FINAL EXAM MEDSURGE QUESTIONS FROM POWERPOINTS

2. When assessing the laboratory work of a 65-year-old patient who is scheduled for surgery this morning, the nurse understands which laboratory value may result in cancellation of the surgery? A. Hemoglobin 10.5 g/dL B. Serum potassium 2.7 mEq/L C. Serum sodium level 149 mEq/L D. Fasting blood glucose 120 mg/dL

2. Answer: B Rationale: Although all the laboratory results listed are not within normal ranges, the presence of hypokalemia (normal serum potassium levels should be between 3.0 and 5.5 mEq/L) increases the risk for toxicity if the patient is taking digoxin, slows recovery from anesthesia, and increases cardiac irritability. Potassium problems must be corrected before the surgery. CHAPTER 14 POWERPOINT Exam 1

7. Identify appropriate interventions for a patient experiencing inadequate oxygenation and tissue perfusion as a result of coronary artery disease. (Select all that apply.) A. Notify the physician. B. Administer Tylenol for pain. C. Maintain or initiate an IV line. D. Apply oxygen via nasal cannula. E. Encourage interaction with family. F. Administer nitroglycerin sublingually.

7. Answer: A, C, D, F A. Notify the physician. C. Maintain or initiate an IV line. D. Apply oxygen via nasal cannula. F. Administer nitroglycerin sublingually. Refer to Chart 38-3 in the textbook (p. 764) for the complete rationale CHAPTER 38 POWERPOINT Exam 3B

3. The nurse understands which is the primary risk factor for lung cancer? A. Air pollution B. Cigarette smoking C. Chronic exposure to asbestos D. Occupational radiation exposure

3. Answer: B. Cigarette smoking Rationale: According to the American Cancer Society, cigarette smoking remains the primary risk factor and is responsible for 9 out of 10 cases of lung cancer. Occupational exposure, secondhand smoke, asbestos, advancing age, and family history are additional risk factors. (Source: Accessed March 31, 2014 from http://www.cancer.org/Cancer/LungCancer-Non-SmallCell/OverviewGuide/lung-cancer-non-small-cell-overview-what-causes) CHAPTER 30 POWERPOINT Exam 2

. Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent finger sticks to check his glucose level. His potassium level is 2.5, and IV potassium supplements have potassium? A. Respiratory rate of less than 24/min B. Production of at least 30 mL/hr of urine C. Level of consciousness and orientation D. Finger stick glucose of less than 200 mg/dL

4. Answer: B Production of at least 30 mL/hr of urine Hypokalemia is a common cause of death in the treatment of DKA. Before giving IV potassium, make sure the patient produces at least 30 mL/hr of urine. CHAPTER 64 POWERPOINT Exam 4

1 Which ethnic group of women typically has the least amount of bone density? A. Asian B. Caucasian C. Native American D. African American

1 Answer: B Caucasian Rationale: Caucasian women tend to have the least amount of bone density of any group, which makes them more likely to have osteoporosis and fractures. CHAPTER 49 POWERPOINT Exam 5

1. A 64-year-old woman is seen in the adult outpatient clinic. She was measured as standing 65 inches tall last year. The nurse observes that the patient now measures 64 inches. She has mild kyphosis. What assessment questions should the nurse ask at this time?

1. Ask the patient if she feels she has gotten shorter. Ask if she experiences pain with lifting, bending, or stooping. Ask if the pain is worse with activity and relieved by rest. CHAPTER 50 POWERPOINT Exam 5

3. In the ED, the patient is diagnosed with diabetic ketoacidosis (DKA). What is the nurse's first priority for managing this condition? A. Airway assessment B. Administration of insulin C. Fluid and electrolyte correction D. Administration of IV potassium

3. Answer: A Airway assessment The first priority is airway management, rapidly followed by the administration of insulin, fluids, and correction of any electrolyte imbalances. CHAPTER 64 POWERPOINT Exam 4

3. You immediately notify the provider and within 45 minutes, the patient is transferred to the CCU for close monitoring. He is in serious condition and has developed crackles bilaterally, and his chest pain level has increased. What medications do you anticipate will be ordered for this patient? (Select all that apply.) A. Morphine B. Furosemide (Lasix) C. Atenolol (Tenormin) D. Prednisone (Deltasone) E. Acetaminophen (Tylenol)

. Answer: A, B, C A. Morphine B. Furosemide (Lasix) C. Atenolol (Tenormin) Based on the assessment findings, several medications will be ordered including IV diuretics (furosemide) and supplemental oxygen. If congestion and shortness of breath become critical, the patient may need to be placed on a ventilator until the fluid volume overload is under control. Once-a-day beta-adrenergic blocking agents (atenolol) decrease the size of the infarct, the occurrence of ventricular dysrhythmias, and mortality rates in patients with MI. A cardioselective beta-blocking agent is usually prescribed within the first 1 to 2 hours after an MI if the patient is hemodynamically stable. Beta blockers slow the heart rate and decrease the force of cardiac contraction. Medical interventions aim to relieve pain and decrease myocardial oxygen requirements through preload and afterload reduction. IV morphine is used to decrease pulmonary congestion and relieve pain. CHAPTER 38 POWERPOINT Exam 3B

3 The patient is diagnosed with osteoporosis. Which intervention by the nurse would be appropriate? A. Teach her to cut down on her cigarette smoking. B. Recommend walking for 30 minutes 3 to 5 times a week. C. Suggest a diet that is high in protein and calcium but low in vitamin D. D. Tell her to include high-impact activities, such as running, in her exercise regimen.

. Answer: B Recommend walking for 30 minutes 3 to 5 times a week. The single most effective exercise for osteoporosis is walking 30 minutes 3 to 5 times a week. Patients should include increased vitamin D along with calcium in the diet. Smoking should be avoided, as should high-impact exercises, which may cause vertebral compression fractures. CHAPTER 50 POWERPOINT Exam 5

A nurse is teaching a group of patients about diabetes, and explains to the group that what percent of the United States population has diabetes? A. 3.2% B. 5.6% C. 8.3% D. 10.1%

. Answer: C 8.3% Rationale: An estimated 25.8 million children and adults in the United States - 8.3% of the population - have diabetes; 18.8 million people are diagnosed, 7.0 million are undiagnosed, 79 million have pre-diabetes, and 1.9 million new cases were diagnosed in people aged 20 and older in 2010. ( CHAPTER 64 POWERPOINT Exam 4

2. A patient is admitted with cough, fever, sore throat, progressive shortness of breath, diarrhea, and vomiting that developed after returning from a business trip overseas. The nurse suspects which illness is the likely cause of the patient's symptoms? A. Pneumonia B. Viral influenza C. Avian influenza D. Tuberculosis exposure

. Answer: C. Avian influenza Rationale: The initial manifestations of avian influenza are similar to other respiratory infections but include cough, fever, sore throat, shortness of breath, pneumonia, diarrhea, vomiting, abdominal pain, and bleeding from the nose and gums. Assess whether the patient has recently (within the past 10 days) traveled to areas of the world affected by H5N1. Pneumonia and tuberculosis exposure will not present with gastrointestinal symptoms. CHAPTER 31 POWERPOINT EXAM 2

The next morning, the patient is taken to the cardiac catheterization laboratory. The cardiologist finds that there is an 80% blockage in the proximal LAD coronary artery.Which procedure is most likely to be performed to correct this condition? A. Coronary atherectomy B. Coronary artery bypass graft surgery C. PTCA with coronary artery stent placement D. Percutaneous transluminal coronary angioplasty (PTCA)

. Answer: C. PTCA with coronary artery stent placement The most common complication of PTCA is re-blockage of the coronary artery. For this reason, a coronary stent is placed to keep the re-opened artery from closing again. CHAPTER 38 POWERPOINT Exam 3B

1. A 58-year-old woman who has been diagnosed with throat cancer 1 week ago comes to the clinic today to discuss surgical options with her health care provider. She is very tearful and appears sad when the nurse calls her back to the examination room. Based on her diagnosis, which clinical manifestation will the nurse likely observe in the patient? A. Hoarseness B. Severe chest pain C. Low hemoglobin level (anemia) D. Numbness and tingling of the face

1. Answer: A Hoarseness The patient may experience several different symptoms. The most commonly seen with throat cancer is hoarseness, as well as mouth sores or a lump in the neck. Anemia can result if surgery is performed. Severe pain in the chest can be associated with many different disorders and is not usually linked to throat cancer. Numbness and tingling of the face cannot be observed. CHAPTER 29 POWERPOINT Exam 2

1. A patient has had bowel surgery. Which symptom, assessed by the nurse, is the best indicator of intestinal activity? A. Passage of flatus or stool B. Patient's report of hunger C. Abdominal cramping with distention D. Detection of bowel sounds upon auscultation

1. Answer: A Passage of flatus or stool Rationale: The presence of active bowel sounds usually indicates return of peristalsis. However, the absence of bowel sounds does not confirm a lack of peristalsis. The best indicator of intestinal activity is the passage of flatus or stool. Abdominal cramping along with distention denotes trapped, nonmoving gas, not peristalsis. CHAPTER 16 POWERPOINT Exam 1

To ensure safe patient care transition from the perioperative nurse to the intraoperative nurse, optimal hand-off communication about the patient includes which elements? (Select all that apply.) A. Providing a recent patient history B. Communicating vital signs, allergy, and medication updates C. Verbally verifying that the operating room nurse understands the report D. Using a standardized hand-off communication tool to provide report (for example, SBAR, Five-Ps, PACE) E. Encouraging the operating room nurse to interrupt to ask questions as the perioperative nurse provides report

1. Answer: A, B, C, D Rationale: Patient care quality and safety can be improved during hand-offs when nurses and physicians follow best practices in providing effective communication. Effective perioperative hand-off should reduce human error through adoption of a standardized process for effective hand-off communication. Essential elements of perioperative hand-off communication include limited interruptions, interactive opportunities to question and clarify, and the ability to verify information with check-backs and read-backs. Use of ambiguous language should be restricted, and medical jargon, confusing terms, and unacceptable abbreviations should be avoided. CHAPTER 14 POWERPOINT Exam 1

1. During the evening shift, the patient has a bedside echocardiogram, which reveals an ejection fraction of 30%. Based on this finding, which medications might the provider order? (Select all that apply.) A. Multivitamin 1 PO each day B. Lisinopril (Zestril) 5 mg PO daily C. Digoxin (Lanoxin) 0.25 mg PO daily D. Ibuprofen (Advil) 200 PO mg twice daily E. Furosemide (Lasix) 20

1. Answer: B, C, E B. Lisinopril (Zestril) 5 mg PO daily C. Digoxin (Lanoxin) 0.25 mg PO daily E. Furosemide (Lasix) 20 Commonly prescribed drug classes for patients with heart failure include ACE inhibitors (lisinopril), diuretics (furosemide), nitrates (digoxin), human B-type natriuretic peptides, inotropics, and beta-adrenergic blockers. CHAPTER 35 POWERPOINT Exam 3B

1. A 56-year-old woman is admitted to the ED with a blood pressure of 168/92 and reports of fatigue and muscle weakness. She has bruising on her arms and 2+ swelling in her ankles. Her weight has gone from 150 lb to 185 lb over the past 6 months. Assessment reveals that she has truncal obesity and thin extremities. Which diagnosis does the nurse suspect? A. Hyperpituitarism (acromegaly) B. Hypercortisolism (Cushing's disease) C. Hyperaldosteronism (Conn's syndrome) D. Adrenal insufficiency (Addison's disease)

1. Answer: B. Hypercortisolism (Cushing's disease) The patient's manifestations of elevated blood pressure, fatigue, muscle weakness, bruising, dependent edema, weight gain, and truncal obesity with thin extremities are all key features of hypercortisolism, or Cushing's disease. Other manifestations of Cushing's disease include "moon face," "buffalo hump," osteoporosis, and thinning skin with striae. CHAPTER 62 POWERPOINT Exam 4

1. The nurse is monitoring a patient who is receiving moderate sedation. An expected outcome for conscious sedation is: A. Blocked multiple peripheral nerves in a specific region B. Decreased motor function in the targeted limb C. Decreased level of consciousness, yet able to respond to verbal commands D. CNS depression, resulting in analgesia and amnesia, with loss of muscle tone and reflexes

1. Answer: C Rationale: Moderate sedation (also called conscious sedation) is the IV delivery of sedative, hypnotic, and opioid drugs to reduce the level of consciousness but allow the patient to maintain a patent airway and to respond to verbal commands. CHAPTER 15 POWERPOINT Exam 1

1. A 54-year-old man presents to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no openings in the skin. A pulse cannot be obtained by touch to the right foot, which is pale and cool to palpation. The patient rates his pain as an "8" on a 0-to-10 scale. What is the priority nursing action at this time? A. Administer pain medication. B. Prepare for reduction. C. Obtain a Doppler of the right foot pulse. D. Notify the physician of the lack of a pulse in the right foot.

1. Answer: C Obtain a Doppler of the right foot pulse The nurse should obtain a Doppler reading to see if any pulse can be detected at all. Then, subsequent actions could include notifying the physician, administering pain medication, and preparing for reduction. CHAPTER 51 POWERPOINT Exam 5

1. The nurse understands that which of the following is the most common manifestation of pneumonia in the older adult patient? A. Fever B. Cough C. Confusion D. Weakness

1. Answer: C. Confusion Rationale: The older adult with pneumonia often has weakness, fatigue, lethargy, confusion, and poor appetite. Fever and cough may be absent, but hypoxemia is usually present. The most common manifestation of pneumonia in the older adult patient is confusion from hypoxia rather than fever or cough. CHAPTER 31 POWERPOINT EXAM 2

1. The patient is a 63-year-old woman admitted to the acute medical care unit. She is 5'4" and weighs 211 lb. Her medical history includes hypertension and GERD. On admission, she reports pain in her hands and joints that is unrelieved by OTC medications.What additional assessment data should you collect from the patient at this time?

1. Based on her age and reports of pain, the patient is most likely experiencing osteoarthritis, which may be precipitated by her weight. It is important to know when the pain started, and she should be asked to rate her pain on a 0-10 scale. Which OTC medications has she taken? How long has she experienced this pain? Does she have a family history? CHAPTER 18 POWERPOINT Exam 5

1. A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?

1. Rule out hypothyroidism - most cases of hypothyroidism in the U.S. occur as a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism. CHAPTER 63 POWERPOINT Exam 4

23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is 34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse. • What does the nurse suspect is happening with this patient? • What serum glucose level would the nurse expect to see with this patient?

1. The manifestations point to diabetic ketoacidosis (DKA). The patient's glucose level is most likely >300 mg/dL. CHAPTER 64 POWERPOINT Exam 4

1. You check the patient's vital signs with the following results: ➢ BP - 142/90 mm Hg ➢ HR - 86/min ➢ R - 8/min ➢ T - 97º F Based on these readings, does the patient have hypertension? Explain your response.

1. The patient's blood pressure indicates he may have hypertension. However, blood pressure should be checked in both arms and two or more readings should be taken at each visit, with the average of the readings used as the value for the visit. CHAPTER 36 POWERPOINT Exam 3B

1. Answer: D Rationale: The nurse providing patient-centered care recognizes "the patient or designee as the source of control and [a] full partner in providing compassionate and coordinated care based on respect for [the] patient's preferences, values, and needs" (www.qsen.org). The KSAs for competence in patient-centered care focus on communication, compassion, culture, patient education and empowerment, and respect for patients and their families. The nurse would assist patients in making decisions about their health care, such as interpreting information for patients and their families about the implications of surgical procedures. The other actions reflect the caregiver role of the medical-surgical nurse. In the caregiver role, medical-surgical nurses assess patients, analyze collected information to determine their needs, develop nursing diagnoses and collaborative problems, plan care, carry out the plan with the health care team, and evaluate the care given Chapter 1 Powerpoint EXAM 1

1. What intervention demonstrates the integration of patient-centered care? A. Home health care for 8 weeks once the patient is discharged B. Physical therapy while hospitalized after the procedure to accelerate the patient's rehabilitation C. Implementation of a low-fat, high-protein diet D. Questions about the procedure answered and a signed informed consent

1. A 59-year-old male is 3 days postoperative after a colon resection. The nurse has delegated to the unlicensed assistive personnel (UAP) to take his morning vital signs. At 8:00 am the NA reports that the patient's oral temperature is 101.6º F. What is the nurse's priority action?

1. When the patient's elevated temperature is reported by the nursing assistant, it is the nurse's responsibility to determine what action should be taken. The nurse should proceed to his room to perform a complete assessment. CHAPTER 37 POWERPOINT Exam 3B

1. Paramedics arrive at the ED with a 78-year-old man who presents with severe chest pain. In triage, he reports that he experienced chest pain for several hours before calling 911. He reports that he takes "heart medications" but he does not know their names. He rates his chest pain as a 9 on a 0-to-10 scale. Patient history includes an MI 6 years ago that resulted in stent placement for severe CAD. One stent was placed in the LAD and another in his circumflex artery. He states that his health care provider told him he also has heart failure. What laboratory tests do you anticipate the provider will order for this patient?

1. While there is no single ideal test to diagnose MI, the most common laboratory tests include --troponins T and I, --Creatine kinase-MB (CK-MB) --Myoglobin. These cardiac markers are specific for MI and cardiac necrosis. Troponins T and I and myoglobin rise quickly. CK-MB is the most specific marker for MI, but does not peak until about 24 hours after the onset of pain. CAD, Coronary artery disease; LAD, left anterior descending artery. CHAPTER 38 POWERPOINT Exam 3B

2 Which statement best validates an older patient's understanding of musculoskeletal health interventions? A. "I should use a cane when I walk." B. "I should drink 8 oz of orange juice daily." C. "I should try to exercise at least five times a week." D. "I should ignore my pain and adapt to moving more slowly."

2 Answer: C "I should try to exercise at least five times a week." Rationale: It is important to prevent falls in older adults. Regular exercise is the most important element in healthy musculoskeletal aging. Assistive devices may be needed for ambulation. A nutrient-rich diet is an important part of maintaining musculoskeletal health. Assessment of pain can present many challenges. Pain can be related to bone, muscle, or joint problems and may be described as acute or chronic. Patients should not ignore changes in musculoskeletal pain CHAPTER 49 POWERPOINT Exam 5

2. Two hours later, the patient is admitted to the cardiac stepdown unit with orders for a saline lock, cardiac diet, and oxygen at 2 L per nasal cannula with follow-up cardiac enzymes, and 12-lead ECG in 6 hours. One hour later, the patient reports severe shortness of breath. His oxygen saturation has dropped to 88%, BP is 96/54, and his monitor shows sinus tachycardia with a rate of 114. He reports mild chest pain. 1. What do you suspect is happening to the patient at this time? 2. The patient's laboratory values include troponin T 0.6 mg/mL. What is your best interpretation of this finding?

2. ** Based on the history of the recent CP and now increased shortness of breath with hypoxemia, the nurse can conclude that the patient may be experiencing heart failure. • Troponin T is elevated. This substance is not found in healthy patients; any rise indicates cardiac necrosis or acute MI. CHAPTER 37 POWERPOINT Exam 3B

2. The nurse understands which symptom to be a hallmark subjective sign of lung disease? A. Cough B. Dyspnea C. Chest pain D. Sputum production

2. Answer: A Rationale: Cough is a main sign of lung disease. Dyspnea (difficulty in breathing or breathlessness) is a subjective perception and varies among patients. A patient's feeling of dyspnea may not be consistent with the severity of the presenting problem. Sputum production may be associated with coughing and indicate an acute or chronic lung condition. Chest pain can occur with other health problems, as well as with lung problems. CHAPTER 27 POWERPOINT EXAM 2

2. During a surgical procedure, the nurse notices the sponge count is incorrect. One sponge is missing. What is the priority nursing intervention? A. Communicate the discrepancy to the surgical team immediately. B. Complete appropriate documentation concerning the error in sponge count. C. Examine the environmental distractions, refocus, and count the sponges again. D. Anticipate that the surgeon will order an x-ray to look for the sponge postoperatively.

2. Answer: A Rationale: There are many risk factors that can contribute to a retained foreign body. The process by which counts are performed is not standardized from operating room to operating room across the country, or even within the same institution. The most significant factor in retained foreign objects in the body is failure to effectively communicate with the surgical team when a discrepancy is discovered. Other factors include environmental stimuli that create distraction-related errors. Current national guidelines suggest that a systematic process for counting and communicating is needed in the operating room to prevent retained foreign body errors in surgery. Although the nurse will complete the interventions in B, C, and D, the priority intervention is to immediately communicate the discrepancy to the surgical team. CHAPTER 15 POWERPOINT Exam 1

2. The nurse understands which symptom to be a hallmark subjective sign of lung disease? A. Cough B. Dyspnea C. Chest pain D. Sputum production

2. Answer: A Cough Rationale: Cough is a main sign of lung disease. Dyspnea (difficulty in breathing or breathlessness) is a subjective perception and varies among patients. A patient's feeling of dyspnea may not be consistent with the severity of the presenting problem. Sputum production may be associated with coughing and indicate an acute or chronic lung condition. Chest pain can occur with other health problems, as well as with lung problems. CHAPTER 27 POWERPOINT EXAM 2

2. Which cardiovascular disease results in the highest number of hospital admissions in the United States? A. Heart failure B. Rheumatic carditis C. Mitral valve disease D. Infective endocarditis

2. Answer: A Heart failure Rationale: According to the American Heart Association, heart failure affects nearly 5.7 million Americans of all ages and is responsible for more hospitalizations than all forms of cancer combined. It is the number one cause for hospitalizations among Medicare patients. With improvement in survival of acute MIs and a population that continues to age, heart failure will continue to increase in prominence as a major health problem in the United States. (Source: Accessed March 25, 2014, from http://emedicine.medscape.com/article/163062-overview#a0156.) CHAPTER 35 POWERPOINT Exam 3B

2. An ankle x-ray confirms that the patient has an ankle fracture. A fiberglass cast is applied to immobilize the ankle and allow for healing. Which are priority interventions after the cast is applied? (Select all that apply.) A. Monitor for signs of infection. B. Assess peripheral capillary refill. C. Ask the patient about frequency of bowel movements. D. Keep the cast uncovered for air-drying over several hours. E. Insert a finger between the skin and the cast to be sure the cast is not too tight.

2. Answer: A, B, E A. Monitor for signs of infection. B. Assess peripheral capillary refill. E. Insert a finger between the skin and the cast to be sure the cast is not too tight. Rationale: A synthetic cast such as fiberglass will dry within 10 to 15 minutes and can bear weight 30 minutes after application. Assessing capillary refill and ability to insert a finger into the space between the skin and the cast allow the nurse to assure that the client's circulation is not compromised by swelling of the tissue or tightness of the cast. Monitoring for signs of infection are always important. CHAPTER 51 POWERPOINT Exam 5

2. The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse's best response? A. "His serum pH is high, and this is a compensatory mechanism." B. "His serum pH is low and this is a compensatory mechanism." C. "His serum potassium is high and this is a compensatory mechanism." D. "His serum potassium is low and this is a compensatory mechanism."

2. Answer: B "His serum pH is low and this is a compensatory mechanism." As ketone levels rise, the buffering capacity of the body is exceeded and the pH of the body decreases, leading to metabolic acidosis. Kussmaul respirations (very deep and rapid) cause respiratory alkalosis in an attempt to correct the acidosis by exhaling carbon dioxide. CHAPTER 64 POWERPOINT Exam 4

2. What is the priority nursing assessment when a patient is admitted to the PACU? A. Level of consciousness B. Airway and gas exchange C. Dressing and incision status D. Vital signs and body temperature

2. Answer: B Airway and gas exchange Rationale: When the patient is admitted to the PACU, the nurse must immediately assess for a patent airway and adequate gas exchange. The other choices are secondary to a patent airway. CHAPTER 16 POWERPOINT Exam 1

2. The nurse is caring for a patient with a cuffed tracheostomy and is aware the patient is at risk for developing which complication? A. Pneumothorax B. Tracheomalacia C. Subcutaneous emphysema D. Trachea-innominate artery fistula

2. Answer: B Tracheomalacia Rationale: Tracheomalacia can develop because of the constant pressure exerted by the cuff, causing tracheal dilation and erosion of cartilage. Pneumothorax can develop during any tracheostomy procedure if the thoracic cavity is accidentally entered. Subcutaneous emphysema can develop during any tracheostomy procedure if air escapes into fresh tissue planes of the neck. Trachea-innominate artery fistula can occur any time a malpositioned tube causes its distal tip to push against the lateral wall of the tracheostomy. CHAPTER 28 POWERPOINT EXAM 2

2. The patient is diagnosed with possible osteoporosis. Which diagnostic tests should the nurse anticipate will be ordered? (Select all that apply.) A. Sodium B. Phosphorus C. Serum calcium D. Thyroid function tests E. Dual x-ray absorptiometry (DXA)

2. Answer: B, C, D, E B. Phosphorus C. Serum calcium D. Thyroid function tests E. Dual x-ray absorptiometry (DXA) All tests listed, except sodium, are tests used to gather information about the bones, or in the case of thyroid function tests, to check for hyperthyroidism. CHAPTER 50 POWERPOINT Exam 5

2. The patient is diagnosed with hypertension. He asks what he can do to improve his health. Which points do you include in your teaching plan? (Select all that apply.) A. Limiting smoking and caffeine to moderate use B. Making lifestyle changes to control blood pressure C. Checking blood pressure only at the clinic to ensure accuracy D. Exercising and weight loss to decrease the need for BP medications E. Alternative therapies such as relaxation techniques to help decrease stress associated with hypertension

2. Answer: B, D, E B. Making lifestyle changes to control blood pressure D. Exercising and weight loss to decrease the need for BP medications E. Alternative therapies such as relaxation techniques to help decrease stress associated with hypertension Lifestyle changes, exercising, weight loss, and alternative therapies are all important components to successfully managing blood pressure. Part of the care plan should include teaching the patient to monitor his blood pressure on a daily basis, not just at his clinical visits. Smoking and caffeine intake should be completely avoided. CHAPTER 36 POWERPOINT Exam 3B

2. A patient is being discharged to home on warfarin (Coumadin) therapy to manage an acute pulmonary embolism. Which patient response indicates a need for further teaching by the nurse? A. "I should limit my alcohol consumption." B. "I should eat more green leafy vegetables like spinach." C. "I should take the medication at the same time every day." D. "I should make a doctor's appointment for weekly blood draws."

2. Answer: B. "I should eat more green leafy vegetables like spinach." Rationale: Patients who experience a venothromboembolism/pulmonary embolism are frequently discharged on anticoagulant therapy (e.g., warfarin [Coumadin]). The patient should be educated to understand the risks and monitoring of this drug to include weekly monitoring for therapeutic levels, consistency in dosing regimens, and foods to avoid (e.g., leafy green vegetables, green tea, alcohol, cranberry juice). (Source: Accessed March 23, 2014 from http://www.mayoclinic.com/print/warfarin/AN00455/METHOD=print.) CHAPTER 32 POWERPOINT EXAM 2

2. While the Rapid Response Team is at the bedside, the patient's healthcare provider arrives. The provider writes several orders. Which order is most important for the nurse to implement immediately? A. Transfer to ICU B. Increase O2 to 3 L per nasal cannula C. ABGs 30 min after oxygen is increased D. Methylprednisolone sodium succinate (Solu-Medrol) 40 mg IVP

2. Answer: B. Increase O2 to 3 L per nasal cannula All of the provider's orders are very important, but based on the patient's severe shortness of breath, the first thing that should be done is to increase her oxygen. Once her oxygen is increased, the nurse should note the time and remember to call for stat ABGs in 30 minutes. The patient should then be transferred to the ICU as soon as possible. Once the patient arrives in the ICU, they can administer the one-time dose of Solu-Medrol. CHAPTER 30 POWERPOINT Exam 2

2. The next day, a student nurse is caring for the patient, who is scheduled for an MRI of the head. The student nurse asks why a patient with Cushing's disease needs this test. A. What is the nurse's best response? B. "They are looking for brain cancer which may have caused the disease." C. "The patient may have had headaches and they are looking for the cause." D. "The most common cause of Cushing's is a pituitary tumor called an adenoma." E. "A tumor of the adrenal gland can cause about 15% of Cushing's disease cases."

2. Answer: C. "The patient may have had headaches and they are looking for the cause." Pituitary adenoma is the most common cause of Cushing's disease, and magnetic resonance imaging (MRI) would visualize such a tumor. CHAPTER 62 POWERPOINT Exam 4

2. When the nurse begins taking the patient's history, the patient asks, "Did you know that I have throat cancer and may not survive?" What is the appropriate nursing response? A. "Are you having difficulty swallowing?" B. "My mother had cancer, so I know how you must be feeling right now." C. "I am sure that your cancer can be cured if you follow your doctor's advice." D. "I know you have been diagnosed with cancer. Are you concerned about what the future may hold?"

2. Answer: D "I know you have been diagnosed with cancer. Are you concerned about what the future may hold?" Although answer A is part of an appropriate history, the patient's need at the moment, represented by her statement, is psychosocial in nature. The nurse should realize that the patient may need psychosocial support. This is the only appropriate therapeutic response. The nurse cannot give her false reassurance (answer C), and the nurse should never compare feelings (answer B). Head and neck cancer is curable when treated early. CHAPTER 29 POWERPOINT Exam 2

2. The provider orders laboratory work that includes thyroid function tests. Which results does the nurse expect to see? A. Normal T3 and T4 levels B. Decreased TSH level C. Increased T3 and T4 levels D. Decreased T3 and T4 levels

2. Answer: D. Decreased T3 and T4 levels Laboratory findings for hypothyroidism include decreased T3 and T4 levels and increased thyroid-stimulating hormone (TSH) levels with primary hypothyroidism. With secondary hypothyroidism, the TSH level can be close to normal. CHAPTER 63 POWERPOINT Exam 4

2. Upon assessment, the nurse notes that the patient is flushed and slightly diaphoretic. He appears lethargic, but responds to simple questions. His vital signs are now BP 90/40, HR 134, RR 26 and deep, and his temperature has risen to 102.8º F. Lungs are clear throughout. His abdominal wound has a dressing that is moist with a moderate amount of purulent drainage. What is the nurse's interpretation of this data?

2. The development of infection should be considered based on the patient's operative history and vital signs. He has tachycardia and increased respirations, as well as a moderate amount of purulent drainage at the abdominal dressing site. Surgical dressings should not contain purulent drainage. CHAPTER 37 POWERPOINT Exam 3B

2. Answer: C Rationale: The nurse should observe for and report common clinical manifestations of patient decline, such as hypotension, tachycardia, and mental status changes. Use of a Rapid Response Team (RRT) has been shown to reduce medical complications and decrease the number of cardiac and respiratory arrests (www.ihi.org). RRTs save lives and decrease the risk for patient harm before a respiratory or cardiac arrest occurs. Therefore it is recommended that the RRT be called whenever a patient has a slow or sudden deterioration in clinical condition. A code team would not yet be appropriate because the patient has not arrested. Chapter 1 Powerpoint EXAM 1

2. The nurse is caring for a patient who has been admitted for heart failure. The patient begins to display signs of confusion. The nurse obtains vital signs showing that the patient's blood pressure has dropped from 132/78 to 108/60, and his pulse is 115 beats/min. What is the appropriate nursing action? A. Call the code team. B. Call the patient's family physician. C. Activate the Rapid Response Team. D. Obtain the opinion of another nurse on the floor.

2. Answer: A. Atrial fibrillation Rationale: Atrial fibrillation (AF) is the most common dysrhythmia seen in clinical practice. It is responsible for a third of hospitalizations for cardiac rhythm disturbances. Patients can live with this dysrhythmia, but most are treated with anticoagulation therapy to avoid possible blood clots. CHAPTER 34 POWERPOINT Exam 3A

2. The nurse understands that patients with which dysrhythmia constitute the largest group of those hospitalized with dysrhythmias? A. Atrial fibrillation B. Sinus tachycardia C. Sinus bradycardia D. Ventricular fibrillation

3. During a preoperative assessment, the nurse asks the patient about allergies. Which allergy cited by the patient would be of greatest concern during the surgical procedure? A. Kiwi B. Codeine C. Shellfish D. Sulfa drugs

3. Answer: A Rationale: An allergy to kiwi or other fruits and nuts may indicate the presence of a latex allergy. The shellfish allergy will indicate that an alternative to the frequently used povidone-iodine scrub will be used before the procedure, but a latex allergy will greatly affect the equipment chosen for use throughout the surgical procedure. CHAPTER 14 POWERPOINT Exam 1

3. The nurse is aware that a patient having surgery is at risk for infection if which additional factor is present? A. Diabetes mellitus B. Age greater than 65 C. Impaired liver function D. Insertion of a surgical drain

3. Answer: A Diabetes mellitus Rationale: The risk for infection is higher in patients with pre-existing health problems such as diabetes mellitus, immune deficiency, obesity, and kidney failure. A surgical drain allows for removal of secretions and fluids from within the tissues around the surgical area. If these secretions are not drained, slowed healing and bacterial growth could result in wound infection. Age increases risk-related skin injury from positioning and prolonged immobility during the surgical procedure. CHAPTER 15 POWERPOINT Exam 1

The provider discusses radiation therapy with the patient because her lesion is small and the cure rate is 80% or higher. The patient asks if her voice will return to normal. What is the appropriate nursing response? (Select all that apply.) A. "At first the hoarseness may become worse." B. "The more you use your voice, the quicker it will improve." C. "Gargling with saline may help decrease the discomfort in your throat." D. "Your voice will improve within 4 to 6 weeks after completion of the therapy." E. "You should rest your voice and use alternative communication during the therapy."

3. Answer: A, C, D, E A. "At first the hoarseness may become worse." C. "Gargling with saline may help decrease the discomfort in your throat." D. "Your voice will improve within 4 to 6 weeks after completion of the therapy." E. "You should rest your voice and use alternative communication during the therapy." The patient should be taught not to use her voice more than necessary during and after therapy, and to work with family to determine alternative forms of communication until after the radiation therapy. Statements A, C, D, and E are appropriate responses that accurately reflect the normal course of progression after radiation therapy for throat cancer. CHAPTER 29 POWERPOINT Exam 2

3. The nurse observes an increased incidence of contaminated blood cultures as indicated by laboratory report, thus requiring that the blood be redrawn. What quality improvement step could the nurse implement to reduce the blood culture contamination rates? A. Inform the unit manager of the concern. B. Evaluate trends and develop a plan for improvement. C. Contact the hospital quality improvement nurse to report the observation. D. Post a journal article on the unit that addresses proper blood culture technique.

3. Answer: B Rationale: To meet the quality improvement competency, nurses are expected to "use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems" (www.qsen.org). Answers A and D transfer the nurse's involvement in quality improvement processes to another individual. Answer C may be an appropriate intervention at a later time, but the nurse should evaluate the problem using data prior to developing a strategy for improvement. Chapter 1 Powerpoint EXAM 1

3. The nurse is assessing a patient who received a heart transplant. Which symptom suggests that the patient may be experiencing organ rejection? A. Fever B. Weight gain C. Tachycardia D. Hypertension

3. Answer: B Weight gain Rationale: Clinical manifestations of heart transplant rejection include shortness of breath, fatigue, fluid gain (edema, increased weight), abdominal bloating, new bradycardia, hypotension, atrial fibrillation or flutter, decreased activity tolerance, and decreased ejection fraction (late sign). CHAPTER 35 POWERPOINT Exam 3B

3. At the end of the visit, the provider prescribes hydrochlorothiazide (HydroDIURIL) 25 mg PO each morning to manage the patient's hypertension. Which statement do you include when teaching the patient about this drug? A. "This is a loop diuretic that decreases sodium reabsorption." B. "Eat foods rich in potassium, such as bananas and orange juice." C. "A potassium supplement will be prescribed along with this drug." D. "HydroDIURIL is a potassium-sparing diuretic that helps prevent the loss of essential potassium."

3. Answer: B. "Eat foods rich in potassium, such as bananas and orange juice." • Hydrochlorothiazide is a thiazide diuretic. The most frequent side effect is hypokalemia, so it's important to teach patients the signs of low potassium, as well as which foods are rich in potassium. Some patients need a potassium supplement, but this is prescribed based on the patient's serum potassium level. CHAPTER 36 POWERPOINT Exam 3B

3. When positioning to decrease pain in the postoperative patient, which intervention is most appropriate? A. Raise the knee gatch of the bed. B. Place pillows under the patient's knees. C. Reposition the patient at least every 2 hours. D. Allow the patient to get out of bed as soon as possible.

3. Answer: C Rationale: In positioning the patient, consider the position during surgery, the location of the surgical incision and drains, and problems such as arthritis and chronic lung disease. Assist the patient to a position of comfort. Support the extremities with pillows. Turn or help the patient turn at least every 2 hours while he or she is bedridden to prevent complications caused by immobility. Do not raise the knee gatch, because this position could restrict circulation and increase the risk for thrombophlebitis. During the PACU recovery, the patient may not yet be able to get out of bed. CHAPTER 16 POWERPOINT Exam 1

3. While suctioning a patient, vagal stimulation occurs. What is the appropriate nursing action? A. Instruct the patient to cough. B. Place the patient in a high Fowler's position. C. Oxygenate the patient with 100% oxygen. D. Instruct the patient to breathe slowly and deeply.

3. Answer: C Oxygenate the patient with 100% oxygen. Rationale: Vagal stimulation may occur during suctioning and result in severe bradycardia, hypotension, heart block, ventricular tachycardia, asystole, or other dysrhythmias. If vagal stimulation occurs, stop suctioning immediately and oxygenate the patient manually with 100% oxygen. Repositioning the patient, slow deep breathing, and coughing will not address the cardiovascular effects of vagal stimulation. CHAPTER 28 POWERPOINT EXAM 2

3. When positioning to decrease pain in the postoperative patient, which intervention is most appropriate? A. Raise the knee gatch of the bed. B. Place pillows under the patient's knees. C. Reposition the patient at least every 2 hours. D. Allow the patient to get out of bed as soon as possible.

3. Answer: C Reposition the patient at least every 2 hours. Rationale: In positioning the patient, consider the position during surgery, the location of the surgical incision and drains, and problems such as arthritis and chronic lung disease. Assist the patient to a position of comfort. Support the extremities with pillows. Turn or help the patient turn at least every 2 hours while he or she is bedridden to prevent complications caused by immobility. Do not raise the knee gatch, because this position could restrict circulation and increase the risk for thrombophlebitis. During the PACU recovery, the patient may not yet be able to get out of bed. CHAPTER 16 POWERPOINT Exam 1

3. Twenty minutes later, the nurse calls the health care provider to report the abnormal findings. The provider orders: A. Tylenol 650 mg PO prn q6h for temp above 101º F B. Blood cultures × 2, 5 min apart C. C & S of abdominal wound drainage D. Vancomycin 750 mg IVPB over 1 hr every 24 hr In what order should the nurse implement these interventions?

3. Answer: C, B, D, A C. C & S of abdominal wound drainage B. Blood cultures × 2, 5 min apart D. Vancomycin 750 mg IVPB over 1 hr every 24 hr A. Tylenol 650 mg PO prn q6h for temp above 101º F Based on the findings, this patient is possibly developing sepsis. The wound should be cultured immediately and the nurse should notify the laboratory that blood cultures must be obtained. All cultures must be drawn before administering the antibiotics. The first anti-infective should be started within 1 hour after the blood and wound cultures are obtained. The nurse may then give the patient Tylenol for his fever. CHAPTER 37 POWERPOINT Exam 3B

The nurse knows that a patient with crush injuries to the lower extremities is at high risk for what complication? A. Bradycardia B. Hypotension C. Acute kidney injury D. Spinal nerve injury

3. Answer: C. Acute kidney injury Rationale: Crush injuries cause several potential complications. The release of myoglobin from the muscle places the patient at high risk for developing rhabdomyolysis and acute kidney injury, which requires immediate intervention. Other complications include hyperkalemia leading to cardiac dysrhythmias, hypovolemia, and peripheral nerve injury. Potassium is also released with crush injuries and may cause cardiac dysrhythmias. If extensive blood volume is lost, the patient is at risk for developing hypovolemia. Presence of peripheral nerve injury should be assessed with all musculoskeletal trauma. Spinal nerve injury is not likely with a lower extremity injury. CHAPTER 51 POWERPOINT Exam 5

3. Which patient statement indicates that further nursing teaching is needed about hypothyroidism? A. "When I go home I should check my heart rate and BP every day." B. "I will be sure to include fiber in my diet and drink plenty of water." C. "I will call my provider if I notice any change in level of consciousness." D. "When I am feeling better in a few months, I will no longer need to take the Synthroid pills."

3. Answer: D "When I am feeling better in a few months, I will no longer need to take the Synthroid pills." The most important educational need for the patient with hypothyroidism is about hormone replacement therapy and its side effects. The need to take these drugs is life-long CHAPTER 63 POWERPOINT Exam 4

3. A patient in acute respiratory failure is classified as having ventilatory failure. The nurse understands that which finding is a potential cause of ventilatory failure? A. Pulmonary edema B. Hypovolemic shock C. Pulmonary embolus D. Opioid analgesic overdose

3. Answer: D. Opioid analgesic overdose Rationale: Acute ventilatory failure is the type of problem in oxygen intake and carbon dioxide removal (ventilation) and blood delivery (perfusion) that causes a ventilation-perfusion (V/Q) mismatch in which perfusion is normal but ventilation is inadequate. It occurs when chest pressure does not change enough to permit air movement into and out of the lungs. As a result, too little oxygen reaches the alveoli and carbon dioxide is retained. Opioid analgesic overdose is a possible cause of ventilatory failure. The other choices listed are related to oxygenation failure. CHAPTER 32 POWERPOINT EXAM 2

A patient is experiencing hypotension, fever, chills, night sweats, and weight loss. Upon assessment, the nurse notes a displaced PMI. The nurse knows this collection of symptoms are associated most closely with which condition? A. Influenza B. Pneumonia C. Tuberculosis D. Pulmonary empyema

3. Answer: D. Pulmonary empyema Rationale: Patients with pneumonia, tuberculosis, and influenza may experience some or all of the symptoms of fever, chills, night sweats, and weight loss. However, because pulmonary empyema is a collection of pus in the pleural space that may cause compromised cardiac function, displaced point of maximal impulse (PMI), and hypotension may result. CHAPTER 31 POWERPOINT EXAM 2

3. The nurse is caring for a patient diagnosed with small cell lung cancer. The nurse understands the patient may also present with which endocrine disorder? A. Adrenal crisis B. Cushing's syndrome C. Diabetes insipidus (DI) D. Syndrome of inappropriate antidiuretic hormone (SIADH)

3. Answer: D. Syndrome of inappropriate antidiuretic hormone (SIADH) Rationale: Cancer (especially lung cancers) increases the risk of the patient developing SIADH. Other risk factors include recent head trauma, cerebrovascular disease, and tuberculosis or other pulmonary disease. A review of past and current medications is also important in searching for the cause of SIADH. (Source: Access May 18, 2014, from http://emedicine.medscape.com/article/280104-clinical.) CHAPTER 62 POWERPOINT Exam 4

3. Answer: D. Administration of oxygen and observation of the heart rhythm Rationale: Current advanced cardiac life support (ACLS) guidelines recommend administration of oxygen and observation of heart rhythm first, followed by administration of an IV antidysrhythmic agent such as amiodarone mixed with dextrose 5%. Synchronized cardioversion would be the next step. CPR and immediate defibrillation would be used only to treat unstable VT. CHAPTER 34 POWERPOINT Exam 3A

3. On a telemetry monitor, the nurse observes that a patient's heart rhythm is sustained ventricular tachycardia (VT). Upon assessment, the patient is alert and oriented with no reports of chest pain, but expresses feeling slightly short of breath. His blood pressure is 108/70. What is the nurse's first action? A. Synchronized cardioversion B. CPR and immediate defibrillation C. Administration of IV amiodarone (Cordarone) and dextrose D. Administration of oxygen and observation of the heart rhythm

3. Answer: B. Weight gain Rationale: Weight gain is the best indicator of fluid retention and is commonly called edema. CHAPTER 33 POWERPOINT Exam 3A

3. The nurse understands that which assessment finding is the best indicator of fluid retention? A. Tachycardia B. Weight gain C. Crackles in the lungs D. Increased blood pressure

4. Which patient statement about self-care indicates a need for further teaching by the nurse? A. "I am going to swim at the YWCA." B. "Low-fat yogurt is on my grocery list." C. "My husband is getting rid of our throw rugs." D. "Joining a bowling team will help me exercise."

4 Answer: D "Joining a bowling team will help me exercise Bowling should be avoided for patients with osteoporosis because it can contribute to compression fractures. Swimming, eating yogurt, and eliminating throw rugs in the house are all appropriate considerations for the patient with osteoporosis. CHAPTER 50 POWERPOINT Exam 5

4. When using a 5-electrode lead ECG monitoring system, the nurse recognizes which lead is most optimal for detecting dysrhythmias? A. III B. V1 C. V5 D. aVR

4. Answer: B V1 Rationale: Five-electrode ECG monitoring systems use four electrode leads to provide six limb lead tracings (leads I, II, III, aVR, aVL, or aVF) and the fifth electrode lead is a chest electrode that can be placed in any of the standard V1 to V6 locations. But in general, V1 is selected because of its value in detecting dysrhythmias (e.g., arrhythmia monitoring). (Source: Accessed March 25, 2014, http://circ.ahajournals.org/content/110/17/2721.full.) CHAPTER 34 POWERPOINT Exam 3A

4. The patient is preparing to go home. What important teaching points should the nurse include in discharge teaching? (Select all that apply.) A. "Your diet should be low-fiber, but with plenty of fluids." B. "Note how many hours you sleep in a 24-hr period." C. "Report any difficulty with orientation to time, place, or person." D. "Be sure that you take your medication every day at the same time." E. "Call the provider if you develop an unsteady gait or tremors in your hands."

4. Answer: B, C, D, E B. "Note how many hours you sleep in a 24-hr period." C. "Report any difficulty with orientation to time, place, or person." D. "Be sure that you take your medication every day at the same time." E. "Call the provider if you develop an unsteady gait or tremors in your hands." The patient's diet should include fiber to prevent constipation. If the patient is constipated, the dose of replacement thyroid hormone may need to be increased. Sleep should be monitored because when the patient has difficulty getting to sleep, the dose may need to be decreased. Changes in orientation, gait, or development of tremors may require an alteration in dose of replacement thyroid hormone. Medication should be taken at the same time daily. CHAPTER 63 POWERPOINT Exam 4

4. In 2013, the ACA/AHA developed guidelines to reduce cardiovascular risk and decrease blood pressure. Which interventions relate to these guidelines? (Select all that apply.) A. Use only sugar in beverages. B. Engage in aerobic exercise 3 to 4 times per week. C. Develop a dietary plan that includes fish, legumes, and nuts. D. Include at least 3000 mg of sodium per day in the dietary plan. E. Encourage a dietary pattern of vegetables, fruits, and whole grains.

4. Answer: B, C, E B. Engage in aerobic exercise 3 to 4 times per week. C. Develop a dietary plan that includes fish, legumes, and nuts. E. Encourage a dietary pattern of vegetables, fruits, and whole grains. • The 2013 ACA/AHA Guidelines on Lifestyle Management to Reduce Cardiovascular Risk outline evidence-based dietary and exercise practices to help lower blood pressure (Eckel et al., 2013). These guidelines are similar to the Dietary Approaches to Stop Hypertension (DASH) and include: • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains. • Consume low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts in the diet. • Limit intake of sweets, sugar-sweetened beverages and red meats. • Lower sodium intake to no more than 2400 mg of sodium per day; a limit of 1500 mg of sodium per day is preferred. • Engage in aerobic physical activity 3 or 4 times a week. Each session should last for 40 minutes on average and involve moderate-to-vigorous physical activity CHAPTER 36 POWERPOINT Exam 3B

. The nurse is caring for a group of patients on the pulmonary unit. Which patient is at greatest risk for having pulmonary hypertension (PH)? A. 29-year old male who is overweight B. 32-year-old female with a family history of PH C. 43-year-old male with history of right-sided heart failure D. 50-year-old female with history of blood clots in the pulmonary artery

4. Answer: B. 32-year-old female with a family history of PH Rationale: Family history is a primary risk assessment variable related to pulmonary hypertension (PH) and pulmonary artery hypertension (PAH). The disease usually develops between the ages of 20 to 60, and occurs more often in women. Other risk factors include obesity, heart and lung diseases, HIV infection, and history of pulmonary embolisms. (Source: Accessed March 29, 2014, from http://www.nhlbi.nih.gov/health/dci/Diseases/pah/pah_risk.html) CHAPTER 30 POWERPOINT Exam 2

4. Over the next hour, the patient continues to decline with a decreased level of consciousness and a temperature of 103.8º F. BP is 80/40, HR is 134, and RR is 34. The nurse calls the provider to report these findings and obtain orders for the patient to be transferred to the ICU. When preparing for this transfer, the nurse notes that the O2 saturation is 87% on room air. What is the priority nursing action? A. Draw an arterial blood gas sample. B. Apply oxygen at 2 to 3 L per nasal cannula. C. Administer acetaminophen 650 mg by mouth. D. Place the patient on a cardiac telemetry monitor.

4. Answer: B. Apply oxygen at 2 to 3 L per nasal cannula. The patient is gravely ill. The first priority is his airway. He has a rapid respiratory rate and a low SaO2, so supplemental oxygen should be applied first. His elevated temperature should also be addressed. The nurse may choose to call the Rapid Response Team to help stabilize the patient, even though he is being transferred to the ICU. CHAPTER 37 POWERPOINT Exam 3B

4. The nurse expects what outcome in a patient who is taking a beta blocker for mild heart failure? A. Improved urinary output B. Improved activity tolerance C. Increased myocardial contractility D. Increased myocardial oxygen

4. Answer: B. Improved activity tolerance Rationale: Beta-blocker therapy for mild and moderate heart failure can lead to improvement in symptoms, including improved activity tolerance and less orthopnea. CHAPTER 35 POWERPOINT Exam 3B

. A middle-aged patient has a tight cast on the left lower leg. Which assessment finding would prompt the nurse to assess further for compartment syndrome? A. Diminished pulses B. Discoloration of some of the toes C. Tingling sensation of the upper leg D. Pain more intense than expected based on initial injury

4. Answer: D. Pain more intense than expected based on initial injury Rationale: The classic sign of acute compartment syndrome is pain, and the pain is more intense than what would be expected from the injury itself. Other symptoms include tingling or burning sensations (paresthesias) in the skin. Decreased pulses and numbness or paralysis are late signs of compartment syndrome. (Source: Accessed April 29, 2014, from http://orthoinfo.aaos.org/topic.cfm?topic=A00204.) CHAPTER 51 POWERPOINT Exam 5

Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from happening again. What should the nurse teach the patient and his wife? (Select all that apply.) A. Monitor glucose whenever the patient is ill. B. Decrease fluid intake when nausea and vomiting occur. C. Watch for and report any illness lasting more than 1 to 2 days. D. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced. E. Check urine ketones when blood glucose is greater than 300 mg/dL.

5. Answer: A,C, D, E A. Monitor glucose whenever the patient is ill. C. Watch for and report any illness lasting more than 1 to 2 days. D. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced. E. Check urine ketones when blood glucose is greater than 300 mg/dL. It is important to teach the patient to reduce the risk of dehydration by maintaining fluid and food intake. Small amounts of fluid may be tolerated even when vomiting is present. The patient should drink at least 3 L of fluid daily and increase this amount when infection is present. CHAPTER 64 POWERPOINT Exam 4

5. As the nurse is assessing a patient with Grave's disease, which finding requires immediate attention? A. Elevated temperature B. Elevated blood pressure C. Change in respiratory rate D. Irregular heart rate and rhythm

5. Answer: A. Elevated temperature Rationale: Increases in temperature may indicate a rapid worsening of the patient's condition and the onset of "thyroid storm." Further evaluation of cardiovascular status is warranted. CHAPTER 63 POWERPOINT Exam 4

5. A patient with cardiovascular disease is prescribed a potassium-wasting diuretic. The nurse will recommend that the patient consume which food to help prevent hypokalemia? A. Dried figs B. Red apples C. Raw avocados D. Baked potatoes

5. Answer: D Baked potatoes • Rationale: Many fruits, beans, and vegetables are high in potassium; however, a baked potato has approximately 1000 mg of potassium, an avocado has 180 mg, dried figs have 271 mg, and an apple has 160 mg. The patient should be encouraged to read nutrition labels for nutrient information as well.

5 The nurse is taking a patient for testing to determine the extent of injury sustained to the patient's knee when a fall occurred at work. The nurse explains that which diagnostic test best demonstrates musculoskeletal and soft tissue damage? A. Standard x-rays B. Electromyography (EMG) C. Computed tomography (CT) D. Magnetic resonance imaging (MRI)

5. Answer: D. Magnetic resonance imaging (MRI) Rationale: MRI is useful in determining the amount of soft tissue damage that may have occurred with the fracture. Standard x-rays and CT are helpful in determining simple and complex bone fractures. EMG assists with diagnosis problems associated with muscles. CHAPTER 51 POWERPOINT Exam 5

5. The patient's condition improves, and he is returned to the cardiac stepdown unit. He is to be discharged after 6 days in the hospital. What patient teaching should you provide before he is discharged from the hospital?

5. Assist the patient in securing personal medical identification alert devices that provide i information regarding his heart condition. In collaboration with the interdisciplinary health care team, assess the patient for activity tolerance and help design an appropriate exercise regimen. • Teach about the signs and symptoms of cardiovascular disease and when to seek medical assistance. • Instruct him about all of his current medications and the most common side effects. • Give him printed information as needed. • Teach him the importance of decreasing the risk for CAD. • Be sure that he has adequate support at home after discharge from the hospital. CHAPTER 38 POWERPOINT Exam 3B

5. Two hours later, laboratory values are drawn to investigate the patient's symptoms. The results are: Sodium 136 mEq/L HCT 41.6% Potassium 4.6 mEq/L HGB 12.8 g/dL Calcium 8.9 mg/dL ESR 28 mm/hr Are any of these results of concern?

5. CBC and electrolytes (sodium, potassium, calcium, HCT, and HGB) are within normal limits. The patient's ESR is high-normal, which is common in patients with osteoarthritis. Results from your sed rate test will be reported in the distance in millimeters (mm) that red blood cells have descended in one hour (hr). The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women. CHAPTER 18 POWERPOINT Exam 5

5. The provider orders calcium 1.5 g orally twice a day (1 g in the morning and 500 mg at bedtime). The patient asks why she must drink extra fluids with this medication. What is the best response by the nurse? 1. The patient also asks why she can't just take the calcium once a day. What is the best response by the nurse?

5. Increased fluid intake helps prevent the formation of calcium-based urinary stones. A third of the daily dose should be given at bedtime because calcium is most readily utilized by the body when the patient is fasting and immobile. CHAPTER 50 POWERPOINT Exam 5

5. Within 30 minutes of the patient's transfer to the ICU, his condition continues to deteriorate. His SaO2 continues to fall, RR is 36/min, and the ICU nurse notes that there is blood oozing around his IV catheter sites. A Foley catheter is placed, and his urine output is minimal. What is the nurse's interpretation of these assessment findings?

5. The patient is going into severe sepsis. The main manifestations are low oxygen saturation, rapid respiratory rate, decreased to absent urine output, and changes in cognition. He is at risk for septic shock. The blood oozing around his IV catheters may indicate the presence of DIC. CHAPTER 37 POWERPOINT Exam 3B

6. During a community education program the nurse is asked about the risk of a woman breaking a bone due to osteoporosis after age 50. The nurse knows which of the following is the risk? A. 1 in 2 women B. 1 in 5 women C. 1 in 7 women D. 1 in 10 women

6. Answer: A 1 in 2 women Rationale: One in two women over the age of 50 will break a bone because of osteoporosis. A woman's risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian, and uterine cancer combined. Women have lighter, thinner bones than men. Many women also lose bone quickly after menopause. Up to one in four men over the age of 50 will break a bone because of osteoporosis. A man older than age 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer. (Source: Accessed April 29, 2014 from http://nof.org/articles/235.) CHAPTER 50 POWERPOINT Exam 5

6. What is the priority nursing intervention for an older female patient with a history of hyperparathyroidism? A. Implement fall precautions. B. Encourage oral fluid hydration. C. Encourage small frequent meals. D. Provide pain medications as prescribed.

6. Answer: A Implement fall precautions. Rationale: Manifestations of hyperparathyroidism may present as bone lesions, pathologic fractures, bone cysts, and osteoporosis. Preventing falls is a priority nursing intervention. Fluid hydration may be used to treat hypercalcemia. Small frequent meals can assist with nutritional need. CHAPTER 63 POWERPOINT Exam 4

6. The older patient with coronary artery disease (CAD) is more likely to have what symptom if experiencing cardiac ischemia? A. Syncope B. Dyspnea C. Chest pain D. Depression

6. Answer: B Dyspnea Rationale: Chest pain may not be evident in the older patient with CAD. Associated symptoms such as unexplained dyspnea, confusion, or GI symptoms may be noted. CHAPTER 38 POWERPOINT Exam 3B

6. A 37-year-old male is admitted with a severely abscessed tooth, BP 90/42, HR 136, RR 28, Spo2 90% on room air, temperature 38.7º C. The nurse suspects that the patient has developed sepsis. What is the priority nursing intervention? A. Insert an indwelling urinary catheter. B. Initiate intravenous fluid resuscitation. C. Obtain a complete chemistry for laboratory analysis. D. Administer prescribed antibiotics prior to blood cultures.

6. Answer: B. Initiate intravenous fluid resuscitation. Rationale: Initiating IV fluids is the primary intervention, followed by obtaining laboratory values, blood cultures, and providing oxygen. Antibiotics should be started ASAP, however, after blood cultures are obtained. An indwelling urinary catheter is lower in the list of necessary priority interventions. The Surviving Sepsis Campaign and IHI Sepsis Bundle provide guidelines for interventions for early resuscitation and treatment of patients with sepsis. Once a patient is suspected of sepsis, the following items (initiated within 6 hours and completed within the first 24 hours) have been found to enhance survival: (1) Obtain, monitor and treat serum lactate. (2) Obtain blood cultures prior to antibiotics. (3) Administer broad spectrum antibiotics as soon as possible. (4) Aggressively treat hypotension with IV fluids. (5) Apply vasopressor agents for hypotension that does not respond to fluids. (6) Assess and maximize tissue oxygenation (monitor SVO2). (See Table 37-5, p. 753.) CHAPTER 37 POWERPOINT Exam 3B

6. Which population group is most likely to be diagnosed with fibromyalgia syndrome? A. Men between 30 and 50 years of age B. Men between 50 and 70 years of age C. Women between 30 and 50 years of age D. Women between 50 and 70 years of age

6. Answer: C Women between 30 and 50 years of age Rationale: Most patients diagnosed with fibromyalgia syndrome are women between 30 and 50 years of age CHAPTER 18 POWERPOINT Exam 5

6. What is the most common symptom associated with hypertension? A. Headache B. Slurred speech C. Fainting and dizziness D. Hypertension is often asymptomatic

6. Answer: D. Hypertension is often asymptomatic • Rationale: Hypertension is often asymptomatic and has become known as the "silent killer" due to the lack of symptoms. Headaches may occur but not always. Hypertension does not cause slurred speech or fainting. • Source: Retrieved March 26, 2014 from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/SymptomsDiagnosisMonitoringofHighBloodPressure/What-are-the-Symptoms-of-High-Blood-Pressure_UCM_301871_Article.jsp%29 CHAPTER 36 POWERPOINT Exam 3B

7. When developing a postoperative plan of care for a patient after a total thyroidectomy, the nurse knows the plan should include which intervention? A. Avoiding extending the patient's neck B. Assessing the patient's voice once per shift C. Encouraging the patient to be out of bed in a chair D. Administering oxygen via nasal cannula as needed

7. Answer: A Avoiding extending the patient's neck Rationale: The nurse should avoid extending the patient's neck to decrease tension on the suture line. The air in the patient's room should be humidified to promote easier respirations and thin respiratory secretions. The patient's voice should be assessed for changes every 2 hours. Sandbags or pillows should be used to support the patient's head or neck, and the patient should be placed in a semi-Fowler's position. CHAPTER 63 POWERPOINT Exam 4

When caring for a patient having a hypoglycemic episode, the nurse knows which symptom requires immediate intervention? A. Hunger B. Confusion C. Headache D. Tachycardia

7. Answer: B Confusion Rationale: Glucose is necessary for brain function. Confusion is a marker of severe hypoglycemia requiring immediate intervention. Irritability/anxiety, hunger, tachycardia, headache, sweating, and seizures are additional signs of hypoglycemia. CHAPTER 64 POWERPOINT Exam 4

7. When assessing a patient for shock, the nurse knows that which symptom is the earliest manifestation of shock? A. Anuria B. Increased heart rate C. A decrease in respiratory rate and depth D. A change in both systolic and diastolic blood pressure

7. Answer: B. Increased heart rate Rationale: The earliest clinical signs of hypovolemic shock are cardiovascular: increased heart rate and respiratory rate are the earliest manifestations of shock. Changes in systolic blood pressure are not always present in the initial stage of shock because of compensatory mechanisms and should not be used as the main indicator of shock presence or progression. CHAPTER 37 POWERPOINT Exam 3B

7. The nurse is assessing a patient who has undergone total knee arthroplasty for which continuous femoral nerve blockade was utilized. The nurse notes that the patient is anxious. Vital signs include BP 92/58, HR 62, RR 12, and SpO2 89%. What is the priority nursing intervention? A. Take vital signs every 10 minutes. B. Notify physician of the vital signs. C. Anticipate administering IV fluids. D. Notify the Rapid Response Team.

7. Answer: D Notify the Rapid Response Team Rationale: Although patients having continuous femoral nerve blockade after TKA have been found to require fewer opioids and antiemetics postoperatively, symptoms that may indicate the local anesthetic is getting into the patient's system include metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, and seizures. This patient's vital signs suggest instability, and a Rapid Response Team should be activated immediately. CHAPTER 18 POWERPOINT Exam 5

7. The nurse knows that a patient with Paget's disease is at greatest risk for developing which complication? A. Kidney stones B. Cardiac failure C. Chronic fatigue syndrome D. Pathologic bone fractures

7. Answer: D Pathologic bone fractures Rationale: Pathologic fractures may be the presenting clinical manifestation of the disorder. The femur and the tibia are most often affected, and fracture of these bones can result from minimal trauma. Patients with Paget's disease frequently are fatigued and, although less common, may develop kidney stones, gout, and heart failure. CHAPTER 50 POWERPOINT Exam 5

8. Which symptom specifically in older patients presenting with acute osteomyelitis would require immediate nursing intervention? A. Pain B. Fatigue C. Low-grade fever D. Elevated leukocyte count

8. Answer: A Pain Rationale: Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte count, fatigue, and general malaise. However, older adults may not have an extreme temperature elevation because of lower core body temperature and compromised immune system that occur with normal aging. CHAPTER 50 POWERPOINT Exam 5

8. During a health history assessment, a patient with rheumatoid arthritis, chronic hypertension, and diagnosis of a recent cerebrovascular accident states that she takes 2 fish oil capsules (5 g) daily as a supplement for her RA. What additional question(s) should the nurse ask? (Select all that apply.) A. "Are you taking anticoagulant medications?" B. "Have you found the fish oil to help your RA?" C. "What other supplements do you currently take?" D. "How long have you been taking fish oil capsules?" E. "Have you notified your physician about taking fish oil capsules?"

8. Answer: A, B, C, D, E A. "Are you taking anticoagulant medications?" B. "Have you found the fish oil to help your RA?" C. "What other supplements do you currently take?" D. "How long have you been taking fish oil capsules?" E. "Have you notified your physician about taking fish oil capsules?" Rationale: Some supplements have been found to help decrease inflammation and prevent bone loss for patients with RA. These supplements include calcium, fish oil capsules containing omega-3 fatty acids, and gamma-linolenic acid. Calcium supplements should not be taken in excess to prevent kidney stones, and fish oil capsules should not be taken if the patient is taking anticoagulant therapy. The nurse should ask all questions in A, B, C, D, and E as part of a complete health history. CHAPTER 18 POWERPOINT Exam 5

8. A patient presents to the ED and is diagnosed with an acute MI. The patient's spouse asks what type of damage has been caused by the "heart attack." What is the appropriate nursing response? A. "The pain is controlled, so there is no damage." B. "It will take years to know the extent of the damage to the heart muscle." C. "The medication will dilate the blood vessels and any damage will be corrected." D. "A heart attack evolves over several hours. We won't know the extent of the damage immediately."

8. Answer: D "A heart attack evolves over several hours. We won't know the extent of the damage immediately." Infarction is a dynamic process that does not occur instantly. The MI evolves over a period of several hours. Controlled pain does not indicate that there is no cardiac muscle damage. The medications do vasodilate to prevent further damage. They do not correct damage that has already been incurred. CHAPTER 38 POWERPOINT Exam 3B

8. Which clinical manifestations does the nurse recognize that indicates worsening in the condition of a patient in the refractory phase of shock? A. Warm, flushed skin B. Urine output of 20 mL/hr C. Increasing respiratory rate D. Bleeding, oozing from IV sites

8. Answer: D. Bleeding, oozing from IV sites • Rationale: The onset of disseminated intravascular coagulation (DIC) as evidenced by bleeding to include oozing from IV sites indicates a consumption of clotting factors that occurs in the refractory stage of shock. The refractory stage or irreversible stage of shock occurs when too much cell death and tissue damage result from too little oxygen reaching the tissues. Vital organs have overwhelming damage. The body can no longer respond effectively to interventions and shock continues. The patient usually requires full system support (for example, mechanical ventilation, vasopressor agents, renal support [dialysis]), rapid loss of consciousness; nonpalpable pulse; cold, dusky extremities; slow, shallow respirations; and unmeasurable oxygen saturation. CHAPTER 37 POWERPOINT Exam 3B

The nurse recognizes that a patient with sleep apnea may benefit from which intervention(s)? (Select all that apply.) A. Weight loss B. Nasal mask to deliver BiPAP C. A change in sleeping position D. Medication to increase daytime sleepiness E. Position-fixing device that prevents tongue subluxation

Answer: A, B, C, E A. Weight loss B. Nasal mask to deliver BiPAP C. A change in sleeping position E. Position-fixing device that prevents tongue subluxation Rationale: All interventions listed are viable interventions that can be of benefit to patients who have sleep apnea. Patients should work with their providers of care to determine the severity of their sleep apnea and which specific interventions would be of most importance to them. Encouraging daytime sleepiness is the opposite of the effect needed for this patient. CHAPTER 29 POWERPOINT Exam 2

4. The nurse is caring for a patient admitted for treatment of neck and throat cancer. Which intervention should the nurse perform? A. Encourage hydration with water. B. Feed the patient if coughing occurs. C. Encourage the patient to sit in a chair for meals. D. Encourage the patient to drink juice to address thirst.

Answer: C. Encourage the patient to sit in a chair for meals. Rationale: Several interventions are necessary to reduce the risk of aspiration. Having the patient sit upright to eat is an important initial step to reduce aspiration. Other interventions include encouraging liquids that are "thick." Avoiding thin liquids like juice, water, and fruits that produce juice are important strategies to reduce aspiration risks. Coughing may be a sign of difficulty with swallowing or aspiration and requires additional assessment. CHAPTER 29 POWERPOINT Exam 2

1. What atypical symptoms might a woman who is having a myocardial infarction experience? A. Sudden, intermittent, stabbing chest pain B. Moderate ache in the chest that is worse on inspiration C. Indigestion, feelings of chronic fatigue, and a choking sensation D. Pain that spreads across the chest and back and/or radiates down the arm

Answer: C. Indigestion, feelings of chronic fatigue, and a choking sensation Rationale: Some patients, especially women, do not experience pain in the chest with a myocardial infarction, but instead feel discomfort or indigestion. Women often present with a "triad" of symptoms. In addition to indigestion or feeling of abdominal fullness, feelings of chronic fatigue despite adequate rest and feelings of "inability to catch one's breath" are also attributable to heart disease. The patient may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or viselike. CHAPTER 33 POWERPOINT Exam 3A

5 The nurse is caring for a patient admitted to the ED after experiencing a fall while rock climbing. The patient has several facial fractures. Which objective assessment finding is most serious? A. Malaligned nasal bridge B. Blood draining from one of the nares C. Crackling of the skin (crepitus) upon palpation D. Clear glucose positive fluid draining from nares

Answer: D. Clear glucose positive fluid draining from nares Rationale: Blood or clear fluid (cerebrospinal fluid, or CSF) may drain from one or both nares. However, the presence of glucose in the clear drainage indicates that CSF is draining, which could be caused by a skull fracture, a serious complication. A malaligned nasal bridge and crepitus may be observed when evaluating general facial fractures. CHAPTER 29 POWERPOINT Exam 2