complex quizzes

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings?

"Have you consistently taken your medications? Patients may stop taking their antihypertensive medications due to side effects; primarily fatigue, sexual dysfunction, cost of medication and possibly no transportation to get medications.

The nurse admits a patient to the hospital with Addisonian crisis. Which patient statement supports the need to plan additional teaching?

"I had the flu earlier this week, so I couldn't take the hydrocortisone."

What factors would suggest a possible attack with a biologic agent? Select all that apply

-People presenting with flu-like symptoms when it isn't influenza season -Multiple people presenting with a similar symptoms -A variety of age groups presenting with similar symptoms

Multiple churches in a coastal community have volunteered to assist with disaster-relief efforts after a hurricane caused widespread damage. What are some ways these churches would be able to help the community recover? Select all that apply

-Serve as distribution centers for emergency workers -Assist government agencies in performing welfare checks in the community -Provide feeding and transportation services

When admitting a patient with possible respiratory failure and a high PaCO2, which assessment information should be immediately reported to the health care provider?

The patient is very somnolent

During the recovery phase of acute kidney injury (AKI), the nurse would expect to see the following assessment findings? (Select all that apply)

increase in glomerular filtration rate (GFR) BUN/Creatinine plateau, then decrease

Using qSOFA recogizing sepsis/septic shock, the patient has altered mental status and a respiratory rate of 28/minute. The primary care provider initiates the 1-Hour Bundle for Sepsis and Septic Shock. In which order will the nurse implement the actions?

1.) Measure lactate level 2.) Obtain blood and urine cultures 3.) Administer broad-spectrum antibiotics or other antimicrobials 4.) Begin administration of balanced crystalloids for hypotension at 30 mL/kg or more 5.) Start norepinephrine early for hypotension to maintain systolic BP > 100-110 mmHg

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-year-old patient with newly diagnosed hypertension?

128/76 mm Hg

A patient with an ideal body weight of 65 kg arrived in the emergency department with septic shock, based on the weight, how many milliliters should the nurse anticipate to bolus this patient using the Sepsis Guidelines?

30ml/kg

A fire breaks out in an apartment complex. Many residents sustain injuries from burns, minor trauma and fractures jumping from higher levels. EMS providers arrive on scene and encounter the following individuals. The nurse knows which patient should be transported first?

32-year-old male with bruising and lacerations to chest, unequal rise and fall of chest

Which patient is at highest risk for hypercapnic respiratory failure?

A patient with fractured ribs and a flail chest

A patient is admitted to the ICU with a diagnosis of unstable angina. Which drug(s) would the nurse expect the patient to receive (select all that apply)?

ACE inhibitor Antiplatelet therapy Thrombolytic therapy Intravenous nitroglycerine

The nurse knows that signs and symptoms suggestive of bacterial meningitis can include: select all that apply

sensitivity to light (photophobia) fever headache vomiting

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with acute kidney injury. Before administering the medication, the nurse should assess the:

serum potassium level

Match the level of burn with the sensation and healing time. Superficial Superficial Partial Thickness Deep Partial Thickness Full-Thickness

Superficial---painful, heals 5-10days Superficial Partial Thickness---painful to temp and pain, 7-21 Deep Partial Thickness---pressure, >3wks, grafting Full-Thickness--- deep pressure/painless, grafting

Which hemodynamic parameter best reflects the effectiveness of drugs that the nurse gives to reduce a patient's left ventricular afterload?

Systemic vascular resistance (SVR)

The leading cause of preventable death in trauma is blood loss

TRUE

Arterial blood gas (ABG) values provide information about (select all that apply)

Acid-base status Underlying cause of imbalance Overall oxygen status Body's ability to regulate pH

A 78-kg patient with septic shock has a pulse rate of 120 beats/minute with low central venous pressure and pulmonary artery wedge pressure. Urine output has been 25 mL/hour for the past 3 hours and a blood pressure of 88/43 mmHg and MAP 58 mmHg. Which order by the health care provider should the nurses question?

Administer furosemide (Lasix) 40 mg. IV

The nurse is caring for a patient who has experienced a burn injury and notes a decrease in blood pressure and an increase in heart rate. The nurse suspects a decrease in preload. The primary intervention would be:

Administer intravenous fluids

Which of the following would be performed in the care of a patient with possible bacterial meningitis?

Administration of abx lumbar puncture blood cultures

The nurse will ask the client being admitted with acute pancreatitis specifically about a history of:

Alcohol consumption

Which laboratory test result will the nurse need to monitor when evaluating the effects of therapy for a client with acute pancreatitis?

Amylase

Antiplatelet Agent Angiotensin-Converting Enzyme (ACE) Inhibitor Calcium Channel Blocker Angiotensin II Receptor Blocker (ARB)

Antiplatelt- Plavix ACE- enalapril CCB- diltiazem ARB- losartan

A 19-year-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal premature ventricular contractions (PVCs). What action should the nurse take next?

Ask the patient about current stress level and caffeine use.

A client is brought to the emergency department with partial-thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this client? Select all that apply

Assess for airway patency administer O2 as prescribed cooling blanket elevate extremities if nor fractures present oral pain med as prescribed

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?

Assess the patient's respiratory effort

A patient is brought into the emergency department by EMS after having been involved in a motor vehicle crash. The patient does not open their eyes, makes incomprehensible sounds, and has abnormal flexion, giving the patient a GCS of 5. What would be the most appropriate initial intervention?

Assist with intubating

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs?

Auscultate lung sounds

The nurse is caring for a patient who has experienced a spinal cord injury at T-10 level and is currently on the rehabilitation unit. The family calls the nurse to the room stating their son is having a very throbbing headache, additional assessment data the nurse obtains; B/P: 220/98, HR: 46, profound diaphoresis above T-10 level, anxiety and nasal congestion. Based on this information, you believe the patient is experiencing:

Autonomic Dysreflexia ▪HTN (up to 300 systolic) ▪ Throbbing headache ▪ Marked diaphoresis above level of injury ▪ Bradycardia (30 to 40 beats/minute)

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (Select all that apply) A. only taking aspirin with milk or bread products B. avoiding taking aspirin and drugs containing aspirin C. taking only drugs prescribed by the healthcare provider D. taking all drugs 1 hour before mealtime to prevent further bleeding E. reading all OTC drug labels to avoid taking those containing stearic acid and calcium

B. avoiding taking aspirin and drugs containing aspirin C. taking only drugs prescribed by the healthcare provider

Remembering the goal of disaster triage principles, match the color with the appropriate definition: Black Green Red Yellow

Black= expectant/deceased Green= nonurgent, minor Red= emergent, immediate Yellow= urgent, but can be delayed

Acute Respiratory distress syndrome -cause -define

Cause: direct or indirect lung injury (aspirate gastric contents or trauma) Define: Alveolar capillary membrane becomes damaged and more permeable to intravascular fluid (filled w fluid)

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?

Check blood pressure, pulse and respirations

The nurse uses topical gentamicin sulfate (Garamycin) on a client's burn injury. Which laboratory value will the nurse monitor?

Creatinine

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin?

Heparin prevents the development of new clots in the coronary arteries.

It is essential to advise patients who are taking NSAIDs to do which of the following to help protect their kidneys from injury?

Drink plenty of water

early and late signs of Acute Respiratory distress?

Early: -dyspnea -tachypnea -cough -restless Late: -crackles -hypoxemia -increase WOB w normal O2

Which diagnostic study best differentiates the various types of cardiomyopathy?

Echocardiography

EMS providers bring in a patient who was an unrestrained driver in a motor vehicle crash. They reported that the patient was thrown through the windshield. The patient was initially unconscious at the scene, had a lucid interval on the ride to the emergency department, then quickly lost consciousness. What is the most likely injury this patient has?

Epidural hematoma

The nurse should implement which interventions in less than 10 minutes following the diagnosis of a myocardial infarction? (select all that apply)

Establish and intravenous access Administer Aspirin 160 mg - 325 mg Begin Oxygen 2 to 4 liters per nasal cannula, SaO2 goal of 92% Establish continuous ECG monitoring

The development of a vaccine is focused on safety, efficacy and side effects and is accomplished in phases. A vaccine that is in Phase 1 development will need between 200-300 healthy people or people with the disease; it usually lasts several months in duration and examines safety and dosage.

False Phase 1= 20-100ppl Phase 2= several hundred Phase 3= 300-3000 Phase 4= more

A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has the following drugs ordered. Which drug should the nurse discuss with the health care provider before giving? a.Pantoprazole (Protonix) 40 mg IV b.Gentamicin (Garamycin) 60 mg IV c.Sucralfate (Carafate) 1 g per nasogastric tube d.Methylprednisolone (Solu-Medrol) 60 mg IV

Gentamicin which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS.

An elderly patient presents with slurred speech, left arm weakness, and slight facial drooping on the left side. Which of the following diagnostic studies should be performed as soon as possible to help determine the cause of the patient's symptoms? Select all that apply

Head CT Blood glucose ABG MRI

After the nurse gives IV atropine to a patient with symptomatic sinus bradycardia, which finding indicates that the drug has been effective?

Increase in the patient's heart rate (atropine=anticholinergic)

A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon?

Increasing neck swelling

A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to:

Initiate cardiopulmonary resuscitation

When assessing a client who arrived in the emergency department following a motor vehicle crash. The nurse notes tachycardia and absent breath sounds over the right lung field. The nurse should prepare for which priority intervention?

Insertion of a chest tube with a chest drainage system

A nurse has administered prescribed IV mannitol to an unconscious patient. Which parameter should the nurse monitor to determine the medication's effectiveness?

Intercranial pressure

The nurse is caring for a patient who has an endotracheal tube in place and is receiving mechanical ventilation. The ventilator alarm is sounding, the priority for the nurse is to:

Look at the patient

Following kidney transplantation surgery, the patient is transferred to ICU. During the immediate postoperative care of this patient, what is the first priority?

Maintenance of fluid and electrolyte balance

Anticipated acid base disturbance when a client has a nasogastric tube to low intermittent suction?

Metabolic alkalosis

The concept of disaster management encompasses an "all hazards" approach. Which of the following are included in in this concept?

Mitigation Preparedness Response Recovery

A patient with septic shock has received 2 L of normal saline, but the blood pressure is still 82/40 mmHg. MAP 55 mmHg and urine output is 0.2 mL/kg/hour. The nurse will anticipate an order for?

NE

During change of shift report, the nurse is told that a patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 4 days. Which finding is most important for the nurse to report to the health care provider?

New onset of confusion

A patient admitted with acute respiratory failure has ineffective airway clearance related to thick secretions. Which nursing intervention would specifically address this patient problem?

Offer the patient fluids at frequent intervals.

The nurse is assessing the patency of a client's left forearm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent?

Palpation of a thrill over the fistula

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

Patient stopped taking the medication 2 days ago

The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that:

Patients should be sedated if cardioversion is done on a non-emergency basis.

Right ventricular filling pressure is referred to as_______________ and is expressed as _______ or _______

Preload and CVP or RAP (2-6)

Left ventricular filling pressure=?

Preload; PCWP, PAWP, PAOP (4-12)

Which actions should the nurse start to reduce the risk for ventilator-associated pneumonia (VAP) (select all that apply)?

Provide a "sedation holiday" daily Give prescribed pantoprazole (Protonix). Provide oral care with chlorhexidine (0.12%) solution daily Elevate the head of the bed to at least 30 degrees.

A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment?

Purplish streaks on the abdomen

To determine whether there is a delay in impulse conduction through the ventricles, the nurse will measure the duration of the patient's

QRS = ventricular depolarization p wave= atrial depolarization

When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of

Rapid, deep respirations

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?

Report of severe chest pain

During the emergent phase of a burn injury, patients are in a hypermetabolic state. Choose all that are correct.

Resting metabolic expenditure may be 50% to 100% above normal Caloric needs are about 5,000 kcal/day Core temp elevated

The nurse recognizes that early clinical manifestations of acute respiratory distress include:

Restlessness

Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?

Serum potassium of 2.9 mEq/L

Which assessment information will be most important for the nurse to report to the health care provider about a client with peritonitis?

The client has a temperature of 101.8 F

Which response by the nurse best explains the purpose of Sandostatin (Octreotide) for a patient admitted with bleeding from esophageal varices?

The medication will provide hemostasis of enlarged veins by vasoconstriction

Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)?

The patient has a serum sodium level of 118 mEq/L. SIADH: -Simultaneous measure of urine and serum osmolality -Hyponatremia -Urine specific gravity greater than 1.025 -concentrated urine Diabetes insipidus: -water deprivation test -hypernatremia -urine specific gravity < 1.005 -diluted urine

Which finding about a patient who is receiving vasopressin to treat septic shock indicates an immediate need for the nurse to report the finding to the health care provider?

The patient is complaining of crushing chest pain

When prone positioning is used for a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective?

The patient's PaO2 is 89 mm Hg, and the SaO2 is 91%

1. persisting hypotension requiring vasopressors to maintain MAP equal to or greater than 65 mmHg. 2. blood lactate > 2 mmol/L despite adequate volume resuscitation

True

A flail chest is multiple, consecutive rib fractures in two or more places on each rib.

True

Every hospital should conduct a hazard vulnerability assessment as part of its disaster management plan.

True

Which preventative actions by the nurse will help limit the development of systemic inflammatory response syndrome (SIRS) in patients admitted to the hospital? (select all that apply)

Use aseptic technique when manipulating invasive lines and devices Remove indwelling urinary catheters as soon as possible after surgery Administer prescribed antibiotics within 1 hour for patients with possible sepsis, after obtaining cultures Ambulate postoperative patients as soon as possible after surgery

The client has experienced a burn injury. The nurse needs to double-check the providers order for intravenous fluid replacement. The nurse has the following data: Client weight: 205 pounds TBSA: 40% Calculate the total amount of fluid replacement the client should receive over the first 24 hours. You may use a calculator.

Weight in kg x 4 mL x % TBSA 14,909 ml

When providing initial care of a client with a diagnosed C4 fracture, priority of care would focus on:

airway management

Identify the rhythm below:

atrial fibrillation?

The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to

balance fluids and electrolytes

A ruptured gallbladder as a complication of cholecystitis will most likely lead to what primary concern?

bile peritonitis

The nurse knows the most reliable method to validate the correct placement of an endotracheal tube following intubation is:

chest xray

Match: dantrolene (Dantrium) Gabapentin (neorotonin) pantaprozaole (protonix) norepinephrine (levophed)

dantrolene (Dantrium)---antispasmodic Gabapentin (neorotonin)---anticonvulsant pantaprozaole (protonix)---PPI norepinephrine (levophed)---catecholamine

You are caring for a patient with acute kidney injury (AKI). While completing their assessment, you note the following cardiac rhythm. What is the likely cause?

hyperkalemia

During the oliguric phase of acute kidney injury, the nurse would expect to see which electrolyte abnormalities? (Select all that apply)

hyperkalemia hyponatremia hypocalcemia Oliguric: <400ml day ; increased BUN, Cr

The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that

laproscopic cholecystectomy is the treatment of choice in most clients who are symptomatic

A 23-year-old male client who has had a full-thickness burn is being discharged from the hospital. Which information is most important for the nurse to provide prior to discharge?

learn dressing changes

The client is admitted to the neurological unit following a diving accident, and has Gardner-Wells Tongs in place. The nurse is planning his care, choose the categories that are priorities for this patient. Select all that apply

pin site care meticulous skin care prism glasses and music

You are caring for a patient in the diuretic phase of acute kidney injury. What assessment findings would you expect? (Select all that apply)

poor skin turgor low central venous pressure (CVP) dry mucous membranes

The nurse is teaching the patient and family that peptic ulcers are:

promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs, stress and H pylori

An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is

sleep pattern disturbance related to frequent waking to void.

Which of the following medications can cause direct kidney tissue injury?

vancomycin

A hospitalized patient with a history of CHRONIC STABLE angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia

will be relieved by rest, nitroglycerine, or both.