EXAM 2 (First 15's)

A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment? A. HCO3 26 mmHg B. Blood pressure 70/45 C. PaO2 80 mmHg D. PaCO2 38 mmHg

B. Blood pressure 70/45 Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and decrease the cardiac output (watch out fora low blood pressure) along with hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs are leaking air).

A nurse is providing dietary teaching to a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet? A.Calcium B.Phosphorus C.Potassium D.sodium

A. Calcium -A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement dietary calcium

DISCHARGE TEACHING TO THE PARTNER OF A CLIENT WHO HAS A NEW DIAGNOSIS OF HEPATITIS A. WHICH OF THE FOLLOWING INSTRUCTIONS SHOULD THE NURSE INCLUDE IN• A. Encourage her to eat foods high in carbs• B. Have her perform moderate exercise to restore her strength more quickly C. During the illness, she may take Tylenol (acetaminophen) for fever or discomfort D. The provider will prescribe medication to help her liver heal faster.

A. Encourage her to eat foods high in carbs• Clients diet should be high in carbs and calories, with only moderate amounts of protein, and fat, especially if nausea is present.

The emergency room (ER) nurse is caring for a client whose arterial blood gases show a metabolic alkalosis. How does a client compensate for metabolic alkalosis? A. Hypoventilation B. Renal excretion of hydrogen ions C. Kidneys conserve bicarbonate ions D. Hyperventilation

A. Hypoventilation

You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis? A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26 C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29 D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body sway of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high(normal is 7.35-7.45) (alkalotic).In the late stage, the patient can enter into respiratory acidosis.

The nurse is caring for a client in the intensive care unit who has been on a ventilator set on 80% FiO2 for three days. The nurse will observe the client for risk of having which condition as a result of prolonged ventilator settings with 80% FiO2? A. Pulmonary fibrosis. B. Pleural effusion .C. Pneumonia. D. Legionnaires Disease

A. Pulmonary fibrosis. This answer is correct because pulmonary fibrosis and oxygen toxicity are the highest risks for a client on a ventilator with high levels of FiO2 for more than 72 hours.

A client was brought into the emergency department for smoke inhalation following a house fire. The nurse will monitor for which signs of acute respiratory distress syndrome (ARDS)? Select all that apply. A. Low oxygen saturation with oxygen delivery at 80% FiO2. B. Blood-tinged mucus and blood gases showing respiratory alkalosis. C. Tachypnea and use of accessory muscles. D. Bluish nail beds and restlessness. E. A productive cough with green sputum.

A. This answer is correct because ARDS is characterized by refractory hypoxemia.This is hypoxemia that does not improve even with high levels of oxygen administered. C. This answer is correct because tachypnea and use of accessory muscles are signs of hypoxemia. Refractory hypoxemia is the hallmark clinical manifestation of ARDS. D. This answer is correct because bluish discoloration of nail beds or cyanosis, and restlessness are signs of hypoxemia. Hypoxemia that does not improve with oxygen administration is the hallmark sign of ARDS.

A nurse is teaching a client who has chronic kidney disease (CKD). Which of the following instructions should the nurse include? A.Limit fluid intake B.Limit caloric intake C.Eat a diet high in phosphorus D.Eat a diet high in protein

A. limit fluid intake A client who has CKD should limit fluid intake to prevent hypervolemia (excessive fluid overload). - Clients with CKD should increase caloric intake so that the body can use protein for protein synthesis instead of energy consumption. A client with CKD should limit phosphorus intake because the kidneys are unable to excrete it. A client who has CKD should not eat excessive protein to prevent the build-up of protein waste products and uremia.

Which of the following ismost likely an early symptomof hypoxia? A.Hypertension B.Skin rash C.Hypotension D.Hyperkalemia E.Hypomagnesia F.Metabolic Alkalosis

A.Hypertension In initial stage of hypoxia tachycardia Upton can increase blood pressure or hypertension. However as hypoxia is sustained, compensatory mechanism often cannot be sustained and blood pressure can become very low. Blood pressure changes are not a good indicator of hypoxia.

A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions should the nurse implement first? A.Give morphine IV. B.Administer oxygen therapy. C.Start an IV infusion of lactated Ringer's. D.Initiate cardiac monitoring.

B. Administer oxygen therapy. Rationale: The greatest risk to the safety of a client who has a pulmonary embolism is hypoxemia with respiratory distressand cyanosis. Oxygen therapy should be applied by the nurse using a nasal cannula or mask. Pulse oximetry should beinitiated to monitor oxygen saturation.

______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine A. Urea B. Creatinine C. Potassium D. Magnesium

B. Creatinine Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.

A client checks into a Convenient Care Clinic reporting, "I feel so nervous, like my heart is racing or flopping around in my chest." Upon assessment, the nurse notes the client's vital signs as follows: BP-138/78, P-118, R-28, T-99.8 F, oxygen saturation (by pulse oximeter)-95% on room air. Based upon this assessment, what should be the nurse's first action? (assuming that an order has been given by the health care provider for each action.) A. Give the client an anti-anxiety medication, such as diazepam B. Have the client rebreathe CO2 by using a rebreather mask or a paper bag C. Give the client a beta blocker, such as metoprolol D. Call the respiratory department to have arterial blood gases done, stat

B. Have the client rebreathe CO2 by using a rebreather mask or a paper bag

A client presents to the walk in clinic, reporting that he has been vomiting "off and on" for the past 24 hours. The nurse is aware that this client is at risk for which of the following complications? A. Hyperkalemia & metabolic acidosis B. Hypokalemia & metabolic alkalosis C. Hypokalemia & metabolic acidosis D. Hyperkalemia & metabolic alkalosis

B. Hypokalemia & metabolic alkalosis

A nurse is preparing to administer meperidine to a client who is postoperative and reports a pain level of 8 on a scale of 0 to 10. Which of the following routes of administration will deliver the medication with the shortest time of onset? A. Oral B. IV C. IM D. Subcutaneous

B. IV - The nurse should identify that meperidine given IV has no barriers to absorption because it is deposited directly into the circulatory system. An instantaneous time of onset and absorption gives the client immediate relief.

During the exudative phase of acute respiratory distress syndrome(ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to? A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema

B. atelectasis Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue)when there is a decrease in production in surfactant.

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take? A. Notify the provider B. Contact the nursing supervisor C. Assess the client's apical pulse D. Complete an incident report

C. Assess the client's apical pulse -Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client's status he/she must first collect adequate data from the client. An assessment will provide the nurse with the knowledge needed to make an appropriate decision.

A nurse is caring for a client who has just developed a pulmonary embolism. Which of the following medications should the nurse anticipate administering? A. Furosemide B. Dexamethasone C. Heparin D. Atropine

C. Heparin Rationale: A pulmonary emboli is a condition in which the pulmonary blood flow is obstructed, resulting in hypoxia and possible death. Most often caused by a blood clot, treatment such as heparin, an anticoagulant, is used to prevent the enlargement of the existing clot or the formation of new clots.

Which of the following is true of acute respiratory distress syndrome (ARDS)? A. More common in women B. More common in men C. High Mortality Rate D. Low Mortality Rate

C. High Mortality Rate

A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal

C. Pre-renal Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

Interpret the following:pH 7.22, PaCO2 58, HCO3 23. A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis.

C. Respiratory acidosis.

A cardiac Intensive Care Unit nurse receives the following information at change of shift report: the client reports dizziness,shortness of breath, and tingling in their extremities. Arterial blood gases (ABGs) are:pH- 7.44CO2- 29HCO3- 20Which interpretation of these ABGs by the nurse is correct? A. Respiratory acidosis, fully compensated B. Metabolic acidosis, fully compensated C. Respiratory alkalosis, fully compensated D. Metabolic alkalosis, fully compensated

C. Respiratory alkalosis, fully compensated

You're providing care to a patient who is being treated foraspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK signand symptom that the patient is developing acuterespiratory distress syndrome (ARDS)? A. The patient is experiencing bradypnea. B. The patient is tired and confused. C. The patient's PaO2 remains at 45 mmHg. D. The patient's blood pressure is 180/96.

C. The patient's PaO2 remains at 45 mmHg. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg)

The nurse, who is caring for a client who recently presented to the emergency room, suspects the client is in metabolic alkalosis. Which arterial blood gas values best validate this condition? A. pH-7.23, PCO2-58, HCO3-26 B. pH-7.58, PCO2-22, HCO3-23 C. pH07.51, PCO2-48, HCO3-34 D. pH-7.38, PCO2-50, HCO3-30

C. pH07.51, PCO2-48, HCO3-34

You're precepting a nursing student who is assisting you care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10mmHg. Your response is: A. "This pressure setting assists the patient with breathing in and out and helps improve airflow." B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs." C. "This pressure setting helps prevent fluid from filling the alveoli sacs." D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation."

D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation." This setting of PEEP (it can range between 10 to 20mmHg of water) and it helps to open the alveoli sacs thatare collapsed, especially during exhalation.

How does a client compensate for metabolic acidosis? A. Renal excretion of HCO3. B. Renal retention of H+. C. Hypoventilation. D. Hyperventilation.

D. Hyperventilation. because the body will compensate for ametabolic acidosis via hyperventilation in order to "blow off" excess CO2 in a state of acidosis

A client is receiving continuous IV heparin for the diagnosis of pulmonary embolism (PE). Which observation by the nurse requires the IV to be stopped and a STAT aPTT level performed? A. Chills with pain and numbness in arms and legs. B. Coughing productive of blood-tinged sputum. C. Client complains of a headache and is sweaty. D. Pinpoint-sized red and purple spots on the client's arms and legs

D. Pinpoint-sized red and purple spots on the client's arms and legs This answer is correct because this is called petechiae and is a hallmark sign of bleeding. The nurse will obtain aPTT so the health care provider(HCP) can reevaluate the dose of heparin. In some cases, the client may be changed over to oral anticoagulation with consistent monitoring of INR, PT, andaPTT lab studies.

A client's total parenteral nutrition (TPN) has 50 mL remaining in the bag and the new one has not been sent by the pharmacy. What is the priority nursing action? A.Hang 0.9% Sodium Chloride B.Hang Dextrose 5% in water C.Hang 0.45% Sodium Chloride D.Hang 10% Dextrose in water

The Answer is D This answer is correct because 10% Dextrose in water will meet the body's glucose demands until total parenteral nutrition is available. The nurse should be careful to order the TPN early enough from the pharmacy to help prevent this situation from occurring. Otherwise, the priority action is to give the client the needed calories from the glucose content in 10% Dextrose IV fluids to keep the client from experiencing hypoglycemia.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

Which patient below with acute kidney injury is in the oliguric stage of AKI: A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.

A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for? A. Hypercalcemia B. Anemia C. Blood clots D. Hyperkalemia

The answer is B. EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia.

Which patient below is NOT at risk for developing chronic kidney disease? A. A 58 year old female with uncontrolled hypertension. B. A 69 year old male with diabetes mellitus. C. A 45 year old female with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury.

The answer is C.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

The answer is C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Don't forget - Hepatitis A and E are spread only via fecal-oral routes. Vaccination is the best protection against HAV & HBV So if a person is exposed to Hep A, make sure others living in the household get the vaccination.

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level

The answer is C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.

A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium

The answer is C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).

The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly? A. Abdominal girth is decreased B. Skin turgor is less than 2 seconds C. Blood glucose is 250 D. Stools appear formed and solid

The answer is D. Pancreatic enzymes help the body break down carbs, proteins, and fats because the body is not sufficiently producing digestive enzymes anymore. Hence, the stool will not appear as oily or greasy (decrease in steatorrhea) but appear solid and formed. Remember these treatments: •Effective pain management •Low-fat, bland diet •Supplemental pancreatic enzymes •ELIMINATE ALCOHOL •Bile salts to facilitate absorption of fat soluble vitamins (ADEK) •Control diabetes à teach to monitor blood glucose •Antacids and anticholinergics to decrease gastric acid •it sometimes takes large, frequent doses of analgesic to relieve pain •small frequent meals, patient do not tolerate fatty, rich and stimulating foods •take after meals, have little overall effect on pt outcomes

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse

The answer is D. Main causes of acute pancreatitis are gallstones and alcohol consumption. Remember: Abdominal pain is the predominant symptom. LUQ or mid-epigastrium, commonly radiates to shoulder or back, often occurs 24-48 hrs after fatty meal or heavy alcohol intake. Can have abdominal tenderness with guarding and rigidity, also can be deep, severe, piercing and continuous pain. frequent onset when patient lying down

A client is admitted for acute pancreatitis. Which symptoms will the nurse expect the client to demonstrate? A. Flu like symptoms of malaise and fatigue B. indigestion, belching, and flatulence C. Intense abdominal pain at McBurney's point D. Abdominal pain with radiation to the back

The answer is D. This answer is correct because abdominal pain with radiation to the back, which occurs suddenly is a sign of acute pancreatitis. The pain can start at the midepigastric or left upper quadrant of the stomach and radiate to the back. The client will also demonstrate abdominal guarding.

A client is being evaluated for pancreatitis. Which labs in the comprehensive metabolic panel, if critical will indicate to the nurse a diagnosis of pancreatitis? A. RBC's and WBC's B. BUN and Creatinine C. ALT and SGPT D. Amylase and lipase

The answer is D. This answer is correct because amylase and lipase are pancreatic enzymes. These labs are considered the most sensitive markers for indication of pancreatitis. Lab values higher than 3 times the normal are considered critical and are a medical emergency.

The nurse is performing discharge teaching to a client who was diagnosed with acute pancreatitis. Which symptom of pancreatitis should the client report to the health care provider (HCP)? A. Abdominal tenderness B. Weight gain C. Foamy urine D. Clay colored stools

The answer is D. This answer is correct because pancreatitis causes narrowing of the pancreas which causes narrowing of the common bile duct.This prevents bile from draining appropriately into the liver. This causes stools to become pale or clay-colored.

The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys.

Select all the signs and symptoms associated with Hepatitis? A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

The answers are A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

You are providing education to a patient with CKD about calcium. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply: A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

The answers are B and D. Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after.

Select all the ways a person can become infected with Hepatitis B: A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

The answers are B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A) 55-year-old male with Hepatitis A. B) An infant who contracted Hepatitis at birth. C) 32-year-old female with Hepatitis using IV drugs. D) 50-year-old male with alcoholism & Hepatitis D. E) 30-year-old who contracted Hepatitis E.

The answers are B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.