Exam 4:lewis 8th ed

When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 140/80 and an ankle pressure of 110/70. The nurse calculates the patient's ankle-brachial index (ABI) as

ANS: 0.78 or 0.79 The ABI is calculated by dividing the ankle systolic BP by the brachial systolic BP.

The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)? ____________________

ANS: 110 MAP = (SBP + 2 DBP)/3

A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? a. Cessation of smoking b. Control of serum lipid levels c. Maintenance of appropriate weight d. Demonstration of meticulous foot care

ANS: A Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease. Other therapies have limited success in treatment of this disease.

Which assessment finding for a patient who takes levothyroxine (Synthroid) to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication? a. Increased thyroxine (T4) level b. Blood pressure 102/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level

ANS: A An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the Synthroid.

A client is having a bone marrow biopsy and is extremely anxious. What action by the nurse is best? a. Assess client fears and coping mechanisms. b. Reassure the client this is a common test. c. Sedate the client prior to the procedure. d. Tell the client he or she will be asleep.

ANS: A Assessing the clients specific fears and coping mechanisms helps guide the nurse in providing holistic care that best meets the clients needs. Reassurance will be helpful but is not the best option. Sedation is usually used. The client may or may not be totally asleep during the procedure.

A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis? a. "I can't get my shoes on at the end of the day." b. "I can never seem to get my feet warm enough." c. "I wake up during the night because my legs hurt." d. "I have burning leg pains after I walk three blocks."

ANS: A Because the edema associated with venous insufficiency increases when the patient has been standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of peripheral artery disease (PAD).

When caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty, which action should the nurse take first? a. Take the blood pressure and pulse rate. b. Check for the presence of pedal pulses. c. Assess the appearance of any ischemic ulcers. d. Start discharge teaching about antiplatelet drugs.

ANS: A Bleeding is a possible complication after catheterization of the femoral artery, so the nurse's first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions also are appropriate but can be done after determining that bleeding is not occurring.

A client has peripheral arterial disease (PAD). What statement by the client indicates misunderstanding about self-management activities? a. I can use a heating pad on my legs if its set on low. b. I should not cross my legs when sitting or lying down. c. I will go out and buy some warm, heavy socks to wear. d. Its going to be really hard but I will stop smoking.

ANS: A Clients with PAD should never use heating pads as skin sensitivity is diminished and burns can result. The other statements show good understanding of self-management.

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which medication category will the nurse plan to include when providing patient teaching about PAD management? a. Statins b. Vitamins c. Thrombolytics d. Anticoagulants

ANS: A Current research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other medication categories in PAD.

The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client best indicates that an important goal for this problem has been met? a. Doing activities of daily living (ADLs) using rest periods b. Helping plan a daily activity schedule c. Requesting a sleeping pill at night d. Telling visitors to leave when fatigued

ANS: A Fatigue is a common problem for clients with leukemia. This client is managing his or her own ADLs using rest periods, which indicates an understanding of fatigue and how to control it. Helping to plan an activity schedule is a lesser indicator. Requesting a sleeping pill does not help control fatigue during the day. Asking visitors to leave when tired is another lesser indicator. Managing ADLs using rest periods demonstrates the most comprehensive management strategy.

The health care provider prescribes an infusion of argatroban (Acova) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to a. avoid giving any IM medications to prevent localized bleeding. b. discontinue the infusion for PTT values greater than 50 seconds. c. monitor posterior tibial and dorsalis pedis pulses with the Doppler. d. have vitamin K available in case reversal of the argatroban is needed.

ANS: A IM injections are avoided in patients receiving anticoagulation. A PTT of 50 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.

A 72-year-old patient is diagnosed with hypothyroidism and levothyroxine (Synthroid) is prescribed. Which assessment is most important for the nurse to make during initiation of thyroid replacement? a. Apical pulse rate b. Nutritional intake c. Intake and output d. Orientation and alertness

ANS: A In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

ANS: A Nonselective b-blockers block b1 and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-blockers will have no effect on the patients peptic ulcer disease or alcohol dependency. b-blocker therapy is recommended after MI.

After the nurse manager at the endocrine clinic has completed the orientation of a new RN, which action by the new RN who is caring for a patient with a goiter and possible hyperthyroidism indicates the charge nurse needs to do more teaching? a. The RN palpates the neck to check thyroid size. b. The RN checks the blood pressure on both arms. c. The RN orders nonmedicated eye drops to lubricate the patient's eyes. d. The RN lowers the thermostat to decrease the temperature in the room.

ANS: A Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says, a. "I should reduce the amount of green, leafy vegetables that I eat." b. "I should wear a Medic Alert bracelet stating that I take Coumadin." c. "I will need to have blood tests routinely to monitor the effects of the Coumadin." d. "I will check with my health care provider before I begin or stop any medication."

ANS: A Patients taking Coumadin are taught to follow a consistent diet with regard to foods that are high in vitamin K, such as green, leafy vegetables. The other patient statements are accurate.

A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best? a. It inhibits thrombin. b. It inhibits fibrinogen. c. It thins your blood.d. It works against vitamin K.

ANS: A Rivaroxaban is a direct thrombin inhibitor. It does not work on fibrinogen or vitamin K. It is not a blood thinner, although many clients call anticoagulants by this name.

A patient with a history of an abdominal aortic aneurysm is admitted to the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first? a. Obtain the blood pressure. b. Ask the patient about tobacco use. c. Draw blood for ordered laboratory testing. d. Assess for the presence of an abdominal bruit.

ANS: A Since the patient appears to be experiencing aortic dissection, the nurse's first action should be to determine the hemodynamic status by assessing blood pressure. The other actions also may be done, but they will not provide information that will determine what interventions are needed immediately for this patient.

A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first? a. Client who had two bloody diarrhea stools this morning b. Client who has been premedicated for nausea prior to chemotherapy c. Client with a respiratory rate change from 18 to 22 breaths/min d. Client with an unchanged lesion to the lower right lateral malleolus

ANS: A The client who had two bloody diarrhea stools that morning may be hemorrhaging in the gastrointestinal (GI) tract and should be assessed first. The client with the change in respiratory rate may have an infection or worsening anemia and should be seen next. The other two clients are not a priority at this time.

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.6 mg/dL b. Serum potassium of 3.8 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 98 mg/dL

ANS: A The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the patient record dietary intake for 3 days. b. Give the patient a detailed list of low-sodium foods. c. Teach the patient about foods that are high in sodium. d. Help the patient make an appointment with a dietitian.

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day food diary. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

A patient at the clinic says, "I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." The nurse should a. attempt to palpate the dorsalis pedis and posterior tibial pulses. b. check for the presence of tortuous veins bilaterally on the legs. c. ask about any skin color changes that occur in response to cold. d. assess for unilateral swelling, redness, and tenderness of either leg.

ANS: A The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness point to venous thromboembolism (VTE).

A patient at the clinic says, I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though. The nurse should a. attempt to palpate the dorsalis pedis and posterior tibial pulses. b. check for the presence of tortuous veins bilaterally on the legs. c. ask about any skin color changes that occur in response to cold. d. assess for unilateral swelling, redness, and tenderness of either leg.

ANS: A The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynauds phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness point to venous thromboembolism (VTE).

All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 19-year-old with no previous health problems who has a nontender lump in the axilla b. 46-year-old with sickle cell anemia who says "that my eyes always look sort of yellow" c. 21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement d. 50-year-old with early-stage chronic lymphocytic leukemia who has complaints of chronic fatigue

ANS: A The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.

A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which action will the nurse anticipate taking next? a. Infuse IV calcium gluconate. b. Suction the patient's airway. c. Prepare for endotracheal intubation. d. Assist with emergency tracheostomy.

ANS: A The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.

A nurse is working with a client who takes atorvastatin (Lipitor). The clients recent laboratory results include a blood urea nitrogen (BUN) of 33 mg/dL and creatinine of 2.8 mg/dL. What action by the nurse is best? a. Ask if the client eats grapefruit. b. Assess the client for dehydration. c. Facilitate admission to the hospital. d. Obtain a random urinalysis.

ANS: A There is a drug-food interaction between statins and grapefruit that can lead to acute kidney failure. This client has elevated renal laboratory results, indicating some degree of kidney involvement. The nurse should assess if the client eats grapefruit or drinks grapefruit juice. Dehydration can cause the BUN to be elevated, but the elevation in creatinine is more specific for a kidney injury. The client does not necessarily need to be admitted. A urinalysis may or may not be ordered.

A client with a history of heart failure and hypertension is in the clinic for a follow-up visit. The client is on lisinopril (Prinivil) and warfarin (Coumadin). The client reports new-onset cough. What action by the nurse is most appropriate? a. Assess the clients lung sounds and oxygenation. b. Instruct the client on another antihypertensive. c. Obtain a set of vital signs and document them. d. Remind the client that cough is a side effect of Prinivil.

ANS: A This client could be having an exacerbation of heart failure or be experiencing a side effect of lisinopril (and other angiotensin-converting enzyme inhibitors). The nurse should assess the clients lung sounds and other signs of oxygenation first. The client may or may not need to switch antihypertensive medications. Vital signs and documentation are important, but the nurse should assess the respiratory system first. If the cough turns out to be a side

A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition? a. Bence-Jones protein in urine b. Epstein-Barr virus: positive c. Hemoglobin: 18 mg/dL d. Red blood cell count: 8.2/mm3

ANS: A This client has possible multiple myeloma. A positive Bence-Jones protein finding would correlate with this condition. The Epstein-Barr virus is a herpesvirus that causes infectious mononucleosis and some cancers. A hemoglobin of 18 mg/dL is slightly high for a male and somewhat high for a female; this can be caused by several conditions, and further information would be needed to correlate this value with a specific medical condition. A red blood cell count of 8.2/mm3 is also high, but again, more information would be needed to correlate this finding with a specific medical condition.

A client has frequent hospitalizations for leukemia and is worried about functioning as a parent to four small children. What action by the nurse would be most helpful? a. Assist the client to make sick day plans for household responsibilities. b. Determine if there are family members or friends who can help the client. c. Help the client inform friends and family that they will have to help out. d. Refer the client to a social worker in order to investigate respite child care.

ANS: A While all options are reasonable choices, the best option is to help the client make sick day plans, as that is more comprehensive and inclusive than the other options, which focus on a single item.

A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action takes priority? a. Calling the Rapid Response Team b. Delegating taking a set of vital signs c. Instituting bleeding precautions d. Placing the client on bedrest

ANS: A With a platelet count this low, the client is at high risk of spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse needs to call the Rapid Response Team as this client has manifestations of a sudden neurologic change. The nurse should not delegate the vital signs as the client is no longer stable. Bleeding precautions will not address the immediate situation. Placing the client on bedrest or putting the client back into bed is important, but the critical action is to call for immediate medical attentioN

A patient with Graves' disease is admitted to the emergency department with thyroid storm. Which of these prescribed medications should the nurse administer first? a. propranolol (Inderal) b. propylthiouracil (PTU) c. methimazole (Tapazole) d. iodine (Lugol's solution)

ANS: A b-adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function

MULTIPLE RESPONSE 1. A student nurse learns that the spleen has several functions. What functions do they include? (Select all that apply.) a. Breaks down hemoglobin b. Destroys old or defective red blood cells (RBCs) c. Forms vitamin K for clotting d. Stores extra iron in ferritin e. Stores platelets not circulating

ANS: A, B, E Functions of the spleen include breaking down hemoglobin released from RBCs, destroying old or defective RBCs, and storing the platelets that are not in circulation. Forming vitamin K for clotting and storing extra iron in ferritin are functions of the liver.

An older client asks the nurse why people my age have weaker immune systems than younger people. What responses by the nurse are best? (Select all that apply.) a. Bone marrow produces fewer blood cells. b. You may have decreased levels of circulating platelets. c. You have lower levels of plasma proteins in the blood. d. Lymphocytes become more reactive to antigens. e. Spleen function declines after age 60.

ANS: A, C The aging adult has bone marrow that produces fewer cells and decreased blood volume with fewer plasma proteins. Platelet numbers remain unchanged, lymphocytes become less reactive, and spleen function stays the same.

A student studying leukemias learns the risk factors for developing this disorder. Which risk factors does this include? (Select all that apply.) a. Chemical exposure b. Genetically modified foods c. Ionizing radiation exposure d. Vaccinations e. Viral infections

ANS: A, C, E Chemical and ionizing radiation exposure and viral infections are known risk factors for developing leukemia. Eating genetically modified food and receiving vaccinations are not known risk factors.

The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?a. Clopidogrel (Plavix) b. Enoxaparin (Lovenox) c. Reteplase (Retavase) d. Warfarin (Coumadin)

ANS: AClopidogrel is a platelet inhibitor. Enoxaparin is an indirect thrombin inhibitor. Reteplase is a fibrinolytic agent. Warfarin is a vitamin K antagonist.

A client is having a bone marrow biopsy today. What action by the nurse takes priority? a. Administer pain medication first. b. Ensure valid consent is on the chart .c. Have the client shower in the morning. d. Premedicate the client with sedatives.

ANS: B A bone marrow biopsy is an invasive procedure that requires informed consent. Pain medication and sedation are important components of care for this client but do not take priority. The client may or may not need or be able to shower.

Which action should the nurse take first when caring for a patient who has just arrived on the unit after a thyroidectomy? a. Check the dressing for bleeding. b. Assess respiratory rate and effort. c. Take the blood pressure and pulse. d. Support the patient's head with pillows.

ANS: B Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and the priority nursing action is to assess the airway. The other actions also are part of the standard nursing care postthyroidectomy but are not as high in priority.

After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first? a. 66-year-old who has white pharyngeal lesions b. 35-year-old who has a fever of 100.8° F (38.2° C) c. 56-year-old who has frequent explosive diarrhea d. 23-year old who is complaining of severe fatigue

ANS: B Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.

Which nursing action will be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? a. Record hourly chest tube drainage. b. Monitor fluid intake and urine output. c. Check the abdominal wound for redness or swelling. d. Teach the reason for a prolonged rehabilitation process.

ANS: B Because renal artery occlusion can occur after endovascular repair, the nurse should monitor parameters of renal function such as intake and output. Chest tubes will not be needed for endovascular surgery, the recovery period will be short, and there will not be an abdominal wound.

Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? a. Complaint of left calf pain b. New onset shortness of breath c. Red skin color of left lower leg d. Temperature of 100.4° F (38° C)

ANS: B New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the health care provider. The other findings are typical of VTE.

In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, a. "I will have to buy some loose clothing that does not bind across my legs or waist." b. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." c. "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily." d. "I will change my position every hour and avoid long periods of sitting with my legs down."

ANS: B Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.

A patient with non-Hodgkin's lymphoma develops a platelet count of 18,000/µl during chemotherapy. An appropriate nursing intervention for the patient based on this finding is to a. provide oral hygiene every 2 hours. b. check all stools for occult blood. c. check the temperature every 4 hours. d. encourage fluids to 3000 mL/day.

ANS: B Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.

A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that a. sitting at the work counter, rather than standing, is recommended. b. compression stockings should be applied before getting out of bed. c. exercises such as walking or jogging cause recurrence of varicosities. d. taking one aspirin daily will help prevent clotting around venous valves.

ANS: B Compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended to the patient who had just had sclerotherapy.

A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, it will be most important to ask about a. back or lumbar pain. b. difficulty swallowing. c. abdominal tenderness. d. changes in bowel habits.

ANS: B Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms.

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? a. Absence of flatus b. Loose, bloody stools c. Hypotonic bowel sounds d. Abdominal pain with palpation

ANS: B Loose, bloody stools at this time may indicate intestinal ischemia or infarction and should be reported immediately because the patient may need an emergency bowel resection. The other findings are normal on the first postoperative day after abdominal surgery

The family of a neutropenic client reports the client is not acting right. What action by the nurse is the priority? a. Ask the client about pain. b. Assess the client for infection. c. Delegate taking a set of vital signs. d. Look at todays laboratory results. .

ANS: B Neutropenic clients often do not have classic manifestations of infection, but infection is the most common cause of death in neutropenic clients. The nurse should assess for infection. The nurse should assess for pain but this is not the priority. The nurse should take the clients vital signs instead of delegating them since the client has had a change in status. Laboratory results may be inconclusive

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective? a. The patient avoids the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). b. The patient exercises indoors during the winter months. c. The patient places the hands in hot water when they turn pale. d. The patient takes pseudoephedrine (Sudafed) for cold symptoms.

ANS: B Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking aspirin and NSAIDs with Raynaud's phenomenon.

When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include? a. "Exercise only if you do not experience any pain." b. "It is very important that you stop smoking cigarettes." c. "Try to keep your legs elevated whenever you are sitting." d. "Put on support hose early in the day before swelling occurs."

ANS: B Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.

Which information will the nurse include when teaching a patient about use of somatropin (Genotropin)? a. The medication will improve vaginal dryness. b. Inject the medication subcutaneously every day. c. Blood glucose levels will decrease when taking the medication. d. Stop taking the medication if swelling of the hands or feet occurs.

ANS: B Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.

A patient admitted to the hospital with hypertension is diagnosed with a pheochromocytoma. The nurse will plan to monitor the patient for a. flushing. b. headache. c. bradycardia. d. hypoglycemia.

ANS: B The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose also may occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/ 82 mm Hg

ANS: B The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patients treatment.

While assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon? a. The patient is sleepy and hard to arouse. b. The patient has increasing swelling of the neck. c. The patient is complaining of 7/10 incisional pain. d. The patient's cardiac monitor shows a heart rate of 112.

ANS: B The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected

A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene? a. The LPN/LVN places the patient in a Fowler's position for meals. b. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. c. The LPN/LVN assists the patient to ambulate 40 feet in the hallway. d. The LPN/LVN administers the ordered aspirin 160 mg after breakfast.

ANS: B The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 43-year-old with a BP of 190/102 who is complaining of chest pain c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

ANS: B The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 200 mL less than the fluid intake. b. The patient is unable to move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

ANS: B The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also likely are caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

Which of these patients admitted to the emergency department should the nurse assess first? a. 62-year-old who has gangrenous ulcers on both feet b. 50-year-old who is complaining of "tearing" chest pain c. 45-year-old who is taking anticoagulants and has bloody stools d. 36-year-old who has right calf tenderness, redness, and swelling

ANS: B The patient's presentation is consistent with dissecting thoracic aneurysm, which will require rapid intervention. The other patients do not need urgent interventions.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.

During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. The most appropriate action by the nurse is to a. palpate the patient's neck more deeply. b. document that the thyroid was nonpalpable. c. notify the health care provider immediately. d. teach the patient about thyroid hormone testing.

ANS: B The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the patient a. that symptoms of hyperthyroidism should be relieved in about a week. b. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. c. to discontinue the antithyroid medications taken before the radioactive therapy. d. about radioactive precautions to take with urine, stool, and other body secretions.

ANS: B There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.

A 78-year-old patient in a long-term care facility has these medications prescribed. After the patient is diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administration of a. docusate (Colace). b. diazepam (Valium). c. ibuprofen (Motrin). d. cefoxitin (Mefoxin).

ANS: B Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the diazepam with the health care provider before administration. The other medications may be given safely to the patient.

A nursing student learns that many drugs can impair the immune system. Which drugs does this include? (Select all that apply.) a. Acetaminophen (Tylenol) b. Amphotericin B (Fungizone) c. Ibuprofen (Motrin) d. Metformin (Glucophage) e. Nitrofurantoin (Macrobid)

ANS: B, C, E Amphotericin B, ibuprofen, and nitrofurantoin all can disrupt the hematologic (immune) system. Acetaminophen and metformin do not.

A nurse works in a gerontology clinic. What age-related changes cause the nurse to alter standard assessment techniques from those used for younger adults? (Select all that apply.) a. Dentition deteriorates with more cavities. b. Nail beds may be thickened or discolored. c. Progressive loss of hair occurs with age. d. Sclerae begin to turn yellow or pale. e. Skin becomes dry as the client ages.

ANS: B, C, E Common findings in older adults include thickened or discolored nail beds, dry skin, and thinning hair. The nurse adapts to these changes by altering assessment techniques. Having more dental caries and changes in the sclerae are not normal age-related changes.

A client has Hodgkins lymphoma, Ann Arbor stage Ib. For what manifestations should the nurse assess the client? (Select all that apply.) a. Headaches b. Night sweats c. Persistent fever d. Urinary frequency e. Weight loss .

ANS: B, C, E In this stage, the disease is located in a single lymph node region or a single nonlymph node site. The client displays night sweats, persistent fever, and weight loss. Headache and urinary problems are not related

When a patient has clinical manifestations of hypothyroidism, which laboratory value should the nurse review to determine whether the hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland? a. Thyroxine (T4) level b. Triiodothyronine (T3) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level

ANS: C A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

A nurse is caring for four clients. After reviewing todays laboratory results, which client should the nurse see first? a. Client with an international normalized ratio of 2.8 b. Client with a platelet count of 128,000/mm3 c. Client with a prothrombin time (PT) of 28 seconds d. Client with a red blood cell count of 5.1 million/L

ANS: C A normal PT is 11 to 12.5 seconds. This client is at high risk of bleeding. The other values are within normal limits.

A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority? a. Genetic testing b. Infection prevention c. Sperm banking d. Treatment options .

ANS: C All teaching topics are important to the client with lymphoma, but for a young male, sperm banking is of particular concern if the client is going to have radiation to the lower abdomen or pelvis

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find a. a positive Homans sign. b. swollen, dry, scaly ankles. c. prolonged capillary refill in all the toes. d. a large amount of drainage from the ulcer.

ANS: C Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find a. a positive Homans' sign. b. swollen, dry, scaly ankles. c. prolonged capillary refill in all the toes. d. a large amount of drainage from the ulcer.

ANS: C Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg? a. Adequate carbohydrate intake b. Prophylactic antibiotic therapy c. Application of compression to the leg d. Methods of keeping the wound area dry

ANS: C Compression of the leg is essential to healing of venous stasis ulcers. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used for venous ulcers. Moist environment dressings are used to hasten wound healing.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b. Assist the patient up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

ANS: C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for frequent BP checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how to self-monitor and record BPs at home. d. Teach the patient about ambulatory blood pressure monitoring.

ANS: C Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3 to 6 months.

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-year-old with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L c. A 70-year-old who recently started taking levothyroxine (Synthroid) and has an irregular pulse of 134 d. A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).

ANS: C Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patient's environment for adverse stimuli that might increase BP.

ANS: C LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

ANS: C Labetalol decreases sympathetic nervous system activity by blocking both - and -adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives.

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? a. "Administration of two anticoagulants reduces the risk for recurrent venous thrombosis." b. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from occurring." c. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." d. "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."

ANS: C Low molecular weight heparin (LMWH) is used because of the immediate effect on coagulation and discontinued once the international normalized ratio (INR) value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE.

A 45-year-old patient with acute myelogenous leukemia (AML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). To assist the patient with treatment decisions, the best approach for the nurse to use is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.

ANS: C Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision.

When reviewing the laboratory results for a patient's total calcium level, which information will the nurse need to consider? a. The blood glucose is elevated. b. The phosphate level is normal. c. The serum albumin level is low. d. The magnesium level is normal.

ANS: C Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

A patient tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about tests for a. hypertension. b. hyperlipidemia. c. autoimmune disorders. d. coronary artery disease.

ANS: C Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis, and patients should be screened for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hypertension, or coronary artery disease.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?

ANS: C Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

When the nurse is caring for a patient who was admitted with tetany, which laboratory value should be monitored? a. Total protein b. Blood glucose c. Ionized calcium d. Serum phosphate

ANS: C Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. check the BP with a home BP monitor every day. b. move slowly when moving from lying to standing. c. increase the dietary intake of high-potassium foods. d. make an appointment with the dietitian for teaching.

ANS: C The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patient's most recent BP reading is 156/94 mm Hg. b. The patient's pulse has dropped from 64 to 58 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

ANS: C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective â-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with â-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements.

ANS: C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

A patient with Graves' disease has exophthalmos. Which nursing action will be included in the plan of care? a. Apply eye patches to protect the cornea from irritation. b. Place cold packs on the eyes to relieve pain and swelling. c. Elevate the head of the patient's bed to reduce periorbital fluid. d. Teach the patient to blink every few seconds to lubricate the cornea.

ANS: C The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos the patient is unable to close the eyes completely. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.

A patient has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for a. calcitonin levels. b. catecholamine levels. c. thyroid hormone levels. d. parathyroid hormone levels.

ANS: D Parathyroid hormone is the major controller for blood calcium levels. Although calcitonin secretion is a countermechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

When planning teaching for a patient who was admitted with myxedema coma and diagnosed with hypothyroidism, which strategy will be best for the nurse to use? a. Delay teaching until patient discharge. b. Ensure privacy by asking visitors to leave. c. Provide written handouts of all information. d. Offer multiple options for management of therapies.

ANS: C Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Since the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid

A client has received a bone marrow transplant and is waiting for engraftment. What actions by the nurse are most appropriate? (Select all that apply.) a. Not allowing any visitors until engraftment b. Limiting the protein in the clients diet c. Placing the client in protective precautions d. Teaching visitors appropriate hand hygiene e. Telling visitors not to bring live flowers or plants

ANS: C, D, E The client waiting for engraftment after bone marrow transplant has no white cells to protect him or her against infection. The client is on protective precautions and visitors are taught hand hygiene. No fresh flowers or plants are allowed due to the standing water in the vase or container that may harbor organisms. Limiting protein is not a healthy option and will not promote engraftment.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. the dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. more diagnostic testing may be needed to determine the cause of the hypertension.

ANS: D A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

Which of the following nursing actions included in the care plan for a patient with neutropenia is appropriate for the RN to delegate to an LPN/LVN who is assisting with patient care? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Developing a discharge teaching plan for the patient and family d. Administering the ordered subcutaneous filgrastim (Neupogen) injection

ANS: D Administration of medications is included in LPN/LVN education and scope of practice. Patient education, assessment, and developing the plan of care require RN level education and scope of practice.

When discussing risk factor modification for a 60-year-old patient who has a 4-cm abdominal aortic aneurysm, the nurse will focus patient teaching on which of these patient risk factors? a. Male gender b. Marfan syndrome c. Abdominal trauma history d. Uncontrolled hypertension

ANS: D All of the factors contribute to the patient's risk, but only the hypertension can potentially be modified to decrease the patient's risk for further expansion of the aneurysm.

A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client? a. Bortezomib (Velcade) b. Dexamethasone (Decadron) c. Thalidomide (Thalomid) d. Zoledronic acid (Zometa)

ANS: D All the options are drugs used to treat multiple myeloma, but the drug used specifically for bone manifestations is zoledronic acid (Zometa), which is a bisphosphonate. This drug class inhibits bone resorption and is used to treat osteoporosis as well.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a. "The medication may not work as well if I take any aspirin." b. "The doctor may order a blood potassium level occasionally." c. "I will call the doctor if I notice that I have a frequent cough." d. "I won't worry if I have a little swelling around my lips and face."

ANS: D Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

Which nursing action in the care plan for a patient who had an open repair of an abdominal aortic aneurysm 3 days previously is appropriate for the nurse to delegate to experienced nursing assistive personnel (NAP)? a. Check the lower extremity strength and movement. b. Monitor the quality and presence of the pedal pulses. c. Teach the patient the signs of possible wound infection. d. Help the patient to use a pillow to splint while coughing.

ANS: D Assisting a patient who has already been taught how to cough is part of routine postoperative care and within the education and scope of practice for an experienced NAP. Patient teaching and assessment of essential postoperative functions such as circulation and movement should be done by RNs.

The history and physical for a newly admitted patient states that thecomplete blood count (CBC) shows a "shift to the left." The nurse will plan to monitor the patient for a.cool extremities .b.pallor and weakness. c.elevated temperature. d.low oxygen saturation.

ANS:C The termshift to the leftindicates that the number of immaturepolymorphonuclear neutrophils, or bands, is elevated and is a sign ofsevere infection. There is no indication that the patient is at risk forhypoxemia, pallor/weakness, or cool extremities.

The nurse is interviewing a patient who has a possible thyroid disorder. Which question will provide the most useful information? a. "What methods do you use to help cope with stress?" b. "Have you experienced any blurring or double vision?" c. "Do you have to get up at night to empty your bladder?" d. "Have you had any recent unplanned weight gain or loss?"

ANS: D Because thyroid function affects metabolic rate, changes in weight may indicate hyper- or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information? a. "When I stand too long, my feet start to swell up." b. "Sometimes I get tired when I climb a lot of stairs." c. "My fingers hurt when I go outside in cold weather." d. "My legs cramp whenever I walk more than a block."

ANS: D Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon. Fatigue that occurs sometimes with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.

When the nurse is obtaining the health history, which statement by a patient indicates further assessment of thyroid function may be necessary? a. "I notice my breasts are tender lately." b. "I am so thirsty that I drink all day long." c. "I get up several times at night to urinate." d. "I feel a lump in my throat when I swallow."

ANS: D Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

Which laboratory test will the nurse use to determine whether the prescribed filgrastim (Neupogen) is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count

ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.

A nursing student is struggling to understand the process of graft-versus-host disease. What explanation by the nurse instructor is best? a. Because of immunosuppression, the donor cells take over. b. Its like a transfusion reaction because no perfect matches exist. c. The clients cells are fighting donor cells for dominance. d. The donors cells are actually attacking the clients cells.

ANS: D Graft versus host disease is an autoimmune-type process in which the donor cells recognize the clients cells as foreign and begin attacking them. The other answers are not accurat

A patient is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a a. basin of ice. b. cardiac monitor. c. vial of glargine insulin. d. vial of 50% dextrose solution.

ANS: D Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given intravenously). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best? a. If the WBCs are high, there already is an infection present. b. The client is in a blast crisis and has too many WBCs. c. There must be a mistake; the WBCs should be very low. d. Those WBCs are abnormal and dont provide protection.

ANS: D In leukemia, the WBCs are abnormal and do not provide protection to the client against infection. The other statements are not accurate.

Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? a. Wrap both the legs in warm blankets. b. Notify the surgeon and anesthesiologist. c. Document that the pulses are absent and recheck in 30 minutes. d. Review the preoperative assessment form for data about the pulses.

ANS: D Many patients with aortic aneurysms also have peripheral arterial disease, so the nurse should check the preoperative assessment to determine whether pulses were present before surgery before notifying the health care providers about the absent pulses. Because the patient's symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 30 minutes before taking action. Warm blankets will not improve the circulation to the patient's legs.

Which information will the nurse include when teaching a patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Surgery will eventually be required to remove the thyroid gland. d. Antithyroid medications may take several weeks to have an effect.

ANS: D Medications used to block the synthesis of thyroid hormones may take several weeks before an effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease, although surgery may be used

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are important in BP control. d. Question the patient about whether the medication is actually being taken.

ANS: D Since noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of dietary protein. c. The patient has only one cup of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

ANS: D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

Which action by a nurse who is administering fondaparinux (Arixtra) to a patient with venous thromboembolism (VTE) indicates that more education about the medication is needed? a. The nurse avoids rubbing the injection site after giving the medication. b. The nurse injects the medication into the abdominal subcutaneous tissue. c. The nurse fails to assess the partial thromboplastin time (PTT) before administration of the medication. d. The nurse ejects the air bubble in the syringe before administering the Arixtra.

ANS: D The air bubble is not ejected before giving Arixtra. The other actions by the nurse are appropriate.

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. Check BP daily before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.

ANS: D The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

Several hours after an open surgical repair of an abdominal aortic aneurysm, the patient develops a urinary output of 20 mL/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for a. an additional antibiotic. b. a white blood cell (WBC) count. c. a decrease in IV infusion rate. d. a blood urea nitrogen (BUN) level.

ANS: D The decreased urine output suggests decreased renal perfusion, and monitoring of renal function is needed. There is no indication that infection is a concern, so antibiotic therapy and a WBC count are not needed. The IV rate may be increased because hypovolemia may be contributing to the patient's decreased urinary output.

A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and a. elevate the left leg on a pillow. b. apply an elastic wrap to the leg. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

ANS: D The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.

Which assessment finding for a 24-year-old patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. BP 166/100 mm Hg b. Bilateral exophthalmos c. Heart rate 136 beats/minute d. Temperature 104.8° F (40.4° C)

ANS: D The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with deep vein thrombosis. The best method for the nurse to use in elevating the patient's feet is to a. place the patient in the Trendelenburg position. b. place two pillows under the calf of the affected leg. c. elevate the bed at the knee and put pillows under the feet. d. put one pillow under the thighs and two pillows under the lower legs.

ANS: D The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the calf level.

A hospitalized client has a platelet count of 58,000/mm3. What action by the nurse is best? a. Encourage high-protein foods. b. Institute neutropenic precautions. c. Limit visitors to healthy adults.d. Place the client on safety precautions.

ANS: D With a platelet count between 40,000 and 80,000/mm3, clients are at risk of prolonged bleeding even after minor trauma. The nurse should place the client on safety precautions. High-protein foods, while healthy, are not the priority. Neutropenic precautions are not needed as the clients white blood cell count is not low. Limiting visitors would also be more likely related to a low white blood cell count

A client is having a radioisotopic imaging scan. What action by the nurse is most important? a. Assess the client for shellfish allergies. b. Place the client on radiation precautions.c. Sedate the client before the scan.d. Teach the client about the procedure.

ANS: DThe nurse should ensure that teaching is done and the client understands the procedure. Contrast dye is not used, so shellfish/iodine allergies are not related. The client will not be radioactive and does not need radiation precautions. Sedation is not used in this procedure.

While examining the lymph nodes during physical assessment, thenurse would be most concerned abouta .a 2-cm nontender supraclavicularnode. b.a 1-cm mobile and nontenderaxillary node. c.an inability to palpate anysuperficial lymph nodes. d.firm inguinal nodes in a patientwith an infected foot.

ANS:A Enlarged and nontender nodes are most suggestive of malignancysuch as lymphoma. Firm nodes are an expected finding in an area ofinfection. The superficial lymph nodes are usually not palpable inadults, but if they are palpable, they are normally 0.5 to 1 cm andnontender

While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patient's use of a.salicylates. b.contraceptives. c.antiseizure drugs. d.antihypertensives.

ANS:A Salicylates interfere with platelet function and can lead to petechiaeand ecchymoses. Antiseizure drugs may cause anemia, but notbleeding. Oral contraceptives increase clotting risk. Antihypertensivesdo not commonly cause problems with decreased clotting.

A patient who has a history of a transfusion-related acute lung injury(TRALI) is to receive a transfusion of packed red blood cells (PRBCs).Which action will the nurse take to decrease the risk for TRALI for thispatient? a.Infuse the PRBCs slowly over 4hours. b.Transfuse only leukocyte-reducedPRBCs. c.Administer the scheduled oraldiuretic before the transfusion. d.Give the PRN dose ofantihistamine before starting thetransfusion.

ANS:B TRALI is caused by a reaction between the donor and the patientleukocytes that causes pulmonary inflammation and capillary leaking.The other actions may help prevent respiratory problems caused bycirculatory overload or by allergic reactions, but they will not preventTRALI

Which action will be included in the care plan for a hospitalized patientwho is neutropenic? a.Avoid any IM or subcutaneousinjections. b.Check the oral temperatureevery 4 hours. c.Omit all fruits or vegetables fromthe diet. d.Place a "No Visitors" sign on thepatient door.

ANS:B The earliest sign of infection in a neutropenic patient is an elevation intemperature. Although unpeeled fresh fruits and vegetables should beavoided, fruits and vegetables that are peeled or cooked areacceptable. Injections may be required for administration ofmedications such as filgrastim (Neupogen). The number of visitors maybe limited and visitors with communicable diseases should be avoided

The complete blood count (CBC) and differential indicate that a patientis neutropenic. Which action should the nurse include in the plan ofcare?a.Avoid intramuscular injections. b.Encourage increased oral fluids. c.Check temperature every 4hours. d.Increase intake of iron-rich foods.

ANS:C Neutropenic patients are at high risk for infection and sepsis andshould be monitored frequently for signs of infection. The other actionswould not address the patient's neutropenia.

Which laboratory test will the nurse use to determine whether theprescribed filgrastim (Neupogen) is effective in the treatment of apatient who is receiving chemotherapy for acute lymphocyticleukemia?a.Platelet count b.Reticulocyte count c.Total lymphocyte count d.Absolute neutrophil count

ANS:D Filgrastim increases the neutrophil count and function in neutropenicpatients. Although total lymphocyte, platelet, and reticulocyte countsalso are important to monitor in this patient, the absolute neutrophilcount is used to evaluate the effects of filgrastim.

When reviewing the complete blood count (CBC) for a patient admitted with abdominal pain, which information will be most important for thenurse to communicate to the health care provider? a.Monocytes 4% b.Hemoglobin 11.6 g/dL c.Platelet count 145,000/μL d.White blood cells (WBCs)13,500/μLn.

ANS:D The elevation in WBCs indicates that an abdominal infection may bethe cause of the patient's pain and that further diagnostic testing isneeded. The monocytes are at a normal level. The slight decreases inhemoglobin and platelet count also would be reported but would notrequire any immediate actio

The health care provider orders an ultrasound of the spleen for apatient who has been in a car accident. Which action should the nursetake before this procedure?a.Check for any iodine allergy. b.Insert a large-bore IV catheter. c.Place the patient on NPO status. d.Assist the patient to a flatposition.x

ANS:D The patient is placed in a flat position before splenic ultrasound. Thepatient does not have to be NPO or have an IV line. No iodine-containing materials are used for ultrasound.

A 64-year-old with acute myelogenous leukemia (AML) who hasinduction therapy prescribed asks the nurse whether the plannedchemotherapy will be worth undergoing. Which response by the nurseis appropriate? a."If you do not want to havechemotherapy, there are otheroptions for treatment such asstem cell transplantation." b."The decision aboutchemotherapy is one that youand the doctor need to makerather than asking what I woulddo." c."You don't need to make adecision about treatment rightnow since leukemias in adultstend to progress quite slowly." d."The side effects of thechemotherapy are difficult, but AML frequently does go intoremission with chemotherapy."

ANS:D This response uses therapeutic communication by addressing thepatient's question and giving accurate information. The otherresponses either give inaccurate information or fail to address thepatient's question, which will discourage the patient from asking thenurse for information

The health care provider performs a bone marrow aspiration from theleft posterior iliac crest on a patient with pancytopenia. Following theprocedure, the nurse should a.elevate the head of the bed to 45degrees. b.apply a sterile Band-Aid at theaspiration site .c.use half-inch sterile gauze topack the wound. d.have the patient lie on the leftside for an hour.

ANS:D To decrease the risk for bleeding, the patient should lie on the left sidefor 30 to 60 minutes. The wound after bone marrow biopsy is small andwill not be packed with gauze. A pressure dressing is used to cover theaspiration site. There is no indication that the head needs to beelevated for this patient

When caring for a patient who is receiving heparin, the nurse willmonitor a.prothrombin time (PT). b.fibrin degradation products(FDP). c.international normalized ratio(INR). d.activated partial thromboplastintime (aPTT).

ANS:D aPTT testing is used to determine whether heparin is at a therapeutic level. FDP is useful in diagnosis of problems such as disseminatedintravascular coagulation (DIC). PT and INR are most commonly usedto test for therapeutic levels of warfarin (Coumadin)

priority population for htn screending? a.AA b.asian americans c.high school sport camps d.women health clinics

a

Barrier to foot care for pt with PVD? a.i wear comfy sweatpants and house shoes b.im glad i get energy assistance so my house isnt cold c.my daughter makes sure i have plenty of lotion on my feet d. my hands shake when i try to do things that require coordination

d

Pt about to have amputation re/t nonhealing arterial ulcer. rn should: a. ask client to describe emotions b. assess the client for support systems c. offer to stay with pt d. relate how smoking contributed e. tell client that many people have amputations

a,b,c

Adm Iv heparin a.assess bleeding b. monitor daily aptt c. stop iv for aptt above baseline d. use iv pump for infusion e. weight client daily

a,b,d

Delegate to bedrest dvt pt? a. apply compression stockings b.assist with ambulation c. encourage cough and deep breathing d, offer fluids frequently e. teach leg exercises

a,b,d

Edu with coumadin/warfarin a. dietary restrictions b. drivin restrictions c. follow up with lab d. possible drug to drug interaction e. reason to take med

a,c,d,e

Factors related to aneurysm: a. atherosclerosis b.down syndrome c. frequent heartburn d. htn e. smoking

a,d,e

RN caring for pt with nonhealing arterial lower leg ulcer. Actin / a. consult wound ostomy care nurse b.give pain meds prior to wound care c. maintain sterile technique for dressing changes d.prepare the client for amputation

a.

what action to take for a pt with a dependent rubor, pad finding a. ankle brachial index b. elevate the client leg above heart c. obtain ice pack d. prepare to teach about heparin

a.

RN assessing a pt with PAD . Pt reports that walking five blocks w/o pain. RN should ask? a.could you walk further than that a few months ago b.do you walk mostly uphill c.have you ever considered swimming d.how much pain meds you take

a. pad progresses it takes less oxygen demand to cause pain. if pt needs to stop activity to stop pain then pad is getting worse.

etho use in women? a.only have 1xdaily b.if larger body mass than you can have more c.two beers 1xdaily d.do not drink any etho

a. 2x daily for men and 1xdaily for women

Pt with dvt is to be discharged on warfarin/coumadin . Pt wants to refuse drugs. Rn action a.assess fear b.remind the client about lab monitoring c.tell client drugs are safer now d.warn client about non compliance consequences

a. discuss experience of someone client knows who took warfarin

pt with hf and htn taking coumadin and prinivil. Pt reports onset cough. What action? a. assess lung sound and oxygenation b.other antihypertensive meds discussion c. obtain v/s and document d. remind the client that cough is a se

a. pt could have exacerbation of hf or experience se of lisinopril.

Pt with femoropopliteal bypass graft with synthetic graft. action by rn to prevent wound infection? a.appropriate hh before giving care b.assessing the clients temperature every 4 hours c.clean technique when changing dressing d.monitor the client daily wbc

a.hand hygiene is the best way to prevent infections in adm pts.

Nonpharm comfort measures to include in poc for vericose veins? a. adm mild analgesics for pain b. applying elastic compression stockings c. elevate legs when sitting or lying d. reminding client to do leg exercises e. teach client about sx options

b,c,d the three E's: elastic, elevation, exercise

Pt with lacerated artery. Action/ a. adm oxygen via non rebreather mask b. ensure the client has patent airway c. prepare to assist with suturing the artery d. start two large bore iv with ns

b. airway always priority

Dvt priority outcome? a.ambulates with assistance b.o2 sat of 98% c.pain of 2/10 d.verbalize risk factors

b.critical complication is pulmonary embolism

Pt with abdominal aortic aneurysm reports dizziness and severe ab pain. The rn assess the client bp at 82/40. Rn action a. adm pain med b.assess distal pulses at 10 mins c. have client sign sx consent d. notify rrt e. take v/s at 10 mins

b.d.e pt may have rupture

4 hours post femoropopliteal by pass. the pt reports throbbing leg pain on affected side, 7/10 . action to take? a.adm pain med b.assess distal pulses and skin color, c.doc the findings d.notify hcp

b.once perfusion has been restored or improved to an extremity client can often feel a throbbing pain due to increase blood flow.

Delegate to UAP for DVT comfort care a. ambulate pt b. apply warm most pack c. massage clients leg d/ provide ice pack

b.warm most packs will help the pain of dvt

All of the following patients are waiting to be admitted by the emergency department nurse. Which one requires the most rapid assessment and care by the nurse? a. The patient with hemochromatosis who is complaining of abdominal pain b. The patient with thrombocytopenia who has oozing after having a tooth extracted c. The patient with chemotherapy-induced neutropenia who has a temperature of 100.8° F d. The patient with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours

c

Foot care in pvd? a. good abrasive pumice stone will keep my feet soft b. ill always wear shoes if i can buy cheap flipflops c. i will keep my feet dry, especially between the toes d. lotion is importatnt to keep my feet smooth and soft e. washing my feet in room temperature water is best

c,d,e

22 y/o with acute myleogenous leukemia develops neutropenia after receiving chemo . which action is most appropriate? a.adm pt to hospital b.pt to come in daily for filgrastim/neupogen injections c.teach pt or family how to adm filgrastim/neupogen injections at home d. obtain a high efficient particulate air filter for pt to use at home

c. pt or fam can self-adm injections

Pt with dvt loses 20. action/ a.ask if weight loss was intended b. encourage high protein and fiber c. measure for new compression stockings d. review 3 day food recall diary

c. stockings must fit correctly in order to work

What is essential htn? a.caused by disease b.essential means it needs to be tx c.with no specific cause d.refers to severe and life threatening

c.essential htn is the most common type of htn and has no specific cause

Rn preparing for pt who will have femoropopliteal bypass sx. Actions to delegate: a. adm preop meds b. ensure consents c. mark pulses with pen d. side rails up e. record baseline v/s

d,e

DURING CARE FOR A PT WITH MULTIPLE MYELOMA, an important rn intervention is a.limit bearing wt and ambulation b.maintain fluid intake 3-4 l/day c.assessing lymph nodes for enlargement d.adm of calcium supplements

d. a high fl intake and urine output helps to prevent complications of kidney stones cause by hypercalcemia and renal failure caused by deposition of bence-jones protein in renal tubules.

26 y/o with stage 2 hodgkin lymphoma ask rn "how long do i have to live. RN response: a.no one can predict how long someone will live, focus on present b.depends on how your disease responds to the radiation c.with ongoing maintenance and chemo, 10 years d.most pts with your stage of hodgkin dx are treated sucessfully.

d. survival rate is almost 90% in pts with early stages of hodgkin lymphoma

A rn student is caring for a pt with abdominal aneurysm. what action requires intervention? a.assess the client for back pain b.auscultate over abdominal bruit c.measures the abdominal girth d.palpates the abdomen in four quadrants

d.palpation can cause rupture

Intervene with student nurse assessing peripheral vascular system of older adult: a.assess bp in both upper extremities b.auscultate the carotid arteries for any bruits c.classify capillary refill of 4 seconds as normal d.palpate both carotid arteries at the same time

d.should not compress both carotid arteries at the same time to avid brain ischemia.

The history and physicalfor a newly adm pt states that the cbc show a shift to the left. rn will plan to monitor: a.elevated temp b.low oxy sat c.pallor and weakness d.cool extremities

shift to left indicates the number of immature polymorphonuclear neutrophils or bands and is elevated with severe infection