NURS 640 EXAM 2-with 100% verified solutions 2024-2025, Exams of Nursing

Download NURS 640 EXAM 2-with 100% verified solutions 2024-2025 and more Exams Nursing in PDF only on Docsity! NURS 640 EXAM 2-with 100% verified solutions 2024- 2025 The nurse is reviewing the medications prescribed for a client diagnosed with dilated cardiomyopathy. Which of the following medications are commonly prescribed for this disease process? ACE inhibitor to prevent further dilation of the heart, Beta-blocker to reduce the strain Diuretics Anticoagulants Antiarrhythmics A client is diagnosed with emphysema. For which of the following hematologic disorders should the nurse include in the assessment of this client? polycythemia caused by an increase in the number of red blood cells in response to a reduced amount of oxygen in the body Inpatient insulin dosing TDD 50% basal 50% prandial may need to add rapid acting for meal titrate 10-20% until goal met . The nurse is listening to the breath sounds of a patient with severe asthma. Air passing through narrowed bronchioles would produce which of these adventitious sounds? Wheezes Caused by air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors, such as with acute asthma or chronic emphysema Wheezes The nurse has just recorded a positive iliopsoas test on a patient who has abdominal pain. This test is used to confirm a(n): An inflamed or perforated appendix irritates the iliopsoas muscle, producing pain in the RLQ. S3 heart sound An auscultated S3 is a sign that increased blood volume remains in the ventricle with each beat and that the heart is beginning to fail S4 heart sound An S4 sound may indicate increased resistance to ventricular filling A client is diagnosed with heart failure. Which of the following diagnostic tests is useful to determine the degree of the failure? Brain natriuretic peptide is a hormone found in the left ventricle; it is used to help diagnose and grade the severity of heart failure Blood cultures used to diagnose carditis Sed Rate used to diagnose pericarditis A nurse is instructing a client regarding medications and substances contraindicated for the client with heart failure. Which of the following would not be contraindicated? Loop diuretics (e.g., furosemide) are part of the recommended medications for heart failure. Contraindications in HF A balloon valvuloplasty is done by inserting a catheter through the femoral vein or artery and stretching the valve open with a balloon. The nurse suspects a client is experiencing left-sided heart failure when which of the following is assessed? dysrhythmic heart rate, tachycardia, heart murmurs, extra heart sounds, lung crackles, and decreased basilar lung sounds .A client diagnosed with heart failure is prescribed furosemide (Lasix). Which of the following should this client be monitored for because of this medication? (Select all that apply.) dehydration, hyponatremia, and hypokalemia Which of the following should the nurse instruct a client diagnosed with hypertrophic cardiomyopathy? (Select all that apply.) Activity level, avoid overexertion, and avoid dehydration The nurse determines that a client diagnosed with pericarditis is demonstrating the classic signs of the Beck triad muffled heart sounds, elevated jugular vein pressure, and hypotension A client is experiencing an alteration in heart rate. The nurse realizes this client is experiencing a disorder of which part of the heart? The sinoatrial node is the dominant pacemaker of the heart. The sinoatrial node has an inherent rate of 60 to 100 bpm A client is suspected of having cardiac damage. The nurse realizes that which of the following diagnostic tests is most commonly used to help diagnose this clients possible cardiac damage or disease? A 12-lead electrocardiogram The nurse is analyzing a clients electrocardiogram tracing. Which of the following complexes is not normally seen on an electrocardiogram tracing? U wave It can indicate electrolyte imbalance, medication effects, and ischemia The nurse is analyzing a clients electrocardiogram tracing and realizes that each small square on the paper is equal to: 0.04 second 5.The nurse is reading an ECG rhythm strip and notes that there are nine QRS complexes in a 6- second strip. The heart rate is: multiplying the QRS complexes in a 6-second strip by 10 .The nurse notes that on a clients electrocardiogram tracing, there is one P wave for every QRS complex and a delay in the impulse transmission at the AV node. This regular rhythm is identified as: First-degree atrioventricular (AV) block A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This rhythm is identified as ventricular tachycardia. An elderly client is demonstrating a change in heart rate that occurs with respirations. When planning care for the client, the nurse knows that treatment may include Pacemaker insertion A clients electrocardiogram tracing shows a sawtooth pattern with F waves. The nurse realizes this client is demonstrating: A Flutter The electrocardiogram tracing for a client shows premature junctional complexes. Which of the following should the nurse do to assist this client? Check on the serum digoxin level Which of the following should the nurse instruct a client who has been diagnosed with an arrhythmia? symptom management, how to take own pulse, and substances to avoid the onset of an arrhythmia A client is diagnosed with supraventricular tachycardia. The nurse should prepare to administer which of the following medications? Adenosine A client diagnosed with acute myeloid leukemia is recovering from a bone marrow transplant. Which of the following nursing interventions would not be appropriate for this client? no anesthesia A client diagnosed with chronic disseminated intravascular coagulation is prescribed heparin. The nurse realizes that this medication is used to: interference with the clotting processes and the chance of preventing further overuse of clotting factors The nurse should assess a client diagnosed with multiple myeloma for which of the following electrolyte imbalances? Destruction of the bone leads to elevated calcium levels A client is receiving treatment for the diagnosis of hemophilia. Which of the following should the nurse assess in this client? joint and muscle pain d/t hemorrhages. A client, diagnosed with acute lymphoblastic leukemia, is receiving the first phase of chemotherapy. The nurse realizes this client is in which phase of treatment for the disorder Induction The nurse is encouraging a client diagnosed with chronic leukemia to join a support group. Which of the following would a support group address? Social isolation is a common concern A client is diagnosed with stage II Hodgkins lymphoma. The nurse realizes that this diagnosis means the disease is: limited to lymph nodes on the same side of the diaphragm. .A client is diagnosed with disseminated low-grade non-Hodgkins lymphoma. Which of the following treatments would be indicated for this client? Watch and wait standard treatment for intermediate-grade non-Hodgkins lymphoma. CHOP A client is diagnosed with G6PD anemia. Which of the following medications should the nurse instruct the client to avoid? (Select all that apply.) antimalarial drugs (e.g., chloroquine), common coal tar analgesics (including aspirin), nitrofurantoin, oral hypoglycemics, sulfonamides, thiazides, diuretics, and vitamin K 2.A client diagnosed with sickle-cell anemia is experiencing vaso-occlusive crisis. Which of the following interventions would be appropriate for this client? adequate hydration, oxygenation, adequate nutrition, rest, medications, management of fever and complications, and use of transfusions. A client is having diagnostic tests to determine the cause of anemia. The nurse realizes that these tests will focus on which of the following? (Select all that apply.) bleeding that results in red blood cell loss, 2) conditions that cause red blood cell destruction, and 3) conditions that cause a reduction in the number of red blood cells made by the body A client tells the nurse that he is anemic because of a poor diet. Which deficiencies cause nutritional anemias? Nutritional anemias can be caused by deficiencies in iron, folic acid, or vitamin B-12 Which of the following should the nurse instruct a client in order to reduce the risk factors for developing arteriosclerosis stop smoking The nurse is concerned that an elderly client has evidence of arteriosclerosis since the clients capillary refill is greater than: 5 seconds .When instructing a client on ways to lower his cholesterol levels, which of the following should the nurse include? Cholesterol is located in animal sources, so decreasing meat and eggs will lower cholesterol levels. A client diagnosed with arteriosclerosis is prescribed an anticoagulant. For which of the following should the nurse assess in this client The nurse is assessing a client diagnosed with a peripheral arterial occlusion. Which of the following will the nurse assess in this client? e six Ps: pulseless, pain, pallor, paresthesia, paralysis, and poikilocythemia The nurse is instructing a client recovering from arterial aneurysm repair. Which of the following should be included in these instructions? imit lifting to 15 to 20 lbs; limit activity for up to 8 weeks after the surgery; use a pillow to splint when coughing; and notify the physician for pain, redness, or swelling around the incision The nurse is utilizing the Wells Scale to assess a client for deep vein thrombosis. Which of the following is assessed when using this scale? treatment or diagnosis of cancer, recent immobility for greater than 3 days, recovery from surgery during which the client received general or regional anesthesia within 12 weeks, entire leg swollen, and pitting edema confined to the symptomatic leg A client is diagnosed with a venous stasis ulcer on the foot. Which of the following will be included in this clients plan of care oral antibiotics if infection is present, cover the wound with hydrocolloidal dressing if indicated to promote the formation of granulation tissue, provide pain medication with debridement Before administering an antacid, the nurse should instruct a client that this medication works in the: stomach to neutralize stomach acids The nurse is assessing a client diagnosed with gastroesophageal reflux disease. Which of the following should be included in this assessment? Presence of pyrosis or heartburn should be assessed in this client. During an assessment, the nurse determines a client is at risk for ulcerative stomatitis and gum disease because the client has a history of: smoking A client is diagnosed with a swallowing disorder. The nurse realizes that which type of diet would be indicated for this client mechanical soft To support the nutritional needs of a client with dysphagia, the nurse realizes that all of the following are mechanisms to provide enteral feeding NG Tube PEG Tube J Tube A client is scheduled for diagnostic tests to determine the ability to swallow. Which of the following diagnostic tests will provide the best information regarding this clients status? videofluoroscopy or a modified barium swallow A client, diagnosed with a hiatal hernia, will experience which of the following symptoms most frequently stomach acids reflux into the esophagus, causing pain and irritation that the patient will associate with heartburn. The nurse is instructing a client diagnosed with a hiatal hernia on ways to reduce the symptoms. Which of the following should be included in these instructions Sitting upright or sleeping with the head of the bed elevated helps keep the stomach contents in the stomach .A client is diagnosed with burning mouth syndrome. Which of the following interventions should be included in this clients plan of care assessing the condition of the teeth During an assessment, the nurse learns that a client is inhaling while swallowing food. Which of the following does this assessment finding suggest to the nurse? Dysphagia which increases risk of aspiration A client is experiencing brash water. The nurse realizes this symptom is associated with sensation of the mouth filling with saliva because of acid backflow into the esophagus, is a symptom of Barretts esophagus A client has been prescribed Zantac for gastroesophageal reflux disease. The nurse realizes this medication is classified as a: histamine H2-receptor antagonist An elderly client has noted blood in her stool for the past few months. Which information in the medical history would strongly suggest colorectal cancer Change in bowel habit The nurse is caring for a client diagnosed with irritable bowel syndrome (IBS) who is experiencing diarrhea. What medication would the nurse expect to administer? Antidiarrheal agents like Imodium .A client complains of acute gastrointestinal distress. While obtaining a health history, the nurse asks about the family history. Which disorder has a familial basis? Ulcerative Colitis client diagnosed with appendicitis asks the nurse why this illness occurred. The nurse should respond that the most common cause of appendicitis is: obstruction A young client is experiencing acute abdominal pain. The nurse realizes that the most common cause for this type of pain would be: appendicitis .A client experiencing abdominal pain and diarrhea tells the nurse that he used to smoke. Which of the following gastrointestinal disturbances is this client most likely experiencing Crohns Disease A client has a history of being treated for ulcerative colitis. The nurse realizes that a lifethreatening complication of this disorder is toxic megacolon 3.The nurse assesses no bowel sounds with occasional splashing sounds over the large intestines. Which of the following do these assessment findings suggest to the nurse Obstruction can be detected with absent bowel sounds and borborygmi or a splashing sound heard over the large intestine The nurse is instructing a client on diagnostic tests used to screen for colorectal cancer. Which of the following should be included in these instructions test for fecal occult blood should be done annually. Laparoscopic surgery is scheduled for a client diagnosed with appendicitis. Which of the following may be a result of laparoscopic surgery? Laparoscopic surgery has less pain and faster recovery times. There are fewer complications, less bleeding, and less risk of infection so the client has a shorter hospital stay he nurse is assessing a client diagnosed with diverticulitis. Which of the following are clinical manifestations associated with this disorder? constipation or diarrhea, lower abdominal pain in the left lower quadrant, and low-grade fever .The nurse is assessing a client diagnosed with irritable bowel syndrome (IBS). Which of the following characteristics are associated with this disorder? recurrent abdominal pain that improves with defecation. The pain will also appear with a change in stool frequency. The pain is also associated with a change in stool appearance. A client, diagnosed with a vitamin B-12 deficiency, tells the nurse that she does not want to receive injections every month to treat the disorder. Which of the following should the nurse instruct the client regarding the effects of vitamin B-12 deficiency? symmetrical paresthesias in the hands and feet, diminished vibratory and proprioceptive sense, ataxia, and spinal cord degeneration The nurse is planning care for a client diagnosed with an acute abdomen. Which of the following nursing diagnoses would be appropriate for this client? fear, deficient fluid volume, acute pain, and risk of infection Sx of hyperglycemia polyuria, polydipsia, polyphagia weakness blurred vision Prolonged hyperglycemia causes weight loss increased infections Urine Ketones Comorbidities: CV, Renal, Wound, Infection Check Lytes, EKG, CBC Avoid volume depletion Monitor/correct electrolyte imbalance Glucose Goals Inpatient Avoid hypoglycemia <70 Treat >140 Preprandial and >180 random Transitioning SSI After 24 hours of hospitalization Type II Acute Insulin Needs Prefer SC administration Combination basal/long acting Prandial Administration Correct Hyperglycemia Avoid Hypoglycemia BS< 100 reassess BS< 70 adjust dose Total Daily Dose (TDD) Calculation kgx0.5 Inpatient Insulin for NPO patients only basal dosing of TDD Insulin gtt calculation 6 hour requirement x4= TDD IV insulin transition give SC prior to d/cing IV Not eating full meals Decrease insulin doses ICU Insulin IV preferred for hyperglycemic states (>400) >180 indicates poor control <110 not indicated avoid hypoglycemia TPN and insulin Regular insulin infusion until needs are met and then add to bag Monitor closely Watch for interruptions Enteral Feedings and Insulin Basal insulin requirements Careful with interruptions PeriOp BG Managment keep 110-180 hold oral meds/non-insulin injectables AM of surgery Type 1 must have insulin Type 2 keep basal dosing- Consider IV insulin for long procedures Post Op Glucose Managment Caution restarting metformin, sulfonylureas, thiazolidines Correct K <3.5 BG Hourly ABG, Lytes Q2hr Hyperchloremic Acidosis (monitor for) Monitor Kidney Fx Monitor Neuro decline titrate insulin when BS <200 Resolution of DKA BG <200 pH >7.3 HCO3 >18 Anion Gap <12 BH Normal Transitioning to SC insulin Give SC dose 1-2 hours prior to stopping gtt monitor for hypoglycemia DKA Acute onset Acidosis r/t ketone production Type 1 DKA causes pump failure insulin deficiency Type 2 DKA Causes severe illness stress DKA S/S Polyuria Polydipsia N/V/D Marked Fatigue AMS, stupor, coma odor to breath DKA PE Neuro Fruity Breath Kussmaul Resp Dehydration Hemodynamic instability Electrolyte derangement DKA DX Triad BS 300-900 Serum Ketones, Beta-Hydroxybutyrate Metabolic Acidosis Anion Gap > 20 Other Lab Findings in DKA K- Norm to high Na- Mild Low HCO3- Low PO4- High BUN/CREAT- High +Leukocytosis HHS BG Higher than DKA No ketone production Hyperosmolar Slower onset