Quizes from class (will be on TEST)
The nurse is teaching a certified nursing assistant about the percentage of oxygen delivered through a nasal cannula. She explains that with 3L nasal cannula the patient receives what percentage of O2? 30% 21% 18% 60%
30%
The nurse is assessing a client with COPD. She is calculating the client's smoking pack-years. The client tells her that he has smoked 2 packs of cigarettes (40 cigarettes) a day for 20 years. The nurse calculates his pack-years as which of the following? 10 years 15 years 20 years 40 years
40 years Number of cigs daily/20 x # of years smoking 2/20x20= 40 (one of these will be on the TEST)
A patient comes to the emergency department in acute decompensated hate heart failure. The patient is very anxious, with a respiratory rate of 30/minute and pink frothy sputum. After placing the patient oxygen via nasal cannula which of the following actions is the next priority? Administer digoxin .025 mg PO Initiate dopamine infusion at 5mcg/kg/min Administer furosemide (lassix) 40mg IV push Obtain an arterial blood gas
Administer furosemide (lassix) 40mg IV push This is left sided heart failure, the pink frothy sputum is due to blood pooling in the lungs They need to pee out the excess-Diuretic =Furosemide (lassix)
Risk factors for BPH (benign prostatic hypertrophy) include: (PROBS ON TEST) Smoking ETOH use Obesity Decreased activity All of the answers are correct
All of the answers are correct All of these can result in hormone changes (androgen stimulation (prof of cells)
When a patient has long-term a-fib, the nurse would expect to include which drug in the plan of care to minimize the greatest risk that is commonly associated with a-fib? Anticoagulants Beta blockers Digoxin Antiarrythmics
Anticoagulants In this condition the heart isn't pumping properly and can start to pool and form clots
The nurse understands that all of the following arrhythmias require defibrillation except: Ventricular Fibrillation Ventricular Tachycardia Torsades de Pointes Asystole
Asystole
The nurse is teaching the parents the teenager just diagnosed with prolonged OT syndrome about the potential dangers of prolonged QT. She explains that there is a risk of which of the following? Cardiac arrest PVC's Heart Failure Valve disease
Cardiac arrest Long QT can also lead to Torsade's, V-fib, and cardiac arrest (SUDDEN DEATH).
The nurse understands that the leading cause for chronic renal failure is: Diabetes Infection Hypertension Heart Failure
Diabetes Diabetes-Intra renal failure Infection-Intra renal failure Hypertension- Pre renal failure Heart Failure-Pre renal failure. LT sided heart failure- LT ventricle is failing and cant pump blood out to the body- hence the kidneys are deprived of necessary nutrients. Post renal failure- BPH and kidney stones
What is the leading post infectious cause of glomerulonephritis? E coli infection C difficile infection Staphylococcus infection Group A streptococcal infection
Group A streptococcal infection This is usually gotten from untreated strep throat infection. get infection-don't get treated- overproduction of antibodies are created- these get stuck in the glomerulus- leads to inflammation in the glomerulus- glomerulonephritis glomerulonephritis is not so much an infection but inflammation due to antibody build up E.coli is the most common cause of UTI, as it lives in stool (clean properly) ,and urethra is shorted even more in pregnancy.
While auscultating the patient's heart, the nurse notes a murmur at the 2nd intercostal space, right sternal border. The patient reports no previous history of murmurs. The nurse understands that if left untreated a stenosis (means narrowing) of this affected valve could result in all of the following except: Jugular venous distension Pulmonary edema Left ventricular hypertrophy Decreased cardiac output
Jugular venous distention This is a sign of LT sided HF The 2nd intercostal space, right sternal border is listening to the Aortic Valve •Will hear aortic on RT side but it causes increased pressure on LT vent= LT heart failure •Will Hear Pulmonic on LT but will more likely to lead to RT heart failure. All Patient take meds Aortic Pulmonic Tricuspid Midclavicular
A patient who is admitted to the cardiac care unit with markedly elevated blood pressure and heart failure is receiving a continuous infusion of nitroprusside. Thirty minutes later, the client appears pale, with cold, clammy skin and reports being lightheaded. Which is the priority nursing action? Auscultate the patient's lungs. Check the patient's capillary refill. Review the patient's echocardiogram. Measure the patient's blood pressure.
Measure the patient's blood pressure.
The nurse understands that all the following are S/S of left sided heart failure except: Dyspnea on exertion Peripheral edema Hemoptysis Orthopnea
Peripheral edema This is RT sided heart failure- its not pumping well and backing up into the inferior or superior vena cava back into the body Signs of LT sided backs up into the pulmonary: Hemoptysis (Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes.) Orthopnea Dyspnea on exertion LT sided heart failure leads to RT sided heart failure
Which renal disease state has no cure and eventually results in kidney failure? Acute pyelonephritis Acute renal injury Polycystic kidney disease Acute glomerulonephritis
Polycystic kidney disease Autosomal dominant -a single copy of the disease-associated mutation is enough to cause the disease. No cure- mainly management Others are treatable
A nurse is assessing a client with status asthmaticus and has the following ABG results: pH 7.32, PaCo2 56 mmHg, HCo3 26 mEq/L. The nurse should interpret these laboratory values as which of the following imbalances? Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
Respiratory Acidosis (uncompensated)
The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? Sitting up and leaning on an overbed table Sitting up in bed Sitting in a recliner chair Side-lying in bed
Sitting up and leaning on an overbed table rationale: Positions that will assist the client with emphysema with breathing include sitting up and leaning on an overbed table, sitting up and resting the elbows on the knees, and standing and leaning against the wall.
Calculation of Glomerular Filtration Rate includes: Creatinine level, age, race and gender. True False
True Liver metabolizes meds, Kidneys excrete meds Creatine will increase with age- be careful with meds be sure PT can take them
At which stage of renal function is a patient eligible for renal transplant? (ON TEST) Stage 1- >90mL/min- Normal renal function Stage 2- 60-89mL/min- mild decrease in GFR Stage 3- 30-59mL/min- moderate decrease in GFR Stage 4- 15-29 mL/min-severe decrease in GFR Stage 5- <15mL/min- ESKD or Chronic Renal Failure
Stage 4- 15-29 mL/min-severe decrease in GFR <25Ml/min Stage 1 is good stage 5 is bad At Stage 5- <15mL/min- ESKD or Chronic Renal Failure they will need dialysis- this is basically syphoning off all of the bad chemicals- which normally kidneys do for you
The nurse is performing a respiratory assessment on a client. The nurse has the client repeat "99" while the nurse places her hands on the client's back. The nurse is checking for which of the following? Crackles COPD Tactile Fremitus Crepitus
Tactile Fremitus Tactile fremitus refers to the palpable vibration of the chest wall that results from the transmission of sound vibrations through the lung tissue to the chest wall. ... Tactile fremitus typically has a greater intensity in areas of increased lung density, such as a consolidated lung. What is a lung consolidation? Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water. a solid, such as stomach contents or cells.
The patient was diagnosed with hypertension 6 months ago and had a recent emergency department visit for a transient ischemic attack (TIA). The patient's blood pressure is 170/88mm Hg. What teaching topic is a priority for the nurse to discuss with the patient? Increasing activity levels. Taking blood pressure medications as prescribed. Decreasing stress levels at work and home. Decreasing sodium intake.
Taking blood pressure medications as prescribed. Priority. This BP is stage 2
The nursing student knows that healthy kidneys do the following physiologic/metabolic functions: (WILL BE ON TEST) (Select all that apply) a Balance electrolytes b Production of T-Lymphocytes c Blood pressure management d Synthesis of coagulation factors e Synthesis of vitamin D f Stimulates production of RBCs
a Balance electrolytes (K, Ca, Phosphorous) c Blood pressure management (RAAS SYSTEM)- has many BP monitors in Kidneys Renin, aldosterone, angiotensin 1, angiotensin 2 e Synthesis of vitamin D cannot absorb calcium without this f Stimulates production of RBCs (erythropoietin lots of athletes dope on this) Liver does Synthesis of coagulation factors Thymus does Production of T-Lymphocytes
The nurse understands that positive pressure ventilation devices such as CPAP and BiPAP are able to deliver PEEP to a patient. PEEP stands for: a Pertinent Expiratory End Pressure b Positive End Expiratory Pressure c Positive Exertional Effect in Patients d Pressures Ensuing Exhalation Phase
b Positive End Expiratory Pressure
Goals of renal calculi management include all of the following except: Pain management Clearance of calculi Increase protein intake to promote nephron healing Prevent nephron destruction
Increase protein intake to promote nephron healing Proteins puts extra stress on kidneys Decrease proteins, sodium, etc All others are true. Clearance takes place by Fluids, ,and 2 meds in study guide. To help prevent future kidney stones: diet avoid PURINES
While osculating the patient heart, the nurse notes a mummer at the 2nd intercostal space, right sternal border The nurse understands that a murmur is most likely effecting which valve? (SEE PIC) Aortic Mitral Pulmonary Tricuspid
Aortic All Patient take meds Aortic (2nd intercostal space, right sternal border) Pulmonic (2nd intercostal space, left sternal border) Tricuspid (lower left sternal border 4th intercostal) Midclavicular (left 5th intercostal medial to interclavicular line)
The nurse is assessing a client with asthma who is restless, tachypneic, and diaphoretic. The nurse does not hear any breath sounds upon auscultating the client's chest. Which of the following should the nurse do first? Call a rapid response Give PO Prednisone STAT Give aspirin immediately to help decrease inflammation in the airway Have the client assume tripod position and slow his breathing
Call a rapid response No breath sounds means they are not moving any air in or out. No point in giving meds if air way is so tight nothing is going in or out. diaphoretic- sweating profusely
The nurse has completed an assessment on a client with decreased cardiac output. Which findings should receive highest priority? Confusion, urine output of 15ml over last 2 hours, orthopnea. BP 110/62, a-fib with HR of 82, bibasilar crackles. SpO2 92% on 2 L nasal cannula, RR 20, 1+ edema bilateral lower extremities. Weight gain of 1kg in 3 days, BP 130/80, mild dyspnea with exercise.
Confusion, urine output of 15ml over last 2 hours, orthopnea. b. A low urine output and confusion are signs of decreased tissue perfusion. Orthopnea is a sign of left-sided heart failure. Crackles, edema and weight gain should be monitored closely, but the levels are not as high a priority. With atrial fibrillation there is a loss of atrial kick, but the blood pressure and heart rate are stable This is potentially low cardiac output The normal range of urine output is 800 to 2,000 milliliters per day
The nurse is assessing a client and auscultates the client's chest. She hears a harsh, high-pitched sound over the trachea. Which of the following should the nurse do next? Continue with the Assessment Immediately notify the Provider Assess the patient for tracheal deviation Apply supplemental Oxygen
Continue with the Assessment This is a normal finding in the trachea, if you hear these sounds over the broucus you should be more concerned.
The nurse is caring for a patient who presents with suprapubic pain, urinary urgency and burning. The patient denies the presence of fever, hematuria or flank pain. The nurse understands that this patient is most likely experiencing: Cystitis Pyelonephritis Glomerulonephritis Renal calculi
Cystitis (inflammation of the bladder) Suprapubic pain happens in your lower abdomen nearwhere your hips and many important organs, such as your intestines, bladder, and genitals, are located
Complications of chronic pyelonephritis include all of the following except: Decreased BUN and creatinine Kidney stone formation Hypertension End stage kidney disease
Decreased BUN and creatinine Direct kidney damage would cause an increase to BUN and creatinine- as well as the others
Restrictive Airway Disease involves all of the following except: Decreased Pulmonary Elasticity Decreased vital capacity Impaired Exhalation Impaired Inhalation
Impaired Exhalation (its easier to breath in through a straw than it is out through a straw) (CANT GET AIR OUT) Restrictive Airway Disease is impaired inhalation. Narrowing of the airways (LIKE breathing through STRAW, CANT get air IN). Restrictive airway vs obstructive. Restrictive airway disease=impaired inhalation Reasons for impaired inhalation Damaged chest wall Damaged connective tissue (sarcardosis, pulmonary fibrosis, muscular dystrophy) Scoliosis
The nurse is admitting a client with right sided heart failure secondary to pulmonary hypertension. What clinical manifestations are most likely found? Decreased abdominal girth Crackles in the lungs Jugular venous distension Orthopnea
Jugular venous distension JVD is RT sided heart failure. All the other options are signs of LT sided heart failure
The nurse is caring for a client on a cardiac monitor, she is noticing frequent PVCs. She reviews the patient's morning labs. Which lab value is the nurse most concerned about? Potassium 2.8 mEq/L Calcium 8.8 mg/dL Sodium 134 mEq/L Phosphorus 4 mg/dL
Potassium 2.8 mEq/L Normal K= 3.5-5.0 Hypokalemia causes PVC's
The nurse instructs a client to use the pursed-lip method of breathing and evaluates the teaching by asking the client about the purpose of this type of breathing. The nurse determines that the client understands if the client states that the primary purpose of pursed-lip breathing is to promote which outcome? Promote oxygen intake Promote carbon dioxide elimination Strengthen the diaphragm Strengthen the intercostal muscles
Promote carbon dioxide elimination Purse lips while breathing out- prolong expiration, and gets lower alveoli involved This is useful for COPD (air trapped in the lungs) Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options 1, 2, and 3 are not the purposes of this type of breathing.
The home care nurse visits her elderly client. Which assessment finding is most concerning? The patient has new dependent edema of the feet. The patient has strong, foul smelling urine. The patient cannot remember what was done yesterday. The patient has a painful red area on the buttocks.
The patient has new dependent edema of the feet Indicative of new heart failure (ABC)