Exam #2 Questions

The heart monitor of a patient shows a rhythm that appears as a wandering or fuzzy baseline. What is the priority action for the nurse? a. Immediately obtain a 12 lead ECG to assess the actual rhythm. b. Assess the patient to differentiate artifact from actual lethal rhythms. c. Check to see if the patient has a do not resuscitate order. d. Ask the patient care technician to take vital signs on the patient.

b. Assess the patient to differentiate artifact from actual lethal rhythms.

Excessive vagal stimulation can result from which activities? ( Select all that apply) a. Jogging b. Carotid sinus massage c. Suctioning d. Voiding e. Valsalva maneuver

b. Carotid sinus massage c. Suctioning e. Valsalva maneuver

1) What does the P wave in an ECG represent? a. Atrial depolarization b. Atrial repolarization c. Ventricular depolarization d. Ventricular repolarization

a. Atrial depolarization

The nurse is assessing a patient's ECG rhythm strip and analyzing the P waves. Which questions does the nurse use to evaluate the P waves? ( select all that apply) a. Are P waves present? b. Are P waves occurring regularly? c. Does one P wave follow each QRS complex? d. Are the P waves greater than .20 seconds? e. Do all P waves look similar? f. Are the P waves smooth, round and upright in appearance?

a. Are P waves present? b. Are P waves occurring regularly? e. Do all P waves look similar? f. Are the P waves smooth, round and upright in appearance?

Traditionally, what medications will most likely be ordered for a patient with a fib? (Select all that apply) a. Diltiazem ( Cardizem) b. Furosemide ( Lasix) c. Heparin d. Enoxaparin ( Lovenox) e. Warfarin ( Coumadin)

a. Diltiazem ( Cardizem) c. Heparin d. Enoxaparin ( Lovenox) e. Warfarin ( Coumadin)

The health care provider recommends to a patient that diagnostic testing be performed to assess for valvular heart disease. The nurse teaches the patient about which test that is commonly used for this purpose? a. Echocardiography b. Electrocardiography c. Exercise testing d. Thallium scanning

a. Echocardiography ultrasound or sonogram of heart

A patient is admitted for pericarditis. How will the patient likely describe his pain? a. Grating substernal pain that is aggravated by inspiration b. Sharp pain that radiates down the left arm. c. Dull ache that feels vaguely like indigestion d. Continuous boring pain that is relieved with rest.

a. Grating substernal pain that is aggravated by inspiration

Which symptom is the most common initial manifestation of PAD? a. Intermittent claudication b. Pain at rest c. Redness in the extremity d. Muscle atrophy

a. Intermittent claudication CONTINUE WALKING EVEN IF PAIN DEVELOPS- NEED TO DEVELOP COLLATERAL CIRCULATION!

What is the ST segment in an ECG normally? a. Isoelectric b. Elevated c. Depressed d. biphasic

a. Isoelectric

A patient is admitted for a medical diagnosis of detectable AAA. What does the nurse expect to find documented in the patient's description of symptoms? a. Hematuria and painful urination that started very suddenly b. Steady and gnawing abdominal; pain unaffected by movement and lasting for days c. No subjective complaints of pain, but episodes of dizziness d. Pain in the lower extremities exacerbated by walking and relieved with rest

b. Steady and gnawing abdominal; pain unaffected by movement and lasting for days

Long term anticoagulation therapy for a patient with valvular heart disease and chronic atrial fibrillation includes which drug? a. Heparin sodium b. Warfarin (Coumadin) c. Diltiazem (Cardizem) d. Enoxaparin (Lovenox)

b. Warfarin (Coumadin) risk for blood pooling in LAA- stroke risk

A patient with a ruptured aneurysm may experience which symptoms? (Select all that apply) a. bradypnea b. tachycardia c. increased systolic pressure d. decreased blood pressure e. severe pain f. decreased level of consciousness

b. tachycardia d. decreased blood pressure e. severe pain f. decreased LOC

Which dysrhythmia causes the ventricles to quiver, resulting in the absence of cardiac output? a. Ventricular tachycardia b. Ventricular fibrillation c. Asystole d. Third degree heart block

b. Ventricular fibrillation

What statements about DI are accurate? (Select all that apply) a. It is caused by ADH deficiency b. It is characterized by a decrease in urination c. Urine output of greater than 4L/24 hours is the first diagnostic indication d. The water loss increases plasma osmolarity e. Nephrogenic DI can be caused by lithium (Eskalith)

A C D

What is the most common cause of an aneurysm? a. Emboli b. Trauma c. Atherosclerosis d. Thrombus formation

c. Atherosclerosis

A nurse is assessing a client with suspected diabetes mellitus, type 1. Which of the following signs and symptoms are consistent with this diagnosis? Select all that apply. polyuria, polydipsia, and polyphagia Kussmaul breathing recent weight gain weakness, fatigue blurred vision

1, 2, 4, and 5: Signs and symptoms consistent with diabetes mellitus, type 1, include the 105 0 following: 3 Ps -polyuria, polydipsia, and polyphagia as the body tries to compensate for the increased glucose level. Recent weight loss: This occurs because protein and stored fat is broken down because of the body's inability to utilize glucose for energy. Weakness, fatigue: Inadequate glucose stores to provide energy needs. Blurred vision: Caused by increased fluid in the lens of the eye. Kussmaul breathing: Hyperventilation that occurs with diabetic ketoacidosis.

A malfunctioning posterior pituitary gland can result in which disorders? (Select all that apply) a. Hypothyroidism b. Altered sexual function c. Diabetes insipidus d. Growth retardation e. Syndrome of inappropriate antidiuretic hormone (SIADH)

C E

A 35-year-old woman is recovering from a thyroidectomy for Hashimoto's thyroiditis. The client complains that she is experiencing a tingling sensation about her mouth and fingers and muscle cramps in her legs. Which of the following complications is most likely the cause of these symptoms? hypocalcemia hypercalcemia hypermagnesemia hypomagnesemia

1: Hypoparathyroidism with hypocalcemia is a complication of thyroidectomy. Hypocalcemia mav occur because of inadvertent removal of all or some of the parathyroid glands but may also occur temporarily after surgery because of edema or manipulation of the parathyroid glands during the thyroidectomy. Typical symptoms include a tingling sensation about the mouth and in the fingers and toes. Some may develop severe muscle cramps and tetany. Transient mild o

The nurse is completing an hrsica ieamination ora clientand evaluating the consisten. Seripheral arterial and venous insureseney, Which of the following findings are conststent with peripheral arterial insufficiency? Select all that apply. brownish discoloration appears about the ankles and anterior tibial area foot exhibits rubor on dependency and pallor on elevation ulcers are evident on end of great toe and heel peripheral edema is marked ulcers are superficial and irregular, often on medial or lateral malleolus

2 and 3: With peripheral arterial insufficiency, the foot exhibits rubor on dependency and pallor on elevation. The skin often feels cool and appears pale and shiny with loss of hair on the leg, foot, and toes. Because of impaired circulation, the toenails may appear thick and ridged. Pedal pulses are weak or absent. Ulcers tend to occur on the tips of toes or between toes and on heels or

A patient is recovering from a transsphenoidal hypophysectomy. What postoperative nursing interventions apply? (Select all that apply) a. Encourage the patient to perform deep breathing exercises b. Vigorous coughing and deep breathing exercises c. Instructing on the use of a hard bristled toothbrush for brushing the teeth d. Strict monitoring for fluid balance e. Hourly neurologic checks for the first 24 hours f. Instructing the patient to alert the nurse regarding postnasal drip.

A D E F

A client has had a pacemaker inserted recently but complains that he is experiencing heart palpitations and generalized weakness and that he has slight pain in the chest and jaw. On examination, the nurse notes that the client appears quite anxious, and the nurse observes pulsations in the neck and abdomen. Which of the following is the most likely cause of these findings? pacemaker wiring has become dislodged infection coronary artery occlusion pacemaker syndrome

4: These symptoms are consistent with mild pacemaker sundrome and occur when the atrial and ventricular contractions are not synchronized properly. This causes decreased cardiac output because the atria do not adequately fil the ventricles. Peripheras causes decreased cardiac suspu compensate initially. Moderate pacemaker syndrome is characterized by increasing dyspnea and orthopnea, dizziness, vertigo, confusion, and sensation of choking. Severe pacemaker syndrome includes pulmonary edema with rales and marked dyspnea, syncope, and heart failure

A patient with a hypophysectomy can postoperatively experience transient DI. Which manifestation alerts the nurse to this problem? a. Output much greater than intake b. Change in mental status indicating confusion c. Laboratory results indicating hyponatremia d. Nonpitting edema

A

Which medication is used to treat DI? a. Desmopressin acetate (DDAVP) b. Lithium (Eskalith) c. Vasopressin (Pitressin) d. Demeclocycline (Declomycin)

A

The nurse in the emergency room is caring for a patient experiencing acute adrenal crisis.What is the first action the nurse should take? Start a peripheral IV Administer hydrocortisone succinate Check blood glucose Administer dextrose and insulin

Acute adrenal crisis is adrenal insufficiency with decreased levels of cortisol. Signs and symptoms include abdominal pain, confusion, fatigue, hypotension, tachycardia, tachypnea, muscle weakness, dark pigmentation, and high fever. Patients may also experience low serum sodium and hyperkalemia. Therapy for acute adrenal crisis is administered intravenously, so the first action is starting an IV. B is incorrect because the drug cannot be administered until IV access has been established. C is incorrect because blood glucose is checked hourly as glucose tends to drop in adrenal crisis but establishing IV access is a greater priority. D is incorrect because dextrose and insulin are administered for hyperkalemia, which may be present with adrenal crisis, but starting an IV is the greater priority.

A patient on the cardiac unit is assessed by the nurse. When an S3 gallop is noted, what is the next action the nurse should take? Assess for symptoms of left-sided heart failure Document the S3 gallop as a normal finding Notify the healthcare provider immediately Arrange to transfer the patient to intensive care

Assess for symptoms of left-sided heart failure Typical heart sounds are noted as S1 and S2. If there is a third heart sound, it is called S3, or S3 gallop. This is typically caused by blood flow suddenly slowing as it flows from the left atrium into the left ventricle. Early diastolic filling is indicated by S3 gallop and signifies increasing left ventricular pressure as well as left ventricular failure. B is incorrect because an S3 gallop is an abnormal finding. Any abnormal finding should be a concern to the nurse. Appropriate nursing actions are to further assess or perform an appropriate nursing intervention if no further assessment data is warranted. C is incorrect because the healthcare provider should be notified once the full assessment is completed. The healthcare provider is called when the nurse has enough assessment information or in a case of a medical emergency. D is incorrect because a full assessment should be completed to see if a higher level of care is warranted. Transferring this patient to ICU without further assessment is "passing the buck."

The nurse is performing an assessment of an adult patient with new onset acromegaly. What does the nurse expect to find? a. Extremely long arms and legs b. Thickened lips c. Changes in menses with infertility d. Rough, extremely dry skin

B

What is the disorder that results from a deficiency of vasopressin (ADH) from the posterior pituitary gland called? a. SIADH b. DI c. Cushing's syndrome d. Addison's disease

B

Which statement about the pathophysiology of SIADH is correct? a. ADH secretion is inhibited in the presence of low plasma osmolality b. Water retention results in dilutional hyponatremia and expanded extracellular fluid volume c. The glomerulus is unable to increase its filtration rate to reduce the excess plasma volume d. Renin and aldosterone are released and help decrease the loss of urinary sodium

B

Which statement about hormone replacement therapy for hypopituitarism is correct? a. Once manifestations of hypofunction are corrected, treatment is no longer needed b. The most effective route of androgen replacement is the oral route c. Testosterone replacement therapy is contraindicated in med with prostate cancer. d. Clomiphene citrate (Clomid) is used to suppress ovulation in women.

C

A patient is given a beta blocker according to the healthcare provider's orders. When the nurse assesses the patient later, which findings should be expected? Blood pressure change from 100/40 mmg to 140/80 mmHg Respiratory rate change from 24 bpm to 16 bpm Oxygen saturation level change from 86% to 98% Pulse rate change from 110 bpm to 76 bpm

Beta blockers are administered to block stimulation of beta-1 00o. This blocks sympathetic response, which decreases the heart rate as well as blood pressure. Ventricular filling time is increased due to the decrease in heart rate. A is incorrect because beta blockers will decrease the heart rate causing decreased cardiac output and decreased blood pressure. These medications do not generally cause hypertension. On the contrary, they are used to treat hypertension. B is incorrect because there is usually no effect on beta-2 adrenergic receptor sites or respiratory status. C is incorrect because there is usually no effect on beta-2 adrenergic receptor sites or respiratory status. An increase in SpO2 is a good outcome for the patient, but it is not a direct action of beta-blockers.

Which patient's history puts him or her at risk for developing SIADH? a. 27 year old patient on high dose steroids b. 47 year old hospitalized adult patient with acute renal failure c. 58 year old patient with metastatic lung or breast cancer d. older adult with a history of stroke within the last year

C

A patient is admitted to the medical-surgical unit for excessive catecholamine release.Which of the following assessment findings does the nurse correlate with the patient's diagnosis? Blood pressure 110/72 mmHg Pulse 112 beats per minute Respirations 8 per minute Urine output 200 ml/hour

Catecholamines, or epinephrine and norepinephrine, are released from the adrenal medulla of the adrenal glands when the sympathetic nervous system is activated. This is part of the fight or flight stress response. Characteristic findings include an increased pulse, increased blood pressure, and increased blood glucose. A is incorrect because catecholamines increase blood pressure. C is incorrect because catecholamines increase respirations. D is incorrect because catecholamines do not increase urine output. Normal urine output is 30-60 ml/hr.

A patient admited to the medical ait for myoeardial infarction has a pulmonary artery pressure of 24/13 mmHig. What is the first action the nurse should take? Compare current pressure to previous readings Increase IV fluid infusion rate Notify the healthcare provider immediately Document the pressure in the patient's chart

Compare current pressure to previous readings PA pressures are obtained through use of a pulmonary artery catheter or Swan-Ganz catheter. This number indicates pressure within the pulmonary artery. Normal PA pressure is between 15-26 mmlig systole and 5-15 mmIg diastolic. This patient's pressure is normal, but the nurse is responsible for assessing for trends, which may indicate the need for intervention. B is incorrect because IV fluids do not need to be increased for normal PA pressures. LOW PA pressure can indicate fluid volume depletion, thus indicating the need for a higher of IV fluid infusion. C is incorrect because the healtheare provider does not need to be notified of normal pressures. The nurse will notify the healtheare provider if the PA pressure drops or increases significantly. D is incorrect because PA pressures should be documented after comparison to previous readings.

The nurse on the surgical unit is caring for a patient after recovery from complete thyroidectomy. When the nurse is reinforcing postoperative teaching, which of the following patient statements demonstrates more education is needed? "I might need calcium replacement after this surgery." "I won't need to take my thyroid medication anymore." "I will be on thyroid hormones for life." "If I need it, I can take pain medication

Complete thyroidectomy may be carried out as a primary treatment for thyroid carcinoma hyperthyroidism. Because the thvroid has been removed completely, the patient will need to take thyroid medication for life to return thyroid hormone levels and metabolic rate to normal. A is incorrect because calcium needs aren't determined until after the patient has been evaluated for parathyroid damage, which is a potential complication after thyroidectomy. If calcium levels fall, the nurse may note hyperirritability of the nerves, twitching hands and feet, and rarely, laryngospasm. The patient's statement indicates that calcium supplementation may be needed. C is incorrect because the patient will need to take thyroid medication for life, indicating correct understanding. D is incorrect because the patient can have pain medication after surgery, indicating correct understanding. Managing pain, avoiding stress on suture lines, increasing humidity, and encouraging rest, relaxation, and nutrition are important components of the postoperative care.

A patient is admitted to the medical-surgical unit with Cushing's disease. In order to prevent injury, which action does the nurse include when planning care? Prepare the client for adrenalectomy Limit vitamin D to prevent hypercalcemia Reposition the patient with a lift sheet Ensure suction equipment is working

Cushing's disease leads to increased cortisol levels in the blood, which causes bone demineralization. This condition increases risk of pathologic bone fractures, so the patient should be repositioned with a lift sheet rather than pulling on the patient. A protective environment is necessary to prevent falls, fractures, and injuries to bones and soft tissues. The patient may also require the nurse's assistance with ambulation to prevent bumping into corners of furniture. A is incorrect because adrenalectomy may be required as a surgical treatment option for Cushing's disease, but this does not address safety needs. B is incorrect because patients with Cushing's disease specifically need adequate amounts of vitamin D in their diet, along with protein and calcium to minimize muscle wasting and osteoporosis. D is incorrect because the patient with Cushing's disease doesn't often require suctioning, and this nursing implementation does not prevent injury.

A female patient has been prescribed hormone replacement therapy. What does the nurse instruct the patient to do regarding this therapy? a. Report any recurrence of symptoms, such as decreased libido, between injections b. Monitor for blood pressure at least weekly for potential hypotension c. Treat leg pain, especially in the calves with gentle muscle stretching d. Take measures to reduce the risk for hypertension and thrombus

D

Patients diagnosed with an anterior pituitary tumor can have symptoms of acromegaly or gigantism. These symptoms are a result of overproduction of which hormone? a. ACTH b. PRL c. Gonadotropins d. GH

D

A deficiency of which anterior pituitary hormone is considered life threatening? (Select all that apply) a. GH b. Melanocyte stimulating hormone (MSH) c. PRL d. Thyroid stimulating hormone (TSH) e. ACTH

D E

The nurse is caring for a patient recovering after endoscopic trans-nasal hypophysectomy.When the nurse teaches the patient regarding the procedure, which patient statement demonstrates correct understanding? "I will wear sunglasses to decrease sun exposure." "I will keep food in upper cabinets to prevent having to bend over." "I will wash my incision daily with half-strength hydrogen peroxide and apply a new dressing." "While awake, I will cough and deep breathe every two hours."

Endoscopic trans-nasal hypophysectomy is performed to remove the portion of the gland or a tumor that is causing excessive secretion of growth hormone. Following the surgery, the patient is advised to avoid bending over and any other activities that may increase intracranial pressure. Other important components of post-hypophysectomy nursing care include monitor I/O, observe for hypoglycemia, check neurological status frequently, and teach the client to avoid toothbrushing for two weeks. A is incorrect because decreasing sun exposure is not necessary after endoscopic trans-nasal hypophysectomy. C is incorrect because there is no visible incision with endoscopic trans-nasal hypophysectomy. D is incorrect because coughing and deep breathing

The nurse on the medical-surgical unit is assessing a patient admitted with Graves disease. When vital signs are taken, it is noted the temperature has risen by 1°F (0.56°C) in the last hour. What is the first action the nurse should take? Turn down the room lights and shut the door Call for a STAT electrocardiogram (ECG) Calculate apical-radial pulse deficit Administer acetaminophen 650 mg PO

Graves disease is overactive thyroid gland as a whole, or hyperthyroidism. Also termed "toxic diffuse goiter," it is the result of autoimmune disease with symptoms including sleeping problems, tachycardia, poor heat tolerance, irritability, and exophthalmos. The temperature increase could indicate thyroid storm is developing, and the nurse needs to notify the healthcare provider after reducing environmental stimuli which could lead to cardiac complications. B is incorrect because environmental stimuli need to be minimized first. C is incorrect because calculating apical-radial pulse deficit is unnecessary. D is incorrect because acetaminophen is not indicated as thyroid activity is responsible for temperature increase. Acetaminophen may reduce the temperature because it is an antipyretic, but it will not treat the overactive thyroid or prevent thyroid storm.

The nurse on the medical unit is caring for a child newly diagnosed with Graves' disease.How should the nurse respond when the patient's mother asks, "Is my daughter's new diagnosis disease due to my type 1 diabetes?" 'Your diabetes did not cause your daughter's Graves disease. There is no known connection between diabetes and Graves' disease." "There is a connection between diabetes and Graves disease, but your diabetes did not likely cause your daughter's Graves disease." "There is an association between Graves' disease and autoimmune diseases such as rheumatoid arthritis, but not with diabetes." "Diabetes can cause hypothyroidism, so yes, that is a possibility."

Graves' disease is over-activity of the thyroid gland as a whole, or hyperthyroidism. Also, termed "toxic diffuse goiter," it is the result of an autoimmune process with symptoms including sleeping problems, tachycardia, poor heat tolerance, irritability, and exophthalmos. Research shows an association between Graves disease and other autoimmune diseases, such as type 1 diabetes, but predisposition is most likely polygenic and not caused by the mother's diabetes. A is incorrect because there is a known connection between diabetes and Graves' disease. C is incorrect because there is a known connection between diabetes and Graves disease. D is incorrect because diabetes does not cause hypothyroidism, and the daughter has hyperthyroidism, not hypothyroidism.

A patient is admitted to the medical-surgical unit with a diagnosis of Hashimoto's thyroiditis and hypothyroidism. When the patient asks the nurse how long the thyroid medication will need to be taken, what is the best response by the nurse? "The medication will need to be taken until the goiter is gone completely." "Thyroiditis is cured by treatment with antibiotics. Once that is resolved you won't require thyroid medication." "Your thyroid will not work again, so you will take thyroid replacement for the rest of your life." "We will test your thyroid function with blood tests, and when your thyroid function returns to normal, the medication can be stopped."

Hashimoto's thyroiditis or Hashimoto's disease is the result of an autoimmune process. The immune system attacks and damages the thyroid which leads to hypothyroidism. Thyroid function is permanently lost, so lifelong thyroid replacement therapy is necessary. A is incorrect because even if the goiter is reduced or eliminated, the patient cannot stop taking the thyroid medication. B is incorrect because antibiotics will not cure the thyroiditis and the patient cannot stop taking the thyroid medication. D is incorrect because the patient cannot stop taking the thyroid medication.

A female patient is in the clinic complaining of body image concerns regarding hirsutism.When assessing this patient, the nurse should ask which of the following questions? "How do you plan to cover the medical bills for your treatments?" "How do you feel when you look in the mirror?" "What are your prescribed medications?" "What measures have you taken to handle this problem?"

Hirsutism is excessive hair growth that occurs on the face and body as a result of endocrine disorder. Especially in female patients, this causes disruption of body image. Self-perception and body image feelings of the patient should be assessed by the nurse. A is incorrect because financial status does not address the patient's presenting physical problem. The nurse should remain focused on the client's here-and-now physical needs as a priority. C is incorrect because current medications do not address the patient's presenting problem. Assessment of current medications is certainly an important component of the nursing assessment, but this assessment is not directly related to the body image concerns the patient is expressing. D is incorrect because hirsutism is not caused by any specific behaviors, and it cannot be prevented totally. Some patients may shave, wax, or use other methods for hair remond but assessing how the patient currently feels is more important than determining past attempts to deal with the problem.

The nurse in the clinic is assessing four patients for potential endocrine disorder. Which patient does the nurse identify as being at the greatest risk of hyperparathyroidism? 28-year-old female who has pregnancy induced hypertension 43-year-old male on dialysis for end stage kidney disease 62-year-old female diagnosed with heart failure 75-year-old male with asthma and hypertension who uses oxygen at home

Hyperparathyroidism can be a result of disorders that cause hypocalcemia. Patients with chronic kidney disease cannot activate vitamin D and have poor absorption of calcium in the gastrointestinal tract. This puts the patient at highest risk for hyperparathyroidism. A is incorrect because pregnancy-induced hypertension does not increase risk of hyperparathyroidism. Pregnancy-induced hypertension can cause thrombocytopenia, HELLP syndrome, and if it progresses to eclampsia, ultimatelv renal failure and cerebral hemorrhage. C is incorrect because heart failure does not increase risk of hyperparathyroidism. Patients with heart failure are at risk for liver failure, atrial fibrillation, and other arrhythmias. D is incorrect because this patient's medical details do not indicate increased risk for hyperparathyroidism.

The nurse in the recovery room is caring for a patient who had a transsphenoidal hypophysectomy. What is the priority action the nurse should take? Keep the patient supine and head of bed flat Educate the patient regarding turning, coughing, and deep breathing Monitor for nasal drainage Prevent dryness of the lips by applying petroleum jelly

Hypophysectomy is partial or complete removal of the pituitary gland. Drainage from the nose after hypophysectomy, especially light yellow or halo effect, would indicate leaking of cerebrospinal fluid. The healthcare provider should be notified of this finding immediately. A is incorrect because the patient should have the head of bed elevated after hypophysectomy. B is incorrect because the patient should not be coughing postoperatively as this can increase the risk for a CSF leak. D is incorrect because petroleum jelly can be applied to the lips, but this is not as important as drainage from the nose.

A 11-year-old male patient is diagnosed with hypopituitarism and has a new prescription for testosterone replacement therapy. When the patient asks the nurse how long the medication should be taken, what is the best response by the nurse? "Therapy will be discontinued once your blood testosterone levels return to normal." "When your voice gets deeper and your beard gets thicker, the dose will be decreased, but you will require medication for life." "Once your sperm count is within normal, the treatment will not be needed anvmore." "Testosterone levels decrease with age, so your treatment will stop when vou reach 50 years of age."

Hypopituitarism (dwarfism) occurs before puberty and causes height below normal with normal body proportions. Bone and tooth growth can be delaved and sexual maturity may be slow. Testosterone replacement therapy is begun with high dose until the patient achieves virility, then the dosage is decreased. The treatment is taken for life. A is incorrect because testosterone replacement is not discontinued when blood testosterone levels are normal. Discontinuing the hormone replacement would lead to a drop in serum levels. C is incorrect because testosterone replacement is not discontinued based on when sperm count is increased. D is incorrect because testosterone replacement is not discontinued when the patient reaches 50 years of age.

The nurse on the medical unit is planning care for a patient admitted for hypothyroidism.Which of the following is a priority problem that should be addressed first by the nurse? Intolerance to heat Body image problems Depression and withdrawal Depressed ventilation

Hypothyroid patients may have ineffective breathing patterns related to depressed ventilation. The nurse must monitor respiratory rate, depth, and pattern. Pulse oximetry and arterial blood gases may be used to determine of oxygenation is adequate. Deep breathing, coughing, and incentive spirometry should be encouraged, and sedative medications should be avoided or used with caution. A is incorrect because intolerance to heat is characteristic of hyperthyroidism, not hypothvroidism. B is incorrect because body image problems are psychosocial and not a greater priority than other concerns which may have a detrimental physical effect on the patient. C is incorrect because a depressed respiratory system is a greater priority than psychosocial issues, such as depression and withdrawal. The depressed patient may have a lack of motivation for self-care, but the nurse must address the respiratory system first.

The nurse is caring for a patient on the medical unit. Which patient statement would alert the nurse that the patient may have hypothyroidism? "My sister has problems with her thyroid." "I'm much more sensitive to heat than others." "I have to add quite a bit of salt to my food to make it taste good." "I could sleep 12 hours and still be tired."

Hypothyroidism is characterized by decreased production of thyroid hormone and happens more often in older adult females. Feeling tired after adequate sleep is common in hypothyroidism. Other symptoms include decreased activity level, weight gain, constipation, alopecia, bradycardia, and decreased ability to perspire. A is incorrect because hypothyroidism is not genetic or inherited. B is incorrect because hypothyroidism causes intolerance to cold. Hyperthyroidism causes sensitivity to heat. C is incorrect because taste loss is not indicative of hypothyroidism.

In order to safely care for the patient with infective endocarditis, which infection control precautions should be used by the nurse? Standard precautions Bleeding precautions Reverse isolation Contact isolation

Infective endocarditis can be caused by several different organisms including streptococci, staphylococcus aureus, and fungi. This can be due to a skin abscess, infected gums, urinary tract infection, IV drug abuse, and even medical and surgical procedures. Infective endocarditis has no specific threat for transmission of causative organism. Standard precautions are sufficient for this patient. B is incorrect because although thrombosis is an element of infective endocarditis, anticoagulation therapy is contraindicated. Bleeding precautions are required, and they are not a form of infection control precautions. C is incorrect because the patient with infective endocarditis is not immunocompromised and does not need to be shielded from potential infection. Reverse isolation is necessary to prevent immunocompromised people from becoming infected by others or objects. This type of isolation may be used for those undergoing chemotherapy, awaiting bone marrow transplant, or on neutropenic precautions. Note: the CDC no longer recognizes reverse isolation as effective because of the negative psychosocial effects on patients. D is incorrect because there is no specific threat for transmission of causative organism with infective endocarditis. Contact precautions are required for patients with infections from multi-drug resistant organisms (MRSA, VRE), C-diff, RSV, rotavirus, and Hep A.

The nurse is preparing a patient for a magnetic resonance imaging (MRI) of the heart. The patient has a pacemaker due to a previous myocardial infarction. What action should be taken by the nurse? Obtain an ECG prior to the MRI Notify the healthcare provider before the MRI is scheduled Draw cardiac enzymes prior to the MRI Encourage the patient to drink more fluids before the MRI

Notify the healthcare provider before the MRI is scheduled In the past, MRI was contraindicated in all patients with implanted cardiac devices. Due to the magnetic field used in the MRI procedure, the pacemaker can be deactivated, device components can be damaged, and rapid pacing can be triggered. The MRI can also cause inappropriate shocks, burning the skin over the pacemaker implantation site. The healthcare provider should be notified of the patient's pacemaker so another diagnostic test can be ordered. MRI is only used with patients who have pacemakers when other alternative radiologic tests have been unsuccessful in making a diagnosis. A is incorrect because an ECG prior to the MRI is not necessarily indicated. C is incorrect because cardiac enzymes are not necessarily indicated. D is not incorect because increased ids are no sedicated for this patient. The patient do is require all to be NPO prior to line prenate cities, but increased fluids are n. . requirement.

A patient had mitral valve replacement surgery and has been prescribed warfarin. When the nurse performs discharge instructions, which patient statement demonstrates the need for more teaching? "I can carry heavy loads after six months. "I will go to the dentist in two weeks to have my teeth cleaned." "I shouldn't eat foods like spinach that are high in vitamin K." 'I should use an electric razor instead of a straight blade."

Patients are placed on anticoagulant therapy, such as warfarin, to prevent blood clots from growing on a new valve. Patients should be instructed to avoid going to the dentist for six months after valve replacement surgery as there is an increased risk of bleeding, even from minor dental procedures. A is incorrect because heavy lifting should be avoided for six months after valve surgery, indicating patient understanding. C is incorrect because if warfarin is prescribed, the patient should avoid consuming foods with high levels of vitamin K, indicating patient understanding. (Vitamin K is the antidote to warfarin, and can lessen the anticoagulant effects of the medication, increasing risk for blood clots.) D is incorrect because patients should be instructed to use an electric razor while on anticoagulant therapy, indicating patient understanding. Other bleeding precautions include using a soft-bristled toothbrush, avoiding contact sports or activities that have a high risk for falling. Bruising, falls, diarrhea, rash, severe or unusual headache, and fever should be reported to the healthcare provider.

The nurse on the medical-surgical unit is caring for a patient admitted with pneumonia and a history of hypothyroidism. What is the priority intervention the nurse should include when planning care? Monitor IV site every shift Administer acetaminophen for fever Ensure suction equipment is working Limit PO fluids to prevent fluid volume overload

Patients with hypothyroidism who are diagnosed with another illness such as pneumonia are at risk for myxedema coma. Myxedema coma is severe hypothvroidism that can present with hypothermia, decreased mental status, and decreased respiratory rate, pulse, and blood pressure. This is an emergency situation in which maintaining airway is priority. Suction equipment must be available in the room and checked for function routinelv if the patient should develop myxedema coma. A is incorrect because monitoring IV site is necessary but not priority. B is incorrect because acetaminophen administration for fever is necessary but not priority. D is incorrect because PO fluids should be encouraged for the patient with hypothyroidism because they are at increased risk for constipation.

A patient is recovering after valve replacement surgery using a prosthetic valve. The patient asks why anticoagulants must be taken for the rest of their life. What is the best response by the nurse? "You are at greater risk of a heart attack with the prosthetic valve." "Artificial replacement valves form blood clots more than tissue valves." "You have reduced circulation in your leg where they took the vein." "There are small clots located in your heart and lungs due to the surgery."

Rationale Platelets can collect easily on synthetic valves and scar tissue, initiating formation of blood clots. Artificial valves are long-lasting as they are made of durable material, but there is an increased risk of clot formation necessitating the use of long-term anticoagulation medication. Thus, the patient is at higher risk for bleeding. A is incorrect because there is not a greater risk of myocardial infarction with a prosthetic valve. Complications after a valve replacement include valve failure and prosthetic valvular endocarditis (PVE.) C is incorrect because veins are not harvested from the leg for valve replacement surgery. D is incorrect because valve replacement surgery does not generally cause thrombi or clots to form in the heart or lungs. The purpose of life-long anticoagulation therapy is to prevent clots.

A patient is scheduled for a serum catecholamine test. When the nurse is collecting the sample, which is the priority action by the nurse? Draw the blood after breakfast Immediately send the blood to the lab after placing on ice Add preservatives to the specimen before sending to the lab Discard the first blood sample then collect the specimen

Rationale: A serum catecholarine test measures epinephrine, dopamine, and norepinephrine, which are all hormones found in the blood made by the adrenal glands. This test assists in diagnosing catecholamine-secreting tumors, such as those found in the adrenal medulla, and in the invesication of lypertension and pheodhromoctoma. Ta hood specimen ,. serum catecholamine test needs to be placed on ice and sent to the lab immediately. A is incorred because the paient should not eat for several hours before the samples drawn. C is incorrect because the correct blood collection tube will have the appropriate preservatives already. D is incorrect because the first blood sample should not be discarded.

A patient with acromegaly has been educated by the nurse regarding an upcoming hypophysectomy procedure. Which of the following patient statements demonstrates more teaching is needed? "I won't need to limit fluid intake after the surgery." "I'm glad I won't have a visible incision." "I hope my shoe size will go back down." "I will wear my house slippers so I don't have to bend over to put shoes on.

Rationale: Acromegaly occurs as a result of excessive growth hormone secretion from the pituitary gland, which causes enlarged body size: hands, feet, forehead, nose, and jaw. Other symptoms include poor coordination, deep voice, sexual abnormalities, and visual field changes. Growth hormone is secreted by the anterior pituitary gland, and a hypophysectomy is performed to remove the portion of the gland or a tumor that is causing excessive secretion of the hormone. After the surgery, many of the symptoms of hyperpituitarism are relieved, but skeletal changes as well as organ enlargement will not generally reverse. A is incorrect because the statement indicates the client understands the teaching abom post op oxpectations. Fluid intake should be encouraged after the patient has recovers from the anesthesia after a hypophysectomy surgery. B is incorrect as this statement indicates understanding because the incision from hypophysectomy is not visible. Dis incorrect because the statement indicates the dient understands to avoid bending over after the hypophysectomy

The nurse on the medical-surgical unit is caring for a patient admitted for aldosterone deficiency. Which of the following assessment findings does the nurse expect to see when caring for this patient? Vasoconstriction Serum sodium 146 mEq/L Increased urine output Blood glucose 96 mg/du

Rationale: Aldosterone is a mineralocorticoid which maintains extracellular fluid volume. Its action stimulates reabsorption of sodium and water and excretion of potassium in the tubules of the kidney. The patient with aldosterone deficiency would, therefore, have increased unne output with sodium loss and potassium retention. A is incorrect because vasoconstriction is not an effect of aldosterone. B is incorrect because in aldosterone deficiency, the sodium level would be decreased. D is incorrect because aldosterone does not affect blood glucose.

The nurse on the medical-surgical unit is caring for a patient admitted for excessive calcitonin. Which electrolyte imbalance does the nurse assess the patient for? Hyperkalemia Decreased sodium Decreased calcium Hypercalcemia

Rationale: Calcitonin is produced by parafollicular cells of the parathyroid gland. This serves the purpose of reducing serum calcium levels, or preventing hypercalcemia. A is incorrect because calcitonin has no effect on potassium. B is incorrect because calcitonin has no effect on sodium. D is incorrect because calcitonin does not cause increased serum calcium. Parathyroid hormone increases calcium levels.

A patient in the clinic has a 24-hour urine collection ordered for hormone excretion. When the patient asks the nurse why the urine needs to be collected for 24 hours instead of random, what is the best response by the nurse? "The 24-hour sample will assess your circadian rhythm hormones." "Hormones are dilute in urine, so a large volume is needed." "You need to urinate multiple times for collection of the correct hormone." "We will be evaluating urine every three hours for 24 hours to determine when certain hormones are secreted in larger amounts."

Rationale: Certain hormones are secreted according to a circadian rhythm. The 24-hour urine collection is the most accurate reflection of hormone secretion. B is incorrect because hormone dilution in urine is not an indication for a 24-hour urine collection. C is incorrect because collecting the correct hormone is not an indication for a 24-hour urine collection. D is incorrect because a 24-hour urine specimen is collected over a full 24-hour period and then sent to the lab at one time.

The nurse on the medical-surgical floor is assessing patients. Which of the following patients is at greatest risk for cardiovascular disease? 74-year-old woman admitted for asthma exacerbation 66-year-old man, recently immigrated from Japan, admitted for colon cancer 53-year-old African American man admitted for diabetes mellitus 62-year-old postmenopausal woman taking hormone therapy

Rationale: Coronary artery disease and hypertension are more prevalent in American Indians than whites and Asian Americans. Risk of hypertension and coronary artery disease is increased with diabetes mellitus patients. African Americans and males are also at higher risk for cardiovascular disease. So, this patient has two risk factors. Modifiable risk factors include hypertension, tobacco use, physical inactivity, hyperlipidemia, and overweight/obesity. A is incorrect because asthma does not lead to increased risk of cardiovascular disease. This patient has one risk factor: increased age. Men are more at risk for cardiovascular disease than premenopausal women. B is incorrect because colon cancer does not lead to increased risk of cardiovascular disease. This patient has no risk factors. Immigrants from eastern Asian countries are at less risk for cardiovascular disease. Their children and grandchildren, however, typically have increased risk for cardiovascular disease than the original immigrants due to adopting the western lifestyle. D is incorrect because hormone therapy does not increase risk of cardiovascular disease. The risk for cardiovascular disease increases after women reach menopause. So, this patient has one risk factor.

A temale patient on the medical unit is admitted with decreased adrenal function. Which Of the following patient statements does the nurse expect when talking with a patient will decreased adrenal function? "I've been craving potato chips." "My face seems to be changing, and I feel like I am starting to look like a man." "I'm always hungry, even after eating." "I've taken extra hormone replacement recently, and I still feel moody."

Rationale: Decreased adrenal function is correlated with cravings for salt. The adrenal glands are responsible for producing hormones that maintain blood pressure, regulate metabolism, and slow the immune response. Lack of these hormones leads to sodium and water wasting and potassium retention. Other symptoms include dehydration, decreased blood pressure, weight loss, alopecia, fatigue, depression, lethargy, and pathological fractures. B is incorrect because masculinization in females is a characteristic of increased adrenal hormone secretion (Cushing's), not decreased adrenal function. C is incorrect because hunger despite eating correlates with diabetes. D is incorrect because although synthetic adrenal hormones may cause moodiness, the nurse should not expect the patient to be doubling the dose. Too much hormone replacement can cause symptoms of Cushing's, such as excessive mood swings.

The nurse is caring for an adult patient hospitalized for an upper respiratory tract infection(URI) and a history of growth hormone deficiency. Which of the following actions should the nurse include? Avoid subcutaneous iniections Put the patient in isolation Reposition the patient with a lift sheet Have the patient dangle the lower extremities before standing

Rationale: Growth hormone helps maintain bone strength and density, so patients with growth hormone deficiency (hypopituitarism, or dwarfism) often have fragile, thin bones. A lift sheet is a safety measure to prevent fractures when repositioning in the bed. A is incorrect because avoiding subcutaneous injections is not a safety measure for a patient with growth hormone deficiency. Some patients with human growth hormone deficiency are treated routinely with subcutaneous human chorionic gonadotropin (HeG) injections. B is incorrect because isolation is not necessary for a patient with growth hormone deficiency. A patient with an URI can share a semi-private room with another patient infected with the same bacteria or can be placed in a private room, but isolation is not necessary. D is incorrect because having the patient dangle the lower extremities before standing is not a necessary safety measure for a patient with growth hormone deficiency.

The nurse on the medical-surgical unit is assessing four patients. Which of the following patients are at the greatest risk for gonadotropin and growth hormone deficiency? 32-year-old female on long term oral contraceptives 45-year-old male with a history of head trauma four years ago 56-year-old female allergic to shellfish 43-year-old male with diabetes mellitus

Rationale: Head trauma can cause hypofunction of the anterior pituitary gland. This may lead to deficiency of gonadotropin and growth hormone. A is incorrect because contraceptives do not increase risk for gonadotropin and growth hormone deficiency. Oral contraceptives increase the risk for breast cancer. C is incorrect because shellfish allergy does not increase risk for gonadotropin and growth hormone deficiency. Allergy to shellfish (which is high in iodine) poses a risk for a client who undergoes a dye-containing procedure, since most dyes used in diagnostic procedures contain iodine. D is incorrect because diabetes mellitus does not increase risk for gonadotropin and growth hormone deficiency.

A patient admitted with acute pericarditis calls the nurse to report substernal precordial pain radiating to the left side of his neck. Which non-pharmacologic comfort measure should the nurse implement? Place an ice pack on the patient's chest Provide neck rubs focusing on the left side Let the patient rest in bed with lights dimmed Have the patient sit up and lean forward on a pillow

Rationale: Laving supine can worsen pain from acute pericarditis. The pain is described as a stabbing chest pain that worsens with coughing and deep breathing in addition to lying down. The usual comfortable position is upright and leaning forward. Gravity helps to take pressure off the pericardial muscle to decrease pain. A is incorrect because ice packs will only have a superficial effect and will not likely relieve the inner pain located within the lining of the heart in this patient. B is incorrect because neck rubs are more likely to increase pain in this patient. C is incorrect because it does not provide pain relief.

The nurse is caring for a patient diagnosed with pericarditis. Which of the following assessment findings should be expected? Heart rate fluctuation between bradycardia and tachycardia Friction rub at the left lower sternal border Regular gallop rhythm Crackles in bilateral lung bases

Rationale: Pericarditis is intlammation of the pericardium and can be characterized by pericardial friction rub and stabbing chest pain that typically worsens with deep inspiration and coughing. The pericardium is made up of three layers: an outer fibrous layer and two inner serous membrane layers. Pericarditis may cause pericardial friction rub at the left lower sternal border as a result of the inflamed inner pericardial layers rubbing together. A is incorrect because heart rate changes are not specific to pericarditis. C is incorrect because regular gallop rhythm is not specific to pericarditis. Complications the nurse will monitor for include heart palpitations and low-grade fever. D is incorrect because crackles in lung bases are not specific to pericarditis. These symptoms are more indicative of left-sided heart failure or fluid volume overload.

A male patient in the clinic reports fluid secretion from the breasts. When the nurse evaluates the results of this patient's blood tests, which hormone value would be assessed first? Posterior pituitary hormone Adrenal medulla hormone Anterior pituitary hormone Parathyroid hormone

Rationale: Prolactin is the hormone responsible for fluid and milk production from the breast, and this hormone is secreted by the anterior pituitary gland. A is incorrect because the posterior pituitary stores and releases oxytocin and vasopressin. B is incorrect because the adrenal medulla converts tyrosine into epinephrine, norepinephrine, and dopamine. D is incorrect because parathyroid hormone is secreted from parathyroid glands and is important for bone remodeling.

The emergency room nurse is monitoring a patient with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient has an IV of 0.9% NaCl running at 100 ml/hr.The lab results reflect a sodium level of 112 mEq/L. What is the first action the nurse should take? Consult the dietitian regarding dietary sodium supplementation Restrict fluid intake to 500 mL/day Reposition the patient with a lift sheet Delegate hourly intake and output to the unlicensed assistive personnel (UAP)

SIADHI is the production of too much antidiuretic hormone from the pituitary gland, leading to small amounts of highly concentrated urine excretion and fluid retention. This will lead to dilutional hyponatremia. Treatment includes removing the underlying cause (lung cancer, brain tumor, central nervous system infection) and fluid restriction. The patient currently has an IV running at 100 ml/hr, which will total 2400 mL/24hrs (this is too high). Fluid must be restricted to 500-600 ml/24hrs with SIADH. Retained water will slowly be excreted through the kidneys and serum sodium will slowly return to normal. Diuretics may also be used. A is incorrect because supplementation of sodium in the diet is not helpful as it may worsen fluid retention. C is incorrect because the patient is not at risk for fractures, and a lift sheet does not address sodium needs. D is incorrect because measuring intake and output is necessary, but the priority action is to reduce fluid intake.

A patient is prescribed spironolactone before surgery for hyperaldosteronism. The nurse will teach the patient about which precautions? "Read labels of salt substitutes." "Don't add salt to food." "Avoid the sun." "Take acetaminophen for pain, not aspirin."

Salt substitutes frequently contain potassium and using spironolactone can lead to hyperkalemia as it is a potassium-sparing diuretic. Use of spironolactone is indicated to maintain or increase potassium levels and use of salt substitutes can be dangerous. B is incorrect because spironolactone can cause hyponatremia and hyperkalemia, and avoiding salt is not necessary. C is incorrect because spironolactone does not cause photosensitivity, so avoiding the sun is not necessary. D is incorrect because avoiding aspirin is not necessary.

A patient's ECG strip is irregular. Which method does the nurse use for an accurate assessment? a. 6 second strip b. memory method c. big block method d. commercial ECG rater ruler

a. 6 second strip

What is the most common location for an aneurysm? a. Abdominal aorta b. Thoracic aorta c. Femoral arteries d. Popliteal arteries

a. Abdominal aorta

What is the definitive treatment for a patient with chronic constrictive pericarditis? a. Antibiotic therapy b. Surgical excision of the pericardium c. Administration of beta blockers and corticosteroids d. Pericardiocentesis- doesn't say there's fluid

Surgical excision of the pericardium pericardectomy (pericardectomy)

A patient is suspected to have an abdominal aortic aneurysm (AAA). What does the nurse assess for? a. Abdominal, flank or back pain b. Chest pain and shortness of breath c. Hoarseness and difficulty swallowing d. Disruption of bowel and bladder problems.

a. Abdominal, flank or back pain

The nurse is caring for a patient who has 24-hour urine collection ordered. When delegating this task to the unlicensed assistive personnel (UAP), which statement does the nurse include? "Document time of the patient's first void of the day and collect the urine specimen for 24 hours." "Preservatives must be added to the specimen container at the end of 24 hours." "The collection will start with first void in the morning." "It is important that no more than one urine collection is missed in the 24 hours."

The 24-hour urine collection is the most accurate reflection of hormone secretion. It is appropriate to delegate this task to UP because it does not require critical thinking. It is performed according to a sequence of steps, and the task does not vary much from one patient situation to another. The nurse is responsible for assuring that the collection process is understood. The collection starts after the first morning void, as the first void is discarded due to length of time in the bladder. The time is documented as start time. B is incorrect because preservatives should be added at the beginning of collection. Cis incorrect because the first void is discarded. Dis incorrect because for accuracy, all voids must be collected within the 24-hour period.

A patient on the medical-surgical unit with adrenal hyperfunction screamed at her husband, threw a water pitcher across the room, then started crying uncontrollably. When the patient tells the nurse she feels like she is losing her mind, what is the best response by the nurse? "I will notify the healthcare provider for a psychiatric consult." "Your hormone levels are causing this. "I can bring you some pamphlets regarding support groups." "I will post a sign on your room restricting visitors and close the door."

The adrenal glands are responsible for secreting cortisol, and the patient with adrenal hyperfunction has hypercortisolism. This can lead to changes in mood and mental behavior, psychosis, or neurotic behavior. The patient must be educated about behavior changes that are not psychiatric in nature and which often improve with blood cortisol level stabilization. A is incorrect because the behavior is not psychiatric in nature. C is incorrect because providing factual information about the physical changes taking place in the body is more appropriate than support groups. D is incorrect because restricting visitors is not needed.

The nurse is teaching a patient newly diagnosed with diabetes mellitus. When the patient asks why blood glucose levels should be maintained at greater than 60 mg/dL, what is the best response by the nurse? "Glucose is the onlv fuel the body uses for energy production." "The brain constantly requires glucose supply as it is unable to store glucose." "When minimum blood glucose is not maintained, the body does not produce red blood cells." "Maintaining blood glucose levels prevents lactic acid buildup and acidosis."

The brain does not synthesize or store glucose, so a constant supply from blood circulation is required for meeting central nervous system needs. The patient needs to be taught about maintaining minimum blood glucose to prevent a hypoglycemia prevention. A is incorrect because fat and protein are also used as fuel by the body. C is incorrect because red blood cell production and glucose are unrelated. Erythropoietin, a hormone secreted by the kidney, stimulates the production of red blood cells. D is incorrect because blood glucose levels are not responsible for formation of lactic acid. Insufficient oxygen supply to muscles is the cause of lactic acid formation.

A patient is admitted to the cardiac unit for bradycardia due to hypothyroidism. Which of the following medications does the nurse anticipate administering to this patient? Atropine sulfate Levothyroxine sodium Propranolol Epinephrine

The cause of ins patient's bradycardia is hypothyroidism, so the nurse anticipates administering levothyroxine sodium. If the patient becomes symptomatic from the bradycardia, atropine or epinephrine could be administered as short-term treatment. A is incorrect because atropine sulfate is only indicated if the patient is experiencing symptomatic bradycardia. When bradycardia is present due to hypothyroidism, the initial medication to increase the heartrate is a thyroid replacement medication, such as levothyroxine sodium. C is incorrect because propranolol is a beta blocker and contraindicated for bradycardia as it will cause a further decrease in the patient's heartrate. D is incorrect because epinephrine is onlv indicated if the patient is symptomatic.

A patient with atrial fibrillation is scheduled to have an electrical cardioversion. The nurse ensures that the patient has a prescription for a 4-6 supply of which type of medication? a. Anticoagulants b. Digitalis c. Diuretics d. Potassium supplements

a. Anticoagulants

A patient with a history of mitral valve stenosis is on the cardiac unit. When assessing the patient, which clinical manifestation should the nurse recognize as progression of stenosis? Oxygen saturation level of 92% Fatigue and shortness of breath on exertion Systolic murmur Rheumatic fever

The mitral valve (also known as the bicuspid is the atrio-ventricular valve in the left side of the heart. Shortness of breath or dyspnea on exertion manifests as the mitral valve orifice is narrowed (stenosed) and the pressure in the lungs increases. The heart has decreased ability and capacity to pump blood to the lungs and periphery, causing backup of blood in the lungs and fatigue due to the extra work of breathing. Medications to help treat symptoms of mitral valve stenosis include diuretics and blood-thinners (to prevent clots from forming). A is incorrect because oxygen saturation levels are not directly related to mitral valve stenosis. C is incorrect because a systolic murmur is not related to mitral valve stenosis. D is incorrect because rheumatic fever is not a sign of worsening mitral valve stenosis. Rheumatic fever is a complication of untreated strep throat or scarlet fever and is the most common cause of mitral valve stenosis.

The nurse in the clinic needs to assess a patient's thyroid gland. When palpating the thyroid, which action should the nurse take? Face the patient to palpate the thyroid gland Have the patient swallow after palpation Palpate the right lobe of the thyroid gland with the left hand Have the patient sit with the chin tucked downward

The nurse has the patient sit down and tuck their chin downward and stands behind the patient to palpate the thyroid gland. A is incorrect because the proper technique for palpating the thyroid gland is standing behind the patient. B is incorrect because the proper way to assess the thyroid gland is to palpate while the patient swallows. C is incorrect because the nurse palpates the right side for the isthmus while the patient swallows and turns the head to the right.

The nurse on the medical unit is assessing a patient who takes levothyroxine for hypothyroidism. Which of the following findings indicates the medication is effective? The patient recognizes thirst and is drinking fluids The patient's weight has increased 1 pound the past three weeks The patient's white blood cell count is 7,000 cells/mm3 The patient's heart rate is 68 bpm

The nurse on the medical unit is assessing a patient who takes levothyroxine for hypothyroidism. Which of the following findings indicates the medication is effective? The patient recognizes thirst and is drinking fluids The patient's weight has increased 1 pound the past three weeks The patient's white blood cell count is 7,000 cells/mm3 The patient's heart rate is 68 bpm

The nurse is planning care for a patient admitted with hyperparathyroidism. Which of th following interventions does the nurse include? Keep the patient on bed rest to prevent stress on bones Encourage PO fluids of 2L/day or more Brush teeth with a soft toothbrush Administer thiazide diuretics to prevent fluid volume overload

The parathyroid gland controls calcium levels in the blood and bones, and hyperparathyroidism causes resorption of calcium from bones to increase. This puts the patient at risk for renal calculi. Fluids intake of 2L or more daily helps decrease formation of kidney stones. Cranberry juice is suggested because it can lower urinary pH. The patient is instructed to report abdominal pain and hematuria, which are signs of renal caleuli A is incorrect because bed rest increases calcium excretion and risk for renal calculi. Mobility with the use of a rocking chair or ambulation is encouraged as much as possible because bones subjected to normal stress give up less calcium. C is incorrect because using a soft toothbrush is not specific to hyperparathyroidism. D is incorrect because thiazide diuretics are contraindicated in a patient with hyperparathyroidism. These medications decrease renal excretion of calcium and increase the risk for hypercalcemic crisis.

The nurse is monitoring a patient after parathyroidectomy. The nurse notes flexion contractions of the patient's hand when the blood pressure is taken. Which of the following lab results would the nurse associate with this finding? Serum potassium 2.8 mEq/L Serum magnesium 1.6 mEg/L Serum sodium 124 mEq/L Serum calcium 5.7 mg/ dL

The parathyrold gland controls calcium levels in the blood and bones. Once the parathyroid gland is removed with surgery, hypocalcemia may occur. This leads to muscle twitches, muscle spasms, and tetany. This is worsened it tissue hypoxia is present. Trousseau's sign is carpal spasm when the blood pressure cuff is applied for three minutes, which indicates hypocalcemia. The nurse may also see Chosteks sign, twitching of the eye, cheek, nose, or mouth when the facial nerve is tapped. A is incorrect because hypokalemia is not associated with parathyroidectomy. B is incorrect because hypomagnesemia is not associated with parathyroidectomy. C is incorrect because hyponatremia is not associated with parathyroidectomy.

The patient has endocarditis. Which findings does the nurse expect when assessing this patient? (Select all that apply) a. Pericardial friction rub b. Osler's nodes c. Petechiae d. A new regurgitant murmur e. Grating pain that is aggravated by breathing

b. Osler's nodes c. Petechiae d. A new regurgitant murmur murmur- aortic regurgitation (lubdub sh)

The unlicensed assistive personnel (UAP) reports to the nurse that while collecting a 24-hour urine specimen, some of the urine was splashed on her hand. What is the next actionthe nurse should take? Ask the UAP if they washed their hands after the splash Tell the UAP to complete an incident report Call the lab and ask about the presence of preservatives in the urine collectioncontainer Have the UAP report to emplovee health services immediately

The priority is to determine if the hands have been washed yet. Standard precautions are in place to protect staff and patients from exposure to contaminated fluids and prevent injury. The UAP may need education on Standard Precautions and the importance of wearing gloves. B is incorrect because an incident report should be completed after the hands are washed. C is incorrect because although preservatives used in some 24-hr urine collection containers can cause the skin to burn, the lab can be called after the hands have been washed. D is incorrect because washing the hands is the priority, and the UAP may not need to report to employee health.

A patient with chronic hypercortisolism is admitted to the medical unit. Which of the following actions does the nurse take? Wash hands upon entering the room Place patient in airborne isolation Observe for signs of infection Assess daily chest X-ray

Washing hands when entering patient rooms is always appropriate but specifically for the patient who has hypercortisolism. Increased levels of cortisol will decrease lymphocytes, inhibit macrophage maturation, decrease antibody synthesis, and inhibit cytokine and inflammatory chemical synthesis. This causes increased risk of infection, so handwashing is vital to prevent bringing unwanted bacteria into the patient's room. B is incorrect because the patient with chronic hypercortisolism does not need airborne isolation. C is incorrect because the patient will not display the usual signs of infection due to hypercortisolism. D is incorrect because the patient does not require daily chest X-rays.

The nurse is teaching a patient about a prescription for prednisone for cortisol deficiency.Which of the following statements does the nurse include in the teaching? "You will need to rotate injection sites." "You will need another drug if you work in the heat outside." "Your diet will need strict sodium restrictions." "Take one pill when you wake up and two pills before bed."

Working outside in the heat necessitates adjustment of steroid dosage, as the patient will sweat more than normal. A is incorrect because prednisone is taken orally for cortisol deficiency. C is incorrect because sodium restriction is not required when taking prednisone. Dis incorrect because dosage is usually two pills in the morning and one pill at night.

A patient with PAD asks "Why should I exercise when walking several blocks seems to make my cramp up?" What is the nurse's best response? a. "Exercise may improve blood flow to your legs because small vessels will compensate for blood vessels that are blocked off." b. "This type of therapy is free and you can do it by yourself to improve the muscles in your legs." c. "The cramping will eventually stop if you continue the exercise routine. If you have too much pain, just rest for a while." d. "Exercise is a noninvasive, nonsurgical technique that is used to increase venous flow to the affected limb."

a. "Exercise may improve blood flow to your legs because small vessels will compensate for blood vessels that are blocked off." COLLATERAL CIRCULATION

The nurse is instructing a patient with PAD about ways to promote vasodilatation. What information does the nurse include? (Select all that apply) a. Maintain a warm environment at home b. Wear socks or insulated shoes at all times c. Apply direct heat to the limb by using a heating pad d. Prevent cold exposure of the affected limb e. Limit fluids to prevent increased blood viscosity f. Completely abstain from smoking or chewing tobacco

a. Maintain a warm environment at home b. Wear socks or insulated shoes at all times d. Prevent cold exposure of the affected limb f. Completely abstain from smoking or chewing tobacco

Which drugs are used to promote circulation in a patient with chronic PAD? (Select all that apply) a. Pentoxifylline (Trental) b. Propranolol hydrochloride (Inderal) c. Aspirin d. Clopidegral; (Plavix) e. Ezetimide (Zetia)

a. Pentoxifylline (Trental) c. Aspirin d. Clopidegral; (Plavix)

A patient is diagnosed with new onset infective endocarditis. Which recent procedure is the patient most likely to report? a. Teeth cleaning b. Urinary bladder catheterization c. Chest radiography d. ECG

a. Teeth cleaning b. Urinary bladder catheterization

Which complications can result from severe PAD ( Select all that apply) a. gangrene b. varicose veins c. aneurysm d. amputation e. ulcer formation

a. gangrene d. amputation e. ulcer formation

Atherosclerosis affects which larger arteries? (Select all that apply) a. renal b. femoral c. coronary d. brachial cephalic e. aorta

a. renal b. femoral c. coronary e. aorta

Which patient is at greatest risk for developing viral pericarditis? a. 35 year old woman with tuberculosis b. 45 year old man who has radiation therapy for lung cancer c. 30 year old man with a respiratory infection d. 50 year old woman with chest trauma

c. 30 year old man with a respiratory infection viral infections- risk for pericarditis

A patient with a history of valvular heart disease requires a routine colonoscopy. The nurse notifies the health care provider to obtain a patient prescription for which type of medication? a. Anticoagulants b. Antihypertensives c. Antibiotics d. Antianginals

c. Antibiotics

1) Which dysrhythmia results in the asynchrony of atrial contraction and decreased cardiac output? a. Sinus tachycardia b. Atrial flutter c. Atrial fibrillation d. First degree AV block

c. Atrial fibrillation

The nurse is teaching a patient with PAD about positioning and position changes. What suggestion does the nurse give to the patient? a. Sit upright in a chair if the legs are not swollen b. Sleep with legs above the heart level if legs are swollen c. Avoid crossing the legs at all times d. Change positions slowly when getting out of bed.

c. Avoid crossing the legs at all times

What is the most preventable cause of valvular heart disease? a. Congenital disease or malformation b. Calcium deposits and thrombus formation c. Beta hemolytic streptococcal infection d. Hypertension or Marfan syndrome

c. Beta hemolytic streptococcal infection

The nurse is assessing a patient with a suspected thoracic aortic aneurysm. Which assessment finding is most likely to be present? a. Loss of pulse distal to the aneurysm b. Decreased level of consciousness c. Hoarseness and difficulty swallowing d. Disruption of bowel and bladder patterns

c. Hoarseness and difficulty swallowing

The nurse assesses a patient and notes red, flat pinpoint spots on the mucous membranes. Which finding has the nurse assessed? a. Pericardia friction rub b. Splinter hemorrhages c. Petechiae d. Systemic emboli

c. Petechiae

A patient is admitted for pericarditis. In order to assist the patient to feel more comfortable, what does the nurse instruct the patient to do? a. Sit in a semi fowlers position with pillows under the arms b. Lie on the side in a fetal position c. Sit up and lean forward d. Lie down and bend the legs at the knees

c. Sit up and lean forward

A patient is admitted to the unit with assessment findings that include substernal pain that radiates to the left shoulder. The pain is described by the patient as grating, as is worse with inspiration and coughing. What likely is the cause of this patient's symptoms? a. Chronic constrictive pericarditis b. Cardiac tamponade c. Hypertrophic cardiomyopathy d. Acute pericarditis

d. Acute pericarditis