NURS 221 - Exam #1 NCLEX STYLE QUESTIONS
True or False: Lactated Ringer's Solution is first-line treatment for fluid resuscitation situations. True False
The answer is FALSE. LR contains glucose which can increase the blood glucose and is not first-line treatment for fluid resuscitations situations
True or False: Osmosis is an active transport process. True False
The answer is FALSE. Osmosis is a passive type of transport process.
A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance?* A. Potassium level of 6.0 B. Potassium level of 2.5 C. Potassium level of 5.0 D. Potassium level of 3.5
A. Potassium level of 6.0
A patient is post-op from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?* A. Respiratory acidosis B. Respiratory alkalosis C. Hypokalemia D. Metabolic acidosis
A. Respiratory acidosis
A patient on mechanical ventilation has the following blood gases: PaCO2 29, pH 7.56, HCO3 23. Which of the following conditions is the patient experiencing?* A. Respiratory alkalosis not compensated B. Respiratory alkalosis partially compensated C. Respiratory alkalosis fully compensated D. Respiratory acidosis partially compensated
A. Respiratory alkalosis not compensated
A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which of the following could NOT be the cause of this condition?* A. Anxiety attack B. Chronic obstructive pulmonary disease (COPD) C. Fever D. Aspirin toxicity
B. Chronic obstructive pulmonary disease (COPD)
Which patient is experiencing partially compensated respiratory acidosis?* A. PaCO2 30, pH 7.35, HCO3 26 B. PaCO2 53, pH 7.23, HCO3 28 C. PaCO2 45, pH 7.49, HCO3 21 D. PaCO2 50, pH 7.30, HCO3 23
B. PaCO2 53, pH 7.23, HCO3 28
A patient with COPD has the following blood gases: PCO2 59, pH 7.26, HCO3 42. Which of the following conditions is presenting?* A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
B. Respiratory acidosis
A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition?* A. Bradypnea B. Tachypnea C. Bradycardia D. None of the options are correct
B. Tachypnea
Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?* A. Calcium and sodium levels B. Potassium and sodium levels C. Calcium and potassium levels D. Potassium and phosphate levels
C. Calcium and potassium levels
A patient attempted to commit suicide by ingesting a bottle of Aspirin. Which of the following conditions is this patient at risk for?* A. Hyperkalemia B. Hypercalcemia C. Respiratory alkalosis D. Respiratory acidosis
C. Respiratory alkalosis
Which of the following is not a cause of respiratory acidosis?* A. Pulmonary edema B. Asthma C. Chronic obstructive pulmonary disease (COPD) D. Hyperventilation
D. Hyperventilation
A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise. Select all that apply:* A. Avoid warming up before exercise. B. Administer a short-acting beta agonist before exercise. C. Administer a short-acting beta agonist after exercise. D. Avoid exercising when experiencing a respiratory illness.
The answer are B and D. Option A is wrong because the patient should warm up for at least 10-15 minutes before exercising, and option C is wrong because the beta agonist should be administered BEFORE exercise (not after).
A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to?* A. Administer the dose at 1400 as ordered B. Notify the physician for further orders C. Hold the 1400 dose D. Collect another blood sample to confirm the level
The answer is A. A normal Theophylline level is 10-20 mcg/mL...therefore the level is normal and the nurse should administer the dose at 1400 as ordered.
Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming?* A. Caffeine B. Dairy C. Wheat D. Shellfish
The answer is A. Caffeine has the same properties as Theophylline and can increase the effects the drug.
Which fluid below is considered an isotonic solution but works as a hypotonic solution? A. Dextrose 5% in water B. Lactated Ringer's solution C. Dextrose 10% in water D. 0.33% Normal Saline
The answer is A. Dextrose 5% in water (D5W) starts out as an isotonic solution, but ends up working as a hypotonic solution. This occurs because once the dextrose in the solution is used by the body (metabolized), there is only free water left over, which has a low osmolarity and acts as a hypotonic solution.
You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising?* A. Prednisone B. Atrovent C. Flagyl D. Levaquin
The answer is A. Prednisone is a corticosteroid and can cause hyperglycemia and bruising.
When would the nurse expect to hear rhonchi during auscultation of the lung fields? A. mainly on expiration but possibly heard during inspiration as well B. beginning of inspiration which can extend to expiration C. toward the end of inspiration D. only on expiration
The answer is A. Rhonchi are mainly on expiration but possibly heard during inspiration as well
A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications?* A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol. C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone. D. The patient inhales the Fluticasone and immediately inhales the Salmeterol.
The answer is A. The bronchodilator inhaler (Salmeterol) is administered first to open up the airways. Then the patient is to wait five minutes and then administer the corticosteroid (Fluticasone). The bronchodilator will open the airways so the corticosteroid can easily enter the airways to decrease inflammation.
An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be:* A. Continue to monitor the patient B. Increase the patient's oxygen level to 3 L C. Notify the doctor for further orders D. Turn off the alarm settings
The answer is A. This patient is not in any distress from the description provided...therefore, you would continue to monitor the patient. Patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels. Therefore, it is normal for patients who have COPD to have an oxygen saturation between 88-93%.....any higher would decrease the stimulation to breathe and they may stop breathing. Therefore, you would not increase the oxygen level to 3 L, notify the doctor, or turn off the alarm settings.
What descriptive word could the nurse use to describe the sound of coarse crackles? A. Bubbling B. Popping C. Snoring D. Harsh-grating
The answer is A: bubbling Coarse crackles can be described as sounding like gurgling or bubbling that does not go away with coughing.
Fill-in-the-blank: Stridor can occur _______________. A. during inspiration or expiration. B. during inspiration only. C. during expiration only. D. during the ending of inspiration only.
The answer is A: during inspiration or expiration
A patient with diabetes insipidus is most likely to experience what type of fluid volume deficit (dehydration)? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration
The answer is A: hypertonic dehydration. Diabetes insipidus (DI) causes the patient to void a high volume of urine. This is due to a low level of ADH being produced in the body. DI will cause the extracellular compartment to lose mainly water rather than electrolytes. This change in osmolarity will further cause fluid to move from intracellular to extracellular compartment and shrink the cell.
What type of dehydration presents with mainly a loss of water rather than electrolytes (solutes)? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration
The answer is A: hypertonic dehydration. This presents with mainly a loss of water rather than electrolytes (solutes). This is also known as hypernatremia.
What type of fluid volume overload occurs because water moves from the intracellular to the extracellular compartment due to an increase in osmolarity of extracellular fluid which increases body water? A. Hypertonic overload B. Hypotonic overload C. Isotonic overload
The answer is A: hypertonic overload. Hypertonic overload occurs because water has moved from the intracellular to the extracellular compartment. This is due to an increase in osmolarity of the extracellular fluid.
A patient received a nebulizer of Albuterol. What is a side effect of this medication?* A. Bradycardia B. Tachycardia C. Drowsiness D. Feeling cold
The answer is B.
Which statement below best summarizes why fine crackles are occurring in a patient? A. "The pleural layers in the lungs are inflamed and rub against each other creating a harsh-grating sound." B. "When inhaled air enters into small airways that are collapsed, they suddenly explode open leading to a crackling sound." C. "As air leaves the trachea and bronchus it hits secretions like mucus and fluid, which creates a snoring like sound." D. "The narrowing of the larynx and trachea from either an object or swelling leads a popping sound on inhalation."
The answer is B.
What type of solution below can be used to treat cerebral edema? A. Isotonic B. Hypertonic C. Hypotonic
The answer is B. Cerebral edema is swelling of the brain. Hypertonic solutions dehydrate the cell which is helpful with cerebral edema.
When would the nurse expect to auscultate coarse crackles during the respiratory cycle? A. end of inspiration B. beginning of inspiration C. end of expiration D. throughout inspiration and expiration
The answer is B. Coarse crackles occur around the beginning of inspiration and can extend to expiration, and is longer than fine crackles.
Your patient's asthma is poorly controlled. The patient reports using their rescue inhaler 4 times a week. In addition, the patient's asthma is not responding to other treatments. The physician orders the patient to take a medication that works by blocking the role of the immunoglobulin IgE. This describes which medication below?
The answer is B. Omalizumab blocks the role of the immunoglobulin IgE, which will decrease the allergic response...hence asthma attacks. It is given subcutaneously and used when a patient's asthma is poorly controlled and other treatments are not working. It is NOT used for quick relief. It is important the patient receives NO LIVE vaccines while receiving this medication.
In regards to the prior question, which action by the patient demonstrates they know how to properly use this medication?* A. The patient rinses their mouth after using the Spiriva inhaler. B. The patient rinses their mouth after using the Pulmicort inhaler. C. The patient dispenses of the inhalers. D. The patient coughs 2 times after using the Pulmicort inhaler.
The answer is B. The patient should rinse the mouth after using any type of corticosteroid inhalers (here Pulmicort is the corticosteroid not Sprivia) to remove the medication from the mouth. If left in the mouth, the patient can develop thrush.
A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?* A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort. C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order.
The answer is B. The patient should use the bronchodilator first which is the Spiriva to open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation.
A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition?* A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.
The answer is B. This is the only correct statement. Option A is wrong because smoking cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong because the patient may develop HIGH LEVELS of red blood cells due to the body trying to compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.
The nurse is educating a patient's parent on how to identify stridor. The nurse asks the parent to verbalize where the sound is mainly located. Which answer by the parent is correct? A. lower airways B. throat C. nasal D. sternal
The answer is B: "throat" Stridor occurs because there is narrowing of the larynx and trachea which can happen due to swelling from an infection or blockage from an object etc. This sound is located in the throat area.
What type of dehydration presents mainly with a loss of electrolytes (solutes) rather than water? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration
The answer is B: hypotonic dehydration. Hypotonic dehydration presents mainly with a loss of electrolytes (solutes) rather than water. This is also known as hyponatremia.
The patient is experiencing a severe case of SIADH (Syndrome of Inappropriate Antidiuretic Hormone). What type of overload is the patient most likely to experience? A. Hypertonic overload B. Hypotonic overload C. Isotonic overload
The answer is B: hypotonic overload. In SIADH, there is too much ADH being released and water is retained. This will increase body water and dilute the extracellular fluid (hence lowering its osmolarity). This will cause water to move from the extracellular to the intracellular compartment and overload both compartments.
What is the fluid compartment that surrounds the outside of the cells and plays a vital role in helping be a medium for electrolytes and other substances to move to and from the cell to the plasma? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment
The answer is B: interstitial compartment
Which patients below should not receive Lactated Ringer's solution? Select all that apply: A. A patient with a mild case of metabolic acidosis. B. A pre-op patient for abdominal surgery. C. A patient experiencing hyperkalemia. D. A patient with liver failure.
The answer is C and D. Lactated Ringer's solution (LR) contains water, potassium, sodium, chloride, calcium, and lactate. Patients who are experiencing hyperkalemia (high potassium level) should not receive this solution since it already has potassium in it. In addition, a patient with liver failure is not a candidate for LR because it contains lactate. The liver is responsible for converting lactate to bicarbonate. When the liver is failing this conversion process cannot happen, which can lead to the buildup of lactate.
What type of fluid can cause the cell the swell and rupture? A. Isotonic B. Hypertonic C. Hypotonic
The answer is C.
The term" blue bloaters" is used to describe patients with?* A. Pulmonary hypertension B. Left-sided heart failure C. Chronic Bronchitis D. Emphysema
The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis, and the term "pink puffers" is used to describe patients with emphysema.
Your patient is receiving 0.45% Normal Saline for hypernatremia. What finding requires you to stop the fluid and notify the doctor? A. decreasing sodium level B. increased urination C. confusion D. polydipsia
The answer is C. 0.45% Normal saline is a hypotonic solution. It can be used to treat hypernatremia (lower the sodium levels in the blood). This fluid causes osmosis to move water from the extracellular space to the intracellular space. If too much is moved to the extracellular space cell swelling can present. Signs of this include mental status changes like confusion. Therefore, the nurse would want to hold the fluid and notify the doctor for further orders. Polydipsia is excessive thirst which presents with hypernatremia. Increase urination and a decreasing sodium level are expected with IV fluid administration.
Which fluid type is MOST likely to cause hypernatremia along with fluid volume overload and requires close monitoring by the nurse during administration? A. 0.45% Normal Saline B. Dextrose 5% in water C. 3% Saline D. 0.225% Saline
The answer is C. 3% Saline is a hypertonic solution and contains a concentrated amount of the sodium. It will cause fluid to leave the intracellular space and enter the extracellular space. This could lead to fluid volume overload and requires very close monitoring by the nurse. The other solutions listed here are hypotonic.
Which characteristic below is found with a pleural friction rub? A. high-pitched B. disappears with suctioning C. pain with coughing, deep breathing, or laughing D. mainly located in the smaller airways like the bronchioles
The answer is C. A pleural friction rub is LOW-pitched, is not affected by suctioning or coughing, does cause pain with coughing/deep breathing/laughing etc., and is located within the pleural layers.
You assist your patient with using their inhaler. The inhaler contains the medication Budesonide. Before administering the inhaler, you will want to connect what device to the inhaler to help decrease the patient from developing ________?* A. Peak flow meter; pneumonia B. Incentive spirometer; thrush C. Spacer; thrush D. Peak flow meter; mouth sores
The answer is C. Budesonide is a corticosteroid. Inhaled corticosteroids can cause thrush. Therefore, it is important to connect a spacer to the inhaler before usage to help prevent the patient from developing thrush and for the patient to gargle and rinse the mouth with water.
You're assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient's lung fields and note expiratory wheezes. The patient's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack?* A. Theophylline B. Tiotropium C. Albuterol D. Cromolyn
The answer is C. During an asthma attack, the patient needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators, such as Albuterol, short-acting beta agonists. Another type of short-acting bronchodilator is an anticholinergic bronchodilator called Ipratropium (this is given if a patient can't tolerated short-acting beta agonists like Albuterol). Theophylline is a bronchodilator but given orally and is NOT for quick relief. Tiotropium is a bronchodilator, as well, but is a LONG-ACTING anticholinergic bronchodilator. Cromolyn is an inhaled nonsteroidal anti-allergy medication that doesn't provide quick relief.
Which patient below is at risk for fluid volume overload while receive 0.9% Normal Saline? A. A patient with hyponatremia. B. A patient experiencing dehydration. C. A patient with heart failure. D. A patient who is vomiting.
The answer is C. In cases of the heart failure, the heart is too weak to pump fluid out of the heart. This can lead the body to become overwhelmed with fluid. Patients who are experiencing heart or kidney failure are at risk for fluid volume overload when receiving fluids.
What type of fluid volume overload presents with no drastic shifting of water from the compartments because osmolarity is equal but overloads the extracellular compartment? A. Hypertonic overload B. Hypotonic overload C. Isotonic overload
The answer is C. Isotonic overload presents with no drastic shifting of water from the compartments because osmolarity is equal but overloads the extracellular compartment. This can happen from heart or kidney failure, too much isotonic IV fluids, and over usage of Corticosteroids (which cause the body to retain sodium and water).
Which statement below is the most accurate about the process of osmosis? A. Water will moves from a solution with a higher solute concentration to a solution with a lower solute concentration. B. Water and solutes will move from a lower water concentration solution to a higher water concentration solution. C. Water will move from a lower solute concentration solution to a higher solute concentration solution. D. Water will move from a fluid of a lower water concentration to a fluid of a higher water concentration.
The answer is C. Osmosis is the movement of water from a fluid of higher water concentration to a fluid of lower water concentration, or, in other words, water will move from a lower solute concentration fluid to a higher solute concentration fluid.
A patient with emphysema may present with all of the following symptoms EXCEPT?* A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia
The answer is C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels).
A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I just feel like ending it all." You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect:* A. Atrovent B. Prednisone C. Roflumilast D. Theophylline
The answer is C. Roflumilast is a phosphodiestrace-4 inhibitor that is used in the treatment of patients with severe COPD due to chronic bronchitis. This medication can caused increased suicidal thoughts, and the patient should be monitored for this while taking Roflumilast.
A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD?* A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax
The answer is C. The key words to let you know the patient is experiencing chronic bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is sometimes referred to as "blue bloaters".
What is the fluid compartment that is found in certain body cavities like the spinal cavity, heart, lungs, and joints? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment
The answer is D: transcellular compartment
True or False: COPD is reversible and tends to happens gradually.* True False
The answer is FALSE. COPD IRREVERSIBLE and tends to happens gradually.
You're educating a patient how to use a peak flow meter to help monitor the status of their asthma. Which statement by the patient demonstrates they understand how to use the device?* A. "This device will help keep my lungs strong so I don't have another asthma attack." B. "I will inhale as hard as I can while using the device." C. "I will use this device at the same time, either in the morning or before bedtime, and compare the readings with my personal best reading." D. "I will notify the doctor if my peak flow rating is 90% or more than my personal best peak flow."
The answer is C. This option is correct. Option A is wrong because this device monitors how controlled a patient's asthma is and if it is getting worst. It doesn't make the lung stronger. Option B is wrong because the patient exhales as hard as they can onto the device. Option D is wrong because a flow rate of 90% of the personal best peak flow is a good reading.
What is the fluid compartment that is found inside the blood vessels? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment
The answer is C: intravascular compartment
Your patient is experiencing a severe gastrointestinal bleed. What type of fluid volume deficit will this patient experience? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration
The answer is C: isotonic dehydration. This type of fluid volume deficit occurs when there is an EQUAL loss of water and electrolytes. This is the most common type of fluid volume deficit seen, and the problem from this type of dehydration arises from the intravascular loss (which can lead to hypovolemic shock).
The nurse notes rhonchi. How could the nurse best describe this sound during documentation? A. popping B. musical whistling C. snoring D. squawking
The answer is C: snoring.
The physician orders the patient to start taking Omalizumab. How will you administer this medication as the nurse?* A. Intravenous B. Intramuscular C. Orally D. Subcutaneously
The answer is D.
Which medication below blocks the function of Leukotriene for the treatment of asthma?* A. Salmeterol B. Theophylline C. Tiotropim D. Montelukas
The answer is D.
What type of fluid below has a low osmolarity? A. 0.9% Normal Saline B. 3% Saline C. Dextrose 5% in 0.9% Normal Saline D. 0.45% Normal Saline
The answer is D. 0.45% Normal Saline is a hypotonic solution. It contains a lower concentration on solutes compared to the blood plasma. Due to this, it will cause water to move from the extracellular space to the intracellular space, which could swell the cell leading to possible rupture.
What is the only fluid type that can be administered with blood products? A. Lactated Ringer's solution B. 0.45% Normal Saline C. 3% Saline D. 0.9% Normal Saline
The answer is D. 0.9% Normal Saline is the ONLY fluid that can be administered with blood products.
A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will?* A. Immediately stop the nebulizer B. Re-adjust the nebulizer C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication. D. Reassure the patient this is a temporary side effect of this medication.
The answer is D. Cromolyn can temporarily cause the following side effects during administration: sneezing, burning in nose, itchy/watery eyes, bad taste in mouth. Reassure the patient that these are temporary side effects of this medication.
You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following:* A. Increase the breathing rate to prevent hypoxemia B. Decrease the use of the abdominal muscles C. Encourages the use of accessory muscles to help with breathing D. Strengthen the diaphragm
The answer is D. Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm.
A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation?* A. Spiriva B. Salmeterol C. Symbicort D. Albuterol
The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator.
Your patient who is receiving treatment for fluid volume overload has lost 2 lbs. since receiving treatment. Based on the patient's weight loss, about how much fluid has the patient lost? A. 2 liters B. 6 liters C. 4 liters D. 1 liter
The answer is D: 1 liter. A general rule to remember is that 1 kg (2.2 lbs) is equal to about 1 liter of fluid. Therefore, if the patient has lost 2 lbs., the patient has lost around 1 liter of fluid.
Which fluid below is NOT categorized as an isotonic fluid? A. 0.9% Normal Saline B. Lactated Ringer's solution (LR) C. Dextrose 5% in water D. Dextrose 5% in 0.45% Normal Saline
The answer is D: Dextrose 5% in 0.45% Normal Saline This is a hypertonic solution. Dextrose 5% in water is considered isotonic but once administered it become hypotonic (it categorized as an isotonic fluid).
A patient is experiencing hypertonic overload. What could cause this type of overload? A. Corticosteroids over usage B. Primary polydipsia C. SIADH D. Excessive sodium intake
The answer is D: excessive sodium intake. This will cause an increase of sodium concentration in the blood (plasma), which will increase osmolarity and cause hypertonic overload.
Which fluid compartment accounts for 2/3 of our body water and is found inside the cell? A. Transcellular B. Interstitial C. Intravascular D. Intracellular
The answer is D: intracellular. The intracellular compartment accounts for 2/3 of our body water and is found inside the cell.
How could a nurse describe the sound of a high-pitched wheeze? A. snoring B. crackling, popping C. bubbling D. musical, whistling
The answer is D: musical, whistling. This is a sound characteristic of what high-pitched wheezes sounds like.
True or False: A pleural friction rub occurs because the layers around the lungs known as the tunica adventitia pleura and parietal pleura are inflamed and rubbing against each other. True False
The answer is FALSE. The statement should say: "A pleural friction rub occurs because the layers around the lungs known as the VISCERAL pleura (NOT tunica adventitia pleura) and parietal pleura are inflamed and rubbing against each other.
True or False: If a solution has a high concentration of solutes, it is considered to have a high osmolarity. True False
The answer is TRUE.
True or False: The extracellular compartment includes the intravascular, interstitial, and transcellular compartments. True False
The answer is True.
True or False: Most of the fluid in the body is found in the intracellular space True False
The answer is true. The intracellular space is the space inside of the cell. The fluid in it accounts for 2/3 of our body water. Therefore, most of our fluid is inside the cell.
Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply:* A. "It is best to eat three large meals a day that are relatively low in calories." B. "Avoid going outside during extremely hot or cold days." C. "It is important to receive the Pneumovax vaccine annually." D. "Smoking cessation can help improve your symptoms."
The answers are A and C. The patient needs to eat high calorie and protein rich meals that are small but frequent. The Pneumovax is definitely recommended for patients with COPD but is given every 5 years (not annually).
Which patient below would be at risk for experiencing high-pitched wheezes? Select all that apply: A. A patient with COPD. B. A patient with epiglottitis. C. A patient with heart failure. D. A patient with asthma.
The answers are A and D. These disease process can lead to narrowing of the airways. While epiglottitis can cause stridor, and heart failure can cause crackles.
Select all the following that can trigger an asthma attack:* A. Sulfites B. Smoke C. Caffeine D. GERD E. Cold, windy weather F. Beta agonist G. Cockroaches
The answers are A, B, D, E, and G. Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack.
A patient is receiving treatment for fluid volume deficit (hypertonic dehydration). What will the nurse implement in the patient's plan of care? Select all that apply: A. Daily weights B. Administer hypotonic IV solutions per physician's order C. Increase sodium intake D. Monitor sodium level E. Encourage the patient to limit fluids to 1-2 liters per day F. Strict intake and output measurements
The answers are A, B, D, and F. The nurse would want to weigh the patient daily (this is a great early indicator of the patient's fluid status). Administer hypotonic IV solutions per physician's order to help rehydrate the cell and fluid compartments. Monitor sodium level because it can become too high in this type of dehydration. However, when the nurse administers hypotonic IV solutions the sodium level should be monitored to ensure it doesn't get too low (hyponatremia) because the hypotonic solution could dilute fluid quickly, if not monitored closely. Limiting fluids should be avoided (1-2 L/day is a low amount of fluid per day and would be initiated in fluid volume OVERLOAD). Finally, the nurse would strictly monitor intake and output to ensure the patient is receiving enough fluid and urinary output is within normal range (30 mL/hr or 0.5 mL/kg/hr).
You're providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient:* A. Easily fatigued with physical activity B. Reduced peak flow meter reading C. Chest retractions D. Cyanosis E. Wheezing with activity F. Nighttime coughing G. No relief with short-acting bronchodilator inhaler
The answers are A, B, E, and F. These are all early warning signs an asthma attack is imminent. Options C, D, and G are signs and symptoms of an active asthma attack that requires medical treatment.
What signs and symptoms could present with fluid volume deficit in an adult patient? Select all that apply: A. Weight loss B. Pitting edema C. Confusion D. Rales E. Thirst F. Orthostatic hypotension G. Weak pulse H. Increase skin turgo
The answers are A, C, E, F, and G. Weight loss, confusion, thirst, orthostatic hypotension, and weak pulse all can present in an adults with fluid volume deficit.
You assess the lab report for your patient who has isotonic fluid volume overload. Which lab results below are expected with this condition? Select all that apply: A. Decreased hemoglobin B. Increased sodium level C. Decreased urine specific gravity D. Increased BUN E. Decreased serum osmolality
The answers are A, C, and E. Remember when fluid volume overload is presenting there is going to be a lot of fluid in the blood and urine. This will make the blood and urine less concentrated (diluted). Therefore, concentration of certain substances in the blood will be decreased. The patient can have: decrease in hemoglobin, hematocrit, decrease in sodium, decreased urine specific gravity and osmolality, and decreased serum osmolality.
Select all the signs and symptoms below that could present with fluid overload: A. Weight gain B. >3 seconds capillary refill C. Orthostatic hypotension D. Frothy, bloody tinged cough E. Ascites F. Jugular venous distention G. Weak pulse H. Rales
The answers are A, D, E, F, and H. All of these are possible signs and symptoms of fluid volume overload. Option B, C, and G are signs found in fluid volume deficit.
Select all the correct options that represent the pathophysiology of an asthma attack.* A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation. B. The mucosa lining experiences severe inflammation. C. The goblet cells within the mucosa lining produce excessive amounts of mucous. D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis.
The answers are B and C. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop....hence acidosis. Remember CO2 is acidic.
Your patient has a diagnosis of fluid volume overload (isotonic). Select all the interventions you plan to implement for this patient:(Required) A. Encourage patient to limit fluid intake to 4 Liter per day B. Strict monitoring of intake and output C. Weigh patient daily at the same time with the same scale D. Administer diuretics per physician's order E. Ensure urinary output is at least 10 mL/hr or greater F. Restrict foods high in sodium
The answers are B, C, D, and F. Option A is not correct because 4 L/day is a high amount of fluid, and the patient should be on a fluid restriction of about 1-2 L/day. Option E is not correct because the nurse should ensure the urinary output is at least 30 mL/hr (0.5mL/kg/day). A urinary output of >10 mL/hr is too low and not an appropriate goal for the patient.
A patient is admitted with fluid volume deficit (isotonic dehydration). What lab results would the nurse expect to see in this patient? Select all that apply: A. Decreased hemoglobin B. Increased serum osmolality C. Increased urine specific gravity D. Decreased urine osmolality E. Increased BUN
The answers are B, C, and E. Lab results are going to depend on the type of dehydration, but in most cases there will be a low amount of fluid in the blood and urine. Therefore, the blood and urine are going to be concentrated. As a result, the tests that check for blood and urine concentrations will be INCREASED: serum osmolality, hemoglobin, hematocrit, BUN, sodium level, urine specific gravity and osmolality.
Where are fine crackles usually located in the respiratory system? Select-all-that-apply: A. Bronchi B. Trachea C. Alveoli D. Bronchioles
The answers are C and D. Fine crackles tend to occur in the smaller airways such as the alveoli and bronchioles.
What signs and symptoms in a young infant would alert the nurse that the patient is likely experiencing fluid volume deficit? Select all that apply: A. Weight gain B. Bulging fontanelles C. Sunken fontanelles D. No tears when crying
The answers are C and D. Sunken fontanelles (the spaces in between the skull bones that present as soft spots on the head during the first part of life) and no tears when crying would alert the nurse the infant is dehydrated. In addition, the infant may be fussy, restless, and experience weight loss.
What signs and symptoms of fluid volume deficit are not likely to present in older adults (geriatric patient populations)? Select all that apply: A. Sluggish capillary refill B. Confusion C. Thirst D. Weight loss E. Decreased skin turgor
The answers are C and E. As people age the thirst response decreases along with skin elasticity. Therefore, thirst and decreased skin turgor are not reliable signs and symptoms of fluid volume deficit in the geriatric population.
