Quiz 10 Adult GI, Shock/ PAD Quiz 11, Shock Millionaire Questions from Class, Hema/Shock random Class Questions, Quiz 14 Endocrine, wow
A nurse is caring for a patient who has systemic lupus erythematousus (SLE) and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate?
Pallor of the toes with cold exposure
A nurse is assessing a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect?
Pallor on elevation of the limbs, and rubor when the limbs are dependent
A nurse is assessing a patient who has been taking prednisone following an exacerbation of inflammatory bowel disease (IBD). The nurse should identify which finding as the priority?
Patient reports having an elevated body tempurature
Signs of heading loss include all of the following except: -patient talking excessively loud -patient tilting head when listening -TV/radio too loud -Patient understanding all conversation without need for clarification
Patient understanding all conversation without need for clarification
Which of the following is included in the care plan of a patient with a halo brace:
Pin site care
Which nursing intervention is the most important when turning a patient following a spinal cord injury?
Placing a pillow between the patient's legs and turning the body as a unit
The partial to complete collapse of the lung due to accumulation of the air in the pleural space is called:
Pneumothorax
Carpal tunnel syndrome involves which of the following: -Sensory/motor changes in thumb, index, middle finger and radial aspect of the ring finger -Chronic autoimmune disorders involving inflammation of tissues - Nodules of the distal phalange joints -Chronic low-back pain that lasts more than three months
Sensory/motor changes in thumb, index, middle finger and radial aspect of the ring finger
The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following?
Spinal shock syndrome
What stage pressure ulcer is intact skin with non-blanchable redness?
Stage I
The nurse is providing home care instructions to the parents of a 15-year-old child with hemophilia. Which sport activity should the nurse suggest for this child?
Swimming
An older patient relates that she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching is helpful to the patient if she has microcytic hypochromic anemia?
Take the iron with orange juice one hour before meals
The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy?
Teach the client and family about the need for hand hygiene.
Which assessment data would warrant immediate interventions by the nurse:
The client diagnosed with DVT who complains of pain on inspiration
The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse?
The client has 450 mL of bright-red drainage in the chest tube.
B.
The emergency room nurse is assessing a patient who is in shock, unknown etiology. What is the priority nursing intervention? A. Check pulse B. Administer oxygen C. Start IV D. Notify family
B.
The nurse in the preoperative holding area keeps a client with gastric bleeding in a dimly lit environment with one family member present. What is the primary rationale for these nursing interventions? A. To stabilize fluid and electrolyte balance B. To minimize oxygen consumption C. To increase client and family comfort D. To prevent infection
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test results will confirm the diagnosis of Hodgkin's disease?
The presence of Reed-Sternberg cells in the lymph nodes
Persons with altered taste problems should try experimenting with spices and other seasonings to help mask taste alterations
True
True or false, Addison's disease education includes information about lifelong hormone therapy.
True
True or false, a patient with a spinal cord injury is prone to developing a gastrointestinal stress ulcer
True
True or false, counseling and support groups are an important part in helping with the losses associated with a spinal cord injury.
True
True or false. Conductive hearing loss can usually be corrected
True
True or false. Nursing management for headaches may include daily exercise, yoga, and relaxation periods
True
True, or false, principles of dialysis include diffusion of solutes from an area of greater concentration to an area of lesser concentration.
True
What finding related to glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report?
Tunnel vision with absence of pain
Which of the following findings is the best indication that fluid replacement for the client in hypovolemic shock is adequate?
Urine output greater than 30ml/hr
D.
What is an example of health promotion education for a client at risk for anaphylatic shock? A. Wear an identification badge/bracelet B. Avoid allergens C. Know how to use epipen D. All of the above
D.
What type of shock would you most likely initially give a vasodialator medication? A. Neurogenic B. Hypovolemic C. Anaphylactic D. Cardiogenic
B.
Which is the priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution? A. Fluid balance B. Anaphylactic reaction C. Pain D. Altered level of consciousness
D.
Which nursing intervention is most important in preventing septic shock? A. Administering IV fluid replacement therapy as ordered B. Obtaining vital signs every 4 hours C. Monitoring red blood cell counts for elevation D. Maintaining asepsis of indwelling urinary catheters
A.
Which of the following findings is the bst indication that fluid replacement for the client in hypovolemic shock is adequate? A. Urine output greater than 30ml/hr B. Systolic blood pressure greater than 110 C. Diastolic blood pressure greateer than 90 D.Respiratory rate of 20/min
A.
Which of the following is a risk factor for hypovolemic shock? A. Hemorrhage B. Antigen-antibody reaction C. Gram-negative bacteria D. Vasodilation
C.
Which of the following is the most important goal of nursing care for a client who is in shock? A. Manage fluid overload B. Manage increased cardiac output C. Manage inadequate tissue perfusion D. Manage vasoconstriction of vascular beds
D.
Which of the following nursing assessment findings indicates hypovolemic shock in a client who has had a 15% blood loss: A. Pulse rate less than 60/min B. Respiratory rate of 4 breaths/min C. Pupils unequally dilated D. Systolic blood pressure less than 90
Coarctation of the aorta
Aorta narrows// ss: cold extremities
The client with burns may be developing DIC. Which symptoms would support the diagnosis of DIC?
Oozing blood from the IV catheter site
A patient in hypovolemic shock has a low pulmonary capillary wedge pressure (PCWP). This should indicate to the nurse that:
fluid replacement is needed
A nurse is teaching a patient who has a new diagnosis of rheumatoid arthritis (RA). Which of the following statements should the nurse include in the teaching?
"You can experience morning stiffness when you get out of bed"
The nurse provides home care instructions to a patient with systemic lupus erythematosus (SLE) and tell the patient about methods to manage fatigue. Which statement by the patient indicates a need for further instruction?
"I should continue exercising if I start to feel pain"
A nurse in a clinic is teaching a patient who has ulcerative colitis. Which of the following statements by the patient indicates understanding of the teaching
"I will plan to limit fiber in my diet"
Intermittent catheterization is frequently done with spinal cord injury patients to prevent:
(All of the answers) - Infection - Renal calculi - Autonomic dysreflexia
Health promotion strategies related to spinal cord injuries include:
(All of the answers) - identifying high risk populations for spinal cord injuries -supporting legislation on seat belts, helmets for motorcycles, child safety seats -facilitate wheelchair accessible health care exam rooms
A. Cardiogenic - results from the heart's inability to adequately circulate blood volume. B. Hypovolemic - a decrease in intravascular volume. C. Obstructive - mechanical blockage in the heart or great vessels. D. Distributive - widespread vasodilation and increased capillary permeability. Results from a change in size of the vascular space without an increase in blood volume. Three types: neurogenic, anaphylactic, septic.
**Describe the four types of shock A. Cardiogenic B. Hypovolemic C. Obstructive D. Distributive
Acute rejection occurs in the first 2 weeks after transplantation. Clinical manifestations include fever, malaise, elevated WBC, acute hypertension, graft tenderness and manifestations of deteriorating renal function (elevated creatinine). Chronic rejection occurs gradually, over a period of months to years.
**What are signs of acute kidney transplant rejection? Chronic kidney transplant rejection?
A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following clinical manifestations should the nurse expect to find? (SELECT ALL THAT APPLY)
- Herberden's nodes - Enlarged joint size - Limp when walking
A nurse working in an outpatient clinic is assessing a patient who has rheumatoid arthritis (RA). The patient reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY)
- Recent influenza - Decreased range of motion - Pain at rest
A nurse is providing information to a patient who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information? (SELECT ALL THAT APPLY)
-Apply heat to joints to alleviate pain - Ice inflamed joints following activity - Install an elevated toilet seat -Complete high-energy activities in the morning
When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing?
0.9% Sodium Chloride
After starting a blood transfusion, the RN stays in the room for how many minutes?
15 minutes
Ventricular Septal Defect... Cyanotic or Acyanotic?
Acyanotic
Which of the following clients are NOT at risk for developing acute respiratory distress syndrome?
A client who has a hemoglobin of 15.1 mg/dL
The BEST nutritional therapy plan for a person who is obese is
A well balanced diet using the food pyramid as a guide
A nurse is completing discharge teaching to a patient who had a wound debridement for osteomyelitis. Which of the following information should the nurse include in the teaching?
Antibiotic therapy should continue for 3 months
Aortic aneurysms can be best assessed in which of the following locations?
Abdomen
Atrial septal defect.. Cyanotic or Acyanotic?
Acyanotic
Increase in pulmonary blood flow... Cyanotic or Acyanotic?
Acyanotic
Left to right shunt... Cyanotic or Acyanotic?
Acyanotic
Patent Ductus Ateriosus... Cyanotic or Acyanotic?
Acyanotic
The bariatric surgical procedure involves creating a gastric pouch that is reversible and no malabsorption occurs. What surgical procedure is this?
Adjustable gastric banding
A patient is diagnosed with scleroderma. Which intervention should the nurse anticipate to be prescribed?
Administer corticosteroids as prescribed for inflammation
The emergency room nurse is assessing a patient who is in shock unknown etiology. Which is the priority nursing intervention?
Administer oxygen
Overall goals in working with leukemia patients include which of the following? -Understand and cooperate with the treatment plan -Experience minimal side effects and complications of disease and treatment -Feel hopeful and supported during periods of treatment, relapse, and remission -All of the above
All of the above
Oral candidiasis involves assessment of which of the following structures: -tongue -buccal mucosa -gums -all of the answers
All of the answers
Things that can trigger a migraine headache include which of the following: -head trauma - missed meals - stress - all of the answers
All of the answers
Which of the following are types of primary headaches? -tension type -migraine -cluster -all of the answers
All of the answers
Results of a patient's most recent blood work indicates an elevated neutrophil level. The nurse should recognize that this diagnostic finding most likely suggests which problem?
An infection
The nurse writes the problem "impaired skin integrity" for a client with stage IV pressure ulcers. What intervention should be included in patient plan of care?
Ask the dietitian to see the client to help with nutrition
What will caring for a patient with a diagnosis of polycythemia likely require the nurse to do?
Assist with or perform phlebotomy at the bedside
A nurse is completing discharge teaching with a patient who has irritable bowel syndrome (IBS). Which of the following should the nurse include in the teaching?
Avoid foods that trigger exacerbation
A nurse is assessing a patient who has systemic lupus erythematousus (SLE). Which of the following findings should the nurse expect?
Butterfly rash
Risk factors for peripheral artery disease include all of the following EXCEPT -cigarette smoking -Hypertension -Diabetes Mellitus -Caffeine intake
Caffeine intake
A nurse is monitoring a group of clients for increased risk for developing pneumonia. Which of the following clients should the nurses expect to be at risk?
Client who has AIDS
When administering medications to the patient with chronic gout, the nurse would recognize which of the following as a treatment for this disease?
Colchicine
A patient is being admitted to the hospital from home with a stage IV pressure ulcer over the sacral area. What assessment tool should be completed on admission to the hospital?
Complete the Braden Scale
Decreased pulmonary blood flow... Cyanotic or Acyanotic?
Cyanotic
Hypoplastic Left Heart Syndrome... Cyanotic or Acyanotic?
Cyanotic
Right to left shunt... Cyanotic or Acyanotic?
Cyanotic
Tetralogy of Fallot... Cyanotic or Acyanotic?
Cyanotic
Transposition of the Great Arteries... Cyanotic or Acyanotic?
Cyanotic
Which instruction should the nurse discuss with the client who has conjunctivitis?
Do not share towels or linens
A nurse is completing discharge teaching with a patient who has Crohn's disease. Which of the following instructions should the nurse include in the teaching?
Drink canned protein supplements
The nurse is assessing a patient's medical history. What aspects of the patient's medical history are most likely to have potential consequences for the patients visual system?
Hypertension and Diabetes mellitus
A nurse is reviewing the serum laboratory data of a patient who has an acute exacerbation of Crohn's Disease. Which of the following will lab tests should the nurse expect to be elevated? (Select all that apply)
Erythrocyte Sedimentation rate (ESR) WBC
Giantism is caused by
Excessive growth hormone
True or false, a nurse should always remove a hard cervical collar from a patient with a cervical spinal cord injury after 24 hours.
False
True or false, diabetes insipidus results from inadequate insulin
False
True or false, headaches always arise from an intracranial source
False
True or false, with syndrome of inappropriate antidiuretic hormone, urine production is increased.
False
Which manifestations in a patient with T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia?
Headache and rising blood pressure
Which of the following is a risk factor for hypovolemic shock?
Hemorrhage
Which criteria must be met for a diagnosis of metabolic syndrome? (Select all that apply)
Hypertension Elevated triglycerides Elevated serum glucose level Increased waist circumference
When planning care for a patient with a C5 spinal cord injury, which nursing diagnosis has the highest priority?
Ineffective airway clearance caused by high cervical spinal cord injury
Trigeminal neuralgia symptoms consist of pain where?
Intense pain in the face
The client comes to the emergency department after splashing chemicals into the eyes. What intervention should the nurse implement first?
Irrigate the eyes with normal saline solution
Which of the following is a group of malignant disorders affecting the blood and blood forming tissue?
Leukemia
Which of the following is the most important goal of nursing care for a client who is in shock?
Manage inadequate tissue perfusion
B.
One of the collaborative goals of shock is to prevent gastrointestinal bleeding. How could the nurse evaluate if the H2 blocker medication is effective? A. No stomach pain B. Stools for occult blood are negative C. Patient is gaining weight D. Tolerating diet well
A.
Multiple organ dysfunction syndrome (MODS) is the failing of two or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention. The first body system that is often the first to show signs of dysfunction in MODS is: A. Respiratory B. Gastrointestinal C. Neurological D. Musculoskeletal
Neuropathy is defined as:
Nerve damage that occurs because of metabolic derangements associated with diabetes
The most specific systems for the nurse to assess related to headaches is:
Neurological assessment
D.
Nursing Diagnoses for the patient in shock may include: A. Ineffective peripheral tissue perfusion with risk for decreased cardiac tissue perfusion B. Ineffective cerebral tissue perfusion C. Ineffective renal perfusion D. All of the above
D.
Nursing Diagnoses for the transplant patient include which of the following: A. Risk for infection B. Risk for injury (rejection) C. Knowledge deficit related to new life-long immunosuppression medication D. All of the above
Pulmonic stenosis
Pulmonary valve doesn't completely open, narrowed
In assessing the patient, which abnormal finding should the nurse relate to thrombocytopenia?
Purpura
Laboratory studies are performed for a patient suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which results indicates this type of anemia?
Reduced red blood cell count with red blood cells that are microcytic and hypochromic
Which one of the following is NOT TRUE about a bone marrow biopsy?
Requires going to surgury
The nurse is reviewing a health care provider's orders for a patient with sickle cell anemia crisis. Which order should the nurse question?
Restrict fluid intake
Which type of hearing loss involves damage to the cochlea or vestibulocochlear nerve (CN VIII)?
Sensorineural hearing loss
A patient with state 1 colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that
follow up colonoscopies will be needed to ensure that the cancer does not recur.
A client has been in a motor vehicle accident and sustained significant injuries. The client is in shock and is semi conscious, but is restless and moaning. The family is concerned the client is in pain and demands the nurse give the ordered morphine. The priority action by the nurse is to a. Check the client's O2 sat b. Give morphine as ordered, slowly c. Politely decline their request d. Reposition the patient
a.
A patient in hypovolemic shock has a low PCWP. This should indicate to the nurse that a. Fluid replacement is needed b. Pulmonary edema may be developing c. Resuscitative measures (CPR) are inadequate d. The client's left ventricle is failing
a.
A patient is admitted to ER with chest pain that is being ruled out as MI. Vitals at 11AM are pulse 92, resp rate 24, B/P 140/88.Vitals at 11:20 are pulse 96, resp rate 26, B/P 128/82Vitals at 11:35 are pulse118, resp rate 32, B/P 88/58These changes are most consistent with: a. Cardiogenic shock b. Cardiac tamponade c. Pulmonary embolism d. Dissecting thoracic aortic aneurysm
a.
A patient with peripheral artery disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is: a. Risk for injury related to decreased sensation. b. Impaired skin integrity related to decreased peripheral circulation. c. Ineffective peripheral tissue perfusion related to decreased arterial blood flow. d. Activity intolerance related to imbalance between oxygen supply and demand.
a.
The nurse assessing acutely ill patients who are at risk for multiple organ dysfunction syndrome would assess for the usual precipitating problem of: a. Bradycardia b.Cerebral anoxia c.High creatinine level d.Hypotension
a.
The nurse caring for a patient in shock who is being mechanically ventilated explains that the rationale for this intervention is to a. Decrease CO2 levels in the blood b. Prevent atelectasis and pneumonia c. Rest the client to decrease metabolism d. Stimulate endorphin production
a.
The nurse caring for a patient newly diagnosed with MODS explains that the method of providing nutrition is likely to be a. Enteral feedings b. Intravenous fluids c. Oral diet d. Parenteral nutrition (TPN)
a.
The nurse would assess the individual in the most serious stage of shock as a a. 22 year old man with a falling B/P b. 35 year old woman with a pulse pressure of 40 c. 50 year old woman with a MAP of 90 d. 60 year old man with a pulse rate of 100
a.
When caring for a patient at risk for MODS, the nurse should place the highest priority on: a. Assisting with incentive spirometry hourly b. Hourly checks of urine output c. Maintaining adequate oral intake d. Performing rang-of-motion exercises
a.
Addison's disease results from destruction or dysfunction of the:
adrenal cortex
Aortic stenosis
aortic valve doesn't completely open/narrowed
A primary cause of peripheral artery disease is:
atherosclerosis
A patient is admitted to ER with a gunshot wound to the abdomen. The nurse anticipates the initial use of which IV solution? a. Dextran b. Normal saline c. Packed red blood d. Whole blood
b.
Distributive shock is primarily due to: a. A fluid shift from the vascular space b. An increase in the size of the vascular space c. Inadequate circulating blood volume d. Inadequate pumping action of the heart
b.
The nurse teaches a patient with peripheral arterial disease. The nurse determines that further teaching is needed if the patient makes which statement? a. "I should not use heating pads to warm my feet." b. "I should cut back on my walks if it causes pain in my legs." c. "I will examine my feet every day for any sores or red areas." d. "I can quit smoking if I use nicotine gum and a support group."
b.
Allusion
boba
A patient is receiving fluid replacement for treatment of shock and the nurse assesses a central venous pressure of 15 cm H2O. The nurse anticipates which of the following interventions? a. Administration of vasoconstrictors b. Administration of vasodilators c. Decreasing fluid infusion d. Increasing fluid infusion
c.
During the progressive stages of shock, lactic acidosis occurs, resulting in: a. Arterial pooling in the periphery b. Constriction of the microvasculature c. Increased capillary permeability d. Movement of fluid into the capillaries
c.
Pruritus in dialysis patients is caused by a. dry skin b. calcium phosphate deposits in the skin c. sensory nephropathy d. all of the above
d.
Pheochromocytoma is a tumor of the adrenal medulla that can increase:
catecholamines
Foramen ovale
connects left aorta to right aorta, bypasses lungs (peds)
Ductus Arteriosus
connects pulmonary artery to aorta, bypasses lungs (peds)
A patient with extreme obesity has undergone Roux-en Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient...
may only have liquids orally, and in very limited amounts, during the early postoperative period
salir
to leave
Cushing's syndrome is a clinical syndrome that results from:
too much corticosteroid
Acromegaly is caused by:
too much growth hormone