persistent, intermittent, moderate persistent, severe persistent
Intermittent
Pain in an affected limb that improves with rest is caused by which of the following?
Intermittent claudication
Which clinical manifestation is characteristic of peripheral arterial disease? Intermittent claudication and pain, pain decreases with activity in affected limb, limb is warm to touch and erythematous, a positive Homan's sign is present in 10% of patients
Intermittent claudication and pain
What type of stroke is a patient with uncontrolled a-fib likely to experience? Ischemic thrombosis, ischemic embolism, hemorrhagic, ischemic stenosis
Ischemic embolism
Which statement is true regarding asthma? Decreased responsiveness to environmental stimuli, involves irreversible airway obstruction, characterized by airway inflammation, extrinsic asthma has sudden onset
It is characterized by airway inflammation
If a patients asthma is not controlled with a low dose ICS, what drug should be added? LABA or medium dose ICS, Racemic epl or LABA, LABA and oral corticosteroid, Cromolyn or LABA
LABA or medium dose ICS
Pt has been diagnosed with pulmonary TB. Nurse anticipates tx... Lasting at least 4-8 weeks, lasting one year, lasting 6-9 months, with one IM injection
Lasting 6-9 months
The pt has diabetes. Which medication is most likely to be prescribed for HTN? Digoxin, Furosemide, Lisinopril, Hydrochlorothiazide
Lisinopril (ACE inhibitor). WHEN IN DOUBT GO WITH AN ACE.
Lisinopril reduces afterload by: reducing excretion of aldosterone, increasing perfusion to the kidney, producing dilation of arterioles, causing venous dilation
Lisinopril is an ACE inhibitor- producing dilation of arterioles
What would you recommend to a patient taking Levodopa/ Carbidopa having nausea and vomiting? Take 30 min before meal and lower dose, take w/ high protein snack and raise dose, take on empty stomach and raise dose, lower dose and take with low protein snack
Lower the dose and take with low protein snack
Client with asthma does not want to use inhaled corticosteroid for prophylaxis. Alternative is: ipatropium, albuterol, oral steroid, montelukast
Montelukast
Walking pneumonia is caused by which organism?
Mycoplasma pneumoniae
What is a common side effect of statin medications? Nausea and vomiting, yellow halos in vision, migraine, myopathy
Myopathy
Which is not a symptom of atelactasis? Tachypnea, decreased chest expansion, absent breath sounds, orthopnea
Orthopnea
A patient on Coumadin (Warfarin) neesd which labs assessed? PT/INR, Potassium, aPTT, Troponin I
PT/ INR
Which branch of the NS system causes bronchoconstriction in asthma?
Parasympathetic.
A pt with HF reports awakening intermittently with shortness of breath. This is? Cyanosis, dyspnea, bradypnea, parosxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea
Tachycardia, decreased absent breath sounds and sudden chest pain on affected side indicate? Sarcoidosis, pneumothorax, hypersensitivity pneumonitis, adult respiratory distress syndrome
Pneumothorax
When a patient is on a loop or thiazide diuretic, what lab should be assessed regularly?
Potassium
Why is heparin used to treat a DVT and not warfarin (Coumadin)? Heparin has few side effects, the onset of coumadin is delayed, coumadin prevents platelet aggregation, heparin has a longer half life.
The onset of coumadin is delayed.
Aspirin can cause all but which of the following? GI bleeding, tinnitus, allergic reaction, thromboembolism
Thromboembolism
Preload
Volume in heart at end of diastole
Stroke volume is defined as
Volume of blood pumped from the left ventricle
A patient on heparin needs which labs assessed? PT/ INR, Potassium, aPTT, Troponin I
aPTT
Type A COPD (emphysema) is characterized by an: increase in alveoli, atrophy of distal air space, loss of elastic tissue, decrease in cilia function
loss of elastic tissue
What is the primary cause of airway obstruction in pts with chronic bronchitis? Thinning bronchial smooth muscle, mucous plugs, hyperventilation, infection
mucous plugs
When does COPD treatment begin? Onset of s/s, peak flow <70% and symptoms, peripheral oxygen <90% and symptoms, peak flow <60%
peak flow <70% and symptoms
Which of the following is NOT a sign of right sided heart failure? JVD, weight gain, persistent cough, peripheral edema
persistent cough
Afterload is defined as
workload of left ventricle to circulate systemic blood
Digital clubbing is associated with what disease?
Emphysema
Pursed-lip breathing is associated with? Emphysema or chronic bronchitis
Emphysema
Use of accessory muscles is associated with? Chronic bronchitis, emphysema
Emphysema
a family member asks how memantine will help the client with alzheimers disease. The nurse responds: "it can improve learning and memory", "it helps improve mood and sleep", "it temporarily reverses the disease process", "it prevents further structural changes in the brain"
"It can improve learning and memory"
The patient calls to report using albuterol 30 minutes ago without a response. The RN advises: "seek medical attention immediately", "make an appt to see your provider this week", "wait one minute and take another puff", "take an antihistamine and wait one hour"
"Seek medical attention immediately"
Patient presents with aphasia, hemiplegia, and visual field blindness. The nurse anticipates what? Order for aspirin, order for complete blood count, an order for CT, order to prep for surgery
An order for a CT
Nurse is about to administer a dose of digoxin. What is a priority nursing intervention? Check BP, Palpate the pedal pulses, Analyze heart rate and rhythm, Assess for Homans' sign
Analyze heart rate and rhythm
Bronchoconstriction, mucosal edema, and wheezing are all symptoms of what disorder? Asthma, emphysema, chronic bronchitis, pneumonia
Asthma
Which disease has airway hyperresponsiveness and reversible airway obstruction? COPD, asthma, chronic emphysema, pneumonia
Asthma
Incomplete expansion of the lung or portion of the lung is? Pneumothorax, pneumonia, atelactasis, pulmonary embolism
Atelactasis
Which is a characteristic of intrinsic non allergic asthma? The prognosis is better than that of extrinsic asthma, the onset is usually in adolescence, attacks are often severe, it is IgE-mediated
Attacks are often severe
The pt has extrinsic asthma. The nurse will teach him to do all of the following except? Carry his albuterol inhaler at all times, manage allergies with meds and/or avoid antigens, avoid excessive exercise, monitor his asthma with a peak flow meter.
Avoid excessive exercise
In a pt with suspected exacerbation of HF, which diagnostic will be used to monitor HF severity? Complete blood count, chest x-ray, BNP, Echocardiogram
BNP: brain natriuretic peptide
What is the goal of pharmacological therapy in the tx of Parkinsons? Increase acetylcholine at presynaptic neurons, balance cholinergic and dopaminergic activity in the brain, reduce dopamine available in the substantia nigra, block dopamine receptors in presynaptic neurons
Balance cholinergic and dopaminergic activity in the brain.
Which statement by the student indicates a need for further teaching regarding beta blockers? Beta blockers block the actions of angiotensin II. Beta blockers decrease heart rate and contractility. Beta blockers decrease peripheral vascular resistance. Beta blockers decrease the release of renin.
Beta blockers block the actions of angiotensin II.
Slow movement and poor coordination are known as ____? Akinesia, "freeze up tremors", bradykinesia, pill rolling
Bradykinesia
In extrinsic asthma, the immune system responds to the presence of allergens by causing what?
Bronchoconstriction
Which do you administer first? Bronchodilator or inhaled glucocorticoid?
Bronchodilator
The pt taking Warfarin has an international normalized ratio of 1.2. What do you do? Administer IV push protamine sulfate, call the healthcare provider to discuss an increase in dose, continue with the current prescription, prepare to administer vitamin K
Call healthcare provider to discuss an increase in dose- blood hasn't been thinned out enough. If the value is 4-5, then you would give Vitamin K.
Teaching for a pt being started on Levidopa/ Carbidopa should include what? Take the medication on a full stomach, the drug may cause the urine to be very dilute, change positions slowly, carbidopa has many adverse effects.
Change positions slowly. These medications can cause dizziness. Shouldn't be taken on a full stomach because it can affect absorption, but this medication can cause GI upset. But don't take it with high protein meals!
Assessment finding include tachycardia, absent breath sounds and pain on the R side and SOB. RN anticipates what? Order for a nebulizer treatment, order for chest tube placement, order for chest x-ray, order for oral corticosteroids
Chest x-ray to make sure lung is collapsed before inserting chest tube
Chronic cough is associated with? Emphysema, chronic bronchitis, asthma
Chronic bronchitis
Excess body fluids are associated with? Emphysema or chronic bronchitis
Chronic bronchitis
Excessive mucus production is associated with? Emphysema or chronic bronchitis.
Chronic bronchitis
Swelling that worsens during the day is caused by? HF, chronic venous insufficiency, pulmonary edema, intermittent claudication
Chronic venous insufficiency
Which medication is contraindicated in people with poor metabolism? Heparin, aspirin, clopidogrel, coumadin
Clopidogrel
Slightly jerky arm movements are known as
Cogwheel rigidity
What clinical manifestation would the nurse expect in a client with left sided heart failure? Cough, JVD, peripheral edema, hepatomegaly
Cough
In a pt with right lower lobe pneumonia, the nurse auscultating this lung field would hear? Stridor, Crackles, wheezing, rhonchi
Crackles
A pt is prescribed lisinopril. For which therapeutic effect will the nurse monitor? Symptoms such as dizziness and fainting, pulse oximetry oxygen saturation of 100%, Slowing of the heart rate, decrease in blood pressure
Decrease in blood pressure. ACE inhibitor blocks angiotensin I from getting to angiotensin II which is a very strong vasoconstrictor so we will have a decrease in BP
Thiazide diuretics work by ________? Decreasing fluid volume overload, increasing pulmonary edema, decreasing exertion tolerance, decreasing cardiac output
Decreasing fluid volume overload
The nurse monitors for which adverse effect after administering hydrochlorothiazide and digoxin? Decreased diuretic effect, digoxin toxicity, dehydration, heart failure.
Digoxin toxicity.
What medication classification is used to decrease preload in pts with heart failure? Calcium channel blockers, corticosteroids, diuretics, beta blockers
Diuretics because it lowers the volume of the blood
In Parkinson's, there is a deficiency of what neurotransmitter?
Dopamine
What is a common side effect of Ropinirole? (Requip) Drowsiness, dry mouth, coughing, dark sweat or saliva
Drowsiness
Skin assessment of chronic venous insufficiency would show which of the following? Pain that decreases when legs are in dependent position, edema increasing as the day progresses, white & shiny skin, diminished or absent pulses
Edema increasing as they day progresses due to incompetent valves
Barrel chest is associated with? Chronic bronchitis, emphysema
Emphysema
Patient has a history of intrinsic asthma and reports an acute onset of wheezing. RN does what? RN asks about drug allergies, RN asks about new soaps or detergents, RN asks for a 24 hour diet recall, RN asks about any recent emotional trauma
RN asks about any recent emotional trauma
A patient is recovering from a stroke with issues understanding speech. What area is affected? Expressive; Wernicke's area. Receptive; Broca's area. Expressive; hippocampus. Rceptive; Wernicke's area
Receptive; Wernicke's area
After an albuterol nebulizer treatment, the patient reports a racing heart and tremors. The RN: recognizes an allergic rxn, recognizes a side effect of the medication, knows that this is an idiosyncratic response, knows the patient is simply anxious
Recognizes a side effect of the medication
The pt taking almodipine reports facial and pedal edema. The nurse will: counsel the pt to discontinue amlodipine, recommend discussing with the prescriber, advise the pt to call 911 when this happens, explain that this will resolve with extended use
Recommend discussing with the prescriber
What is the action of an ACE inhibitor? Help lower LDL cholesterol, help raise HDL cholesterol, increase venous return to the heart, reverse pathological changes in the heart
Reverse pathological changes in the heart
Teaching for a pt beginning fluticasone/ salmeterol will include: Take this every four hours as needed, carry this with you wherever you go, rinse your mouth after using, do not use this with albuterol
Rinse your mouth after using.
For a patient with acute asthma exacerbation, what medication is the best choice? Inhaled corticosteroid, anticholinergic, SABA, LABA
SABA
What medications are used in step 1 of asthma treatment? SABA, low-dose ICS, LABA, oral corticosteroid
SABA
What 2 medications are in Advair?
Salmeterol/ Fluticasone
Mr. H has high BP due to obstructive sleep apnea. He has ____ HTN: secondary, idiopathic, primary, essential
Secondary
Which type of hypertension is secondary to an identifiable cause?
Secondary
Digoxin and furosemide are ordered. Before administering the furosemide, the RN checks: serum sodium, serum troponin, serum potassium, blood urea nitrogen
Serum potassium
The most common cause of chronic bronchitis is? Bacterial infection, chemical irritants, chemical irritants, smoking
Smoking
The client asks the nurse, what's the best thing I can do to prevent a heart attack? Nurse responds: "Lose weight", "stop smoking", "start exercising", "eat less fried food"
Stop smoking
Therapeutic effects of diuretics include: decreasing fluid volume, lower blood pressure, improved exercise tolerance, all of the above
all of the above
What is the main reason people stop use of ACE inhibitors?
development of non-productive cough
