cm3 final exam practice questions

✗The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? ✗A. Increased triglyceride levels ✗B. Increased high-density lipoproteins (HDL) ✗C. Decreased low-density lipoproteins (LDL) ✗D. Decreased very-low-density lipoproteins (VLDL)

A: Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The health care provider ordered arterial blood gases (ABGs) for a patient. Which rationale given by the nurse indicates an understanding of the order?

ABGs evaluate gas exchange and acid-base balance."

The nurse is assessing for signs of hypoxia, which sign or symptom would be a priority cause for concern?

Early signs of hypoxia are anxiety, confusion, and restlessness; if hypoxia is not corrected, hypotension will develop.

A patient is questioning the nurse about circulation and perfusion. What is the nurse's best response? A. Perfusion assists the body by preventing clots and increasing stamina.B. Perfusion assists the cell by delivering oxygen and removing waste products.C. Perfusion assists the heart by increasing the cardiac output.D. Perfusion assists the brain by increasing mental alertness.

B. Perfusion assists the cell by delivering oxygen and removing waste products.Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.

A patient with suspected heart failure is being assessed by the nurse. Which set of clinical manifestations indicate that the patient is presenting with left-sided failure? Distended veins of the neck and edema of lower limbs Right upper quadrant pain, weakness, nausea, and vomiting Edema of the feet and legs, anorexia, and nausea Fatigue, dizziness, shortness of breath, and cough

Fatigue, dizziness, shortness of breath, and cough

✗You are caring for an older patient who is receiving IV fluids postoperatively. During the 8:00 AM assessment of this patient, you note that the IV solution, which was ordered to infuse at 125 mL/hr, has infused 950 mL since it was hung at 4:00 AM. What is the priority nursing intervention? ✗A. Slow the rate to keep vein open until next bag is due at noon. ✗B. Notify the health care provider and complete an incident report. ✗C. Listen to the patient's lung sounds and assess respiratory status ✗D. Assess the patient's cardiovascular status by checking pulse and blood pressure

C: After 4 hours of infusion time, 500 mL of IV solution should have infused, not 950 mL. This patient is at risk for fluid volume excess, and you should assess the patient's respiratory status and lung sounds as the priority action and then notify the health care provider for further orders.

✗After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? ✗A. Chronic HF ✗B. Left-sided HF ✗C. Right-sided HF ✗D. Acute decompensated HF

C: An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

✗Assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? ✗A. Acute respiratory failure ✗B. Secondary respiratory infection ✗ ✗C. Fluid volume excess from cor pulmonale ✗ ✗D. Pulmonary edema caused by left-sided heart failure

C: Fluid volume excess from cor pulmonale Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

✗You receive a provider's prescription to change a patient's IV from 5% dextrose in 0.45% saline with 40 mEq KCl/L to 5% dextrose in 0.9% saline with 20 mEq KCl/L. Which serum laboratory values best support the rationale for this IV order change? ✗A. Sodium, 136 mEq/L; potassium, 3.6 mEq/L ✗B. Sodium, 145 mEq/L; potassium, 4.8 mEq/L ✗C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L ✗D. Sodium, 144 mEq/L; potassium, 3.7 mEq/L

C: The normal range for serum sodium is 136 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV order decreases the amount of potassium and increases the amount of sodium. Therefore, for this order to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.

✗A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? ✗A. Review urinary output for the previous 24 hours ✗B. Restrict the patient's oral fluid intake to 500 mL/day. ✗C. Assist the patient to a sitting position with arms on the overbed table ✗D. Teach the patient to use pursed-lip breathing until the dyspnea subsides

C: The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.

When assessing a client with heart failure, the nurse asks what aggravates the problem. Which activity should the nurse expect will cause the client the greatest distress?

Climbing a flight of stairs to the bedroom

The nurse is teaching a patient with COPD (chronic obstructive pulmonary disease) how to keep mucous thin. What instruction should the nurse include, if not contraindicated?

Follow a prescribed exercise program.Receive a pneumococcal vaccine and annual influenza immunization.Avoid respiratory irritants.Maintain adequate fluid intake.

The nurse is preparing to perform a thorough assessment of Mrs. Basile's leg circulation. What assessments should the nurse perform? Select all that apply.

-Skin color -Skin temperature -Peripheral pulses -Capillary refill -Sensation -Hair growth

While auscultating the heart, a healthcare provider notices S3 heart sounds in four clients. Which client is at more risk for heart failure?

Older adult client The S3 is the third heart sound heard after the normal "lub-dub." It is indicative of congestive heart failure in adults over 30 years old. In young, pregnant, and under 30 year old clients, the third heart sound is often considered to be a normal parameter.

The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. Which is the priority nursing intervention?

Place client in a high-Fowler position Placing the client in a high-Fowler position promotes lung expansion and gas exchange; it also decreases venous return and cardiac workload. Initiating oxygen therapy may be done, but positioning should be done first because it will have an immediate effect. Time is needed to set up the system for the delivery of oxygen. Maintaining adequate oxygen exchange is the priority; an x-ray film can be obtained, but after breathing is supported. A friction rub is related to inflammation of the pleura, not to heart failure.

Over time, persons with chronic obstructive pulmonary disease (COPD) may develop cardiac complications. Which of the following may occur as a complication of COPD?

Right ventricular heart failure

Which of the following factors, identified as part of health history, may predispose a patient to developing COPD (chronic obstructive pulmonary disease). Select all that apply.

Smoking, environmental and seasonal allergies, intubation, state of immunosuppression, and personal history of chronic obstructive pulmonary disease, asthma, pneumonia, cystic fibrosis

•The nurse is reviewing the erythrocyte sedimentation rate (ESR) of a patient to determine which significant finding? •a. Determines specific causes of inflammation •b. Identifies the location of inflammation within the body •c. Confirms the nonspecific presence of inflammation •d. Indicates a diagnosis of systemic lupus

•c. Confirms the nonspecific presence of inflammation

`•In planning care for a client with Chron's disease, the nurse recognizes that a major difference between ulcerative colitis and Chron's disease is that Chron's disease: •a. frequently results in toxic megacolon •b. causes fewer nutritional deficiencies •c. often reoccurs after surgery •d. is manifested by rectal bleeding and anemia more often

•c. often reoccurs after surgery

✗The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? ✗A. "I will go running when my blood sugar is too high to lower it." ✗B. "I will go fishing frequently and pack a healthy lunch with plenty of water." ✗C. "I do not need to increase my exercise routine since I am on my feet all day at work." ✗D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

●D: The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and walking at work are light activity, and running is considered vigorous activity.

✗A patient with chronic obstructive pulmonary disease becomes dyspneic at rest. The baseline ABG results are PaO2 70mm Hg, PaCO2 52mm Hg and pH 7.34. What updated patient assessment requires the nurse's priority intervention? ✗A. Arterial pH 7.26 ✗B. PaCO2 50mm Hg ✗ ✗C. Patient in tripod position ✗ ✗D. Increased sputum expectoration

✗A. Arterial pH 7.26 (A: The patient's pH shows acidosis that supports an exacerbation of COPD along with the worsening dyspnea. The PaCO2 has improved from baseline, the tripod position helps the patient's breathing, and the increase in sputum expectoration will improve the patient's ventilation.)

✗When caring for a patient with COPD, the nurse determines that the patient's nutritional status is impaired after noting a weight loss of 30lbs. What intervention should the nurse add to the plan of care for this patient? ✗A. Order fruits and fruit juices to be offered between meals. ✗B. Order a high-calorie, high-protein diet with six small meals a day ✗C. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet ✗D. Encourage the patient to double carbohydrate consumption and decrease fat intake

✗B. Order a high-calorie, high-protein diet with six small meals a day B: Because the patient with COPD needs to use greater energy to breathe, there is often decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat 6 small meals per day taking in a high-calorie, high-protein diet, with nonprotein calories divided evenly between fat and carbohydrate. The other interventions will not increase the patient's caloric intake.

✗The home health care nurse visits a patient with chronic heart failure. Which assessment findings would indicate pulmonary edema? ✗A. Fatigue, orthopnea, and dependent edema ✗B. Severe dyspnea and blood streaked, frothy sputum ✗ ✗C. Temperature of 100.4 and pulse of 102 beats/min ✗ ✗D. Respirations 24 breaths/min with oxygen by nasal cannula

✗B. Severe dyspnea and blood streaked, frothy sputum B: Manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.

✗The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with chronic obstructive pulmonary disease (COPD) are successful based on which finding? ✗A. Absence of dyspnea ✗B. Improved mental status ✗ ✗C. Effective and productive coughing ✗D. PaO2 within normal range for the patient

✗C. Effective and productive coughing C: Airway clearance is most directly evaluated as successful if the patient can engage in effective and productive coughing. Absence of dyspnea, improved mental status, and PaO2 within normal range for the patient show improved respiratory status but do not evaluate airway clearance

✗The nurse is assigned to care for a patient who has anxiety and an exacerbation of COPD. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? ✗A. Giving care will calm the patient ✗B. Observing for signs of diaphoresis ✗C. Evaluating the use of intercostal muscles ✗D. Monitoring the patient for bilateral chest expansion

✗C. Evaluating the use of intercostal muscles C: The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress. The other options may also occur, but they are not the primary reason for inspecting the chest wall of this patient.

✗A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? ✗A. "Long-term home oxygen therapy should be used to prevent respiratory failure." ✗B. "Oxygen will not be needed unless you are in the terminal stages of this disease." ✗C. "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." ✗D. "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

✗D. "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia." D: Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered