Perfusion/Gas exchange test 1

10. True or False: Hyperinflation of the lungs leads to diaphragm flattening.* True False

The answer is TRUE.

The nurse is providing discharge teaching for a post-myocardial infarction (MI) client who will be taking 1 baby aspirin a day. The nurse determines that the client understands the use of this medication if the client makes which statement? 1. "I will take this medication every day." 2. "I will take this medication every other day." 3. "I will take this medication until I feel better." 4. "I will take this medication only when I have pain."

1

A 24-year-old man seeks medical attention for complaints of claudication in the arch of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. Next, the nurse should check the client's medical history for which item? 1. Smoking history 2. Recent exposure to allergens 3. History of recent insect bites 4. Familial tendency toward peripheral vascular diseas

1

A client brings the following medications to the clinic for a yearly physical. The nurse realizes which medication has been prescribed to treat heart failure? 1. Digoxin 2. Warfarin 3. Amiodarone 4. Potassium chloride

1

A client complaining of chest pain has an as-needed (PRN) prescription for sublingual nitroglycerin. Before administering the medication to the client, the nurse should first check which parameter? 1. Blood pressure 2. Cardiac rhythm 3. Respiratory rate 4. Peripheral pulses

1

A client with a diagnosis of myocardial infarction has a new activity prescription allowing the client to have bathroom privileges. As the client stands and begins to walk, the client begins to complain of chest pain. The nurse should take which action? 1. Assist the client to get back into bed. 2. Report the chest pain episode to the health care provider. 3. Tell the client to stand still, and take the client's blood pressure. 4. Give a nitroglycerin tablet, and assist the client to the bathroom.

1

A student nurse is assigned to assist in caring for a client with acute pulmonary edema who is receiving digoxin and heparin therapy. The nursing instructor reviews the plan of care formulated by the student and tells the student that which intervention is unsafe? 1. Restricting the client's potassium intake 2. Encouraging the client to rest after meals 3. Administering the heparin with a 25-gauge needle 4. Holding the digoxin for a heart rate less than 60 beats per minute

1

The nurse is planning measures to decrease the incidence of chest pain for a client with angina pectoris. The nurse should do which intervention to effectively accomplish this goal? 1. Provide a quiet and low-stimulus environment. 2. Encourage the family to come visit very frequently. 3. Encourage the client to call friends and relatives each day. 4. Recommend that the client watch TV as a constant diversion.

1

The nurse is preparing to obtain a sputum specimen from the client. Which nursing action is essential in obtaining a proper specimen? 1. Have the client take three deep breaths. 2. Limit fluids before obtaining the specimen. 3. Ask the client to obtain the specimen after eating. 4. Ask the client to spit into the collection container.

1

True or False: COPD is reversible and tends to happens gradually.* True False

The answer is FALSE. COPD IRREVERSIBLE and tends to happens gradually.

Which are signs and symptoms characteristic of emphysema? Select all that apply. 1. Cyanosis 2. Wheezing 3. Weight loss 4. Barrel chest 5. Shortness of breath 6. Decreased lung sounds

1 3 4 5 6 The client with emphysema has a barrel chest, weight loss, and decreased lung sounds. Late signs and symptoms include shortness of breath and cyanosis. Wheezing is absent but is noted in other conditions such as asthma.

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse (RN) and expects which interventions to be prescribed? Select all that apply. 1. Administering oxygen 2. Inserting a Foley catheter 3. Administering furosemide 4. Administering morphine sulfate intravenously 5. Transporting the client to the coronary care unit 6. Placing the client in a low-Fowler's side-lying position

1,2,3,4 Oxygen is always prescribed, and the client is placed in a high-Fowler's position to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to accurately measure output. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and reduces the work of breathing

About which laboratory values should the nurse be immediately concerned because they could cause cardiac arrest? Select all that apply.Rationale: Normal laboratory values are calcium, 8.4 to 10.6 mg/dL; sodium, 135 to 145 mEq/L; potassium, 3.5 to 5.0 mEq/L; chloride, 96 to 106 mEq/L; and magnesium 1.3 to 2.1 mg/dL. Decreased calcium and/or increased potassium can lead to cardiac arrest Client Needs: Physiological Integrity Cognitive Ability: Analyzing Content Area: Adult Health: Cardiovascular Integrated Process: Nursing Process/Data Collection Priority Concepts: Clinical Judgment, Safety Strategy(ies): Strategic Words 1. Calcium 7.9 mg/L 2. Potassium 5.9 mEq/L 3. Sodium 138 mEq/L 4. Chloride 104 mEq/L 5. Magnesium 1.7 mg/dL

12 Normal laboratory values are calcium, 8.4 to 10.6 mg/dL; sodium, 135 to 145 mEq/L; potassium, 3.5 to 5.0 mEq/L; chloride, 96 to 106 mEq/L; and magnesium 1.3 to 2.1 mg/dL. Decreased calcium and/or increased potassium can lead to cardiac arrest

The health care provider is discharging a client with a diagnosis of primary hypertension. Which health maintenance instructions should the nurse reinforce in the discharge teaching plan? Select all that apply. 1. Monitor the blood pressure at home. 2. Restrict sodium intake as prescribed. 3. Take a calcium supplement to lower blood pressure. 4. Eye examinations with an ophthalmoscope should be routine. 5. Follow-up appointments for blood pressure checks are important.

1245

The nurse is caring for a client with left-sided heart failure. Which clinical signs are most important for the nurse to communicate to the health care provider? Select all that apply. 1. Pink-tinged frothy sputum 2. Increase in respiratory rate 3. Ankle and lower leg swelling 4. Paroxysmal nocturnal dyspnea 5. Auscultation of crackles throughout the lungs

125

The nurse is caring for a client who has been admitted to the hospital with a diagnosis of angina pectoris. What are included in the discharge plan? Select all that apply. 1. Smoking cessation 2. Get a flue vaccination 3. Avoid aspirin products 4. Decrease protein in diet 5. Limit activity in cold weather 6. Check blood pressure and pulse

1256 Treatment of angina includes reducing modifiable risk factors (smoking, overweight and obesity, high blood pressure). Low-dose aspirin is prescribed as an anticoagulant to reduce the risk of a myocardial infarction. Activity in cold weather frequently triggers an angina attack. Diet should be low in fat and cholesterol. A flu vaccination will decrease the risk of infection.

The health care provider is discharging a client with a diagnosis of chronic heart failure. Which health maintenance instructions should the nurse reinforce in the discharge teaching plan? Select all that apply. 1. Obtain annual influenza vaccination. 2. Restrict fluid intake to 1000 mL per day. 3. Avoid adding salt to foods or in cooking. 4. Report a weight gain of 3 or more pounds in a week. 5. Take an extra dose of prescribed diuretic for swollen ankles.

134

A client with left-sided heart failure has been admitted to the hospital. The nurse is reviewing the medical record and notes which signs and symptoms? Select all that apply. 1. Orthopnea 2. Weight gain 3. Sleep apnea 4. Pitting edema 5. Pink frothy sputum

135 Left-sided signs and symptoms include fatigue, dyspnea, wheezing, orthopnea, sleep apnea, pulmonary edema (pink, frothy sputum), pallor, and clammy skin. Right-sided heart failure signs and symptoms include fatigue, edema in sacrum, legs, feet, ankles, hepatomegaly, abdominal distention as a result of ascites, weight gain, and dyspnea.

A client has a history of left-sided heart failure. The nurse should look for the presence of which finding to determine whether the problem is currently active? 1. Presence of ascites 2. Bilateral lung crackles 3. Jugular vein distention 4. Pedal edema bilaterally

2

A client is at risk for complications of heart failure. Which is the nurse's priority for early detection of the most likely cause of complications with this client? 1. Checking vital signs 2. Evaluating total body fluid 3. Reviewing serum electrolytes 4. Monitoring electrocardiogram

2

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased. The nurse explains that this can be harmful because it could cause which difficulty? 1. It could be drying to nasal passages. 2. It could decrease the client's oxygen-based respiratory drive. 3. It could increase the risk of pneumonia from drier air passages. 4. It could decrease the client's carbon dioxide-based respiratory drive.

2

A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds expecting to hear which breath sounds bilaterally? 1. Rhonchi 2. Crackles 3. Wheezes 4. Diminished breath sounds

2

A hospitalized client with a history of angina pectoris is ambulating in the corridor. The client suddenly complains of severe substernal chest pain. The nurse should take which action first? 1. Check the client's vital signs. 2. Assist the client to sit or lie down. 3. Administer sublingual nitroglycerin. 4. Apply nasal oxygen at a rate of 2 L/min.

2

An older client with ischemic heart disease has experienced an episode of dizziness and shortness of breath. The nurse reviews the plan of care and notices documentation of decreased cardiac output, dyspnea, and syncopal episodes. The nurse plans to take which important action? 1. Monitor oxygen saturation levels. 2. Place the client on a cardiac monitor. 3. Measure blood pressure every 4 hours. 4. Check capillary refill at least once per shift.

2

The nurse instructs a client on pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse indicates that the client is performing the technique correctly? 1. The client breathes in through the mouth. 2. The client breathes out slowly through the mouth. 3. The client avoids using the abdominal muscles to breathe out. 4. The client puffs out the cheeks when breathing out through the mouth.

2

The nurse is reinforcing instructions to a client with angina pectoris about measures to reduce recurrence of chest pain. The nurse should stress to the client the importance of taking which measure? 1. Saving all chores for the end of the day 2. Avoiding exposure to either very hot or very cold weather 3. Eating large meals to reduce the work of the gastrointestinal tract 4. Keeping items stored above shoulder level to encourage exercise

2

The nurse is collecting data on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain. During the admission, the client reports chest pain. The nurse immediately asks the client which question? 1. "Are you having any nausea?" 2. "Where is the pain located?" 3. "Are you allergic to any medications?" 4. "Do you have your nitroglycerin with you?"

2 If a client complains of chest pain, the initial assessment question is to ask the client about the pain intensity, precipitating factors, location, radiation, and quality. Although options 1, 3, and 4 may be components of the assessment, these would not be the initial assessment questions in this situation.

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which should the nurse expect to note? 1. Hypocapnia 2. Hyperinflated lungs on chest x-ray 3. Increased oxygen saturation with exercise 4. A widened diaphragm noted on chest x-ray

2 Signs/symptoms of chronic obstructive pulmonary disease include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed? 1. Strict bed rest for 24 hours 2. Bathroom privileges and self-care activities 3. Unrestricted activities because the client is monitored 4. Unsupervised hallway ambulation with distances less than 200 feet

2 Upon transfer from the coronary care unit, the client is allowed self-care activities and bathroom privileges. Supervised ambulation in the hall for brief distances is encouraged, with distances gradually increased (50, 100, 200 feet).

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which should the nurse expect to note in this client? Select all that apply. 1. Hypocapnia 2. Dyspnea during exertion 3. Presence of a productive cough 4. Difficulty breathing while talking 5. Increased oxygen saturation with exercise 6. A shortened expiratory phase of respiration

2 3 4

A client with right-sided heart failure has been admitted to the hospital. The nurse is reviewing the medical record and notes which signs and symptoms? Select all that apply.Rationale: 1. Orthopnea 2. Weight gain 3. Sleep apnea 4. Pitting edema 5. Pink frothy sputum

2 4 The signs and symptoms of right-sided heart failure include fatigue; edema in the sacrum, legs, feet, and ankles; hepatomegaly; abdominal distention as a result of ascites; weight gain; and dyspnea. Left-sided signs and symptoms include fatigue, dyspnea, wheezing, orthopnea, sleep apnea, pulmonary edema (pink, frothy sputum), pallor, and clammy skin.

The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary in order to control disease progression. Which statements by the client indicate a need for further teaching? Select all that apply. 1. "I will avoid using table salt with meals." 2. "I am going to switch to electronic cigarettes." 3. "It is best to exercise once a week for an hour." 4. "I will take nitroglycerin whenever chest discomfort begins." 5. "I will use muscle relaxation to cope with stressful situations

23

Which nursing actions would contribute to monitoring and maintaining a patent airway for the postoperative client? Select all that apply. 1. Repositioning client every 4 hours 2. Position on the side until fully recovered 3. Encouraging coughing and deep breathing 4. Monitoring pulse oximetry readings frequently 5. Encouraging the use of an incentive spirometer

2345

The nurse is admitting a client with a possible diagnosis of chronic bronchitis. The nurse collects data from the client and notes that which signs/symptoms support this diagnosis? Select all that apply. 1. Scant mucus 2. Early onset cough 3. Marked weight loss 4. Purulent mucous production 5. Mild episodes of dyspnea

245 Key features of pulmonary emphysema include dyspnea that is often marked, late cough (after onset of dyspnea), scant mucous production, and marked weight loss. By contrast, chronic bronchitis is characterized by an early onset of cough (before dyspnea), copious purulent mucous production, minimal weight loss, and milder episodes of dyspnea.

A client has a prescription for continuous monitoring of oxygen saturation by pulse oximetry. The nurse performs which best action to ensure accurate readings on the oximeter? 1. Apply the sensor to a finger that is cool to the touch. 2. Apply the sensor to a finger with very dark nail polish. 3. Ask the client to limit motion in the hand attached to the pulse oximeter. 4. Place the sensor distal to an intravenous (IV) site with a continuous IV infusion.

3

A client who has just suffered a flail chest is experiencing severe pain and dyspnea. Which would be the appropriate nursing action? 1. Reposition the client. 2. Document the findings. 3. Notify the registered nurse. 4. Medicate the client for pain.

3

A client with heart failure is scheduled to be discharged to home with digoxin and furosemide as ongoing prescribed medications. The nurse teaches the client to report which sign/symptom that indicates the medications are not producing the intended effect? 1. Decrease in pedal edema 2. High urine output during the day 3. Weight gain of 2 to 3 pounds in a few days 4. Cough accompanied by other signs of respiratory infection

3

The licensed practical nurse (LPN) is assisting in caring for a client with a diagnosis of myocardial infarction (MI). The client is experiencing chest pain that is unrelieved by the administration of nitroglycerin. The registered nurse administers morphine sulfate to the client as prescribed by the health care provider. Following administration of the morphine sulfate, the LPN plans to monitor which indicator(s)? 1. Mental status 2. Urinary output 3. Respirations and blood pressure 4. Temperature and blood pressure

3

The nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse should expect to note which specific characteristic of this condition? 1. Dyspnea 2. Hacking cough 3. Dependent edema 4. Crackles on lung auscultation

3

The nurse working in a long-term care facility is collecting data from a client experiencing chest pain. The nurse should interpret that the pain is likely a result of myocardial infarction (MI) if which observation is made by the nurse? 1. The client is not experiencing nausea or vomiting. 2. The pain is described as substernal and radiating to the left arm. 3. The pain has not been relieved by rest and nitroglycerin tablets. 4. The client says the pain began while trying to open a stuck dresser drawer.

3

While the nurse is involved in preparing a client for a cardiac catheterization, the client says, "I don't want to talk with you. You're only the nurse. I want my doctor." Which response by the nurse should be therapeutic? 1. "Your doctor expects me to prepare you for this procedure." 2. "That's fine, if that's what you want. I'll call your health care provider." 3. "So you're saying that you want to talk to your health care provider?" 4. "I'm concerned with the way you've dismissed me. I know what I am doing."

3

A hypertensive client who has been taking metoprolol has been prescribed to decrease the dose of the medication. The client asks the nurse why this must be done over a period of 1 to 2 weeks. In formulating a response, the nurse incorporates the understanding that abrupt withdrawal could affect the client in which way? 1. Result in hypoglycemia 2. Give the client insomnia 3. Precipitate rebound hypertension 4. Cause enhanced side effects of other prescribed medications

3 Beta-adrenergic blocking agents should be tapered slowly. This will avoid abrupt withdrawal syndrome characterized by headache, malaise, palpitations, tremors, sweating, rebound hypertension, dysrhythmias, and possibly myocardial infarction (in clients with cardiac disorders including angina pectoris). Options 1, 2, and 4 are incorrect

An ambulatory clinic nurse is interviewing a client who is complaining of flulike symptoms. The client suddenly develops chest pain. Which question best assists the nurse to discriminate pain caused by a noncardiac problem? 1. "Can you describe the pain to me?" 2. "Have you ever had this pain before?" 3. "Does the pain get worse when you breathe in?" 4. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"

3 Chest pain is assessed using the standard pain assessment parameters, (characteristics, location, intensity, duration, precipitating and alleviating factors, and associated symptoms). Describing the pain, asking if it has occurred in the past, and rating the pain using a pain scale may or may not help determine the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.

The nurse is caring for an older client who is on bed rest. The nurse plans which intervention to prevent respiratory complications? 1. Decreasing oral fluid intake 2. Monitoring the vital signs every shift 3. Changing the client's position every 2 hours 4. Instructing the client to bear down every hour and to hold his or her breath

3 Frequent position changes help mobilize lung secretions and prevent pooling. This is the only intervention identified in the options that will prevent respiratory complications. The nurse should encourage fluid intake to thin secretions and thus enable the client to expectorate more easily. It is important to encourage coughing and deep breathing to mobilize lung secretions. The nurse should assess the client's vital signs every 4 hours to identify an elevated

The nurse has given simple instructions on preventing some of the complications of bed rest to a client who experienced a myocardial infarction. The nurse should intervene if the client were performing which of these contraindicated activities? 1. Deep breathing and coughing 2. Repositioning self from side to side 3. Isometric exercises of the arms and legs 4. Ankle circles, plantar, and dorsiflexion exercises

3 The client with myocardial infarction should avoid activities that tense the muscles such as isometric exercises. These increase intra-abdominal and intrathoracic pressures and can decrease the cardiac output. They also can trigger vagal stimulation causing bradycardia. The exercises in options 1, 2, and 4 are acceptable.

A client has been diagnosed with Prinzmetal's angina. The nurse reviews the medical record and notes which accompanying characteristics? Select all that apply. 1. Relieved by rest 2. Occurs after exercise 3. Prolonged severe pain 4. Nitroglycerine relieves the pain 5. Happens at the same time each day

3 5 Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often in the morning. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets.

A client in a long-term care facility who has a history of angina pectoris wants to go for a short walk outside with a family member. It is a sunny but chilly December day. The nurse should perform which intervention to care for this client in a holistic manner? 1. Tell the client that this is not allowed. 2. Tell the family member not to take the client outdoors. 3. Give the client a cup of hot coffee before going outside. 4. Instruct the family member to dress the client warmly before going outside.

4

A client is admitted to the hospital with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which arterial blood gas supports this diagnosis? 1. Po2 of 68 mm Hg and Pco2 of 40 mm Hg 2. Po2 of 55 mm Hg and Pco2 of 40 mm Hg 3. Po2 of 70 mm Hg and Pco2 of 50 mm Hg 4. Po2 of 60 mm Hg and Pco2 of 50 mm Hg

4

A client is seen in the health care provider's office for a physical examination after experiencing unusual fatigue over the last several weeks. Height is 5 feet, 8 inches, with a weight of 220 pounds. Vital signs are temperature 98.6° F oral, pulse 86 beats per minute, respirations 18 breaths per minute, and blood pressure 184/96 mm Hg. Random blood glucose is 110 mg/dL. In order to best collect relevant data, which question should the nurse ask the client first? 1. "Do you exercise regularly?" 2. "Would you consider losing weight?" 3. "Is there a history of diabetes mellitus in your family?" 4. "When was the last time you had your blood pressure checked?

4

The nurse is working with a client who has been diagnosed with Prinzmetal's (variant) angina. The nurse plans to reinforce which information about this type of angina when teaching the client? 1. Prinzmetal's angina is effectively managed by beta-blocking agents. 2. Prinzmetal's angina improves with a low-sodium, high-potassium diet. 3. Prinzmetal's angina has the same risk factors as stable and unstable angina. 4. Prinzmetal's angina is generally treated with calcium channel blocking agent

4

The nurse provides instructions to a client about the use of an incentive spirometer. The nurse determines that the client needs further teaching about its use if the client makes which statement? 1. "I need to sit upright when using the device." 2. "I will inhale slowly, maintaining a constant flow." 3. "I need to place my lips completely over the mouthpiece." 4. "After maximal inspiration, I will hold my breath for 10 seconds and then exhale."

4

What is the purpose of pursed lip breathing? 1-promote O2 intake 2-strengthen the diaphragm 3-strengthen the intercostal muscles 4-promote carbon dioxide elimination

4

The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage does the nurse instruct the client to select from the menu? 1. Tea 2. Cola 3. Coffee 4. Lemonade

4 A client with a diagnosis of MI should not consume caffeinated beverages. Caffeinated products can produce a vasoconstrictive effect leading to further cardiac ischemia. Coffee, tea, and cola all contain caffeine and need to be avoided in the client with MI.

The nurse is talking with a client with angina about factors that can precipitate an angina attack. Which statement by the client indicates an understanding of the precipitating events? 1. "I am going to run a mile each day." 2. "I am going to switch to electronic cigarettes." 3. "I will walk up two flights of stairs without stopping." 4. "I will pay my neighbor to shovel my snow this winter."

4 Excessive exertion and cold frequently trigger angina attacks. Having the neighbor shovel snow will prevent the client from exertion in cold weather. Electronic cigarettes contain nicotine, which causes vasoconstriction.

A client diagnosed with angina pectoris returns to the nursing unit after experiencing an angioplasty. The nurse reinforces instructions to the client regarding the procedure and home care measures. Which statement by the client indicates an understanding of the instructions? 1. "I am considering cutting my workload." 2. "I need to cut down on cigarette smoking." 3. "I am so relieved that my heart is repaired." 4. "I need to adhere to my dietary restrictions."

4 Following the angioplasty, the client needs to be instructed about specific dietary restrictions that must be followed. Following the recommended dietary and lifestyle changes helps prevent further atherosclerosis. Abrupt closure of the artery can occur if the recommended dietary and lifestyle changes are not followed. Cigarette smoking needs to be stopped. An angioplasty does not repair the heart.

A patient who has a diagnosis of chronic bronchitis is experiencing an acute exacerbation. Assessments include increasing dyspnea and a cough producing thick, purulent mucus. Which class of medications should the healthcare provider to administer first? A Leukotriene inhibitor B Beta-222 agonist C Non-steroidal anti-inflammatory agent D Mucolytic

B

A patient who has chronic bronchitis will be receiving oxygen therapy at home. The teaching plan for this patient should include which of these instructions? A "Be careful around open flames because liquefied oxygen is highly flammable." B "Do not allow smoking in your home while you are receiving oxygen therapy." C "Your body may forget to breathe if you turn the oxygen up too high." D "Oxygen can be addictive so it should be used only when needed." E "Be sure to wash the nasal cannula prongs twice each week to decrease infection risk."

BCE

The healthcare provider is caring for a patient experiencing an acute exacerbation of chronic bronchitis. The patient is coughing uncontrollably and is using accessory muscles to breathe. Which of these interventions will support the patient's respiratory status? A Administer cough suppressant B Administer a corticosteroid C Provide humidified oxygen via face mask D Assist the patient to a side-lying position. E Administer a short acting beta-222 agonist

BCE

The healthcare provider is teaching a patient strategies to manage chronic bronchitis. Which of these will be included in the teaching? A "You should decrease fluid intake to control the amount of edema." B "Here's the address of a nearby smoking cessation support group." C "It's important for you to avoid being around people who are sick." D "Limiting your physical activity is very important." E "I'll show you how to use a spacer when you take your medication."

BCE

A patient who has a diagnosis of chronic bronchitis is receiving albuterol (Proventil) via nebulizer to treat an acute exacerbation. Which assessment noted by the healthcare provider is an indication the patient is experiencing an side effect of this medication? A Urinary incontinence B Sedation C Tachycardia D Hypoglycemia

C

The healthcare provider is admitting a patient who has worked in a textile factory for the past 181818 years. The patient reports a chronic productive cough, increasing fatigue, and exercise intolerance. What additional assessment findings are anticipated? A Pleural friction rub and increased temperature B Inspiratory stridor and diminished breath sounds C Peripheral edema and digital clubbing D Bronchial breath sounds and arterial oxygen saturation of 85\,\text{mmHg}85mmHg

C

The healthcare provider prepares to administer a pneumococcal vaccine to a 656565-year-old patient who has a diagnosis of chronic bronchitis. The patient states, "I got that vaccine 555 years ago." What is the most appropriate response by the healthcare provider? Choose 1 answer: Choose 1 answer: (Choice A) A "You will need this vaccination annually, just like the flu shot." (Choice B) B "This vaccination is given every other year to anyone with lung disease." (Choice C) C "Your last shot was when you were 606060 so a repeat vaccination is recommended." (Choice D) D "We can give you a flu shot instead of a pneumococcal vaccination."

C

The healthcare provider is assessing a patient with a 202020 year history of smoking and a chronic cough. Which description of the patient's cough best supports a diagnosis of chronic bronchitis? A "Usually my cough occurs in the evening." B "My cough is brassy and hoarse." C "I sound like a barking seal when I cough." D "I cough up a lot of thick mucus."

D

When evaluating the arterial blood gases (ABGs) of a patient with a 202020 year history of chronic bronchitis, which of these would the healthcare provider expect? Choose 1 answer: Choose 1 answer: A Metabolic alkalosis, compensated B Metabolic acidosis, uncompensated C Respiratory alkalosis, uncompensated D Respiratory acidosis, compensated

D

7. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?* A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.

Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.

2. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition?* A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.

You're working on a medical surgical floor. You have the following patients below. Select all the patients below that are at risk for a pressure injury:* A. A 19 year old female who is a quadriplegic. B. A 35 year old male with a BMI of 13.6 that is incontinent of stool and has a right leg splint. C. A 55 year old female who has controlled diabetes and is ambulating three times a day. D. A 76 year old male with an elevated ammonia level and is excessively sweaty. E. A 45 year old with a Braden Scale score of 7.

The answer are A, B, D, and E. The only patient not at risk for a pressure injury is the patient in option B. Remember altered sensory perception, any type of moisture issue (incontinence, sweating etc.), immobility, poor nutrition, altered mental status (high ammonia level can cause confusion and drowsiness), Braden scale score less than 9 are all risk factors for a pressure injury.

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.

3. Which of the following is most commonly found in a patient with emphysema?* A. Barrel chest B. Cyanosis C. V/Q mismatch D. Excessive productive cough

The answer is A. Cyanosis, V/Q mismatch, and excessive productive cough are found in chronic bronchitis.

18. A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level?* A. Losartan B. Norvasc C. Aspirin D. Cardizem

The answer is A. Losartan is an ARB. ARBs (angiotensin receptor blockers) and ACE inhibitors (angiotension converting enzyme inhibitors) can cause an INCREASE potassium level because of it affects of decreasing aldosterone. A normal potassium level is 3.5-5.1.

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 corticosterioid and can cause hyperglycemia and brusing.

2. True or False: Patients with emphysema experience hypoventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.* True False

The answer is FALSE. Patients with emphysema experience HYPERventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.

8. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time?* A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Last consumption of caffeine D. CK result and when the next CK level is due to be collected

The answer is A. The key words in this question are "chest pain" and "been in the ER for 5 hours". The patient should have already had one troponin level drawn since it starts to elevate 2-4 hours after injury and has been in the ER for 5 hours. Therefore, it is essential you know what the level is and when the next level is due. If the patient's chest pain is caused by a myocardial event the troponin levels will trend upward. Troponin levels are usually ordered every 6 hours x 3. CK results are not as specific as a troponin levels. This question wanted to know the MOST important, and the troponin level for this patient/when it is drawn next is MOST important. Diet status and last consumption of caffeine are things the nurse needs to know but not the MOST important.

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.

7. In which of the following conditions below do the alveolar sacs lose elasticity which can lead to "air-trapping":* A. Chronic Bronchitis B. Emphysema

The answer is B.

17. A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect?* A. Losartan B. Lisinopril C. Cardizem D. Lipitor

The answer is B. ACE inhibitors, such as Lisinopril, can cause a nagging cough that is continuous. The patient may be switched to an ARB (angiotensin receptor blocker) if the cough is troublesome.

While performing a skin assessment on a patient who is immobile, you note a purplish black area on the patient's left heel. The skin is intact. On palpation the site feels heavy and spongy. You suspect this may be?* A. Stage 1 pressure injury B. Deep-tissue injury C. Stage 4 pressure injury D. Stage 2 pressure injury

The answer is B. Deep-tissue injuries present as purplish or blackish areas over skin that is intact. The fatty tissue below is injured. Also, they may look like a black blistered area and may feel heavy or squishy.

22. Which of the following is a common side effect of Spironolactone?* A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

The answer is B. Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).

2. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage?* A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease.

The answer is B. The LCA (if blocked) can cause the MOST amount of damage to the heart muscle. It affects the ANTERIOR part of the heart which affects the LEFT ventricle. The left descending artery is MOST likely to be affected by coronary artery disease.

20. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?* A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

The answer is B. The best answer for this particular question is option B. All the options are important for the nurse to perform. However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling.

1. You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them?* A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.

The answer is B. The most common cause of a myocardial infarction is CORONARY ARTERY DISEASE...not coronary spasm which is uncommon.

In regards to question before, 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.

6. A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?* A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correc

The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation.

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 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.

11. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?* A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.

The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier.

12. A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this?* A. Coreg B. Cardizem C. Lovenox D. Lipitor

The answer is C. Lovenox is an antithrombotic. An adverse side effect of this medication is bleeding. Coreg (beta-blocker), Cardizem (calcium channel blocker), and Lipitor (statin) do NOT cause excessive bleeding.

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.

2. 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".

14. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?* A. Narcan B. Aminophylline C. Digibind No medication because this is a normal Digoxin level.

The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.

You're educating a group of nursing students about the different stages of a pressure injury. Which statement is correct about a stage 3 pressure injury?* A. There is full loss of skin tissue that can extend to the muscle, bone, or tendon. B. A hallmark of a stage 3 pressure injury is that the skin will be intact but it not blanch. C. The skin will not be intact and there will be full loss of skin tissue that can extend to the subcutaneous tissue. D. The wound edges will never roll away (epibole) as with a stage 2 pressure injury.

The answer is C. This is the only correct statement about a stage 3 pressure injury.

15. A patient taking Lovenox is having a severe reaction. What is the antidote for this medication?* A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate

The answer is D.

9. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers.* A. Myoglobin B. CK-MB C. CK D. Troponin

The answer is D.

9. Which of the following is NOT a sign and symptom of chronic bronchitis?* A. Productive cough B. Shortness of breath C. Cyanosis D. Barrel chest

The answer is D. Barrel chest is most commonly found in patients with emphysema.

4. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition?* A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.

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.

23. The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?* A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

The answer is D. Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient.

8. Patients with chronic bronchitis and emphysema can MOST COMMONLY experience what type of acid-base imbalance?* A. High oxygen level and high carbon dioxide level B. Low oxygen level and low carbon dioxide level C. High oxygen level and low carbon dioxide level D. Low oxygen level and high carbon dioxide level

The answer is D. Low oxygen levels and high carbon dioxide levels (respiratory acidosis) are found in patients with chronic bronchitis and emphyesma.

6. Which of the following is NOT a treatment for chronic bronchitis or emphysema?* A. Albuterol B. Spirvia C. Theophylline D. Metoprolol

The answer is D. Metoprolol is a beta blocker used to treat heart conditions. Albuterol, Spirvia, and Theophylline are types of bronchodilators which are used to treat chronic bronchitis & emphysema.

9. Which of the following tests/procedures are NOT used to diagnose heart failure?* A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring

The answer is D. Options A, B, and C are all used to diagnose heart failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm.

12. You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?* A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."

The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.

13. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of Heparin therapy and requires intervention?* A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000

The answer is D. Platelet value of <150,000 indicates thrombocytopenia and is found in patients with Heparin-Induced Thrombocytopenia. The potassium and hemoglobin level are normal. The PTT level is therapeutic (60-80 seconds) for Heparin and isn't a cause for concern.

15. Which of the following is a late sign of heart failure?* A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.

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.

16. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?* A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

The answer is D. This is a description of ACE inhibitors (option D).

10. What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.* A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction

The answer is D. This statement describes left ventricular DIASTOLIC dysfunction.

18. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?* A. Lisinopril B. Losartan C. Lasix D. Digoxin

The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

5. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.* True False

The answer is TRUE. Patient with left-sided DIASTOLIC dysfunction heart failure normally have a normal ejection fraction. However, patients with left-sided SYSTOLIC dysfunction heart failure usually do not because the heart is unable to CONTRACT efficiently rather than fill properly as with diastolic dysfunction.

8. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?* A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe

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).

10. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status:* A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time

The answers are A, D, E, G, and H.

19. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure:* A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

The answers are B and D.

1. Select ALL the options that are TRUE about chronic bronchitis and emphysema:* A. Patients with chronic bronchitis have the ability to fully exhale but have limited airflow. B. Emphysema and chronic bronchitis are irreversible. C. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema. D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".

The answers are B and D. Option A is wrong because patients with chronic bronchitis DON'T have the ability to fully exhale AND have limited airflow as well. Option C is wrong because SPRIOMETRY is used to diagnose chronic bronchitis and emphysema.

13. Select all the correct statements about educating the patient with heart failure:* A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.

You're developing a plan of care for a patient who is at risk for pressure injury development. The patient is 75 years old and weighs 95 lbs. The patient is confused and has right and left leg contractures. In addition, the patient has a urinary tract infection and is incontinent of urine. The patient is on aspiration precautions and is ordered a honey thick liquid diet with pureed foods. Select all the nursing intervention you will include in the patient's plan of care to prevent a pressure injury:* A. When feeding the patient keep the head of bed elevated at 45' degree and avoid elevating the foot of the bed. B. Apply barrier cream as needed to the skin daily. C. Turn the patient every 4 hours. D. Keep linens and gowns dry and wrinkle free. E. Use a wedge pillow for the right and left legs daily

The answers are B, D, and E. Option A is wrong because when the patient is sitting up you want to prevent them from sliding down in the bed. This can cause friction and shear, which can lead to a pressure injury. Raising the foot of the bed when the HOB is elevated will help prevent the patient from sliding down. Option C is wrong because you will need to turn the patient every 2 hours NOT every 4 hours. Option E is beneficial for the leg contractures to prevent a pressure injury to the knees and ankles.

3. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply:* A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.

An 86 year old female patient is immobile and is in the right lateral recumbent position. As the nurse you know that which sites below are at most risk for pressure injury in this position?* A. Sacral B. Patella C. Ankle D. Ear E. Elbow F. Hip G. Heel H. Shoulder

The answers are: B, C, D, F, and H. The right lateral recumbent position is where the patient is positioned on their right side. Therefore, the ankle, ear, hip, knee, and shoulders are sites where a pressure injury can occur.

1. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:* A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza)

A patient who has a diagnosis of chronic bronchitis is experiencing an acute exacerbation and is progressing to respiratory failure. When assessing the patient, which of these will be expected? A Bradycardia B Altered level of consciousness C Weak, thready pulse D Hypotension

b

The healthcare provider is assessing a patient with a diagnosis of chronic bronchitis. Which of these physical findings represents the effects of air trapping in this patient? A The sternum is prominently protruding from the chest. B There are indentations in the intercostal spaces during inspiration. C Asymmetrical expansion of the thorax is noted during inspiration. D The width of the chest is equal to the depth of the chest.

d