Prep u questions
A nurse and a nursing student are caring for a client with pericarditis and perform the physical assessment together. The client has a pericardial friction rub audible on auscultation. When the nurse and student leave the room, the student asks how to distinguish a pericardial from a pleural friction rub. The nurse's best response is which of the following
"Ask the client to hold the breath while you auscultate; the pericardial friction rub will continue, while the pleural friction rub will stop.
A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which of the following explanations from the nurse would be most accurate?
"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following?
"Hypertension often causes no symptoms."
A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures
"I have my wife look at the soles of my feet every day"
A nurse is teaching an elderly client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?
"I need to use laxatives regularly to prevent constipation"
A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test?
"I'll avoid eating or drinking anything 6 to 8 hours before the test.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?
"Maintain a moderate exercise program."--->The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.
During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
"You must avoid hyperextending your neck after surgery" --->To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing
The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following?
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."---> Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion.
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen?
10 to 14 days
nurse is receiving report from the emergency room regarding a new client being admitted to the medical-surgical unit with a diagnosis of peptic ulcer disease. The nurse expects the age of the client will be between
40 and 60 years
Which of the following diagnostic tests are done to determine suspected pituitary tumor?
A computer tomography scan CT-->A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. However, measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
A female client, aged 82, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand.------>A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. You would not teach the client to take the medicine on an empty stomach. (less)
Over secretion of GH- growth hormone
Acromegaly
A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems?
Acute gastritis
Under secretion of ACTH
Addisons
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?
Adminiistering 1 ampule of 50 % dextrose solution per physcian order
A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first?
Administer 50% glucose intravenously-->The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth.
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.---->Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the physician before completing the initial assessment is premature
A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?
Administering large doses of IV antibiotics as ordered
A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?
Administering morphine IV as ordered
The nurse is providing care to a client following a knee arthroscopy. Which of the following would the nurse expect to include in the client's plan of care?
Administering the prescribed analgesic-->After an arthroscopy, the client's entire leg is elevated without flexing the knee. A cold pack is placed over the bulky dressing covering the site where the arthroscope was inserted. A prescribed analgesic is administered as necessary. The client is allowed to resume his or her usual diet as tolerated.
The sounds of sirens announce the arrival of the latest trauma to address the trauma center where you practice nursing. Your heart is pounding, your mouth is dry. What gland is responsible for your physiologic response?
Adrenal glands-->The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response
Which of the following hormones controls secretion of adrenal androgens?
Adrenocorticotropic hormone ACTH--->ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
Which of the following digestive enzymes aids in the digesting of starch?
Amylase
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an:
Anticoagulant
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment?
Assess the client's level of pain and administer prescribed analgesics.
Which condition most commonly results in coronary artery disease?
Atherosclerosis--->Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.
Which medication is the drug of choice for sinus bradycardia?
Atropine
Treatment of symptompatic bradycardia includes which of the following?
Atropine--->Treatment of symptomatic bradycardia includes transcutaneous pacing and atropine. Lidocaine may be used in the treatment of ventricular fibrillation. Cardioversion and Adenocard may be used in patients diagnosed with atrial flutter.
A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to
Ausculate lung sounds every 4 hours
A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the:
Beta cells of the pancreas-->The beta cells of the pancreas secrete insulin. The adenohypophysis, or anterior pituitary gland, secretes many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism.
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?
Bone Fracture
Acromegaly Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?
Buldging forehead-->Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet. Excessive urine output, weight loss, and constant thirst are associated with diabetes insipidus.
The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea?
By questioning how many pillows the client normally uses for sleep-->The nurse should ask the client about nocturnal dyspnea by questioning how many pillows the client normally uses for sleep. This is because being awakened by breathlessness may prompt the client to use several pillows in bed. Collecting the client's urine output, observing the client's diet, or measuring the client's abdominal girth does not help assess for nocturnal dyspnea
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering?
Calcium gluconate--->Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.
The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD.
Chest pain, weight gain, fatigue-->Chest pain, weight gain, fatigue, dizziness, ascites, and confusion are all symptoms of CVD. Rash, extra-ocular eye movements, ecchymosis, and petechiae are not usually indicative of CVD.
You are caring for a client with a damaged tricuspid valve. You know that the tricuspid valve is held in place by which of the following?
Chordae tendineae
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
Cirrhosis
Which of the following clients is at highest risk for peptic ulcer disease?
Client with blood type O
A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?
Constant, intense back pain and falling BP
A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:
Consuming a low carb- high protein diet and avoiding fasting--->To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following?
Continuous IV infusion-->The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion
A client comes to the Emergency Department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client?
Coronary artery disease
Over secretion of ACTH
Cushings
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?
D
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output
During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?
Decreased cardiac output
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of:
Deficient knowledge----> The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.
As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client?
Demonstrate hoe to apply and remove elastic support stockings
Under secretion of ADH
Diabetes insipidus
A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?
Diarrhea
Which suggestion would be most important to give a client who has a mild case of bunions?
Don prper footweat
Under secretion of GH- growth hormone
Dwarfism
Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred?
Echocardiogram--->An echocardiogram is recommended method of determining whether hypertrophy has occurred. ECG and blood chemistry are part of the routine work up. Renal damage may be suggested by elevations in BUN and creatinine levels.
The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?
Echocardiography
A 65-year-old client has come to the emergency department reporting lightheadedness, chest pain, and shortness of breath. As you finish your assessment, the physician enters and orders tests to ascertain what is causing the client's problems. In your client education, you explain the tests. Which test is used to identify cardiac rhythms?
Electrocardiogram
The nurse is to administer a cyclic feeding through a gastric tube. It is most important for the nurse to
Elevate the head of bed to 45 degrees
Which of the following nursing action would the nurse include when caring for a client with endemic goiter and experiencing respiratory symptoms?
Elevating the head of the bed-->The nurse should monitor the respiratory status and elevate the head of the bed to relieve respiratory symptoms. A high-iodine diet does not relieve respiratory distress. Although proper air circulation in the room and avoiding physical exertion may be important, these actions do not address the respiratory symptoms.
Which dietary modification is utilized for a patient diagnosed with acute pancreatitis?
Elimination of coffee
You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels?
Enzymes---->When tissues and cells break down, are damaged, or die, great quantities of certain enzymes are released into the bloodstream. Enzymes can be elevated in response to cardiac or other organ damage. After an MI, RBCs and platelets should not be elevated. WBCs would only be elevated if there was a bacterial infection present.
A 76-year-old client has a significant history of congestive heart failure. During his semiannual cardiology examination, for what should you, as his nurse, specifically assess? Choose all correct options.
Examine the client's neck for distended veins, monitor the client for signs of lethargy or confusion---->During a head-to-toe assessment of a client with congestive heart failure, the nurse checks for dyspnea, auscultates apical heart rate and counts radial heart rate, measures BP, and documents any signs of peripheral edema, lethargy, or confusion
Which of the following would the nurse expect to find in a client with severe hyperthyroidism?
Exopthalmos--->Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
The nurse prepares to auscultate heart sounds. Which nursing interventions would be most effective to assist with this procedure?
Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard
Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)?
Fatigue---> is an early warning symptom
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis?
Glucagon--->Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.
Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed
Heart transplant
Which of the following is the most common complication associated with peptic ulcer?
Hemorrhage
Jack Donohue, a 62-year-old stock broker, attends his annual physical appointment and indicates physical changes since his last examination. He reports chest pain and palpitation during and after his morning jogs. Jack's family history reveals includes coronary artery disease. His lipid profile reveals his LDL level to be 122 mg/dl. Which of the following correctly states the Jack's condition?
High LDL level----->LDL levels above 100 mg/dl are considered high. The goal is to decrease the LDL level below 100 mg/dl
Diet therapy for patients diagnosed with IBS include which of the following?
High fiber diet
Diet therapy for patients diagnosed with IBS include which of the following?
High-fiber diet
A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis?
History of aortic valve replacement
A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?
Homan's---->A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.
Over secretion of TSH
Hyper thyroid
Over secretion of PTH
Hyperparathroidism
Wallace Guterman, a 36-year-old construction manager, is being seen by a physician in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet and frequent headaches. What could be causing his symptoms?
Hyperpituitarism--->Acromegaly is a condition in which GH is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
A blood pressure of 140/90 mm hg is considered to be
Hypertension--->A BP of 140/90 mm Hg or higher is hypertension. A blood pressure of less than 120/80 mm Hg is considered normal. A BP of 120 to 129/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.
Under secretion of PTH
Hypo parathyroidism
Under secretion of TSH
Hypo thyroid
An elderly patient diagnosed with diarrhea is taking digoxin (Lanoxin). Which of the following electrolyte imbalances should the nurse be alert to?
Hypokalemia
The pharmacology instructor is diagramming the nervous and endocrine systems. What organ would the instructor diagram as the connector between the nervous and endocrine systems?
Hypothalamus-->The hypothalamus is the coordinating center for the nervous and endocrine responses to internal and external stimuli. The pituitary, thyroid, and parathyroid glands all play an important role in hormones, but do not connect the nervous and endocrine systems
When describing abdominal hernias to a group of nursing students, the instructor would identify which type as most common?
INguinal
You enter your client's room and find them pulseless and unresponsive. What would be the treatment of choice for this client?
Immediate defibrillation--->Defibrillation is used during pulseless ventricular tachycardia, ventricular fibrillation, and asystole (cardiac arrest) when no identifiable R wave is present.
A patient diagnosed with a pericarditis and pericardial effusion. Based on the physiologic mechanisms of increased pericardial fluid and its effect on the heart, which of the following effects would be expected?
Inability of the ventricles to distend and fill adequately---->An increase in pericardial fluid raises the pressure within the pericardial sac and compresses the heart. This causes increased right and left ventricular end-diastolic pressures, decreased venous return, and inability of the ventricles to distend and fill adequately
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?
Inadequate tissue perfusion
A nurse is discussing pharmacologic therapy used in the treatment of coronary vascular disease with a nursing student. The nurse would be correct in identifying the use of a positive inotrope as having which of the following functions?
Increase in myocardial contractility--> A positive inotrope is a medication that increases myocardial contractility (force of contraction). Medications that increase the heart rate are positive chronotropes. Negative chronotropic medications decrease the heart rate. Negative chronotropes decrease myocardial contractility
A nurse is discussing pharmacologic therapy used in the treatment of coronary vascular disease with a nursing student. The nurse would be correct in identifying the use of a positive inotrope as having which of the following functions?
Increase in myocardial contractility-->A positive inotrope is a medication that increases myocardial contractility (force of contraction). Medications that increase the heart rate are positive chronotropes. Negative chronotropic medications decrease the heart rate. Negative chronotropes decrease myocardial contractility
Margaret Lawson, a 52-year grocery clerk, has been experiencing a decrease in serum calcium. She has undergone diagnostics and her physician proposes her calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone?
Increase serum calcium level--->The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
Increasing fluid intake to prevent dehydration
A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?
Insulin is absorbed more rapidly at abdominal injection site then others
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes?
Insulin production insuficent
NPH is an example of which type of insulin?
Intermediate acting
A new client has been admitted with right-sided heart failure. The nurse knows to look for which of the following assessment findings when assessing this client?
Jugular vein distention--->When the right ventricle cannot effectively pump blood from the ventricle into the pulmonary artery, the blood backs up into the venous system and causes jugular venous distention and congestion in the peripheral tissues and viscera. All the other choices are symptoms of left-sided heart failure.
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.
Kidney, prostate, lung, breast, ovary
An 83-year-old client is undergoing lipid profile studies in an effort to determine a proper nutritional balance for his CAD. In his lipid profile, his LDL is greater than his HDL. Why is this a risk factor for this client?
LDL sticks to arteries
A 68-year-old resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. She receives nutrition via a PEG tube. The client remains physically and socially active and has adapted well to the tube feedings. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. Which of the following is the most likely cause of this client's constipation?
Lack of free water intake
Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for receiving oxygenated blood from the lungs
Left atrium--> The left artrium receives oxygenated blood from the lungs
Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for pumping blood to all the cells and tissues of the body?
Left ventricle
Which of the following is an inaccurate clinical manifestation of a fracture?
Lengthening
Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?
Leukocytosis and localized bone pain
The preferred preparation for treating hypothyroidism includes which of the following?
Levothyroxine (Synthroid)
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?
Limiting my salt intake to 2 grams per day will improve my blood pressure."
The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?
Loss of arterial elasticity
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?
Measure abdominal girth according to a set routine
Swallowing is regulated by which area of the central nervous system (CNS)?
Medulla oblongata
When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure?
Methylprednisolone (Solu-Medrol)---->Prior to cardiac catheterization, the patient is assessed for previous reactions to contrast agents or allergies to iodine-containing substances, as some contrast agents contain iodine. If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed. Lasix, Ativan, and Dilantin do not counteract allergic reactions.
Which of the following would be most important to ensure that a client does not retain any barium after a barium swallow?
Monitoring stool passage and its color
A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit?
Moon face---->Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except:
Morphine IV-->Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine.
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma
A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities?
Participate in regular walking program-->Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.
Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome?
Pericardial friction rub
Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome?
Pericardial friction rub--->The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.
A 36-year-old mother of six has been recently diagnosed with type 2 diabetes. She reports increased hunger and food consumption while continuing to lose weight. What is the term used to describe this condition?
Polyphagia
the nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures
Prednisone (Deltasone)
The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care?
Provide frequent mouth care
A client is being assessed for his semiannual examination and you hear crackles bilaterally in his lungs. Which of the following could be a cause of crackles in the bases of his lungs
Pulmonary congestion--> crackles heard in the bases of the lungs are signs of pulmonary congestion
You are the clinic nurse doing assessments on your clients before they have outpatient diagnostic testing done. What would you document when assessing the client's pulse?
Rate, quality, and rhythm
Which of the following terms is given to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) with the discontinuation of therapy?
Rebound-->Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.
Decreased pulse pressure reflects
Reduced stroke volume
Medical management of cardiac failure, whether it is right-sided or left-sided, demonstrates similar methodology. Measures such as dietary modifications, lifestyle changes, medications to reduce dyspnea and relieve anxiety, etc. are all used with one primary intention. What is the primary goal in the medical management of heart failure?
Reducing cardiac workload
Which of the following is the most successful treatment for gastric cancer?
Removal of tumor
Which of the following nursing interventions is most appropriate when caring for a client with a nursing diagnosis of risk for injury related to side effects of medication (enoxaparin [Lovenox])?
Report any incident of bloody urine, stools, or both---->The client who takes an anticoagulant, such as a low-molecular-weight heparin, is routinely screened for bloody urine, stools, or both.
What is the most common cause of mitral stenosis
Rheumatic endocarditis
Over secretion of ADH
SIADH
Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency?
Scurvy
Which of the following terms describes high blood pressure from an identified cause, such as renal disease?
Secondary hypertension
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias?
Serum potassium level-->The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias.
The patient is on a continuous tube feeding. The tube placement should be checked every
Shift
The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits?
Short bones
The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following?
Signs and symptoms of bleeding
A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for the client?
Signs of hypoglycemia
A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient
Signs of hypoglycemia--->The nurse should observe the patient receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are the symptoms of diabetes mellitus.
A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client?
Signs of sepsis--->If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client
A 26-year-old client is returning for diagnostic followup. Her Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats per minutes. What type of dysrhythmia would you expect the cardiologist to diagnose?
Sinus tachycardia---->Sinus tachycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a faster than usual rate (100-150 beats/min)
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?
Six small meals daily with 120 ml fluid between meals
Of the following diuretic medications, which conserves potassium?
Spironolactone (Aldactone)---->Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia.
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion--->PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E
You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension?
Stroke
The nurse is preparing to examine the abdomen of a client complaining of a change in his bowel pattern. The nurse would place the client in which position?
Supine with knees flexed
In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?
Surgical debridement
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
Sweating, tremors and tachycardia
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Tetany-->Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstructio
Which of the following is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobble stone appearance
A class of beginning nursing students is learning about heart failure in their pathophysiology class. What should the students be taught is the reason for heart failure?
The heart cannot pump sufficient blood to meet the body's metabolic needs
Every shift you work in the hospital unit where you practice nursing, blood pressures are measured as a component of your policy-scheduled assessments. Much information can be gleaned from comparing blood pressure measurements. What does a blood pressure reading indicate
The measured BP reflects the ability of the arteries to stretch and fill with blood, the efficiency of the heart as a pump, and the volume of circulating blood.
A nurse is caring for a client with an intracapsular hip fracture. Identify the area where this client's fracture occurred
The round head
Which statement best describes the therapeutic action of loop diuretics?
They block sodium reabsorption in the ascending loop and dilate renal vessels.---> Loop diuretics block sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. They also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule.
Which of the following instructions should a nurse provide a patient with a history of rheumatic fever before the patient has any dental work done
To take prophylatic antibiotics
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set
Which of the following are assoicated with compartment syndrome
Trauma from accidents Surgery Casts Tight bandages crushing injuries
The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred
Troponin T and I---->After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.
Which of the following is also termed preinfarction angina?
Unstable angina
Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?
Vagus
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
Vitamin A
client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
Vitamin A
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?
Walk or perform weight-bearing exercises outdoors
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis?
Weight gain, decreased appetite, and constipation--->Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.
Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur?
Worsening angina
Which type of graft is utilized when a heart valve replacement is made of tissue from an animal heart valve?
Xenograft
The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include?
Your family and friends may want to take a CPR class-->Having friends and family learn to take a pulse and perform CPR will help patients to manage their condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness are symptoms which should be reported to the provide
Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity, which action by the nurse is most appropriate
administer medication as ordered for the reported discomfort
Which diagnostic test does the nurse expect the client with psteoporosis to undergo
dual-energy x ray absorption
The pt with a fractured left humerus reports dyspnea and chest pain, pulese ox 88%, temp 100.2, HR 110, resp 32. the nurse suspects the client is experiencing
fat embolism syndrome
Over secretion of Prolactin
hyperprolactinoma--> abnormal milk production
The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience
pain 2 to 3 hours after a meal
A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum?
ppyloric sphincter
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former arrangement
remodeling
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply
smoking, physical inactivity, diabetes mellitus