NURS H 356Extra QuestionsNURS H 356Extra Questions, Exams of Nursing

Download NURS H 356Extra QuestionsNURS H 356Extra Questions and more Exams Nursing in PDF only on Docsity! NURS H 356 Extra Questions DIABETES MELLITUS QUESTIONS 1. Which of the following persons would most likely be diagnosed with diabetes mellitus? A 44- year-old: a. Caucasian woman. b. Asian woman. c. African-American woman. d. Hispanic male. Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence. 2. Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.) a. Age over 45 years b. Overweight with a waist/hip ratio >1 c. Having a consistent HDL level above 40 mg/dl d. Maintaining a sedentary lifestyle Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle. 3. Which laboratory test should a nurse anticipate a physician would order when an older person is identified as high-risk for diabetes mellitus? (Select all that apply.) a. Fasting Plasma Glucose (FPG) b. Two-hour Oral Glucose Tolerance Test (OGTT) c. Glycosylated hemoglobin (HbA1C) d. Finger stick glucose three times daily Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long- term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels. 4. Of which of the following symptoms might an older woman with diabetes mellitus complain? a. Anorexia b. Pain intolerance c. Weight loss d. Perineal itching NURS H 356 Extra Questions Rationale: Older women might complain of perineal itching due to vaginal candidiasis. 5. When an older adult is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the gerontology nurse should anticipate which of the following secondary medical diagnoses? a. Impaired glucose tolerance b. Gestational diabetes mellitus c. Pituitary tumor d. Pancreatic tumor Rationale: The onset of hyperglycemia in the older adult can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumor. 6. The principal goals of therapy for older patients who have poor glycemic control are: a. Enhancing quality of life. b. Decreasing the chance of complications. c. Improving self-care through education. d. All of the above. Rationale: The principal goals of therapy for older persons with diabetes mellitus and poor glycemic control are enhancing quality of life, decreasing the chance of complications, improving self-care through education, and maintaining or improving general health status. 7. Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus? a. Physical exercise can slow the progression of diabetes mellitus. b. Strenuous exercise is beneficial when the blood glucose is high. c. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. d. Adjusting insulin regimen allows for safe participation in all forms of exercise. Rationale: Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise. 8. A diabetic patient experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia might be manifesting which of the following? NURS H 356 Extra Questions Sliding Scale- BG 251- 275- 6 Units regular Insulin Ketones small- 2 units Ketones moderate- 3 units How many units of insulin should the client receive at 7:00 AM? a. 25 Units of 70/30; 4 units regular b. 18 Units of 70/30; 6 units regular c. 25 Units of 70/30; 8 units regular d. 25 Units of 70/30; 6 units regular 15. Place the following activities to be performed by the person with diabetes in the correct order. a. Eat breakfast (3) b. Give self insulin (2) c. Test blood glucose (1) d. Take a walk (4) A person with diabetes needs to wake up in the AM, monitor fasting glucose level, and inject his insulin 15-60 minutes before his meal depending on the type of insulin. In order to avoid hypoglycemia, it is best for the person with diabetes to take a walk after meals instead of before. 16. The nurse is teaching a client how to self administer insulin. Which is essential for the client to do before being discharged home? a. Perform a return demonstration on himself b. Explain the differences between varying insulin types c. Give an injection to another person d. Demonstrate good hand washing technique The nurse needs to see the client inject himself so that any problems can be dealt with at this point before discharge. 17. The client with Type 1 diabetes wakes up with nausea and vomiting. The client has been taught by the diabetes educator to: (check all that apply) a. Take prescribed insulin as ordered b. Monitor blood glucose every 2-4 hours c. Monitor urinary ketones d. Eat a good breakfast NURS H 356 Extra Questions e. Get as much exercise as possible When sick, a person with Type I diabetes should continue taking insulin since the release of stress hormones increases insulin requirements. Blood glucose and ketones are monitored to detect a shift into DKA. The person should drink fluids and get as much rest as possible. 18. The client with Type 2 diabetes is feeling hungry and faint. He should first: a. Eat 15 grams of carbohydrate b. Eat a source of protein c. Monitor blood glucose d. Decrease physical activity It is best to check the blood sugar first to determine how low it is. Then the carbohydrate can be eaten. (If a blood glucose monitor is not available, then eating the carbohydrate first is okay.) Then check the blood glucose a second time after 15 minutes if the client still has symptoms. If there are more than 45 – 60 minutes before the next meal the person should then eat a long acting source of glucose/protein such as milk. 19. A client has the following blood glucose record. His diet includes 3 meals and a bedtime snack. Time of day Day One Day Two Day Three Pre Breakfast 180 184 192 Pre Lunch 140 136 126 Pre Supper 144 148 150 Which initial strategy would you recommend to the client to gain better control? a. Eliminate bedtime snack b. Increase evening insulin dosage c. Increase AM insulin dosage d. Increase both AM and PM insulin Eliminating the snack will reduce the amount of carbohydrate the evening dose of insulin is working on and should reduce pre breakfast glucose levels. The second step would be to increase evening insulin dosage to further decrease prebreakfast levels if needed. This strategy will take about three days to determine a full effect on levels. NURS H 356 Extra Questions RENAL DISORDERS 1. Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions? a. Osmosis and diffusion b. Passage of fluid toward a solution with a lower solute concentration c. Allowing the passage of blood cells and protein molecules through it. d. Passage of solute particles toward a solution with a higher concentration. Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it. 2. A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client’s plan of care? a. Keep the AV fistula site dry. b. Keep the AV fistula wrapped in gauze. c. Take the blood pressure in the left arm d. Assess the AV fistula for a bruit and thrill Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non- functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV NURS H 356 Extra Questions 7. The nurse is assisting a client on a lowpotassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction? a. Cantaloupe b. Spinach c. Lima beans d. Strawberries Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving. 8. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? a. Monitor the clients level of consciousness b. Maintain strict aseptic technique c. Add heparin to the dialysate solution d. Change the catheter site dressing daily The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 4 may assist in preventing infection, this option relates to an external site. NURS H 356 Extra Questions 9. The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action? a. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration. b. Encourage increased vegetables in the diet c. Place the client on a cardiac monitor d. Check the sodium level The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action at this time. 10. The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a client’s outflow is less than the inflow. Select actions that the nurse should take. a. Place the client in good body alignment b. Check the level of the drainage bag c. Contact the physician d. Check the peritoneal dialysis system for kinks e. Reposition the client to his or her side. If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client’s position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client’s abdomen to NURS H 356 Extra Questions enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician. 11. The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate? a. Excess fluid volume related to the kidney’s inability to maintain fluid balance. b. Increased cardiac output related to fluid overload. c. Ineffective tissue perfusion related to interrupted arterial blood flow. d. Ineffective therapeutic Regimen Management related to lack of knowledge about therapy. Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client’s fluid status should be monitored carefully for imbalances on an ongoing basis. 12. The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply. a. Excess Fluid Volume b. Imbalanced Nutrition; Less than Body Requirements c. Activity Intolerance d. Impaired Gas Exchange NURS H 356 Extra Questions d. MOM is high in sodium Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. MOM is harsher than Miralax, but magnesium toxicity is a more serious problem. A client may find both MOM and Miralax unpalatable. MOM is not high in sodium. 15. In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate? a. Providing all needed teaching in one extended session. b. Validating frequently the client’s understanding of the material. c. Conducting a oneonone session with the client. d. Using videotapes to reinforce the material as needed. Uremia can cause decreased alertness, so the nurse needs to validate the client’s comprehension frequently. Because the client’s ability to concentrate is limited, short lesions are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape. 16. The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure? a. High carbohydrate, high protein NURS H 356 Extra Questions b. High calcium, high potassium, high protein c. Low protein, low sodium, low potassium d. Low protein, high potassium Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day. 17. The main indicator of the need for hemodialysis is: a. Ascites b. Acidosis c. Hypertension d. Hyperkalemia 18. When caring for a patient with acute renal failure, the nurse would plan which one of the following treatment goals: a. Prevent infection by administering antibiotics b. Compensate for renal impairment by restoring fluid balance c. Increase fluids to prevent kidney stones d. Maintain adequate nutrition by encouraging a high protein and calorie diet NURS H 356 Extra Questions The treatment goals for acute renal failure include: identifying and correcting the underlying cause, preventing kidney damage, restoring urine output and kidney function and compensating for renal impairment. 19. The patient with chronic renal failure has a serum K+ of 6.6 mEq/L. The nurse should anticipate an order for: a. Furosemide (Lasix) b. Aluminum hydroxide (Amphojel) c. Propanolol (Inderal) d. Sodium polystyrene sulfonate (Kayexalate) The patient with renal failure with a K+ level above 6.5 mEq/L is treated with Kayexalate, which exchanges Na+ ions for K+ in the intestines. Lasix removes sodium and excess fluid. Amphojel is used to control hyperphosphatemia. Propanolol may control HTN. 20. The patient has just returned from hemodialysis. It is essential for the nurse to evaluate the patient for: a. CHF b. Hyperkalemia c. Peripheral edema and headache d. Signs of disequilibrium syndrome Dialysis can cause disequilibrium syndrome if fluid is withdrawn too quickly. The nurse should assess for headache, nausea, vomiting, change in LOC and HTN. Dialysis pulls off fluid and K+. NURS H 356 Extra Questions C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia Rationale – Administration of IVF and Lasix to attempt to get the kidneys to act depletes the Na+ and K+ Lasix is non – K+ sparing Pg 1104 Lewis 2. A 52yearold man with chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which action should the nurse take? E. Assess skin turgor to determine hydration status. F. Insert a urinary catheter for the expected diuresis. G. Evaluate the patient’s lower extremities for edema. H. Check the patient’s urine for the presence of ketones. Rationale – Pg 1105 With a kidney client who is needing a test with contrast media it is important for the client to be optimally hydrated. 3. A 56yearold woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. The nurse should assess the patient for I. fatigue. J. flank tenderness. K. cardiac dysrhythmias. L. elevated triglycerides. NURS H 356 Extra Questions Rationale Remember in the 5th semester you are not held accountable for rhythm strips. With the K+ level 6.8 mEq/L, you need to be aware to watch for cardiac dysrhythmias. 4. A major advantage of peritoneal dialysis? M. The diet is less restricted and dialysis can be performed at home N. The dialysate is biocompatible and causes not long term consequences 2. High glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss. A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. Rationale Bridge question from evolve Chapter 47 The diet is less restricted and dialysis can be performed at home is the best choice from the options provided. The other responses – do make sense. 5. The home care nurse visits a 34yearold woman receiving peritoneal dialysis. Which statement, if made by the patient, indicates a need for immediate followup by the nurse? B. “Drain time is faster if I rub my abdomen.” C. “The fluid draining from the catheter is cloudy.” D. “The drainage is bloody when I have my period.” NURS H 356 Extra Questions E. “I wash around the catheter with soap and water.” Rationale – Noticing the fluid draining is cloudy – indicative of infection. AIDS IMMUNITY AND INFECTION *human immunodeficiency virus attacks T cells, thereby compromising immune system *CDC criteria- CD4+ count < 200, opportunistic infection, wasting syndrome, AIDS dementia complex (ADC) T-cells helpers, suppressors, killers; attack directly; small lymphocytes developed in the thymus, which orchestrate the immune system's response to infected or malignant cells. CD4 a glycoprotein that serves as a co-receptor on MHC class II-restricted T cells. Most helper T cells have it white blood cells (leukocytes) cells produced in the bone marrow which fight infection list the white blood cells: Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils macrophages phagocyte which is found in blood and lymph/lymphatic organs; engulfs and destroys invaders of the body (neutrophils, monocytes) After cell injury… 1. Arterioles in area briefly undergo transient hemostasis to stop the flow of blood (vasoconstriction and clot formation). 2. After release of histamine and other chemicals by the injured cells, vessels dilate, resulting in hyperemia. 3. Vasodilation (increased blood flow) and capillary permeability (edema) cause redness, heat, and swelling (inflammation). 4. Blood flow through capillaries in the area of inflammation slows as fluid is lost and viscosity increases. 5. Neutrophils and monocytes move to the inner surface of the capillaries and then migrate through the capillary wall to the site of the injury (chemotaxis). Neutrophils NURS H 356 Extra Questions Rationale: Aspirin interferes with the inflammatory process by inhibiting the production of prostaglandins. Also, aspirin does not lower core temperature by interfering with the autonomic nervous system. The autonomic nervous system does not participate in the thermoregulatory process. The mechanism of Aspirin is the reduction of prostaglandin synthesis. 5. The nurse selected the nursing diagnosis: risk for infection r/t open wound as evidenced by (AEB) moderate wound exudates for a client with a wound secondary to cellulitis on the left leg. What nursing interventions should the nurse add to the plan of care? Select all that apply. a. Monitor the wound for signs of progressive infection. b. Measure the circumference of the lef t leg. c. Monitor vital signs every 12 hours. d. Apply cold compresses to the affected area. e. Evaluate the client’s complete blood count. Rationale: The nurse should assess the wound for signs and symptoms of infection to determine wound progression or deterioration. Measuring the circumference of the left leg helps assess the amount of edema present from the infected wound. Monitoring the client’s WBC helps identify the client’s response to treatment. Vital signs should be assessed frequently, such as every four hours during the acute phase of the infection to detect subtle changes. Applying cold compresses to the area is contraindicated due to the vasocontrictive properties of cold compresses. 6. A client who is experiencing knee pain tells the nurse, “my knee is swollen and hurts. It must be infected.” Which is the best response? a. “Yes, your knee is probably infected due to pain and edema.” b. “No, your leg is not infected because there is an absence of drainage and fever.” c. “Your body reacts to various injuries by activating the inflammatory response.” d. “Your body responds to injuries by inhibiting the inflammatory response.” Rationale: The body reacts to various injuries by activating the inflammatory response. The inflammatory response is activated in any type of injury; physical or bacterial. During the inflammatory process, the client will have edema due to the rush of neutrophils and histamine to the site. A diagnosis of infection should be made by the healthcare professional once more definitive testing has been performed such as; body fluid culture, and WBC count. NURS H 356 Extra Questions 7. When the nurse teaches a client how to care for a leg wound, which of the following elements should be included? Select all that apply. a. “Make sure you wash your hands before and after each dressing change.” b. “Double bag all exudate and soiled dressings.” c. “Soiled clothes and linens must be washed in bleach.” d. “Clean the site thoroughly with saline or betadine.” e. “Use gloves while changing the dressing.” Rationale: Hand washing prevents cross-contamination of bacteria from the client’s hands to the wound. It also prevents the client from contaminating other surfaces after the dressing has been changed. Soiled dressings should be double-bagged to prevent possible bacterial leakage onto floor surfaces. Soiled clothes and linens may be washed in soap and water; bleach is not necessary. Cleaning the wound with saline or betadine may be contraindicated. Wound care orders are not included in the scenario. The nurse should not assume that saline and/or betadine may be used on the wound. 8. Although the isolation units are filled, a nurse working on an inpatient unit admits several clients with transmissible infections. When an opening does occur, the nurse is most likely to transfer which of the following clients first? a. Streptococcal infection upper respiratory infection b. Staphylococcal infection of both of the client’s lower legs c. Methicillin resistance staphylococcal aureus (MRSA) of the lungs d. Receiving prophylactic antituberculin drugs because of a recent exposure Rationale: MRSA is a bacterial infection that is difficult to treat and contagious. MRSA of the lungs is transmitted by droplet and contact modes. This client should be placed in isolation immediately. A streptococcal infection of the upper respiratory system is contagious; however, it is treated with an oral penicillin or cephalosporin antibiotic. A staphylococcal infection of the legs is a common form of cellulitis that is easily treated with a combination of oral, intravenous, or topical antibiotics. In option four, this client does not have an active form of tuberculosis, but is being treated for exposure to someone who had active tuberculosis. This client is being placed on isolation as a prophylactic measure to decrease the possibility of the transmission of microorganisms. 9. A client is receiving a unit of packed red blood cells that was started at 0900. At 1000 the client calls the nurse and is complaining of low back pain and chills. Which action should the nurse take first? NURS H 356 Extra Questions a. call the physician b. stop the transfusion c. administer an analgesic d. take an oral temperature Rationale: Limiting the exposure to a substance that may be causing a reaction by withdrawing the substance is the first course of action. 10.A patient with an open fracture of the left tibia and soft tissue damage underwent a surgical reduction and fixation of the tibia with debridement of nonviable tissue and drain placement. When assessing the patient during the postoperative period, the nurse will be most concerned about a. fever with chills and night sweats. b. light yellow drainage from the wound. c. pain on movement of the affected limb. d. muscle spasms around the affected bone. Rationale: Fever, chills, and night sweats are suggestive of osteomyelitis. The other clinical manifestations are typical after a fracture repair. 11.A patient is hospitalized for initiation of regional antibiotic perfusion for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care? a. Frequent weight-bearing exercise b. Immobilization of the right leg c. Avoid administration of NSAIDs d. Support right leg in a flexed position Rationale: Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent contractures. 12.Which of the following nursing interventions is of highest priority in preventing infections in a multiple trauma victim? a. assessment of temperature every 3-4 hours b. providing a diet high in calories and protein c. hand washing before all client contact d. changing dressings every shift NURS H 356 Extra Questions d. the body currently is able to produce an adequate number of CD4+ cells to replace those destroyed by viral activity. The patient is the early chronic stage of infection, when the body is able to produce enough CD4+ cells to maintain the CD4+ count at a normal level. The risk for opportunistic infection is low because of the normal CD4+ count. Although the viral load in the blood is low, intracellular reproduction of virus still occurs. Anti-HIV antibodies produced by B cells attack the viruses in the blood, but not intracellular viruses. 19.A patient who tested positive for HIV 3 years ago is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP). Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), the patient is diagnosed as having a. early chronic infection. b. HIV infection. c. AIDS. d. intermediate chronic infection. Development of PCP pneumonia meets the diagnostic criterion for AIDS. The other responses indicate an earlier stage of HIV infection than is indicated by the PCP infection. 20.The occupational health nurse will teach the nursing staff that the highest risk of acquiring HIV from an HIV-infected patient is a. a needlestick with a suture needle during a surgical procedure. b. contamination of open skin lesions with vaginal secretions. c. a needlestick with a needle and syringe used to draw blood. d. splashing the eyes when emptying a bedpan containing stool. Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus. 21.When assessing an individual who has been diagnosed with early chronic HIV infection and has a normal CD4+ count, the nurse will a. ask about problems with diarrhea. b. examine the oral mucosa for lesions. c. check neurologic orientation. d. palpate the regional lymph nodes. NURS H 356 Extra Questions Persistent generalized lymphadenopathy is common in the early stage of chronic infection. Diarrhea, oral lesions, and gait abnormalities would occur in the later stages of HIV infection. HYPERTENSION 1. Hypertension is an intermittent or sustained elevation of the systolic and diastolic blood pressure 2. What is the most significant determinant of BP? Blood vessel diameter 3. What are the two types of HTN? Primary and secondary 4. In primary HTN, the etiology is... Unknown 5. Secondary HTN is the result of... A specific physiological condition 6. Hypertension is often fatal if untreated (T/F) true 7. HTN is more common in blacks or whites blacks 8. Aging decreases risk T/F false 9. Obesity increases risk T/F true 10.Oral contraceptives increase BP T/F True 11.Which four organs does HTN affect the most brain-stroke eyes-blindness heart- MI NURS H 356 Extra Questions kidney- renal failure NURS H 356 Extra Questions Rationale: Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic. 23.Essential hypertension would be diagnosed in a 40-year-old male whose blood pressure readings were consistently at or above which of the following? a. 120/ 90 mm Hg. b. 130/ 85 mm Hg. c. 140/ 90 mm Hg. d. 160/ 80 mm Hg. Rationale: American Heart Association standards define hypertension as a consistent systolic blood pressure level greater than 140 mm Hg and a consistent diastolic blood pressure level greater than 90 mm Hg. 24.When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II. Rationale: Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction. Propranolol does not increase norepinephrine secretion, cause vasodilation, or block conversion of angiotensin I to angiotensin II. 25.A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that diuretics help reduce blood pressure by: a. Removing serum potassium. b. Dilating peripheral blood vessels. c. Reducing sympathetic outflow. NURS H 356 Extra Questions d. Constricting blood vessels. Rationale: Diuretics decrease blood volume, which in turn decreases the workload of the heart and reduces blood pressure. They do not dilate blood vessels. Some diuretics promote potassium loss, but this does not reduce the blood pressure. Central-acting antihypertensives work by blocking sympathetic outflow. 26.The most important long-term goal for a client with hypertension would be to: a. Learn how to avoid stress. b. Explore a job change or early retirement. c. Make a commitment to long-term therapy. d. Lose weight. Rationale: Compliance is the most critical element of hypertension therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management is an important component of hypertension therapy, but the priority goal is related to compliance. It is not necessary for the client to change jobs or retire, but rather to learn to manage stress if the job is stressful. Losing weight may be necessary and will contribute to lower blood pressure, but the client must first accept the need for a lifelong management plan to control the hypertension. 27.The client has had hypertension for 20 years. The nurse should assess the client for? a. Renal insufficiency and failure. b. Valvular heart disease. c. Endocarditis. d. Peptic ulcer disease. Rationale: Renal disease, including renal insufficiency and failure, is a complication of hypertension. Effective treatment of hypertension assists in preventing this complication. Valvular heart disease, endocarditis, and peptic ulcer disease are not complications of hypertension. 28.The nurse is developing a care plan with an older adult and is instructing the client that hypertension can be a silent killer. The nurse should instruct the client to be aware of signs and symptoms of other system failures and encourage the client to report signs of which of the following diseases that are often a result of undetected high blood pressure? a. Cerebrovascular accidents (CVAs). NURS H 356 Extra Questions b. Liver disease. c. Myocardial infarction. d. Pulmonary disease. Rationale: Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVAs can be related to long-term hypertension. Liver or pulmonary disease is not generally associated with hypertension. Myocardial infarction is generally related to coronary artery disease. 29.In teaching the hypertensive client to avoid orthostatic hypotension, the nurse should emphasize which of the following instructions? Select all that apply. a. Plan regular times for taking medications. b. Arise slowly from bed. c. Avoid standing still for long periods. d. Avoid excessive alcohol intake. e. Avoid hot baths. Rationale: Changing positions slowly and avoiding long periods of standing may limit the occurrence of orthostatic hypotension. Scheduling regular medication times is important for blood pressure management but this aspect is not related to the development of orthostatic hypotension. Excessive alcohol intake and hot baths are associated with vasodilation. 30.A client receiving furosemide (Lasix) as an adjunct to treatment of hypertension returns for follow-up. Which of the following objective data should the nurse consider when determining the effectiveness of the drug therapy? a. Blood pressure log notes blood pressure 120/70-134/88 since discharge. b. Weight loss of six pounds in the past month c. Frequency of voiding of at least six times per day d. Absence of edema in lower extremities Rationale: Maintenance of blood pressure within normal limits indicates that treatment goals are achieved. Absence of edema, weight loss, and urinating all indicate that the diuretic has promoted fluid loss, but are not the best measure of the drug's effectiveness for hypertension. 31.The nurse preparing to administer HCTZ (Hydrodiuril) 25 mg to a client with hypertension checks laboratory values and finds that the potassium level is 2.8 mEq. The appropriate action is to: a. Give the client a banana, and recheck the potassium level. b. Hold the medication, and notify the health care provider. NURS H 356 Extra Questions 38.When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: a. Moderate doses of two different types of diuretics are more effective than a large dose of one type b. This combination promotes diuresis but decreases the risk of hypokalemia c. This combination prevents dehydration and hypovolemia d. Using two drugs increases osmolality of plasma and the glomerular filtration rate Rationale: Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance. 39.Laboratory testing is ordered for a patient during a clinic visit for routine assessment of hypertension. When monitoring for target organ damage, the nurse will be most concerned about a. blood urea nitrogen (BUN) of 15 mg/dl (5.4 mmol/L). b. serum hemoglobin of 14.7 g/dl (135 g/L). c. serum creatinine of 2.6 mg/dl (230 mmol/L). d. serum potassium of 3.8 mEq/L (3.2 mmol/L). Rationale: BUN and creatinine are useful in determining whether renal failure is developing as a result of hypertension. The BUN level is normal. The serum creatinine is elevated and will require further investigation. The serum potassium level and hemoglobin level are normal. 40.A 62-year-old patient who has just arrived in the emergency department complaining of a sudden-onset severe headache and nausea has a BP of 240/118 mm Hg. The patient gives a history of taking clonidine (Catapres) and hydrochlorothiazide (HydroDIURIL) for 10 years for hypertension. The most appropriate question by the nurse at this time is a. Have you recently taken any antihistamine medications? b. Have you been taking the Catapres and HydroDIURIL lately? c. Do you have any recent stressful events in your life? d. Did you take any acetaminophen (Tylenol) yet today? Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP, but not usually to the level in this patient. PRIORITIZATION AND DELEGATION NURS H 356 Extra Questions REMEMBER: • You cannot delegate TEA: Teaching, Evaluation, Assessment • Prioritize in order of ABC: Airway, Breathing, Circulation (Pain can be psychosocial, so it does not take priority.) 1. The staff nurse delegates AM care for two patients to the CNA. What principle of delegation is the nurse following? Delegation requires a situation with clearly defined superiors. Delegation can only exist with a subordinate. Delegation is a tool only used by nurses. You can delegate only those tasks for which you are responsible. 2. You are evaluating and assessing a patient with a diagnosis of chronic emphysema. The patient is receiving oxygen at a flow rate of 5 L/min by nasal cannula. Which finding concerns you immediately? a. The patient has fine bibasilar crackles b. The patient's respiratory rate is 8 breaths/min. c. The patient sits up and leans over the night table. d. The patient has a large barrel chest. Rationale: For patients with chronic emphysema, the stimulus to breathe is a low serum oxygen level (the normal stimulus is a high carbon dioxide level). This patient's oxygen flow is too high and is causing a high serum oxygen level, which results in a decreased respiratory arrest. Crackles, barrel chest, and assumption of a sitting position leaning over the night table are common in patients with chronic emphysema 3. A patient with sleep apnea has a nursing diagnosis of Sleep Deprivation related to disrupted sleep cycle. Which action should you delegate to the nursing assistant? a. Discuss weight-loss strategies such as diet and exercise with the patient b. Teach the patient how to set up the BiPAP machine before sleeping c. Remind the patient to sleep on his side instead of his back. d. Administer modafinil (Provigil) to promote daytime wakefulness Rationale: The nursing assistant can remind patients about actions that have already been taught by the nurse and are part of the patient's plan of care. Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN. The RN can delegate administration of medication to an LPN/LVN NURS H 356 Extra Questions 4. You are acting as preceptor for a newly graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide care to which patients? (Select all that apply) a. A 38-year old with moderate persistent asthma awaiting discharge b. A 63-year old with a tracheostomy needing tracheostomy care every shift. c. A 56-year old with lung cancer who has just undergone left lower lobectomy d. A 49-year old just admitted with a new diagnosis of esophageal cancer. Rationale: The new RN is at an early point in her orientation. The most appropriate patients to assign to her are those in stable condition who require routine care. The patient with the lobectomy will require the care of a more experienced nurse, who will perform frequent assessments and monitoring for postoperative complications. The patient admitted with newly diagnosed esophageal cancer will also benefit from care by an experienced nurse. This patient may have questions and needs a comprehensive admission assessment. As the new nurse advances through her orientation, you will want to work with her in providing care for these patients with more complex needs 5. A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant? a. Assisting the patient to sit up on the side of the bed b. Instructing the patient to cough effectively c. Teaching the patient to use incentive spirometry d. Auscultating breath sounds every 4 hours Rationale: Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Teaching, instructing, and assessing patients all require additional education and skills and are more appropriate for a licensed nurse 6. The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? a. Observe how well the patient performs pursed-lip breathing b. Plan a nursing care regiment that gradually increases activity intolerance c. Assist the patient with basic activities of daily living d. Consult with the physical therapy department about reconditioning exercises Rationale: Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. Assisting patients with ADLs is more NURS H 356 Extra Questions of the RN. Teaching patients about adequate fluid intake and techniques that facilitate coughing requires additional education and skill, and is within the scope of practice of the RN 12. The charge nurse is making assignments for the next shift. Which patient should be assigned to the fairly new nurse (6 months experience) pulled from the surgical unit to the medical unit? a. A 58-year old on airborne precautions for tuberculosis (TB) b. A 68-year old just returned from bronchoscopy and biopsy c. A 72-year old who needs teaching about the use of incentive spirometry d. A 69-year old with COPD who is ventilator dependent Rationale: Many surgical patients are taught about coughing, deep breathing, and use of incentive spirometry preoperatively. To care for the patient with TB in isolation, the nurse must be fitted for a high- effeciency particulate air (HEPA) respirator mask. The bronchoscopy patient needs specialized procedure, and the ventilator-dependent patient needs a nurse who is familiar with ventilator care. Both of these patients need experienced nurses. 13. When a patient with TB is being prepared for discharge, which statement by the patient indicates the need for further teaching? a. "Everyone in my family needs to go and see the doctor for TB testing." b. "I will continue to take my isoniazid until I am feeling completely well.” c. "I will cover my mouth and nose when I sneeze or cough and put my used tissues in a plastic bag.” d. "I will change my diet to include more foods high in iron, protein, and vitamin C.” Rationale: Patients taking isoniazid must continue the drug for 6 months. The other 3 statements are accurate and indicate understanding of TB. Family members should be tested because of their repeated exposure to the patient. Covering the nose and mouth when sneezing or coughing, and placing the tissues in plastic bags help prevent transmission of the causative organism. The dietary changes are recommended for patients with TB 14. Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team? a. Evaluating the patient's complaint of chest pain b. Monitoring laboratory values for changes in oxygenation c. Assessing for symptoms of respiratory failure d. Auscultating the lungs for crackles NURS H 356 Extra Questions Rationale: An LPN who has been trained to auscultate lungs sounds can gather data by routine assessment and observation, under supervision of an RN. Independently evaluating patients, assessing for symptoms of respiratory failure, and monitoring and interpreting laboratory values require additional education and skill, appropriate to the scope of practice of the RN 15. You are assigned to provide nursing care for a patient receiving mechanical ventilation. Which action should you delegate to an experienced nursing assistant? a. Assessing the patient's respiratory status every 4 hours b. Taking vital signs and pulse oximetry readings every 4 hours c. Checking the ventilator settings to make sure they are as prescribed d. Observing whether the patient's tube needs suctioning every 2 hours Rationale: The nursing assistant's educational preparation includes measurement of vital signs, and an experienced nursing assistant would know how to check oxygen saturaton by pulse oximetry. Assessing and observing the patient, as well as checking ventilator settings, require the additional education and skills of the RN 16. You are making a home visit to a 50-year old patient who was recently hospitalized with a right leg deep vein thrombosis and a pulmonary embolism. The patient's only medication is enoxaparin (Lovenox) subcutaneously. Which assessment information will you need to communicate to the physician? a. The patient says that her right leg aches all night b. The right calf is warm to the touch and is larger than the left calf c. The patient is unable to remember her husband's first name d. There are multiple ecchymotic areas on the patient's arms Rationale: Confusion in a patient this age is unusual and may be an indication of intracerebral bleeding associated with enoxaparin use. The right leg symptoms are consistent with a resolving deep vein thrombosis; the patient may need teaching about keeping the right leg elevated above the heart to reduce swelling and pain. The presence of ecchymoses may point to a need to do more patient teaching about avoiding injury while taking anticoagulants but does not indicate that the physician needs to be called. 17. The high-pressure alarm on a patient's ventilator goes off. When you enter the room to assess the patient, who has ARDS, the oxygen saturation monitor reads 87% and the patient is struggling to sit up. Which action should you take next? NURS H 356 Extra Questions a. Reassure the patient that the ventilator will do the work of breathing for him b. Manually ventilate the patient while assessing possible reasons for the high-pressure alarm c. Increase the fraction of inspired oxygen on the ventilator to 100% in preparation for endotracheal suctioning d. Insert an oral airway to prevent the patient from biting on the endotracheal tube Rationale: Manual ventilation of the patient will allow you to deliver an Fio2 of 100% to the patient while you attempt to determine the cause of the high-pressure alarm. The patient may need reassurance, suctioning, and/or insertion of an oral airway, but the first step should be assessment of the reason for the high-pressure alarm and resolution of the hypoxemia 18. When assessing a 22-year old patient who required emergency surgery and multiple transfusion 3 days ago, you find that the patient looks anxious and has labored respirations at the rate of 38 breaths/min. The oxygen saturation is 90% with the oxygen delivery at 6 L/min via nasal cannula. Which action is most appropriate> a. Increase the flow rate on the oxygen to 10 L/min and reassess the patient after about 10 minutes b. Assist the patient in using the incentive spirometer and splint his chest with a pillow while he coughs c. Administer the ordered morphine sulfate to the patient to decrease his anxiety and reduce the hyperventilation d. Switch the patient to a nonrebreather mask at 95% to 100% oxygen and call the physician to discuss the patient's status. Rationale: The patient's history and symptoms suggest the development of ARDS, which will require intubation and mechanical ventilation. The maximum oxygen delivery with a nasal cannula is an Fio2 of 44%. This is achieved with the oxygen flow at 6 L/min, so increasing the flow to 10 L/min will not be helpful. Helping the patient to cough and deep breathe will not improve the lung stiffness that is causing his respiratory distress. Morphine sulfate will only decrease the respiratory drive and further contribute to his hypoxemia. 19. Which of these medication orders for a patient with a pulmonary embolism is more important to clarify with the prescribing physician before admnistration? a. Warfarin (Coumadin) 1.0 mg by mouth (PO) b. Morphine sulfate 2 to 4 mg IV c. Cephalexin (Keflex) 250 mg PO d. Heparin infusion at 900 units/hr Rationale: Medication safety guidelines indicate that use of a trailing zero is not appropriate when writing medication orders because the order can easily be mistaken for a larger dose, such as 10 mg. The