Med Surg 2 - Exam 1 - Spring 2021

35. A nurse is caring for an older adult client who has left sided heart failure which of the following assessment findings should the nurse expect

- Frothy sputum

10. A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which of the following manifestations should the nurse identify as indicating the client is hypokalemic?

Fatigue

42. A nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client's EKG should the nurse interpret as a sign of hypokalemia?

abnormally prominent U wave

31. Aflutter

aflutter

46. a client who has a history of myocardial infarction is prescribed aspirin 325 mg. The nurse correctly understands that the aspirin is ordered due to its action as a..

anti platelet aggegate

38. A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.)

- Hypercholesterolemia - Hypertension - Obesity - Smoking

4. A patient has a history of heart failure. Which if the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?

- I've noticed that I've gained 6lbs in one week - While I sleep I have to prop myself up with a pillow so that I can breathe

36. A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

- Increased anterposterior diameter of the chest

1. A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect select all that apply (ATI)

- Increased heart rate - Increased blood pressure - Increased respiratory rate

34. A nurse and an emergency department is planning care for a client who is having an acute myocardial infarction. The nurse should plan to administer which of the following medications after the initial acute phase to manage the clients pain and anxiety

- Morphine

26. A client with CHF is about to take a dose of furosemide. Which of the following K levels, if noted on the clients record, should be reported before giving the due medication?

- 3.3 mEq/L

25. Which of the following are NOT typical s/sx RIGHT sided HF?

- Orthopnea - Persistent cough - Crackles

19. A nurse is caring for a client who reports a new onset of severe chest pain. Which of the following actions should the nurse take to determine if the client is experiencing a myocardial infarction

- Perform a 12-lead ECG

24. A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG strip should the nurse recognize as normal sinus rhythm?

- The P wave falls before the QRS complex

24. During a visit to a 78 year old with CHF, the home care nurse finds that the patient has ankle endema, 2 kg weight gain over the past 2 days, and complains of feeling too tired to get out of bed. Based on the data, the nursing diagnosis is

- Activity intolerance related to fatigue

27. You are assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patients lung fields and note expiratory wheezes. The patient peak flow rate is 78 percent less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these s/sx of an asthma attack?

- Albuterol

7. A nurse is assessing a client who has infective endocarditis. Which of the following findings should be the priority for the nurse to report to the provider (ATI Cardiac)

- Dyspnea

23. A nurse is providing discharge instructions for a client who has congestive heart failure. Which of the following client statements indicates to the nurse that the teaching was effective?

"I plan to slow down if I am tired the day after exercising"

14. A nurse is teaching a client who has emphysema about self-management strategies. Which of the following statements by the client indicates an understanding of the teaching?

"I will follow a daily diet high in calories and protein."

41. A nurse is teaching a client who has chronic obstructive pulmonary disease about ways to facilitate eating. Which of the following statements indicates a need for further teaching?

"I will take my bronchodilators after meals"

43. A nurse is teaching the partner of a client who had an acute myocardial infarction about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzyme studies?

"These tests help determine the degree of damage to the heart tissues."

21. A nurse is caring for a client with diarrhea and dehydration. The nurse determines that the client has received adequate fluid replacement if the BUN decrease to?

- 18 mg/ dl

43. The nurse is assessing the chest tube drainage of a client with a hemothorax following a motor vehicle accident. Which findings will be expected findings in a normally functioning chest tube system? SATA a. The chest tube system secured to the floor bedside the clients bed b. tidaling in the water seal chamber with respirations c. presence of an occlusive dressing d. All the above e. 100 ml sanguineous blood in the drainage collection chamber

- The chest tube system secured to the floor bedside the clients bed - tidaling in the water seal chamber with respirations - presence of an occlusive dressing

18. The nurse is preparing instructions for a client with COPD. Which demonstration by the client will be mastreed for pursed lip breathing technique?

- The client will inhale mouth closed, pursed lips and exhale with counting to four

25. A nurse is caring for a client who came to the emergency department reporting chest pain. The provider suspects a myocardial infarction. While waiting for the troponin levels report the nurse asks what this blood test will show. Which of the following explanations to the nurse provide the client

- Troponin is a heart muscle protein that appears in the bloodstream when there is damage to the heart

6. Which of the following patients are MOST at risk for developing endocarditis. Select all that apply. A.a 25 year old male who reports using intravenous drugs on a daily basis B.a 55 year old male who is post-opt from aortic valve replacement C.a 63 year old female who is newly diagnosed with hyperparathyroidism and taking Aspirin D.a 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever

- a 25 year old male who reports using intravenous drugs on a daily basis - a 55 year old male who is post-opt from aortic valve replacement - a 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever

15. A patient with left sided HF is having trouble breathing. Which of the following is the most appropriate nursing intervention?

- assist the patient into High- Fowlers position

1. Which of the following are typical signs and symptoms of pneumonia? Select all that apply. A.stridor B.coarse crackles C.oxygen saturation less than 90% D.non-productive, nagging cough E.elevated white blood cells F.low Pc02 of less than 35 G.tachypnea

- coarse crackles - oxygen saturation less than 90% - elevated white blood cells tachypnea

32.The nurse is instructing a client on using a meter dose inhaler and will include which instructions? SATA a. hold MDI 1-2 inches from mouth or use spacer b. After inhalation, close the mouth and hold the breath for 5-10 c. take short quick breaths with each inhalation d. exhale deeply after inhalation of medication

- hold MDI 1-2 inches from mouth or use spacer b. After inhalation, close the mouth and hold the breath for 5-10

20. What are the typical signs and symptoms of infective endocarditis? Select all that apply. A.hyperthermia b.S4 gallop C.enlarged spleen D.hyperkalemia E.substernal pain that radiates to the back F.heart failure G.cardiac murmur

- hyperthermia - enlarged spleen - heart failure - cardiac murmur

4. Please interpret the following ekg strip NO PR INTERVAL SAW TOOTH

A flutter

2. Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include demonstration of the proper use of: (Nurseslabs)

A manual toothbrush

5. Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include demonstration of the proper use of: a.A manual toothbrush b.An electric toothbrush c.An irrigation device d.Dental floss

A manual toothbrush

50. A nurse is caring for a client who has valvular heart disease and is at risk for developing left-sided heart failure. Which of the following manifestations should alert the nurse the client is developing this condition?

Breathlessness

33. What area of the heart is responsible for delay of conduction between the atrium and ventricle?

AV node

29. Rhythm is irregular, no pr interval normal qrs complex hrt 80

Aflutter??

30. a nurse is assessing a client for hypoxemia during an asthma attack

Agitation

49. A nurse in a clinic sees a client who has an acute asthma exacerbation. Which of the following medications should reduce the symptoms?

Albuterol via jet nebulizer

30. A nurse in interpreting the ECG strip of a client who has bradycardia. Which of the following cardiac complications should the nurse identify as the role of the P-wave? a. Atrial depolarization b. ventricular depolarization c. Slow repolarization of ventricular purkinjie fibers d. early ventricular repolarization

Atrial depolarization

17. A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a r ate of 120 beats a minute. The nurse interprets this rhythm as:

Atrial fibrillation

48. A 74 year old Female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the ling fields, respiratory rate of 25 and an oxygen rate of 25 and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of HF? a. BUN 9 b. Troponin <0.02 c. K +5.6 d. BNP 820

BNP 820

8. The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? A) B) The average amount of blood ejected during one complete cardiac cycle C) Determined by measuring the electrical activity of the heart and the patient's heart rate D) The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure

Calculated by multiplying the patient's stroke volume by the heart rate

6. A nurse in a provider's office is assessing an older adult client whose son reports that the client has been sick with a respiratory illness for the past 6 days. Which of the following assessment findings is a manifestation of pneumonia in the older adult client? (Oxygenation ATI Quiz)

Confusion

8. A nurse in the emergency department is assessing an older adult client who has community- acquired pneumonia. Which of the following findings should the nurse expect? (Oxygenation ATI)

Confusion

44. A nurse is assessing a client who has infective endocarditis. Which of the following findings should be the priority for the nurse to report to the provider?

Dyspnea.

18. A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. Which of the following findings should the nurse expect?

Elevated central venous pressure (CVP).

22. A nurse is caring for a client who has chronic obstructive pulmonary disease. The client tells the nurse" I can feel the congestion in my lungs, but I can't seem to cough it up. Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?

Encouraging the client to drink 2 to 3 L of water daily

21. A nurse is providing discharge teaching to a client who has a new diagnosis of heart failure. Which of the following instruction should the nurse include in the teaching?

Exercise at least three times per week.

27. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as the cause of the client's low potassium level?

Furosemide

11. A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect? (ATI Cardiovascular, or Perfusion)

Hacking cough

45. A nurse is caring for a client 4hr following a cardiac catheterization. Which of the following action should nurse take?

Having a client lie flat in the bed

31. A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A nurse assesses the client for:

Hypotension and dizziness

17. The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output?

It is calculated by multiplying the patient's stroke volume by the heart rate.

7. You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. Which classification of medications should you withhold until consulting with the health care provider? Loop diuretics Antibiotics Antihypertensives Bronchodilators

Loop diuretics

3. Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaÓ 90 mm Hg, PaCÓ 23 mm Hg, and HCǑ 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment? (Nurseslabs)

Metabolic Acidosis, Partially, Compensated

20. Ricky's grandmother has been suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?

Metabolic Alkalosis, Uncompensated

28. Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCÓ 37 mmHg and HCǑ 30 mEq/L. What is your assessment?

Metabolic Alkalosis, Uncompensated

5. A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury. Which of the following findings should the nurse identify as indicating an increased risk of acute kidney injury (AKI) ?

Serum creatinine 1.8mg/dL

13. The nurse is caring for a client with a pneumothorax and observes continuous buddling in the water seal chamber. Which action by the nurse is the best? a. change the clients position to promote ventilation b. encourage cough deep breath c. continue to monitor. Continuous buddling is expected d. NP of the continuous buddling

NP of the continuous buddling

46. Please interpret the following EKG strip the measurements are as follows: Heart rate 60-90 PR 0.12 - 0.20s QRS 0.10 and 0.12 P wave for each QRS complex

Normal Sinus rhythm

37. Hrt 60 rhythm is regular pr 0.12 to 0.20 qrs 0.04 to 0.10 p wave for every qrs complex

Normal sinus rhythm

45. A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:

Normal sinus rhythm

32. A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia. Which of the following actions should the nurse take?

Obtain a sputum culture.

10. A patient recovering from heart surgery develops pericarditis and complains of a level 6/10 chest pain. Which pf the prescribed PRN meds will be the most appropriate for the nurse to give?

Oral ibuprofen (Motrin 600 mg)

11. A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow.On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as? a.Janeway Lesions b.Roth Spots c.Osler's Nodes d.Trousseau's Sign

Osler's Nodes

47. A patient who has a chronic failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as Paroxysmall nocturnal dyspnea

Paroxysmall nocturnal dyspnea

28. A client enters the ER with difficulty breathing, chest pain during inhalation and a fever. Assessment by the nurse revealed dull resonance on percussion with diminished breath sounds in the left lower lobe. Based on the nurse's assessment findings, which diagnosis is most likey? a. Pneumothorax b. Pneumonia c. Pleurisy d. Deviated trachea

Pneumonia

40. George Kent is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?

Respiratory Acidosis, Partially Compensated

39. Mrs. Johansson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client's respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean

Respiratory Acidosis, Uncompensated -

48. A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean?

Respiratory Alkalosis, Uncompensated

9. Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings? (Nurseslabs)

Respiratory Alkalosis, Uncompensated

29. On an EKG the P- wave represents what area of the heart? a. SA node b. AV node c. Bachman's bundle d. Left bundle branch

SA node

9. What area of the heart's electrical conduction is known as the "pacemaker" of the heart? a.SA node b.AV node c.Purkinje Fibers d.Bundle of His

SA node

42. What is the correct sequence of electrical conduction of the heart? a.SA nose, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fiber b.AV node, internodal pathways, SA node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers c.SA node, internodal pathways, AV node, Purkinje Fibers, Right and Left Bundle Branch, Bundle of His d.None of the options are correct

SA nose, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fiber

16. Regular rate hrt rate less than 55 pr interval 0.12 to 0.20 qrs 0.04-0.10

Sinus bradycardia

15. Regular hrt rate is greater than 150 pr interval normal qrs normal

Supraventricular tachycardia

47. A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The complication the nurse will constantly observe for is:

Systemic emboli

41. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) auscultates wheezes and diminished breath sounds. The wheezes and diminished breath sounds indicate that the client is experiencing which complication of COPD?

The client is experiencing a bronchospasm

49. The nurse is preparing instruction for a client with chronic obstructive pulmonary disease(COPD). Which demonstration by the client will be mastered for pursed lip breathing technique? A. The client will take a deep breath with lips pursed then exhale fully with mouth open B. The client will breathe in longer than breathing out C. The client will inhale with mouth closed, purse lips and exhale while counting to four. D. The client will inhale while counting to four, and then forcefully blow out on exhalation.

The client will inhale with mouth closed, purse lips and exhale while counting to four.

26. a nurse in the emergency department is caring for a client who is experiencing manifestations of a myocardial in (MI)

Troponin

33. A nurse is reviewing the laboratory values of a client who had a myocardial infarction 3 hr ago. The nurse should expect which of the following laboratory values to be elevated?

Troponin

12. A nurse is caring for a client who came to the emergency department reporting chest pain. The provider suspects a myocardial infarction. While waiting for the troponin levels report, the client asks what this blood test will show. Which of the following explanations should the nurse provide to the client?

Troponin is a heart muscle protein that appears in the bloodstream when there is damage to the heart.

13. No p waves present regular wide bizarre qrs complex

V tach (Ventricular tachycardia)

19. AFIB

a

12. No ventricular rate no p waves no pr interval no qrs complex

asystole

22. The nurse assesses a client with pneumonia after the unlicensed health personnel reports the client is having chest pain. The nurse determines the client may have pleuritic chest pain based on which finding? a. Complains of mild but constant aching in the chest b. chest pain that worsens on inspiration c. rapid, shallow, painful respirations d. coughing that triggers muscle spasm

chest pain that worsens on inspiration

16. . On physical assessment of a patient with pericarditis, you may hear what type of heart sound?

d.pericardial friction rub

23. During nursing care of a client with asthma the client experiences an acute asthma attack. As the nurse provides immediate interventions. Which observation by the nurse is the most concerning? a. restlessness and diaphoresis b. decrease wheezing and silent chest c. The use of accessory muscles to breath d. Coarse breath sounds and wheezing

decrease wheezing and silent chest

Exam 1

exam 1

14. patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia? A.aspiration pneumonia B.ventilator acquired pneumonia C.hospital-acquired pneumonia D.community-acquired pneumonia

hospital-acquired pneumonia

2. A nurse is assessing a newly admitted client with chronic HF who forgot to take prescribed medications and seems confused. The patient has peripheral edema and SOB. Which assessment should the nurse complete first? a. skin turgor b. heart sounds c. mental status d. Capillary refill

mental status

3. The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide every day at bedtime b. the nitroglycerin patch is to be used when the chest pain develops c. she will call the clinic if her weight goes up 3 pounds in 1 week d. an additional pillow can her sleep if she is SOB

she will call the clinic if her weight goes up 3 pounds in 1 week