Practice Exam

203. The nurse is planning for discharge teaching with a patient with Addison's disease. On which of the following should the nurse place the highest priority for teaching purposes? A. strategies for coping with a chronic disease B. strategies for maintaining compliance with therapy C. strategies for preventing hypertension D. strategies for achieving long-term weight loss

(A); Addison's disease is a chronic disease, so the nurse should focus on living with a chronic disease and maintaining an optimal state of wellness.

220. The nurse is caring for a patient with Type II diabetes. Which of the following statements by the patient indicates understanding of predisposing factors for the disease? A. "Both of my parents and one grandparent had diabetes." B. "My youngest child was diagnosed with Type I diabetes." C. "I got diabetes because I've eaten too many sweets over the years." D. "My pancreas stopped making insulin, which caused my disease."

(A); Family history of Type II diabetes is a strong predictor for diabetes in an individual. Patients do not get the disease as a result of intake of sweets. The pancreas typically still produces insulin with Type II diabetes.

200. The nurse is assigned to care for a patient who has been admitted with hypothyroidism. Based on this information, which of the following findings would the nurse anticipate? A. flat affect B. fever C. pink, warm, dry skin D. hyperalertness

(A); Manifestations of hypothyroidism include dry, puffy skin; thin hair; hoarseness; large tongue; bradycardia; shallow, slow respirations; chronic constipation; slow mentation; and slow reflexes.

202. The nurse is assigned to care for a patient with Cushing's disease. Based on the diagnosis, the nurse would expect which of the following characteristic findings during assessment of this patient? A. hypertension and impaired immunity B. hypoglycemia and tachycardia C. hyperthermia and thin skin D. osteoporosis and polyphagia

(A); Patients with Cushing's disease experience a vast array of symptoms, including hypertension and impaired immunity.

219. The nurse has been providing teaching to a pregnant woman with Type I diabetes. Which of the following statements by the patient indicates an understanding of the impact of pregnancy on insulin needs? A. "Because pregnancy increases my metabolism, I'll need less insulin." B. "During my pregnancy, I will need more insulin to have stable glucose levels." C. "Because my blood glucose levels are stable, I'll check them only once per day." D. "My placenta continually produces insulin, which decreases my blood glucose."

(B); During pregnancy, production of hormones increases a woman's insulin needs.

201. The nurse is assigned to care for a patient with Addison's disease. Based on the diagnosis, the nurse would expect which of the following characteristic symptoms when assessing this patient? A. weakness and hyperglycemia B. hypoglycemia and hyperkalemia C. hypertension and bradycardia D. emaciation and tachycardia

(B); Patients with Addison's disease would have hypoglycemia and hyperkalemia.

204. The nurse is providing education about glucocorticoid therapy for a patient with Addison's disease. Which of the following statements by the patient indicates understanding of the instructions? A. "I need to have a supply of my drugs at home at all times." B. "I will take two-thirds of my daily dose at 9 a.m. and one-third at 5 p.m." C. "I will perform self-monitoring of blood glucose at least four times daily." D. "I might develop increased muscle mass after I've taken this for a while."

(B); Glucocorticoids should be administered by two-thirds of the total daily dose in the morning and the remaining one-third in the evening.

224. The nurse is providing education about treatment for hypoglycemia to a patient with diabetes. Which of the following treatments should the nurse advise for the patient? A. graham crackers and peanut butter; recheck glucose in 4 hours B. 4 oz of orange juice; recheck glucose in 1 hour C. 8 oz of orange juice with sugar; recheck glucose in 1 hour D. 8 oz skim milk; recheck glucose in 2 hours

(B); The nurse should advise the patient with hypoglycemia to drink 4 oz of orange juice (15 grams of carbohydrate) and recheck the glucose in 1 hour. Orange juice with sugar is not recommended. Neither is skim milk or graham crackers with peanut butter. Current recommendations are to administer the equivalent of 15 grams of carbohydrate and recheck the glucose within an hour.

199. A patient presents to the emergency department with the following symptoms: polydipsia, polyuria, abdominal pain, nausea, and fruity breath. The emergency department nurse immediately recognizes these symptoms as typical for patients with: A. Addison's disease. B. diabetic ketoacidosis. C. hyperosmolar hyperglycemic state. D. myxedema coma.

(B); The symptoms described (polydipsia, polyuria, abdominal pain, nausea, and fruity breath) are classic signs of diabetic ketoacidosis.

221. The nurse is providing teaching to a patient who has been diagnosed with Type I diabetes. Which statement by the patient indicates an understanding of key characteristics of the disease? A. "I may be able to decide if I take insulin or oral medications." B. "I probably developed this disease because I am overweight." C. "My pancreas has completely stopped producing insulin." D. "My body has developed insulin resistance over time."

(C); Because there is absolutely no insulin production by the pancreas in Type I diabetes, patients with the disease become very ill very quickly. Patients must take insulin to survive.

205. The nurse is caring for a patient with Graves' disease. When the patient asks the nurse how the disease is normally treated, the best response by the nurse is: A. "You will receive artificial thyroid stimulating hormone to normalize your levels." B. "You will receive oral catecholamines to help to normalize your metabolism." C. "You may require surgical removal of some or all of your thyroid gland." D. "You may require treatment with intravenous potassium."

(C); Graves' disease is a form of hyperthyroidism. Treatment is likely to involve removal of some or all of the thyroid tissue to reduce hormone production.'

222. The nurse is caring for a patient in the emergency department who was admitted with a serum glucose level of 857 mg/dL. The patient is nauseated, vomiting, lethargic, and polyuric. Vital signs are BP 78/50; P 125; R 28. A priority nursing intervention for this patient would be: A. monitor vital signs every 4 hours. B. encourage small sips of water to increase fluid status. C. administer fluid resuscitation as ordered. D. admit to a medical-surgical floor for follow-up.

(C); This patient is severely dehydrated because of nausea, vomiting, and polyuria. Hemodynamic effects are highlighted by hypotension and tachycardia. The priority intervention for this patient must be to administer fluid resuscitation as ordered. Vital signs should be monitored at least hourly, and the patient should remain NPO and be admitted to a critical care monitored bed because the situation could be life-threatening.

223. The nurse is providing education about hypoglycemia to a patient who was newly diagnosed with Type II diabetes. The nurse realizes that teaching has been effective when the patient makes which of the following statements? A. "I should always carry some sugar-free candy or Life Savers with me." B. "I will know when my blood glucose is low because I will be nauseous." C. "My blood glucose is likely to be very low because I have started medication." D. "It is not extremely likely that I will experience hypoglycemia."

(D); It is not extremely likely that a patient with new onset Type II diabetes will experience hypoglycemia. Typically, physicians will prescribe conservative doses of medication to be used in conjunction with dietary modification and exercise. Also, patients will be instructed to test the blood glucose three to four times per day and to document the findings over a few weeks' time.

218. A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

1. Fever 2. Nausea 4. Tremors 5. Confusion Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

212. The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call my primary health care provider (PHCP) because of these symptoms."

1. "I need to stop my insulin." When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the PHCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones during illness.

213. A client with a diagnosis of Addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional healthcare team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

1. Hypotension 3. Hyperkalemia In Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as acute adrenal insufficiency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor. Addisonian crisis is a life-threatening emergency. One of the roles of endogenous cortisol is to enhance vascular tone and vascular response to the catecholamines epinephrine and norepinephrine. Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. The role of aldosterone in the body is to support the blood pressure

210. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

1. Polyuria Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus.

214. The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1. Tremors 3. Irritability 4. Nervousness Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the manifestations of hypoglycemia. In hypoglycemia, usually the client feels hunger. Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

206. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level

2. Comatose state 3. Deep, rapid breathing 5. Elevated blood glucose level Rationale: Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid by-products of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect, because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.

211. The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2. Inadequate fluid volume An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the information in the question.

196. A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10 to 11.1 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Atenolol 2. Prednisone 3. Phenelzine 4. Allopurinol

2. Prednisone Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

186. Nifedipine (Procardia) has been ordered for a client with HT. In the care plan, the nurse includes the need to monitor for which ADVERSE effect? 1. Rash & chills 2. Reflex tachycardia 3. Increased U/O 4. Weight Loss

2. Reflex tachycardia Nifedipine (procardia) a CCB may cause hypotension with Reflex Tachycardia.

207. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2. Shakiness 3. Palpitations 5. Lightheadedness Rationale: Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

217. A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hoarseness 2. Hypocalcemia 3. Audible stridor 4. Edema at the surgical site

3. Audible stridor Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

216. The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

209. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (52.9 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.3 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

3. IV fluids containing dextrose Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (13.9 to 16.7 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (13.9 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.

195. Which intervention should the nurse implement prior to administering the beta blocker metoprolol (Lopressor)? 1. Check the client's serum potassium level. 2. Ensure the client has had something to eat. 3. Take the client's apical pulse and blood pressure. 4. Ask the client if he/she has had a cough.

3. Take the client's apical pulse and blood pressure. Beta blockers decrease the sympathetic stimulation to the heart; therefore, the nurse would question administering the medication if the apical pulse is less than 60 and blood pressure is less than 90/60. The potassium level is not affected by this medication; the client does not have to take the medication on a full stomach; and the cough is pertinent to an angiotensin-converting enzyme inhibitor, not a beta blocker.

215. The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 70 mg/dL (3.9 mmol/L), temperature of 101° F (38.3° C), pulse of 82 beats per minute, respirations of 20 breaths per minute, and blood pressure of 118/68 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

3. Temperature In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.

208. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L)."

4. "I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L)." During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the PHCP if the level is higher than 250 mg/dL (13.9 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the PHCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

198. A client with Addison's disease has been admitted with a history of nausea and vomiting for the past three days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement? A. Glucometer readings as ordered B. Intake/output measurements C. Evaluating the sodium and potassium levels D. Daily weights

Answer A is correct. IV glucocorticoids raise the glucose levels and often require coverage with insulin. Answer B is not necessary at this time, sodium and potassium levels would be monitored when the client is receiving mineral corticoids, and daily weights is unnecessary; therefore, answers B, C, and D are incorrect.

197. The nurse cares for a client with Addison's disease. Which should the nurse expect to observe when assessing the client? A. Anorexic appearance. B. Tachycardia. C. Edema. D. Dry skin.

Answer: A. Addison's disease is caused by hyposecretion of the adrenal hormones (mineralocorticoids, glucocorticoids, and androgens). Signs and symptoms of Addison's disease include anorexia, loss of appetite, weight loss, abdominal cramps, syncope, dehydration, hypotension from fluid loss, muscle weakness, depression, and irritability. Dry skin and hair is a symptom of hypothyroidism, and tachycardia is a symptom of hyperthyroidism.

234. Which of the following patients does not have a risk factor for hypertension? A. A 25 year old male with a BMI of 35. B. A 35 year old female with a total cholesterol level of 100. C. A 68 year old male who reports smoking 2 packs of cigarettes a day. D. A 40 year old female with a family history of hypertension and diabetes.

B. A 35 year old female with a total cholesterol level of 100.

185. Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects and instructs the client to immediately report: A.Blood pressure 110/70-114/78 for two successive readings. B.Dizziness when changing positions. C.Increased shortness of breath and orthopnea. D.Weight loss of two pounds per week.

C.Increased shortness of breath and orthopnea. Rationale: Nifedipine (Procardia) is a calcium channel blocker. Calcium channel blockers decrease myocardial contractility, increasing the risk of heart failure. Dizziness can occur, especially when the medication is started. The BP is a desired reading.

235. The male client diagnosed with hypertension has epistaxis and a flushed face. Which action should the nurse implement first? 1. Notify the client's HCP. 2. Assess the client's blood pressure lying, standing, and sitting. 3. Elevate the client's head of the bed. 4. Prepare to administer an intravenous antihypertensive medication.

Correct answer 2: The client is exhibiting signs of a hypertensive crisis; therefore; the nurse should check the client's blood pressure. Epistaxis is a nosebleed. Elevating the head of the bed (option 3), administering antihypertensive medication (option 4), and notifying the HCP (option 1) should be done in this order.

233. Which family of drugs are the following medications considered: Amlodipine, Verapamil, Diltiazem? A. Beta blockers (BB) B. ACE Inhibitors (ACEI) C. Angiotension Receptor Blockers (ARBs) D. Calcium Channel Blockers (CCBs)

D. Calcium Channel Blockers (CCBs)

230. A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description? A. venous ulcer B. arterial ulcer C. diabetic ulcer D. deep pressure Injury

The answer is A. These findings are associated with a venous ulcer.

231. You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient? A. "It is important I quit smoking." B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad. C. "A walking program would be beneficial in treatment of my PAD." D. "I will avoid wearing tight socks or shoes."

The answer is B. The patient should try to prevent the feet and legs from getting too cold because this causes vasoconstriction, which impedes blood flow further. Therefore, they should dress warmly with LOOSE layers. However, they should AVOID using heating pads because of the reduce of sensation from compromised blood flow. A walking program is a great way to prevent intermittent claudication, lower the cholesterol, and improve oxygen levels in the blood....which are all great ways of treating PAD.

225. Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the? A. Dependent position B. Horizontal position C. Elevated position above heart level D. Knee-flexed position

The answer is C. Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower extremities and can't flow back to the heart. Therefore, the patient is experiencing dull and achy sensations along with edema and brownish pigmentation. The nurse should place the patient's lower extremities in the elevated position above the heart to help facilitate blood return to the heart and alleviate the pain.

227. Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks: A. cyanotic; rubor B. rubor; pallor C. cyanotic, pallor D. pallor; rubor

The answer is D. In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position (dangling) they will appear rubor (red and warm...this occurs due to inflammation of the vessels).

229. Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply: A. Thick, tough B. Thin, scaly C. Hairless D. Brown pigmented

The answers are A and D. This is commonly found in severe peripheral venous disease. Options B and C are found in peripheral ARTERIAL disease.

226. You're assessing a patient's health history for peripheral vascular disease. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease? Select all that apply: A. "I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." B. "If I stand or sit too long my legs start to feel heavy and achy." C. "It hurts to elevate my legs." D. "Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away."

The answers are A, C, and D. Peripheral arterial disease occurs when there is impediment of blood flow to the lower extremities (hence the lower extremities are being deprived of blood flow and this causes pain). The pain most commonly occurs at night and can wake up the patient. It is known as "rest pain". This occurs because when the legs are horizontal the blood flow is compromised and it causes pain...therefore the patient will report they dangle the leg off the bed to help ease the pain (the dependent position (dangling) will help blood flow down to the extremity). In addition, it hurts to elevate the legs (again because this further compromises blood flow). Option B occurs in peripheral venous disease. Option D is known as intermittent claudication and is a HALLMARK sign and symptom in PAD.

228. A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply: A. Elevate the lower extremities below heart level frequently B. Application of compression stockings C. Limit long periods of standing and sitting D. Use the knee-flexed position while lying in bed

The answers are B and C. The patient with peripheral VENOUS disease should elevate the lower extremities ABOVE heart level (this helps return blood to the heart and decrease swelling/pain), avoid crossing the legs (or the knee-flexed position) because this impedes blood flow, and limit long periods of standing and sitting (this limits blood return to the heart and increases swelling). In addition, the application of compression stockings is very beneficial in peripheral venous disease because it helps blood return to the heart and prevents the stasis of blood in the lower extremities.

194. What signs and symptoms below would demonstrate a patient is experiencing an overdose of a beta blocker medication? Select all that apply: A. Blood pressure 200/110 B. Heart rate 35 beats per minute C. EKG shows atrial fibrillation with rapid ventricular rate (RVR) D. Patient is maniac and agitated E. Dyspnea F. Patient is severely drowsy G. EKG shows 3rd degree AV block

The answers are B, E, F, and G. Signs and symptoms of beta blocker overdose would be the opposite of the effects of the sympathetic nervous system. Beta blockers slow down the heart rate (overdose: severe bradycardia...heart rate of 35 and heart block 2nd or 3rd degree), decrease blood pressure (overdose: severe hypotension), and severely drowsy (due to very slow heart rate and decreased cardiac output to the brain).

192. The nurse is caring for a group of clients on a Telemetry unit. When providing client education, which client will the nurse determine most needs information regarding preventing pulmonary embolism(PE)? a. A woman who frequently flies to Europe (prolonged travel) b. A man who works on a farm c. A man admitted for a myocardial infarction d. A woman with a bleeding disorder

a. A woman who frequently flies to Europe (prolonged travel) Individuals who engage in prolonged and frequent air travel are at higher risk for PE due to the dependent position of the legs during long air flights. A 67-year-old man who works on a farm poses a low risk due to his active lifestyle. A myocardial infarction is caused by a thrombus or occlusion of the coronary arteries, not of the leg veins. If the MI client is on prolonged bedrest, the client's risk is increased. PE is a clotting disorder, not a bleeding disorder.

189. A client is on intravenous heparin to treat a pulmonary embolism. The clients most recent partial thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate? a. Decrease the heparin rate. b. Increase the heparin rate. c. No change to the heparin rate. d. Stop heparin; start warfarin (Coumadin)

b. Increase the heparin rate. For clients on heparin, a PTT of 1.5 to 2.5 times the normal value is needed to demonstrate the heparin is working. A normal PTT is 25 to 35 seconds, so this clients PTT value is too low. The heparin rate needs to be increased. Warfarin is not indicated in this situation.

191. A client is being discharged soon on warfarin (Coumadin). What menu selection for dinner indicates the client needs more education regarding this medication? a. Hamburger and French fries b. Large chef's salad and muffin c. No selection; spouse brings pizza d. Tuna salad sandwich and chips

b. Large chef's salad and muffin Warfarin works by inhibiting the synthesis of vitamin Kdependent clotting factors. Foods high in vitamin K thus interfere with its action and need to be eaten in moderate, consistent amounts. The chefs salad most likely has too many leafy green vegetables, which contain high amounts of vitamin K. The other selections, while not particularly healthy, will not interfere with the medications mechanism of action

188. A nurse answers a call light and finds a client anxious, short of breath, reporting chest pain, and having a blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse takes priority? a. Assess the clients lung sounds. b. Notify the Rapid Response Team. c. Provide reassurance to the client. d. Take a full set of vital signs.

b. Notify the Rapid Response Team. This client has manifestations of a pulmonary embolism, and the most critical action is to notify the Rapid Response Team for speedy diagnosis and treatment. The other actions are appropriate also but are not the priority.

187. Nifedipine (Procardia) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that Procardia will a. help to prevent clotting in the coronary arteries. b. decrease spasm of the coronary arteries. c. increase the force of myocardial contraction. d. reduce the "fight or flight" response.

b. decrease spasm of the coronary arteries. Rationale: Prinzmetal's angina is caused by coronary artery spasm. Calcium-channel blockers (e.g., nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors, such as aspirin, help to prevent coronary artery thrombosis, and β-blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

232. The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day.

c. Bleeding may increase when taken with aspirin.

193. The nurse is developing a plan of care for a client with pulmonary embolism (PE). Which client problem does the nurse establish as the priority? a. Inadequate nutrition related to food-drug interactions with anticoagulant therapy b. Risk for infection related to leukocytosis c. Hypoxemia related to ventilation-perfusion mismatch d. Insufficient knowledge related to the cause of PE

c. Hypoxemia related to ventilation-perfusion mismatch The client problem given priority by the nurse is hypoxia related to ventilation-perfusion mismatch. Restoring adequate oxygenation and tissue perfusion takes priority. Obstruction of blood flow through the pulmonary artery or branches impairs ability of the alveolus to deliver oxygen to the left side of the heart; the resulting hypoxemia may be profound. Initially the client breathes more rapidly and eliminates CO2 causing respiratory alkalosis. A large PE causes hypoventilation and prolonged hyperventilation causes muscle fatigue and hypoventilation; hypoventilation leads to respiratory acidosis. Although nutrition must be addressed, priorities include airway, breathing, and circulation. The client has a leukocytosis, elevated WBC count, an expected response to lung inflammation. Leukopenia places clients at risk for infection, but neither is the priority at this time. Education as to the cause of PE must be postponed until oxygenation and hemodynamic stability are ensured.

190. A client has a pulmonary embolism and is started on oxygen. The student nurse asks why the clients oxygen saturation has not significantly improved. What response by the nurse is best? a. Breathing so rapidly interferes with oxygenation. b. Maybe the client has respiratory distress syndrome. c. The blood clot interferes with perfusion in the lungs. d. The client needs immediate intubation and mechanical ventilation.

c. The blood clot interferes with perfusion in the lungs. A large blood clot in the lungs will significantly impair gas exchange and oxygenation. Unless the clot is dissolved, this process will continue unabated. Hyperventilation can interfere with oxygenation by shallow breathing, but there is no evidence that the client is hyperventilating, and this is also not the most precise physiologic answer. Respiratory distress syndrome can occur, but this is not as likely. The client may need to be mechanically ventilated, but without concrete data on FiO2 and SaO2, the nurse cannot make that judgment.