MedSurg Final PrepU

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? 31

A client diagnosed with kidney disease Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension.

The nurse is educating the client about management of diabetes. An inappropriate statement by the nurse is 3/4

"Checks of blood glucose level are to be done ac and hs."

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is: 31

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

A client with peripheral arterial disease asks the nurse about using a heating pad to warm the feet. The nurse's best response is which of the following? 30

"It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet."

Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which of the following actions illustrates the nociception process of pain transmission? 12

A child quickly removing a hand when touching a hot object Transduction, the first process involved in nociception, refers to the processes by which noxious stimuli, such as a surgical incision, release of a number of excitatory compounds which move pain along the pain pathway. Transmission, the second process involved in nociception, is responsible for a rapid reflex withdrawal from painful stimulus. The third process involved in nociception is perception. Imagery is based on the belief that the brain processes can strongly influence pain perception. A dual mechanism analgesic agent, such as tramadol (Ultram), involves many different neurochemicals as in the process of modulation.

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? 31

A client diagnosed with kidney disease

A patient is ordered to receive hypotonic IV solution to provide free water replacement. Which of the following solutions will the nurse anticipate administering? 13

0.45% NaCl Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace cellular fluid because it is hypotonic compared with plasma. Another is to provide free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. Lactated Ringer's solution and normal saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.

A 77-year-old retired male client visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is this client retaining if his weight increases by 2 lb? 13

1 L

Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. 31

140, 90

The normal serum value for potassium is 13

3.5 to 5.5 mEq/L.

A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose? 31

4.8 mL

You are assessing a client recently admitted to your unit for hypotension. While assessing this client, you find a pulsatile mass near the umbilicus. What would you suspect? 30

Aortic aneurysm A pulsating mass may be felt or even seen around the umbilicus or to the left of midline over the abdomen. Options A, C, and D would not present with a pulsating mass near the umbilicus; therefore, they are incorrect.

A patient has been admitted to the health care center, diagnosed with cardiac dysfunction. The nurse notices that the patient's ankles and feet have swollen. When the nurse uses critical thinking skills, which of the following nursing interventions does the nurse need to perform next? 3/4

Assess patient for dependent edema

You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? 30

Atherosclerosis

A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? 21

Auscultation

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack? 30

Avoid situations that contribute to ischemic episodes.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? 30

Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

Which stage of the transtheoretical model occurs when the patient has serious consideration of change, but it is sometime in the future? 3/4

Contimplation

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? 31

Continuous IV infusion

A client being treated for rheumatoid arthritis has been prescribed a type of drug that is commonly used for joint inflammation. The nurse will administer an initial dose as an injection, and the client will continue taking an oral form of the medication. Which type of analgesic drug will the nurse administer? 12

Corticosteroid

A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type? 20

Crackles

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected? 25

Crackles

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation? 20

Crackles at lung bases

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels? 25

Enzymes When tissues and cells break down, are damaged, or die, great quantities of certain enzymes are released into the bloodstream. Enzymes can be elevated in response to cardiac or other organ damage. After an MI, RBCs and platelets should not be elevated. WBCs would only be elevated if there was a bacterial infection present

Which of the following statements is accurate regarding Reynaud's disease? 30

Episodes may be triggered by unusual sensitivity to cold. Episodes of Reynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.

A patient with severe anemia is admitted to the hospital. Due to religious beliefs, the patient is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells?

Epoetin alfa (Epogen) Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis.

When providing care to a patient with anxiety, which intervention would be the highest priority? 6

Exploring appropriate coping strategies

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? 31

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.

Which phase of the nursing process encompasses the establishment of expected outcomes? 4

Planning

Which of the following electrolytes is a major cation in body fluid? 13

Potassium Potassium is a major cation that affects cardiac muscle functioning. Chloride is an anion. Bicarbonate is an anion. Phosphate is an anion

A systolic blood pressure of 135 mm Hg would be classified as which of the following? 31

Prehypertension A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP of greater than or equal to 160 is classified as stage 2 hypertension.

When assessing a patient with left-sided heart failure, what would be noted on auscultation of lungs? 25

Wheezes with wet lung sounds If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound and wheezes and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal high pitch sound.

An advanced directive in which one person identifies another person to make health care decisions on his or her behalf is known as 3

a durable power of attorney for health care.

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs? 20

Impaired gas exchange

The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? 25

"My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."

A 55-year-old man newly diagnosed with hypertension returns to his physician's office for a routine follow-up appointment after several months of treatment with Lopressor (metoprolol). During the nurse's initial assessment the patient's blood pressure (BP) is recorded as 180/90 mm Hg. The patient states he does not take his medication as prescribed. The best response by the nurse is which of the following? 31

"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?"

Mrs. Riley is an elderly client who has been a resident of a long-term care facility for several years. Her condition has deteriorated to the point that she is now unable to eat. Her physician has recommended surgical implantation of a feeding tube. Her daughter has a legal document outlining Mrs. Riley's wishes in regard to measures such as this. What is this document? 3

Advance directive

Which of the following medications is considered a thrombolytic? 30

Alteplase Alteplase is considered a thrombolytic, which lyses and dissolves thrombi. Thrombolytic therapy is most effective when given within the first 3 days after acute thrombosis.

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? 25

B-type natriuretic peptide (BNP)

Of the following terms, which is used to refer to the period of time during which mourning a loss takes place? 16

Bereavement Bereavement is the period of time during which mourning a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill patients and their families.

The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive? 31

Beta blocker Atenolol is classified as a beta blocker. Beta blockers block beta adrenergic receptors of the sympathetic nervous system, causing vasodilation and decreased cardiac output and heart rate. Atenolol is not classified as a diuretic, ACE inhibitor, or vasodilator.

The nurse is caring for a patient with clubbing of the fingers and toes. The nurse should complete which of the following actions given these findings? 25

Obtain an oxygen saturation level.

You are caring for a client with a damaged tricuspid valve. You know that the tricuspid valve is held in place by which of the following? 25

Chordae tendineae

Which component of the nursing process deals with the identification of patient problems? 3

Diagnosis Nursing diagnoses are actual or potential health problems that can be managed by independent nursing interventions. Assessment is the systematic collection of data to determine the patient's health status and any actual or potential health problems. Planning is the development of goals and outcomes. Implementation is the actualization of the plan of care through nursing interventions.

A patient has been diagnosed with congestive heart failure (CHF). The physician has ordered a medication to enhance contractility. The nurse would expect which medication to be ordered for the patient? 25

Digoxen (Lanoxin)

Which of the following nursing interventions should a nurse perform when caring for a patient who is prescribed opiate therapy for pain? 12

Do not administer if respirations are less than 12 per minute

A nurse is preparing a client for bronchoscopy. Which instruction should the nurse give to the client? 20

Don't eat.

Which of the following is a cognitive or mental activity that nurses use in critical thinking? 3

Drawing on past clinical experiences and knowledge to explain what is happening

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? 31

Heart and blood vessels

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? 30

Homans' A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.

An increase in the number of new cells in an organ or tissue that is reversible when the stimulus for production of new cells is removed is which of the following? 6

Hyperplasia

A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings? 13

Hypokalemia Potassium is the major intracellular electrolyte. Hypocalemia (below 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting, muscles weakness, leg cramps, decreased bowel motility, and paresthesias.

Which of the following would be a potential cause of respiratory acidosis? 13

Hypoventilation Respiratory acidosis is always due to inadequate excretion of CO, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid. In addition to an elevated PaCO, hypoventilation usually causes a decrease in PaO.

Which of the following is a nursing diagnosis related to health education? 4

Ineffective health maintenance

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? 13

Instruct the client to breathe into a paper bag. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation? 21

Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.

A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is 12

Instruct the son about lack of client consent.

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? 30

Intermittent claudication The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease

Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis.

Lack of erythropoietin

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 13

Lactated Ringer's solution Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic.

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for receiving oxygenated blood from the lungs? 25

Left Atrium

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for pumping blood to all the cells and tissues of the body? 25

Left ventricle The left ventricle pumps that blood to all the cells and tissues of the body. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs to be oxygenated. The right atrium receives deoxygenated blood from the venous system.

The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? 31

Loss of arterial elasticity

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? 13

Metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure? 25

Methylprednisolone (Solu-Medrol) Prior to cardiac catheterization, the patient is assessed for previous reactions to contrast agents or allergies to iodine-containing substances, as some contrast agents contain iodine. If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed. Lasix, Ativan, and Dilantin do not counteract allergic reactions

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? 12

Neuropathic Pain An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located

An 82-year-old client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. He is without breakthrough pain at this point in time. How would his pain be classified? 12

Neuropathic and chronic

A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan? 16

Pain is viewed as a means of cleansing by God.

A 50-year-old patient is an alcoholic. He has been diagnosed with cancer of the pancreas. He underwent surgery for removal of the tumor. Despite the tumor being removed, the physician informs the patient that he needs to start chemotherapy immediately. Using evidence-based practice, which of the following interventions might the nurse expect the physician to include with the goal of improved quality of life, mood, and longer median survival. 16

Palliative care

A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following? 16

Palliative care is the same as hospice care.

A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? 30

Peripheral pulses every 15 minutes following surgery The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable.

Which of the follow arteries carries deoxygenated blood? 25

Pulmonary artery The pulmonary artery is the only artery carrying deoxygenated blood. Oxygenated blood returns to the left atrium via the pulmonary veins.

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? 31

Renal dysfunction resulting from atherosclerosis

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? 13

Respiratory alkalosis

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? 13

Respiratory alkalosis

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? 13

Respiratory alkalosis Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. Metabolic acidosis is marked by a decrease in HCO3? to less than 22 mEq/L, and a decrease in blood pH to less than 7.35. In respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg. In metabolic alkalosis, the HCO3? is greater than 26 mEq/L and the pH is greater than 7.45.

Which of the following findings indicates that hypertension is progressing to target organ damage? 31

Retinal blood vessel damage

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? 30

Reynaud's disease

The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred? 25

Troponin T and I After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? 13

Serum bicarbonate of 28 mEq/L Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.

The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium? 31

Spironolactone (Aldactone)

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? 30

Stabilizing heart rate and blood pressure and easing anxiety For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority? 20

Swallow reflex

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? 13

Tachycardia Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons? 25

The client is at risk for renal failure due to the contrast agent that will be given during the procedure. The contrast medium must be excreted by the kidneys. If there is already a degree of renal impairment (which these laboratory values indicate), the risk for contrast agent-induced nepropathy and renal failure is high.

Which of the following is a reliable source for quantifying pain? 12

The client's description of the pain

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the rise in pH? 13

The lungs are not able to blow off carbon dioxide. In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, it is the lungs ability to remove the carbon dioxide from the system. Although individuals with COPD frequently have a history of smoking, cilia is not the cause of the acidosis.

A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? 16

The stages are applicable to any loss.

The nurse understands that an overall goal of hypertension management includes which of the following? 31

There is no indication of target organ damage.

The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes? 20

They can be heard during inspiration and expiration.

The nurse is providing preoperative information about hip replacement to a group of clients scheduled for this surgery. One of the clients is slightly hearing impaired. The best action of the nurse is to 3/4

Use a model of the hip.

Which type of pain arises from an internal organ, such as the kidneys? 12

Visceral Visceral pain arises from internal organs, such as the heart, kidneys, and intestines, that are diseased or injured. Neuropathic pain is pain that is processed abnormally by the nervous system. Nociceptive pain is the noxious stimuli that are transmitted from the point of cellular injury over peripheral sensory nerves to pathways between the spinal cord and thalamus, and eventually from the thalamus to the cerebral cortex of the brain

A patient comes into the emergency room with complaints of an enlarged tongue. The tongue appears smooth and beefy red in colour. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the patient states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which of the following problems?

Vitamin B12 deficiency

When assessing a patient with left-sided heart failure, what would be noted on auscultation of lungs? 25

Wheezes with wet lung sounds

The most common site of aneurysm formation is in the: 30

abdominal aorta, just below the renal arteries. About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 30

forcing blood into the deep venous system.

It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine 31

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

The nurse auscultates lung sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as 20

pleural friction rub

While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply. 16

• "This must be very difficult for you." • "Tell me more about what's on your mind."

Therapeutic communication techniques between client and nurse facilitate continuity of care. Which of the following identifies the value of therapeutic communication? Select all that apply. 3/4

• Allows the nurse to display interest in the client and the communication • Helps the nurse to assist the client to explore and understand his or her problems

The nurse is assessing the cardiovascular status of a client who was found unresponsive in a lobby area. Following transfer of the client, the family asks how blood circulates through the body. The nurse is most correct to state the proper circulation as which? 25

• Right ventricle • Pulmonary artery • Pulmonary vein • Left atrium • Left ventricle • Aorta The pathway of blood flow from the right atrium includes the right ventricle. The blood flows to the lungs via the pulmonary artery and returns to the heart in an oxygenated state via the pulmonary vein. The oxygenated blood then enters the left atrium then left ventricle pump through the aorta to the systemic circulation.

To confirm an acid-base imbalance, it is necessary to assess which of the following findings from the results of a client's arterial blood gas (ABG) results? Select all that apply. 13

• pH • PaCO2 • HCO3