Med/Surg Quiz 2

A 48-year-old African-American man is newly diagnosed with hypertension and Stage 1 chronic kidney disease (CKD). His primary health care provider has prescribed a thiazide diuretic. The client reports that he has increased his activity and changed his diet, which resulted in a 10 lbs (4.5 kg) in the past 2 months. The client says he feels well and does not want to take any drugs. What is the nurse's best response? a. "Reducing your blood pressure may slow or prevent progression of your chronic kidney disease." b. "Your provider prescribed the diuretic because it will reverse the damage caused by kidney disease." c. "Taking medications is a personal decision, and you have the right to decline this prescription." d. "Because your lifestyle changes have resulted in weight loss, this intervention is all that is needed to reduce your risk for progression of kidney disease."

ANS: A African Americans have greater risk for hypertension, CKD, and complications from both conditions. Blood pressure control is critical in the treatment of patients with CKD - lowering the blood pressure reduces the risk of stroke, MI, and progression of CKD. Stage 1 CKD already indicates some irreversible damage. Management of blood pressure at this stage of CKD can greatly slow its progression. A diuretic does not improve kidney function or reverse CKD damage. It does not alter the course of CKD progression. It does improve elimination of fluid, and fluid overload can contribute to hypertension. While personal values and preferences are essential decision points in determining a plan of care for each adult, it is also important that the client be well informed about the consequences of decisions. His risk for progression of CKD is not low and his blood pressure has not achieved a target goal, despite weight loss. It is time to consider additional interventions such as drug prescription. While this client has had a good outcome from diet and lifestyle, it has not been sufficient to meet targeted blood pressure goals and cannot slow progression of CKD. Cognitive Level: Applying or higher Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Implementation

An 84-year-old client with heart failure presents to the emergency department with confusion, blurry vision, and an upset stomach. Which assessment data is most concerning to the nurse? a. Digoxin (Lanoxin) therapy daily. b. Daily metoprolol (Lopressor). c. Furosemide (Lasix) twice daily. d. Currently taking an antacid for upset stomach.

ANS: A Confusion, blurry vision, and upset stomach are symptoms of Digoxin toxicity, which is common in older adults and requires immediate treatment. The other answers are important assessment data but do not indicate immediate connection to the client's presentation.

A client diagnosed with atherosclerosis and hypertension has been newly prescribed a combination drug of amlodipine and atorvastatin (Caduet). Which statement by the client indicates a need for further teaching? a. "I will continue to take my amlodipine with the new medication." b. "I'll follow up with my nurse practitioner on a regular basis." c. "I need to quit smoking as soon as I possibly can." d. "I shouldn't drink grapefruit juice while on this drug."

ANS: A The patient should not be taking amlodipine (Norvasc) and Caduet. Caduet is a combination drug that contains a statin as well as amlodipine (Norvasc). All other options are correct statements. Cognitive Level: Application Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Evaluatio

A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? (Select all that apply.) a. Peripheral edema b. Crackles in both lungs c. Increased abdominal girth d. Ascites e. Tachypnea

ANS: A, C, D, E Peripheral edema, increased abdominal girth, ascites, and tachypnea are all symptoms associated with right-sided heart failure due to the back up into the peripheral system. Crackles in the lungs are associated with left-sided heart failure. Cognitive Level: Application Client Needs Category: Safe Effective Care Environment: Management of Care Nursing Process Step: Assessment

The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to report to the health care provider immediately?

ANS: B All listed laboratory values are out of the normal range. However, the only value that has reached or is approaching a critical level is the serum potassium, which shows hyperkalemia. This problem must be addressed immediately. Cognitive Level: Applying or higher Client Needs Category: Safe and Effective Care Environment Nursing Process Step: Assessment

Which question does the nurse ask the client who has a urinary tract infection to assess the risk for possible pyelonephritis? a. What drugs do you take for asthma? b. How long have you had diabetes? c. How much fluid do you drink daily? d. Do you take your antihypertensive drugs at night or in the morning?

ANS: B Pyelonephritis risk is increased in the client who has diabetes and a urinary tract infection (UTI). While it is important to know all the drugs that a client takes, neither asthma drugs nor asthma itself increases the risk for pyelonephritis. (An exception would be high-dose systemic corticosteroids; however, these are rarely recommended in current asthma therapy). Although insufficient fluid intake may make a UTI worse, it does not increase the risk for pyelonephritis. Antihypertensives are not a risk factor for pyelonephritis. Cognitive Level: Applying or higher Client Needs Category: Safe and Effective Care Environment Nursing Process Step: Assessing Diabetes have glucose in their urine which provides a sustainable environment for them. With neuropathy, patients with DM will not urinate as frequently leading to increase pyelonephritis.

The nurse assesses a client who had a coronary artery bypass graft yesterday. Which assessment finding will cause the nurse to suspect cardiac tamponade? a. Incisional pain with decreased urine output b. Muffled heart sounds with the presence of JVD c. Sternal wound drainage with nausea d. Increased blood pressure and decreased heart rate

ANS: B Symptoms are part of Beck's Triad which are indicative of tamponade. Incisional pain is expected. While sternal wound drainage is a problem, it is not an indicator of cardiac tamponade. With tamponade, blood pressure will decrease and the heart rate will increase. Cognitive Level: Analysis Client Needs Category: Physiological Integrity Nursing Process Step: Assessment

A 48-year-old female client having an annual physical asks the nurse about her risk for developing a myocardial infarction (MI). The nurse discusses risk factors with the client. Which modifiable risk factors will the nurse assess to guide the client's teaching plan? (Select all that apply.) Older age b. Tobacco use c. Female d. High-fat diet e. Family history f. Obesity

ANS: B, D, F Tobacco use, diet, and obesity are all considered modifiable risk factors and should be included in the plan of care. Cognitive Level: Application Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Planning/Implementation

A 70-year-old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? a. A 5-pack year history of smoking 45 years ago b. Difficulty starting and stopping the urine stream c. A 30-year occupation as a long-distance truck driver d. A recent colon cancer diagnosis in his 72-year-old brother

ANS: C Although cigarette smoking is a risk factor for bladder cancer, a 5-pack year history more than 45 years ago is not significant as a potential cause of cancer. Bladder cancer does not appear to have a familial or genetic predisposition. Difficulty starting or stopping urination is a symptom, usually of prostate issues, not a harbinger of bladder cancer. The latest research indicates exposure to gasoline and diesel fuel is a major risk factor for bladder cancer. Cognitive Level: Applying or higher

1. The nurse is assessing a client with chest pain. Which symptoms assessed by the nurse would be most indicative of myocardial infarction? (Select all that apply.) a. Substernal chest discomfort associated with exertion b. Chest pain that is relieved with rest c. Chest pain associated with ECG changes d. Chest pain relieved with nitroglycerin e. Chest pain relieved only by opioids f. Chest pain associated with shortness of breath g. Chest pain that lasts less than 10 minutes

ANS: C, E, F Refer to chart 38-2. Pain associated with myocardial infarction is associated with ECG changes (dysrhythmias and ST elevation), is often only relieved by opioids and has associated symptoms such as shortness of breath and nausea. The options are associated with angina pain. Cognitive Level: Application Client Needs Category: Physiological Integrity Nursing Process Step: Assessment

1. When the nurse caring for a client with severe chronic kidney disease asks what dietary modifications he has made for the disease, he reports the following actions. Which action indicates to the nurse that additional client education is needed? a. Using a scale to measure protein weight b. Taking calcium and vitamin D supplements daily c. Eliminating bananas, citrus fruits, and avocados d. Using a salt-substitute instead of ordinary table salt

ANS: D Salt substitutes contain very little sodium, which is a good thing because sodium restriction is needed. However, the sodium is replaced with potassium. Clients with CKD must restrict their intake of potassium severely to avoid life-threatening cardiac dysrhythmias. Cognitive Level: Applying or higher Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Implementation

1. The nurse is preparing a client for discharge who experienced an acute kidney injury during coronary artery by-pass graft surgery. The nurse notices that the client has a serum creatinine of 1.2 mg/dL (106 mcmol/L) and a glomerular filtration rate (GFR) of 75 mL/kg/1.73 m2. Which is the priority nursing action?

ANS: D The serum creatinine is within normal limits but the GFR is reduced, indicating risk for CKD. Follow-up is needed but not urgently and follow-up should occur within the health care team members who are familiar with her hospital course and general health. Protein is an essential nutrient needed for wound healing after surgery. A normal creatinine typically does not require protein restriction to avoid progression of kidney problems. Water or electrolyte-free fluid is recommended for hydration unless there is an indication that electrolytes are being excreted in urine. Although the rest of the metabolic panel should be evaluated by the discharge nurse, the primary care provider need only be informed of critical values in an urgent manner. Cognitive Level: Applying or higher Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Evaluation

The nurse is evaluating a patient with coronary artery disease (CAD). What is an expected patient outcome that demonstrates hemodynamic stability? a. Blood pressure and pulse are within range and adequate for metabolic demands. b. Urine output increases from 15 to 30 mL per hour. c. P waves are regular and there are no abnormal heart sounds. d. Patient expresses verbal understanding of risk factors and need for compliance.

Ans A Hemodynamic stability is when BP and pulse are within normal ranges and adequate for metabolic demands

The intensive care nurse is caring for a patient who has just had coronary artery bypass graft (CABG) surgery. What does the nurse do to assess for postoperative bleeding? a. Measure mediastinal and pleural chest tube drainage at least hourly and report drainage amounts over 150 mL/hr to the surgeon. b. Measure mediastinal and pleural chest tube drainage at least once a shift and report drainage amounts over 50 mL/hr to the surgeon. c. Assess the dressing over the sternal site every 4 hours and reinforce the dressing with sterile gauze as needed. d. Assess the donor site every 4 hours and report serous drainage and increasing pain to the surgeon.

Ans: A

When heart failure develops, what is the initial compensatory mechanism of the heart that maintains cardiac output? a. Sympathetic stimulation b. Parasympathetic stimulation c. Renin-angiotensin activation system (RAAS) d. Myocardial hypertrophy

Ans: A Sym. NS is activated by the baroreceptors in the brain. It senses tissue hypoxia (lack of o2 to tissues) and release catacholamines hormones such as (NE, Ephineprine) which stimulates the heart contract faster and increase CO).

The nurse coming on duty receives the change of shift report. Which patient must be assessed first by the nurse? a. Patient with anxiety, nausea, diaphoresis, and shortness of breath b. Patient with diabetes mellitus and elevated serum lipid levels c. Patient with a friction rub and elevated temperature d. Patient with fever, instability of sternum, and increased white blood cell count

Ans: A (SOB is always a priority)

A patient continues to have chest pain despite compliance with medical therapy. The nurse teaches the patient about which diagnostic test? a. Cardiac catheterization b. Percutaneous transluminal coronary angioplasty (PTCA) c. Coronary artery bypass grafting (CABG) d. Stent placement in coronary artery

Ans: A (cardiac catherization)

Which diagnostic test is performed after an- gina or myocardial infarction (MI) to deter- mine cardiac changes that are consistent with ischemia, to evaluate medical interventions, and to determine whether invasive intervention is necessary? a. Exercise tolerance test b. Electrocardiogram c. Echocardiography d. Chest x-ray

Ans: A (excercise tolerance test or aka stress test)

A patient with atrial fibrillation (AF) suddenly develops shortness of breath, chest pain, hemoptysis, and a feeling of impending doom. The nurse recognizes these symptoms as which complication? a. Pulmonary embolism b. Embolic stroke c. Absence of atrial kick d. Increased cardiac output

Ans: A (pulmonary embolism) Since this is a clot that develops and could block the artery which blocks blood flow

What is the most common problem for the patient with valvular heart disease? a. Reduced cardiac output b. Difficulty coping c. Shortness of breath d. Altered body image

Ans: A (reduced cardiac output) When you have valvular heart disease, CO is decreased since backflow occurs. This causes CHF and fluid overload.

Which patients may be potential candidates for coronary artery bypass graft (CABG)? Select all that apply. a. Patient with angina and greater than 50% occlusion of left main coronary artery that cannot be stented b. Patient with unstable angina with moderate one vessel disease appropriate for stenting c. Patient with valvular disease d. Patient with coronary vessels unsuitable for PCI e. Patient with acute myocardial infarction (MI) responding to therapy f. Patient with signs of ischemia or impend- ing MI after angiography or PCI

Ans: A, C, D, F

A patient is admitted with a vascular problem. Based on the pathophysiology of systemic arte- rial pressure, the systemic arterial pressure is a product of what factors? Select all that apply. a. Cardiac output b. Norepinephrine c.Preload d. Total peripheral vascular resistance f. Diastolic blood pressure g. Afterload

Ans: A, D Those two factors, CO and peripheral vascular resistance make up the systemic arterial pressure.

A patient is having an elective coronary artery bypass graft (CABG) with a minimally inva- sive surgical technique. What does the nurse include in the preoperative teaching? a. Prevention of edema and scarring at the harvest site b. Protection and splinting of the chest incision while coughing c. Availability of analgesics if needed, but probably unnecessary d. Limitation of ambulation for several days after the procedure

Ans: B

A patient has been admitted for acute angina. Which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or a myocardial infarction (MI)? a)Exercise tolerance test b)Cardiac catheterization c)Thallium scan d) Multigated angiogram (MUGA) scan

Ans: B Cardiac catherization will determine if invasive management is needed since this measures pressure in the heart and determines if there is tissue damage

A patient is in full cardiac arrest, and CPR is in progress. The electrocardiogram (ECG) moni- tor shows ventricular fibrillation. What does the nurse expect will be the next intervention? a. The patient will have an endotracheal tube placed. b. The patient will be defibrillated using the asynchronous mode. c. The health care provider will insert a central line for emergency drugs. d. Family members will be escorted to a waiting area and updated as needed.

Ans: B (debrillation) Pt will be defibrillated to set back to asynchonous mode)

A patient reports chest pain and dizziness af- ter exertion, and the family reports a concur- rent new onset of mild confusion in the patient, as well as difficulty concentrating. What is the priority problem for this patient? a. Activity intolerance b. Decreased cardiac output c. Acute confusion d. Inadequate oxygenation

Ans: B (decreased cardiac output) This causes angina and SOB.

The intensive care nurse is caring for a patient who has just had coronary artery bypass graft (CABG) surgery. The patient has a systolic blood pressure of 80 mm Hg. What is the primary concern related to this patient's hypotension? a. It is associated with warm cardioplegia. b. It may result in the collapse of the graft. c. It will result in acute tubular necrosis. d. It is related to mechanical ventilation. .

Ans: B (related to the the collapse of the graft) CABG- coronary arterial bypass graft is a tube or healthy arteries and vein are used to revascularize the heart

The patient with left ventricular myocardial infarction (MI) is to have coronary artery bypass graft (CABG) surgery. Which interventions does the nurse perform to protect against sternal wound infection? Select all that apply. a. Shave the patient's body from neck to knees b. Instruct the patient to shower with 4% chlorhexidine gluconate (CHG). c. Prepare the surgical site by clipping hair and applying CHG with isopropyl alcohol (either 0.5% or 2%). d. Send urine and sputum to the lab for cul- ture and sensitivity. e. Administer IV antibiotics one hour prior to the surgical procedure. f. Wear gown, gloves, and a mask while pre- paring the patient for surgery.

Ans: B, C, E

Which factors can increase systemic arterial pressure? Select all that apply. a. Decreased cardiac output b. Increased heart rate c. Increased peripheral vascular resistance d. Increased stroke volume e. Decreased blood pressure f. Decreased stroke volume

Ans: B,C,D Inc. Arterial BP is due increased CO, increased peripheral resistance (afterload), Increased SV (amount of blood pumped by the left ventricle)

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

Ans: B-Ventricular fibrillation Since different areas of the ventricles are firing at different rapid pace.

A patient had coronary artery bypass graft (CABG) surgery with the radial artery used as a graft. The nurse performs which assessment specific to this patient? a: Check the blood pressure every hour on the unaffected arm or use the legs. b: Check the fingertips, hand, and arm for sensation and mobility every shift. c: Assess hand color, temperature, ulnar/ radial pulses, and capillary refill every hour initially. D: Note edema, bleeding, and swelling at the donor site, which are expected.

Ans: C

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

Ans: C (atrial fibrillation) since in atrial flutter, we don't see any p waves. With Afib, we still see p waves but in an irregular fashion. This is irregular irregular.

An older adult patient is taking digoxin for treatment of heart failure. What is the priority nursing action for this patient related to the medication therapy? a. Give the medication in conjunction with an antacid. b. Keep the patient on the cardiac monitor and observe for ventricular dysrhythmias. c. Monitor for early signs of toxicity such as bradycardia on the ECG tracing. d. Advise the patient that there is increased mortality related to toxicity.

Ans: C (monitor for toxcitiy) Digoxin-used to treat arrythmias and makes the heart contract stronger

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

Ans: C, Atherosclerosis The plaque can break loose which will cause coagulation with the RBC forming the thrombus. Aneurysm-ballooning of the artery

Which laboratory test does the nurse monitor for potential cardiac problems and digoxin toxicity? a. Complete blood count b. Blood urea nitrogen (BUN) c. Serum potassium d. International Normalized Ratio (INR)

Ans: C- (serum potassium) Hypokalemia (low K) will cause the heart to go into tachycardia

After coronary artery bypass graft (CABG) surgery, a postoperative patient suddenly has a decrease in mediastinal drainage, jugular vein distention with clear lung sounds, pulsus paradoxus, and equalizing pulmonary artery wedge pressure (PAWP) and right atrial pres- sure. What do these signs suggest to the nurse? d a. Acute myocardial infarction (MI) b. Occlusion at the donor site c. Cardiac tamponade d. Prinzmetal's angina (Kumagai 317)

Ans: C- cardiac temponade- when you loose 20% of the total body fluid

What is the primary significance of ventricu- lar tachycardia (VT) in a cardiac patient? a. It increases the ventricular filling time, therefore increasing cardiac output. b. It signals that the patient needs potassium supplement for replacement. c. It warrants immediate initiation of cardio- pulmonary resuscitation. d. It is commonly the initial rhythm before de- terioration into ventricular fibrillation (VF).

Ans: D (V tach --> V fib) V fib is when multiple area in the ventricle is firing at a rapid rate.

Which diagnostic tests are used to assess myocardial damage caused by a myocardial infarction (MI)? Select all that apply. a. Positive chest x-ray b. ST depression on ECG c. Thallium scan d. Troponin I isoenzyme elevation e. Cardiac catheterization f. Fasting lipid profile

Ans: D, E, F Troponin 1 is released when there is heart damage (after heart attack). Cardiac cathetherization measures the pressure in the heart. Fasting lipid profile measures the lipid in the artery which is responsible for atherosclerosis. - HDL- greater than 60 mg/dl LDL- less than 130 Triglycerides- less than 150 total cholesterol- less than 200

Atherosclerosis affects which larger arteries? Select all that apply. a. Renal b. Femoral c. Coronary d. Brachial cephalic e. Aorta f. Carotid

Ans: a, b, e, f

The intensive care nurse is caring for a patient who has just had coronary artery bypass graft (CABG) surgery. The nurse notes that the patient has peripheral edema. To adjust fluid administration, the nurse collects which addi- tional information and then consults the health care provider? Select all that apply. a. Blood pressure b. Pulmonary artery wedge pressure (PAWP) c. Skin turgor d. Cardiac output e. Blood loss f. Urine output

Ans: a,b,d,e,f Must assess blood pressure, PAWP, CO, blood loss, and urine output

Which definition best describes left-sided heart failure? a. Increased volume and pressure develop and result in peripheral edema. b. It can occur when cardiac output remains normal or above normal. c. There is decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels. d. It is the percentage of blood ejected from the heart during systole.

Ans: c Left sd HF backs up to the pulmonary circulation and increases pressure in the pulmonary vessels. This causes pulmonary edema)

A patient reports chest pain after coronary artery bypass graft (CABG) surgery. Which statement by the patient suggests that the pain is related to the sternotomy and not anginal in origin? a. "The pain goes down my arm or some- times into my jaw." b. "My pain increases when I cough or take a deep breath." c. "The nitroglycerin helped to relieve the pain." d. "I feel nausea and shortness of breath when the pain occurs.

B (pain increases when I cough or take a deep breath). This stimulates the heart and therefore causes pain

A patient had coronary artery bypass graft (CABG) surgery with a vein graft. To help pre- vent collapse of the graft, what assessment does the nurse perform? a. Auscultate lung sounds. b. Monitor for hypotension. c. Assess for motion and sensation. d. Observe for generalized hypothermia.

B- monitor for hypotension

A patient is receiving beta-blocker therapy for treatment of myocardial infarction (MI). What does the nurse monitor for in relation to this therapy? Select all that apply. a. Tachycardia b. Hypotension c. Decreased level of consciousness d. Chest discomfort e. Increased urinary output f. Auscultate lungs for crackles or wheezes

ans: B, C, D, F Beta blockers block catecholamines (Ephinephrine, norepinephrine, adrenanine) from reaching the heart therefore slows the heart