Final Pathopharm 1
Which of the following best describes these ABGs?: PH: 7.31 CO2: 50mmHg HCO3: 22mEq/L A) Metabolic Acidosis, Compensated B) Respiratory Acidosis, UNcompensated C) Metabolic Acidosis, UNcompensated D) Respiratory Acidosis, Compensated
B
A client is admitted reporting chest pain and left arm numbness/tingling. When you go to check on this client you find him in the rhythm below with no palpable pulse. What rhythm is this?
Pulseless Electrical Activity
A nurse is preparing to administer cefazolin IVPB over 20 min. Available is cefazolin 1 g in 100 mL of dextrose 5% in water (D5W). The drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number):
75 (100mL/20min X 15gtt/1mL =75gtt/min) The mL gets crossed out.
A client who has a history of myocardial infarction (MI) is prescribed aspirin 81 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication?: A) Anti-Platelet aggregation B) Analgesic C) Anti-Inflammatory D) Anti-Pyretic
A
CV The nurse is discussing medications with a client with hypertension who has a prescription for furosemide. the client needs further education when they state which of the following?: A) "I know I should not drive after taking this medication" B) "I should be careful to not stand up too quickly when taking this medication" C) "I should take this medication in the morning instead of at bedtime" D) "I need to be sure to take a potassium supplement that the doctor prescribed"
A
CV The nurse notes that a client's HR drops from 63 to 50 bpm on the monitor. The nurse should first...: A) Assess level of consciousness B) Administer 0.5 mg IVP of Atropine C) Auscultate breath sounds D) Prepare for pacemaker insertion
A
For the client admitted with new onset of atrial fibrillation, in addition to anti-dysrhythmics, what other medications need to be considered for this client to prevent a major complication of this rhythm?: A) Anticoagulants B) Anti-hypertensives C) Anti-inflammatories D) Analgesics
A
What acid-base imbalance do the following ABGs reveal: PH: 7.38 CO2: 28 HCO3: 16 A) Metabolic Acidosis, Fully Compensated B) Respiratory Alkalosis, Uncompensated C) Respiratory Acidosis, Partially Compensated D) Metabolic Alkalosis, Fully Compensated
A
Which of the following is the most appropriate intervention for the patient in the rhythm below? The patient has a pulse, but is lethargic. BP is 80/40, RR 26, pulse of 91% on 10L oxymask. (Torsads is the picture "party streamer": A) IV Amiodarone B) Defibrillation C) IV Epinephrine D) Balloon Angioplasty
A
Which of the following is the priority intervention for treating the rhythm shown below. This patient has no pulse: A) Defibrillation B) Cardioversion C) Administer 1mg of Epinephrine D) Cardiopulmonary resuscitation
A
Which of the following statements below is true regarding these rhythm strips?: A) These are very similar atrial dysrhythmias (similar s/s, treatments, complications) but do have different EKG tracings B) These two dysrhythmias differ in that for atrial fibrillation the client has no pulse and for atrial flutter they do C) Both of these dysrhythmias require immediate defibrillation D) Atrial Fibrillation is the dysrhythmia we see right before a patient experiences a myocardial infarction whereas atrial flutter is not associated with MIs
A
A client is diagnosed with urosepsis. Which assessment finding is most concerning and requires immediate follow-up?: A) Confusion B) WBC count of 12,000 C) Oral temperature of 100.2F (37.8C) D) Cloudy, malodorous urine
A (CONCERNING MEANS ORGAN DAMAGE)
A client with advanced kidney disease and anuria has a serum potassium of 7.8, and a creatinine 4.5. What is the nurse's next most appropriate intervention?: A) Give IVP dextrose and insulin B) Give IVP furosemide C) Give IVP Calcium Gluconate D) Prepare client for AV fistula placement
A (This will move the potassium into the cells)
A client with end stage renal disease comes to a dialysis clinic this morning for hemodialysis treatment. Which action should the nurse take to prepare the client for hemodialysis?: A) Palpate the AV fistula in the client's arm to feel for a thrill and auscultate for a bruit B) Administer the 3 blood pressure medications that the client has scheduled for mornings C) Start a new peripheral intravenous line in the same arm as the client's AV fistula D) Use clean technique to access the AV fistula at the beginning of treatment
A (You should hear a bruit/thrill)
A client with chronic kidney disease is admitted for hypervolemia and is complaining of nausea, vomiting, and a severe headache. What is the initial nursing action? A) Check blood pressure B) Contact the healthcare provider C) Offer the client a carbonated beverage D) Administer Acetaminophen
A (hypervolemia causes high BP going to the head causing a headache so this is a good initial intervention)
The nurse is caring for a client 8 hours post laparoscopic cholecystectomy. The client has not urinated since surgery. Which of the following would be the most appropriate initial intervention?: A) Help the client out of bed and to the restroom B) Perform a bladder scan to determine if there is urinary retention C) Insert an indwelling urinary catheter using sterile technique D) Wait another 4 hours and then call HCP if still no urine output
A (mobility helps promote urination)
A client comes to the emergency department complaining of experiencing palpitations on and off for the past few months. What other signs or symptoms of a dysrhythmia might the client report? Select All That Apply: A) Syncopal episodes B) Dizziness C) Frequent eructing D) Weakness E) Activity intolerance
A, B, D, E
A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80, and proteinuria. The nurse should include which most accurate indicator of fluid loss or gain?: A) Blood Pressure Measurements B) Daily Weights C) Intake and Output measurements D) Severity of Pitting Edema
B
A client is being discharged home after the placement of an Implanted Cardioverter Defibrillator (ICD). Which of the following should be included in the nurse's discharge instructions to the client?: A) "You can no longer use microwaves now that you have this ICD" B) "You must let your dentist know about your ICD at your next visit" C) "You can never go through a security screening ever again" D) "You will have to be on anticoagulant therapy for the rest of your life"
B
A client with End Stage Renal Disease has a left-arm (non-dominant hand) arteriovenous fistula (AVF). Which of the following statements indicates the client understands how to care for the AVF properly?: A) I don't need to call my HCP if a have numbness in my left arm B) I will try not to sleep on my left arm C) I will make sure to always have my blood pressure taken on my non-dominant, left arm D) I should notify my HCP if I feel a vibrating sensation when touching the AVF
B
A nurse provides care to a client on continuous ECG monitoring and observes the rhythm below. Which of the following interventions should the nurse implement?: A) Call the rapid response team B) Obtain a blood pressure C) Notify the healthcare provider D) Give IVP Atropine
B
A patient is admitted to the emergency department with 10/10 substernal chest pain radiating to their left jaw. Which of the following is the priority nursing actions?: A) Administer 0.4mg sublingual nitroglycerin B) Obtain a 12-lead EKG C) Administer 81mg of aspirin D) Question the patient regarding recent musculoskeletal injuries to the chest
B
A patient is found in this rhythm. While waiting for defibrillator to arrive, which of the following is the most appropriate next intervention? (Picture is vfib): A) Administer 0.5mg of Atropine B) Begin CPR C) Call the patient's family D) Contact the charge nurse
B
CV A client with a history of heart failure is taking furosemide and digoxin daily. The client has nausea, blurred vision, and headache. The nurse also notes confusion. The nurse should further assess the client for signs of which of the following?: A) Pulmonary edema B) Digoxin toxicity C) Fluid deficit D) Hypokalemia
B
Renal A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis? A) Hyperactive bowel sounds B) Abdominal rigidity C) Bradycardia D) Increased urine output
B
Which of the following best describes these ABGs?: PH: 7.36 CO2: 46 mmHg HCO3: 32 mEq/L A) Metabolic acidosis, partially compensated B) Respiratory acidosis, fully compensated C) Respiratory acidosis, partially compensated D) Metabolic alkalosis, uncompensated
B
Which of the following is the most life-threatening dysrhythmia of the 4 options listed?: A) Atrial fibrillation B) Ventricular fibrillation C) Ventricular tachycardia with a pulse D) Normal sinus rhythm
B
Renal Which of the following urinalysis (UA) results indicates dehydration?: A) Straw-colored urine B) Urine specific gravity of 1.127 C) Trace amounts of protein D) WBC count of 0-5 cells
B (Indicates concentrated urine)
CV A nurse completes assessments of clients with decreased cardiac output. Which finding is the highest priority?: A) BP 110/62, atrial fibrillation with a HR of 82, bibasilar crackles B) Confusion, urine output of 15mL/hr over past 2 hours, orthopnea C) SpO2 of 92 on 2L NC, respirations 20, 1+ pitting edema in feet D) Weight gain of 1 kg in 3 days, BP 130/78, mild dyspnea with exercise
B (Signs of organs beginning to fail)
A nurse is caring for a 5-year-old client admitted for nephrotic syndrome. Which statement from the parents requires further teaching regarding the management of this condition?: A) "It is best to provide a healthy diet that is low salt for our child" B) "When edema is getting worse we should emphasize additional exercise and play" C) "We will restrict our child's fluid intake during times of increasing edema" D) "During exacerbations, it is best to limit our child's interactions with other children"
B (They should be on bed rest and elevating extremities)
Renal A nurse is caring for a client immediately following a hemodialysis treatment. For which of the following manifestations will the nurse administer a PRN dose of lorazepam?: A) Pain an tingling at the HD access site B) Full-body, convulsive movements C) Muscle cramps D) Hypotension
B (anticonvulsant for seizures)
A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?: A) Ototoxicity B) Hypotension C) Hyperthermia D) Rhabdomyolysis
B (calcium channel blocker, lowers bp)
The nurse prepares to administer a dose of PO sodium polystyrene sulfonate to a client with hyperkalemia. Which of the following actions is most important for the nurse to perform prior to administration?: A) Assisting the client to the bedside commode B) Assessing abdomen and reviewing medical record for stool frequency C) Assessing potassium and sodium levels D) Assessing for signs and symptoms of edema
B (can't give if pt has bowel issues because it can cause frequency may be damaging)
14. A client is administered sodium polystyrene sulfonate. Which explanation by the nurse best describes the purpose of this medication?: A) "It is a rectal form of contrast given to visualize the colon." B) "It is administered to promote GI motility for patients receiving opioids" C) "It is given to assist in removal of excess potassium from the body through the GI system." D) "It is administered prior to bowel surgery to sterilize the bowel and decrease risk of infection."
C
A client who has been receiving scheduled furosemide IVP for the past several days is now reporting palpitations. Which of the following is a priority to assess?: A) Capillary refill time B) Sodium level C) Potassium level D) D-dimer
C
The client admitted with this rhythm reports shortness of breath for the past few weeks. The client's vital signs are BP 79/42, RR 24, pulse of 90% on room air. What rhythm is displayed on the monitor?: A) Ventricular tachycardia B) Sinus tachycardia C) Atrial fibrillation D) Pulseless electrical activity
C
The patient below called 911 reporting severe epigastric pain. The patient chewed 325mg of aspirin given by EMS. This EKG was transmitted to the nearest hospital. Which of the following is the priority intervention for the patient with the rhythm shown below? (ST segment elevation picture): A) Administer another 325mg of aspirin B) Administer 1mg of morphine C) Prepare the patient for percutaneous coronary intervention D) Initiate heparin infusion
C
This client has a BP of 113/72 and is alert and oriented x 4. What rhythm is shown here?: A) Sinus Tachycardia B) Sinus Bradycardia C) Normal Sinus Rhythm D) Pulseless Electrical Activity
C
Which of the following is the most common cause of ischemic stroke?: A) Peripheral arterial occlusion B) Deep Vein Thrombosis C) Atrial fibrillation D) Sinus tachycardia
C
A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is to be used with caution in clients who have a history of which of the following conditions?: A) Migraines B) Anxiety C) COPD D) Supra-ventricular Tachycardia
C (BETA-1 blockers have beta 2 action which causes bronchoconstriction)
Renal Which patient is unlikely to have a prescription to supplement potassium daily?: A) Client taking daily Furosemide B) Client with Diabetes Insipidus C) Client on Hemodialysis D) Client with Polyuria
C (Because they don't make urine anymore)
A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and vomiting. Which of the following is the priority request from the nurse when speaking to the HCP regarding this client?: A) A consult for a dietician B) An order for a PRN anti-emetic C) An order for a STAT digoxin level D) An order for meal replacement shakes for client
C (digoxin toxicity=dizziness)
A client with end stage renal disease comes to the emergency department after having missed 5 hemodialysis sessions. Serum potassium is 7.2 and the ECK/EKG shows tall, peaked T-waves. Which prescription/intervention is to be given immediately to prevent hyperkalemia-related dysrhythmias: A) Transfer to the dialysis unit B) IVP Furosemide C) IV Calcium Gluconate D) IVP Sodium Bicarbonate
C (if you see ekg waves peaking give this drug to protect the heart calms the electrical conduction system of the heart)
A nurse is giving medications to a patient scheduled for a cardiac catheterization this afternoon. Which medication should the nurse plan to withhold from the patient this morning?: A) Amiodarone B) Nitroglycerin C) Metformin D) Insulin
C (they will get contrast dye + the metformin is nephrotoxic)
Renal A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values? A) RBC B) WBC C) Albumin D) Potassium
D
A client has been receiving repeated doses of IV Azithromycin for a COVID-19 infection. You are comparing the client's admission EKG to the one from today. What change do you note?: A) ST elevation B) Premature ventricular contraction C) ST depression D) QT prolongation
D
A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client to test a troponin level. Which of the following statements should the nurse make regarding this lab?: A) "Cardiac enzymes like troponin assist in diagnosing the presence of pulmonary congestion." B) "This test will enable the provider to determine the heart structure and mobility of the heart valves." C) "Cardiac enzymes like troponin will identify the location of the MI." D) "This test helps determine the degree of damage to the heart tissue."
D
After reviewing a urinalysis result (see below), which of the following question would be most appropriate for the nurse to ask the patient?: Color: Amber Specific Gravity: 1.071 RBCs: Rare WBC: Rare Protein: Rare Glucose: Absent A) Do you have a history of diabetes mellitus? B) Are you experiencing any painful urination? C) Have you experienced any recent kidney trauma? D) What has your fluid intake quantity been in the past 24 hours?
D
CV A client with chest pain is prescribed IV nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?: A) Serum potassium of 3.6 B) ST elevation is present on EKG/ECG C) Heart rate is 71 bpm D) Blood pressure is 81/44
D
Client is admitted with 10/10 substernal chest pain. EKG/ECG shows the image displayed above. Troponin level is 10.52. Clients vital signs: BP 150/92, HR 91 bpm, SpO2: 92% on 2L NC. Which of the following is the priority intervention for this client?: A) Defibrillation B) Echocardiogram C) IVP Adenosine D) Cardiac catheterization
D
Renal A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching? A) CAPD are scheduled 3 times per week B) CAPD filters the client's blood through an artificial device called a dialyzer C) CAPD requires dialysis sessions that last 3-4 hours D) CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires
D
Which of the following best describes these ABGs?: PH: 7.47 CO2: 48 mmHg HCO3: 30 mEq/L A) Respiratory Acidosis, UNcompensated B) Respiratory Alkalosis, Partially Compensated C) Metabolic Acidosis, Fully Compensated D) Metabolic Alkalosis, Partially Compensated
D
Which of the following patient newly started on furosemide needs follow up with their HCP as soon as possible?: A) Client with improved orthopnea B) Client who notes a decrease in lower extremity edema C) Client whose weight was 150kg and is now 147kg D) Client whose creatinine was 0.57 and is now 1.51
D
Renal Which of the following medications should be avoided in a client with chronic kidney disease stage 3?: A) Carvedilol B) Acetaminophen C) Penicillin D) Meloxicam
D (NSAID)
A nurse is admitting a child with Wilms' tumor who is scheduled for a nephrectomy in the morning. Which of the following is the priority in the child's pre-operative plan of care?: A) Assessing client's stage of cognitive development B) Checking for orthostatic hypotension C) Monitoring for indications of pain D) Avoiding palpation of the abdomen
D (Risks breaking tumor apart)
Which of the following shows the correct sequence of electrical conduction in a heart?: A) AV node → SA node → Purkinje fibjers → bundle of his → Bundle branches B) SA node → bundle of His → AV node → Purkinje fibers → Bundle branches C) Bundle of His → SA node → AV node → Purkinje fibers → SV node D) SA node → AV node → bundle of His → Bundle branches → Purkinje fibers
D (SEND A BIG BOUNDING PULSE)
A client with acute glomerulonephritis is admitted to the hospital. Which of the following would be a priority to monitor frequently?: A) Hematuria B) Urine specific gravity C) Intake and output D) Blood pressure
D (These pts gets extremely hypertensive).
A client with chronic kidney disease is scheduled to receive erythropoietin. The client's hemoglobin is 7.9. What is the appropriate nursing action?: A) Administer erythropoietin IM in the gluteal muscle B) Hold erythropoietin and notify the HCP C) Check apical heart rate after administering D) Check blood pressure prior to administering
D (causes hypertension)
A client with a history of renal calculi is admitted with suspected pyelonephritis. The nurse asseses chills, oral temp of 101.2F, and flank pain. Which of the following is the next most appropriate nursing intervention?: A) Administer IV antibiotics B) Check baseline serum creatinine C) Assess for costovertebral angle tenderness D) Obtain urine and blood cultures
D (obtain culture prior to antibiotics)
What acid-base imbalance do the following ABGs reveal: PH: 7.29 CO2: 71 HCO3: 37 A) Metabolic alkalosis, uncompensated B) Metabolic acidosis, partially compensated C) Respiratory alkalosis, fully compensated D) Respiratory acidosis, partially compensated
D (ph is low, CO2 & HCO3 are decreased (opposite diresctions) so it makes it Respritory, Its helpful to have an increased hco3 levels to help decrease the acidity, and its partical beceause the ph is still outside the normal range
A client with chronic kidney disease is scheduled to receive erythropoietin. The client's hemoglobin is 7.9. What is the appropriate nursing action?: A) Administer erythropoietin IM in the gluteal muscle B) Hold erythropoietin and notify the HCP C) Check apical heart rate after administering D) Check blood pressure prior to administering
D (they need it because hemoglobin is <8, but check BP b/c if heart rate is high you don't administer)
Which of the following best describes these ABGs?: PH: 7.29 CO2: 37mmHg HCO3: 10mEq/L A) Metabolic alkalosis B) Respiratory alkalosis C) Respiratory acidosis D) Metabolic acidosis
D (uncompensated b/c the CO2 is not less than 35mmHg, so respiratory system is not helping your body out, it's not exhaling the CO2)