EAQ Exam 3 questions
Which treatment may increase restlessness and insomnia in a patient with chronic obstructive pulmonary disease (COPD)? β 2 agonists Anticholinergics Massage and postural drainage techniques Oxygen supplementation through a nasal mask
β 2 agonists β 2 agonists may cause restlessness and insomnia in patients with COPD. Anticholinergics are not associated with insomnia. Massage and postural drainage techniques will not lead to insomnia and restlessness. Oxygen supplementation through a nasal mask will not cause restlessness and insomnia.
The patient has a prescription for albuterol 3 mg by nebulizer. Available is a solution containing 24 mg/mL. How many mL should the nurse administer? 0.125 mL 0.15 mL 0.6 mL 0.75 mL
0.125 mL 1 mL x 3 mg / 24 mg = 0.125 mL
Which ankle-brachial index (ABI) value indicates noncompressible arteries? 0.92 0.96 1.2 1.5
1.5 The ABI is a screening tool for peripheral artery disease. It is performed by using a hand-held Doppler. The ABI is calculated by dividing the ankle systolic BP by the higher of the left and right brachial systolic BP. An ABI of more than 1.3 indicates noncompressible arteries. An ABI between 0.91 and 0.99 indicates borderline ABI. An ABI between 1 and 1.3 is a normal ABI.
The patient has a prescription to receive 600 mg of guaifenesin every four hours PRN. Available are 400-mg tablets. How many tablets should the nurse prepare to give? 1 tablet 1.5 tablets 2 tablets 2.5 tablets
1.5 tablets Using ratio and proportion, multiply 400 by x and multiply 600 × 1 to yield 400x = 600. Divide 600 by 400 to yield 1.5 tablets.
Which systolic BP (SBP) measurement correlates with stage 1 hypertension? 118 mm Hg 129 mm Hg 132 mm Hg 142 mm Hg
132 mm Hg Stage 1 hypertension is defined as an SBP of 130 to 139 or a diastolic BP (DBP) of 80 to 89 mm Hg. Normal BP is defined as an SBP of less than 120 mm Hg and a DBP of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
How many minutes is the appropriate recovery period after activity for the patient with chronic obstructive pulmonary disease (COPD)? 5 10 15 20
5 Developing exercise endurance is very important. If it takes longer than 5 minutes to return to baseline, the patient has most likely "overdone it" and should proceed at a slower pace during the next exercise period.
A patient's BP reading is 142/91 mm Hg. How should the nurse classify the BP? Normal Prehypertension Hypertension, stage 1 Hypertension, stage 2
Hypertension, stage 2 Normal BP is defined as a systolic BP (SBP) of less than 120 mm Hg and a diastolic BP (DBP) of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
A patient has not reached goal BP despite taking full doses of an appropriate three-drug therapy regimen, including a diuretic. Which finding in the patient history is the likely cause of resistant hypertension? Increasing obesity Excess pepper intake Consumes peppermints Erectile dysfunction (ED) medication
Increasing obesity An increase in obesity is one of the causes of resistant hypertension. Licorice (rather than peppermint), excess salt (rather than pepper) intake, and oral contraceptives (rather than ED medications) are also possible causes of resistant hypertension.
A patient is diagnosed with primary hypertension and asks the nurse what caused the condition. Which response would the nurse give? "There is no identified cause." "A decrease in plasma renin levels." "Too much plaque in the blood vessels." "Kidney disease is the most common cause."
"There is no identified cause." There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels.
Which instruction will the nurse include when teaching a patient to use a dry powder inhaler (DPI)? "Shake the canister vigorously before each use." "Inhale slowly and deeply after activating the device." "Keep your mouth open slightly while inhaling the medication" "Try to hold your breath for at least 10 seconds after inhaling the medication."
"Try to hold your breath for at least 10 seconds after inhaling the medication." The patient should hold the breath for as long as possible to increase the amount of medication absorbed by the lungs. DPIs are not shaken prior to use. Since delivery of medication to the airways depends on the patient's inspiratory effort when using a DPI, a rapid and deep respiration is needed. The patient's mouth should be sealed around the DPI mouthpiece to maximize delivery of the medication to the airways.
Which response by the nurse is best when a patient with asthma asks "How will I know when my metered-dose inhaler (MDI) is empty?" "The canister will float in water." "There will be no sound when shaking the canister." "Your wheezing will not improve despite inhaler use." "You need to keep track of how many puffs you have used."
"You need to keep track of how many puffs you have used." The MDI canister will state how many total doses are available, and the patient will need to track how many doses are used to avoid running out of medication. Floating the canister in water was recommended in the past, but is no longer recommended because water can enter the chamber. The canister may or may not produce a sound when shaking. It is not safe for the patient to wait for wheezing to worsen before getting a new inhaler.
Which information will the nurse include when educating a patient with asthma about use of a peak flow meter? "The peak flow meter should be used weekly." "The peak flow meter reduces asthma attacks." "You will need to measure peak flows soon after arising in the morning" "You should find your personal best peak flow reading for comparison."
"You should find your personal best peak flow reading for comparison." It is important that the patient initially determine the personal best readings when first using a peak flow meter to evaluate for decreasing airway function. It should be used at least twice a day for the first two weeks to determine the patient's personal best, which will be used to monitor airway constriction. After the personal best peak flow is determined, daily peak flow readings are recommended. The peak flow meter does not reduce asthma attacks; it helps monitor symptoms of asthma. Peak flows are ideally measured between 12 noon and 2:00 p.m. because peak flows are highest in the early afternoon.
When an asthmatic patient has been prescribed 4 puffs of salmeterol daily and the metered-dose inhaler (MDI) canister has 200 total puffs available, the MDI will need to be replaced in how many days?
50 To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day. Since the canister has a capacity of 200 puffs and the patient needs 4 puffs daily, the number of days for which the canister may be used is 200/4 = 50.
When a patient has a prescription for albuterol 5 mg via nebulizer and the albuterol is available as a solution containing 2.5 mg/3 mL, how many mL will the nurse use for the correct dose?
6 2.5 mg/3 mL = 5 mg/6 mL. Therefore the nurse will use 6 mL.
Which factors are possible triggers for asthma exacerbations? Select all that apply. Select all that apply Aspirin Perfumes Animal dander Humid weather Gastroesophageal reflux disease (GERD)
Aspirin Perfumes Animal dander Gastroesophageal reflux disease (GERD) Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDS), perfumes, animal dander, and GERD are all possible triggers for acute asthma exacerbations. Humidity is not an asthma trigger.
Which time is best to obtain peak flow readings? Five minutes after meals Between noon and 2:00 p.m. Early in the morning on an empty stomach Two hours after inhaling a short-acting β 2 agonist
Between noon and 2:00 p.m. The peak flow readings should be taken between noon and 2:00 p.m. because the peak flow is highest during this period. The patient may feel nauseous if the peak flow readings are taken five minutes after meals. The peak flow readings are not at a high level early in the morning. Since the peak effect of the short-acting β 2agonists occurs in about 20 minutes, peak flows would be measured about 20 minutes after administration of the medication.
Which time is best to obtain peak flow readings? Five minutes after meals Between noon and 2:00 p.m. Early in the morning on an empty stomach Two hours after inhaling a short-acting β 2 agonist
Between noon and 2:00 p.m. The peak flow readings should be taken between noon and 2:00 p.m. because the peak flow is highest during this period. The patient may feel nauseous if the peak flow readings are taken five minutes after meals. The peak flow readings are not at a high level early in the morning. Since the peak effect of the short-acting β 2agonists occurs in about 20 minutes, peak flows would be measured about 20 minutes after administration of the medication.
Which nursing actions will be included for a patient with chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy through a mask? Select all that apply. Take a chest radiograph. Choose the optimal oxygen device. Assess the need to change IV fluids. Assess the need to adjust the oxygen flow rate. Monitor for signs of adverse effects of oxygen therapy.
Choose the optimal oxygen device. Assess the need to adjust the oxygen flow rate. Monitor for signs of adverse effects of oxygen therapy. Choosing the optimal oxygen device, assessing the need for adjustment in oxygen flow rate, and monitoring signs of adverse effects of oxygen therapy are all duties that the nurse should perform when evaluating the response of the patient to oxygen therapy. Taking a chest radiograph and assessing the need to change IV fluids are not relevant to this situation.
The nurse reviews the assessment findings of a patient with atherosclerosis and notes an ankle-brachial index (ABI) of 0.8, decreased Doppler pressures, aspirin intolerance, and arterial stenosis. Which treatment would likely be prescribed for this patient? Nifedipine Clopidogrel Furosemide Doxycycline
Clopidogrel The patient's symptoms suggest peripheral artery disease (PAD), which is treated with antiplatelet drugs. Because the patient has aspirin intolerance, clopidogrel would be beneficial. Nifedipine is a calcium channel blocker used to reduce the severity of a vasospastic attack. Furosemide is a diuretic and used to treat hypertension. Doxycycline is used to treat aortic aneurysms.
The nurse identifies that a patient is in the initial stage of Raynaud's disorder. Which assessment finding is consistent with the early stage of this condition? Throbbing, tingling, and swelling of the limbs Chronic ischemic pain and ulcers on both feet Color changes of fingers from white to blue to red Hypertension, hyperglycemia, and inflamed arteries
Color changes of fingers from white to blue to red The vasospasm-induced color changes (from white to blue to red) of fingers, toes, ears, and nose are the usual characteristics of Raynaud's disorder. Decreased perfusion leads to pallor (white), followed by cyanotic (bluish purple) digits that further turn red when blood flow is restored. In the later phases of the disease, the patient may complain about numbness and coldness along with throbbing, tingling, and swelling. Chronic ischemic pain and ulceration may indicate peripheral arterial disease, whereas hypertension, hyperglycemia, and inflamed arteries may indicate one or more cardiovascular disorders.
When a patient is experiencing an acute asthma attack, how will the nurse position the patient? Supine Lithotomy High-Fowler's Reverse Trendelenburg
High-Fowler's The goal for positioning during an asthma attack is to maximize the patient's ability to inhale and exhale deep breaths, and the semi-to-high-Fowler's position will allow optimal chest expansion. When the patient is supine, the abdomen can push up against the chest and it is more difficult to fully expand the chest. The abdomen will place pressure against the chest in the lithotomy position, making it more difficult to fully expand the lungs. While a reverse Trendelenburg position will decrease abdominal pressure on the chest, a more upright position is better for chest expansion.
Which position will the nurse use when caring for a patient who is experiencing an asthma exacerbation? Prone Supine High-Fowler's Trendelenburg
High-Fowler's The patient experiencing an asthma attack should be placed in high-Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The prone position will place pressure on the chest and decrease chest expansion. In the supine position, the abdomen pushes up on the chest and decreases chest expansion. In the Trendelenburg position, the abdomen pushes up against the chest and decreases the ability of the chest to expand.
To prevent respiratory complications of chronic obstructive pulmonary disease, which vaccines will the nurse plan to administer? Select all that apply. Tetanus Influenza Herpes zoster Pneumococcal Bacille Calmette-Guérin (BCG)
Influenza Pneumococcal The pneumococcal and influenza vaccines are important for patients with a history of heart or lung disease to prevent viral and bacterial pneumonia. Tetanus vaccine may be needed if there is possible exposure to Clostridium tetani but will not protect against respiratory infection. Herpes zoster immunization will protect from shingles but will not prevent respiratory infections. BCG is used to protect against tuberculosis in some countries but not in the United States.
Which medication would likely be prescribed to a patient who has intermittent claudication? Ramipril Warfarin Simvastatin Pentoxifylline
Pentoxifylline Pentoxifylline is used to treat intermittent claudication. Ramipril is an angiotensin-converting enzyme (ACE) inhibitor and is used to treat hypertension. Warfarin is an anticoagulant drug and is used to prevent strokes and heart attack. Simvastatin is used to lower low-density lipoprotein and triglyceride levels.
A patient reports a recent onset of pain in the calf when climbing stairs. The pain is relieved when the patient sits and rests for about two minutes. Which condition would the nurse suspect? Muscle cramping Venous insufficiency Intermittent claudication Sore muscles from overexertion
Intermittent claudication Intermittent claudication feels like a cramp and is caused by decreased arterial blood flow to an extremity during activity. It may be caused by arterial spasm, atherosclerosis, or occlusion of an artery to the limb. Symptoms are usually relieved by a few minutes of rest, and definitive treatment depends on the cause. Muscle cramping, venous insufficiency, and sore muscles from overexertion are all incorrect in light of the patient's presenting complaints.
The nurse is teaching an older patient with hypertension about developing an exercise program. Which instructions would the nurse include? Perform weightlifting on a daily basis. Perform flexibility and balance exercises daily. Perform muscle-strengthening activities twice a week. Perform high-intensity activity for 30 minutes on most days.
Perform muscle-strengthening activities twice a week. All adults should perform muscle-strengthening activities using the major muscles of the body at least twice a week. Weightlifting is not recommended for a patient with hypertension because it may increase BP. Flexibility and balance exercises are recommended at least twice a week for older adults, especially those at risk for falls. It is recommended to perform moderate-intensity aerobic physical activity for at least 30 minutes on most days (i.e., more than five days a week).
Which measure should a patient with chronic obstructive pulmonary disorder (COPD) take when performing physical activity? Walk briskly or bicycle with pursed lips. Exhale while at rest and inhale while pushing. Administer β-agonists immediately after exercise. Remember to think about steps and breathing while walking.
Remember to think about steps and breathing while walking. It is essential to involve the patient with COPD in physical activity for 20 minutes three times a week. The patient should remember to think about steps and breathing, which will help decrease anxiety and also slow the pace. The patient must walk slowly with pursed lips to breathe. The patient should exhale while pushing and inhale while at rest. The patient should wait for five minutes to relax and regain a normal breathing rate before administration of a β-agonist after exercise.
Which laboratory test result indicates the presence of target organ damage in a patient with hypertension? Serum uric acid of 3.8 mg/dL Serum creatinine of 2.6 mg/dL Serum potassium of 3.5 mEq/L Blood urea nitrogen (BUN) of 15 mg/d
Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level of 2.6 mg/dL indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.
Which laboratory test result indicates the presence of target organ damage in a patient with hypertension? Serum uric acid of 3.8 mg/dL Serum creatinine of 2.6 mg/dL Serum potassium of 3.5 mEq/L Blood urea nitrogen (BUN) of 15 mg/dL
Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level of 2.6 mg/dL indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.
A patient is diagnosed with peripheral artery disease (PAD). The nurse anticipates that which medication will be prescribed? Sildenafil Bosentan Cilostazol Simvastatin
Simvastatin Lipid management is essential in the patient with PAD. Statins such as simvastatin lower the low-density lipoprotein (LDL) and triglyceride levels and are used to treat peripheral arterial disease. Sildenafil is used to treat Buerger's disease. Bosentan is used as an endothelin receptor antagonist in patients with Raynaud's phenomenon. Cilostazol is also used to treat Buerger's disease.
Which treatment may help prevent amputation in patients with critical limb ischemia? Nifedipine Pseudoephedrine Spinal cord stimulation Oxygen via nasal cannula
Spinal cord stimulation Spinal cord stimulation helps to manage pain and prevents the need for amputation in patients with critical limb ischemia. Nifedipine is used to reduce severity of vasospastic attacks. Pseudoephedrine should not be given to patients with critical limb ischemia because it may produce vasoconstrictive effect. Oxygen supplementation is recommended to treat myocardial ischemia.
The nurse reviews the care options for patients with lower extremity peripheral artery disease (PAD). Which treatment is used to stimulate blood vessel growth? Urokinase Stem cell therapy Plasminogen activator Spinal cord stimulation
Stem cell therapy Stem cell therapy is used to stimulate blood vessel growth, or angiogenesis. Urokinase is recommended to reduce complications associated with a thrombectomy. Plasminogen activator is used if surgical thrombectomy is not recommended. Spinal cord stimulation is helpful to control pain and prevent amputation.
A patient develops leg edema following peripheral artery bypass surgery. In which position will the nurse place the patient? Sitting Supine Side-lying Knee-flexed
Supine Edema of the lower extremity may occur after peripheral artery bypass surgery due to an excessive volume of fluid accumulation in the tissues. The supine position with elevating the leg above heart level helps reduce edema. The sitting position will increase edema. The side-lying position will not help in venous return. The knee-flexed position may increase edema.
As treatment for hypertensive crisis, a patient has received sodium nitroprusside for three days. For which reason would the nurse plan to monitor the patient's thiocyanate levels? The medication has a long half-life. The medication is metabolized to cyanide, then thiocyanate. An increased level indicates interactions with other drugs the patient is taking. An increased level indicates adverse effects on target organs caused by the medication.
The medication is metabolized to cyanide, then thiocyanate. Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the BP. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than or equal to 4 mcg/kg/min. An increased level does not indicate adverse effects on target organs. It does not indicate interactions with other medications. The cause of concern and the need to assess the thiocyanate level do not relate to the medication's half-life.
Which type of equipment will the nurse use to deliver a precise amount of oxygen to a patient experiencing an exacerbation of chronic obstructive pulmonary disease (COPD)? Venturi mask Simple face mask Non-rebreather mask Laryngeal mask airway
Venturi mask The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. A non-rebreather and simple face mask are less precise in terms of the amount of oxygen delivered. The laryngeal mask airway is an invasive airway used for surgical procedures or emergency situations.
Which patient action indicates good understanding of the nurse's instructions about the use of a metered-dose inhaler (MDI)? Inhales rapidly when activating the inhaler Holds the MDI sideways to increase ease of use Waits one minute between each puff from the MDI Breathes through the nose with activation of the MDI
Waits one minute between each puff from the MDI The patient should wait at least one minute in between puffs to increase medication dispersion throughout the lungs. The patient is taught to inhale slowly and deeply when using an MDI. The MDI is held in the upright position. The patient should breathe through the mouth after activating the MDI.
A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the BP is now within the normal range. Which response would the nurse provide? "You may stop the medication now because your BP is normal." "Begin taking half-doses of the medication because the BP has decreased." "You may stop taking the medication only if you maintain a healthy lifestyle." "Continue the medication unless your health care provider advises discontinuing it."
"Continue the medication unless your health care provider advises discontinuing it." Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.
Which systolic BP (SBP) measurement correlates with stage 1 hypertension? 118 mm Hg 129 mm Hg 132 mm Hg 142 mm Hg
132 mm Hg Stage 1 hypertension is defined as an SBP of 130 to 139 or a diastolic BP (DBP) of 80 to 89 mm Hg. Normal BP is defined as an SBP of less than 120 mm Hg and a DBP of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
Which action would the nurse take when caring for a patient who has a history of asthma and experiences wheezing after vigorous exercise? Advise the patient to avoid breathing dry air. Teach that breathing cold air will decrease wheezing. Recommend continuing vigorous exercise despite dyspnea. Instruct the patient to avoid swimming in indoor, heated pools.
Advise the patient to avoid breathing dry air. The patient data indicate exercise-induced asthma (EIA). Cold and dry air can precipitate bronchospasm and should be avoided in patients with EIA. Since cold air is likely to cause bronchospasm, the patient should avoid breathing cold air. The patient should stop exercising if dyspnea develops until consulting with a health care provider about possible treatments to prevent EIA. Swimming in indoor, heated pools is encouraged, since warm and moist air is less likely to trigger an asthma attack.
Which inhaler would the nurse be prepared to administer to the patient at the onset of an asthma attack? Albuterol Fluticasone Salmeterol Tiotropium
Albuterol Albuterol is a short-acting bronchodilator that should be given first when the patient experiences an asthma attack. Fluticasone is an inhaled corticosteroid (ICS) used to prevent asthma attacks and does not result in rapid bronchodilation. Salmeterol is a long-acting bronchodilator and will not work rapidly to relieve bronchospasm in an acute attack. Tiotropium is a long-acting anticholinergic bronchodilator that is recommended only for use in chronic obstructive pulmonary disease and would not work to rapidly improve breathing in an asthma attack.
The nurse reviews the treatments for lower extremity peripheral artery disease (PAD). Which therapy involves percutaneous transluminal angioplasty (PTA) and cold therapy? Stent Cryoplasty Atherectomy Endothelial progenitor cell therapy
Cryoplasty Cryoplasty involves percutaneous transluminal angioplasty and cold therapy that use a specialized balloon filled with liquid nitrous oxide. Expansion of gas causes cooling that prevents restenosis. A stent is an expandable metallic device that helps keep an artery open. Atherectomy is the process of removing obstructing plaque. Endothelial progenitor cell therapy is used to stimulate blood vessel growth.
Which changes in vital signs indicate that a patient who has just stood up is experiencing postural hypotension? Increased systolic BP and/or decreased heart rate (HR) Increased diastolic BP and/or decreased HR Decreased systolic BP, decreased diastolic BP, and/or increased HR Decreased systolic BP, increased diastolic BP, and no change in HR
Decreased systolic BP, decreased diastolic BP, and/or increased HR A decrease in both systolic and diastolic BP and an increase in HR would be seen in a patient with postural hypotension. BP drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The HR increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic BP and decreased HR; increased diastolic BP and increased HR; and decreased systolic BP, increased diastolic BP, and no change in HR are all incorrect.
Before administering ipratropium bromide, the nurse must confirm that the patient does not have which comorbidity? Glaucoma Depression Hypertension Chronic obstructive pulmonary disease (COPD)
Glaucoma Ipratropium bromide is an anticholinergic, which can increase intraocular pressure and should be avoided in a patient with glaucoma. COPD is an indication for the use of this medication. Hypertension and depression are not contraindications to the use of ipratropium bromide.
Which condition would the nurse check for in the patient's history before administering cilostazol? Heart failure Diabetes mellitus Buerger's disease Intermittent claudication
Heart failure Cilostazol inhibits phosphodiesterase III and worsens the symptoms of heart failure. Cilostazol use is safe in diabetic patients. Cilostazol is used to treat Buerger's disease. Intermittent claudication in a patient is not a contraindication to cilostazol use.
A patient with hypertension receives a prescription for lisinopril. Which mechanism of action would the nurse expect from this medication? Blocks α-adrenergic effects Relaxes arterial and venous smooth muscle Inhibits conversion of angiotensin I to angiotensin II Reduces sympathetic outflow from the central nervous system (CNS)
Inhibits conversion of angiotensin I to angiotensin II Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-adrenergic receptor blockers (β-blockers) result in vasodilation and a decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and BP.
Which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia? Diltiazem Metoprolol Prednisone Hydromorphone
Metoprolol Metoprolol, a β-adrenergic receptor blocker (β-blocker), slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of the failure of the heart rate to respond to decreasing glucose levels and should be instructed to look for other signs of hypoglycemia. Diltiazem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels.
Which assessment finding is considered the classic manifestation in lower extremity peripheral artery disease (PAD)? Rest pain Skin ulcerations Intermittent claudication Paresthesia in the feet and toes
Intermittent claudication The "gold standard" in terms of identifying lower extremity PAD is intermittent claudication, which is ischemic muscle pain that is caused by exercise, resolves within 10 minutes or less with rest, and is reproducible. The ischemic pain is a result of the buildup of lactic acid from anaerobic metabolism. Once the patient stops exercising, the lactic acid is cleared, and the pain subsides. Rest pain, skin ulcerations, and paresthesia in the feet and toes may develop with lower extremity PAD but are not considered the classic symptoms.
Which action by a patient indicates a good understanding of the best way to determine if the prescribed metered-dose inhaler (MDI) canister is empty? Placing it in water to see if it floats Keeping track of the number of inhalations used Shaking the canister while holding it next to the ear Checking the indicator line on the side of the canister
Keeping track of the number of inhalations used The best method to determine when to replace an MDI for a regularly scheduled medication is by knowing the maximum puffs available per MDI and then replacing it when those inhalations have been used (100 puffs/2 puffs each day = 50 days). For rescue MDI inhalers which are used only PRN, the patient will need to keep track of the doses used. Although floating the canister in water was previously recommended, this method may lead to water leaking into the MDI and is not recommended now. Shaking the canister is inaccurate, as the patient may not hear anything even if the MDI is not empty. MDIs do not have an indicator line on the canister and most do not have a counter.
Which findings are associated with peripheral artery disease? Select all that apply. Lack of hair on lower legs History of hypertension for last 20 years History of diabetes mellitus for last 10 years Report of numbness and tingling of legs and feet Report of leg pain when climbing 2 flights of stairs that is relieved by rest Pedal erythema when sitting in a chair with feet on floor
Lack of hair on lower legs History of hypertension for last 20 years History of diabetes mellitus for last 10 years Report of numbness and tingling of legs and feet Report of leg pain when climbing 2 flights of stairs that is relieved by rest Pedal erythema when sitting in a chair with feet on floor Lack of hair on lower legs along with a history of hypertension and diabetes mellitus are often seen in patients with peripheral artery disease. Other signs and symptoms include numbness and tingling of legs and feet, pain with exercise that is relieved by rest (called intermittent claudication), and pedal erythema when in a dependent position.
A patient with intermittent claudication experiences pain in the leg muscles while exercising that resolves within 10 minutes after stopping. Which substance building up in the leg is causing the ischemic pain? Lactic acid Triglycerides Homocysteine Blood viscosity
Lactic acid Intermittent claudication is a symptom of lower extremity peripheral artery disease. Exercise increases lactic acid levels in the body from anaerobic metabolism, which results in intermittent claudication. Increased triglyceride levels increase the risk of peripheral artery disease. Tobacco smoke increases the risk of peripheral artery disease by increasing homocysteine levels in the body. Nicotine consumption increases blood viscosity and causes peripheral artery disease.
The nurse provides discharge teaching to a female patient who was newly diagnosed with primary hypertension. Which instruction would be included? Decrease the intake of omega-3 fatty acids. Restrict sodium to less than or equal to 2300 mg/day. Limit the intake of alcohol to no more than one drink per day. Begin taking a calcium supplement to help lower BP.
Limit the intake of alcohol to no more than one drink per day. Excessive alcohol intake is strongly associated with hypertension. Women and lighter-weight men should limit their intake to no more than one drink per day. Calcium supplements are not recommended to lower BP. Increased levels of dietary omega-3 fatty acids are associated with lower BP. People with hypertension should restrict sodium to less than or equal to 1500 mg/day.
Which action may be beneficial to a patient with chronic obstructive pulmonary disease (COPD) to maximize food intake? Avoiding cold foods Limiting fluids during mealtimes Avoiding frequent meals and snacks Performing physical activity before meals
Limiting fluids during mealtimes Patients with COPD should limit fluid intake during mealtimes because too much liquid might make the patient feel too full to eat. COPD patients should eat cold foods rather than hot foods to feel less full. COPD patients should eat frequent meals and snacks because it helps the diaphragm move freely and makes gas exchange in the lungs easier. Performing physical activity before meals may increase breathlessness and may affect food intake.
The nurse is assessing a patient for orthostatic hypotension. First, the nurse measured the BP and heart rate (HR) with the patient in the supine position. Which action would the nurse take next? Repeat BP and HR every 15 minutes in the supine position. Ask the patient to stand, and then measure the BP and HR within 15 minutes. Move the patient to a standing position and immediately measure the BP and HR. Move the patient to a sitting position and measure the BP and HR within two minutes.
Move the patient to a sitting position and measure the BP and HR within two minutes. When assessing for orthostatic changes, after measuring the BP and HR in the supine position, the patient then is placed in a sitting position, and the BP and HR are measured within one to two minutes. The patient is then repositioned to the standing position, and BP and HR are measured again within one to two minutes. The results then are recorded, with a decrease of 20 mm Hg or more in systolic BP (SBP), a decrease of 10 mm Hg or more in diastolic BP (DBP), or an increase in the pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.
Which oxygen delivery device may be used for a patient who requires oxygen administration in low concentrations of 24% at 1 L/min for a long duration? Face mask Nasal cannula Tracheostomy collar Partial and non-rebreather masks
Nasal cannula A nasal cannula is the most commonly used device for a patient requiring low concentrations of oxygen of 24% at 1 L/min. It is safe and simple and allows freedom of movement. It can be used for a long time. Simple face masks can be used only for a short duration, especially during transportation. Partial and non-rebreather masks are useful for short-term therapy with high concentrations of oxygen. A tracheostomy collar is used to deliver high humidity and oxygen.
The nurse would monitor which comorbidity in the patient who requires high doses of inhaled corticosteroids (ICSs) for asthma management? Hyperlipidemia Hypothyroidism Cholecystitis Osteoporosis
Osteoporosis Although ICS use is generally not associated with systemic complications, patients who use high doses of ICSs will need monitoring for corticosteroid-induced osteoporosis. Hyperlipidemia is not a complication of ICS use. Thyroid function is not impaired by ICS use. Cholecystitis is not caused by ICS use.
Which delivery device is used for long-term oxygen therapy? Nasal cannula Simple face mask Oxygen-conserving cannula Partial and non-rebreather masks
Oxygen-conserving cannula An oxygen-conserving cannula is generally indicated for long-term therapy at home or during hospitalization. A nasal cannula is used for patients requiring low oxygen concentrations. A simple face mask is used only for short periods because longer use is typically not tolerated. Partial and non-rebreather masks are useful for short-term therapy in patients needing higher oxygen
Which delivery device is used for long-term oxygen therapy? Nasal cannula Simple face mask Oxygen-conserving cannula Partial and non-rebreather masksr
Oxygen-conserving cannula An oxygen-conserving cannula is generally indicated for long-term therapy at home or during hospitalization. A nasal cannula is used for patients requiring low oxygen concentrations. A simple face mask is used only for short periods because longer use is typically not tolerated. Partial and non-rebreather masks are useful for short-term therapy in patients needing higher oxygen
A patient with lower extremity peripheral artery disease (PAD) undergoes a balloon angioplasty with stent placement. Which medication coating on the stent would reduce restenosis? Bosentan Paclitaxel Doxycycline Amphetamine
Paclitaxel A stent is an expandable metallic device that helps in keeping the artery open. The stent should be covered with paclitaxel. Paclitaxel limits the amount of new tissue growth in the stent and reduces the risk of restenosis. Bosentan is used to treat critical ischemia. Doxycycline is used to treat infection. Amphetamines should not be administered because they may cause a vasoconstrictive effect.
Which intervention would the nurse include in the plan of care for a patient diagnosed with peripheral arterial disease? Soak patient's feet daily. Place pillow under calves. Apply compression stockings. Apply wet-to-dry dressings on any foot ulcer.
Place pillow under calves. Placing pillows under the patient's calves will keep the heels off the bed and will reduce pressure that may cause ulceration. Other interventions include keeping the patient's feet clean and dry; do not soak feet to prevent maceration. Footwear should be lightweight and roomy; do not use compression stockings. Cover ulcers with a dry, sterile dressing.
Which complications in a patient with chronic obstructive pulmonary disorder (COPD) require acute intervention? Select all that apply. Atelectasis Pneumonia Cor pulmonale Mucoid impact Exacerbations
Pneumonia Cor pulmonale Exacerbations The patient with COPD may develop complications such as pneumonia, cor pulmonale, and exacerbations of COPD, which require acute interventions. After the crisis is resolved, the patient has to undergo assessment for the degree and severity of the underlying respiratory problem. This information helps the nurse plan a better care plan. Atelectasis and mucoid impact are complications of asthma.
Which rationale supports gene and stem cell therapy for a patient who has critical limb ischemia? Reduces pain Increases perfusion Prevents maceration Promotes angiogenesis
Promotes angiogenesis Gene therapy stimulates blood vessel growth and causes angiogenesis and helps improve critical limb ischemia. Opioid analgesics are administered to reduce ischemic pain. Placing the patient's bed in the reverse Trendelenburg position will increase perfusion. Refraining from soaking the patient's feet prevents skin maceration.
Which mechanism of hypertension causes target organ damage? Promotion of atherosclerosis and damage to the walls of the arteries Thickening of the capillary membranes, leading to hypoxia of organs Direct pressure on organs that results in necrosis and replacement of cells with scar tissue Increased blood viscosity that contributes to intravascular coagulation and tissue necrosis
Promotion of atherosclerosis and damage to the walls of the arteries Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues. Hypertension does not thicken capillary membranes, cause direct pressure on organs, or increase blood viscosity.
Which rationale explains the use of ramipril in a patient with symptomatic peripheral artery disease (PAD)? Reduces hypertension Reduces vasospastic attack Slows growth rate of aneurysm Lowers low-density lipoproteins
Reduces hypertension Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It reduces hypertension by inhibiting the production of angiotensin II. Nifedipine is used to reduce vasospastic attack. Doxycycline is used to slow the growth rate of aneurysms. Simvastatin is used to lower low-density lipoproteins.
Which patient care goals are appropriate for a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. Relief of symptoms Improved quality of life Healing of damaged lung tissue Prevention of disease progression Ability to perform activities of daily living (ADLs)
Relief of symptoms Improved quality of life Prevention of disease progression Ability to perform activities of daily living (ADLs) The overall goals are that the patient with COPD will have (1) prevention of disease progression, (2) ability to perform ADLs and improved exercise tolerance, (3) relief from symptoms, (4) no complications related to COPD, (5) knowledge and ability to implement a long-term treatment regimen, and (6) overall improved quality of life. Lung tissue does not regenerate, so "healing" is not a realistic goal. Patients need to know that symptoms can be managed, but COPD cannot be cured.
Which discharge teaching about nutrition will the nurse include for a patient with chronic obstructive pulmonary disease (COPD) and pneumonia? Increase intake of hot foods. Eat three large meals per day. Rest for 30 minutes before eating. Exercise before meals to increase appetite.
Rest for 30 minutes before eating. The patient with COPD should conserve energy to eat and should rest for at least 30 minutes before eating to increase energy needed to eat. The patient should consume five to six small meals per day, avoid hot foods, and exercise after eating to conserve energy.
The nurse is preparing to measure the BP of a patient who is lying down on a bed. Which technique should the nurse use? Place the BP cuff on the forearm when measuring the BP. Measure the BP in both arms and record the lowest reading. Rest the patient's arm on a pillow during the BP measurement. Measure the BP twice in quick succession and average the readings.
Rest the patient's arm on a pillow during the BP measurement. For measurements taken in a supine position, raise and support (e.g., with a small pillow) the arm at the heart level. If the arm is resting on the bed, it will be below the heart level. This allows the blood to drain from the arm and prevents inaccurate readings. If the patient is in a lying-down position, the arm should be placed on a pillow so that it is at the heart level. The upper arm, not the forearm, is the preferred site of BP cuff placement because of its accuracy of recordings. Atherosclerosis in the subclavian artery may result in a falsely low BP in the affected side; therefore the arm that has the highest recording of the BP should be used for further measurements. BP measurements should be taken at least one minute apart.
Which instruction is important for the nurse to provide to a patient about the management of stage 1 hypertension? Restrict all caffeine. Restrict sodium intake. Increase protein intake. Use calcium supplements.
Restrict sodium intake. The patient should decrease the intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.
Which method of oral care helps to prevent oral infection for the patient who is taking fluticasone? Rinse the mouth daily with an oral antibiotic solution. Rinse the mouth with water before each puff of medication. Brush the teeth before and after medication administration. Rinse the mouth with water after the second puff of medication.
Rinse the mouth with water after the second puff of medication. The patient should rinse the mouth with water after the second puff of medication to reduce the risk of fungal overgrowth and oral infection. An oral antibiotic solution is not indicated and would not treat a fungal infection. Brushing the teeth is not necessary before medication administration and the mouth should be rinsed after, not before, medication administration.
Which instruction will the nurse include when teaching a patient to use a hand-held nebulizer? Sit in an upright position during the treatment. Take short, shallow breaths while inhaling the medication. Rinse the nebulizer equipment under running water once a week. During the treatment, breathe in and hold the breath for 10 seconds.
Sit in an upright position during the treatment. The patient is placed in an upright position that allows for most efficient breathing to ensure adequate penetration and deposition of the aerosolized medication. Deep and slow breaths help ensure deposition of the medication throughout the lung. To reduce bacterial growth, the patient is asked to wash the nebulizer equipment daily in soap and water, rinse it with water, and soak it for 20 to 30 minutes in a 1:1 white vinegar-water solution, followed by a water rinse and air drying. The patient is taught to hold the breath for two to three seconds during nebulizer treatments.
A patient receives instructions about monitoring BP levels at home. Which information would the nurse teach the patient about measuring the BP in a supine position? Take the reading immediately after lying down. Support the arm with a pillow during measurement. Take at least two consecutive readings one after another. Use the arm with the lower BP for all future measurements.
Support the arm with a pillow during measurement. When measuring BP in a supine position, the patient should support the arm with a small pillow to raise the position of the hand to the level of the heart. Record the average pressure by taking two consecutive readings at least one minute apart; this allows the blood to drain from the arm and prevents inaccurate readings. The first reading should be taken after two to three minutes of rest in a supine position. If bilateral BP measurements are not equal, the patient should use the arm with the highest BP for all future measurements.
Which assessment finding by the nurse indicates a common adverse effect of a patient's prescribed albuterol inhaler? Diarrhea Headache Tachycardia Oral candidiasis
Tachycardia Tachycardia is a common adverse effect of the use of inhaled β 2-adrenergic agonists because of its stimulant effect. Headache is not a common adverse effect of albuterol. Diarrhea is not commonly seen with albuterol use. Oral candidiasis may be seen with inhaled corticosteroid use, but it is not an adverse effect with albuterol.
A patient who underwent percutaneous transluminal angioplasty (PTA) to treat lower leg peripheral artery disease is prescribed 75 mg of aspirin daily. Which action is the desired effect of this medication? To prevent platelet agglutination To stimulate collateral circulation To decrease liver production of vitamin K To control pain resulting from the procedure
To prevent platelet agglutination Aspirin is prescribed for its antiplatelet effect. It interferes with platelet agglutination (sticking together to form a blood clot). Exercise is a means to improve collateral circulation. Warfarin (Coumadin) is an anticoagulant that blocks vitamin K production by the liver. A single daily dose of 75 mg of aspirin is insufficient for pain relief.
A patient who has been taking clonidine for 10 years tells the nurse, "I decided to quit taking the medication a few days ago." For which manifestation would the nurse monitor this patient? Tremors Lethargy Dysphasia Bradycardia
Tremors Sudden discontinuation may cause withdrawal syndrome, including rebound hypertension, tachycardia, headache, tremors, apprehension, and sweating, Bradycardia, lethargy, and dysphasia are not indicators of withdrawal syndrome.
The nurse will suggest which intervention for the patient experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD)? Walk for 30 minutes. Drink more fluids at mealtime. Use typed messages to communicate. Speak continuously in sentences by taking deep breaths.
Use typed messages to communicate. Sometimes patients with COPD or those who use oxygen (O 2) therapy have difficulty speaking because of shortness of breath. These patients should be encouraged to use typed messages as an alternative to phone conversations to communicate to avoid increased dyspnea. The patient should avoid exercise or walking during the attack because severe dyspnea may lead to respiratory failure. The patient should have an adequate diet to prevent weight loss. Hence the patient should avoid consuming more fluids at mealtime. Patients with dyspnea often cannot speak in continuous sentences because of difficulty in breathing.
Which interventions does the nurse anticipate will be included in pulmonary rehabilitation (PR)? Select all that apply. Using the Internet to deliver daily motivational messages Planning the rehabilitation program for three consecutive weeks Providing pulmonary care if the patient is unable to quit smoking Considering pulmonary care as the last possible attempt to help the patient Teaching exercises that focus on the muscles used for ambulation along with upper limb exercises
Using the Internet to deliver daily motivational messages Teaching exercises that focus on the muscles used for ambulation along with upper limb exercises PR is an evidence-based intervention that helps individualize treatment for each patient. It helps improve the quality of life of patients with severe chronic obstructive pulmonary disease (COPD) by intervening to improve exercise capacity and decrease hospitalization. PR uses an Internet program to deliver daily motivational messages that are linked with individualized walking goals. It also helps the patient provide feedback related to pedometer use. PR provides exercise training to improve the patient's physical fitness. Exercise is also helpful in assessing unexpected changes in arterial blood gases. The PR plan lasts for six weeks, and many insurance plans pay for it; the longer the program, the more effective the results. Some rehabilitation programs refuse to take patients who are not committed to quitting smoking. PR should not be considered the last possible attempt to help a patient with a severe pulmonary disorder.
