Complex Health Alterations Final Exam Review

A client with type 1 diabetes is admitted to the ED with dehydration following the flu. The client has a blood glucose level of 325 mg/dl and a potassium level of 3.5 meq. The nurse should question the order for which of the following IV fluids for the patient? a. LR b. NS c. D5W d. 0.45%NS

D5W

A client regularly takes Acetaminophen (Tylenol) for chronic arthritis. Which finding would indicate possible acetaminophen toxicity? a. WBC 5,500 mm3 b. Platelets 350,000 c. Direct bilirubin 2.0 mg/dL d. Aspartate aminotransferase (AST) 30 u/L

Direct bilirubin 2.0 mg/dL

Which of the following would be an appropriate expected outcome for an adult client with well controlled asthma? a. chest x-ray demonstrates minimal hyperinflation b. temperature remains lower than 100 F c. ABG's demonstrate a decrease in PaO2 d. Breath sounds are clear

Breath sounds are clear

What might be a treatment indicated for this client?

Calm patient down, slow breathing, breathe into paper bag

List populations at risk for under treatment of pain:

Children, infants, elderly, addicts

The client with type 1 DM is taught to take NPH insulin at 5 pm each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time? a. 1100 b. 1300 c. 1600 d. 0100

0100

Hypomagnesemia is a serum level below__________. Clinical signs of this include:

1.5 meq/dL hyperactive dtr, paresthesia, tetany, positive C/T

A client who takes 325mg ASA daily develops prolonged bleeding from a superficial injury. The nurse recognizes this most likely reflects: a. A PT of 10 seconds b. aPTT of 34 seconds c. A bleeding time of 12 minutes d. An AST of 32

A bleeding time of 12 minutes

A nurse reviews the serum phosphorus level and notes client's is 2.0 mg/dL. Which condition most likely caused this serum phosphorus level? a. Alcoholism b. Hypoparathyroidism c. Tumor lysis syndrome d. Renal insufficiency

Alcoholism

Provide examples of adjuvant medications for neuropathic pain.

Amitriptyline, gabapentin

Identify if symptom/condition is related to fluid volume excess (FVE) or fluid volume deficit (FVD) a. rales b. bulging neck veins c. hypotension d. weight gain e. decreased central venous pressure f. bounding pulses g. SIADH h. Diabetes Insipidus i. hemorrhage

FVE: rales bulging neck veins weight gain bounding pulses SIADH FVD: hypotension decreased central venous pressure Diabetes Insipidus hemorrhage

Explain how each hormone affects blood glucose levels: a. glucagon b. insulin

Glucagon: glycogenolysis is the conversion of glycogen to glucose and gluconeogenesis: conversion of protein to glucose; insulin decreases blood glucose

A client is prescribed Isoniazid and rifampin for tuberculosis. A nurse reviews the medical record of the client. Which of the following, if noted, would require notifying the physician? a. Heart disease b. Allergy to penicillin c. Hepatitis B d. Rheumatic fever

Hepatitis B

A client with a history of acquired thrombocytopenia has been instructed on how to prevent and control hemorrhage. Which statement indicates that the client needs more teaching? a. I can apply direct pressure to cuts for at least 5-10 minutes to stop a venous bleed. b. I can count the number of tissues saturated to detect blood loss during a nosebleed. c. I can take hormones to decrease blood loss during my menses d. I can count the number of pads to detect excess blood loss during my menses.

I can count the number of tissues saturated to detect blood loss during a nosebleed.

Which is a priority nursing diagnosis for the client with a total laryngectomy due to cancer? a. Deficient fluid volume r/t difficulty swallowing b. Impaired verbal communication r/t inability to speak c. Feeding self-care deficit r/t inability to swallow d. Powerlessness r/t diagnosis of cancer

Impaired verbal communication r/t inability to speak

The following are causes of sickle cell crisis:

Infections, stress, hypoxia, dehydration

Explain the rationale for using insulin and glucose to treat hyperkalemia:

Insulin facilitates movement of potassium from intravascular to ICF

The nurse knows that the client with pernicious anemia will have which distinguishing lab findings? a. RBC's 5 million b. Sed rate 16 mm/hr c. Intrinsic factor- absent d. Schillings test- elevated

Intrinsic factor- absent

What is the coolest thing about ketorolac?

Ketorolac is the only NSAID that can be administered IVP

How will fluid shift with administration of each solution? ICF -> ECF ICF <- ECF No fluid shift a. LR- b. NS 0.9%- c. D5W- d. D5 0.5%NS- e. 0.45%NS- f. 3%NS-

LR- no shift NS 0.9%- no shift D5W- ecf to icf D5 0.5%NS- ecf to icf 0.45%NS- ecf to icf 3%NS- icf to ecf

In a client who has excessively used oral antacids, the nurse knows that this can result in which acid/base disturbance? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

Metabolic alkalosis

Ibuprofen is an appropriate analgesic for ________ pain and works by:

Mild; decreasing prostaglandins

The physician has ordered IV naloxone to reverse respiratory depression from morphine administration. Which intervention would be most appropriate after giving naloxone? a. Check respirations in 5 minutes as naloxone is immediately effective b. Check respirations in 30 minutes as the morphine effect will have worn off by then c. Monitor respirations frequently for 4-6 hours because client may need naloxone repeated d. Monitor respirations each time the client receives morphine sulfate 10 mg IM.

Monitor respirations frequently for 4-6 hours because client may need naloxone repeated

Which is the best indicator of a client's need for pharmacological pain intervention? a. Blood pressure 140/80 b. Pain rating of 9 c. Stage 4 decubitus ulcer on coccyx d. Bone metastasis

Pain rating of 9

The nurse cares for a client with renal failure. Blood gases indicate a pH of 7.30, PCO2 of 32 mm/Hg, HCO3 of 20 meq/L. Which of the following lab values would be expected to also note? a. phosphorus level 4.0 mg/dl b. Potassium of 5.6 meq/L c. Magnesium 2.0 mg/dl d. Sodium 145 meq/

Potassium of 5.6 meq/L

The nurse prepares to administer IV potassium chloride as prescribed to a client with hypokalemia. Which would not be a part of the nurse's plan regarding the preparation and administration of potassium? a. Prepare for bolus administration b. Obtain a IV infusion pump c. Dilute in appropriate amount of normal saline d. Monitor urine output during infusion

Prepare for bolus administration

A client is to receive epoetin injections. What lab value should the nurse assess before giving the injection? a. RBC b. PTT c. Hemoglobin d. PT

RBC

The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's disease is present, the histologic exam will reveal: a. Tay Sachs cells b. Sarcoidosis cells c. Reed Sternberg cells d. Duchenne's cells

Reed Sternberg cells

A nurse plans care for a patient with COPD knowing that this patient is most likely to experience what type of acid-base imbalance? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

Respiratory acidosis

A client with reported shortness of breath and tingling in his fingers presents to the ER with shallow rapid breathing. Blood glucose is normal. No EKG changes noted. No respiratory or cardiac history noted. He uses several anti- anxiety meds. ABG's are done: pH 7.48, PaCO2 28mmHg; PaO2 85mm Hg; HCO3 22meq/L. What acid/base imbalance, if any is he experiencing? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

Respiratory alkalosis

The patient with idiopathic thrombocytopenic purpura (ITP) asks why she must take steroids. The best response is: a. Steroids destroy the antibodies and prolong platelet life. b. Steroids neutralize the antigens and prolong platelet life. c. Steroids increase phagocytosis and increase platelet life. d. Steroids alter the spleen's recognition of platelets and increase the life of platelets.

Steroids alter the spleen's recognition of platelets and increase the life of platelets.

How does the nurse illicit the Chvostek's sign? What does this imply if positive?

Tap cheek in front of ear; hypocalcemia

A nine-month-old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mom does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is: a. The child will become dehydrated if the supplement is not taken b. The child needs these enzymes to help the digestive system absorb fats, carbohydrates, and proteins. c. The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear. d. The child will experience severe diarrhea if the supplement is not taken.

The child needs these enzymes to help the digestive system absorb fats, carbohydrates, and proteins.

Which of the following areas is a priority to evaluate when completing discharge planning for a client who has had a lobectomy for lung cancer treatment? a. The support available to assist the client at home b. The distance the client lives from the hospital c. the client ability to do home blood pressure monitoring d. the client knowledge of the causes of lung cancer

The support available to assist the client at home

A patient has the following electrolyte results: Na 133 meq/L; K 3.4 meq/L. Which of the following treatments likely resulted in these values? a. Three tap water enemas b. 0.9%NaCl at 50 ml/hr c. D5W with 20mEq potassium at 80ml/hr d. Administration of glucocorticoids

Three tap water enemas

The nurse is reviewing a patient's labs and finds the serum calcium to be 4.0 mg/dL. The nurse understands that which condition most likely caused this serum calcium level? a. Vitamin D deficiency b. Excessive administration of Vitamin D c. Bone metastases d. Hyperparathyroidism

Vitamin D deficiency

A nurse caring for a patient with bone marrow suppression would report the following. Select all that apply. a. WBC 3500/mm3 b. RBC 4/mm3 c. Platelets 100,000/mm3 d. Oral temp 100.5*F e. Hemoglobin 12g/L

WBC 3500/mm3 Platelets 100,000/mm3 Oral temp 100.5*F

A client is admitted for iron deficiency anemia with bloody emesis. Which question would be most appropriate to ask in determining the extent of the client's activity intolerance? a. What activities could you do 6 months ago compared to now? b. How long have you had this problem? c. Have you been able to keep up with your usual activities? d. Are you more tired than you used to be?

What activities could you do 6 months ago compared to now?

While at a home visit, a diabetic client tells the nurse, "I just can't stand the thought of giving myself a shot every day." Which of the following would be the best response? a. If you do not give yourself your insulin shots, you will die. b. We can teach your daughter so you won't have to do it. c. I can arrange for a homecare nurse to come every day to give you your shot. d. What is it about giving yourself insulin shots that bothers you?

What is it about giving yourself insulin shots that bothers you?

A client says I don't want any more tests. "Who cares what kind of leukemia this is? I just want to be treated now." What is the best response for the nurse? a. I'm sure you are frustrated and want to be well now. b. Your treatment can be more effective if it is based on more specific information about your disease. c. Now, you know these tests are needed and you are just upset right now. d. I understand.

Your treatment can be more effective if it is based on more specific information about your disease.

A nurse cares for a group of clients and reviews labs. A potassium level of 5.5 is noted on one client's report. The nurse knows that which client is most at risk for developing this potassium value? a. a client who has been abusing laxatives b. a client with colitis c. a client with a traumatic burn d. a client with Cushing's Syndrome

a client with a traumatic burn

A community nurse is conducting education with community members regarding tuberculosis. The nurse tells the group that the first symptom associated with TB is: a. bloody productive cough b. a productive morning cough c. chest pain d. dyspnea

a productive morning cough

When teaching the client with MI, the nurse explains that pain associated with MI is caused by: a. left ventricular overload b. impending circulatory collapse c. extracellular electrolyte imbalance d. insufficient oxygen reaching the heart muscle

insufficient oxygen reaching the heart muscle

Interpret the following ABGs a. pH 7.62 PaCO2 48 mmHg HCO3 45 meq/L b. pH 7.26 PaCO2 56 mmHg HCO3 24 meq/L c. pH 7.38 PaCO2 76 mmHg HCO3 42 meq/L d. pH 7.52 PaCO2 30 mmHg HCO3 24 meq/L

a. Partially compensated metabolic alkalosis b. Uncompensated respiratory acidosis c. Compensated respiratory acidosis d. Uncompensated respiratory alkalosis

What is the antidote for acetaminophen toxicity?

acetylcysteine (Mucomyst)

A client is scheduled for a cardiac cath using radiopaque dye. Which of the following assessments is most critical prior to the procedure? a. intake and output b. baseline peripheral pulse rates c. height and weight d. allergy to shellfish and iodine

allergy to shellfish and iodine

The nurse watches the cardiac monitor; a client's rhythm suddenly changes. There are no P waves, instead wavy lines as the atria are not depolarizing effectively. The nurse interprets this rhythm as: a. sinus tachycardia b. atrial fibrillation c. ventricular tachycardia d. ventricular fibrillation

atrial fibrillation

When teaching a client about propranolol, the nurse should base the information on knowledge that propranolol: a. blocks beta adrenergic stimulation and thus decreases heart rate, myocardial contractility, and conduction b. increases nor epinephrine secretion and decreases blood pressure c. is a potent vasodilator that reduces peripheral vascular resistance d. is an angiotensin converting enzyme inhibitor that blocks aldosterone

blocks beta adrenergic stimulation and thus decreases heart rate, myocardial contractility, and conduction

The nurse knows that which of the following indicated a complication of diabetes mellitus? a. inflamed painful joints b. blood pressure of 158/100 c. creatinine 1.0 mg/dL d. hemoglobin of 9 g/dL

blood pressure of 158/100

The client with DM asks the nurse to recommend something to remove corns on his feet. The nurse would best advise him to: a. apply high quality corn plaster to area b. consult his physician/podiatrist to remove c. apply iodine before peeling them off d. soak feet in borax to peel off

consult his physician/podiatrist to remove

Which of the following sets of conditions is an indication that a client with a history of left sided heart failure is developing pulmonary edema? a. distended jugular veins and wheezing b. dependent edema and anorexia c. course crackles and tachycardia d. hypotension and tachycardia

course crackles and tachycardia

A nurse is caring for a patient with acute heart failure who is receiving high doses of furosemide. On assessment, the nurse notes that the client has flat neck veins and trending decreased urine output. The nurse suspects fluid volume deficit. Which other assessment finding would the nurse expect to find in this situation? a. crackles on auscultation b. increased BP c. decreased hematocrit d. decreased CVP

decreased CVP

The client with PAD asks the nurse why her legs hurt when she walks. The nurse bases her answer on the knowledge that the main characteristic of PAD is: a. decreased blood flow b. increased blood flow c. slow blood flow d. thrombus formation

decreased blood flow

A 10-year-old child with asthma is treated for acute exacerbation in the emergency room. A nurse reports which of the following, knowing that it is not an indication that the condition is improving? a. increased wheezing b. decreased wheezing c. warm dry skin d. a pulse rate of 90bpm

decreased wheezing

A client comes to the ED with diabetic ketoacidosis. The nurse should identify which of the following nursing diagnoses as a priority problem? a. insomnia b. ineffective health maintenance c. imbalance nutrition: less than body requires d. deficient fluid volume

deficient fluid volume

The client receiving thrombolytic therapy is expected to have an outcome of: a. improved cerebral perfusion b. decreased vascular permeability c. dissolved emboli d. prevention of further cerebral hemorrhage

dissolved emboli

Which of the following signs and symptoms should the nurse include in a teaching plan as an early warning sign of laryngeal cancer? Select all that apply a. dysphagia b. hoarseness c. back pain d. stomatitis e. throat pain f. diarrhea

dysphagia hoarseness throat pain

A client with DKA presents in the ED, which finding would a nurse expect to find in confirming this diagnosis? a. elevated blood glucose and low plasma bicarb b. decreased urine output c. increased respirations and increased pH d. comatose state

elevated blood glucose and low plasma bicarb

A client who had an exploratory laparotomy 3 days ago has a WBC diff with a shift to the left. The nurse instructs the unlicensed personnel to report which clinical manifestation? a. incisional swelling b. redness around incision c. elevated temperature d. purulent wound drainage

elevated temperature

The client realizes the importance of quitting smoking, and the nurse develops a plan to help the client achieve this goal. Which of the following nursing interventions should be the initial step in this plan? a. review the negative effects of smoking on the body b. discuss the effects of passive smoking on environmental pollution c. establish the client's daily smoking pattern d. explain how smoking worsens high blood pressure

establish the client's daily smoking pattern

The following clinical manifestations can be present in all types of anemia. Select all that apply: a. fatigue b. dyspnea c. red, beefy tongue d. tachycardia e. activity intolerance f. jaundice

fatigue dyspnea tachycardia activity intolerance

The client with pneumonia has a temperature of 102.6 F, is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care? a. position changes every 4 hours b. nasotracheal suctioning to clear secretions c. frequent linen changes d. frequent offering bedpan

frequent linen changes

A nurse is teaching a client with chronic respiratory failure to use a metered dose inhaler correctly. The nurse instructs the client to: a. inhale through the nose b. inhale quickly c. take two inhalations during one breath d. hold breath 5-10 secs after inhalation

hold breath 5-10 secs after inhalation

A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note in evaluating this client? a. increased O2 sat with exercise b. hypocapnia c. hyper inflated chest on x-ray d. widened diaphragm on chest x-ray

hyper inflated chest on x-ray

The nurse assesses a client with a suspected diagnosis of hypercalcemia. Which of the following sign/symptoms would be indicative of this diagnosis? a. hypoactive bowel sounds b. paresthesias c. hyperactive deep tendon reflexes d. positive Trousseau's sign

hypoactive bowel sounds

Which of the following is a priority nursing diagnosis for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness? a. imbalanced nutrition: less than body requires b. ineffective health maintenance r/t ineffective coping skills c. acute pain d. activity intolerance

imbalanced nutrition: less than body requires

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? a. incorporate physical exercise as tolerated into daily routine b. monitor peak flow numbers at mealtime and bedtime c. eliminate stressors at home and at work d. Use sedatives to ensure uninterrupted sleep

incorporate physical exercise as tolerated into daily routine

In order to avoid a common side effect of narcotic treatment, the nurse should encourage: a. eating a high protein diet b. increasing fresh fruits, vegetables, and whole grains c. decreasing fluid intake d. eating high potassium foods

increasing fresh fruits, vegetables, and whole grains

The nurse understands that a priority nursing diagnosis for the client with hypertension would be: a. pain b. deficient fluid volume c. impaired skin integrity d. ineffective health maintenance

ineffective health maintenance

The nurses assesses a patient with puffy eyelids, crackles bilaterally in bases, and bilateral ankle edema. The nurse knows that these clinical finding are most specifically associated with fluid excess in which of the following compartments? a. interstitial b. intravascular c. extracellular d. intracellular

interstitial

A nurse is caring for a patient who has a magnesium level of 3.9. Based on the knowledge of this electrolyte, what signs/symptoms would the nurse expect to see? a. nausea, decreased deep tendon reflexes, drowsiness/lethargy b. hyperactive reflexes c. positive Trousseau's sign d. hyperactivity

nausea decreased deep tendon reflexes drowsiness/lethargy

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after an aortoiliac bypass graft. The affected leg is warm and the nurse notes redness and edema. The pedal pulse is palpable and unchanged since admission. The nurse interprets this assessment as: a. normal, because of increased blood flow through leg b. slightly deteriorating c. moderately impaired; call the surgeon d. adequate from the arterial approach, but venous complications are arising

normal, because of increased blood flow through leg

A nurse reviews the blood gas results of a patient. After analysis, the nurse determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse's determination? a. pH 7.50 PCO2 52mmHg b. pH 7.35 PCO2 40 mmHg c. pH 7.25, PCO2 50 mmHg d. pH 7.50, PCO2 30 mmHg

pH 7.25, PCO2 50 mmHg

A potassium level of 5.4 meq/L should alert the nurse to assess the client for: a. flat U waves b. peaked T waves c. polyuria d. constipation

peaked T waves

The nurse instructs a client to use pursed lip breathing method. The client asks the nurse about the purpose of this breathing. The nurse responds knowing the primary purpose is to: a. promote oxygen intake b. strengthen the diaphragm c. strengthen the intercostal muscles d. promote CO2 elimination

promote CO2 elimination

A client with acute asthma is prescribed short term corticosteroid therapy. Which is the rationale for use of steroids in clients with asthma? Select all that apply a. promote bronchodilation b. act as an expectorant c. have an anti-inflammatory effect d. prevent development of respiratory infections e. reduce anxiety f. increase blood pressure

promote bronchodilation have an anti-inflammatory effect

A client with type 1 diabetes has diabetic ketoacidosis. Which of the following findings has the greatest effect on fluid loss? a. hypotension b. decreased serum potassium level c. rapid and deep respirations d. warm, dry skin

rapid and deep respirations

In the administration of opioids, caution should be exercised in which situations? Select all that apply. a. sedated client w/resp rate 8/minute b. client using multiple opioids c. client with urinary retention d. client with increased intracranial pressure e. client with stage 4 lung cancer

sedated client w/resp rate 8/minute client using multiple opioids client with urinary retention client with increased intracranial pressure

The nurse is instructing a hospitalized client with a diagnosis of chronic airflow limitation about measures that will enhance the effectiveness of breathing during periods of dyspnea. Which of the following positions will the nurse instruct the client to assume? a. side lying in bed b. sitting up in bed c. sitting on the side of the bed and leaning on the over-bed table d. sitting in a recliner

sitting on the side of the bed and leaning on the over-bed table

Differentiate symptoms with stable and unstable angina a. stable angina b. unstable angina

stable angina is predictable, occurs with activity/exertion, and is relieved by nitro and/or rest; unstable angina is unpredictable, unrelieved by rest and/or nitro, increases in intensity, duration, occurrence

The nurse assesses the client's use of medications. Which of the following may cause a complication with the treatment plan of a client with diabetes? a. aspirin b. steroids c. sulfonylureas d. ACE inhibitors

steroids

A 55-year-old male client has recently been diagnosed with type 2 diabetes and is prescribed the glipizide. The nurse explains that glipizide is believed to lower the blood glucose by which of the following actions? a. potentiating the action of insulin b. lowering the renal threshold of glucose c. stimulating insulin release from beta cells d. combining with glucose to render it inert

stimulating insulin release from beta cells

Which early symptom does the nurse assess in a client with thrombocytopenia who has developed a hemorrhage? a. tachycardia b. bradycardia c. decreased PaCO2 d. narrowed pulse pressure

tachycardia

A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? a. seating the client with arm bared, supported and at heart level b. measuring the pressure after the client has been seated quietly for 5 minutes c. using a cuff with a bladder that encircles at least 50% of the limb d. taking the pressure within 20 minutes of smoking or caffeine ingestion.

taking the pressure within 20 minutes of smoking or caffeine ingestion.

Twenty-four hours after a bone marrow aspiration, the nurse evaluated which as an appropriate client outcome? a. the client is on bedrest b. there is redness and swelling at site c. the client requests morphine for pain d. there is no bleeding at site

there is no bleeding at site

The nurse should teach the client with thrombocytopenia and family to avoid which: a. using enemas b. using a HEPA filter mask c. Performing perianal care after each BM d. Performing oral care after each meal.

using enemas

Captopril is given to a client with heart failure because it acts as a: a. vasopressor b. volume expander c. vasodilator d. potassium sparing diuretic

vasodilator

The asthmatic client should be taught that which of the following is one of the most common precipitating factors of an acute asthma attack? a. occupational exposure to toxins b. viral respiratory infections c. avoidance of cigarette smoke d. non aerobic exercise

viral respiratory infections

A nurse has an order to begin administering warfarin to a patient. While implementing this order, the nurse ensures that which of the following meds is available on the unit as the antidote to warfarin? a. aminocaproic acid b. protamine sulfate c. vitamin K d. potassium chloride

vitamin K

The nurse knows which following symptom is common in clients with active tuberculosis? a. weight loss b. increased appetite c. dyspnea on exertion d. mental status changes

weight loss