Complex Med-Surge Exam 1 Study Guide
A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25 mg/day. Which of the following statements by the client indicates an understanding of the teaching? A. "I should eat a lot of fruits and vegetables, especially bananas and potatoes." B. "I will report any changes in heart rate to my provider." C. "I should replace the saltshaker on my table with a salt substitute." D. "I will decrease the dose of this medication when I no longer have headaches and facial redness."
"I will report any changes in heart rate to my provider." --Teach the client how to monitor his or her heart rate. Ch. 36 - ATI
A charge nurse is teaching a group of nurses about conditions related to metabolic acidosis. Which of the following statements by a unit nurse indicates the teaching has been effective? A. "Metabolic acidosis can occur due to diabetic ketoacidosis." B. "Metabolic acidosis can occur in a client who has myasthenia gravis." C. "Metabolic acidosis can occur in a client who has asthma." D. "Metabolic acidosis can occur due to cancer."
"Metabolic acidosis can occur due to diabetic ketoacidosis." -Due to excess production of hydrogen ions, which occurs in diabetic ketoacidosis. --Myasthenia gravis: Respiratory Acidosis --Asthma: Respiratory Acidosis --Cancer: Respiratory Acidosis Ch. 45 - ATI
What are the four bodily mechanisms that regulate blood pressure?
-Arterial baroreceptors -Regulation of bodily-fluid volume -Renin-angiotensin-aldosterone system -Vascular autoregulation Ch. 36 - ATI
What are complications associated with head injuries?
-Brain herniation -Hematoma and intracranial hemorrhage -Pulmonary edema -Diabetes insipidus or syndrome of inappropriate antidiuretic hormone Ch. 14 - ATI
What diagnostic procedures can be used to assess the size and location of an aneurysm?
-Computed tomography (CT) -Ultrasonography Ch. 38 - ATI
What is a craniotomy and why would it be utilized for a head injury?
-Craniotomy: Removal of nonviable brain tissue that allows for expansion and/or removal of epidural or subdural hematomas. -Used: To decrease intracranial pressure and remove brain tumors. Ch. 14 - ATI
What are the manifestations of hypovolemic shock?
-Diaphoresis -Nausea/vomiting -Faintness -Apprehension -Decreased or absent peripheral pulses -Neurologic deficits -Hypotension & tachycardia (initial symptoms) -Oliguria Ch. 38 - ATI
What are the locations in the brain where an intracranial hemorrhage can occur?
-Epidural space -Subdural space -Intracerebral space Ch. 14 - ATI
What are findings associated with brain herniation?
-Fixed dilated pupils -Deteriorating level of consciousness -Cheyne-Stokes respirations -Hemodynamic instability -Abnormal posturing Ch. 14 - ATI
What should be monitored in patients with hypertension?
-Headaches, in the morning. -Facial flushing -Dizziness -Fainting -Retinal changes, visual disturbances -Nocturia --Most cases don't show symptoms associated with hypertension. Ch. 36 - ATI
What are the 5 H's for common causes of pulseless electrical activity?
-Hypovolemia -Hypoxia -Hydrogen ion accumulation -> leading to acidosis -Hyperkalemia & Hypokalemia -Hypothermia Ch. 2 - ATI
What are risk factors for secondary hypertension?
-Kidney disease -Cushing's disease (excessive glucocorticoid secretion) -Pheochromocytoma (excessive catecholamine release) -Primary aldosteronism (causes hypertension and hypokalemia) -Brain tumors, encephalitis -Medications (estrogen, steroids, sympathomimetics) -Pregnancy Ch. 36 - ATI
What are the five-levels of Triage?
-Level one: Resuscitation -Level two: Emergent -Level three: Urgent -Level four: Less urgent -Level five: Non-urgent Ch. 2 - ATI
What are some risk factors for head injuries?
-MVC/motorcycle crashes -Illicit drug and alcohol use -Sports injuries -Assault -Gunshot wounds -Falls Ch. 14 - ATI
What are risk factors for aneurysms?
-Male sex -Atherosclerosis (most common cause) -Uncontrolled hypertension -Tobacco use -Hyperlipidemia -Family history -Blunt force trauma -History of syphilis -Age (older adults) Ch. 38 - ATI
What are medications given for ICP and what do they do to treat injury?
-Mannitol (osmotic diuretic): The medication draws fluid from the brain into the blood. -Barbiturates: To place client in a coma, to decrease cellular metabolic demand until ICP can be decreased. -Phenytoin: Used prophylactically to prevent or treat seizures. -Opioids (Morphine sulfate or Fentanyl): Used to control pain and restlessness. Ch. 14 - ATI
What are the levels of hypertension?
-Normal -Elevated -Stage 1 hypertension -Stage 2 hypertension -Hypertensive crisis Ch. 36 - ATI
What are risk factors for essential (primary) hypertension?
-Positive family history -Excessive sodium intake -Physical inactivity -Obesity -High alcohol consumption -African American -Smoking -Hyperlipidemia -Stress -Age greater than 60 or post-menopausal Ch. 36 - ATI
What are the two forms of aneurysms?
-Saccular -Fusiform Ch. 38 - ATI
What are manifestations of increased intracranial pressure?
-Severe headache -N/V -Deteriorating level of consciousness, restlessness, irritability -Dilated or pinpoint nonreactive pupils -Cranial nerve dysfunction -Alteration in breathing pattern (Cheyne-Stokes respirations, central neurogenic hyperventilation, apneas) -Deterioration in motor function, abnormal posturing (Decerebrate, Decorticate, Flaccidity) -Cushing's triad -Seizures Ch. 14 - ATI
What are signs/symptoms to look out for in patients that may have a hematoma or intracranial hemorrhage?
-Severe headache -Rapid decline in level of consciousness (LOC) -Worsening neurologic function and herniation -Changes in intracranial pressure Ch. 14 - ATI
What are manifestations of Hypertensive crisis?
-Severe headache -Extremely high blood pressure (SBP: greater than 180 mm Hg, DBP: greater than 120 mm Hg) -Blurred vision, dizziness, disorientation -Epistaxis (bleeding from the nose) Ch. 36 - ATI
What are some complications associated with surgical interventions for ICP?
-Severe neurologic impairment -Infection -Persistent seizures -Neurologic deficiencies -Death Ch. 14 - ATI
What are the three surgical approaches for treatment of intracranial hemorrhages?
-Supratentorial: Above the tentorial. -Infratentorial: Below the tentorial, brain stem. -Transsphenoidal: Through the mouth and nasal sinuses. Ch. 14 - ATI
What are symptoms that occur with low blood pressure?
-Tachycardia -Tachypnea -low 02
What are the 5 T's for common causes of pulseless electrical activity?
-Toxins (accidental or deliberate overdose) -Tamponade (cardiac) -Tension pneumothorax -Thrombosis (coronary) -Thrombosis (pulmonary) Ch. 2 - ATI
What are the Emergency Nursing Principles?
-Triage -Primary survey -ABCDE principle -Poisoning -Rapid Response Team -Cardiac emergency -Post resuscitation Ch. 2 - ATI
What are the normal ranges for HCO3- levels?
22 - 26. -Less than 22 is acidosis. -More than 45 is alkalosis. Ch. 45- ATI
What are the normal ranges for CO2 levels?
35 - 45. -Less than 35 is alkalosis. -More than 45 is acidosis. Ch. 45- ATI
What are the normal ranges for pH levels?
7.35-7.45. -Less than 7.35 is acidosis. -More than 7.45 is alkalosis. Ch. 45- ATI
A nurse is caring for a client who was in a motor-vehicle accident. The client reports chest pain and difficulty breathing. A chest x-ray reveals the client has a pneumothorax. Which of the following arterial blood gas findings should the nurse expect? A. pH 7.06, PaO2 86 mm Hg, PaCO2 52 mm Hg, HCO3- 24 mEq/L B. pH 7.42, PaO2 100 mm Hg, PaCO2 38 mm Hg, HCO3- 23 mEq/L C. pH 6.98, PaO2 100 mm Hg, PaCO2 30 mm Hg, HCO3- 18 mEq/L D. pH 7.58, PaO2 96 mm Hg, PaCO2 38 mm Hg, HCO3- 29 mEq/L
A pH 7.06 PaO2 86 mm Hg PaCO2 52 mm Hg HCO3- 24 mEq/L -A pneumothorax can cause alveolar hypoventilation and increased carbon dioxide levels, resulting in RESPIRATORY ACIDOSIS. --pH 7.42, PaO2 100 mm Hg, PaCO2 38 mm Hg, HCO3- 23 mEq/L (Homeostasis). --pH 6.98, PaO2 100 mm Hg, PaCO2 30 mm Hg, HCO3- 18 mEq/L (Metabolic Acidosis). --pH 7.58, PaO2 96 mm Hg, PaCO2 38 mm Hg, HCO3- 29 mEq/L (Metabolic Alkalosis). Ch. 45 - ATI
What is the definition of an INTRACRANIAL HEMORRHAGE?
A collection of blood following head trauma. Ch. 14 - ATI
What is the definition of Ventricular Asystole?
A complete absence of electrical activity and ventricular movement of the heart. --The client is in complete cardiac arrest & requires implementation of BLS and ACLS protocol. Ch. 2 - ATI
What is the definition of Ventricular Fibrillation (VF)?
A fluttering of the ventricles causing loss of consciousness, pulselessness, and no breathing. --This normally requires collaborative care to defibrillate immediately using ACLS (Advanced Cardiac Life Support) protocol. Ch. 2 - ATI
What is the definition of Pulseless Electrical Activity (PEA)?
A rhythm that appears to have electrical activity but is not sufficient to stimulate effective cardiac contractions. --This requires implementation of BLS and ACLS protocol. Ch. 2 - ATI
What is the definition of an aneurysm?
A weakness in a section of a dilated artery that causes a widening or ballooning in the wall of the blood vessel. Ch. 38 - ATI
What is the definition of a DIFFUSE AXONAL INJURY?
A widespread injury to the brain that results in coma and is seen in severe head trauma. Ch. 14 - ATI
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus and reports difficulty following the diet and remembering to take the prescribed medication. Which of the following actions should the nurse take to promote client compliance? (Select all that apply). A. Ask the dietitian to assist with meal planning. B. Contact the client's support system. C. Assess for age related cognitive awareness. D. Encourage the use of a daily medication dispenser. E. Provide educational materials for home use.
A, B, D, E -Ask the dietitian to assist with meal planning. -Contact the client's support system. -Encourage the use of a daily medication dispenser. -Provide educational materials for home use. **Assessing for age-related cognitive awareness doesn't apply as an enhancement to the client's compliance. Ch. 1 - ATI
A nurse in the critical care unit is completing an admission assessment of a client who has a gunshot wound to the head. Which of the following assessment findings are indicative of increased ICP? (Select all that apply). A. Headache B. Dilated pupils C. Tachycardia D. Decorticate posturing E. Hypotension
A, B, D. -Headache -Dilated pupils -Decorticate posturing --Bradycardia (not tachycardia) is associated with increased ICP. --Hypertension (not hypotension) is associated with increased ICP. Ch. 14 - ATI
A nurse in the emergency department is caring for a client who fell through the ice on a pond and is unresponsive and breathing slowly. Which of the following actions should the nurse take? (Select all that apply). A. Remove wet clothing B. Maintain normal room temperature C. Apply warm blankets D. Use a rapid rewarming water of 40* to 42* C (104* to 108* F) E. Infuse warmed IV fluids
A, C, D, E. -Remove wet clothing (The body temperature can rise more quickly when heat is applied to dry skin). -Apply warm blankets (The client's body temperature can rise more quickly when warm blankets are applied). -Use a rapid rewarming water of 40* to 42* C (104* to 108* F) (The client's body temperature can rise more quickly when a rapid rewarming bath water is used to warm the client's body and preserve tissues). -Infuse warmed IV fluids (The client's body temperature can rise more quickly when warmed IV fluids are infused). Ch. 2 - ATI
What does ABCDE stand for in the ABCDE principle?
A: Airway B: Breathing C: Circulation D: Disability E: Exposure Ch. 2 - ATI
What does the AVPU mnemonic stand for when checking a patient's level of consciousness?
A: Alert V: responsive to Voice P: responsive to Pain U: Unresponsive Ch. 2 - ATI
What are the actions of Angiotensin-II receptor antagonists (ARBs), and what are some examples of ARBs?
Action: Block the effects of angiotensin II at the receptor and decrease peripheral resistance. Examples: Valsartan and Losartan Ch. 36 - ATI
What are the actions of Beta blockers, and what are some examples of beta blockers?
Action: Block the sympathetic nervous system (beta adrenergic receptors) and produce a slower heart rate and lowered blood pressure. Examples: Metoprolol and Atenolol Ch. 36 - ATI
What are the actions of Aldosterone-receptor antagonists, and what are some examples of aldosterone-receptor antagonists?
Action: Blocks aldosterone action, which promotes the retention of potassium and excretion of sodium and water. Examples: Eplerenone and Spironolactone Ch. 36 - ATI
What are the actions of Angiotensin-converting enzyme (ACE) inhibitors, and what are some examples of ACE inhibitors?
Action: Prevent the conversion of angiotensin I to angiotensin II, preventing vasoconstriction. Examples: Lisinopril and Enalapril Ch. 36 - ATI
What are the actions of Central-alpha 2 agonists, and what is an example of a central-alpha 2 agonist?
Action: Reduce peripheral vascular resistance and decrease blood pressure by inhibiting the reuptake of norepinephrine. Example: Clonidine Ch. 36 - ATI
What are the actions of Alpha-adrenergic antagonists, and what are examples of alpha-adrenergic antagonists?
Action: Reduces blood pressure by causing vasodilation. Examples: Prazosin and Doxazosin Ch. 36 - ATI
What are the actions of potassium-sparing diuretics, and what is an example of a potassium-sparing diuretic?
Actions: Affect the distal tubule and prevent reabsorption of sodium in exchange for potassium. Example: Spironolactone Ch. 36 - ATI
What are the actions of calcium-channel blockers, and what are some examples of calcium-channel blockers?
Actions: Alter the movement of calcium ions through the cell membrane, causing vasodilation and lowering blood pressure. Examples: Verapamil, amlodipine, diltiazem Ch. 36 - ATI
What are the actions of loop diuretics, and what is an example of a loop diuretic?
Actions: Decrease sodium reabsorption and increase potassium excretion. Example: Furosemide Ch. 36 - ATI
A nurse is reviewing the common emergency management protocol for clients who have asystole. Which of the following actions should the nurse plan to take during the cardiac emergency? A. Perform defibrillation B. Prepare for transcutaneous pacing C. Administer IV epinephrine D. Elevate the client's lower extremities
Administer IV epinephrine. -This increases heart rate, improves cardiac output, and promotes bronchodilation. **Elevate the client's lower extremities: Is indicated for patients in shock. Ch. 2 - ATI
What does ACLS stand for and what does it include?
Advanced Cardiac Life Support. -Cardiac monitoring for specific resuscitation rhythms. -Invasive airway management. -Electrical therapies (Defibrillation & Cardioversion). -Obtaining IV access. -Administration of IV antidysrhythmic medications. -Management of client post resuscitation. Ch. 2 - ATI
What is a fusiform aneurysm?
An aneurysm involving the complete circumference of the artery. Ch. 38 - ATI
What is a saccular aneurysm?
An aneurysm that only affects one side of the artery. Ch. 38 - ATI
What is the definition of Pulseless Ventricular Tachycardia (VT)?
An irritable firing of ectopic ventricular beats at a rate of 140 - 180 beats/min. --The client over time will become unconscious and deteriorate into ventricular fibrillation. Ch. 2 - ATI
A nurse is caring for a client who has ingested a toxic agent. Which of the following actions should the nurse plan to take? (Select all that apply). A. Induce vomiting B. Instill activated charcoal C. Perform a gastric lavage with aspiration D. Administer syrup of ipecac E. Infuse IV fluids
B, C, E. -Instill activated charcoal (Absorbs toxic substances, without passing into the bloodstream). -Perform a gastric lavage with aspiration (Removes the toxic substance when the instilled fluid is suctioned from GI tract). -Infuse IV fluids (IV fluids help dilute the toxic substances in the bloodstream and promote elimination from the body through the kidneys). Ch. 2 - ATI
A nurse is screening a client for hypertension. The nurse should identify that which of the following actions by the client increase the risk for hypertension? (Select all that apply). A. Drinking 8 oz nonfat milk daily B. Eating popcorn at the movie theater C. Walking 1 mile daily at 12 min/mile pace D. Consuming 36 oz beer daily E. Getting a massage once a week
B, D. -Eating popcorn at the movie theater. -Consuming 36 oz beer daily. Ch. 36 - ATI
A nurse is caring for a client who has a closed-head injury with ICP readings ranging from 16 to 22 mm Hg. Which of the following actions should the nurse take to decrease the potential for raising the client's ICP? (Select all that apply). A. Suction the endotracheal tube frequently. B. Decrease the noise level in the client's room. C. Elevate the client's head on two pillows. D. Administer a stool softener. E. Keep the client well hydrated.
B, D. -Decrease the noise level in the client's room. -Administer a stool softener (Decreases the need to bear down (Valsalva maneuver) during bowel movements). Ch. 14 - ATI
Which labs can be indicative of Kidney disease?
BUN & Creatinine. Ch. 36 - ATI
What does BLS stand for and what does it include?
Basic Life Support. -Restores ABCs. Ch. 2 - ATI
How is secondary hypertension treated?
By removing the cause, such as: -Adrenal tumor removals -Medications to improve cause. Ch. 36 - ATI
A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle of aspirin lying next to the bed. Vital signs reveal blood pressure 104/72 mm Hg, heart rate 116/min with regular rhythm, and respiratory rate 42/min and deep. Which of the following arterial blood gas findings should the nurse expect? A. pH 7.68, PaO2 96 mm Hg, PaCO2 38 mm Hg, HCO3- 28 mEq/L B. pH 7.48, PaO2 100 mm Hg, PaCO2 28 mm Hg, HCO3- 23 mEq/L C. pH 6.98, PaO2 100 mm Hg, PaCO2 30 mm Hg, HCO3- 18 mEq/L D. pH 7.58, PaO2 96 mm Hg, PaCO2 38 mm Hg, HCO3- 29 mEq/L
C pH 6.98 PaO2 100 mm Hg PaCO2 30 mm Hg HCO3- 18 mEq/L -Metabolic acidosis. --pH 7.68, PaO2 96 mm Hg, PaCO2 38 mm Hg, HCO3- 28 mEq/L (Metabolic Alkalosis). --pH 7.48, PaO2 100 mm Hg, PaCO2 28 mm Hg, HCO3- 23 mEq/L (Respiratory Alkalosis). --pH 7.58, PaO2 96 mm Hg, PaCO2 38 mm Hg, HCO3- 29 mEq/L (Metabolic Alkalosis). Ch. 45 - ATI
What is "Halo signs" when it comes to cerebral spinal fluid leakage?
Clear or yellow-tinted rings around a drop of blood when bloody drainage is placed on a piece of gauze. Ch. 14 - ATI
A nurse on a medical-surgical unit is caring for a group of clients. The nurse should notify the rapid response team for which of the following clients? A. Client who has a pressure injury of the right heel whose blood glucose is 300 mg/dL. B. Client who reports right calf pain and shortness of breath. C. Client who has blood on a pressure dressing in the femoral area following cardiac catheterization. D. Client who has dark red coloration of left toes and absent pedal pulse.
Client who reports right calf pain and shortness of breath. -Due to risk for respiratory arrest due to a possible embolism. --> Rapid response team should be called in this case. Ch. 2 - ATI
What is secondary hypertension caused by?
Disease states, such as: -Kidney disease -Adverse effect of medications Ch. 36 - ATI
What is a brain herniation?
Downward shift of brain tissue due to cerebral edema. Ch. 14 - ATI
How is a craniotomy completed?
Drilling a burr hole or creating a bone flap to permit access to the affected area. Ch. 14 - ATI
A nurse is assessing a client who has pancreatitis. The client's arterial blood gases reveal metabolic acidosis. Which of the following are expected findings? (Select all that apply). A. Tachycardia B. Hypertension C. Bounding pulses D. Hyperreflexia E. Dysrhythmia F. Tachypnea
E and F. -Dysrhythmia -Tachypnea --Tachycardia: Respiratory Acidosis or Metabolic Alkalosis. --Hypertension: Respiratory Acidosis. --Bounding pulses: Respiratory Acidosis (due to hypertension). --Hyperreflexia: Metabolic Alkalosis. Ch. 45 - ATI
A nurse in the emergency department is assessing a client who is unresponsive. The client's partner states, "He was pulling weeds in the yard and slumped to the ground." Which of the following techniques should the nurse use to open the client's airway? A. Head-tilt, chin-lift B. Modified jaw thrust C. Hyperextension of the head D. Flexion of the head
Head-tilt, chin-lift. -This method is used due to the client being unresponsive without suspicion of trauma. **Modified jaw thrust: Used for client who is unresponsive with suspected traumatic neck injury. **Hyperextension of the head: This method can close off the airway and cause injury. **Flexion of the head: This method does not open the airway. Ch. 2 - ATI
How do respiratory buffers work to decrease hydrogen ions?
Hyperventilation. -Helps to blow off excess hydrogen ions. Ch. 45- ATI
A nurse is caring for a client who has increased ICP and a new prescription for mannitol. For which of the following adverse effects should the nurse monitor? A. Hyperglycemia B. Hyponatremia C. Hypervolemia D. Oliguria
Hyponatremia. Ch. 14 - ATI
How do respiratory buffers work to increase hydrogen ions?
Hypoventilation. Ch. 45- ATI
How do thiazide diuretics work to lower blood pressure?
Inhibit water and sodium reabsorption and increase potassium excretion. Ch. 36 - ATI
A nurse is caring for a client who was recently admitted to the ED following a head-on motor vehicle crash. The client is unresponsive, has spontaneous respirations of 22/min, and has a laceration on the forehead that is bleeding. Which of the following is the priority nursing action at this time? A. Keep neck stabilized. B. Insert nasogastric tube. C. Monitor pulse and BP frequently. D. Establish IV access and start fluid replacement.
Keep neck stabilized. --Stabilization is key to prevent permanent damage to the spinal cord if a cervical injury exists. Ch. 14 - ATI
What is the third line of defense when it comes to acid-base imbalances?
Kidney buffers. -Slowest to respond but the most effective buffering system with the longest duration. Ch. 45- ATI
What type of ABG is long-term diarrhea considered?
Metabolic acidosis. Ch. 45- ATI
A nurse is obtaining arterial blood gases for a client who has vomited for 24 hr. The nurse should expect which of the following acid-base imbalances to result from vomiting for 24 hr? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
Metabolic alkalosis. -Vomiting can cause a loss of gastric acids and an accumulation of bicarbonate in the blood. Ch. 45 - ATI
What type of ABG is long-term vomiting considered?
Metabolic alkalosis. Ch. 45- ATI
A nurse is providing discharge teaching for a client who has a prescription for furosemide 40 mg PO daily. The nurse should instruct the client to take this medication at which of the following times of day? A. Morning B. Immediately after lunch C. Immediately before dinner D. Bedtime
Morning. --So that the peak action and duration of the medication occurs during waking hours. Ch. 36 - ATI
A nurse is caring for a client who is admitted to the emergency department with blood pressure of 266/147 mm Hg. The client reports a headache and double vision. The client states, "I ran out of diltiazem 3 days ago, and I am unable to purchase more." Which of the following actions should the nurse take first? A. Administer acetaminophen for headache. B. Provide teaching regarding the importance of not abruptly stopping an antihypertensive. C. Obtain IV access and prepare to administer an IV antihypertensive. D. Call social services for a referral for financial assistance in obtaining prescribed medication.
Obtain IV access and prepare to administer an IV antihypertensive. --The IV route for antihypertensive medication works more rapidly than by the oral route. Ch. 36 - ATI
What is the definition of a CONCUSSION/MILD TRAUMATIC BRAIN INJURY?
Occurs after head trauma that results in a change in the client's neurologic function but no identified brain damage and usually resolves within 72 hours. Ch. 14 - ATI
A nurse is caring for a client who has just been admitted following surgical evacuation of a subdural hematoma. Which of the following is the priority assessment? A. Glasgow Coma Scale B. Cranial nerve function C. Oxygen saturation D. Pupillary response
Oxygen saturation. --This uses the ABC priority-setting framework. **Brain tissue can only survive for 3 minutes before permanent damage occurs. Ch. 14 - ATI
How are body fluids regulated for blood pressure?
Properly functioning kidneys retain fluid during hypotension and excrete fluid during hypertension. Ch. 36 - ATI
How does the renin-angiotensin-aldosterone system work?
Renin is converted into angiotensin II, which causes vasoconstriction and controls aldosterone release, causing the kidneys to reabsorb sodium and inhibit fluid loss. Ch. 36 - ATI
What type of ABG is having 3 days of pneumonia considered?
Respiratory alkalosis. Ch. 45- ATI
What is the definition of Cardiac Arrest?
Sudden cessation of cardiac function caused most commonly by ventricular fibrillation or ventricular asystole. Ch. 2 - ATI
What are the ranges of elevated blood pressure?
Systolic blood pressure: 120-129 mm Hg. Diastolic blood pressure: Less than 80 mm Hg. Ch. 36 - ATI
What are the ranges for stage 1 hypertension?
Systolic blood pressure: 130-139 mm Hg. Diastolic blood pressure: 80-89 mm Hg. Ch. 36 - ATI
What are the ranges for stage 2 hypertension?
Systolic blood pressure: Greater than or equal to 140 mm Hg. Diastolic blood pressure: Greater than or equal to 90 mm Hg. Ch. 36 - ATI
What are the ranges for hypertensive crisis?
Systolic blood pressure: Greater than or equal to 180 mm Hg. Diastolic blood pressure: Greater than or equal to 120 mm Hg. Ch. 36 - ATI
What are the ranges of normal blood pressure?
Systolic blood pressure: Less than 120 mm Hg. Diastolic blood pressure: Less than 80 mm Hg. Ch. 36 - ATI
What are manifestations of hyperventilation (Respiratory Alkalosis) vital signs in ABGs?
Tachypnea. Ch. 45- ATI
A nurse in an urgent care clinic is obtaining a history from a client who has type 2 diabetes mellitus and a recent diagnosis of hypertension. This is the second time in 2 weeks that the client experienced hypoglycemia. Which of the following client data should the nurse report to the provider? A. Takes psyllium daily as a fiber laxative B. Drinks skim milk daily as a bedtime snack C. Takes metoprolol daily after meals D. Drinks grapefruit juice daily with breakfast
Takes metoprolol daily after meals. --Metoprolol can mask the effects of hypoglycemia in clients with diabetes mellitus. Ch. 36 - ATI
What can verify left-ventricular hypertrophy on an ECG?
Tall R-waves. Ch. 36 - ATI
What is the definition of a CONTUSION (BRAIN RELATED)?
The brain is bruised, and the client has a period of unconsciousness associated with stupor and/or confusion. Ch. 14 - ATI
How do aortic dissections (dissecting aneurysms) occur?
When blood accumulates within the artery wall (hematoma) following a tear in the lining of the artery (due to hypertension). --This condition is a life-threatening condition. Ch. 38 - ATI
What diagnostic procedure is used to detect the presence of an aneurysm?
X-ray. Ch. 38 - ATI
For ABG's what does fully compensated mean?
pH is in range. Ch. 45- ATI
For ABG's what does partially compensated mean?
pH is out of range. Ch. 45- ATI
