Meiner Ch. 19 & 20

The nurse gives priority to assessing an older patient who presents with symptoms of acute respiratory distress for which other condition? A. Substernal chest pain B. A history of panic attacks C. Any known allergies D. Bruising on the chest

ANS: A The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others.

Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange, the nurse would assess which patient further? A. An afebrile patient with a nonproductive cough B. Irritability in a usually pleasant patient C. Pale nail beds in a patient of color D. Has an elevated white blood cell (WBC)

ANS B An early sign of respiratory problems is a change in mental status. Because the physiologic responses to hypoxemia and hypercapnia are blunted in older patients, compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer. Mental status changes may include subtle increases in forgetfulness and irritability. The other options do not address the age-related change.

A nurse is assessing clients on a med-surg unit. Which client should the nurse identify as being at greatest risk for Afib? A. A 45-year-old who takes an aspirin daily. B. A 50-year-old who is post coronary artery bypass surgery. C. A 78-year-old who had a carotid endarterectomy. D. An 80-year-old with COPD.

ANS B Rationale: Afib occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery. The other conditions do not place these clients at higher risk for atrial fibrillation.

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate? A. Make certain that your bath water is warm. B. Avoid straining while having a bowel movement. C. Limit your intake of caffeinated drinks to one a day. D. Avoid strenuous exercise such as running.

ANS B Rationale: Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the heart rate. Such a result is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition.

An older adult with chronic obstructive pulmonary disease (COPD) asks why he should quit smoking now. What response by the nurse is best? A. "It will keep your disease from getting worse." B. "There are many benefits to quitting even now." C. "It will decrease the risk of getting cancer too." D. "You're right; there really isn't a reason to quit."

ANS B There are many benefits to smoking cessation including reduction in the number of respiratory infections, improvement in the function of the mucociliary clearance of the lungs, decreased coughing and dyspnea, increased appetite, and decreased sputum production. This is a more comprehensive answer than keeping the disease from worsening and lowering the chance of getting cancer. Telling the patient that there really isn't a reason to quit not only is inaccurate, it's dismissive of the patient's desire to improve health habits.

The nurse notes that a client's cardiac rhythm shows absent P waves and no PR interval. How should the nurse interpret this rhythm? A.Bradycardia B.Tachycardia C.Afib D.Normal sinus rhythm (NSR)

ANS C Rationale: In Afib, the P waves may be absent. There is no PR interval, and the QRS duration usually is normal and constant. Bradycardia is a slowed heart rate, and tachycardia is a fast heart rate. In NSR a P wave precedes each QRS complex, the rhythm is essentially regular, the PR interval is 0.12 to 0.20 seconds in duration, and the QRS interval is 0.06 to 0.10 seconds in duration.

A client has developed Afib, which a ventricular rate of 150 beats per minute. A nurse assesses the client for: A.Hypertension and headache B.Nausea and Vomiting C.Hypotension and Dizziness D.Flat neck veins

ANS C Rationale: The client with uncontrolled Afib with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia? A. Aspiration pneumonia B. Ventilator acquired pneumonia C. Hospital-acquired pneumonia D. Community-acquired pneumonia

ANS C The key words to let you know this is hospital-acquired pneumonia and NOT community-acquired is that the patient was admitted with a gunshot wound AND has been hospitalized for 48 hours. If the patient presents with signs and symptoms of pneumonia 48-72 hours after admission it is classified as hospital-acquired. This is not ventilator acquired because the patient is not on mechanical ventilation and there is nothing in the scenario that leads us to think it is aspiration pneumonia.

A frail, older patient is in the emergency department in severe respiratory distress. The patient has had repeated hospitalizations for the same thing. After stabilizing the patient, which action by the nurse is most appropriate? A. Determine what the patient's end-of-life wishes are. B. Assess the family caregiver for compliance with treatment. C. Administer intravenous (IV) fluids at a rapid rate. D. Prepare to vaccinate the patient against pneumonia.

ANS: A Because of the lifesaving modalities needed to care for such a patient, the nurse and physician work together to determine what the patient's end-of-life wishes are. In the emergency department, patient stabilization comes first, but once this has been accomplished a discussion should occur with the patient and family about further treatment desires. The family caregiver may or may not be adherent, or the patient may assume all self-care. IV fluids should not be given at a rapid rate because of the risk of heart failure. The patient should receive an immunization against pneumonia per guidelines.

A patient has been taught about nutrition related to COPD. Which menu selection may indicate a need for further teaching? A. Bagel and cream cheese B. Broiled chicken breast C. Beans and peas D. Tofu stir-fry

ANS: A Carbohydrates should not make up more than 50% of the daily intake of calories because they break down into carbon dioxide, worsening breathing. The other selections show good understanding. Of course, the nurse needs to take into consideration the amount of carbohydrates in the entire day and not just one selection.

When administering metoprolol to an older adult patient with hypertension, the nurse is careful to have the patient's care plan include A. frequent assessment for dizziness or syncope. B. education of the signs and symptoms of thromboembolism. C. regular evaluation of the patient's muscle strength. D. regularly scheduled serum potassium levels.

ANS: A Dizziness is an adverse reaction to beta-blockers such as metoprolol.

A novice nurse requires additional education on arterial vascular deficiency when suggesting the condition's symptoms include A. 2+ edema in calf and foot of left leg. B. a 2-cm ulcer between two toes on the left foot. C. skin on the left leg is cool to the touch. D. toenails on the left foot are thick and brittle.

ANS: A Edema is not generally observed in cases of arterial deficiency, but rather in venous insufficiency. The other options are manifestations of arterial vascular deficiency.

The nurse caring for patients using continuous positive airway pressure (CPAP) knows what about treatment effectiveness? A. Effectiveness depends on compliance. B. It's too expensive for many older adults. C. It is rarely effective for sleep apnea. D. Complicated settings make it hard to use.

ANS: A Effectiveness is determined by compliance for nearly any regime, and unfortunately noncompliance with CPAP is 29-83%. The other statements are incorrect.

An older patient is hospitalized on the general medical floor with pneumonia secondary to influenza and is prescribed antibiotics. What assessment finding would indicate a higher level of care is needed for this patient? A. Spreading infiltrates on chest x-ray B. Creatinine 3.2 mg/dL C. White blood cell count 18,000/mm3 D. Positive sputum cultures for pneumococcus

ANS: A Spreading infiltrates on x-ray or extrapulmonary sites of infection seen on chest x-ray is an indication that the patient needs a higher level of care, perhaps even mechanical ventilation. The creatinine is high, reflecting a renal disorder. The elevated white blood cell count is indicative of infection although many older adults do not mount such an immune response. The type of pneumonia is not a definitive criterion for intensive care placement.

The nurse is evaluating the effectiveness of an older patient's self-management of asthma. What does the nurse assess as the priority? (Select all that apply.) A. How many times a week a rescue inhaler treatment is needed B. How well the patient is able to avoid the known triggers C. Whether the patient experience frequent respiratory infections D. Whether the patient requires rest periods during the day E. Whether the patient believes he or she has the support of family and friends

ANS: A, B The evaluation of self-management is based on the patient's success in following through with the plan. Determine the frequency of rescue inhaler use, success at avoiding triggers, and the patient's ability to monitor and address lifestyle changes.

When teaching older adult asthmatic patients, the nurse stresses the importance of which of the following? (Select all that apply.) A. Being alert for the early signs of breathing problems B. Fostering an effective relationship with your health care provider C. Identifying and avoid personal triggers D. Incorporating regular rest periods into your daily routine E. Increasing vitamin C consumption, especially during winter months

ANS: A, B, C The prognosis for an older adult with asthma is relatively good. Success is based on a partnership between the patient and the health care provider to properly use prescribed medications, avoid asthma triggers, identify early signs of exacerbation, and maintain a healthy lifestyle. Rest may or may not be an issue if the patient has mild asthma. Vitamin C may have immune system benefits.

The nurse encouraging an older patient to start pulmonary rehabilitation shares the benefits of the program, including which of the following? (Select all that apply.) A. Socialization B. Decreased cardiac risks C. Nutrition counseling D. Weight management E. Sports participation

ANS: A, B, C, D There are many aspects to pulmonary rehabilitation, including socialization, decreased cardiac risks, nutrition counseling, and weight management. Sports are not included, although exercise is.

The nurse is coordinating care for a newly admitted older adult. The patient is diagnosed with hypertension, asthma, atrial fibrillation, mild osteoarthritis, and glaucoma. Before administering the patient's corticosteroid medication, the nurse is especially interested in which of the following? (Select all that apply.) A. The name of the patient's hypertension medication B. What the patient uses to manage arthritic pain C. Whether the patient feels the asthma is well controlled D. Whether the patient takes low-dose aspirin regularly E. Whether the patient has ever had glaucoma-related surgery

ANS: A, B, D Asthma may be exacerbated by the use of nonsteroidal anti-inflammatory agents for arthritis, aspirin for circulation, nonselective beta-blockers for hypertension, or glaucoma eye drops that contain beta-blockers. Feeling that the asthma is under control and previous surgery are not directly related.

1. To minimize an older adult's risk for developing postsurgical atelectasis, the nurse does which of the following? (Select all that apply.) A. Regularly assesses and medicates for pain. B. Teaches effective deep-breathing techniques. C. Provides oxygen via nasal cannula. D. Encourages the patient to drink all fluids on meal trays. E. Assesses lung sounds frequently.

ANS: A, B, D Promotion of deep breathing, effective pain management, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis. Providing oxygen and assessing lung sounds will not prevent atelectasis from occurring.

An older adult recovering from a myocardial infarction (MI) has been taking subcutaneous heparin but is now to receive oral warfarin. The nurse prepares to teach the patient which topics? (Select all that apply.) A. Administration of both medications for up to 5 days B. Need to use a soft bristle toothbrush C. Use of atropine as an antidote for excessive bleeding D. Need to continue drawing partial thromboplastin times E. Need to drink at least eight cups of fluids daily

ANS: A, B, D Heparin and warfarin are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after an MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the international normalized ratio (INR); the antidote is vitamin K. Patients who initially receive heparin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complication. Patients need to be taught bleeding precautions. All people should drink at least 8 cups of water a day unless another medical condition prohibits this.

A 77-year-old patient is being treated for cardiac arrhythmia. The nurse determines that the patient's cardiac output is adequate with which assessments? (Select all that apply.) A. Urine output of 140 cc over 4 hours B. Systolic blood pressure that remains within 20 mm of baseline C. Denial of substernal pain D. Recollection of the birthdays of all of her grandchildren E. Absence of rales and crackles

ANS: A, B, D, E The patient will maintain an adequate cardiac output, as evidenced by heart rate and rhythm within normal range, stable blood pressure, adequate peripheral pulses, mental alertness, urine output of 30 mL/hr, and clear breath sounds. Normal mentation also denotes good cardiac output, but the patient may have too many birthdays to remember, so this is not the best indicator of cognitive status. Denial of pain does not necessarily denote good cardiac output.

To evaluate an older patient for possible renal failure as a result of chronic untreated hypertension, nurse prepares to A. schedule an ultrasound. B. collect a urine sample. C. monitor intake and output. D. order an abdominal x-ray.

ANS: B A urinalysis will investigate for proteinuria or other signs of renal failure. The kidneys are a target organ for damage from hypertension. An ultrasound, intake and output, and abdominal x-rays are not used before a urinalysis.

The nurse is preparing information for the caregivers of a patient with chronic respiratory issues. The nurse will make the greatest impact on their ability to provide quality care while maintaining the patient's emotional well-being by including what information? A. Suggestions regarding proper nutrition and exercise B. An explanation on how to preserve the patient's sense of autonomy C. Encouragement for the primary caregiver to take care of themselves D. Referrals to pulmonary rehabilitation or support groups

ANS: B Many patients with respiratory illness feel a loss of control over their lives because of their symptoms. They may become demanding and controlling in dealing with their families and friends. Well-being is enhanced by having some control over one's life. Proper nutrition and exercise, referrals, and the caregiver taking care of him- or herself will not do as much to maintain the patient's emotional well-being as finding ways to give the patient control.

An older adult's pulmonary function studies indicate that his vital capacity is reduced and his residual volume is increased. Where does the nurse know these changes will manifest? A. Ineffective cough reflex B. Shallow breathing C. Slow respiratory rate D. Frequent respiratory infections

ANS: B Normal aging results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways as well as reduced elastic recoil of the lung and the opposing forces of the chest wall. The lung becomes less elastic as collagenic substances surrounding the alveoli and alveolar ducts stiffen and form cross-linkages that interfere with the elastic properties of the lungs. Any and all of these structural changes make it more difficult for the older person to ventilate.

The nurse shows an understanding of how anemia symptoms present in the older population when A. questioning the patient about dizziness when turning over in bed. B. assessing the patient for pale oral mucous membranes. C. asking whether the patient takes supplementary iron tablets. D. assessing the patient's weekly intake of red meat.

ANS: B Skin color is not a good indicator of pallor because of varying pigmentation. Oral mucous membranes, as well as conjunctivae and nail beds, are better indicators. The other options are not related to symptoms.

An 80-year-old patient is concerned about contracting pneumonia. What information is the most important for the nurse to share with the patient? A. Early recognition of the symptoms B. Being vaccinated per government guidelines C. Minimizing contact with the public during the winter months D. Supplementing one's daily diet with vitamin C

ANS: B The key to pneumonia prevention is being appropriately vaccinated. All individuals should be vaccinated at age 65 unless they have conditions that lead them to earlier vaccination. Revaccination is indicated in certain circumstances. Signs and symptoms are subtle in the aging population but would appear after the patient contracted pneumonia. Minimizing contact during winter months is an appropriate suggestion, just not the best one. Vitamin C may have immune system benefits.

An older patient in the internal medicine clinic reports usually being able to walk 1 mile without complaint. However, in the past 2 weeks, after walking just mile, the patient's legs begin to ache. The pain goes away with rest. What action by the nurse is most appropriate? A. Elevate the patient's legs. B. Assess the pedal pulses. C. Take the patient's blood pressure. D. Measure the patient for TED hose.

ANS: B This patient has intermittent claudication, a sign of peripheral arterial disease. The nurse assesses the patient's pedal pulses. Elevation will further compromise circulation and should be avoided. A blood pressure reading is taken during all health care visit. The patient does not need TED hose for an arterial problem.

A novice nurse learns that normal aging can result in changes in the ECG of a 73-year-old patient. The experienced geriatric nurse explains that these changes may include which of the following? (Select all that apply.) A. An inverted T wave B. A notched P wave C. A prolonged PR interval D. Decreased amplitude of the QRS complex E. A slurred T wave

ANS: B, C, D, E The number of pacemaker cells located in the sinoatrial node decreases with age, which results in less responsiveness of the cells to adrenergic stimulation. Common aging changes that are reflected by the electrocardiogram (ECG) include a notched P wave, a prolonged PR interval, decreased amplitude of the QRS complex, and a notched or slurred T wave.

The effect of aging on the cardiovascular system is evidenced by which symptoms in an older adult performing a stress test? (Select all that apply.) A. Chest pain during exercise B. Slow increase of heart rate in response to stress C. Exercise induce dyspnea D. Slow decrease of heart rate post exercise E. Stress-induced arrhythmias

ANS: B, D During stress or stimulation, the heart rate increases more slowly; however, once elevated, it takes longer to return to the resting rate. The other manifestations are not related to age-induced physiologic changes.

An older patient is prescribed nifedipine for hypertension. What teaching topic is most important to discuss with this patient? A. Need to monitor blood pressure B. Need to follow low-salt diet C. Need to change positions slowly D. Need to add exercise to daily routine

ANS: C Calcium channel blockers such as nifedipine can cause orthostatic hypotension and dizziness in older adults. The nurse educates the patient on preventing this by slow position changes. The other topics are appropriate for all patients on medication for hypertension.

A patient had a heart attack and the nurse identifies the diagnosis as activity intolerance. What assessment finding indicates a priority goal for this diagnosis is being met? A. Mild chest pain getting into the chair B. Feels unsteady when getting out of bed C. O2 saturation 98% after using the commode D. Less dyspnea when changing positions

ANS: C Activity intolerance is measured by changes in vital signs, electrocardiogram (ECG), and symptoms such as chest pain or shortness of breath. The oxygen saturation indicates physiologic tolerance to activity. The other options do not show physiologic tolerance.

An older patient is overwhelmed at the number of lifestyle changes needed to manage newly diagnosed cardiovascular disease. What action by the nurse will reduce this barrier to teaching? A. Tell the patient even small changes over time makes a big difference. B. Tell the patient that smoking is the biggest risk factor and needs to stop. C. Help the patient choose a change and incorporate it into daily life. D. Educate the patient on the consequences of not making changes

ANS: C Although it is true that small changes over time have a great impact, the nurse needs to do more by helping the patient choose a small change to implement. The nurse should help the patient work on the risk factor he or she is most willing to change. Education is important, but it will not enable the patient to make changes.

An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg daily, rifampin 600 mg daily, and pyrazinamide 1,500 mg daily. What information is the priority for the nurse to give the patient? A. Wear tinted glasses when out in the sun. B. Minimize contact with children younger than 3 years old. C. Avoid alcohol while on the drug therapy. D. Eat and drink dairy sparingly.

ANS: C Isoniazid can lead to toxic hepatitis which could be compounded by alcohol intake. Patients should not drink alcohol while taking this medication. The other information is not related to isoniazid.

A patient has a pulmonary embolism and asks the nurse to explain the purpose of the heparin infusion. What response by the nurse is best? A. "It helps dissolve the clot in your lungs." B. "It keeps you from getting septic." C. "It prevents the clot from getting bigger." D. "It prevents clots from forming in your heart."

ANS: C Heparin keeps the clot from getting bigger and hopefully prevents further clots from forming. It does not dissolve the clot. It does not specifically target the heart. It does not prevent sepsis.

The nurse best maximizes an older adult's potential to avoid developing a postsurgical respiratory infection with which intervention? A. Walking the patient to the bathroom instead of using the bedside commode B. Encouraging compliance with prescribed antibiotic therapy C. Evaluating the patient's ability to effectively cough and deep breathe D. Offering fluids every hour while the patient is awake

ANS: C Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increasing difficulty clearing secretions. The other activities also help avoid atelectasis and infection but evaluating the patient's ability to cough and deep breathe can indicate that other treatment measures may be needed postoperatively.

A patient has peripheral vascular disease. What statement by the patient indicates a need for further teaching? A. "I will have the podiatrist cut my toenails." B. "I will be sure to wear sturdy shoes." C. "I can only walk limited distances now." D. "I will report any injury to my foot or leg."

ANS: C Patients with venous insufficiency are encouraged to begin a graduated exercise program. The other statements show good understanding.

The patient is an older, female, African American adult who has a 10-year history of type 2 insulin-dependent diabetes. The nurse notes that the patient's greatest risk for developing secondary hypertension is her A. gender. B. ethnic origin. C. vascular system status. D. insulin therapy.

ANS: C Secondary hypertension identified in the vascular system refers to elevated blood pressure caused by underlying disease such as renal artery disease, renal parenchymal disorders, endocrine and metabolic disorders, central nervous system (CNS) disorders, coarctation of the aorta, and increased intravascular volume. Gender, ethnic origin, and insulin therapy are not diseases that cause hypertension.

An older patient is upset with a blood pressure reading of 180/78 mmHg. What response by the nurse is best? A. "It looks like you need blood pressure medicine now." B. "Most people get hypertension when they get older." C. "Let's plan to check it again tomorrow." D. "Don't worry, there are lots of good medications for this."

ANS: C With age, elastin in vessel walls decreases, making them stiffer. Systolic blood pressure (SBP) is increased in older adults because of a loss of arterial distensibility resulting from arterial stiffening. The diagnosis of hypertension is a reading over 130/80 mmHg in older people taken on three different occasions during more than two office visits. The nurse plans for the patient to return for another blood pressure reading. The patient needs a diagnosis of hypertension to begin medications. Many people do have higher blood pressures as they age, but stating this does nothing to ease the patient's concern. Telling the patient not to worry is patronizing and dismissive.

The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for asthma. What does the nurse teach about this medication? (Select all that apply.) A. Taken just before retiring for the night B. Reserved for acute attacks only C. Used in increasing doses as needed D. How to use and rinse the inhaler E. There are few side effects to worry about.

ANS: C, D Corticosteroids are an effective long-term control medication that can be used in increasing doses as needed for asthma and related disorders. It is given by the inhalation method, so the nurse teaches the patient how to use and maintain the inhaler. Inhaled corticosteroids have side effects such as a reduction in bone mineral content. They are not usually taken just before bed and they are considered long-term control medications and so would not be used in an acute attack.

The nurse educates the obese older adult patient that the single most important outcome that will affect his or her cardiac health is A. compliance with drug therapy. B. adherence to the DASH diet. C. 20 minutes of exercise daily. D. a 10% reduction in weight.

ANS: D A 10% reduction of total weight will decrease blood pressure in many overweight individuals. This factor has significance because it underscores the importance of weight reduction in the older adult population. The other factors are important but not as significant to overall cardiac health as is weight loss in this obese patient.

A 76-year-old patient has been recently diagnosed with cardiac valvular disease. The nurse assesses the patient and recognizes that the medical diagnosis is supported by which finding? A. Cyanotic fingertips B. Weight loss of 10 pounds in 3 months C. Angina pain D. Shortness of breath with activity

ANS: D Individuals with valvular disease may be asymptomatic for many years, but with the deterioration of the valves and hypertrophic changes in the atria or ventricles, symptoms become evident. Exertional dyspnea is frequently the initial symptom. Other symptoms include dizziness, fatigue, weakness, and palpitations. The other signs are not manifestations of valve disease.

An older patient with severe peripheral arterial disease wishes to quit smoking. The nurse provide education to this patient on which of the following? A. "Cold turkey" method B. gradual reduction C. Nicotine patches D. Bupropion hydrochloride

ANS: D Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction. Bupropion hydrochloride is an appropriate choice.

The nurse is teaching cardiovascular risk factors to a group of older adults. The nurse stresses that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers. What is the reason behind this statement? A. Smoking interferes with the development of collateral coronary vessels. B. Smoking produces coronary artery stricture. C. Smoking results in carbon monoxide poisoning. D. Smoking increases platelet aggregation.

ANS: D Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygen-carrying capacity of the blood. Smoking does not interfere with collateral circulation or produce strictures, but it may contribute to higher levels of carbon monoxide in the blood.

A nurse has provided discharge teaching for an older adult patient who had a pacemaker implanted. Which statement by the patient indicates appropriate understanding of the device? A. "The battery will need charging every 2 years or so." B. "I'm supposed to call my doctor if my pulse is within 10 beats of my preset rate." C. "My wife will have to be the one who makes the microwave popcorn." D. "I'll take my pulse each morning before my first cup of coffee."

ANS: D The radial pulse should be taken at the same time daily and recorded. The patient should notify the provider if the pulse is lower than the preset lower limit on the pacemaker. Battery life is longer than 2 years. Microwaves are safe to use.

A client with a diagnosis of rapid rate Afib asks the nurse why the health care provider is going to perform carotid massage. The nurse responds that this procedure may stimulate which? A. Vagus nerve to slow the heart rate B. Vagus nerve to increase the heart rate C. Diaphragmatic nerve to slow the heart rate D. Diaphragmatic nerve to increase the heart rate

Answer: A Rationale: Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. The other maneuvers are the Valsalva maneuver of inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm.

An older adult resident in a long-term-care facility becomes confused and agitated, telling the nurse, "Get out of here! You're going to kill me!" Which action will the nurse take first? A. Check the resident's oxygen saturation. B. Do a complete neurologic assessment. C. Give the prescribed PRN lorazepam (Ativan). D. Notify the resident's primary care provider.

Answer: A Decrease in blood flow to the brain can cause temporary psychotic symptoms

You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of the following is the correct way to use this device? A. Encourage the patient to use it twice a day. B. The patient exhales into the device rapidly and then coughs. C. The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales. D. The patient rapidly inhales 10 times from the device and then exhales for 6 seconds.

Answer: C. Incentive means to inhale, making B incorrect. It should also be used hourly in order to be effective, making A incorrect. This tool measures how deeply one can breathe in, so D would not be correct.

Which of the following patients are MOST at risk for developing pneumonia? Select-all-that-apply: A.A 53 year old female recovering from abdominal surgery B.A 69 year old patient who recently received the pneumococcal conjugate vaccine. C.A 42 year old male with COPD and is on continuous oxygen via nasal cannula D.A 8 month old with RSV (respiratory syncytial virus) infection

Answers : A, C, and D. Risks factors for pneumonia include: recent surgery, lung disorder (ex: COPD), and viral infection (ex: RSV). Option B is a preventive measure in preventing pneumonia

A nurse is caring for a patient taking furosemide. What assessment finding needs to be reported to the provider immediately? A. Weight gain of 1/2 pound (1.1 kg) in 24 hours B. 2+/4+ pedal and pretibial edema C. Potassium level: 2.6 mEq/L D. Sodium level: 138 mEq/L

ans: c Furosemide is a potassium-wasting diuretic and the patient's potassium is critically low. This finding should be reported. The weight gain should be charted but does not need immediate reporting. Without knowing what the patient's baseline edema is, there is no indication this needs to be reported. The sodium level is normal.