Exam 4 Practice Exam

The patient is prescribed warfarin. His INR is 5.2 at what level is this dose? A) Sub therapeutic B) Therapeutic C) Elevated D) Within prescribed limits

C) Elevated

Heparin

A pharmaceutical preparation of the natural coagulant t produced primarily by mast cells in peri-capillary connective tissue

Which client is most as risk for developing DVT? A) A 62 year old female recovering from a total hip replacement B) A 35 year old female, two days postpartum C) A 33 year old male runner with Achilles tendonitis D) An ambulatory 70 year old male who is recovering from pneumonia

A) A 62 year old female recovering from a total hip replacement

While palpating a client's abdomen, the nurse notes a pulsating abdominal mass. How should the nurse interpret this assessment? A) Abdominal aortic aneurysm B) Enlarged spleen C) Gastric distension D) Gastritis

A) Abdominal aortic aneurysm

A nurse is completing the admission assessment of a client with peripheral arterial disease. What assessments are consistent with this diagnosis? Select all that apply A) Absence of hair on the toes B) Superficial ulcer with irregular edges C) Pitting edema of the lower extremities D) Reports of pain associated with exercising E) Increased pigmentation of the medial malleolus area

A) Absence of hair on the toes D) Reports of pain associated with exercising

The nurse is planning care for a client who has returned to the medical-surgical unit following repair of an aortic aneurysm. The nurse first should assess the client for A) Alteration in renal perfusion B) Electrolyte imbalance C) Ineffective coping D) Wound infection

A) Alteration in renal perfusion

An overweight client taking warfarin has a nursing diagnosis of ineffective tissue perfusion related to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply A) Apply lanolin or petroleum jelly on intact skin B) Encourage a reduced-calorie, reduced-fat diet C) Inspect the involved areas daily for new ulcerations D) Instruct the client to limit activities of daily living E) Use an electric razor to shave

A) Apply lanolin or petroleum jelly on intact skin B) Encourage a reduced-calorie, reduced-fat diet C) Inspect the involved areas daily for new ulcerations E) Use an electric razor to shave

Metoprolol is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with furosemide. An expected therapeutic effect is A) Decrease in heart rate B) Lessening of fatigue C) Improvement in blood sugar levels D) Increase in urine output

A) Decrease in heart rate

A nurse is reviewing the laboratory results of a client with anemia. Which laboratory values are abnormal? A) Erythrocyte count of 3.1 B) Neutrophil count of 2100 C) Leukocyte count of 2300 D) Platelets count of 115,000

A) Erythrocyte count of 3.1

A client is receiving warfarin. Which test result should the nurse use to determine if the daily dose of this anticoagulant is therapeutic? A) INR B) APTT C) Bleeding time D) Sedimentation rate

A) INR

A nurse is counseling a client about risk factors for hypertension. While receiving the client's history, which information is consistent with the diagnosis of primary hypertension? Select all that apply A) Obesity B) Glomerulonephritis C) Head injury D) Stress E) Hormonal contraceptive use F) High intake of sodium or saturated fat

A) Obesity D) Stress F) High intake of sodium or saturated fat

When convalescing from abdominal surgery a client develops thrombophlebitis. Which clinical indicators of this complication should the nurse expect to identify when assessing the client? Select all that apply A) Pain in the calf B) Intermittent claudication C) Redness in the affected area D) Pitting edema of the lower leg E) Ecchymotic areas around the ankle F) Localized warmth in the lower extremity

A) Pain in the calf C) Redness in the affected area F) Localized warmth in the lower extremity

A nurse is assessing a client, with a history of varicose veins, for possible superficial thrombophlebitis. What would the nurse document? Select all that apply A) Redness B) Induration C) Warmth D) Tenderness E) Twisted appearance F) Blue-color

A) Redness B) Induration C) Warmth D) Tenderness

A nurse is assessing the legs of a client with a history of chronic venous insufficiency. What physiologic changes should the nurse conclude are the result of this disease process? Select all that apply A) Stasis ulcer B) Necrotic tissue C) Ecchymotic areas D) Diminished pulses E) Brown discoloration

A) Stasis ulcer E) Brown discoloration

Which oral medication would the nurse anticipate being prescribed to prevent further thrombus formation? A) Warfarin B) Heparin C) Furosemide D) Metoprolol

A) Warfarin

Captopril

ACE inhibitor; inhibit the activity of the angiotensin converting enzyme and decreases production of angiotensin II, thus decreasing sodium and water retention and thereby lowering blood pressure

Spironolactone

Antagonist of aldosterone, stimulates removal of excess fluid from the body

ACE inhibitors

Antihypertensive, ends in "pril", vasodilator and decreases aldosterone. monitor BP and pulse, monitor I & O and daily weights, monitor for orthostasis

A nurse is teaching a group of clients with peripheral vascular disease about a smoking cessation program. Which physiologic effect of nicotine should the nurse explain to the group? A) Constriction of the superficial vessels dilates the deep vessels B) Constriction of the peripheral vessels increases the force of flow C) Dilation of the superficial vessels causes reflex constriction of visceral vessels D) Dilation of the peripheral vessels causes reflex constriction of visceral vessels

B) Constriction of the peripheral vessels increases the force of flow

The client is admitted with left lower leg pain, a positive Homan's sign, and a temperature of 100.4 F. The nurse should assess the client further for signs of A) Aortic aneurysm B) DVT in the left leg C) IV drug abuse D) Intermittent claudication

B) DVT in the left leg

A client is prescribed Lisinopril for the treatment of hypertension. The client asks a nurse about possible adverse effects. Which common adverse effects of ACE inhibitors would the nurse include in the teaching? Select all that apply A) Constipation B) Dry cough C) Headache D) Hyperglycemia E) Hypotension F) Impotence

B) Dry cough C) Headache E) Hypotension

A common abnormal laboratory result associated with the development of peripheral vascular disease is A) High serum calcium levels B) High serum lipid levels C) Low serum, potassium level D) Low serum lipid levels

B) High serum lipid levels

A nurse is teaching a client about the effects of angiotensin II on blood pressure. The nurse knows that teaching has been effective when the client states A) It is a powerful vasodilator B) It increases aldosterone secretion C) It brings about a diuretic effect D) It stimulates the parasympathetic nervous system

B) It increases aldosterone secretion

A client is discharged after being hospitalized for thrombophlebitis. She will be driving home with her daughter, who lives 2 hours away. During the 2 hour ride, the nurse should advise the client to A) Perform arm circles while riding in the car B) Perform ankle pumps and foot range-of-motion exercises C) Elevate her legs while riding in the care D) Take an ambulance home

B) Perform ankle pumps and foot range-of-motion exercises

During a blood transfusion a client develops chills and a headache. What is the priority nursing action? A) Cover the client B) Stop the transfusion at once C) Decrease the rate of the blood infusion D) Notify the health care provider immediately

B) Stop the transfusion at once

In what ways do the kidneys attempt to normalize blood pressure when hypertension occurs? 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) The kidneys excrete sodium and excrete water

Essential hypertension would be diagnosed in a 40-year old male whose blood pressure readings were consistently at or above which of the following? A) 120/90 mmHg B) 230/85 mmHg C) 140/90 mmHg D) 160/80 mmHg

C) 140/90 mmHg

When instructing the client who has been diagnosed with Raynaud's phenomenon about management of care, the nurse should discuss which of the following topics? A) Scheduling a sympathectomy procedure for the next visit B) Using a beta blocker medication C) Follow-up monitoring for development of connective tissue disease D) Benefit of an angioplasty to the affected extremities

C) Follow-up monitoring for development of connective tissue disease

How would the nurse best describe the characteristics of primary hypertension to a client? A) It is uncontrollable, and has a rapid onset of complications B) It is a rapidly progressive increase in blood pressure C) It is a gradual and asymptomatic increase in blood pressure D) It can be corrected by treating the underlying conditions

C) It is a gradual and asymptomatic increase in blood pressure

The client with Raynaud's phenomenon complains of cold and numbness in her fingers. The nurse assesses the client for effects of vasoconstriction. Which of the following is an early sign of vasoconstriction? A) Cyanosis B) Gangrene C) Pallor D) Rubor

C) Pallor

A client is admitted to the hospital with pallor, fatigue, dry lips, and a smooth, bright-red tongue. A preliminary diagnosis of pernicious anemia has been made. Which diagnostic test would confirm this diagnosis? A) Bone marrow examination B) Ventilation-perfusion scan C) Schilling test D) Tensilon test

C) Schilling test

A client with an abdominal aortic aneurysm is admitted to a step-down unit. The nurse should intervene immediately if this client experiences A) A migraine like headache B) Cramping in the legs C) Sudden, severe back pain D) Diaphoresis

C) Sudden, severe back pain

Verapamil

Calcium channel blocker, reduces inotropy and chronotropy, thus reducing heart rate and blood pressure

Diuretics

Cause antihypertensive effects usually attributed to sodium and water depletion

Calcium Channel Blockers

Dilate peripheral arteries and decrease peripheral vascular resistance by relaxing vascular smooth muscle

A client being treated for hypertension reports having a persistent hacking cough. What class of antihypertensive should the nurse identify as a possible cause of this response when reviewing a list of this client's medications? A) ACE inhibitors B) Thiazide diuretics C) Calcium channel blockers D) Angiotensin receptor blockers

D) Angiotensin receptor blockers

When assessing an individual with peripheral vascular disease, which clinical manifestation would indicate complete arterial obstruction in the lower left leg? A) Aching pain in the left calf B) Burning pain in the left calf C) Numbness and tingling in the left leg D) Coldness of the left foot and ankle

D) Coldness of the left foot and ankle

Which statement best describes the action of furosemide for the treatment of 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) It inhibits reabsorption of sodium and water in the loop of Henle

A client is admitted to the unit with a diagnosis of thrombophlebitis and a deep vein thrombosis of the right leg. A loading dose of heparin had been given in the emergency room and IV heparin will be continued for the next several days. The nurse should develop a plan of care for this client that will involve A) Administering aspirin as ordered B) Encouraging green leafy vegetables in the diet C) Monitoring the client's prothrombin time (PT) D) Monitoring the client's activated partial thromboplastin time (aPTT) and INR

D) Monitoring the client's activated partial thromboplastin time (aPTT) and INR

Peripheral blood flow is dependent on which of the following variables? A) Blood viscosity and diameter of vessel B) Diameter and resistance of vessels C) Force of contraction of the heart and resistance of vessels D) Pressure differences in the arterial and venous systems and resistance

D) Pressure differences in the arterial and venous systems and resistance

A client with acute pulmonary edema has been taking an angiotensin-converting enzyme inhibitor (ACE inhibitor). The nurse explains that this medication has been ordered to A) Promote diuresis B) Increase cardiac output C) Decrease contractility D) Reduce blood pressure

D) Reduce blood pressure

What should the nurse teach a client who is taking antihypertensive to do to minimize orthostatic hypotension? A) Wear support hose continuously B) Lie down for 30 minutes after taking medication C) Avoid tasks that require high energy expenditure D) Sit on the edge of the bed for 5 minutes before standing

D) Sit on the edge of the bed for 5 minutes before standing

A client is on complete bed rest. The nurse should assess the client for risk for developing which of the following complications? A) Air embolus B) Fat embolus C) Stress fractures D) Thrombophlebitis

D) Thrombophlebitis

Beta- adrenergic blocking agents

Decrease heart rate, force of myocardial contraction, cardiac output, and renin release form the kidneys

ARBs

Developed to block the strong blood pressure raising effects of angiotensin I

Warfarin

The most commonly used oral anticoagulant, acts in the liver to prevent synthesis of vitamin K-dependent clotting factors

Calcium channel blockers

antihypertensive, decrease calcium uptake thereby reducing excitation of cardiac muscle, monitor pulse and BP before dose, monitor I & O, monitor daily weights, monitor potassium level, monitor for orthostasis

Beta blockers

antihypertensive, ends in "lol", block beta receptors, monitor pulse before dose, monitor BP< monitor for orthostasis

Clonidine

decreases heart rate and BP, vasodilator by inhibiting vasoconstriction

Antiadrenergic (sympatholytic) drugs

inhibit activity of the SNS

Hydrochlorothiazide

reduces blood volume by acting on the kidneys to decrease sodium reabsorption in the distal convoluted tubule

Loop diuretics

work in the loop of Henle to decrease sodium retention. Must monitor for orthostasis, dizziness, I & O, daily weights, monitor potassium

Diuretics

works in the distal tubule in the kidney to prevent reabsorption of sodium and water. Monitor I & O, monitor daily weights, monitor potassium level, monitor for orthostasis

Postassium-sparing diuretic

works in the kidney to decrease sodium and water retention, while at the same time sparing the loss of potassium. Monitor I & O, monitor daily weights, monitor potassium level, monitor for orthostasis