Pathopharm 2 Exam 4 (All) EX

The client is prescribed digoxin (Lanoxin) for treatment of HR. Which of the following statements by the client indicates the need for further teaching by the nurse? "I should not get short of breath anymore." "This drug will help my heart muscle pump less." "I may notice my heart rate decrease." "I may feel tired during early treatment."

"This drug will help my heart muscle pump less." Rationale: The ability to increase the strength of contractions is a characteristic of cardiac glycosides. It may result in a decrease in pulse. Initially the client may experience some fatigue. Symptoms of CHF, such as dyspnea, should improve.

Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for the development of which of teh following adverse effects of this drug? SELECT ALL THAT APPLY 1. Hyperkalemia 2.Hypocalcemia 3. Cough 4. Dizziness 5. Heartburn

1. Hyperkalemia 2.Hypocalcemia 3. Cough 4. Dizziness

A patient has been researching cardiac cells on the internet. Which information indicates the patient has a good understanding? Cardiac cells can withstand ischemic conditions for _____ minutes before irreversible cell injury occurs. A. 5 B. 60 C. 20 D. 90

20

The nurse teaches a patient with gout that naproxen [Naprosyn] is an agent of first choice for treatment over colchicine. The nurse should use which rationale for the teaching? A Naproxen achieves more predicable pain relief with fewer side effects. B Treatment with naproxen must continue over a long period to restore joint function. C Naproxen causes less impairment of carbohydrate metabolism and less risk of hyperglycemia. D Naproxen reduces uric acid levels sooner and with less risk to the kidneys.

A Naproxen achieves more predicable pain relief with fewer side effects.

A nurse should establish which outcomes when planning care for optimal bone health in a child? (Select all that apply.) A Takes a multivitamin containing vitamin D B Has daily exposure to sunlight C Has a daily intake of cereal, cheese, and milk D Has absence of skeletal deformities E Has negative dual-energy x-ray absorptiometry (DEXA) scan

A Takes a multivitamin containing vitamin D B Has daily exposure to sunlight C Has a daily intake of cereal, cheese, and milk D Has absence of skeletal deformities

When evaluating the effects of probenecid, the nurse should monitor which laboratory result? A Uric acid level B Sodium level C Hemoglobin D Blood pH

A Uric acid level

A 52-year-old male is diagnosed with primary hypertension. He has no other health problems. Present treatment would cause the nurse to anticipate administering which drug to the patient? A. A beta-adrenergic agonist B. A calcium channel agonist C. An alpha-adrenergic agonist D. A diuretic

A diuretic

A client with HF has an order for lisnopril (Prinivil, Zestril) Which of the following conditions in the client's history would lead a nurse to confirm the order with the provider? 1. A history of HT previously treated with diuretics. 2. A history of seasonal allergies currently treated with antihistamines. 3. A history of angioedema after taking enalapril (Vasotec) 4. A history of alcoholism, currently abstaining.

A history of angioedema after taking enalapril (Vasotec)

Which of the following cancers involves the proliferation of plasma cells in the bone marrow, causing skeletal pain? A) Myeloma B) Leukemia C) Lymphoma D) Osteosarcoma

A) Myeloma

A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to: a. administer a beta blocker. b. administer a drug that dilates veins. c. reduce the dose of hydralazine. d. give the patient a diuretic.

ANS: A This patient is showing signs of reflex tachycardia, so a beta blocker is indicated to slow the heart rate. Patients with heart failure who take hydralazine often require the addition of isosorbide dinitrate, which also dilates veins. There is no indication for reducing the dose of hydralazine. A diuretic can be given with hydralazine if sodium and water retention is present.

Which patients may receive hydralazine to treat hypertension? (Select all that apply.) a. A 1-month-old infant b. A 5-year-old child c. A pregnant woman d. A mother breast-feeding a newborn e. An older adult

ANS: A, B, E Hydralazine may be used in infants as young as one month of age, in children, and in older adults. Hydralazine is labeled pregnancy category C and data is lacking regarding transmission of hydralazine in breast-feeding women, so benefits should outweigh risks.

A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent: a. cyanide poisoning. b. fluid retention. c. rebound hypertension. d. reflex tachycardia.

ANS: C Sodium nitroprusside acts rapidly and is given only intravenously. Rebound hypertension occurs immediately when the IV is stopped, so an oral antihypertensive should be given simultaneously. Cyanide poisoning can occur with sodium nitroprusside, but giving hydralazine does not counter this adverse effect. Hydralazine does not prevent fluid retention or reflex tachycardia.

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? a. Captopril PO b. Hydralazine [Apresoline] 25 mg PO c. Minoxidil 20 mg PO d. Sodium nitroprusside [Nitropress] IV

ANS: D Sodium nitroprusside is the drug of choice for hypertensive emergencies and is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be used but should be given IV. Minoxidil is effective, but its severe side effects make it a second-line drug.

A 60-year-old male presents to his primary care provider reporting chest pain. He is diagnosed with atherosclerosis. This disease is caused by: A. Abnormal thickening and hardening of vessel walls B. Abnormally dilated arteries and veins C. Autonomic nervous system imbalances D. Arterial wall thinning and weakening

Abnormal thickening and hardening of vessel walls

A patient's localized infection has progressed to the point where septic shock is now suspected. What medication is an appropriate treatment modality for this patient? a-Insulin infusion b- IV administration of epinephrine c- Aggressive IV crystalloid fluid resuscitation d- Administration of nitrates and β-adrenergic blockers

Aggressive IV crystalloid fluid resuscitation Rationale: Patients in septic shock require large amounts of crystalloid fluid replacement. Nitrates and β-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Epinephrine is indicated in anaphylactic shock, and insulin infusion is not normally necessary in the treatment of septic shock (but can be).

Which condition should cause the nurse to assess for high-output failure in a patient? A. Hypovolemia B. Hypothyroidism C. Metabolic alkalosis D. Anemia

Anemia

Which teaching is essential for a client who has had a permanent pacemaker inserted? a. Avoid talking on a cell phone. b. Avoid contact sports and blows to the chest. c. Avoid sexual activity. d. Do not take tub baths.

Answer: Avoid contact sports and blows to the chest. Rationale: No pressure should be applied over the generator site.

The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate? Select all that apply a. Bearing down for a bowel movement b. Possible inferior wall myocardial infarction (MI) c. Client stating that he just had a cup of coffee d. Client becoming emotional when visitors arrived e. Diltiazem (Cardizem) administered an hour ago

Answer: Bearing down for a bowel movement; Possible inferior wall myocardial infarction (MI); Diltiazem (Cardizem) administered an hour ago Rationale: The Valsalva maneuver stimulates the vagus nerve, causing bradycardia. Inferior wall MI is a cause of bradycardia and heart blocks. Calcium channel blockers such as diltiazem may cause bradycardia.

The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the new graduate when the graduate offers to perform which intervention? a. Defibrillation b. Cardiopulmonary resuscitation (CPR) c. Administration of atropine d. Administration of oxygen

Answer: Defibrillation Rationale: Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over: in asystole, there is no rhythm to interrupt; therefore this intervention is not used.

The nurse teaches a client with new-onset atrial fibrillation that risk factors for this dysrhythmia may include which? Select all that apply. a. Use of beta-adrenergic blockers b. Excessive alcohol use c. Advancing age d. High blood pressure e. Palpitations

Answer: Excessive alcohol use; Advancing age; High blood pressure Rationale: Excessive alcohol use may cause atrial fibrillation. Atrial fibrillation occurs more frequently in older people. Hypertension is a risk factor in the development of atrial fibrillation.

The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication? a. ST segment b. Heart rate c. Troponin d. Myoglobin

Answer: Heart rate Rationale: The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol.

The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? a. Heparin b. Atropine c. Dobutamine d. Magnesium sulfate

Answer: Heparin Rationale: Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).

A bone breaks in a place where there was pre-existing disease. What type of fracture is being described? A) Transchondral B) Pathological C) Stress D) Fatigue

B) Pathological

Which of the following molecules form the crystalline structure of hydroxyapatite? A) Calcium and magnesium B) Phosphate and calcium C) Albumin and phosphate D) Magnesium and hydrogen

B) Phosphate and calcium

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I will take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I will increase my intake of fluids and foods that are high in fiber."

B. "I will rise slowly when changing from a sitting to a standing position." Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions. She is diagnosed with infective endocarditis. When the patient wants to know what caused the disease, what is the nurse's best response? The most likely cause of the disease is: A. Viruses B. Bacteria C. Parasites D. Fungi

Bacteria

For an infection to progress to septic shock, which of the following factors should the nurse determine occurred? A. The infection must be gram negative. B. Bacteria must enter the bloodstream. C. The individual must be immunosuppressed. D. The myocardium must be impaired.

Bacteria must enter the bloodstream

Which of the following lab tests will the nurse check to help diagnose heart failure and provide insight into its severity? A. Renin level B. Potassium C. Brain natriuretic D. Troponin

Brain natriuretic

The nurse is caring for several patients. For which patient would a prescription for nifedipine (Adalat) be least appropriate? A. A 60-year-old man with angina and hypertension B. A 48-year-old woman with primary hypertension C. A 78-year-old man with atrial fibrillation D. A 55-year-old woman with vasospastic angina

C. A 78-year-old man with atrial fibrillation Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris and essential hypertension.

A 60-year-old male is diagnosed with cerebral aneurysm. Where does the nurse suspect the cerebral aneurysm is located? A. Basilar artery B. Vertebral arteries C. Carotid arteries D. Circle of Willis

Circle of Willis

Individuals with Raynaud disease need to be counseled to avoid which of the following conditions to prevent severe symptoms? A. Allergic reactions B. Cold exposure C. Hot water immersion D. Tissue injury

Cold exposure

21. A patient outcome that is appropriate for the patient in shock who has a nursing diagnosis of decreased cardiac output related to relative hypovolemia is a. urine output of 0.5 ml/kg/hr. b. decreased peripheral edema. c. decreased CVP. d. oxygen saturation 90% or more.

Correct Answer: A Rationale: A urine output of 0.5 ml/kg/hr indicates adequate renal perfusion, which is a good indicator of cardiac output. The patient may continue to have peripheral edema because fluid infusions may be needed despite third-spacing of fluids in relative hypovolemia. Decreased central venous pressure (CVP) for a patient with relative hypovolemia indicates that additional fluid infusion is necessary. An oxygen saturation of 90% will not necessarily indicate that cardiac output has improved.

15. The nurse evaluates that fluid resuscitation for a 70 kg patient in shock is effective on finding that the patient's a. urine output is 40 ml over the last hour. b. hemoglobin is within normal limits. c. CVP has decreased. d. mean arterial pressure (MAP) is 65 mm Hg.

Correct Answer: A Rationale: Assessment of end-organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level is not useful in determining whether fluid administration has been effective unless the patient is bleeding and receiving blood. A decrease in CVP indicates that more fluid is needed. The MAP is at the low normal range, but does not clearly indicate that tissue perfusion is adequate.

12. All of these collaborative interventions are ordered by the health care provider for a patient stung by a bee who develops severe respiratory distress and faintness. Which one will the nurse administer first? a. Epinephrine (Adrenalin) b. Normal saline infusion c. Dexamethasone (Decadron) d. Diphenhydramine (Benadryl)

Correct Answer: A Rationale: Epinephrine rapidly causes peripheral vasoconstriction, dilates the bronchi, and blocks the effects of histamine and reverses the vasodilation, bronchoconstriction, and histamine release that cause the symptoms of anaphylaxis. The other interventions are also appropriate but would not be the first ones administered.

23. A patient in compensated septic shock has hemodynamic monitoring with a pulmonary artery catheter and an arterial catheter. Which information obtained by the nurse indicates that the patient is still in the compensatory stage of shock? a. The cardiac output is elevated. b. The central venous pressure (CVP) is increased. c. The systemic vascular resistance (SVR) is high. d. The PAWP is high.

Correct Answer: A Rationale: In the early stages of septic shock, the cardiac output is high. The other hemodynamic changes would indicate that the patient had developed progressive or refractory septic shock.

4. While caring for a seriously ill patient, the nurse determines that the patient may be in the compensatory stage of shock on finding a. cold, mottled extremities. b. restlessness and apprehension. c. a heart rate of 120 and cool, clammy skin. d. systolic BP less than 90 mm Hg.

Correct Answer: B Rationale: Restlessness and apprehension are typical during the compensatory stage of shock. Cold, mottled extremities, cool and clammy skin, and a systolic BP less than 90 are associated with the progressive and refractory stages.

9. The patient with neurogenic shock is receiving a phenylephrine (Neo-Synephrine) infusion through a left-forearm IV. Which assessment information obtained by the nurse indicates a need for immediate action? a. The patient has an apical pulse rate of 58 beats/min. b. The patient's urine output has been 28 ml over the last hour. c. The patient's IV infusion site is cool and pale. d. The patient has warm, dry skin on the extremities.

Correct Answer: C Rationale: The coldness and pallor at the infusion site suggest extravasation of the Neo-Synephrine. The nurse should discontinue the IV and, if possible, infuse the medication into a central line. An apical pulse of 58 is typical for neurogenic shock but does not indicate an immediate need for nursing intervention. A 28-ml output over 1 hour would require the nurse to monitor the output over the next hour, but an immediate change in therapy is not indicated. Warm, dry skin indicates that the patient is in early neurogenic shock.

16. The nurse is caring for a patient admitted with a urinary tract infection and sepsis. Which information obtained in the assessment indicates a need for a change in therapy? a. The patient is restless and anxious. b. The patient has a heart rate of 134. c. The patient has hypotonic bowel sounds. d. The patient has a temperature of 94.1° F.

Correct Answer: D Rationale: Hypothermia is an indication that the patient is in the progressive stage of shock. The other data are consistent with compensated shock.

The pathophysiology of osteomalacia involves: A) increased osteoclast activity. B) collagen breakdown in the bone matrix. C) crowding of cells in the osteoid. D) abnormal calcium crystallization.

D) abnormal calcium crystallization.

The cause of most cases of endogenous osteomyelitis is (are): A) fungal skin infection. B) viral pneumonia. C) parasitic infection of the gastrointestinal tract. D) blood-borne bacteria.

D) blood-borne bacteria.

Which agent is most likely to cause the side effect of constipation? A. Nifedipine (Adalat) B. Amlodipine (Norvasc) C. Isradipine (DynaCirc) D. Diltiazem (Cardizem)

D. Diltiazem (Cardizem) Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.

Which is the only cardiovascular indication for minoxidil (Rogaine)? A. Heart failure B. Myocardial infarction C. Mild hypertension D. Severe hypertension

D. Severe hypertension Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.

The nurse is caring for a patient receiving hydralazine (Apresoline). The primary care provider prescribes propranolol (Inderal). The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia

D. To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

A 42-year-old female is diagnosed with constrictive pericarditis. The nurse assesses the blood pressure for decreased cardiac output because of: A. Pericardial effusions B. Fibrosis and calcification of the pericardial layers C. Hemorrhage in the pericardial cavity D. Cardiomyopathy

Fibrous and calcification of the pericardial layers

A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis? A. Race B. Age C. Diet D. Genes

Genes

A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and vomiting, and of seeing halos around lights. The client's serum digoxin level is 2.5 ng. The appropriate nursing intervention is to: Administer both drugs as ordered. Document the findings; the lab results are within normal limits. Hold the digoxin and HCTZ. Hold the digoxin, and give HCTZ as ordered.

Hold the digoxin and HCTZ. Rationale: Thiazide diuretics increase serum digitalis levels by promoting potassium loss, which increases the risk of digoxin toxicity. A digitalis level above 2.0 ng is toxic.

The nurse would recognize which clinical manifestation as suggestive of sepsis? a- Sudden diuresis unrelated to drug therapy b- Hyperglycemia in the absence of diabetes c-Respiratory rate of seven breaths per minute d-Bradycardia with sudden increase in blood pressure

Hyperglycemia in the absence of diabetes Rationale: Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachypnea and tachycardia.

Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for which electrolyte imbalance of this drug? Hyponatremia Hyperkalemia Hypokalemia Hypernatremia

Hyperkalemia Rationale: ACE inhibitors block aldosterone secretion, which results in sodium loss and potassium retention. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics.

A nurse is planning care for a patient in shock. Which principle should the nurse remember? During shock states, glucose uptake is usually: A. Normal B. Enhanced C. Energy intensive D. Impaired

Impaired

A 68-year-old male presents to the ER reporting chest pain. He has a history of stable angina that now appears to be unstable. He most likely has: A. Decreased myocardial oxygen demand B. Impending myocardial infarction (MI) C. Electrical conduction problems in the heart D. Mild to moderate atherosclerosis

Impending myocardial infarction (MI)

When a person is in shock, a nurse remembers impairment in cellular metabolism is caused by: A. Free radical formation B. Lack of nervous or endocrine stimulation C. Inadequate tissue perfusion D. Release of toxic substances

Inadequate tissue perfusion

The nurse developing a teaching plan for a client receiving thiazide diuretics should include the following. Teaching the client to take apical pulse. Decreasing potassium-rich foods in the diet. Including citrus fruits, melons, and vegetables in the diet. Teaching the client to check blood pressure t.i.d.

Including citrus fruits, melons, and vegetables in the diet. Rationale: Thiazide diuretics are potassium wasting, and levels should be closely monitored. Encouraging foods rich in potassium could help maintain potassium levels. Taking an apical pulse is indicated before administering cardiac glycosides and beta blockers. It would not be necessary to check blood pressure TID unless the client was experiencing hypotension.

What laboratory finding fits with a medical diagnosis of cardiogenic shock? A. Decreased liver enzymes B. Increased white blood cells C. Decreased red blood cells, hemoglobin, and hematocrit D. Increased blood urea nitrogen (BUN) and serum creatinine levels

Increased blood urea nitrogen (BUN) and serum creatinine levels

A 59-year-old female is diagnosed with left ventricular failure. If a decrease in kidney perfusion occurs, the nurse knows this would ultimately cause: A. Decreased left ventricular preload B. Decreased cardiac oxygen demand C. Increased systemic vascular resistance D. Increased pulmonary capillary permeability

Increased systemic vascular resistance

When caring for a patient in acute septic shock, what should the nurse anticipate? a- Infusing large amounts of IV fluids b- Administering osmotic and/or loop diuretics c- Administering IV diphenhydramine (Benadryl) d- Assisting with insertion of a ventricular assist device (VAD)

Infusing large amounts of IV fluids Rationale: Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the administration of IV fluids is the cornerstone of therapy. The administration of diuretics is inappropriate. VADs are useful for cardiogenic shock not septic shock. Diphenhydramine (Benadryl) may be used for anaphylactic shock but would not be helpful with septic shock.

The nurse is preparing a nitroprusside (Nitropress) IV drip for a client with severe hypertension. Which of the following actions by the nurse reflect correct preparation? (Select all that apply.) Instructs the client to keep the shades in the room closed during the infusion. Keeps an opaque cover over the solution and tubing. Mixes the drug in 250 mL of 5% dextrose and water. Piggybacks the drug into the client's maintenance IV of normal saline solution, NSS. Removes the opaque cover before administering.

Keeps an opaque cover over the solution and tubing. Mixes the drug in 250 mL of 5% dextrose and water. Rationale: Nitropress is only compatible with D5W, and should not be mixed with other solutions or drugs. The drug is light-sensitive and must be covered with an opaque substance, but it would not be necessary to keep the client's room dark.

A 60-year-old female was diagnosed with mitral stenosis. As a result, the nurse realizes the patient has incomplete emptying of the: A. Left ventricle B. Left atrium C. Right atrium D. Right ventricle

Left atrium

A 75-year-old obese female presents to her primary care provider reporting edema in the lower extremities. Physical exam reveals that she has varicose veins. Upon performing the history, which of the following is a possible cause for the varicose veins? A. Trauma to the deep veins B. Long periods of standing C. Extreme exercise D. Ischemia

Long periods of standing

A nurse is teaching staff about endocarditis. Which information should the nurse include? Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because the: A. Colonies overwhelm the phagocytes. B. Microorganisms are resistant. C. Valves are avascular. D. Microorganisms are sequestered in a fibrin clot.

Microorganisms are sequestered in a fibrin clot

A nurse recalls the most common cardiac valve disease in the United States, which tends to be most prevalent in young women, is: A. Tricuspid valve prolapse B. Pulmonary stenosis C. Mitral valve prolapse D. Aortic stenosis

Mitral valve prolapse

Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock? A) Avoid elevating head of bed. B) Check temperature every 2 hours. C) Monitor breath sounds frequently. D) Assess skin for flushing and itching.

Monitor breath sounds frequently.

When caring for a client receiving triamterene (Dyrenium), the nurse places priority on which nursing intervention? Monitor electrolytes for hyperkalemia. Monitor electrolytes for hypernatremia. Monitor heart rate closely. Monitor blood pressure closely.

Monitor electrolytes for hyperkalemia. Rationale: Dyrenium is a potassium-sparing diuretic. The client should be monitored for signs of hyperkalemia. Hyponatremia, not hypernatremia may occur. BP and heart rate should be monitored, but are not priority with this drug.

A client is being started on lisinopril (Zestril). Nursing interventions during initial therapy with this medication must include Monitoring blood pressure. Monitoring intake and output. Monitoring EKG. Monitoring serum levels.

Monitoring blood pressure. Rationale: Lisinopril is an ACE inhibitor, which can cause severe hypotension with initial doses. The nurse should monitor the client closely for several hours.

A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to: A. Ventricular dilation and wall thinning B. Myocardial hypertrophy and ventricular remodeling C. Inhibition of renin and aldosterone D. Alterations in alpha and beta receptor function

Myocardial hypertrophy and ventricular remodeling

A 75-year-old male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of cardiac troponins I and T. Based upon the lab findings, the nurse suspects which of the following has occurred? A. Orthostatic hypotension B. Varicose veins C. Myocardial infarction (MI) D. Raynaud disease

Myocardial infarction (MI)

A patient has a spinal cord injury at T4. Vital signs include falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing: a. a relative hypervolemia. b. an absolute hypovolemia. c. neurogenic shock from low blood flow. d. neurogenic shock from massive vasodilation.

Neurogenic shock from massive vasodilation Rationale: Neurogenic shock results in massive vasodilation without compensation as a result of the loss of sympathetic nervous system vasoconstrictor tone. Massive vasodilation leads to a pooling of blood in the blood vessels, tissue hypoperfusion, and, ultimately, impaired cellular metabolism. Clinical manifestations of neurogenic shock are hypotension (from the massive vasodilation) and bradycardia (from unopposed parasympathetic stimulation).

Nifedipine (Procardia) has been ordered for a client with HT. In the care plan, the nurse includes the need to monitor for which ADVERSE effect? 1. Rash & chills 2. Reflex tachycardia 3. Increased U/O 4. Weight Loss

Nifedipine (procardia) a CCB may cause hypotension with Reflex Tachycardia.

While planning care for a patient with superior vena cava syndrome (SVCS), which principle should the nurse remember? SVCS is a progressive _____ of the superior vena cava (SVC) that leads to venous distention of the upper extremities and head. A. Distention B. Occlusion C. Sclerosis D. Inflammation

Occlusion

A 55-year-old male died of a myocardial infarction. Autopsy would most likely reveal: A. Embolization of plaque from the aorta B. Platelet aggregation within the atherosclerotic coronary artery C. Decreased ventricular diastolic filling time D. Smooth muscle dysplasia in the coronary artery

Platelet aggregation within the atherosclerotic coronary artery

Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension. A. Secondary B. Congenital C. Acquired D. Primary

Primary

A 51-year-old male is at the health clinic for an annual physical exam. After walking from the car to the clinic, he developed substernal pain. He also reported discomfort in his left shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. The nurse suspects he is most likely experiencing: A. Prinzmetal angina B. Myocardial infarction (MI) C. Unstable angina D. Stable angina

Prinzmetal angina

Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunction? A. Heart failure B. Connective tissue disorders C. Syphilis infection D. Rheumatic fever or heart disease

Rheumatic fever or heart disease

A 65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures should the nurse assess for in this patient? A. Low-output failure B. Left heart failure C. Right heart failure D. High-output failure

Right heart failure

Which patient is most prone to multiple organ dysfunction syndrome (MODS)? In a patient with: A. Autoimmune disease B. Septic shock C. Myocardial infarction (MI) D. Pulmonary disease

Septic shock

The nurse reviews lab studies of a client receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include a Serum sodium level of 140 mEq/L. Serum digoxin level of 1.2 ng/dL. Serum potassium level of 3.0 mEq/L. Hemoglobin 14.4 g/dL.

Serum potassium level of 3.0 mEq/L. Rationale: Normal serum potassium level is 3.5-5.0 mEq/L. Hypokalemia may predispose the client to digitalis toxicity. The other lab values are WNL.

A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is: A. Edema above the knee B. Gangrene C. Deep vein thrombus formation D. Skin hyperpigmentation

Skin hyperpigmentation

When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do? A. Eat B. Physical exertion C. Lie down D. Stand up

Stand up

While planning care, the nurse remembers which principle? In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely. A. Regurgitation B. Insufficiency C. Incompetence D. Stenosis

Stenosis

A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic cancer. He developed edema and venous distention in the upper extremities and face. Which of the following diagnosis will the nurse observe on the chart? A. Thromboembolism B. Chronic venous insufficiency C. Deep vein thrombosis D. Superior vena cava syndrome (SVCS)

Superior vena cava syndrome (SVCS)

A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience? A. Syncope and fainting B. Nausea and vomiting C. Chest pain and palpitations D. Headache and blurred vision

Syncope and fainting

A nurse takes an adult patient's blood pressure and determines it to be normal. What reading did the nurse obtain? A. Systolic pressure greater than 140 mm Hg and a diastolic pressure of 100 mm Hg B. Systolic pressure between 140 mm Hg and 150 mm Hg C. Systolic pressure less than 100 mm Hg regardless of diastolic pressure D. Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg

Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg

The client is taking atenolol (Tenormin) and doxazosin (Cardura). what is the rationale for combining 2 anti-HT drugs? 1. BP will decrease faster 2. Lower doses of both drugs may be given with fewer adverse effects. 3.There is less daily medication dosing. 4. Combination therapy will treat the patient's other medical conditions.

The advantage of using a combo of 2 drugs like atenolol (Tenormin)-a beta blocker and doxazosin (Cardura) an alpha1 antagonist is that Lower doses of both drugs may be given with fewer adverse effects. FALSE BP will decrease faster--s/b gradually lowered to a safe limit. FALSE There is less daily medication dosing. -- # of doses per day dependent on half-life, not the combo of drugs. Maybe True but NOT Truest Combination therapy will treat the patient's other medical conditions.

A 75-year-old female has been critically ill with multiple organ dysfunction syndrome (MODS) for longer than a week and has developed a severe oxygen supply and demand imbalance. The statement that best describes this imbalance is which of the following? A. The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver. B. Increased oxygen delivery to cells fails to meet decreased oxygen demands. C. The amount of oxygen consumed by cells depends only on the needs of cells, because there is oxygen in reserve. D. The situation results in supply-independent consumption.

The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver

A 60-year-old female had a myocardial infarction. She was brought to the hospital 30 minutes later. She survived, but now the nurse is providing care for impaired ventricular function because: A. The resulting ischemia leads to hypoxic injury and myocardial cell death. B. The cells become hypertrophic. C. There is too much stress on the heart. D. There is a temporary alteration in electrolyte balance.

The resulting ischemia leads to hypoxic injury and myocardial cell death

What term should the nurse document for a detached blood clot? A. Thrombus B. Infarction C. Embolus D. Thromboembolus

Thromboembolus

Which statement by a patient indicates to the nurse that further teaching about tiludronate [Skelid] is required? A "I'll need to take the medication with at least a full glass of water." B "I'll need to avoid taking my daily aspirin for 2 hours after taking the Skelid." C "I will take the Skelid at 7 AM each morning and have breakfast at 9 AM or after." D "Taking Maalox three times a day will help reduce heartburn from taking the Skelid."

D "Taking Maalox three times a day will help reduce heartburn from taking the Skelid."

Raloxifene [Evista] has been shown to have protective effects against which disorder in women? A Ovarian cysts B Polycystic ovary syndrome (PCOS) C Endometriosis D Breast cancer

D Breast cancer

A patient is ordered intravenous ibandronate [Boniva] for treatment of postmenopausal osteoporosis. What is a contraindication to administration of the drug? A Serum creatinine level of 2.0 mg/dL B Creatinine clearance of 40 mL/min C Blood urea nitrogen (BUN) of 20 mg/dL D Concurrent administration of cyclosporine because of a history of liver transplantation

D Concurrent administration of cyclosporine because of a history of liver transplantation

A nurse monitors the calcium level of a patient who has had a thyroidectomy. The nurse should notice which finding if the patient's calcium level is 7.5 mg/dL? A Dull, aching bone pain B Nausea and vomiting C Lethargy and confusion D Muscle twitching and tetany

D Muscle twitching and tetany

Which clinical manifestation in a patient taking etanercept [Enbrel] requires a prompt call by the nurse to the prescriber? A Swollen, tender joints B Itching and erythema at the injection sites C Tenting of the skin and dry mucous membranes D New onset of an S3 heart sound and crackles in the lower third of the lungs

D New onset of an S3 heart sound and crackles in the lower third of the lungs

A nurse teaches a patient who is postmenopausal and is scheduled to start taking calcium carbonate as a dietary supplement. The nurse instructs the patient to avoid taking it with which food? A Milk B Carrots C Potatoes D Spinach

D Spinach

A patient is taking methotrexate [Rheumatrex] for rheumatoid arthritis. Which therapeutic action should a nurse expect if the medication is having the desired effect? A Selective inhibition of cyclooxygenase B Neutralization of tumor necrosis factor C Inhibition of T-cell activation D Suppression of T and B lymphocytes

D Suppression of T and B lymphocytes

In addition to joint pain, rheumatoid arthritis often manifests with which of the following systemic symptoms? A) Fever B) Malaise C) Lymphadenopathy D) All of the above

D) All of the above

Which of the following ions is released from the sarcoplasmic reticulum to initiate a muscle contraction? A) Sodium B) Potassium C) Magnesium D) Calcium

D) Calcium

Which of the following bones belongs to the appendicular skeleton? A) Sternum B) Sacrum C) Mandible D) Ilium

D) Ilium

Patients with osteoporosis are at risk for which of the following problems? A) Rhabdomyolysis B) Osteomyelitis C) Osteomalacia D) Pathologic bone fractures

D) Pathologic bone fractures

Individuals with gout are 1000 times more likely to develop which of the following problems? A) Coronary artery disease B) Osteoarthritis C) Contractures D) Renal stones

D) Renal stones

A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? a. Aldosterone antagonist b. Angiotensin II receptor blocker (ARB) c. Beta blocker d. Direct renin inhibitor (DRI)

ANS: A Aldosterone antagonists are added to therapy for patients with worsening symptoms of HF. Aldosterone promotes myocardial remodeling and myocardial fibrosis, so aldosterone antagonists can help with this symptom. ARBs are given for patients who do not tolerate ACE inhibitors. Beta blockers do not prevent fibrotic changes. DRIs are not widely used.

A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will: a. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b. contact the provider to report digoxin toxicity. c. request an order for a decreased dose of digoxin. d. review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L.

ANS: A Anorexia, nausea, and vomiting are the most common adverse effects of digoxin and should cause nurses to evaluate for more serious signs of toxicity. If the HR is greater than 60 beats per minute, the dose may be given. Nausea by itself is not a sign of toxicity. A decreased dose is not indicated. A serum potassium level less than 3.5 mEq/L is an indication for withholding the dose.

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for: a. decreased urine output. b. increased blood pressure. c. jugular vein distension. d. shortness of breath.

ANS: A As the heart rate increases, ventricular filling decreases, and cardiac output and renal perfusion decrease. Tachycardia does not elevate blood pressure. Jugular vein distension and shortness of breath occur with fluid volume overload.

A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? a. "I may become constipated, so I should increase fluids and fiber." b. "I may experience a rapid heart rate as a result of taking this drug." c. "I may have swelling of my hands and feet, but this will subside." d. "I may need to increase my digoxin dose while taking this drug."

ANS: A Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and patients should notify their prescriber if this occurs, because the prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced.

A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug? a. Improved exercise tolerance b. Increased cardiac output c. Prevention of cardiac remodeling d. Prolonged survival

ANS: A Diuretics help reduce fluid volume overload, which, by reducing pulmonary edema, can improve exercise tolerance. Diuretics do not improve cardiac output. ACE inhibitors are used to prevent cardiac remodeling and to improve long-term survival.

A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient? a. Evaluating ankle edema b. Monitoring for nausea and vomiting c. Noting the presence of hypertrichosis d. Obtaining a blood glucose

ANS: A Fluid retention is a common and serious adverse effect of minoxidil, because it can lead to cardiac decompensation. If present, a diuretic is indicated. Nausea and vomiting may occur with this drug but is not a serious side effect. Hypertrichosis occurs in about 80% of patients taking the drug, but its effects are cosmetic and not life threatening. It may be important to monitor the blood glucose level in some patients, because the drug can alter glucose tolerance, but this effect is not as serious as fluid retention.

A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will: a. caution the patient not to get up abruptly. b. encourage the patient to increase fluid intake. c. tell the patient to report shortness of breath. d. warn the patient about the possibility of bradycardia.

ANS: A Postural hypotension occurs when moving from a supine or seated position to an upright position. It is caused by relaxation of smooth muscle in veins, which allows blood to pool in veins and decreases venous return of blood to the heart. Patients taking such drugs should avoid abrupt transitions to prevent falls. Prolonged use of vasodilators can lead to expansion of blood volume and fluid overload, so increasing fluid intake is not appropriate. Shortness of breath is a symptom associated with heart failure. Tachycardia can occur when the blood pressure drops as a result of the baroreceptor reflex.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to: a. avoid potassium supplements. b. monitor for a decreased heart rate. c. take extra fluids. d. use a salt substitute instead of salt.

ANS: A Spironolactone is added to therapy for patients with worsening symptoms of HF. Because spironolactone is a potassium-sparing diuretic, patients should not take supplemental potassium. Patients taking digoxin need to monitor their heart rate. Extra fluids are not indicated. Salt substitutes contain potassium.

The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? a. Blocking aldosterone receptors b. Increasing diuresis c. Reducing venous pressure d. Reducing afterload

ANS: A Spironolactone prolongs survival in patients with HF primarily by blocking receptors for aldosterone. Spironolactone cause only minimal diuresis. It does not reduce afterload, and it does not reduce venous pressure enough to prolong survival, because it causes only minimal diuresis.

A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: a. ACE inhibitors and beta blockers. b. biventricular pacemakers. c. dietary supplements and exercise. d. diuretics and digoxin.

ANS: A This patient is classified as having Stage B heart failure with no current symptoms but with structural heart disease strongly associated with the development of heart failure. Treatment at this stage includes an ACE inhibitor and a beta blocker to help prevent the progression of symptoms. Biventricular pacemakers are used for patients in Stage C heart failure and have more advanced structural disease and symptoms. Dietary supplements and exercise have not been proven to prevent structural heart disease. Diuretics and digoxin are used for patients with Stage C heart failure.

The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient? a. Decrease in cardiac work b. Increase in cardiac output c. Increase in tissue perfusion d. Increase in venous return

ANS: A Vasodilators that dilate capacitance vessels, or veins, lead to a decrease in venous return to the heart, which reduces preload and the force of ventricular contraction. The resultant effect is a decrease in cardiac work. With a decrease in ventricular contraction, cardiac output is reduced, as is tissue perfusion. Dilation of veins causes a decrease in venous return.

A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for: a. AV blockade. b. gingival hyperplasia. c. migraine headaches. d. reflex tachycardia.

ANS: A Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, and its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes reflex tachycardia.

A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate: a. administering intravenous norepinephrine (NE) and atropine and glucagon. b. assisting with direct-current (DC) cardioversion. c. placing the patient in an upright position. d. preparing to administer a beta blocker.

ANS: A Verapamil toxicity can cause bradycardia and hypotension. Atropine and glucagon should be given to treat bradycardia and NE for hypotension. DC cardioversion is indicated for ventricular tachydysrhythmias, which this patient does not have. Patients with hypotension should be placed in Trendelenburg's position. Beta blockers will only exacerbate these effects.

A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment? a. Check the patient for other symptoms of digitalis toxicity. b. Withhold the next dose of furosemide. c. Continue to monitor the patient for heart failure. d. Document the findings and reassess in 1 hour.

ANS: A Yellow halos around lights indicate digoxin toxicity. The use of furosemide increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient should also be assessed for headache, nausea, and vomiting, and blood should be drawn for measurement of the serum digoxin level. The nurse should not withhold the dose of furosemide until further assessment is done, including measurement of a serum digoxin level. No evidence indicates that the patient is in worsening heart failure. Documentation of findings is secondary to further assessment and prevention of digoxin toxicity.

Which are therapeutic uses for verapamil? (Select all that apply.) a. Angina of effort b. Cardiac dysrhythmias c. Essential hypertension d. Sick sinus syndrome e. Suppression of preterm labor

ANS: A, B, C Verapamil is used to treat both vasospastic angina and angina of effort. It slows the ventricular rate in patients with atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. It is a first-line drug for the treatment of essential hypertension. It is contraindicated in patients with sick sinus syndrome. Nifedipine has investigational uses in suppressing preterm labor.

Which medications are included in first-line therapy for heart failure? (Select all that apply.) a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) b. Aldosterone antagonists c. Beta blockers d. Cardiac glycosides e. Diuretics

ANS: A, C, E For routine therapy, heart failure is treated with agents that inhibit the RAAS, beta blockers, and diuretics. Aldosterone antagonists and cardiac glycosides are not first-line drugs for HF.

A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason? a. It causes tachycardia and increases the cardiac workload. b. It does not correct the underlying pathology of heart failure. c. It has a wide therapeutic range that makes dosing difficult. d. It may actually shorten the patient's life expectancy.

ANS: B Digoxin improves cardiac output, alters electrical effects, and helps to decrease sympathetic outflow from the central nervous system (CNS) through its neurohormonal effects; however, it does not alter the underlying pathology of heart failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the cardiac workload by increasing contractility. It has a narrow therapeutic range and many adverse effects. Digoxin does not improve life expectancy; in women it may actually shorten life expectancy.

A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug? a. "I will need to ask for assistance when getting up out of a chair." b. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." c. "I may develop joint pain, but this side effect will decrease over time." d. "This drug may cause excessive hair growth on my face, arms, and back."

ANS: B Hydralazine can cause severe reflex tachycardia; a beta blocker is usually given to counter this effect. Postural hypotension is minimal with hydralazine. Patients should be taught to report joint pain, which indicates an SLE syndrome and requires discontinuation of the drug. Minoxidil can cause excessive hair growth, not hydralazine.

An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family? a. Antidysrhythmic medications b. End-of-life care c. Heart transplantation d. Implantable mechanical assist devices

ANS: B Patients in Stage D heart failure have advanced structural heart disease. For eligible patients, the best long-term solution is heart transplantation, but this patient probably is not eligible, given his advanced age. End-of-life care should be discussed. Antidysrhythmic medications are not indicated and may make symptoms worse. An implantable mechanical assist device is used in patients awaiting heart transplantation.

A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon? a. "Baroreceptors in the aortic arch stimulate the heart to beat faster." b. "Reflex tachycardia can negate the desired effects of vasodilators." c. "Reflex tachycardia is more likely to occur when beta blockers are given." d. "Venous dilation must occur for reflex tachycardia to occur."

ANS: B Reflex tachycardia, which is a compensatory mechanism in response to decreased blood pressure, can negate the desired effect of a vasodilator by eventually increasing blood pressure. Baroreceptors relay information to the vasomotor center of the medulla; the medulla sends impulses to the heart. Beta blockers are given to counter reflex tachycardia. Reflex tachycardia can be produced by dilation of both arterioles and veins.

A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? a. Contact the provider to request an increased dose of digoxin. b. Give the dose of digoxin and notify the provider of the potassium level. c. Request an order for a diuretic. d. Withhold the dose and notify the provider of the heart rate.

ANS: B The patient's serum potassium level is above normal limits, but only slightly. An elevated potassium level can reduce the effects of digoxin, so there is no risk of toxicity. There is no indication that an increased dose of digoxin is needed. There is no indication for a diuretic. The heart rate is acceptable; doses should be withheld if the heart rate is less than 60 beats per minute.

A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed? a. "I can expect dizziness and facial flushing with nifedipine." b. "I should notify the provider if I have swelling of my hands and feet." c. "I will need to take a beta blocker to prevent reflex tachycardia." d. "I will need to take this drug once a day."

ANS: C Amlodipine produces selective blockade of calcium channels in blood vessels with minimal effects on the heart. Reflex tachycardia is not common, so a beta blocker is not indicated to prevent this effect. Dizziness and facial flushing may occur. Peripheral edema may occur and should be reported to the provider. Amlodipine is given once daily.

A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: a. hypernatremia. b. hypertension. c. hyperkalemia. d. hypokalemia.

ANS: C One of the principal effects of angiotensin-converting enzyme (ACE) inhibitors is hyperkalemia, which is due to decreased aldosterone release arising from blockage of angiotensin II. There is no indication that careful monitoring of sodium for increased levels is indicated. Vasotec is indicated for heart failure, not hypertension. The drug therapy should be monitored to ascertain its effectiveness, but hyperkalemia is the main concern. Hyperkalemia, not hypokalemia, is a concern because of the decreased aldosterone release that occurs with blockage of angiotensin II.

A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request: a. adding spironolactone [Aldactone]. b. reducing the dose of digoxin. c. discontinuing the quinidine. d. giving potassium supplements.

ANS: C Quinidine can cause plasma levels of digoxin to rise; concurrent use of quinidine and digoxin is contraindicated. There is no indication for adding spironolactone unless this patient's potassium level is elevated. The dose of digoxin ordered is a low dose. Potassium supplements are contraindicated with digoxin.

A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching? a. "I will check to see when the last dose of the beta blocker was given." b. "I will monitor vital signs closely to assess for hypotension." c. "I will monitor the heart rate frequently to assess for reflex tachycardia." d. "I will prepare to administer intravenous norepinephrine if necessary."

ANS: C Reflex tachycardia is not an expected effect; the greater risks are cardiosuppression and bradycardia. Because beta blockers and verapamil have the same effects on the heart, there is a risk of excessive cardiosuppression. To minimize this risk, the two drugs should be given several hours apart. Hypotension may occur and should be treated with IV norepinephrine.

A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure? a. "An increase in arteriolar tone to improve tissue perfusion can decrease resistance." b. "An increase in contractility to increase cardiac output can cause pulmonary edema." c. "When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles." d. "When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs."

ANS: C The heart rate increases to improve cardiac output, but it may prevent adequate ventricular filling. An increase in arteriole tone improves tissue perfusion but also increases both the resistance to the pumping of the heart and the cardiac workload. Increased contractility helps improve cardiac output but is detrimental because it increases the oxygen demand of the heart. An increase in venous tone improves ventricular filling, but as the ventricles fail, blood can back up and cause pulmonary edema.

A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient: a. has digoxin toxicity. b. is showing signs of renal failure. c. is experiencing worsening of the disease. d. needs a potassium-sparing diuretic.

ANS: C This patient has a normal serum potassium level, and the digoxin level is normal. The patient is showing signs of pulmonary edema, which indicates progression of heart failure. The digoxin level is within normal limits, and the heart rate is above 60 beats per minute, so digoxin toxicity is not likely. There is no sign of renal failure. A potassium-sparing diuretic is not indicated.

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? a. ACE inhibitor b. Digoxin [Lanoxin] c. Furosemide [Lasix] d. Spironolactone [Aldactone]

ANS: C This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a loop diuretic, which can produce profound diuresis very quickly even when the glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid volume overload. Digoxin has a positive inotropic effect on the heart, which may improve renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak diuresis effects; it is used in conjunction with other diuretics to improve electrolyte balance.

A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? a. Decreased cardiac preload b. Decreased cardiac output c. Increased tissue perfusion d. Increased ventricular contraction

ANS: C Vasodilators that dilate resistance vessels, or arterioles, cause a decrease in afterload, which allows cardiac output and tissue perfusion to increase. A decrease in preload would be the result of dilation of capacitance vessels, or veins. Dilation of arterioles increases cardiac output. Ventricular contraction results when preload is increased.

Which are expected effects of cardiac glycosides? (Select all that apply.) a. Decreased cardiac output b. Decreased force of contraction c. Decreased heart rate d. Modulation of neurohormonal systems e. Positive inotropic effects

ANS: C, D, E Digoxin slows the heart rate, modulates the activity of neurohormonal systems, and increases the force of contraction. It does not decrease cardiac output or reduce the force of contraction.

Which medications are most likely to cause postural hypotension? (Select all that apply.) a. Minoxidil b. Diltiazem [Cardizem] c. Prazosin [Minipress] d. Captopril [Capoten] e. Losartan [Cozaar]

ANS: C, D, E Postural, or orthostatic, hypotension is defined as a fall in blood pressure related to a change in position. Minoxidil and diltiazem dilate arterioles; therefore, they are not likely to cause postural hypotension. Prazosin, captopril, and losartan all reportedly can cause orthostatic hypotension

A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: a. reduce flushing. b. minimize gingival hyperplasia. c. prevent constipation. d. prevent reflex tachycardia.

ANS: D Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta blockers can reduce the adverse cardiac effects of nifedipine.

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: a. complete blood count. b. ejection fraction. c. maximal exercise capacity. d. serum electrolyte levels.

ANS: D Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. This patient is taking the drugs recommended for patients with Stage C heart failure; although the patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not recommended.

A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take? a. Withhold the drug for an hour and reassess the level. b. Withhold the drug and notify the prescriber immediately. c. Administer Digibind to counteract the toxicity. d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

ANS: D The optimum plasma digoxin range is 0.5 to 0.8 ng/mL. The patient's pulse should be checked before administration, as always, and the digoxin should be administered. The digoxin does not have to be withheld, nor does the prescriber need to be notified. If the digoxin level is demonstrating a trend of increasing, the issue should be discussed in rounds. Digibind is not indicated, because the digoxin level is therapeutic.

A 28-year-old female presents to the ER reporting severe chest pain that worsens with respirations or lying down. She has a fever, tachycardia, and a friction rub. Based upon the assessment findings, the nurse determines the patient is experiencing: A. Myocardial infarction (MI) B. Stable angina C. Acute pericarditis D. Pericardial effusion

Acute pericarditis

The nurse is teaching the client with a new permanent pacemaker. Which statement by the client indicates the need for further discharge education? a. "I will be able to shower again soon." b. "I need to take my pulse every day." c. "I might trigger airport security metal detectors." d. "I no longer need my heart pills."'

Answer: "I no longer need my heart pills."' Rationale: All discharge medications are still needed after the pacemaker is implanted.

In teaching clients at risk for bradydysrhythmias, what information does the nurse include? a. "Avoid potassium-containing foods." b. "Stop smoking and avoid caffeine." c. "Take nitroglycerin for a slow heartbeat." d. "Use a stool softener."

Answer: "Use a stool softener." Rationale: Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps to prevent this.

When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be which of the following? a. 60 Beats/min b. 75 Beats/min c. 100 Beats/min d. 150 Beats/min

Answer: 100 Beats/min Rationale: Since each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).

The nurse is determining whether the client's rhythm strip demonstrates proper firing of the sinoatrial (SA) node. Which waveform indicates proper function of the SA node? a. The QRS complex is present. b. The PR interval is 0.24 second. c. A P wave precedes every QRS complex. d. The ST segment is elevated.

Answer: A P wave precedes every QRS complex. Rationale: A P wave is generated by the SA node and represents atrial depolarization.

A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan? a. Synchronized cardioversion b. Electrophysiology studies (EPS) c. Anticoagulation d. Radiofrequency ablation therapy

Answer: Anticoagulation Rationale: Because of the risk for thromboembolism, anticoagulation is necessary.

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which of the following nursing interventions is most appropriate at this time? a. Reinforcing the pressure dressing as needed b. Encouraging range-of-motion exercises of the involved arm c. Assessing the incision for any redness, swelling, or discharge d. Applying wet-to-dry dressings every 4 hours to the insertion site

Answer: Assessing the incision for any redness, swelling, or discharge Rationale: After pacemaker insertion, it is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement. The nonpressure dressing is kept dry until removed, usually 24 hours postoperative. It is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site.

The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets that this rhythm is which of the following? a. Sinus tachycardia b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

Answer: Atrial fibrillation Rationale: Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating.

A patient in asystole is likely to receive which of the following drug treatments? a. Atropine and epinephrine b. Lidocaine and amiodarone c. Digoxin and procainamide d. β-Adrenergic blockers and dopamine

Answer: Atropine and epinephrine Rationale: Normally the patient in asystole cannot be successfully resuscitated. However, administration of atropine and epinephrine may prompt the return of depolarization and ventricular contraction.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate the client at 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Give the client IV lidocaine.

Answer: Check the client for a pulse. Rationale: The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate using 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Administer IV ibutilide (Corvert).

Answer: Check the client for a pulse. Rationale: The nurse needs to assess the pulse and client stability before proceeding with further interventions; pulseless ventricular tachycardia is treated with defibrillation.

The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0.24 second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record. What action should the nurse take? a. Administer atropine. b. Administer digoxin. c. Administer clonidine. d. Continue to monitor.

Answer: Continue to monitor. Rationale: The client is displaying sinus rhythm with first-degree atrioventicular heart block; this is usually asymptomatic and does not require treatment. Atropine is used in emergency treatment of symptomatic bradycardia. This client has normal vital signs. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm. Clonidine is used in the treatment of hypertension; a side effect is bradycardia.

A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next? a. Defibrillate at 200 J. b. Establish IV access. c. Place an oral airway and ventilate. d. Start cardiopulmonary resuscitation (CPR).

Answer: Defibrillate at 200 J. Rationale: Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols.

The nurse receives in report that the client with a pacemaker has experienced loss of capture. Which situation is consistent with this? a. The pacemaker spike falls on the T wave. b. Pacemaker spikes are noted, but no P wave or QRS complex follows. c. The heart rate is 42, and no pacemaker spikes are seen on the rhythm strip. d. The client demonstrates hiccups.

Answer: Pacemaker spikes are noted, but no P wave or QRS complex follows. Rationale: Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode.

The nurse is caring for a client with heart rate of 143. For which manifestations should the nurse observe? Select all that apply. a. Palpitations b. Increased energy c. Chest discomfort d. Flushing of the skin e. Hypotension

Answer: Palpitations; Chest discomfort; Hypotension Rationale: Tachycardia, heart rate greater than100 beats/min, produces palpitations, that is, the ability to feel the heart beating in the chest. Chest discomfort may occur because decreased time for diastole results in lower perfusion through the coronary arteries to the myocardium. Hypotension results from decreased time for ventricular filling, secondary to shortened diastole and therefore reduced cardiac output and blood pressure.

A patient has sought care following a syncopal episode of unknown etiology. Which of the following nursing actions should the nurse prioritize in the patient's subsequent diagnostic workup? a. Preparing to assist with a head-up tilt-test b. Assessing the patient's knowledge of pacemakers c. Preparing an intravenous dose of a b-adrenergic blocker d. Teaching the patient about the role of antiplatelet aggregators

Answer: Preparing to assist with a head-up tilt-test Rationale: A head-up tilt-test is a common component of the diagnostic workup following episodes of syncope. IV b-blockers are not indicated and addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient education surrounding antiplatelet aggregators is not directly relevant to the patient's syncope.

The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. a. Respiratory rate b. QT interval c. Heart rate and rhythm d. Magnesium level e. Urine output

Answer: QT interval; Heart rate and rhythm; Magnesium level Rationale: Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore monitoring of heart rate and rhythm is needed.Electrolyte depletion, specifically potassium and magnesium, may predispose to further dysrhythmia. Although it is always important to monitor vital signs and urine output, these assessments are not specific to amiodarone.

Which of the following ECG characteristics is consistent with a diagnosis of ventricular tachycardia (VT)? a. Unmeasurable rate and rhythm b. Rate 150 beats/min; inverted P wave c. Rate 200 beats/min; P wave not visible d. Rate 125 beats/min; normal QRS complex

Answer: Rate 200 beats/min; P wave not visible Rationale: VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. P wave inversion and a normal QRS complex are not associated with VT. Rate and rhythm are not measurable in ventricular fibrillation.

What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin? a. It is important to consume a diet high in green leafy vegetables. b. You should take aspirin or ibuprofen for headache. c. Report nosebleeds to your provider immediately. d. Avoid caffeinated beverages.

Answer: Report nosebleeds to your provider immediately. Rationale: Warfarin causes decreased ability to clot; a nosebleed could be indicative of excessive dosing.

The nurse recognizes that which intervention provides safety during cardioversion? a. Using the defibrillator at 200 joules b. Obtaining informed consent c. Setting the defibrillator to the synchronized mode d. Removing oxygen

Answer: Setting the defibrillator to the synchronized mode Rationale: Setting the defibrillator to the synchronized mode ensures discharging the shock during the vulnerable period on the T wave, which may cause ventricular fibrillation.

The client's rhythm strip shows a heart rate of 76 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.24 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? a. Normal sinus rhythm b. Sinus bradycardia c. Sinus rhythm with first-degree atrioventricular (AV) block d. Sinus rhythm with premature ventricular contractions

Answer: Sinus rhythm with first-degree atrioventricular (AV) block Rationale: These are the characteristics of sinus rhythm with first-degree AV block.

You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit? a. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min b. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min c. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min d. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min

Answer: The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min Rationale: This client has a stable, asymptomatic dysrhythmia, which usually requires no treatment; this client can be managed by a nurse with less cardiac dysrhythmia training.

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? a. The client is semirecumbent in bed. b. Chest leads are placed as for the previous ECG. c. The client is instructed to breathe deeply through the mouth. d. The client is instructed to lie still.

Answer: The client is instructed to breathe deeply through the mouth. Rationale: Normal breathing is required or artifact will be observed, perhaps leading to inaccurate interpretation of the ECG.

Which information would cause the nurse to withhold digoxin in the client with atrial fibrillation and heart failure? a. The client has sinus tachycardia with a rate of 102. b. The cardiac monitor shows atrial fibrillation with a heart rate of 98. c. The client has a creatinine level of 1.0 mg/dL. d. The digoxin level is 2.8 mg/dL.

Answer: The digoxin level is 2.8 mg/dL. Rationale: The therapeutic range for digoxin is 0.8 to 2.0 ng/mL; hold the medication because this client has digoxin toxicity.

Which of the following statements best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? a. The length of time it takes to depolarize the atrium b. The length of time it takes for the atria to depolarize and repolarize c. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers d. The length of time it takes for the electrical impulse to travel from the SA node to the AV node

Answer: The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers Rationale: The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. The P wave represents atrial contraction and the R wave is part of the QRS complex that represents ventricular contraction. Therefore when measuring the time from the beginning of the P wave to the beginning of the QRS (PR interval), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers.

How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia? a. Client states he is dizzy and weak. b. The nurse notes dyspnea. c. The client has a heart rate of 42. d. The monitor shows sinus rhythm.

Answer: The monitor shows sinus rhythm. Rationale: Sinus rhythm presents with heart rates from 60 to 100 beats/min; by definition, the bradydysrhythmia has resolved.

The nurse obtains a 6-second rhythm strip and charts the following analysis: atrial rate 70, regular; ventricular rate 40, regular; QRS 0.04 sec; no relationship between P waves and QRS complexes; atria and ventricles beating independently of each other. Which of the following would be a correct interpretation of this rhythm strip? a. Sinus dysrhythmias b. Third-degree heart block c. Wenckebach phenomenon d. Premature ventricular contractions

Answer: Third-degree heart block Rationale: Third-degree heart block represents a loss of communication between the atrium and ventricles. This is depicted on the rhythm strip as no relationship between the P waves, representing atrial contraction, and QRS complexes, representing ventricular contraction. The atrium are beating totally on their own at 70 beats/min, whereas the ventricles are pacing themselves at 40 beats/min.

For which of the following dysrhythmias is defibrillation primarily indicated? a. Ventricular fibrillation b. Third-degree AV block c. Uncontrolled atrial fibrillation d. Ventricular tachycardia with a pulse

Answer: Ventricular fibrillation Rationale: Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.

A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. While planning care, which characteristic changes should the nurse remember? A. High fevers that damage collagen in valve leaflets B. Blood-borne organisms that adhere to the valvular surface C. Antigens that bind to the valvular lining, triggering an autoimmune response D. Rheumatoid factor in the blood, stimulating valvular degeneration

Antigens that bind to the valvular lining, triggering an autoimmune response

Which interventions should be used for anaphylactic shock (select all that apply)? a. Antibiotics b. Vasodilator c. Antihistamine d. Oxygen supplementation e. Colloid volume expansion f. Crystalloid volume expansion

Antihistamine, Oxygen supplementation, and Colloid volume expansion Rationale: Due to the massive vasodilation, release of vasoactive mediators, and increased in capillary permeability from the immediate reaction, fluid leaks from the vascular space into the interstitial space. By administering a colloid (which contain larger particles that do not penetrate the semipermable membrane), the large particles will stay intravascularly. Due to their smaller size particle composition, a crystalloid would not stay intravascularly and leak interstitially.

A 72-year-old female has a history of hypertension and atherosclerosis. An echocardiogram reveals backflow of blood into the left ventricle. Which of the following is the most likely diagnosis documented on the chart? A. Mitral regurgitation B. Mitral stenosis C. Aortic regurgitation D. Aortic stenosis

Aortic regurgitation

Upon assessment of the patient, the nurse finds a widened pulse pressure and throbbing peripheral pulses. Which valve disorder does the nurse suspect? A. Mitral regurgitation B. Aortic stenosis C. Mitral stenosis D. Aortic regurgitation

Aortic regurgitation

A 67-year-old female was previously diagnosed with rheumatic heart disease. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely diagnosis recorded on the chart? A. Mitral regurgitation B. Aortic stenosis C. Mitral stenosis D. Aortic regurgitation

Aortic stenosis

Atenolol (Tenormin) is prescribed for a client with hypertension. The nurse recognizes that a safe dose for this drug is: Atenolol (Tenormin) 100 mg b.i.d. Atenolol (Tenormin) 150 mg q.d. Atenolol (Tenormin) 50 mg b.i.d. Atenolol (Tenormin) 75 mg b.i.d.

Atenolol (Tenormin) 50 mg b.i.d. Rationale: The maximum dosage range for Atenolol (Tenormin) is 100 mg/day.

When a patient asks the nurse what is the most common cause of myocardial ischemia, which statement is the correct response? The most common cause of myocardial ischemia is: A. Idiopathic vasospasm B. Atherosclerosis C. Venous emboli D. Arterial emboli from heart valve

Atherosclerosis

A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. Which of the following is the most likely diagnosis to be recorded on the chart? A. Atrial tachycardia B. Idioventricular rhythm C. Sinus dysrhythmia D. Atrial fibrillation

Atrial fibrillation

A patient who is postmenopausal is scheduled to begin taking alendronate [Fosamax] to prevent osteoporosis. Which instruction should the nurse give the patient? A "For the best absorption, take the drug while eating a meal." B "After taking the medication, sit or stand for 30 minutes." C "It will be normal to experience some heartburn." D "Take the medication with orange juice or coffee."

B "After taking the medication, sit or stand for 30 minutes."

Which statement by a patient does not indicate a need for further teaching by the nurse about the administration of alendronate [Fosamax]? A "I'll need to take my Fosamax with a glass of orange juice each morning to increase the medication absorption." B "I'll need to make sure I stand or sit for at least 30 minutes after taking my Fosamax." C "I can break the pill in half or crush it if I have difficulty swallowing it." D "It's not uncommon to develop heartburn while taking Fosamax, so I should not be overly concerned."

B "I'll need to make sure I stand or sit for at least 30 minutes after taking my Fosamax."

A nurse is teaching a patient with chronic tophaceous gout who is scheduled to start taking allopurinol [Zyloprim]. Which of these statements should the nurse include in the teaching? A "You'll see the joint swelling reduced in your toe in just a few days." B "You may notice an increase in your pain attacks in the first month." C "We need to collect periodic hair samples to measure uric acid levels." D "It'll be important to minimize fluid intake so the kidneys can rest."

B "You may notice an increase in your pain attacks in the first month."

A female patient is to start treatment with teriparatide [Forteo] for osteoporosis. The nurse assesses the patient's history for which of these disorders that would be a contraindication to treatment? A Multiple sclerosis B Bone cancer C Myocardial infarction D Glaucoma

B Bone cancer

A patient has been taking raloxifene [Evista] for treatment of postmenopausal osteoporosis. Which patient complaint requires immediate investigation by the healthcare provider? A Pain on swallowing B Edema and tenderness in the left calf C Hot flashes D Urinary frequency

B Edema and tenderness in the left calf

A nurse instructs a patient at risk of developing osteoporosis to implement which measures to maximize bone strength? (Select all that apply.) A Start hormone replacement therapy. B Engage in regular weight-bearing exercise. C Ensure a daily intake of calcium and vitamin D. D Have routine bone mineral density (BMD) tests. E Avoid smoking and excessive alcohol.

B Engage in regular weight-bearing exercise. C Ensure a daily intake of calcium and vitamin D. D Have routine bone mineral density (BMD) tests. E Avoid smoking and excessive alcohol.

When planning interventions for pain control in a patient with gouty arthritis, the nurse should assess for pain in which joints? A Hands B Feet C Shoulders D Neck

B Feet

A nurse is monitoring a patient who is receiving an intravenous infusion of rituximab [Rituxan] for severe rheumatoid arthritis. Which finding is a complication of this treatment that would require the nurse to stop the infusion? A Nosebleed B Hypotension C Seizure activity D Hypoglycemia

B Hypotension

To normalize a low serum calcium level, the body releases parathyroid hormone (PTH); this results in which therapeutic effect? A Decrease in the intestinal absorption of calcium B Increase in bone resorption of calcium C Increase in renal calcium excretion D Increase in plasma levels of phosphate

B Increase in bone resorption of calcium

What assessment is essential before treatment with hydroxychloroquine [Plaquenil] is started for a patient with rheumatoid arthritis (RA)? A T3, T4, TSH B Ophthalmic examination C PPD and chest x-ray D BUN and creatinine

B Ophthalmic examination

A nurse teaches a patient who is to start taking infliximab [Remicade] for rheumatoid arthritis. Which of these cardiac findings should the nurse instruct the patient to report as a complication of the treatment? A Calf pain B Pedal edema C Cool, pale toes D Clubbed fingernails

B Pedal edema

A nurse is monitoring a patient who takes etanercept [Enbrel] for rheumatoid arthritis. The nurse should obtain the results of which laboratory test when evaluating for adverse effects? A Arterial blood gases (ABGs) B Skin test for tuberculosis C Electrocardiogram (ECG) D 24-hour urine collection for creatinine clearance

B Skin test for tuberculosis

Which of the following substances prevent proper bone healing? A) Vitamins C and E B) Alcohol and nicotine C) High-protein diet D) Dehydration

B) Alcohol and nicotine

Spongy (cancellous) bone is found in which of the following locations? A) Diaphysis of long bones B) Epiphysis of long bones C) Cortical bone areas D) All of the above

B) Epiphysis of long bones

Which muscle delivers the power stroke during the cross-bridge cycle of muscle contraction? A) Calcium B) Myosin C) Actin D) Tropomyosin

B) Myosin

Which cells have the capability of dissolving bone tissue and releasing the stored calcium into the bloodstream? A) Osteoblasts B) Osteoclasts C) Osteocytes D) Osteoids

B) Osteoclasts

Severe muscle trauma from crush injuries can result in which of the following complications? A) Myotonia B) Rhabdomyolysis C) Myocarditis D) Fibromyalgia

B) Rhabdomyolysis

Which structure is the contractile subunit of the myofibril in a skeletal muscle cell? A) Sarcoplasmic reticulum B) Sarcomere C) Myosin D) Motor end plate

B) Sarcomere

Phase 1 of the bone remodeling cycle involves: A) secondary bone formation. B) bone cell activation. C) bone tissue resorption. D) trabeculae configuration.

B) bone cell activation.

The primary manifestation of osteoarthritis is: A) joint fusion. B) joint pain. C) hypermobility of joints. D) contractures.

B) joint pain.

Known causes of osteoporosis include all of the following except: A) family history. B) late menopause. C) smoking. D) anorexia.

B) late menopause.

A partial tear of a ligament is called a: A) first-degree strain. B) second-degree strain. C) first-degree sprain. D) second-degree sprain.

B) second-degree strain.

A torus fracture occurs when: A) the injury occurs at the epiphyseal growth plate. B) the cortex of the bone buckles. C) the spongy bone is damaged without affecting the cortical bone. D) a long bone splinters into many fragments.

B) the cortex of the bone buckles.

Pain and inflammation associated with gout are caused by crystallization of _____ in the tissues. A) amino acid B) uric acid C) ketones D) hyaluronic acid

B) uric acid

The nurse is caring for a patient with hypertension who is receiving verapamil (Calan). The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (Select all that apply.) A. Peripheral vasoconstriction B. Peripheral vasodilation C. Coronary vasodilation D. Increased heart rate E. Increased force of contraction

B, C Verapamil causes peripheral vasodilation and coronary vasodilation, which lead to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on the heart rate or contractility in healthy hearts.

The nurse is caring for a patient receiving a nitroprusside (Nipride) intravenous infusion. The patient's wife asks why furosemide (Lasix) is being prescribed along with this drug. The nurse's response is based on which concept? A. Furosemide will help reduce reflex tachycardia. B. Many vasodilators cause retention of sodium and water. C. Thiocyanate may accumulate in patients receiving nitroprusside. D. Vasodilators can cause serious orthostatic hypotension.

B. Many vasodilators cause retention of sodium and water. Nitroprusside is a potent vasodilator that can cause retention of sodium and water. Furosemide, a diuretic, often is combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

A client receiving furosemide (Lasix) as an adjunct to treatment of hypertension returns for follow-up. Which of the following objective data should the nurse consider when determining the effectiveness of the drug therapy? Blood pressure log notes blood pressure 120/70-134/88 since discharge. Weight loss of six pounds in the past month Frequency of voiding of at least six times per day Absence of edema in lower extremities

Blood pressure log notes blood pressure 120/70-134/88 since discharge. Rationale: Maintenance of blood pressure within normal limits indicates that treatment goals are achieved. Absence of edema, weight loss, and urinating all indicate that the diuretic has promoted fluid loss, but are not the best measure of the drug's effectiveness for hypertension.

Which statement by a patient indicates understanding of teaching about leflunomide [ARAVA]? A "I'll need to learn how to give myself injections." B "Constipation is a common side effect, so I'll need to take a stool softener." C "I'll need to be extremely conscientious about taking my birth control pills." D "I'll need to have routine eye examinations to make sure I'm not having any side effects of the medication."

C "I'll need to be extremely conscientious about taking my birth control pills."

A nurse obtains a health history from a patient who has gout and is taking a glucocorticoid. The nurse should follow up on which finding? A Flushing and urticaria B Heart rate of 88 beats per minute C Blood glucose level of 140 mg/dL D 6-kg weight loss

C Blood glucose level of 140 mg/dL

The nurse should be concerned about which finding in a patient on long-term, low-dose colchicine therapy to prevent gout? A White blood cell (WBC) count of 6500/mcL B Platelet count of 200,000/mcL C Complaints of muscle pain and weakness D Complaints of headache

C Complaints of muscle pain and weakness

A nurse teaches a patient to avoid undergoing which procedure before receiving an intravenous dose of zoledronate [Reclast]? A Skin test for tuberculosis B Heart catheterization C Dental procedures D Mammography

C Dental procedures

The nurse should follow up on which finding if it is identified in a patient receiving periodic intravenous infusions of abatacept [Orencia] for rheumatoid arthritis? A Itching and hives B Blurred vision and eye pain C Fever and malaise D Jaundice and dark urine

C Fever and malaise

Which medication requires screening for tuberculosis before treatment is started? A Celecoxib [Celebrex] B Minocycline [Minocin] C Leflunomide [ARAVA] D Sulfasalazine [Azulfidine]

C Leflunomide [ARAVA]

The main energy source or fuel for skeletal muscle contraction is: A) calcium. B) albumin. C) ATP. D) actin.

C) ATP.

Myoglobinuria (rhabdomyolysis) can result in failure of which of the following organs? A) Liver B) Lungs C) Kidneys D) Pancreas

C) Kidneys

Which of the following musculoskeletal tumors usually forms in the bone marrow? A) Rhabdosarcoma B) Liposarcoma C) Osteosarcoma D) Chondrosarcoma

C) Osteosarcoma

Which of the following disorders in characterized by enlargement and softening of the bones? A) Osteomyelitis B) Osteoporosis C) Paget disease D) Rickets

C) Paget disease

Which of the following pairs of symptoms is likely to manifest following a femoral fracture? A) Chest pain and shortness of breath B) Low blood glucose and seizures C) Pain and swelling in the thigh D) Limb paralysis and referred pain

C) Pain and swelling in the thigh

Which of the following fractures involves fragmentation of the articular cartilage and generally occurs in adolescents? A) Greenstick B) Stress C) Transchondral D) Insufficiency

C) Transchondral

The best screening test for osteoporosis is: A) an x-ray. B) a bone biopsy. C) a dual energy x-ray absorptiometry (DEXA) scan. D) a thorough physical exam.

C) a dual energy x-ray absorptiometry (DEXA) scan.

An avulsion occurs when: A) the synovial capsule is torn. B) the body of a ligament is torn. C) a tendon is torn off its bony attachment. D) a tendon becomes inflamed.

C) a tendon is torn off its bony attachment.

Rheumatoid arthritis results from joint inflammation caused by: A) bacterial infection. B) trauma. C) autoimmune injury. D) congenital hypermobility.

C) autoimmune injury.

Pain in fibromyalgia is attributed to: A) inflammation. B) autoimmune destruction of muscle tissue. C) decrease in pain tolerance. D) increased levels of peripheral neurotransmitters.

C) decrease in pain tolerance.

The chief pathologic feature of degenerative joint disease is: A) stress fractures of the epiphysis. B) loss of synovial fluid. C) degeneration of articular cartilage. D) thinning of the joint capsule.

C) degeneration of articular cartilage.

Complications that can occur as a fractured bone heals include all of the following except: A) malunion. B) nonunion. C) disunion. D) delayed union.

C) disunion.

Episodes of gout are often triggered by all of the following factors except: A) alcohol. B) drugs. C) high-fat diet. D) trauma.

C) high-fat diet.

A tear in a tendon is commonly known as a: A) fracture. B) sprain. C) strain. D) subluxation.

C) strain.

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2

C. Beta1 Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.

Before administering hydralazine (Apresoline), it is most important for the nurse to obtain which assessment? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill

C. Blood pressure Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

A nurse is caring for a client who is starting captopril (Capoten) for HT. For which of the following adverse effects should the nurse monitor the client? 1. Hypokalemia 2. Hypernatremia 3. Neutropenia 4. Anemia

Captopril -- ACE-I, 3. Neutropenia Side effects --Hyperkalemia NOT hypo --cause excretion of sodium & water (expected)

A client with congestive heart failure, CHF, is prescribed digoxin (Lanoxin) and furosemide (Lasix). Nursing interventions will include: (Select all that apply.) Encourage intake of water and fruit juices. Restrict intake of green, leafy vegetables. Checking apical pulse before administering medication. Monitor hemoglobin and hematocrit levels. Monitor serum electrolytes.

Checking apical pulse before administering medication. Monitor serum electrolytes. Rationale: Digoxin is a cardiac glycoside. which can slow heart rate, and an apical heart rate is checked prior to administration. Lasix is a loop diuretic used in treatment of CHF, which promotes not only water loss, but also loss of electrolytes. A low potassium level increases risk of digoxin toxicity. Fluids are often restricted with CHF. H and H level do not need to be checked, and green, leafy vegetables would not need to be restricted.

5. When assessing the hemodynamic information for a newly admitted patient in shock of unknown etiology, the nurse will anticipate administration of large volumes of crystalloids when the a. cardiac output is increased and the central venous pressure (CVP) is low. b. pulmonary artery wedge pressure (PAWP) is increased, and the urine output is low. c. heart rate is decreased, and the systemic vascular resistance is low. d. cardiac output is decreased and the PAWP is high.

Correct Answer: A Rationale: A high cardiac output and low CVP suggest septic shock, and massive fluid replacement is indicated. Increased PAWP indicates that the patient has excessive fluid volume (and suggests cardiogenic shock), and diuresis is indicated. Bradycardia and a low systemic vascular resistance (SVR) suggest neurogenic shock, and fluids should be infused cautiously.

19. While assessing a patient in shock who has an arterial line in place, the nurse notes a drop in the systolic BP from 92 mm Hg to 76 mm Hg when the head of the patient's bed is elevated to 75 degrees. This finding indicates a need for a. additional fluid replacement. b. antibiotic administration. c. infusion of a sympathomimetic drug. d. administration of increased oxygen.

Correct Answer: A Rationale: A postural drop in BP is an indication of volume depletion and suggests the need for additional fluid infusions. There are no data to suggest that antibiotics, sympathomimetics, or additional oxygen are needed.

13. A patient with a myocardial infarction (MI) and cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. Hemodynamic monitoring reveals an elevated PAWP and decreased cardiac output. The nurse will anticipate a. administration of furosemide (Lasix) IV. b. titration of an epinephrine (Adrenalin) drip. c. administration of a normal saline bolus. d. assisting with endotracheal intubation.

Correct Answer: A Rationale: The PAWP indicates that the patient's preload is elevated and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase myocardial oxygen demand and might extend the MI. The PAWP is already elevated, so normal saline boluses would be contraindicated. There is no indication that the patient requires endotracheal intubation.

26. An assessment finding indicating to the nurse that a 70-kg patient in septic shock is progressing to MODS includes a. respiratory rate of 10 breaths/min. b. fixed urine specific gravity at 1.010. c. MAP of 55 mm Hg. d. 360-ml urine output in 8 hours.

Correct Answer: B Rationale: A fixed urine specific gravity points to an inability of the kidney to concentrate urine caused by acute tubular necrosis. With MODS, the patient's respiratory rate would initially increase. The MAP of 55 shows continued shock, but not necessarily progression to MODS. A 360-ml urine output over 8 hours indicates adequate renal perfusion.

22. A patient who has just been admitted with septic shock has a BP of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose 246 mg/dl. Which order will the nurse accomplish first? a. Start insulin drip to maintain blood glucose at 110 to 150 mg/dl. b. Give normal saline IV at 500 ml/hr. c. Titrate norepinephrine (Levophed) to keep MAP at 65 to 70 mm Hg. d. Infuse drotrecogin- (Xigris) 24 mcg/kg.

Correct Answer: B Rationale: Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy. The other actions are also appropriate and should be initiated quickly as well.

17. Norepinephrine (Levophed) has been ordered for the patient in hypovolemic shock. Before administering the drug, the nurse ensures that the a. patient's heart rate is less than 100. b. patient has received adequate fluid replacement. c. patient's urine output is within normal range. d. patient is not receiving other sympathomimetic drugs.

Correct Answer: B Rationale: If vasoconstrictors are given in a hypovolemic patient, the peripheral vasoconstriction will further decrease tissue perfusion. A patient with hypovolemia is likely to have a heart rate greater than 100 and a low urine output, so these values are not contraindications to vasoconstrictor therapy. Patients may receive other sympathomimetic drugs concurrently with Levophed.

6. A patient who has been involved in a motor-vehicle crash is admitted to the ED with cool, clammy skin, tachycardia, and hypotension. All of these orders are written. Which one will the nurse act on first? a. Insert two 14-gauge IV catheters. b. Administer oxygen at 100% per non-rebreather mask. c. Place the patient on continuous cardiac monitor. d. Draw blood to type and crossmatch for transfusions.

Correct Answer: B Rationale: The first priority in the initial management of shock is maintenance of the airway and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood for transfusions should also be rapidly accomplished, but only after actions to maximize oxygen delivery have been implemented.

11. A patient who is receiving chemotherapy is admitted to the hospital with acute dehydration caused by nausea and vomiting. Which action will the nurse include in the plan of care to best prevent the development of shock, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction syndrome (MODS)? a. Administer all medications through the patient's indwelling central line. b. Place the patient in a private room. c. Restrict the patient to foods that have been well-cooked or processed. d. Insert a nasogastric (NG) tube for enteral feeding.

Correct Answer: B Rationale: The patient who has received chemotherapy is immune compromised, and placing the patient in a private room will decrease the exposure to other patients and reduce infection/sepsis risk. Administration of medications through the central line increases the risk for infection and sepsis. There is no indication that the patient is neutropenic, and restricting the patient to cooked and processed foods is likely to decrease oral intake further and cause further malnutrition, a risk factor for sepsis and shock. Insertion of an NG tube is invasive and will not decrease the patient's nausea and vomiting.

8. The nurse caring for a patient in shock notifies the health care provider of the patient's deteriorating status when the patient's ABG results include a. pH 7.48, PaCO2 33 mm Hg. b. pH 7.33, PaCO2 30 mm Hg. c. pH 7.41, PaCO2 50 mm Hg. d. pH 7.38, PaCO2 45 mm Hg.

Correct Answer: B Rationale: The patient's low pH in spite of a respiratory alkalosis indicates that the patient has severe metabolic acidosis and is experiencing the progressive stage of shock; rapid changes in therapy are needed. The values in the answer beginning "pH 7.48" suggest a mild respiratory alkalosis (consistent with compensated shock). The values in the answer beginning "pH 7.41" suggest compensated respiratory acidosis. The values in the answer beginning "pH 7.38" are normal.

25. To monitor a patient with severe acute pancreatitis for the early organ damage associated with MODS, the most important assessments for the nurse to make are a. stool guaiac and bowel sounds. b. lung sounds and oxygenation status. c. serum creatinine and urinary output. d. serum bilirubin levels and skin color.

Correct Answer: B Rationale: The respiratory system is usually the system to show the signs of MODS because of the direct effect of inflammatory mediators on the pulmonary system. The other assessment data are also important to collect, but they will not indicate the development of MODS as early.

14. The triage nurse receives a call from a community member who is driving an unconscious friend with multiple injuries after a motorcycle accident to the hospital. The caller states that they will be arriving in 1 minute. In preparation for the patient's arrival, the nurse will obtain a. a liter of lactated Ringer's solution. b. 500 ml of 5% albumin. c. two 14-gauge IV catheters. d. a retention catheter.

Correct Answer: C Rationale: A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and will not be ordered until the patient had been assessed for possible liver abnormalities. Although colloids may sometimes be used for volume expansion, it is generally accepted that crystalloids should be used as the initial therapy for fluid resuscitation. A catheter would likely be ordered, but in the 1 minute that the nurse has to obtain supplies, the IV catheters would take priority.

18. When the nurse is caring for a patient in cardiogenic shock who is receiving dobutamine (Dobutrex) and nitroglycerin (Tridil) infusions, the best evidence that the medications are effective is that the a. systolic BP increases to greater than 100 mm Hg. b. cardiac monitor shows sinus rhythm at 96 beats/min. c. PAWP drops to normal range. d. troponin and creatine kinase levels decrease.

Correct Answer: C Rationale: Because PAWP is increased in cardiogenic shock as a result of the increase in volume and pressure in the left ventricle, normalization of PAWP is the best indicator of patient improvement. The changes in BP and heart rate could occur with dobutamine infusion even if patient tissue perfusion was not improved. Troponin and creatine kinase (CK) levels are indicators of cardiac cellular death and are not used as indicators of improved tissue perfusion.

27. When caring for a patient who has just been admitted with septic shock, which of these assessment data will be of greatest concern to the nurse? a. BP 88/56 mm Hg b. Apical pulse 110 beats/min c. Urine output 15 ml for 2 hours d. Arterial oxygen saturation 90%

Correct Answer: C Rationale: The best data for assessing the adequacy of cardiac output are those that provide information about end-organ perfusion such as urine output by the kidneys. The low urine output is an indicator that renal tissue perfusion is inadequate and the patient is in the progressive stage of shock. The low BP, increase in pulse, and low-normal O2 saturation are more typical of compensated septic shock.

24. When caring for a patient with cardiogenic shock and possible MODS, which information obtained by the nurse will help confirm the diagnosis of MODS? a. The patient has crackles throughout both lung fields. b. The patient complains of 8/10 crushing chest pain. c. The patient has an elevated ammonia level and confusion. d. The patient has cool extremities and weak pedal pulses.

Correct Answer: C Rationale: The elevated ammonia level and confusion suggest liver failure in addition to the cardiac failure. The crackles, chest pain, and cool extremities are all consistent with cardiogenic shock and do not indicate that there are failures in other major organ systems.

7. A patient with massive trauma and possible spinal cord injury is admitted to the ED. The nurse suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock, based on the finding of a. cool, clammy skin. b. shortness of breath. c. heart rate of 48 beats/min d. BP of 82/40 mm Hg.

Correct Answer: C Rationale: The normal sympathetic response to shock/hypotension is an increase in heart rate. The presence of bradycardia suggests unopposed parasympathetic function, as occurs in neurogenic shock. The other symptoms are consistent with hypovolemic shock.

3. A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the compensatory physiologic mechanism that leads to altered urinary output is a. activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries. b. stimulation of cardiac -adrenergic receptors, leading to increased cardiac output. c. release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. d. movement of interstitial fluid to the intravascular space, increasing renal blood flow.

Correct Answer: C Rationale: The release of aldosterone and ADH lead to the decrease in urine output by increasing the reabsorption of sodium and water in the renal tubules. SNS stimulation leads to renal artery vasoconstriction. -Receptor stimulation does increase cardiac output, but this would improve urine output. During shock, fluid leaks from the intravascular space into the interstitial space.

10. A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and cardiac output. The nurse anticipates the administration of a. nitroglycerine (Tridil). b. dobutamine (Dobutrex). c. norepinephrine (Levophed). d. sodium nitroprusside (Nipride).

Correct Answer: C Rationale: When fluid resuscitation is unsuccessful, administration of vasopressor drugs is used to increase the systemic vascular resistance (SVR) and improve tissue perfusion. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Dobutamine will increase stroke volume, but it would also further decrease SVR. Nitroprusside is an arterial vasodilator and would further decrease SVR.

20. The best nursing intervention for a patient in shock who has a nursing diagnosis of fear related to perceived threat of death is to a. arrange for the hospital pastoral care staff to visit the patient. b. ask the health care provider to prescribe a sedative drug for the patient. c. leave the patient alone with family members whenever possible. d. place the patient's call bell where it can be easily reached.

Correct Answer: D Rationale: The patient who is fearful should feel that the nurse is immediately available if needed. Pastoral care staff should be asked to visit only after checking with the patient to determine whether this is desired. Providing time for family to spend with the patient is appropriate, but patients and family should not feel that the nurse is unavailable. Sedative administration is helpful but does not as directly address the patient's anxiety about dying.

2. A diabetic patient who has had vomiting and diarrhea for the past 3 days is admitted to the hospital with a blood glucose of 748 mg/ml (41.5 mmol/L) and a urinary output of 120 ml in the first hour. The vital signs are blood pressure (BP) 72/62; pulse 128, irregular and thready; respirations 38; and temperature 97° F (36.1° C). The patient is disoriented and lethargic with cold, clammy skin and cyanosis in the hands and feet. The nurse recognizes that the patient is experiencing the a. progressive stage of septic shock. b. compensatory stage of diabetic shock. c. refractory stage of cardiogenic shock. d. progressive stage of hypovolemic shock.

Correct Answer: D Rationale: The patient's history of hyperglycemia (and the associated polyuria), vomiting, and diarrhea is consistent with hypovolemia, and the symptoms are most consistent with the progressive stage of shock. The patient's temperature of 97° F is inconsistent with septic shock. The history is inconsistent with a diagnosis of cardiogenic shock, and the patient's neurologic status is not consistent with refractory shock.

A patient with ST-segment elevation in several ECG leads is admitted to the ED and diagnosed as having an AMI. Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy? a. "Is there any family history of heart disease?" b. "Do you take aspirin on a daily basis?" c. "Can you describe the quality of your chest pain?" d. "What time did your chest pain begin?"

"What time did your chest pain begin?" Rationale: Fibrinolytic therapy should be started within 6 hours of the onset of the MI, so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information will also be needed, but it will not be a factor in the decision about fibrinolytic therapy.

A 40-year-old man with a history of IV drug use presents with cellulitis with multiple abscesses of the right upper extremity. His current weight is 70 kg (lean body weight). He rapidly develops worsening respiratory distress and hypotension and ultimately requires intubation and mechanical ventilation. Blood gas analysis shows a pH of 7.23, Paco2 of 58 torr, Pao2 of 60 torr, and an oxygen saturation of 88%. His ventila- tor settings are assist-control mode with a tidal vol- ume of 420 mL, respiratory rate of 16 breaths/min,positive end-expiratory pressure (PEEP) of 5 cm H2O, and Fio2 of 70%. His plateau pressure on the ventilator is 29 cm H2O. A chest radiograph shows bilateral interstitial infiltrates, and a 2-dimensional echocardiogram demonstrates normal left ventricular function. What ventilator adjustments should be made? (A) Change the ventilator mode to synchronized intermittent mandatory ventilation (B) Increase PEEP (C) Increase respiratory rate to 24 breaths/min (D) Increase tidal volume to 600 mL (E) Leave the ventilator settings unchanged

(B) Increase PEEP. The largest trial of a volume and pressure-limited strategy showed a 9% decrease in all-cause mortality in patients ventilated with tidal volumes of 6 mL/kg of estimated lean body weight as compared with a tidal volume of 12 mL/kg (target plateau pressure, < 30 cm H2O).3 Based on the results of this study, a strategy of using low tidal volume and high PEEP is recommended for mechanical ventilation of acute lung injury/ARDS patients.

Which of the following is true of vasopressin in septic shock? (A) Continuous infusion at low doses improves 28-day overall mortality (B) Continuous infusion at low doses improves mortality in patients with severe septic shock (C) Continuous infusion at low doses increases cardiac output (D) Continuous infusion at low doses reduces the catecholamine infusion requirement

(D) Continuous infusion at low doses reduces the catecholamine infusion requirement. Vasopressin is a peptide synthesi zed in the hypothalamus and released from the posterior pituitary. Vasopressin produces a wide range of physiologic effects, including blood pressure maintenance. Acting through vascular V1receptors, the endogenous hormone directly induces vasoconstriction in hypotensive patients but does not significantly alter vascular smooth muscle constriction in humans with normal blood pressure. Landry and colleagues8 demonstrated that patients with septic shock had inappropriately low levels of serum vasopressin compared with patients with cardiogenic shock, who had normal or elevated levels. In addition, they demonstrated that supplementing a low-dose infusion of vasopressin in septic shock patients allowed for the reduction or removal of the other catecholamine vasopressors. This was seen de- spite a reduction in cardiac output. Although these results were duplicated in subsequent studies, none evaluated outcomes such as length of stay or mortal- ity until recently. A randomized double-blind study comparing vasopressin versus norepinephrine for the treatment of septic shock demonstrated no dif- ference in 28-day mortality between the 2 treatment groups.9 Subgroup analysis of patients with severe septic shock, defined as requiring 15 μg/min of norepinephrine or its equivalent, also did not demonstrate a mortality benefit. However, patients with less severe septic shock (ie, requiring 5-15 μg/min of norepinephrine) experienced a trend toward lower mortality when treated with low-dose (0.01-0.03 U/min) vasopressin.

A 70-year-old man presents to the emergency de- partment with a 2-day history of fever, chills, cough, and right-sided pleuritic chest pain. On the day of admission, the patient's family noted that he was more lethargic and dizzy and was falling frequently. The patient's vital signs are: temperature, 101.5°F; heart rate, 120 bpm; respiratory rate, 30 breaths/min; blood pressure, 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry, 80% without oxygen supplementation. A chest radiograph shows a right lower lobe infiltrate. What is the first step in the initial management of this patient? (A) Antibiotic therapy (B) β-Blocker therapy to control heart rate (C) Intravenous (IV) fluid resuscitation (D) Supplemental oxygen and airway management (E) Vasopressor therapy with dopamine

(D) Supplemental oxygen and airway management. The initial evaluation of any critically ill patient in shock should include assessing and establishing an airway, evaluating breathing (which includes consideration of mechanical ventilator support), and restoring adequate circulation.2 Adequate oxygenation should be ensured with a goal of achieving an arterial oxygen saturation of 90% or greater.

Which of the following patients is an ideal candi- date for noninvasive positive pressure ventilation (NIPPV)? (A) A 30-year-old comatose woman suspected of drug overdose (B) A 55-year-old man with acute anterior wall myocardial infarction with cardiogenic shock and recurrent ventricular arrhythmias (C) A 60-year-old man with peritonitis requiring 2 vasopressors (D) A 65-year-old patient with a massive stroke and inability to protect airway (E) A 70-year-old alert patient with respiratory failure due to chronic obstructive pulmonary disease exacerbation

(E) A 70-year-old alert patient with respiratory failure due to chronic obstructive pulmonary disease exacerbation. NIPPV can be considered in carefully selected patients with sepsis. Patients with shock, altered mental status, or increased airway secretions should not be treated with NIPPV.4 Studies regarding the use of NIPPV in patients with sepsis-induced acute lung injury/ARDS are limited. In our experience, patients with normal mental status who are likely to recover within 48 to 72 hours seem to be good candidates for NIPPV.

A nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for 1 month. the digoxin level is 0.25 ng/mL. The nurse should notify the provider and anticipate which of the following: 1. An increase in the client's digoxin dose. 2. A decrease in the client's digoxin dose. 3. No change in the client's digoxin dose. 4. Dicontinuation of the client's digoxin dose.

1. An increase in the client's digoxin dose.

A nurse is planning care for a client who is receiving furosemide (Lasix) IV for peripheral edema. Which of the following should the nurse include in the plan of care? SELECT ALL THAT APPLY 1. Assess for tinnitus 2. Report U/O of 50 mL/hr 3. Monitor serum potassium levels 4. Elevate the head of the bed slowly before ambulation. 5. Recommend eating a banana daily.

1. Assess for tinnitus 3. Monitor serum potassium levels 4. Elevate the head of the bed slowly before ambulation. 5. Recommend eating a banana daily.

A nurse is reviewing the health record of a client who is starting propranolol (Inderal) to treat HT. Which of the following conditions is a contraindication for taking propranolol? 1. Asthma 2. Diabetes 3. Angina 4. Tachycardia

1. Asthma -- Proranolol is a non-selective beta adrenergic blocker that blocks both beta 1&2 receptors. Blockade of beta2 receptors in the lungs causes broncho-constriction, so it is contraindicated in clients who have asthma.

A nurse is providing teaching to a client who has a new prescription for digoxin (Lanoxin) Which of the following may indicate dig toxicity & should be reported to the provider? 1. Fatigue 2. constipation 3. Anorexia 4. Rash 5. Diplopia

1. Fatigue Not constipation but -- nausea, vomiting & diarrhea 3. Anorexia b/c GI disturbances 5. Diplopia -- visual changes , halo, yellow-tinged vision.

A nurse is teaching a client who is starting verapamil (Calan) to control HT. Which of the following should the nurse include in the teaching? 1. Increase the amount of dietary fiber in the diet 2. Drink grapefruit juice daily to increase vit. C 3. Decrease the amount of calcium in the diet 4. Withhold food for 1 hour after the medication is taken.

1. Increase the amount of dietary fiber in the diet --Avoid drinking grapefruit juice because concurrent use can lead to toxicity. Also not necessary to increase vit. c. --No restriction on dietary calcium. --Can take with or with out food.

A nurse is providing information to a client who has a new prescription for HCTZ (hyrdodiuril) Which of the following information should the nurse include? 1. Take the medication with food 2. Plan to take the medication at bedtime. 3. Expect increased swelling of the ankles. 4. Fluid intake should be limited in the morning.

1. Take the medication with food

A patient is treated in the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to a. check the blood pressure. b. obtain an oxygen saturation. c. attach a cardiac monitor. d. check level of consciousness.

1.Correct Answer: B Rationale: The initial actions of the nurse are focused on the ABCs, and assessing the airway and ventilation is necessary. The other assessments should be accomplished as rapidly as possible after the oxygen saturation is determined and addressed.

A nurse is reviewing a client's medication history and notes that the client is taking digoxin (Lanoxin), an anti-HT med & NSAIDs. The client has a new prescription for toresmide (Demadex). The nurse should plan to monitor for which of the following medication interactions. SELECT ALL THAT APPLY 1. decrease in serum digoxin level 2. Hypokalemia 3. Hypotension 4. Low urine output 5. Ventricular dysrhythmias

2. Hypokalemia (adverse effect of Loop --> dig toxicity) 3. Hypotension (monitor when other anti-HT drugs are being admin) 4. Low urine output (when Loop & NSAID b/c NSAID decrease blood flow to kidneys which reduces the diuretic effect.) 5. Ventricular dysrhythmias (can occur with dig toxicity with toresmide & digoxing)

A nurse is administering a dopamine infusion at a moderate dose to a client who has severe HF. Which of the following is an expected effect? 1. Lowered heart rate 2. Increased myocardial contractility 3. Decreased conduction through the AV node D. Vasoconstriction of the renal blood vessels

2. Increased myocardial contractility -- thus increasing CO

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. concurrent use of which of the following medications places the client at risk for dig toxicity? 1. Phenytoin (Dilantin) 2. Verapamil (Calan) 3. Warfarin (Coumadin) 4. Aluminum hydroxide (Amphojel)

2. Verapamil (Calan) -- CCB, can increase digoxin levels. if used together dig dosage may need to be lowered.

A nurse in an acute care facility is infusing IV nitroprusside for a client who is in hypertensive crisis. For which of the following adverse reactions should the nurse monitor this client? 1. Intestinal ileus 2. Neutropenia 3. Delirium 4.Hypothermia

3. Delirium -- & other mental status changes can occure in thiocyanate toxicity when IV nitroprusside is infused at a high dosage in clients with kidney dysfunction. the level of thiocyanate may be monitored during therapy and should remain below 10mg/dL

A client who has increased intracranial pressure is receiving mannitol (Osmitrol) Which of the following findings should the nurse report to the provider? 1. Blood Glucose 150 mg/dL 2. U/O 40mL/hour 3. Dyspnea 4. Headache

3. Dyspnea -- can indicate HF, and adverse effect of mannitol. The nurse should stop the medication and notify the provider.

A nurse in a provider's office is monitoring serum electrolytes for 4 older adult clients who take digoxin(Lanoxin) & furosemide(Lasix). Which of the following electrolyte values puts a client at risk for dig toxicity? 1. Calcium 9.2 mg/dL 2. Calcium 10.3 mg/dL 3. Potassium 3.4 mEq/L 4. Potassium 4.8 mEq/L

3. Potassium 3.4 mEq/L

A nurse is monitoring a client who is receiving spironolactone (Aldactone) which of the following findings should the nurse report to the provider? 1. Serum sodium 148 mEq/L 2. U/O of 120 mL in 4 hours 3. Serum potassium of 5.2 mEq/L 4. Blood pressure 140/90 Hg

3. Serum potassium of 5.2 mEq/L -- indicates hyperkalemia. Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider.

The nurse is assisting in the care of several patients in the critical care unit. Which patient is at greatest risk for developing multiple organ dysfunction syndrome (MODS)? a-22-year-old patient with systemic lupus erythematosus who is admitted with a pelvic fracture after a motor vehicle accident b-48-year-old patient with lung cancer who is admitted for syndrome of inappropriate antidiuretic hormone and hyponatremia c-65-year-old patient with coronary artery disease, dyslipidemia, and primary hypertension who is admitted for unstable angina d-82-year-old patient with type 2 diabetes mellitus and chronic kidney disease who is admitted for peritonitis related to a peritoneal dialysis catheter infection

82-year-old patient with type 2 diabetes mellitus and chronic kidney disease who is admitted for peritonitis related to a peritoneal dialysis catheter infection Rationale: A patient with peritonitis is at high risk for developing sepsis. In addition, a patient with diabetes is at high risk for infections and impaired healing. Sepsis and septic shock are the most common causes of MODS. Individuals at greatest risk for developing MODS are older adults and persons with significant tissue injury or preexisting disease. MODS can be initiated by any severe injury or disease process that activates a massive systemic inflammatory response.

A patient is ordered calcium gluconate for treatment of hypocalcemia. Which statement by the patient indicates a need for further teaching? A "I will take calcium 1 hour before eating." B "I will need to avoid eating whole-grain cereals." C "I should drink a large glass of water each time I take my calcium." D "I will need to call my healthcare provider if I develop vomiting, constipation, or frequency of urination."

A "I will take calcium 1 hour before eating."

The nurse is teaching a patient with rheumatoid arthritis who is scheduled to start a treatment regimen that includes nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and glucocorticoids. Which statement by the nurse is correct? A "It will take at least 3 to 5 months for the DMARD to produce effects." B "In large doses, the NSAIDs will stop most of the disease process." C "Remission is achieved quickly, and usually the medications can be stopped." D "The glucocorticoid will need to be taken for at least 2 years."

A "It will take at least 3 to 5 months for the DMARD to produce effects."

A nurse teaches a patient who takes raloxifene [Evista] for prevention of postmenopausal osteoporosis to report which finding as an adverse effect of the medication? A Calf pain and leg swelling B Fever and fatigue C Bleeding and bruising D Hematuria and dysuria

A Calf pain and leg swelling

A patient who has Paget's disease is receiving calcitonin-salmon [Miacalcin] nasal spray. A nurse should expect the patient to have which therapeutic response if the medication is having the desired effect? A Decrease in bone pain B Increase in the serum calcium level C Lower daily requirement of vitamin D D Elevated serum alkaline phosphatase level

A Decrease in bone pain

Which drug would not be included in the pretreatment plan for a patient who is to receive an infusion of infliximab [Remicade]? A Epinephrine B Acetaminophen C Diphenhydramine D Methylprednisolone

A Epinephrine

In addition to local joint pain and limited range of motion, a nurse should recognize which findings as systemic manifestations of rheumatoid arthritis? (Select all that apply.) A Fatigue B Hyperglycemia C Osteoporosis D Vasculitis E Corneal ulcers

A Fatigue D Vasculitis E Corneal ulcers

Synovial joint problems in rheumatoid arthritis are due to which of the following pathologies? A) Articular cartilage is lost through enzymatic breakdown. B) Free radicals attach to the synovial membrane and articular cartilage. C) Neutrophils and inflammatory cytokines cause damage to articular cartilage. D) Cysts develop in the subchondral bone and create fissures in the articular cartilage.

A) Articular cartilage is lost through enzymatic breakdown.

Which of the following disorders presents with significant bone demineralization from a vitamin D deficiency and usually results in skeletal pain? A) Osteomalacia B) Osteopenia C) Osteomyelitis D) Osteoporosis

A) Osteomalacia

Which of the following diseases is characterized by osteomalacia in the growing bones of children? A) Rickets B) Osteosarcoma C) Paget disease D) Rhabdomyoma

A) Rickets

Which of the following are both types of fibrous joints? A) Sutures and syndesmoses B) Symphyses and synchondroses C) Gomphoses and symphyses D) Diarthroses and amphiarthroses

A) Sutures and syndesmoses

Which of the following structures is present in spongy bone and absent in compact bone? A) Trabeculae B) Lacunae C) Lamellae D) Haversian canals

A) Trabeculae

Which molecule prevents a muscle contraction from occurring when the muscle is at rest? A) Troponin B) Calcium C) Actin D) Myosin

A) Troponin

A fracture in which the bone breaks into two or more fragments is termed a(n): A) comminuted fracture. B) open fracture. C) greenstick fracture. D) occult fracture.

A) comminuted fracture.

Factors contributing to the development of osteoporosis in older women include: A) decreased estrogen levels. B) increased androgen levels. C) excessive dietary calcium. D) strenuous exercise.

A) decreased estrogen levels.

Inflammation of a tendon where it attaches to the bone at its origin is called: A) epicondylitis. B) arthritis. C) delta lesions. D) bursitis.

A) epicondylitis.

Risk factors for osteoarthritis include all of the following except: A) low calcium intake. B) older age. C) obesity. D) orthopedic injury.

A) low calcium intake.

The displacement of two bones in which the articular surfaces partially lose contact with each other is called: A) subluxation. B) subjugation. C) sublimation. D) dislocation.

A) subluxation.

The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called: A) tophaceous gout. B) monarticular arthritis. C) complicated gout. D) asymptomatic hyperuricemia.

A) tophaceous gout.

A characteristic feature of fibromyalgia is: A) trigger point pain. B) headache. C) permanent shortening of muscles. D) muscle atrophy.

A) trigger point pain.

Ankylosing spondylitis results in: A) vertebral joint fusion. B) instability of synovial joints. C) costal cartilage degeneration. D) temporomandibular joint degeneration.

A) vertebral joint fusion.

A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside (Nipride) infusion. Which activities should the nurse implement? (Select all that apply.) A. Obtain a baseline weight and weigh daily. B. Collaborate with the physician on insertion of an arterial line. C. Discontinue the infusion when the blood pressure is at an acceptable level. D. Observe for signs of hypertrichosis during the infusion. E. Cover the IV bottle containing the medication with an opaque bag.

A, B, E A Nipride infusion is ordered in micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the appropriate dose. Also, tracking daily weights and comparing them with the baseline values helps the nurse determine whether the adverse effect of fluid retention has developed. An arterial line allows for continuous and accurate measurement of blood pressure. Because light degrades nitroprusside, the infusion bottle should be covered. The infusion should not be discontinued abruptly, because the blood pressure will return to the pretreatment levels within minutes. Hypertrichosis (excessive hair growth) is a side effect of minoxidil.

The nurse is teaching an older adult patient with hypertension who has a new prescription for verapamil (Calan). Which statement or statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I will avoid exposing my skin to the sun." C. "I will call my physician if I notice swelling in my ankles." D. "I will avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."

A, C Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

A 70-year-old man presents to the emergency department with a 2-day history of fever, chills, cough, and right-sided pleuritic chest pain. On the day of admission, the patient's family noted that he was more lethargic and dizzy and was falling frequently. The patient's vital signs are: temperature, 101.5°F; heart rate, 120 bpm; respiratory rate, 30 breaths/min; blood pressure, 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry, 80% without oxygen supplementation. A chest radiograph shows a right lower lobe infiltrate. This patient's condition can best be defined as which of the following? (A) Multi-organ dysfunction syndrome (MODS) (B) Sepsis (C) Septic shock (D) Severe sepsis (E) Systemic inflammatory response syndrome (SIRS)

D) Severe sepsis. The patient fulfills criteria for severe sepsis, defined as sepsis with evidence of organ dysfunction, hypoperfusion, or hypotension. SIRS is defined as an inflammatory response to insult manifested by 2 of the following: temperature greater than 38°C (100.4°F) or less than 36°C (96.8°F), heart rate greater than 90 bpm, respiratory rate greater than 20 breaths/min, and white blood cell count greater that 12 × 103/μL, less than 4 × 103/μL, or 10% bands. A diagnosis of sepsis is given if infec- tion is present in addition to meeting criteria for SIRS. Septic shock includes sepsis-induced hypotension (despite fluid resuscitation) along with evidence of hypoperfusion. MODS is the presence of altered organ function such that hemostasis cannot be maintained without intervention.1 This patient's lack of fluid resuscitation classifies him as having severe sepsis rather than septic shock.

All of the following events occur following a bone fracture except: A) development of a blood clot beneath the periosteum. B) leukocyte infiltration into bone tissue. C) blood vessel growth at the fracture site. D) an increase in the number of osteoclasts at the fracture site.

D) an increase in the number of osteoclasts at the fracture site.

In children, growth in long bones primarily takes place at the: A) ends of the epiphyses. B) middle of the diaphysis. C) medullary cavity. D) epiphyseal plate.

D) epiphyseal plate.

The epimysium, perimysium, and endomysium in the body of a skeletal muscle are made of: A) thin sheets of cartilage. B) simple epithelial tissue. C) stratified epithelial tissue. D) fascia.

D) fascia.

The component(s) of the bone matrix that gives bone compressive strength is (are): A) collagen. B) glycoproteins. C) the periosteum. D) hydroxyapatite.

D) hydroxyapatite.

In osteomyelitis, the area of necrotic bone at the site of the infection is called the: A) periosteum. B) involucrum. C) drainage tract. D) sequestrum.

D) sequestrum.

A patient is prescribed Calan SR 120 mg daily. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I will swallow the pill whole."

D. "I will swallow the pill whole." "SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.

One consequence of switching from aerobic to anaerobic cellular metabolism during shock states is: A. Decreased adenosine triphosphate (ATP) production B. Cellular dehydration C. Cellular alkalosis D. Free radical formation

Decreased adenosine triphosphate (ATP) production

A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI). He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia, and tachypnea. His skin is pale and cool. The primary cause of his shock is most likely: A. Decreased cardiac contractility B. Rapid heart rate C. Increased capillary permeability D. Decreased afterload due to vasodilation

Decreased cardiac contractibility

When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which clinical manifestation of multiple organ dysfunction syndrome (MODS)? a- Increased serum albumin b- Decreased respiratory compliance c- Increased gastrointestinal (GI) motility d- Decreased blood urea nitrogen (BUN)/creatinine ratio

Decreased respiratory compliance Rationale: Clinical manifestations of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism.

The client's serum digoxin level is 2.2 ng/dL and the heart rate is 120 and irregular. The nurse expects to administer which of the following drugs? Digoxin immune Fab (Digibind) Furosemide (Lasix) 60 mg I.V. Digoxin 0.5 mg bolus I.V. Potassium 40 mEq added to I.V. fluids

Digoxin immune Fab (Digibind) Rationale: Digibind binds and removes digoxin from the body and prevents toxic effects of digoxin overdose. A serum level of 2.2 is elevated, and the client is exhibiting signs of digoxin toxicity. The question does not indicate that the potassium level is low. Giving additional digoxin would exacerbate the toxicity. Giving Lasix may reduce potassium levels and contribute to increased toxicity.

The client presents to the medical office with a history of blood pressure 140/90-154/92 for the past month. There is no history of other medical conditions. The nurse recognizes the most likely initial treatment to include is: Lasix 40 mg q.d. Lasix 40 mg, amlodipine (Norvasc) 5 mg q.d. Diuril 25 mg, nifedipine 30 mg q.d. Diuril 25 mg b.i.d.

Diuril 25 mg b.i.d. Rationale: Blood pressure of 140/90-154/92 is Stage I hypertension. Initial treatment includes use of a thiazide diuretic in the absence of other symptoms.

Appropriate treatment modalities for the management of cardiogenic shock include (select all that apply): a. dobutamine to increase myocardial contractility. b. vasopressors to increase systemic vascular resistance. c. circulatory assist devices such as an intraaortic balloon pump. d. corticosteroids to stabilize the cell wall in the infarcted myocardium. e. Trendelenburg positioning to facilitate venous return and increase preload.

Dobutamine to increase myocardial contractility and Circulatory assist devices such as an intraaortic balloon pump. Rationale: Dobutamine (Dobutrex) is used in patients in cardiogenic shock with severe systolic dysfunction. Dobutamine increases myocardial contractility, decreases ventricular filling pressures, decreases systemic vascular resistance and pulmonary artery wedge pressure, and increases cardiac output, stroke volume, and central venous pressure. Dobutamine may increase or decrease the heart rate. The workload of the heart in cardiogenic shock may be reduced with the use of circulatory assist devices such as an intraaortic balloon pump or ventricular assist device.

A nurse recalls acute orthostatic hypotension can be caused by (select all that apply): A. Drug action B. Starvation C. Exercise D. Volume depletion E. Prolonged immobility

Drug action Starvation Volume depletion Prolonged immobility

Which of the following is an indication for using corticosteroids in septic shock? (A) Acute respiratory distress syndrome (ARDS) (B) Necrotizing pneumonia (C) Peritonitis (D) Sepsis responding well to fluid resuscitation (E) Vasopressor-dependent septic shock

E) Vasopressor-dependent septic shock. An inappropriate cortisol response is not uncommon in patients with septic shock. Low-dose IV corticosteroids (hydrocortisone 200-300 mg/day) are recommended

A patient wants to know what causes atherosclerosis. How should the nurse respond? In general, atherosclerosis is caused by: A. Endothelial injury and inflammation B. Congenital heart disease C. High serum cholesterol levels D. An increase in antithrombotic substances

Endothelial injury and inflammation

The nurse preparing to administer HCTZ (Hydrodiuril) 25 mg to a client with hypertension checks laboratory values and finds that the potassium level is 2.8 mEq. The appropriate action is to: Give the client a banana, and recheck the potassium level. Hold the medication, and notify the health care provider. Administer the drug with orange juice. Administer the drug as ordered, and continue to monitor the potassium level.

Hold the medication, and notify the health care provider. Rationale: The normal serum potassium level is 3.5-5.0. HCTZ is a potassium-depleting drug. The drug should be held until a consultation with the health care provider takes place.

What laboratory finding fits with a medical diagnosis of cardiogenic shock? a-Decreased liver enzymes b-Increased white blood cells c-Decreased red blood cells, hemoglobin, and hematocrit d-Increased blood urea nitrogen (BUN) and serum creatinine levels

Increased blood urea nitrogen (BUN) and serum creatinine levels Rationale: The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, while white blood cell levels do not typically increase in cardiogenic shock. Red blood cell indices are typically normal because of relative hypovolemia.

Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects and instructs the client to immediately report: Blood pressure 110/70-114/78 for two successive readings. Dizziness when changing positions. Increased shortness of breath and orthopnea. Weight loss of two pounds per week.

Increased shortness of breath and orthopnea. Rationale: Nifedipine (Procardia) is a calcium channel blocker. Calcium channel blockers decrease myocardial contractility, increasing the risk of heart failure. Dizziness can occur, especially when the medication is started. The BP is a desired reading.

A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a priority nursing diagnosis? a-Acute pain b-Impaired tissue integrity c-Decreased cardiac output d-Ineffective tissue perfusion

Ineffective tissue perfusion Rationale: The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every body system. This nursing diagnosis supersedes the other diagnoses.

When caring for a patient in acute septic shock, what should the nurse anticipate? A. Infusing large amounts of IV fluids B. Administering osmotic and/or loop diuretics C. Administering IV diphenhydramine (Benadryl) D. Assisting with insertion of a ventricular assist device (VAD)

Infusing large amounts of IV fluids

A 52-year-old female is diagnosed with coronary artery disease. The nurse assesses for myocardial: A. Necrosis B. Inflammation C. Ischemia D. Hypertrophy

Ischemia

The nurse is caring for a 29-year-old man who was admitted a week ago with multiple rib fractures, a pulmonary contusion, and a left femur fracture from a motor vehicle crash. After the attending physician tells the family that the patient has developed sepsis, the family members have many questions. Which information should the nurse include in explaining the early stage of sepsis? a-Antibiotics are not useful once an infection has progressed to sepsis. b-Weaning the patient away from the ventilator is the top priority in sepsis. c-Large amounts of IV fluid are required in sepsis to fill dilated blood vessels. d-The patient has recovered from sepsis if he has warm skin and ruddy cheeks.

Large amounts of IV fluid are required in sepsis to fill dilated blood vessels. Rationale: Patients with sepsis may be normovolemic but because of acute vasodilation, relative hypovolemia and hypotension occur. Patients in septic shock require large amounts of fluid replacement and may require frequent fluid boluses to maintain circulation. Antibiotics are an important component of therapy for patients with septic shock. They should be started after cultures (e.g., blood, urine) are obtained and within the first hour of septic shock. Oxygenating the tissues is the top priority in sepsis, so efforts to wean septic patients from mechanical ventilation halt until sepsis is resolving. Addititonal respiratory support may be needed during sepsis. Although cool and clammy skin is present in other early shock states, the patient in early septic shock may feel warm and flushed because of a hyperdynamic state.

A 73-year-old female has increased pulmonary pressure resulting in right heart failure. The nurse should monitor for a possible complication because a potential cause for her heart to fail is: A. Pericarditis B. Hypertension C. Acute pneumonia D. Left heart failure

Left heart failure

Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses: A. Left end-diastolic volume decreases. B. Pulmonary vascular resistance decreases. C. Left ventricular preload increases. D. Systemic vascular resistance decreases.

Left ventricular preload increases

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are a. blood pressure, pulse, and respirations. b. breath sounds, blood pressure, and body temperature. c. pulse pressure, level of consciousness, and pupillary response. d. level of consciousness, urine output, and skin color and temperature.

Level of consciousness, urine output, and skin color and temperature. Rationale: Adequate tissue perfusion in a patient with multiple-organ dysfunction syndrome is assessed by the level of consciousness, urine output, capillary refill, peripheral sensation, skin color, extremity skin temperature, and peripheral pulses.

A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of assessment findings would the nurse expect the patient to exhibit? A. Low blood pressure, tachycardia, generalized edema B. Severe respiratory distress, jugular venous distention, chest pain C. Reduced cardiac output, increased systemic vascular resistance, moist cough D. Bradycardia, palpitations, confusion, truncal rash

Low blood pressure, tachycardia, generalized edema

The client is prescribed captopril (Capoten) for treatment of HF. The nurse teaches that the primary action of the drug is to Prevent influx of calcium. Lower peripheral resistance and reduce blood volume. Increase strength of ventricular contractions. Increase heart rate.

Lower peripheral resistance and reduce blood volume. Rationale: ACE inhibitors decrease peripheral resistance and reduce blood volume by enhancing the excretion of sodium and water. This results in decreased afterload and increased cardiac output.

Which organ should the nurse monitor closely since it is often the first to fail in patients with multiple organ dysfunction syndrome (MODS)? A. Pancreas B. Heart C. Liver D. Lungs

Lungs

A staff member asks a nurse what foam cells are. What is the nurse's best response? Foam cells in a fatty streak are: A. Macrophages that engulf low-density lipoprotein (LDL) B. Deposited adipose cells C. Lipid-laden mast cells D. Injured neutrophils

Macrophages that engulf low-density lipoprotein (LDL)

The nurse is caring for a 72-year-old man in cardiogenic shock after an acute myocardial infarction. Which clinical manifestations would be of most concern to the nurse? a-Restlessness, heart rate of 124 beats/minute, and hypoactive bowel sounds b-Mean arterial pressure of 54 mm Hg, increased jaundice, and cold, clammy skin c-PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and bleeding from puncture sites d-Agitation, respiratory rate of 32 breaths/minute, and serum creatinine level of 2.6 mg/dL

PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and bleeding from puncture sites Rationale: Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold/ clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock.

Following coronary artery bypass graft surgery a patient has postoperative bleeding that requires returning to surgery to repair the leak. During surgery, the patient has a myocardial infarction (MI). After restoring the patient's body temperature to normal, which patient assessment is the most important for planning nursing care? a- Cardiac index (CI) 5 L/min/m2 b-Central venous pressure 8 mm Hg c-Mean arterial pressure (MAP) 86 mm Hg d-Pulmonary artery pressure (PAP) 28/14 mm Hg

Pulmonary artery pressure (PAP) 28/14 mm Hg Rationale: Pulmonary hypertension as indicated by an elevated PAP indicates impaired forward flow of blood because of left ventricular dysfunction or hypoxemia. Both can be due to the MI. The CI, CVP, and MAP readings are normal.

When a patient with left heart failure starts to have a cough and dyspnea, which principle should the nurse remember? Pulmonary symptoms, common to left heart failure, are a result of: A. Bronchoconstriction B. Decreased cardiac output C. Pulmonary vascular congestion D. Inflammatory pulmonary edema

Pulmonary vascular congestion

A 64-year-old woman is admitted to the emergency department vomiting bright red blood. The patient's vital signs are blood pressure 78/58 mm Hg, pulse 124 beats/minute, respirations 28 breaths/minute, and temperature 97.2° F (36.2° C). Which physician order should the nurse complete first? a-Obtain a 12-lead ECG and arterial blood gases. b-Rapidly administer 1000 mL normal saline solution IV. c-Administer norepinephrine (Levophed) by continuous IV infusion. d-Carefully insert a nasogastric tube and an indwelling bladder catheter.

Rapidly administer 1000 mL normal saline solution IV. Rationale: Isotonic crystalloids, such as normal saline solution, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products. Other orders (e.g., insertion of nasogastric tube and indwelling bladder catheter and obtaining the diagnostic studies) can be initiated after fluid resuscitation is initiated.

A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that diuretics help reduce blood pressure by: Removing serum potassium. Dilating peripheral blood vessels. Reducing sympathetic outflow. Constricting blood vessels.

Reducing sympathetic outflow. Rationale: Diuretics decrease blood volume, which in turn decreases the workload of the heart and reduces blood pressure. They do not dilate blood vessels. Some diuretics promote potassium loss, but this does not reduce the blood pressure. Central-acting antihypertensives work by blocking sympathetic outflow.

A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation? A. Lung disease B. Rigidity of the aorta C. Vasospasm D. Decreased sodium intake

Rigidity of the aorta

What health teaching should the nurse provide for the client receiving nadolol (Corgard)? 1. Increase fluids & fiber to prevent constipation 2.Report weight gain of 1kg / month or more 3. Immediately stop taking meds if sexual dysfunction occurs. 4. Rise slowly after prolonged periods of sitting or lying down.

Rise slowly after prolonged periods of sitting or lying down.

A 78-year-old man has confusion and temperature of 104° F (40° C). He is a diabetic with purulent drainage from his right heel. After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow; CO 8 L/minute; and PAWP 4 mm Hg. This patient's symptoms are most likely indicative of: a. sepsis. b. septic shock. c. multiple organ dysfunction syndrome. d. systemic inflammatory response syndrome.

Septic Shock Rationale: Septic shock is the presence of sepsis with hypotension despite fluid resuscitation along with the presence of inadequate tissue perfusion. To meet the diagnostic criteria for sepsis, the patient's temperature must be higher than 100.9° F (38.3° C), or the core temperature must be lower than 97.0° F (36° C). Hemodynamic parameters for septic shock include elevated heart rate; decreased pulse pressure, blood pressure, systemic vascular resistance, central venous pressure, and pulmonary artery wedge pressure; normal or elevated pulmonary vascular resistance; and decreased, normal, or increased pulmonary artery pressure, cardiac output, and mixed venous oxygen saturation.

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication SELECT ALL THAT APPLY 1. Reflex hypertension 2.Hyperkalemia 3. Persistent cough 4. Angioedema 5. Hypotension

Side effects of enalapril (Vasotec), an ACE-I will included 2.Hyperkalemia 3. Persistent cough 4. Angioedema 5. Hypotension #1 is incorrect but could develop Reflex tachycardia depending on how fast & low the blood pressure decreases.

A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure? A. Hypertension B. Decreased urine output C. Dyspnea upon exertion D. Significant edema to both lower legs and feet

Significant edema to both lower legs and feet

The client is prescribed a beta-blocker as adjunct therapy to treatment of heart failure. The nurse recognizes that beta blockers act by Increasing contractility and cardiac output. Decreasing preload. Slowing the heart and decreasing afterload. Decreasing peripheral resistance

Slowing the heart and decreasing afterload. Rationale: Beta-blockers improve symptoms of HF by slowing heart rate and decreasing blood pressure. The decreased afterload causes decreased workload on the heart.

A 56-year-old male is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change? A. Eating meat B. Living arrangements C. Drinking tomato juice D. Smoking cigarettes

Smoking cigarettes

What factors make a patient prone to neurogenic shock? Neurogenic shock can be caused by any factor that inhibits the: A. Thalamus B. Parasympathetic nervous system C. Somatic nervous system D. Sympathetic nervous system

Sympathetic nervous system

A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure. The nurse understands this is most likely caused by: A. Sympathetic nervous system compensation for decreased cardiac output B. Diastolic dysfunction C. Stress hormones promoting increased cardiac contractility D. Cardiotoxic effects of catecholamines and angiotensin

Sympathetic nervous system compensation for decreased cardiac output

The nurse reviews the teaching plan with a client receiving nifedipine (Procardia). Which of the following client behaviors indicates understanding? The client avoids taking the drug with grapefruit juice. The client consumes three servings of alcohol daily. The client breaks an enteric-coated tablet for ease of swallowing. The client monitors blood pressure every week.

The client avoids taking the drug with grapefruit juice. Rationale: Grapefruit juice increases absorption of nifedipine, resulting in increased serum level. Blood pressure ideally should be monitored more frequently. Alcohol intake of three times a day is excessive. Breaking enteric tablets will interfere with time release of the medication.

A client with significant HT unresponsive to other medications is given a prescription for hydralazine (Apresoline) An additional prescription of propranolol (Inderal) is also given to the client. The client inquires why 2 drugs are needed. What is the nurses' best response? 1. Giving the 2 drugs together will lower the blood pressure even more than just one alone. 2. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits. 3.The propranolol is to prevent lupus erythematosus from developing. 4. Direct-acting vasodilators such as hyrdalazine cause fluid retention and the propranolol will prevent excess fluid buildup.

The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits. hydralazine (Apresoline) -- direct vasodilator propranolol (Inderal) -- beta blockers non-selective

A 51-year-old male presents with recurrent chest pain on exertion. He is diagnosed with angina pectoris. When he asks what causes the pain, how should the nurse respond? The pain occurs when: A. The myocardial oxygen supply has fallen below demand. B. Myocardial stretch has exceeded the upper limits. C. Cardiac output has fallen below normal levels. D. The vagus nerve is stimulated.

The myocardial oxygen supply has fallen below demand

Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of 220/110. What action by a new nurse would require intervention by the charge nurse? The nurse inserts a Foley catheter. The nurse documents the IV rate and status of site every 15 minutes. The nurse uses electronic monitoring of blood pressure every hour. The nurse cautions the client to call for assistance before getting out of bed.

The nurse uses electronic monitoring of blood pressure every hour. Rationale: Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored very closely—e.g., every 5-15 minutes.

Which of the following findings in the patient with Raynaud disease would indicate a need for further teaching? A. The patient eats bananas twice a day. B. The patient smokes cigarettes. C. The patient takes calcium channel blockers. D. The patient wears mittens outside.

The patient smokes cigarettes

A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL). Which of the following should the nurse advise him to avoid? A. Trans fats B. Saturated fats C. Monounsaturated fats D. Polyunsaturated fats

Trans fats

A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is: A. Vasodilation caused by gram-negative bacterial infection B. Vasodilation caused by a decrease in sympathetic stimulation C. Hypovolemia caused by evaporative fluid losses D. Hypovolemia caused by blood loss Reset Selection

Vasodilation caused by a decrease in sympathetic stimulation

A 32-year-old female presents with lower leg pain, with swelling and redness. While obtaining the patient's history, which finding could have caused her condition? A. Bacterial infection B. Heart valve damage C. Venous thrombus D. Atherosclerosis

Venous thrombus

A nurse is planning to administer a first dose of captopril (Capoten) to a hospitalized client who has HT. Which of the following medications can intensify EARLY adverse effects of captopril? 1. Simvastatin (zocor) 2. HCTZ (hydrodiuril) 3. Phenytoin (dilantin) 4. clonidine (Catapress) 5. Aliskiren (Tekturna)

can intensify hypotension. 2. HCTZ (hydrodiuril) -- thiazide diuretic 4. clonidine (Catapress) -- central acting alpha2 agonist 5. Aliskiren (Tekturna) -- a direct renin inhibitor

The nurse includes the definition of HF in the teaching plan for the client. An accurate description of the mechanism of HF is that [Hint] there is too much fluid in the heart. the heart cannot get oxygen. the heart is unable to pump effectively. there is too much fluid in the lungs.

the heart is unable to pump effectively.

A 65-year-old female presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the: A. Thoracic aorta B. Renal arteries C. Cerebral vessels D. Inferior vena cava

thoracic aorta