NURS 310 Final Exam

Peripheral arterial disease leads to a decrease in rich oxygenated blood being delivered to the lower extremities, which leads to ischemia and necrosis of skin tissue.

true

True or False: Depolarization of the heart muscle is when the muscle contracts and repolarization is when the heart muscle rests.

true

Which nursing assessment finding supports the possible diagnosis of deep vein thrombosis (DVT)?

unilateral swelling of the calf, pain, warmth in extremity

An older patient who was just diagnosed with a terminal disease states, "All my life I attended church, but I am still worried about what will happen after death." The nurse's best response is which of the following?

unknown may be frightening, do you want to talk about it

During a home visit to an 88-year-old client who is taking digoxin 0.25mg/day to treat heart failure and atrial fibrillation, the nurse obtains this assessment information. Which finding is MOST important to communicate to the health care provider?

vision that is becoming fuzzy

The nurse is preparing to administer the following medications to a client with multiple health problems who have been hospitalized with deep vein thrombosis. Which medication is MOST important to double-check based on the laboratory result every day?

Warfarin 2.5 mg PO

Your client with CHF gained three pounds more since yesterday. You should......

notify the physician

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to

notify the physician of the change in the peripheral perfusion

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

numbness of the extremities

At 10:00 AM, a hospitalized client receives a new order for transesophageal echocardiography (TEE) as soon as possible. Which action will the nurse take FIRST?

Put client on NPO status

You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient?

2."To prevent my feet and legs from getting too cold at night, I will use a heating pad.

A nurse is organizing a support group for older individuals with COPD in the community. The nurse knows that which of the following individuals is most likely to have COPD?

2.A 72-year-old non-Hispanic white female who never worked outside of the home and is a former smoker

The daughter of a patient who has a chronic illness that has reached the terminal phase talks about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care?

1 "I know that palliative care is only available to people who have 6 months or less to live. That is really hard to cope with."

Loss of health, spouse and independence are examples of a transition of aging. Correctly identify the stages of grief in order which are identified by Dr. Kubler-Ross:

1 Denial, Anger, Bargaining, Depression, Acceptance

A patient with chronic heart failure who has been following a low-sodium diet tells the nurse at the clinic about a 5-pound weight gain in the last 3 days. The nurse's first action will be to:

3.assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring.

A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise? Select all that apply

1. 2. Administer a short-acting beta agonist before exercise 3. 4.Avoid exercising when experiencing a respiratory illness

You're assessing a patient's health history for peripheral vascular disease. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease? Select all that apply:

1."I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." 3. "It hurts to elevate my legs." 4."Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away."

You're providing discharge teaching to a patient who was admitted with asthma. You discussed the EARLY warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient:

1.Easily fatigued with physical activity 2.Reduced peak flow meter reading 3. 4.Wheezing with activity 5.Nighttime coughing 6.

correct sequence of electrical conduction of heart

1.SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers

Select all the signs and symptoms a patient can experience with the stimulation of the sympathetic nervous system: Select all that apply

1.Tachycardia 2. 3.Hyperglycemia 4. Dilated pupils 5. Sweating 6.Bronchodilation 7.

A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply:

Raynaud's disease is triggered by cold temperatures or stress, affects the toes/fingers/and sometimes the ear/nose

The admissions department at a local hospital is registering a male older adult for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this client?

2 "Advance directives are limited only to health care instructions and directives."

One difference between palliative care and hospice care is:

2 Palliative care begins at the initial phase of the disease and focusses on symptom management

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime?

2."Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime."

The daughter of an older patient with chronic bronchitis says to the nurse, "I don't understand why my father has not been prescribed antibiotics for his bronchitis. The last time I had bronchitis I got antibiotics." The nurse considers the following when formulating a response:

2.Antibiotics are not prescribed in chronic bronchitis since the cause is usually not bacterial

A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply:

2.Application of compression stockings 3.Limit long periods of standing and sitting

Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse?

3 "My dad wanders at night and I can't be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep.

An investigation into reports of substandard care on the subacute geriatric unit of an acute care facility has been undertaken. Which event would support malpractice on the part of the nursing staff?

4 A client who was immobile was not turned over during the night shift and developed a pressure ulcer on the coccyx.

A nurse is preparing a presentation on ethics for a group of nursing assistants working at local long-term and acute care facilities. Which example would be most appropriate to use to describe the ethical principle of beneficence?

nurse answers call bells quickly and deliberately

The client is being admitted with Folic acid deficiency anemia. Which would be the most appropriate referral?

AA

The nurse is caring for a patient with heart failure. While auscultating heart sounds of this patient, the nurse hears an extra heart sound immediately after the second heart sound (S2). How would the nurse document this?

S3

What area of the heart's electrical conduction is known as the "pacemaker" of the heart?

SA node

The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse?

the client dx with aplastic anemia experiencing pancytopenia

The client was dx with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client?

the stools can be very dark, and this can mask blood

The emergency department nurse is caring for a client who was just admitted with left anterior chest pain, possible acute myocardial infarction(MI). Which action will the nurse take FIRST?

Administer sublingual NTG after checking VS

A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be MOST useful to monitor?

B-type natriuretic peptide

Which of the following conditions precipitate heart failure in older adults?

CAD, HTN, smoking

A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply:

DM, high cholesterol, uncontrolled HTN, smoking

A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder?

IM

The nurse is reviewing the laboratory results for a client with an elevated cholesterol level who is taking atorvastatin. Which result is most important to discuss with the health care providers?

LDL 170 mg/dl

1 / 1 pts Which of the following medications is useful in treating heart failure symptoms due to its ability to prevent coronary artery vasospasm and reduce preload and afterload thus decreasing myocardial oxygen demand?

NTG

The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which laboratory value will be MOST important to monitor?

Potassium level

A client who has just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be MOST useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol?

Troponin 1 Level

The nurse is admitting a 24-year-old American American female client with a dx of rule-out anemia. The client has a hx of gastric bypass surgery for obesity 4 years ago. Current assessment findings include a height of 5'5, wt. 75 kg, P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed?

Vit B12 deficiency

What conditions below can result in an increased cardiac afterload? Select all that apply: 1 Vasoconstriction 2 Aortic stenosis 3 Vasodilation 4 Dehydration 5 Pulmonary Hypertension

What conditions below can result in an increased cardiac afterload? Select all that apply: 1 Vasoconstriction 2 Aortic stenosis 5 Pulmonary Hypertension

Signs of left-heart failure include

a low cardiac output

When going to the hospital, which forms should patients be encouraged to bring with them in case end of life care becomes an ethical or legal issue?

advance directive

Which is NOT explaining cardiac output?

amount of blood pumped by each ventricle in 60 min

1 / 1 pts The nurse working in a cardiac care unit is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume. The nurse recognizes that afterload is increased when there is ...

arterial vasoconstrictiob

A dying client begins to experience restlessness, inability to pay attention and complete tasks they are typically able to do as well as attempting to get out of bed and remove their IV site. What is the best intervention for this client?

ask a family mmeber to sit with the client

Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to?

assess and grade LE pulses bilaterally

The nurse enters the room of the patient diagnosed with CHF. The patient is lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement FIRST to immediately relieve the symptoms. ?

assist the patient to an upright position

The MOST common cause of peripheral arterial disease is?

atherosclerosis

A patient you are caring for has just been diagnosed with terminal cancer. You hear your pateint saying "God, if you let me live, I will go to church every day". This is an example of which stage of grief identified by Dr. Kubler-Ross?

bargaining

What are some side effects of adrenergic antagonist drugs (sympatholytic): select all that apply

bradycardia, bronchoconstriction

Select all the signs and symptoms a patient can experience when the stimulation of the parasympathetic nervous system: Select all that apply:

bradycardia, bronchoconstriction, constrict pupils

The nurse is reviewing the medical record of a 72-year-old client admitted for treatment of a myocardial infarction. The client has a history of hypertension and heart failure. During the night, the client voided four times. Upon reviewing the client medication regimen, which medication would the nurse identify as being implicated in the client's nocturia?

thiazide diuretic

The nurse is caring for a dying patient with an advanced directive stating Do Not Resusictate and Do Not Intubate. During the next assessment the nurse finds the client to have Cheyene- Stokes respirations and pale/blueish skin tone. There is no family at the bedside at this time. What should the nurse do next?

call client family, client is actively dying

A do not resuscitate order (DNR) is a specific type of advanced directive. If the patient's code status is not immediately known, and the patient is found with no pulse and no respirations. What should the nurse do first?

call code alert, call dr

A client has active TB. Which of the following symptoms will he exhibit?

chills, fever, night sweats, hemoptysis

A client has been diagnosed with heart failure that has not yet responded to treatment. What breath sound should the nurse expect to assess on auscultation?

crackles

Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? Select all that apply

daily weight, sx of worsening HF, how to read for Na content

Rest pain is a manifestation of PAD that occurs due to a chronic

decrease in arterial blood flow to the nerves of the feet

A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will?

decrease pt BP and decrease cardiac afterload

When cardiac output is insufficient, compensatory mechanisms are activated. which compensatory mechanism is not included in this initial compensatory mechanism?

decreased HR

A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of heart failure and peripheral arterial disease (PAD). At present, the client is unable to stand or ambulate due to pain in the lower extremity. Based on his medical history, the nurse should implement measures to prioritize the prevention of what complications?

deep vein thrombosis

______________is the stage of grief in which the client may refuse treatment for a disease for which they are diagnosed.

denial

What is NOT a sign and symptom of initial LEFT heart failure?

dependent edema

A student nurse is providing education to a group of older adults about emphysema. What should the student include in the teaching? Emphysema is:

destruction of walls of alveoli with nonproductive cough

An older client with a history of arthritis has fallen after an episode of dizziness. Laboratory data reveal anemia and stool positive for occult blood. Which assessment question would be most appropriate for the nurse to ask to ascertain the client's health situation?

do you take aspirin for the tx of pain/inflammation

Diagnostic tests for congestive heart failure include......

echocardiogram, ECG, CXR

Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the?

elevated position above heart level

A client with poorly controlled diabetes has developed end-stage kidney injury and consequent anemia. When reviewing this client's treatment plan, the nurse should anticipate the use of what drug?

epoeitin alfa

Which of the following blood components is decreased in anemia?

erythrocytes

True or False: The least common type of anemia is iron-deficiency anemia.

false

What two factors are used to calculate cardiac output? Select all that apply:

heart rate, stroke volume

You receive a morning report on your patient with CHF and are told that you are to administer Lasix 40 mg IV to your patient at 0800 and 1800. The morning labs have just been received and they are: Sodium 148, BNP 600, Potassium 3.0, Creat 1.2 and BUN 10. The night RN reports bilateral pitting edema of +3. Which of the following nursing interventions is PRIORITY?

hold the dose of lasix and notify the physician about the potassium level

Mrs. Hart is admitted with Heart Failure and is receiving furosemide (Lasix), a loop diuretic to reduce edema. The nurse should observe for the following lab disorder:

hypokalemia

A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by:

increase, increasing preload

1 / 1 pts The heart is composed of three layers. the middle layer is composed of specialized cell, called myocytes, responsible for conducting the system blood pumping action. What is this layer called?

myocardium

A nurse is providing care to a 71-year-old client who is in the late stages of cancer and who has painful bone metastases. The client is nonresponsive but groans and grimaces intermittently. The nurse is drawing up a breakthrough dose of morphine for the client, but a colleague cautions that, "Sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage." The colleague's statement prioritizes which ethical principle?

nonmaleficence

Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply

thick/tough, brown pigmented

The most significant etiology for chronic obstructive pulmonary disease (COPD) is:

tobacco use

A 50-year-old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and a sedentary lifestyle. When developing an individualized care plan for her, thenurse determines that the most important risk factors for peripheral artery disease (PAD) that need to be modified are:

tobacco use and high blood pressure

Your patient has a severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks:

pallor, rubor

What is the accessory valve structure that is attached to between Chordae tendinase and inside ventricle walls that contract during ventricle systolic phage? ​

papillary muscles

Impaired blood flow to the extremities is caused by which of the following common disorders?

peripheral vascular disease

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching?

pernicious anemia is caused by not consuming enough b12

How do older adults deal with loss and grief?

physical sx and immobilization

1 / 1 pts Chronic Obstructive Pulmonary Disease (COPD) consists of a group of diseases including all of the following except:

pnuemonia

Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume (cardiac output):

preload, contractility, afterload

Afterload is defined as...

pressure against which the left ventricle ejects

The nurse recognizes the value of hospice care in promoting quality of life and the end of life. Which of the following older adult patients reflects an eligibility requirement for hospice care?

pt experienced stroke and has been given 3 months to live

1 / 1 pts An older adult client who is status post a right hip total arthroplasty is found to have a DVT in the right lower leg. The nurse is assessing the client and finds them to be restless, complaining a dyspnea, a heart rate of 110 beats/min and a respiratory rate of 24 breaths/min. What problem does the nurse suspect the client is experiencing?

pulmonary embolism

Examination of a patient in a supine position reveals jugular veins distended from the base of the neck to the angle of the jaw. This finding indicates:

right-sided heart failure

Signs of right -sided heart failure include

signs of fluid retention

A nurse is giving a presentation at a community center about chronic bronchitis. Which of the following information should the nurse include as effective for preventing this disorder?

smoking cessation

Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing?

smoking cessation

A patient received a nebulizer of Albuterol. What is a side effect of this medication?

tachycardia

1 / 1 pts Which statement below best describes the term cardiac preload?

the amount ventricles stretch at the end of diastole