PCC 2 Exam 3

Which of the following organisms most commonly causes community-acquired pneumonia in adults? A. Haemophilus influenzae B. Klebsiella pneumoniae C. Streptococcus pneumoniae D. Staphylococcus aureus

C

What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction

D

What types of medications are used to reduce afterload?

- ACE inhibitors - ARBs - Human BNP

What types of medications are used to enhance contractility?

- digoxin - beta blockers - aldosterone antagonists

What types of medications are used to reduce preload?

- diuretics - venous vasodilators

Sleep apnea would be diagnosed in a patient who has which of these findings? Select all that apply. 1. More than 15 apnea episodes per hour of sleep 2. More than 5 apnea episodes per hour over an 8-hour period 3. More than 75% of the apneas are obstructive. 4. More than 75% of the apneas and hypopneas are obstructive.

1, 3, 4

Normal bicarb range for ABG?

22-26

Normal PaCO2 range for ABG?

35-45 mm Hg

Normal pH range for ABG?

7.35-7.45

Normal pO2 range for ABG?

80-100 mmHg

The most common side effects of beta- 2 agonists are; A. dry mouth, urinary retention, and glaucoma B. muscle tremor and palpitations C. nausea and vomiting, and headaches D. hoarseness (dysphonia) and oral candidiasis

A

Which of the following medication may be suspected as a possible cause of bronchial asthma? A. Acetylsalicylic acid (aspirin) B. Milk of magnesia C. Famotidine D. Diphenhydramine

A

The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is: a. a loud, harsh murmur with a systolic tremor. b. cyanosis when crying. c. blood pressure higher in the arms than in the legs. d. a machinery-like murmur.

A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply: A. Raynaud's Disease is triggered by cold temperatures or stress. B. Raynaud's Disease occurs due to a vasospasm of the peripheral veins. C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose. D. Raynaud's Disease is prevented by glucose control.

A and C. Raynaud's Disease occurs when vasospasm of peripheral arteries occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It is triggered by exposure to cold or during stress. It can be prevented by keeping the toes, fingers, ears, and nose warm and avoid stress. Medications can also be used as well that help prevent vasospasm.

When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation? A. Bronchial B. Bronchovesicular C. Tubular D. Vesicular

A. Bronchial Chest auscultation reveals bronchial breath sounds over areas of consolidation. When bronchial sounds are heard in areas distant from where they normally occur, the patient may have consolidation (as occurs with pneumonia) or compression of the lung. These conditions cause the lung tissue to be dense.

Which goal will a nurse deem as most essential when caring for a 14-month-old toddler with bronchiolitis? a. Ensuring that antibiotics are initiated as ordered b. Providing a cough suppressant as ordered as necessary c. Setting up and facilitating the use of a mist tent d. Promoting and maintaining adequate hydration

d. Hydration is very important in children with bronchiolitis (RSV) to loosen secretions, prevent shock, and maintain basic physiological needs.

Pulmonary artery wedge pressure (PAWP) is increased with which type of heart failure?

left-sided heart failure

An elderly client with pneumonia may appear with which of the following symptoms first? A. Altered mental status and dehydration B. Fever and chills C. Hemoptysis and dyspnea D. Pleuritic chest pain and cough

A Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

After assessing the patient, you document the following: Jugular venous distention 2+ edema in feet and ankles Swollen hands and fingers Distended abdomen Bibasilar crackles on auscultation Productive cough with pink-tinged sputum What is your most likely interpretation of these findings? A. Biventricular failure B. Class IV heart failure C. Left-sided heart failure D. Right-sided heart failure

A. The patient has key features of both right-sided and left-sided heart failure.

During the evening shift, the patient has a bedside echocardiogram, which reveals an ejection fraction of 30%.Based on this finding, which medications might the provider order? (Select all that apply.) A. Multivitamin 1 PO each day B. Lisinopril (Zestril) 5 mg PO daily C. Digoxin (Lanoxin) 0.25 mg PO daily D. Ibuprofen (Advil) 200 PO mg twice daily E. Furosemide (Lasix) 20

Answer: B, C, E Commonly prescribed drug classes for patients with heart failure include ACE inhibitors (lisinopril), diuretics (furosemide), nitrates (digoxin), human B-type natriuretic peptides, inotropics, and beta-adrenergic blockers.

A 51-year-old man came to the hospital 2 days ago for recurrent exacerbation of heart failure. He weighs 237 lbs and is 5ʹ8ʺ tall. He has IV access in his left forearm and is on oxygen at 2 L per nasal cannula. When you assess the patient, he is sitting on the side of the bed and appears to be short of breath. He tells you that he has just returned from the bathroom. He is sweating and his nasal cannula is laying on the bedside table. Which action should you take first? A. Take his vital signs. B. Replace the nasal cannula. C. Sit him up in a bedside chair. D. Call the Rapid Response Team.

B

A patient received a nebulizer of Albuterol. What is a side effect of this medication? A. Bradycardia B. Tachycardia C. Drowsiness D. Feeling cold

B

Select ALL the signs and symptoms that can present in pernicious anemia: A. Erythema B. Paresthesia of hands and feet C. Racing thoughts D. Extreme hunger E. Depression F. Unsteady gait G. Shortness of breath with activity

B, E, F, and G. These are the signs and symptoms that present in pernicious anemia.

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime? A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

B. A patient with pernicious anemia cannot absorb vitamin B12 through the GI system. So, eating foods or taking supplements of vitamin B12 are pointless because the patient lacks intrinsic factor to absorb vitamin B12. Therefore, the typical regime for a patient with pernicious anemia is to receive vitamin B12 through intramuscular injections. Normally, the physician will order weekly injections and then monthly as maintenance, which is usually a lifelong treatment.

The nurse expects what outcome in a patient who is taking a beta blocker for mild heart failure? A. Improved urinary output B. Improved activity tolerance C. Increased myocardial contractility D. Increased myocardial oxygen

B. Beta-blocker therapy for mild and moderate heart failure can lead to improvement in symptoms, including improved activity tolerance and less orthopnea.

Which of the following symptoms would the nurse anticipate in a patient with right-sided heart failure? (Select all that apply.) A. Pulmonary congestion B. Shortness of breath C. Neck vein distension D. Enlarged abdominal girth E. A third heart sound

C, D. Right ventricular failure is associated with increased systemic venous pressures and congestions, which creates neck vein distension and enlarged abdominal girth. The other options are associated with left-sided heart failure.

A doctor suspects pernicious anemia in a patient presenting with a beefy red tongue. The patient reports feeling extremely fatigued and numbness and tingling in the hands. The doctor orders a peripheral blood smear. From your nursing knowledge, how will the red blood cells appear in the peripheral blood smear if pernicious anemia is present? A. Round-shaped and hypochromic B. Oval-shaped and hyperchromic C. Large and oval-shaped D. Small and hyperchromic

C. In pernicious anemia, the RBCs will appear very large (rather than normal size) and oval-shaped (rather than round).

While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant's skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to? A. Continue feeding the infant and place the infant on oxygen. B. Stop feeding the infant and provide suction. C. Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen. D. Assess the infant's heart rate and rhythm.

C. The patient is experiencing a "tet spell". This is where during any type of activity like feeding, crying, playing etc. the child's heart (due to Tetralogy of Fallot) is unable to maintain proper oxygen levels in the blood (these activities place extra work on the heart and it can't keep up). Therefore, there are low amounts of oxygen in the blood, and the skin will become cyanotic (bluish tint) and the respiratory rate will increase (this is the body's way of trying to increase the oxygen levels in the body but it doesn't work because it's not a gas exchange problem in the lungs but a heart problem). The nurse would want to place the infant in the knee-to-chest position. WHY? This increases systemic vascular resistance (which will help decrease the right to left shunt that is occurring in the heart...hence helps replenish the body with oxygenated blood). In addition, the nurse would want to place the patient on oxygen.

A patient with severe sleep apnea has been prescribed continuous positive airway pressure (CPAP). A nurse adjusts the blower to maintain adequate positive pressure during inspiration and expiration. The nurse should maintain the pressure in what range? A.1-5 cm of H2O B.5-10 cm of H2O C.5-25 cm of H2O D.1-25 cm of H2O

C. The pressure required to maintain an adequate positive pressure is 5-25 cm of H2O. This range of pressure is essential to avoid collapse of the airway.

Fifteen minutes after the oxygen is replaced via nasal cannula and he has rested, the patient denies being short of breath. You obtain an oxygen saturation, which is 96%. Based on this result, what should you do next? A. Call the provider as soon as possible. B. Encourage the patient to take some deep breaths. C. Increase the oxygen level to 5 L per nasal cannula. D. Continue the assessment, as 96% is considered acceptable.

D

The physician orders the patient to start taking Omalizumab. How will you administer this medication as the nurse? A. Intravenous B. Intramuscular C. Orally D. Subcutaneously

D

You're caring for a newborn who has Tetralogy of Fallot with severe cyanosis. You anticipate the newborn will be started on ___________? A: Indomethacin B. Diclofenac C. Celecoxib D. Alprostadil

D. Alprostadil, prostaglandin E, will keep the ductus arteriosus open after birth.

A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences: A. Decreased anxiety level. B. Increased comfort level. C. Reduction of N/V. D. Decreased frequency and intensity of cough.

D. Decreased frequency and intensity of cough. Benzonatate is a locally acting antitussive the effectiveness of which is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex. Benzonatate is an oral antitussive drug used in the relief and suppression of cough in patients older than ten years of age. Currently, benzonatate is the only non-narcotic antitussive available as a prescription drug. It works to reduce the activity of cough reflex by desensitizing the tissues of the lungs and pleura involved in the cough reflex.

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: A. Maintain a fluid intake of 800 ml every 24 hours. B. Experience chills only once a day. C. Cough productively without chest discomfort. D. Experience less nasal obstruction and discharge.

D. Experience less nasal obstruction and discharge. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Decongestants and combination antihistamine/decongestant medications can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and sneezing during the first 2 days of a cold in adults.

True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.

TRUE. Patients with left-sided DIASTOLIC dysfunction heart failure normally have a normal ejection fraction. However, patients with left-sided SYSTOLIC dysfunction heart failure usually do not because the heart is unable to CONTRACT efficiently rather than fill properly as with diastolic dysfunction.

You are assessing the heart sounds of a patient with a severe case of Tetralogy of Fallot. You would expect to hear a __________ murmur at the _______ of the sternal border?

systolic; left The patient will have a harsh systolic murmur due to pulmonary stenosis, which would lead you to find the murmur at the LEFT of the sternal border (the sound location of the pulmonary valve).

A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply: A. Pregnancy B. Being Female C. High Cholesterol D. Diabetes Mellitus E. Uncontrolled hypertension F. Varicose veins G. Smoking

C, D, E, and G. High cholesterol, diabetes mellitus, uncontrolled hypertension, and smoking are risk factors for peripheral arterial disease (PAD). Pregnancy, being female, varicose veins are risk factors for peripheral venous disease.

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to: A. Promote expectoration. B. Suppress the cough. C. Relax smooth muscles of the bronchial airway. D. Prevent infection.

C. Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. Theophylline causes smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNS and cardiac stimulation.

The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

D. Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient.

Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.

As the nurse you know which statements are TRUE about Tetralogy of Fallot? Select all that apply: A. "Tetralogy of Fallot is a cyanotic heart defect." B. "In this condition the heart has to work harder to pump blood to the lungs, which cause the right ventricle to work harder and enlarge." C. "Tetralogy of Fallot is treated with only palliative surgery." D. "Many patients with this condition will experience clubbing of the nails."

A, B, and D. Option C is wrong because this condition can be treated with both palliative surgery (used to help alleviate symptoms until the child is old enough for complete repair) and complete repair. All the other options are correct.

True or False: Peripheral venous disease can occur due to narrowing of the valves in the veins of the lower extremities.

FALSE. Peripheral venous disease can occur due to overstretched valves of the veins (NOT narrowed) in the lower extremities. In addition, it can occur when the veins become damaged.

Select all the medications used to treat pneumonia that are narrow-spectrum: A. Macrolides B. Tamiflu C. Fluroquinolones D. Penicillins

A and D. These are the only options that are considered narrow spectrum antibiotics which means they target specific family of bacteria.

What is the rationale for using CPAP to treat sleep apnea? A) positive air pressure holds the airway open B) negative air pressure holds the airway closed C) delivery of oxygen facilitates respiratory effort D) alternating waves of air stimulate breathing

A) positive air pressure holds the airway open

During a home​ visit, the nurse assesses a​ 2-year-old child. Which factor should the nurse identify as putting the child at risk for contracting respiratory syncytial virus​ (RSV)? (Select all that​ apply.) A. Both parents are unemployed. B. Both parents smoke cigarettes. C. The toddler shares a drinking cup with older brother. D. There is an absence of soap at the kitchen sink. E. The toddler wears clean but rumpled pants and shirt.

A, B, C, D

Select all the following that can trigger an asthma attack: A. Sulfites B. Smoke C. Caffeine D. GERD E. Cold, windy weather F. Beta agonist G. Cockroaches

A, B, D, E, and G. Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack.

You're providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient: A. Easily fatigued with physical activity B. Reduced peak flow meter reading C. Chest retractions D. Cyanosis E. Wheezing with activity F. Nighttime coughing G. No relief with short-acting bronchodilator inhaler

A, B, E, and F. These are all early warning signs an asthma attack is imminent. Options C, D, and G are signs and symptoms of an active asthma attack that requires medical treatment.

Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza)

Which of the following patients are MOST at risk for developing pneumonia? Select-all-that-apply: A. A 53 year old female recovering from abdominal surgery. B. A 69 year old patient who recently received the pneumococcal conjugate vaccine. C. A 42 year old male with COPD and is on continuous oxygen via nasal cannula. D. A 8 month old with RSV (respiratory syncytial virus) infection.

A, C, and D. Risks factors for pneumonia include: recent surgery, lung disorder (ex: COPD), and viral infection (ex: RSV).

Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming? Select all that apply: A. Caffeine B. Dairy C. Wheat D. Shellfish

A. Caffeine has the same properties as Theophylline and can increase the effects the drug.

A patient is being discharged home on Doxycyline for treatment of pneumonia. Which statement by the patient indicates they understood your education material? A. "I will wear sunscreen when outdoors." B. "I will avoid green leafy vegetables while taking this medication." C. "I will monitor my blood glucose regularly due to the side effects of hypoglycemia." D. "I will take this medication with a full glass of milk."

A. Doxycycline increases the skin's sensitivity to the sun, so the patient should wear sunscreen when outdoors. Also, the patient should not take this medication with antacids or milk products because this affects the absorption of the medication.

A 25 year-old female patient with pneumonia is prescribed Doxycycline. What question is important to ask the patient prior to administration of this medication? A. "Do you take birth control pills?" B. "Are you allergic to Penicillin?" C. "Are you allergic to eggs?" D. "Do you have a history of diabetes?"

A. Doxycycline is part of the Tetracycline antibiotic family. This medication can decrease the effectiveness of birth control pills. Since the patient is female and within child-bearing age, the question should be asked if she is taking birth control pills so you can educate her on using another form of birth control to prevent pregnancy.

A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed? A. Macrolide B. Cephalosporins C. Pencillin G D. Tamiflu

A. Macrolides are used to treat gram-positive bacterial infections and are used in patients with penicillin allergies. Penicillin G is a penicillin antibiotic and would not be used because of the patient's allergy. In addition, usually if a patient is allergic to penicillin there is an increased chance they are allergic to cephalosporin....therefore it would not be used as well.

A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications? A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol. C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone. D. The patient inhales the Fluticasone and immediately inhales the Salmeterol.

A. The bronchodilator inhaler (Salmeterol) is administered first to open up the airways. Then the patient is to wait five minutes and then administer the corticosteroid (Fluticasone). The bronchodilator will open the airways so the corticosteroid can easily enter the airways to decrease inflammation.

A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description? A. venous ulcer B. arterial ulcer C. diabetic ulcer

A. These findings are associated with a venous ulcer.

You're caring for a patient with pneumonia. The patient has just started treatment for pneumonia and is still experiencing hypoxemia. You know that respiratory acidosis is very common with patients with pneumonia. Which arterial blood gas readings below represent respiratory acidosis that is NOT compensated? A. pH 7.29, PaCO2 55, HCO3 23, PO2 85 B. pH 7.48, PaCO2 35, HCO3 22, PO2 85 C. pH 7.20, PaCO2 20, HCO3 28, PO2 85 D. pH 7.55, PaCO 63, HCO3 19, PO2 85

A. This is the only ABG result that represents respiratory acidosis.

Select the patient below who is at MOST risk for pernicious anemia: A. A 75 year old male who recently had surgery on the ileum. B. A 25 year old female who reports craving ice and clay. C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells. D. All the patients above are at risk for pernicious anemia.

A. elderly, patients who've had GI surgery, have endocrine disorders, or GI disease are at risk for pernicious anemia.

A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client? A. "Is there any possibility that you could be pregnant?" B. "Are you wearing any metal chains or jewelry?" C. "Can you hold your breath easily?" D. "Are you able to hold your arms above your head?"

A. "Is there any possibility that you could be pregnant?" The most important item to ask about is the client's pregnancy status because pregnant women should not be exposed to radiation.

The nurse is caring for an infant who is recovering from bronchiolitis. The parents ask if there will be any future risk for the child. Which condition should the nurse​ describe? A. Decreased lung capacity B. Asthma C. Chronic respiratory infections D. Chronic obstructive pulmonary disease​ (COPD)

B

The term _____________ implies a familial tendency to manifest such conditions as asthma, rhinitis, urticaria, and eczematous dermatitis. A. tropical allergy B. atopic allergy C. sensitization D. exocytosis

B

A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation? A. Chronic obstructive bronchitis B. Emphysema C. Bronchial asthma D. Bronchial asthma and bronchitis

B. Emphysema The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, which is referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion.

Select all the correct options that represent the pathophysiology of an asthma attack. A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation. B. The mucosa lining experiences severe inflammation. C. The goblet cells within the mucosa lining produce excessive amounts of mucous. D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis.

B and C. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop....hence acidosis. Remember CO2 is acidic.

A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise. Select all that apply: A. Avoid warming up before exercise. B. Administer a short-acting beta agonist before exercise. C. Administer a short-acting beta agonist after exercise. D. Avoid exercising when experiencing a respiratory illness.

B and D. Option A is wrong because the patient should warm up for at least 10-15 minutes before exercising, and option C is wrong because the beta agonist should be administered BEFORE exercise (not after).

The nurse is examining a child with bronchiolitis. Which symptom should the nurse interpret as a sign of​ dehydration? (Select all that​ apply.) A. Intercostal muscle retractions B. Weak peripheral pulses C. Decreased urine output D. Dry, sticky mucous membranes E. Delayed capillary refill

B, C, D, E

Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply: A. Stridor B. Coarse crackles C. Oxygen saturation less than 90% D. Non-productive, nagging cough E. Elevated white blood cells F. Low PCO2 of less than 35 G. Tachypnea

B, C, E, and G. These are typical signs and symptoms of pneumonia. Stridor is not very common. A PRODUCTIVE cough that can be nagging is very typical, and there is usually a HIGH PCO2 of 45 or greater due to the lungs retaining carbon dioxide.

Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

B, D

A 4-month-old is diagnosed with Tetralogy of Fallot. You're providing an illustration to the parent to help him understand the pathophysiology of this condition. What defects must be present in the illustration to help the parent understand their child's condition? Select all that apply: A. Aortic stenosis B. Ventricular septal defect C. Coarctation of aorta D. Right ventricular hypertrophy E. Displacement of the aorta F. Pulmonic stenosis G. Patent ductus arteriosus

B, D, E, and F. Let the condition's name help you: "TETRAOLOGY"...this means there will be FOUR problems with this heart defect. Remember the mnemonic RAPS: Right ventricular hypertrophy, Aorta displacement, Pulmonary stenosis, Septal defect (ventricular)

A 72 year-old male patient who is diagnosed with bilateral lower lobe pneumonia is admitted to your unit. The patient has a history of systolic heart failure and arthritis. On assessment, you note the patient has a respiratory rate of 21, oxygen saturation 93% on 2L nasal cannula, is alert & oriented, and has a productive cough with green/yellowish sputum. Which of the following nursing interventions will you provide to this patient based on your assessment findings and the patient's diagnosis? Select-all-that-apply: A. Keep head-of-the-bed less than 30 degrees at all times. B. Collect sputum cultures. C. Encourage 3L of fluids a day to keep secretions thin. D. Encourage incentive spirometer usage E. Provide education about receiving the Pneumovax vaccine every 5 years.

B, D, and E. You would not keep the head-of-bed less than 30 degrees because this impedes breathing and increases the risk of aspiration. Also, since the patient has systolic heart failure you would NOT encourage 3L of fluids per day because the patient would not tolerate the extra fluid. However, in normal situations (if a patient does not have heart failure etc.) you would want to encourage fluids to keep secretions thin.

Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.

You're providing discharge teaching to a patient who was admitted for pneumonia. You are discussing measures the patient can take to prevent pneumonia. Which of the following statements by the patient indicates they did NOT understand your education material? A. "I'll use hand sanitizer regularly while I'm out in public." B. "It is important I don't receive the Pneumovax vaccine since I'm already immune to pneumonia." C. "I will try to avoid large crowds of people during the peak of flu season." D. "It is important I try to quit smoking."

B. All the other options are correct statements regarding the prevention of pneumonia. However, option B is incorrect because although the patient has had pneumonia they should still receive the Pneumovax vaccine to prevent other forms of pneumonia.

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure 100-300 present >300 pg/mL mild >600 pg/mL moderate >900 pg/mL severe

A patient is admitted with rupture of the Achilles tendon. The patient was recently treated with antibiotics for pneumonia. Which of the following medications below can cause this adverse effect? A. Penicillin B. Fluroquinolones C. Tetracyclines D. Macrolides

B. Fluroquinolones can cause tendon rupture along with c.diff infection and cardiac arrhythmia such as prolonged QT interval.

Your patient's asthma is poorly controlled. The patient reports using their rescue inhaler 4 times a week. In addition, the patient's asthma is not responding to other treatments. The physician orders the patient to take a medication that works by blocking the role of the immunoglobulin IgE. This describes which medication below? A. Montelukast B. Omalizumab C. Cromolyn D. Salmeterol

B. Omalizumab blocks the role of the immunoglobulin IgE, which will decrease the allergic response...hence asthma attacks. It is given subcutaneously and used when a patient's asthma is poorly controlled and other treatments are not working. It is NOT used for quick relief. It is important the patient receives NO LIVE vaccines while receiving this medication.

Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

B. Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).

The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia? A. Hyperchromic and macrocytic B. Hypochromic and microcytic C. Hyperchromic and macrocytic D. Hypochromic and macrocytic

B. The RBCs would appear pale (hypochromic) and small (microcytic).

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? A. Encouraging additional fluids for the next 24 hours B. Ensuring the return of the gag reflex before offering foods or fluids C. Administering atropine intravenously D. Administering small doses of midazolam (Versed).

B. Ensuring the return of the gag reflex before offering foods or fluids After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours.

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the: A. Brachial and radial arteries, and then releases them and observes the circulation of the hand. B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. C. Radial artery and observes for color changes in the affected hand. D. Ulnar artery and observes for color changes in the affected hand.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allen's test. This involves compressing the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to become pale. The nurse then releases pressure on one artery and observes whether circulation is restored quickly. The nurse repeats the process, releasing the other artery. The blood sample may be taken safely if collateral circulation is adequate.

A patient is presenting with mild symptoms of pneumonia. The doctor diagnoses the patient with "walking pneumonia". From your nursing knowledge, you know this type of pneumonia is caused by what type of infectious agent? A. Fungi B. Streptococcus pneumoniae C. Mycoplasma pneumoniae D. Influenza

C

Salbutamol is a _____________ A. corticosteroid. B. alpha-adrenergic receptor agonists. C. beta-adrenergic receptor agonist. D. anticholinergic.

C

The nurse is working with a mother and discussing the process of keeping the airway clear for a child diagnosed with respiratory syncytial virus​ (RSV). Which should the nurse teach the parent to do at​ home? A. Use a catheter to suction the airway B. Perform chest percussion C. Use a bulb syringe to suction the nose D. Auscultate lung sounds

C

A nurse is caring for a client who has sleep apnea and is prescribed modafinil (Provigil). The client asks, "How will this medication help me?" How should the nurse respond? a."This medication will treat your sleep apnea." b."This sedative will help you to sleep at night." c."This medication will promote daytime wakefulness." d."This analgesic will increase comfort while you sleep."

C Modafinil is helpful for clients who have narcolepsy (uncontrollable daytime sleep) related to sleep apnea. This medication promotes daytime wakefulness.

As the registered nurse you are developing a plan of care for a patient with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below that would be specific to this patient: A. Risk for deficient fluid volume B. Ineffective airway clearance C. Activity Intolerance D. Failure to thrive E. Risk for impaired liver function

C and D. A patient with TOF will have activity intolerance because remember this is a cyanotic heart defect where there is not enough oxygen in the blood (due to the structural defect of the heart) and any activity (feeding, crying, play etc.) can increase the demands for oxygen. Therefore, the patient will experience activity intolerance. In addition, the patient can experience failure to thrive because the constant hypoxemia (low oxygen in the blood) experienced can lead the child to have poor growth, weight loss, clubbing of the nails etc. Remember organs need plenty of oxygen to work and grow but in TOF this isn't happening very well. Options A, B, and E are not appropriate nursing diagnoses.

Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the? A. Dependent position B. Horizontal position C. Elevated position above heart level D. Knee-flexed position

C. Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower extremities and can't flow back to the heart

You assist your patient with using their inhaler. The inhaler contains the medication Budesonide. Before administering the inhaler, you will want to connect what device to the inhaler to help decrease the patient from developing ________?* A. Peak flow meter; pneumonia B. Incentive spirometer; thrush C. Spacer; thrush D. Peak flow meter; mouth sores

C. Budesonide is a corticosteroid. Inhaled corticosteroids can cause thrush. Therefore, it is important to connect a spacer to the inhaler before usage to help prevent the patient from developing thrush and for the patient to gargle and rinse the mouth with water.

You're assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient's lung fields and note expiratory wheezes. The patient's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack? A. Theophylline B. Tiotropium C. Albuterol D. Cromolyn

C. During an asthma attack, the patient needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators, such as Albuterol, short-acting beta agonists. Another type of short-acting bronchodilator is an anticholinergic bronchodilator called Ipratropium (this is given if a patient can't tolerated short-acting beta agonists like Albuterol). Theophylline is a bronchodilator but given orally and is NOT for quick relief. Tiotropium is a bronchodilator, as well, but is a LONG-ACTING anticholinergic bronchodilator. Cromolyn is an inhaled nonsteroidal anti-allergy medication that doesn't provide quick relief.

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).

A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia? A. Aspiration pneumonia B. Ventilator acquired pneumonia C. Hospital-acquired pneumonia D. Community-acquired pneumonia

C. The key words to let you know this is hospital-acquired pneumonia and NOT community-acquired is that the patient was admitted with a gunshot wound AND has been hospitalized for 48 hours. If the patient presents with signs and symptoms of pneumonia 48-72 hours after admission it is classified as hospital-acquired. This is not ventilator acquired because the patient is not on mechanical ventilation and there is nothing in the scenario that leads us to think it is aspiration pneumonia.

Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing? A. Low fat diet B. Blood glucose control C. Smoking cessation D. Blood pressure control

C. The most common cause of Buerger's Disease (thromboangiities obliterans) is tobacco usage (smoking). Buerger's Disease occurs when the blood vessels of the hands and feet become inflamed and clots form. The clots will block blood flow. The nurse should make it priority to educate the patient on smoking cessation.

A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.

C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind. therapeutic level: 0.8-2.0ng/mL toxicity >2.4ng/mL

A patient is admitted with iron- deficiency anemia and has been receiving iron supplementation. The patient voices concern about how their stool is dark black. As the nurse, you would? A. Notify the doctor B. Hold the next dose of iron C. Reassure the patient this is a normal side effect of iron supplementation D. None of the options are correct

C. This is a normal side effect of iron supplementation and demonstrates the body is absorbing the iron.

You're educating a patient how to use a peak flow meter to help monitor the status of their asthma. Which statement by the patient demonstrates they understand how to use the device? A. "This device will help keep my lungs strong so I don't have another asthma attack." B. "I will inhale as hard as I can while using the device." C. "I will use this device at the same time, either in the morning or before bedtime, and compare the readings with my personal best reading." D. "I will notify the doctor if my peak flow rating is 90% or more than my personal best peak flow."

C. This option is correct. Option A is wrong because this device monitors how controlled a patient's asthma is and if it is getting worst. It doesn't make the lung stronger. Option B is wrong because the patient exhales as hard as they can onto the device. Option D is wrong because a flow rate of 90% of the personal best peak flow is a good reading.

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? A. A 60-year-old man with a hiatal hernia. B. A 36-year-old woman with 3 children. C. A 50-year-old woman caring for a spouse with cancer. D. A 60-year-old woman with osteoarthritis.

C. A 50-year-old woman caring for a spouse with cancer. Individuals who are household members or home care providers for high-risk individuals are high-priority targeted groups for immunization against influenza to prevent transmission to those who have a decreased capacity to deal with the disease. The wife who is caring for a husband with cancer has the highest priority of the clients described.

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? A. Removes the cap and shakes the inhaler well before use. B. Press the canister down with your finger as he breathes in. C. Inhales the mist and quickly exhales. D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

C. Inhales the mist and quickly exhales. Take the inhaler out of the mouth. If the client can, he should hold his breath as he slowly counts to 10. This lets the medicine reach deep into the lungs. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.

You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of the following is the correct way to use this device? A. Encourage the patient to use it twice a day. B. The patient exhales into the device rapidly and then coughs. C. The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales. D. The patient rapidly inhales 10 times from the device and then exhales for 6 seconds.

C. The patient will inhale slowly from the device until no longer able, and then hold breath for 6 seconds and exhale. The patient should use the device at least 10 times every 1-2 hours while awake.

The mechanism of action of beta-2 receptor agonists in bronchial asthma include all the following, EXCEPT: A. Relaxation of airway smooth muscle B. Inhibition of plasma exudation and airway edema C. Increased mucociliary clearance D. Increasing the release of mast cell mediator

D

Which intervention should the nurse identify as a preventive measure for​ bronchiolitis? A. Antibiotic therapy B. Immunization C. Sputum culture D. Palivizumab

D

Which medication below blocks the function of Leukotriene for the treatment of asthma? A. Salmeterol B. Theophylline C. Tiotropim D. Montelukast

D

Which of the following drug is NOT available as metered-dose inhaler (MDI)? A. salbutamol B. terbutaline C. albuterol D. Aminophylline

D

Which of the following pathophysiological mechanisms that occur in the lung parenchyma allow pneumonia to develop? A. Atelectasis B. Bronchiectasis C. Effusion D. Inflammation

D The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. The resident macrophages serve to protect the lung from foreign pathogens. Ironically, the inflammatory reaction triggered by these very macrophages is what is responsible for the histopathological and clinical findings seen in pneumonia.

A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.

A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will? A. Immediately stop the nebulizer B. Re-adjust the nebulizer C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication. D. Reassure the patient this is a temporary side effect of this medication.

D. Cromolyn can temporarily cause the following side effects during administration: sneezing, burning in nose, itchy/watery eyes, bad taste in mouth. Reassure the patient that these are temporary side effects of this medication.

Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks: A. cyanotic; rubor B. rubor; pallor C. cyanotic, pallor D. pallor; rubor

D. In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position (dangling) they will appear rubor (red and warm...this occurs due to inflammation of the vessels).

A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

D. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.

You are about to hang a bag of intravenous Vancomycin for a patient who has severe pneumonia. Which statement by the patient causes you to hold the bag of Vancomycin and notify the doctor immediately? A. "I'm seeing yellow halos around the light." B. "My mouth tastes like metal." C. "My head hurts." D. "I have this constant ringing in my ears."

D. Vancomycin can cause ototoxicity. Roaring or ringing in the ears are a possible sign/symptom of this adverse effect. Option A happens with Digoxin toxicity. Options B and C are vague and are not a common adverse reaction to Vancomycin.

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin

D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? A. "Use your nasal decongestant spray regularly to help clear your nasal passages." B. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." C. "It is important to increase your activity. A daily brisk walk will help promote drainage." D. "Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks."

D. "Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks." It is important for clients with allergic rhinitis to determine the precipitating factors so that they can be avoided. Keeping a diary can help identify these triggers. Patients often underestimate the severity of this condition and fail to seek medical therapy. It is important to adequately control AR, especially due to the link between AR and asthma, with poor control of rhinitis predicting poor control of asthma.

A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests? A. ABG analysis B. Chest x-ray C. Blood cultures D. Sputum culture and sensitivity

D. Sputum culture and sensitivity Sputum C & S is the best way to identify the organism causing the pneumonia.

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? A. Constipation B. Diarrhea C. Bradycardia D. Tachycardia

D. Tachycardia Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat. Due to the vasodilatory effect of peripheral vasculature and subsequent decrease in cardiac venous return, compensatory mechanisms manifest as tachycardia are relatively common, especially within the first weeks of usage.

A nurse is formulating a plan of care for a 22-month-old child with a diagnosis RSV. Which symptoms indicate to the nurse that the child is experiencing impending respiratory failure? a. Hoarseness b. Retractions of the accessory chest muscles c. Decreased inspiratory breath sounds d. Restlessness and irritability

c. Decreased inspiratory breath sounds are a sign of physical exhaustion and indicate impending respiratory failure.