SYnthesis first exam

10 After an anterior-wall myocardial infarction (MI), which problem is indicated by auscultation of crackles in the lungs? A. Left-sided heartfailure B. Pulmonic valve malfunction C. Right-sided heart failure D. Tricuspid valve malfunction

1

After experiencing an anxiety attack, a client comes to the emergency department complaining of dizziness and light-headedness. Arterial blood gas (ABG) analysis reveals a pH of 7.62, PaCO2, of 22 mm Hg, PaO2, of 96 mm Hg, and HC03- of 24 mEq/L. Which action should the nurse take? Do nothing; these ABG values are normal. Encourage the client to breathe into a paper bag. Notify the physician and prepare to give sodium bicarbonate. Notify the physician and prepare to give supplemental oxygen.

2 Respiratory alkalosis- hyperventilating and blowing off CO2 want io increase CO2=> reuptake CO2

During an eight-hour shift a client drinks two 6-ounce cups of tea and vomits 125 mL of fluid. Intravenous fluids absorbed equaled the urinary output. During this eight-hour period the client's fluid balance would be: Answer:

235 ml intake more 1 ounce=30mL 2 6-oz =360 mL 360-125= 235

50 An S6-year-old client with heart failure is receiving furosemide (Lasix), 40 mg I.V. The physician orders 40 mEq of potassium chloride in 100 ml of dextrose 5 in water, to infuse over 4 hours. The client's most recent serum potassium level is 3.0 mEq/L. At which infusion rate should the nurse set the I.V. pump? _________ml/hour

25

A client with hypertension is being taught to restrict the intake of sodium. The nurse would know that the teaching about foods low in sodium was understood when the client states, "I can eat: Broiled scallops." Bologna on rye bread." Shredded wheat cereal." Carrot and celery sticks."

3 celery- high in Salt

39. A 52-year-old client with a history of hypertension has just had a total hip replacement. The physician orders hydrochlorothiazide 35 mg oral solution by mouth, once per day. The label on the solution reads hydrochlorothiazide 50 mg/5 milliliters. To administer the correct dose, how many milliliters should the nurse pour? ________ml

3.5

A client's arterial blood gas (ABG) analysis reveals: pH 7.18, PaCO2 of 73 mm Hg, PaO2 of 77 mm Hg, and HCO3 of 24 mEq/L. What do these values indicate? Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory acidosis

4

The dietary practice that will help a client reduce the dietary intake of sodium would be: Increasing the use of dairy products Using steak sauce for flavoring foods Restricting the use of artificial sweeteners Avoiding the use of carbonated beverages

4

Which finding suggests that fluid resuscitation has been effective for a 23-year-old client admitted in hypovolemic shock? Urine output of 15 ml/hour Urine output of 20 ml/hour Urine output of 25 ml/hour Urine output of 30 ml/hour

4

15. Which symptom is most commonly associated with left-sided heart failure? A. Crackles B. Arrhythmias C. Hepatic engorgement D. Hypotension

A

28. A client presents with a possible urinary tract infection. Which urine characteristic should the nurse assess first? A. Urine clarity B. Urine specific gravity C. Urine acetone D. Urine protein

a

20. Which recurring condition most commonly occurs in clients with cardiomyopathy? A. Heart failure B. Diabetes mellitus C. Myocardial infarction (MI) D. Pericardial effusion

a Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy

20. The nurse is assessing a client who reports painful urination during and after voiding. The nurse suspects the client may have a problem with which area ofthe client's urinary system? A. Bladder B. Kidneys C. Ureters D. Urethra

a bladder-pain after voiding ureter-from kidney to bladder urethra-from bladder to out- pain during voiding

9 What supplemental medication is most frequently ordered in conjunction with furosemide (Lasix)? A. Chloride B. Digoxin C. Potassium D. Sodium

C

7 When performing a physical assessment, the nurse discovers a client's urinary drainage bag lying next to him. Based on this finding, the nurse identifies which priority nursing diagnosis? A. Risk for infection B. Reflex urinary incontinence C. Impaired comfort D. Risk for compromised human dignity

A

The physician orders a client's IV fluids to be delivered at 80 mL /hour. To adjust the drip rate when administering the IV via gravity, the nurse must know the: Total volume of fluid in the IV bag Size of the needle or catheter in the vein Drops per milliliter delivered by the infusion set Diameter of the tubing being used to instill the fluid

C

53 A 23-year-old client develops cardiac tamponade when the car he was driving hits a telephone pole; he wasn't wearing a seat belt. The nurse helps the physician perform pericardiocentesis. Which outcome would indicate that pericardiocentesis has been effective? A. Neck vein distention B. Pulsus paradoxus C. Increased blood pressure D. Muffled heart sounds

C Beck's Triad; low arterial blood pressure, distended neck veins, and distant, muffled heart sounds.

21. A client is ordered diuretics. Which of the following would be the best time of day for the nurse to schedule this medication? A. Anytime B. Nighttime C. Morning D. Noon

c

22. A client is injected with radiographic contrast medium and immediately shows signs of dyspnea, flushing, and pruritis. Which intervention should take priority? A. Check vital signs. B. Make sure the airway is patent. C. Apply a cold pack to the I.V. site. D. Call the physician.

B

24. Which condition is associated with a predictable level of pain that occurs as a result of physical or emotional stress? A. Anxiety B. Stable angina C. Unstable angina D. Variant angina

B

29. A client with an acute episode of ulcerative colitis is admitted to the hospital. Blood studies reveal that the chloride level is low. This electrolyte deficiency can best be corrected by: A. A low-residue diet B. Intravenous therapy C. Total parenteral nutrition D. An oral electrolyte solution

B

3 Which landmark is the correct one for obtaining an apical pulse? A. Left fifth intercostal space, midaxillary line B. Left fifth intercostal space, midclavicular line C. Left second intercostal space, midclavicular line D. Left second intercostal space, midaxillary line

B

30. A nurse is preparing a client for cardiac catheterization. Which assessment is most important prior to the procedure? A. Weight and height B. Allergy to iodine or shellfish C. Apical heart rate D. Cardiac rhythm

B

31. A client with a history of cardiac dysrhythmias is admitted to the hospital with the diagnosis of dehydration. The nurse should anticipate that the physician will order: A. A glass of water every hour until hydrated B. Small, frequent intake of juices, broth, or milk C. Short-term NG replacement of fluids and nutrients D. A rapid IV infusion of an electrolyte and glucose solution

B

32. A client is diagnosed as having renal failure. During the oliguric phase the nurse should assess the client for: A. Alkalosis B. Hyperkalemia C. Hypocalcemia D. Hypernatremia

B

33. A 64-year-old client has been diagnosed as having cancer of the bladder and is scheduled for a total cystectomy and the formation of an ileal conduit. When assessing the client eight hours after surgery, the nurse notes all of the following findings. The finding that should be promptly reported to the physician would be: A. An edematous stoma B. A dusky-colored stoma C. Pink-tinged urinary drainage D. The absence of bowel sounds

B

35. The nurse is aware that the most serious complication for a client with acute renalfailure is: A. Anemia B. Infection C. Weight loss D. Platelet dysfunction

B

36. A nurse knows that kidneys play an important role in regulating blood pressure. When hypertension occurs, which responses by the kidneys help normalize blood pressure? A. The kidneys retain sodium and excrete water. B. The kidneys excrete sodium and excrete water. C. The kidneys retain sodium and retain water. D. The kidneys excrete sodium and retain water.

B

43 When teaching a client who has just started peritoneal dialysis about the procedure, the home health care nurse should inform the client that if drainage of dialysate from the peritoneal cavity ceases before the required amount has drained out, the client should: A. Drink 8 oz of water B. Turn from side to side C. Deep-breathe and cough D. Periodically rotate the catheter

B

45 A client is hospitalized with epigastric pain, nausea, and vomiting of four days' duration. The following laboratory values are noted: a plasma pH of 7.51; a PCO2 of 50 mm Hg; a bicarbonate of 58 mEq/L; a chloride of 55 mEq/L; a sodium of 132 mEq/L; and a potassium of 3.8 mEq/L. The nurse recognizes that the collected data indicate: A. Hyperkalemia B. Hypernatremia C. Hyperchloremia D. Metabolic alkalosis

D

45 Which precaution should a client be instructed to take after an episode of acute pulmonary edema? A. Limit caloric intake. B. Restrict carbohydrates. C. Measure weight twice per day. D. Call the physician if there is weight gain of more than 3 lb (1.5 kg) in 1 day.

D

40. A client with uremic syndrome has the potential to develop many complications. The com- plication that the nurse should anticipate in such a client is: A. Hypotension B. Hypokalemia C. Flapping hand tremors D. An elevated hematocrit value

C

5 While assessing a client's heart sounds, a murmur is heard at the second left intercostal space along the left sternal border. Which valve is most likely involved? A. Aortic B. Mitral C. Pulmonic D. Tricuspid

C

Which arterial blood gas (ABG) results should a nurse expect to see in a client with emphysema? pH, 7.52; PaCO2, 18 mm Hg; HC03-, 22 mEq/L pH, 7.50; PaCO2, 38 mm Hg; HC03-,38mEq/L pH, 7.30; PaCO2, 52 mm Hg; HC03-, 30mEq/L pH, 7.30; PaCO2, 40 mm Hg; HC03-, 18mEq/L

3 CO2 is trapped in alveoli.So want high Co2

19. The nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because: A. A person's body tends to retain fluid when a salt substitute is included in the diet B. Limiting salt substitutes in the diet prevents a buildup of waste products in the blood C. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats D. A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca

3 salt sub contains high K

When administering albumin intravenously, the nurse is aware that body water will shift from the: Interstitial compartment to the extracellular compartment Extracellular compartment to the intracellular compartment Intravascular compartment to the interstitial compartment Intracellular compartment to the intravascular compartment

4

14. A client with renal insufficiency is admitted with a diagnosis of pneumonia. He's being treated with I.V. antibiotics, which can be nephrotoxic. Which laboratory value(s) should be monitored closely? A. Blood urea nitrogen (BUN) and creatinine levels B. Arterial blood gas (ABG) levels C. Platelet count D. Potassium level

A

If the electrolyte, potassium, is not added to a basic total parenteral nutrition solution, hypokalemia results. The nurse knows that the signs of hypokalemia include: Hyperventilation Metabolic alkalosis Dysrhythmias such as heart block A decreased serum potassium of 5. mEq/L

C hypoventilation, irritability, shallow respirations, confusion, weakness, thready pulse, arrythmia,

37. The sign that would be an indication of adequate fluid replacement for a client with a 30% total body surface area burn is a: A. Urinary output of 15 to 20 mL /hr B. CVP falling from 5 to 1 mm water C. Slowing of a previously rapid pulse D. Hematocrit level rising from 50 to 55

C hypovolemic shock= tachycardia, hypotension

23. An 80-year-old man is admitted for a cystoscopy with biopsy of the bladder. After obtain- ing a history, surgery is postponed. Which reason would be cause to postpone this client's surgery? A. The client stopped taking his anticoagulant 3 days ago. B. The client has a urinary tract infection. C. The client has previously been treated for carcinoma of the bladder. D. The client took an antibiotic prior to the procedure.

b cystoscopy-bladder cameral thru urethra

27. When teaching a client about cystitis, a nurse explains that females are more prone to the disorder than males. Which factor explains a female's increased susceptibility? A. Higher estrogen levels B. Inadequate fluid intake C. Urethral proximity to the rectum D. Continuous nature of the mucosa

c

53 A client is receiving total parenteral nutrition. The adaptation that would indicate that the client was hyperglycemic would be: A. Polyuria B. Paralytic ileus C. Hypoventilation D. A serum glucose of 105 mg/100mL

1

A male client with a history of heart failure and atrial fibrillation comes to the clinic for his regular two-week visit. The client is nine pounds heavier than his usual weight. The nurse interprets that the most likely cause of this sudden weight gain would be: Fluid retention Urinary retention Renal insufficiency Abdominal distention

1

A young, male client with a history of ulcerative colitis had been admitted to the hospital with severe abdominal pain and loose, bloody stools. Two months after leaving the hospital against medical advice, the client is readmitted for an exacerbation of the illness. At this time he is weak, thin, and irritable and is now willing to consider surgery. To best assist the client at this time, the nurse should attempt to: Replace his lost fluids and electrolytes Help him regain his former body weight Teach him how to use an ileostomy appliance Encourage his interaction with other postileostomy clients

1

The nurse is aware that the shift of body fluids associated with the intravenous administration of albumin occurs by the process of: Osmosis Filtration Diffusion Active transport

1

When evaluating a client's response to fluid replacement therapy, the observation that indicates adequate tissue perfusion to vital organs would be: Urinary output of 30 mL per hour Central venous pressure reading of 2 cm H20 Pulse rates of 120 and 110 in a 15-minute period Blood pressure readings of 50/30 and 70/40 mm Hg within 30 minutes

1

The nurse knows that one of the complication of total parenteral nutrition would be: Infection Hepatitis Anorexia Dysrhythmias

1 TPN input glucose into blood, making it more prone for infection

A 79-year-old male resident of a nursing home has been refusing to eat or drink for the past few days, and his urinary output has dropped to less than 300 mL/day. He is confused and hypotensive. He is diagnosed as having renal failure secondary to dehydration. The physician orders 50% glucose and regular insulin. The nurse understands that this is ordered for a client in renal failure to: A. Prevent cardiac arrest B. Increase urinary output C. Prevent respiratory acidosis D. Decrease serum calcium levels

1 insulin pulls K into cell, causing a decrease in K

A 31-year-old client is admitted to the hospital with respiratory failure. He's intubated in the emergency department, placed on 100 FiO2 and is coughing up copious secretions. Which intervention should be done first? Get an X-ray. Suction the client. Restrain the client. Obtain an arterial blood gas (ABG) analysis.

2

A client has a decreased serum sodium level. The nurse should assess for signs of hyponatremia, which include: Dry skin Confusion Tachycardia Pale coloring

2

A client who had a thoracotomy is using oxygen and having an arterial blood gas (ABG) analysis. Which statement is correct to tell the client? ''The nurse will shave the puncture site before the test." "You need to keep the oxygen mask on for the entire test." "You'll be suctioned immediately before the blood is drawn." "You won't be allowed to drink anything for 2 hours before the blood is drawn."

2

A client with bulimia and a history of purging by vomiting is hospitalized for further observation because she's at risk for which of the following? Diabetes mellitus Electrolyte imbalance GI obstruction Septicemia

2

A client's clinical symptoms indicate a possible gastric ulcer. Considering the symptoms of epigastric pain, vomiting, dehydration, weakness, lethargy, and shallow respirations, and the laboratory results that demonstrate metabolic alkalosis, the primary nursing diagnosis for this client would be: Impaired gas exchange related to pain Deficient fluid volume related to vomiting Risk for injury related to increased weakness Chronic pain related to hypersecretion of gastric acids

2

20. The nurse is aware that total parenteral nutrition is a more desirable therapy than just intravenous fluids for clients with gastrointestinal problems. The nurse understands that clients receiving only IV fluids lose weight because of: A. Lack of bulk in the diet B. Deficient carbohydrate intake C. Insufficient intake of water-soluble vitamins D. Increased concentrations of electrolytes in cells

2 bulk=fiber

A client is to receive an intravenous solution containing potassium chloride. When starting this IV infusion the nurse should select: The antecubital space in the client's arm The largest possible vein in the client's arm A vein in the back of the client's dominant hand A vein in the back of the client's nondominant hand

2 injection of KCL will cause pain and phlebitis.

The physician orders total parenteral nutrition for a client with cancer of the pancreas. A right subclavian catheter is inserted by the physician. The nurse knows that the most important reason for using a central line is that: It prevents the development of phlebitis It is more convenient so clients can use their hands There is less chance of this infusion infiltrating The amount of blood in a major vein helps to dilute the solution

4

14. A client is ordered to start receiving digoxin 0.25 mg PO. Which parameter should be checked first before administering digoxin? A. Apical pulse B. Blood pressure C. Radial pulse D. Respiratory rate

A

18. While palpating a client's abdomen, the nurse notes a pulsating abdominal mass. This may indicate which condition? A. Abdominal aortic aneurysm B. Enlarged spleen C. Gastric distention D. Gastritis

A

31. Which intervention should be the first priority when treating a client experiencing chest pain while walking? A. Sit the client down. B. Get the client back to bed. C. Obtain an electrocardiogram (ECG). D. Administer sublingual nitroglycerin.

A

36. The most essential nursing care for a client with a nephrostomy tube would be to: A. Ensure free drainage of urine B. Milk the tube every two hours C. Keep an accurate record of intake and output D. Instill 2 mL of normal saline every eight hours

A

39. A client's extensive burns are being treated with silver nitrate 0.5 mg dressings. A week after treatment is begun, the nurse notes that the client's sodium level is 135 mEq/L and the potassium level is 3.0 mEq/L. The nurse should notify the physician and expect to: A. Add KCl to current IV of Ringer's lactate B. Add NaCl to current IV of Ringer's lactate C. Change the NaCl with 20 mEq KCl to 5% D5W D. Change the 5% D5 W with 40 mEq KCl to 5% D5W

A

42. While the nurse is at the bedside of a client in acute renal failure, the client states, "My doctor said that I will be getting some insulin. Do I also have diabetes?" The response that best demonstrates an understanding of the use of insulin in acute renal failure would be: A. "No, the insulin will help your body handle a chemical called potassium." B. "Why don't you ask that question when the doctor comes to see you today." C. "You probably had an elevated blood sugar level, so your doctor is being cautious." D. "No, insulin reduces the toxins in your blood by lowering your metabolic rate."

A

43 Which oral medication is administered to prevent further thrombus formation? A. Warfarin (Coumadin) B. Heparin C. Furosemide (Lasix) D. Metoprolol (Lopressor)

A

44 Which action is the appropriate initial response to a client coughing up pink, frothy sputum? A. Call for help. B. Call the physician. C. Start an I.V. line. D. Suction the client.

A

47 A client with chronic renal failure is accepted for a kidney transplant and attends a group educational program for potential transplant candidates. The client asks the nurse which kidney will be removed. The nurse's best response would be: A. "Neither of your kidneys will be removed unless they are infected." B. "It is up to the surgeon as to which kidney is replaced with the new one." C. "The kidney that is the most diseased is removed and replaced with the new one." D. "Your right kidney will be removed because it has a longer renal vein, making transplant easier."

A

47 Which statement by a nurse to the health care aide best explains the need to promptly report changes in respiratory rate for a client diagnosed with heart failure? A. "Pulmonary edema, a life-threatening condition, can develop in minutes." B. "Severe acute respiratory syndrome (SARS) is a complication of heart failure." C. "Pneumonia is a consequence of inadequate ventilation with heart failure." D. "Pneumothorax, a life-threatening condition, can develop in minutes."

A

49 After unsuccessful cardiopulmonary resuscitation efforts, the nurse must prepare an Islamic client for the morgue. Which nursing action should the nurse take? A. Allowing the client's family to perform the ritualistic washing B. Doing nothing; the Burial Society will perform a ritual cleansing C. Doing nothing; only the family and close friends may touch the body D. Providing routine postmortem care

A

51 A charge nurse is preparing client care assignments for the next shift. A client who underwent femoral-popliteal bypass surgery is scheduled to return from the postanesthesia care unit. Which staff member should receive this client? A. Registered nurse with 1 year of experience B. Licensed practical nurse (LPN) with 5 years of experience C. Nursing assistant with 15 years of experience

A

52 A client is receiving total parenteral nutrition through a subclavian vein. The nurse should: A. Place the client in the supine position before changing the tubing B. Monitor the blood pressure frequently to assess for hypovolemia C. Administer IV antibiotics through this central line to prevent infection D. Determine blood glucose levels routinely and decrease the infusion rate if they are elevated

A

3 A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which intervention is important? A. Strain all urine. B. Limit fluid intake. C. Enforce strict bed rest. D. Encourage a high-calcium diet.

A Flat plate= xray

When a client is receiving total parenteral nutrition, it is important for the nurse to assess the: Blood for glucose Stool for occult blood Urine for specific gravity Abdomen for bowel sounds

A TPN bypasses GI and go directly to blood.

34. Which drug is most commonly used to treat cardiogenic shock? A. Dopamine B. Enalapril (Vasotec) C. Furosemide (Lasix) D. Metoprolol (Lopressor)

A dopamine is inotropic and vasopressor. Improve BP, CO and renal perfusion when in shock so increase UO.

40. The laboratory findings of a 40-year-old man with burns are BUN, 30 mg/dL; serum potassium 6.3, mEq/L; pH, 7.1; POz, 90 mm Hg; and Hgb, 7.4 g/dL. The nurse is aware that these findings indicate: A. Azotemia B. Hypokalemia C. Metabolic alkalosis D. Respiratory alkalosis

A abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood.

1. A client with pneumonia is transferred to the intensive care unit for mechanical ventilation. His blood pressure is 70/40, his heart rate is 115 beats/minute, and his respiratory rate is 32 breaths/minute with accessory muscle use. I.V.s are infusing at 150 ml/hour. Urine output is 50 ml for the past 4 hours. This client is most at risk for which of the following? A. Postrenal failure B. Prerenal failure C. Intrarenal failure D. Chronic renal failure

B

1. A nurse on a telemetry unit teaches a student nurse how coronary arteries primarily receive blood flow. It would be most important for the nurse to emphasize that most of the blood flow to coronary arteries is supplied during which of the following? A. During inspiration B. During diastole C. During expiration D. During systole

B

11. What is the first intervention for a client experiencing myocardial infarction (MI)? A. Administer morphine. B. Administer oxygen. C. Administer sublingual nitroglycerin. D. Obtain an electrocardiogram (ECG).

B

12. With which disorder is jugular vein distention most prominent? A. Abdominal aortic aneurysm B. Heart failure C. Myocardial infarction (MI) D. Pneumothorax

B

2 Discharge instructions for a client treated for acute pyelonephritis should include which statement? A. Avoid taking any dairy products. B. Return for follow-up urine cultures. C. Stop taking the prescribed antibiotics when the symptoms subside. D. Recurrence is unlikely because you've been treated with antibiotics.

B

37. The nurse is teaching a client about blood pressure and hormones. Which of the following responses indicates the client understands which hormone raises arterial pressure and promotes venous return? A. Angiotensin I B. Angiotensin II C. Thyroid hormone D. Insulin

B

38. A client, who had a suprapubic prostatectomy for cancer of the prostate, returns to the post anesthesia care unit with a continuous bladder irrigation. The nurse realizes that the purpose of this irrigation is to: A. Promote continuous formation of urine B. Prevent the formation of clots in the bladder C. Facilitate the measurement of urinary output D. Provide continuous pressure on the prostatic fossa

B

38. During the first 48 hours following a thermal injury, the nurse should assess for: A. Hypokalemia and hyponatremia B. Hyperkalemia and hyponatremia C. Hypokalemia and hypernatremia D. Hyperkalemia and hypernatremia

B

40. Which term refers to the condition of blood coagulating faster than normal, causing thrombin and other clotting factors to multiply? A. Embolus B. Hypercoagulability C. Venous stasis D. Venous wall injury

B

42. A client with ascites has a paracentesis, and 1500 mL of fluid is removed. Immediately following the procedure it is most important for the nurse to observe for: A. Decreased peristalsis B. A rapid, thready pulse C. Respiratory congestion D. An increase in temperature

B

44 A client appears very anxious, with 40 shallow respirations per minute. The client complains of feeling dizzy and lightheaded and of having tingling sensations of the fingertips and around the lips. The nurse should recognize that the client's complaints are probably related to: A. Eupnea B. Hyperventilation C. Kussmaul's respirations D. Carbon dioxide intoxication

B

44 A client with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the client must be assessed for signs of developing: A. Renal failure B. Hypovolemia C. Hyperkalemia D. Metabolic acidosis

B

49 A 62-year-old woman, who has been on hemodialysis for one year, asks the nurse what substances are being removed by the dialysis. The nurse identifies that one of the substances passing through the membrane would be: A. RBCs B. Sodium C. Glucose D. Bacteria

B

50 Diet instruction for a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis should include the need for: A. Low-calorie foods B. High-quality protein C. Increased fluid intake D. Foods rich in potassium

B

50 The physician orders intravenous serum albumin for a client with advanced cirrhosis of the liver. The expected outcome from this treatment will be a decrease in: A. Urinary output B. The abdominal girth C. Hepatic encephalopathy D. The serum ammonia level

B

8. An older female adult who lives alone had not answered her phone for several days. She was found unconscious on the bathroom floor by her family and was admitted to the hospital the diagnoses of a fractured hip and renal failure due to dehydration. In the 24 hours since she has been hospitalized, she has received 1500 mL of intravenous fluid. Her next serum electrolyte series reflects hyponatremia. The nurse recognizes that this may result from an increase in: A. Salt intake B. Fluid intake C. Sodium absorption D. Glomerular filtration

B

9 A client with acute renal failure has a serum potassium level of7.0 mEq/L. The nurse's priority for this client is to assess which of the following? A. Urine specific gravity B. Electrocardiogram (ECG) results C. Mental status D. Blood pressure

B

The physician has ordered 1000 mL TPN in 12 hours to be infused via a subclavian catheter. When preparing the equipment it would be most important for the nurse to obtain: A. A steady IV pole B. An infusion pump C. An infusion set delivering 60 gtt/mL D. A set of clamps (hemostats) taped at the bedside

B

Thirty-six hours after a young male is admitted with severe burns he is placed on a fluid diet. Considering his potassium level is still 6.0 mEq/L, the nurse should recommend: Milk Jell-O Orange juice Tomato juice

B

30. When assessing a client with diabetes mellitus, the nurse expects that the primary fluid shift that occurs would be: A. Intravascular to interstitial because of glycosuria B. Intracellular to intravascular because of hyperosmolarity C. Extracellular to interstitial because of hypoproteinemia D. Intercellular to intravascular because of increased hydrostatic pressure

B SInce level of glucose increases in blood, fluid will move from cell to blood. (leading to polyuria)

32. The nurse is assessing a client with heart failure. The client is experiencing tachycardia, decreased blood pressure, and decreased peripheral pulses. The nurse interprets these symptoms as indicating which condition? A. Anaphylactic shock B. Cardiogenic shock C. Distributive shock D. Myocardial infarction (MI)

B cardiogenic shock-reduced Cardiac output, and ineffective pumping of heart distributive-changes in intravascular volume distribution and increased cardiac output

16. Proper maintenance of a continuous bladder irrigation system includes which intervention? A. Regulate irrigant flow to maintain red urine. B. Regulate irrigant flow to maintain pink urine. C. Maintain a slow flow rate of irrigant to prevent bladder distention. D. Stop the irrigation if there's leakage of large amounts of urine around the catheter.

B slow rate will cause clots.

When a client is in profound (late) hypovolemic shock, the nurse should assess the client's laboratory values, especially the arterial blood gases, because people in late shock will develop: Hypokalemia Metabolic acidosis Respiratory alkalosis A decreased PCO2 level

B- Decreased oxygen leads to lactic acid production (anaerobic).

13. In what position should the nurse place the head of the bed to obtain the most accurate reading of jugular vein distention? A. High Fowler's B. Raised 10 degrees C. Raised 30 degrees D. Supine

C

2 Medical treatment of coronary artery disease (CAD) includes which procedure? A. Cardiac catheterization B. Coronary artery bypass surgery C. Oral medication administration D. Percutaneous transluminal coronary angioplasty

C

23. If medical treatment for cardiomyopathy fails, the nurse should prepare the client for which of the following procedures? A. Cardiac catheterization B. Coronary artery bypass graft (CABG) C. Heart transplantation D. Intra-aortic balloon pump (IABP)

C

26. A nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis? A. High urine specific gravity B. High urine osmolarity C. Normal to low urine specific gravity D. Elevated urine pH

C

28. A client with angina pectoris comes to the emergency room. Which of the following drugs can the nurse expect to administer as the drug of choice? A. Aspirin B. Furosemide (Lasix) C. Nitroglycerin D. Nifedipine (Procardia)

C

34. Before administering a prescribed intravenous solution that contains potassium chloride, the assessment by the nurse that should be brought to the physician's attention would be: A. Poor skin turgor with "tenting" B. Behaviors indicating irritability and confusion C. A urinary output of 200 mL during the previous shift D. An oral intake of 300 mL of fluid during the previous shift

C

35. A client with hyperpyrexia who has just been started on IV antibiotics has a diminished urine output. The nurse should recognize that this is probably the result of: A. A declining blood pressure B. Bacterial invasion of the kidneys C. A compensatory response to fever D. Nephrotoxicity from antimicrobial agents

C

36. A client with partial- and full-thickness burns over 25% of the total body surface area (TBSA) is hospitalized in the burn unit. A large-bore central venous line is inserted to permit rapid administration of fluids and electrolytes. The large amounts of lactated Ringer's solution and 5 dextrose in saline are administered to: A. Prevent fluid shifts B. Expand the plasma C. Maintain blood volume D. Replace electrolytes lost

C

39. The nurse would be aware that a client with chronic renal failure recognizes an adequate source of high-biologic-value protein when the food the client selected from the menu was: A. Apple juice B. Raw carrots C. Cottage cheese D. Whole wheat bread

C

41. The nurse notes that the latest potassium level for a client in renal failure is 6.2 mEq. The first action by the nurse should be to: A. Alert the cardiac arrest team B. Call the laboratory and repeat the test C. Take the vital signs and notify the physician D. Obtain an ECG strip and have lidocaine available

C

43 After abdominal surgery a client should be encouraged to turn from side to side and to carry out deep breathing exercises. These activities are essential to prevent: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C

46 A client has end-stage renal disease and is on hemodialysis. During dialysis, the client complains of nausea and a headache and appears confused. Operating on standing protocols, the nurse should: A. Administer an antiemetic B. Attempt to reorient the client C. Decrease the rate of exchange D. Monitor for changes in vital signs

C

48 A client has an order for lactated Ringer's solution to run at 150 mL per hour with an administration set that delivers 15 gtt/mL. An IV pump is not available. The nurse should set the IV to run at: A. 26 drops per minute B. 34 drops per minute C. 38 drops per minute D. 42 drops per minute

C

48 If a client on peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution, the nurse should: A. Slow the rate of infusion B. Auscultate the lungs for breath sounds C. Drain the fluid from the peritoneal cavity D. Place the client in a low-Fowler's position

C

48 One hour after I.V. furosemide (Lasix) is administered to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which electrolyte imbalance should the nurse suspect? A. Hypocalcemia B. Hypermagnesemia C. Hypokalemia D. Hypernatremia

C

6 Which blood test is the best indicator for myocardial injury? A. Lactate dehydrogenase (LD) B. Complete blood count (CBC) C. Troponin I D. Creatine kinase (CK)

C

8 In caring for a client with cardiac problems, the nurse must know that the condition most likely responsible for myocardial infarction (MI) is which of the following? A. Aneurysm B. Heart failure C. Coronary artery thrombosis D. Renal failure

C

47 The physician determines that a client has metabolic acidosis from severe dehydration. The characteristic respiration that the nurse would expect with metabolic acidosis is: A. Dyspnea B. Hyperpnea C. Kussmaul's breathing D. Cheyne-Stokes breathing

C Cheyne-Stokes in HF, brain injury

52 A client with new onset of atrial fibrillation is receiving warfarin (Coumadin) to help prevent thromboemboli. The warfarin dosage will reach therapeutic levels when the International Normalized Ratio (INR) falls within which range? A. 1 to 2 B. 1.5 to 2.5 C. 2 to 3 D. 2.5 to 3.5

C INR-standarize measure of prothrombin time- time it takes to clot blood when taking Warfarin note: PT (10-13)is for warfarin; PTT (25-41) for heparin

6 Which instruction about skin care at the stoma site should be given to a client with an ileal conduit? A. Change the appliance at bedtime. B. Leave the stoma open to air while changing the appliance. C. Clean the skin around the stoma with mild soap and water, and dry it thoroughly. D. Cut the faceplate or wafer of the appliance no more than 4 mm larger than the stoma.

C Shouldn't be larger than 3 mm

10 A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which discharge instruction should be emphasized? A. Report any signs of depression or a decreased appetite. B. Report any dizziness and bleeding from the incision. C. Report any fever, a flushed feeling, or lethargy. D. Report any stomach discomfort or dyspepsia.

C Sign of rejection

34. To prevent future attacks of glomerulonephritis, the nurse planning discharge teaching should include instructions for the client to: A. Take showers instead of bubble baths B. Avoid situations that involve physical activity C. Seek early treatment for respiratory infections D. Continue the same restrictions on fluid intake

C Strep infection (respiratory) can lead to glomerulonephritis

13. A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the clamp is opened to allow the dialysate to drain. The nurse notes that drainage has stopped and that only 500 ml has drained; the amount of dialysate instilled was 1,500 ml. Which intervention should be done first? A. Change the client's position B. Call the physician. C. Check the catheter for kinks or obstruction. D. Clamp the catheter and instill more dialysate at the next exchange time

C.....then A

45 A client with end-stage renal disease is receiving continuous ambulatory peritoneal dialysis. The nurse is preparing to teach the client to monitor for signs of complications associated with peritoneal dialysis. Check all the complications to be included in this teaching plan. A. Pruritus B. Oliguria C. Tachycardia D. Cloudy outflow E. Abdominal pain

CDE

16. In which disorder would the nurse expect to assess sacral edema in a bedridden client? A. Diabetes mellitus B. Pulmonary emboli C. Chronic kidney disease D. Right-sided heart failure

D

18. A client is admitted with severe nausea, vomiting, and diarrhea. He is hypotensive and is noted to have severe oliguria with elevated blood urea nitrogen (BUN) & creatinine levels. The physician will most likely write an order for which treatment? A. Force oral fluids. B. Give furosemide 20 mg I.V. C. Start hemodialysis after a temporary access is obtained. D. Start LV. fluid of normal saline solution bolus followed by a maintenance dose.

D

19. What is the best treatment for a ruptured aneurysm? A. Antihypertensive medication administration B. Aortogram C. Beta-adrenergic blocker administration D. Surgical intervention

D

21. Dyspnea, cough, weight gain, weakness, and edema are classic signs and symptoms of which condition? A. Pericarditis B. Hypertension C. Myocardial infarction (MI) D. Heart failure

D

25. After undergoing a cardiac catheterization, a client has a large puddle of blood under his buttocks. Which step should the nurse take first? A. Call for help. B. Obtain vital signs. C. Ask the client to "lift up." D. Apply gloves and assess the groin site.

D

29. While assessing a client diagnosed with angina, the client asks what causes it. Which of the following responses by the nurse would be the most appropriate? A. Increased preload B. Decreased afterload C. Coronary artery spasm D. Inadequate oxygen supply to the myocardium

D

30. To facilitate micturition in a male client, the nurse should instruct him to: A. Use a urinal for voiding B. Drink cranberry juice daily C. Wash his hands after voiding D. Assume the normal position for voiding

D

32. A male client, age 56, is being worked up for possible cancer of the urinary bladder. Of the client's symptoms, the one that is most significant for cancer of the urinary tract is: A. Dysuria B. Retention C. Hesitancy D. Hematuria

D

33. What is the first treatment goal for cardiogenic shock? A. Correct hypoxia B. Prevent infarction C. Correct metabolic acidosis D. Increase myocardial oxygen supply

D

35. Which of the following is a key point to include when teaching the nursing assistant about the major determinant of diastolic blood pressure? A. Baroreceptors B. Cardiac output C. Renal function D. Vascular resistance

D

37. When planning care for a client with a continuous bladder irrigation after a transurethral vaporization of the prostate the nurse should: A. Measure the output hourly B. Monitor the specific gravity of the urine C. Irrigate the catheter with saline three times daily D. Exclude the amount of irrigant instilled from the output

D

38. Which of the following statements, if made by the client, indicates an understanding of why furosemide (Lasix) is administered to treat hypertension? A. It dilates peripheral blood vessels. B. It decreases sympathetic cardioacceleration. C. It inhibits the angiotensin-converting enzyme. D. It inhibits reabsorption of sodium and water in the loop of Henle.

D

4 Which system is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration? A. Cardiac B. Gastrointestinal C. Musculoskeletal D. Pulmonary

D

41. While assessing a client with deep vein thrombosis (DVT), which of the following terms indicates calf pain experienced by the client due to sharp dorsiflexion of the foot? A. Dyskinesia B. Eversion C. Positive Babinski's reflex D. Positive Homans' sign

D

42. A client is admitted to the unit with intermittent claudication (cramplike pain in the calves). Which of the following responses by the nurse would most accurately explain the cause of the condition to the client? A. Inadequate blood supply B. Elevated leg position C. Dependent leg position D. Inadequate muscle oxygenation

D

49 Because of delayed treatment, a client with hepatitis B (HBV) developed cirrhosis and is admitted to a medical unit. One potential sequela of chronic liver disease is fluid and electrolyte imbalance. The nurse recognizes this may be attributed to a decrease in serum albumin level, which leads to: A. Hemorrhage and subsequent anemia B. Diminished resistance to bacterial insult C. Malnutrition of cells, especially hepatic cells D. Reduction of colloidal osmotic pressure in the blood

D

7 What is the primary reason for administering morphine to a client with a myocardial infarction? A. To sedate the client B. To decrease the client's pain C. To decrease the client's anxiety D. To decrease oxygen demand on the client's heart

D

8 Which method should be used to collect a specimen for urine culture? A. Have the client void in a clean container. B. Clean the foreskin of the penis of uncircumcised men before specimen collection. C. Have the client void into a urinal, and then pour the urine into the specimen container. D. Have the client begin the stream of urine in the toilet and catch the urine in a sterile container midstream.

D

15. A client had transurethral prostatectomy for benign prostatic hypertrophy and is currently being treated with continuous bladder irrigation. He's complaining of an increase in severity of bladder spasms. Which intervention should be done first? A. Administer an oral analgesic. B. Stop the irrigation and call the physician. C. Administer a belladonna and opium suppository as ordered by the physician. D. Check for the presence of clots, and make sure the catheter is draining properly.

D Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn't be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only after assessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.

4 A client is receiving a radiation implant for the treatment of bladder cancer. Which inter- vention is appropriate? A. Flush all urine down the toilet. B. Restrict the client's fluid intake. C. Place the client in a semiprivate room. D. Monitor the client for signs and symptoms of cystitis.

D Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation implants require a private room. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. It is recommended that fluid intake be increased.

29. A client is scheduled for an intravenous pyelogram (IVP). The nurse explains that on the day before the IVP the client must: A. Eat a fat-free dinner B. Drink a large amount of fluids C. Omit dinner and limit beverages D. Take a laxative before going to bed

D IVP-kidney xray with dye want to take laxatives to get rid of stools that may block the view

17. Which of the following drug classes should be administered to a client with heart failure to maximize cardiac performance by increasing ventricular contractility? A. Beta-adrenergic blockers B. Calcium channel blockers C. Diuretics D. Inotropic agents

D Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output Ca channel blocer- for HPN, angina-block Ca entry into myocardium. Beta-adrenergic-HPN, angian, HF; cause bradycardia

25. Adverse reactions of prednisone therapy include which conditions? A. Acne and bleeding gums B. Sodium retention and constipation C. Mood swings and increased temperature D. Increased blood glucose levels and decreased wound healing

D Na retention, mood swing, increased gluc, decreased wound healing

11. A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which assessment finding should be expected? A. Hypotension B. Normal body temperature C. Decreased white blood cell (WBC) counts D. Elevated blood urea nitrogen (BUN) and creatinine levels

D Other signs- hypertension, high T, high WBC, elevated BUN, creatine

46 A client with acute pulmonary edema has been taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse teaches him that this medication has been ordered for which reason? A. To promote diuresis B. To increase contractility C. To decrease contractility D. To reduce blood pressure

D blocks conversion of angiotension I to angiotensin II (vasoconstrictor). Lowers BP

17. A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed, and postobstructive diuresis is occurring. Which intervention should be performed? A. Take vital signs every 8 hours. B. Weigh the client every other day. C. Assess the urine output every shift. D. Monitor the client's electrolyte levels.

D diuresis- need to watch K should take VS more often than 8 hr need to weigh every day

27. Which type of angina is most closely associated with an impending myocardial infarction (MI)? A. Variant angina B. Chronic stable angina C. Microvascular angina D. Unstable angina

D stable-relieved by rest and nitroglycerin unstable-progressively increasing frequency, duration-related to MI variant angina- coronary artery spasm

26. A client with angina pectoris has an electrocardiogram (ECG) performed during an episode of chest pain. Which change on the ECG indicates myocardial ischemia? A. Increased QRS duration B. Shortened PR interval C. Pathological Q-wave formation D. T-wave inversion

D increased QRS- bundle block shortened PR-junctional rhythm patho Q-wave- myocardial infarction

33. The physician prescribes a protein-, sodium-, and potassium-restricted diet for a client with end stage renal disease who is receiving dialysis. The nurse would know that the dietary teaching was effective when the client says, "I: A. Must exclude meat from my diet." B. Cannot add seasoning to my food." C. Can eat canned, no-salt vegetables." D. Should avoid using salt substitutes."

D. Salt substitute is high in k

12. A client is diagnosed with chronic renal failure and is told he must start hemodialysis. Client teaching should include which instruction? A. Follow a high-potassium diet. B. Strictly follow the hemodialysis schedule. C. There will be few changes in your lifestyle. D. Use alcohol on the skin to clean it because of integumentary changes

b

5 A client has undergone a radical cystectomy and has an ileal conduit for the treatment of bladder cancer. Which postoperative assessment finding must be reported to the physician immediately? A. A red, moist stoma B. A dusky colored stoma C. Urine output more than 30 ml/hour D. Slight bleeding from the stoma when changing the appliance

b

22. Which class of drugs is most widely used in the treatment of cardiomyopathy? A. Anticoagulants B. Beta-adrenergic blockers C. Calcium channel blockers D. Nitrates

b By decreasing the heart rate and contractility, beta-blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in clients who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as effective as beta-blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.

31. To help prevent a cycle of recurring urinary tract infections, the nurse should plan to instruct a female client to: A. Increase the daily intake of citrus juice B. Douche frequently with alkaline agents C. Urinate as soon as possible after intercourse D. Cleanse from the vaginal orifice to the urethra

c

10. A client weighed 210 pounds on admission to the hospital. After two days of diuretic therapy the client weighs 205.5 pounds. The nurse could estimate that the amount of fluid the client has lost is: A. 0.5 L B. 1.0 L C. 2.0 L D. 3.5 L

c 1L= 2 lbs 4.5/2~ 2

19. A client has a history of chronic renal failure and receives hemodialysis treatments three times a week through an arteriovenous (AV) fistula in the left arm. Which intervention is included in this client's care? A. Keep the AV fistula site dry. B. Keep the AV fistula wrapped in gauze. C. Take the blood pressure in the left arm. D. Assess the AV fistula for a bruit and thrill.

d

24. Which client is at greatest risk for developing acute renal failure? A. A dialysis client who gets influenza B. A teenager who has an appendectomy C. A pregnant woman who has a fractured femur D. A client with diabetes who has a heart catheterization

d using contrast for catherization causes kidney to work hard. diabetes already had damaged kidney