PERIOPERATIVE NURSING MS QUIZ WITH QUESTIONS AND ANSWERS VERIFIED BY EXPERTS 2023-2024, Exams of Nursing

Download PERIOPERATIVE NURSING MS QUIZ WITH QUESTIONS AND ANSWERS VERIFIED BY EXPERTS 2023-2024 and more Exams Nursing in PDF only on Docsity! PERIOPERATIVE NURSING MS QUIZ WITH QUESTIONS AND ANSWERS VERIFIED BY EXPERTS 2023-2024 1. A nurse plans care for a client and notes that all of the following must be completed for a client being prepared for surgery. Which intervention should the nurse complete first? 1. Complete the preoperative checklist. 2. Assess the client’s preoperative vital signs. 3. Remove the client’s rings, gold chain, and wristwatch. 4. Administer 10 mEq KCL IV for a serum potassium level of 3.0 mEq/L 2. Which client statement made during a presurgical admission assessment needs the most immediate follow-up? 1. “I haven’t eaten foods or had any fluids for the past 12 hours.” 2. “I donated my own blood in case I need a transfusion; the last donation was 4 days ago.” 3. “I took my usual dose of warfarin (Coumadin®) and other cardiac meds this morning with a sip of water.” 4. “I brought a copy of my Health Care Directives so others will know my wishes should my heart stop during surgery.” 3. A nurse is to witness the signature of a surgical con?sent for multiple clients scheduled for surgery the following day. In evaluating the health history of each client, the nurse should plan to obtain a signature from the next of kin for: 1. a 75-year-old client who is blind. 2. a 60-year-old client who does not understand English. 3. a 50-year-old client who is forgetful, but fully oriented. 4. a 16-year-old educated client who fully understands the surgery 4. A nurse receives the written laboratory results of a positive pregnancy test for a client scheduled for an emergency appendectomy. The nurse should first: 1. call the lab to verify the results of the test. 2. inform the client of the positive results. 3. report the results immediately to the surgeon. 4. notify the client’s primary physician of the results 5. During a presurgical admission assessment, a client states, “I’ve told my surgeon that I am a Jehovah’s Witness and I won’t accept a blood transfusion.” Which statement by the nurse would be most appropriate? 1. “Tell me about your fear of receiving a blood transfusion.” 2. “Your request to not receive a transfusion would be honored. Your consent is needed to administer blood or blood products.” 3. “You don’t need to worry about getting a blood transfusion. We have newer equipment that causes less blood loss during surgery.” 4. “Are you sure you wouldn’t want a blood transfusion if one is needed during surgery? You can always change your mind after surgery.” 6. A nurse is analyzing serum laboratory results for a 73-year-old female client scheduled for surgery in 2 hours. The nurse concludes that which result would warrant the most immediate notification of the physician? 1. Hemoglobin 10 g/dL 2. Creatinine 1.0 mg/dL 3. Potassium 4.5 mEq/dL 4. Prothrombin time 22 seconds 7. A nurse is reviewing preoperative orders for a client who is to have surgery on the large intestine the next day. Which written orders should the nurse question? SELECT ALL THAT APPLY. 1. NPO after midnight 2. Erythromycin 500 mg bid 3. Tap water enemas until hard stool passed 4. Clear liquid diet the day before surgery 5. Begin incentive spirometer (IS) use prior to surgery 8. A physician writes an order to hold all medications the morning of surgery for a client with a history of type 1 diabetes mellitus and hypertension. A nurse should call the physician to clarify the hold order for what medication? 1. Acetylsalicylic acid (aspirin) 2. Ducosate sodium (Colace®) 3. Regular and NPH insulin (Humulin®) 4. Clonidine (Catapres® 9. Which client statement indicates that a client who is scheduled for a 3-hour surgery under general anesthesia needs further teaching? 1. “A breathing tube will be placed when I am in the operating room.” 2. “I should shave the skin in the surgical area the evening prior to surgery.” 3. “I should splint my incision with a pillow when coughing and deep breathing after surgery.” 19. A nurse is planning the discharge of a client following recovery from an exploratory laparotomy. The client has a history of chronic back pain and limited ability to ambulate. The nurse plans for further discharge teaching when the client states: 1. “I can leave my elastic antiembolic (TEDS®) stockings off once I get home.” 2. “I should be eating a diet high in protein, calories, and vitamin C now and when I get home.” 3. “An alternative method to control pain and reduce swelling is applying ice to my incision.” 4. “I use my incentive spirometer every 2 hours so I can reach my volume goal before discharge.” 20. A nurse is reviewing a plan of care for a postoperative client with a history of sickle cell disease. Which nursing diagnosis, documented on the client’s care plan, should the nurse address first? 1. Anxiety 2. Impaired skin integrity 3. Deficient fluid volume 4. Ineffective airway clearance 21. A nurse is caring for a postoperative client who reports an inability to void. Which initial action by the nurse is most appropriate? 1. Turning on running water 2. Inserting a urinary catheter 3. Palpating the client’s bladder 4. Reviewing the client’s chart for the time of the last voiding 22. A postoperative client who received a spinal anesthetic is experiencing a headache, photophobia, and double vision. A nurse’s initial intervention should be to: 1. immediately notify the surgeon. 2. position the client flat in bed. 3. limit the client’s fluid intake. 4. administer steroid medications. 23. A physician documents in a client’s postoperative progress notes that the client is experiencing a respiratory infection with a shift to the left in the white blood cell (WBC) differential count. Which finding by a nurse reviewing the client’s laboratory report would support the physician’s documentation? 1. Decreased WBC count 2. Increased band cells 3. Decreased hemoglobin 4. Increased C-reactive protein 24. In reviewing a physician’s orders for a postoperative client who underwent gynecological surgery, which order should a nurse determine is specifically written with the intent to prevent postoperative thrombophlebitis and pulmonary embolism? 1. Have the client dangle the legs the evening of surgery 2. Administer enoxaparin (Lovenox®) 40 mg subcutaneously daily 3. Administer hydromorphone (Dilaudid®) 1 to 4 mg IV every 3 to 4 hours as needed (prn) 4. Encourage coughing and deep breathing (C&DB) every hour while awake 25. A nurse assesses that a client on the second postoperative day following abdominal surgery has diminished breath sounds in both lung bases, is taking shallow breaths, is able to achieve only 500 mL on an incentive spirometer, and has been smoking one pack of cigarettes per day prior to surgery. The nurse’s best interpretation of these findings is that the client is experiencing: 1. atelectasis. 2. pneumonia. 3. a normal postoperative course. 4. chronic obstructive pulmonary disease (COPD) 26. A nurse notes redness, swelling, and warmth of and around the incision when assessing a client’s leg incision 48 hours after femoral popliteal bypass surgery. The nurse’s best analysis should be that the incision is: 1. healing normally for the second postoperative day. 2. showing signs of rejection of the suture materials. 3. inflamed and could indicate the presence of an infection. 4. infected and showing signs of wound dehiscence. 27. Which outcome should indicate to a nurse that a postsurgical client’s coughing and deep breathing (C&DB) is most effective? 1. Respirations are 16 per minute and unlabored. 2. Lung sounds are audible and clear on auscultation. 3. Coughs include small amount of clear secretions. 4. Cough effort is strong and productive. 28. A client is to receive a second dose of oxycodone/ acetaminophen (Percocet®) for postoperative incisional pain. When a nurse brings the medication to the client, the client says, “Why bring this medication again? It makes me feel sick.” Which statement is the most appropriate initial nurse response? 1. “I can call the doctor to see what else can be ordered for your pain.” 2. “Describe what you feel when you say that the medication makes you feel sick.” 3. “The doctor has ordered an antacid. I can give you this along with the medication.” 4. “Many people say the same thing. The aspirin in the medication is hard on your stomach.” 29. A nurse evaluates that the drainage from a client’s nasogastric (NG) tube, inserted for gastric decompression during emergency surgery, would be normal if it: 1. returns brown-liquid in color. 2. returns greenish-yellow in color. 3. has an alkalotic hydrogen level (pH). 4. measures less than 25 mL in volume. 30. A nurse notifies a physician after assessing a client 5 days after an exploratory laparotomy and noting a distended abdomen, abdominal pain, absence of flatus, and absent bowel sounds. Which typical complication of abdominal surgery should the nurse conclude may be occurring? 1. Paralytic ileus 2. Silent peritonitis 3. Fluid volume excess 4. Malabsorption syndrome 31. Which statement should a nurse include when teaching a client prior to discharge following abdominal surgery? 1. “Return to work in about 4 weeks because working increases your physical activity gradually.” 2. “The ordered iron and vitamins tablets will promote wound healing and red blood cell growth.” 3. “Daily walking carrying 10-pound weights will help to strengthen your incision.” 4. “Home-care nursing service is usually paid by insurance if you need help around the house. 32. The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? 1. Urinary output of 20 mL/hr 2. Temperature of 37.6° C (99.6° F) 3. Blood pressure of 100/70 mm Hg 4. Serous drainage on the surgical dressing laboratory result would be reported to the surgeon’s office by the nurse, knowing that it could cause surgery to be postponed? 1. Hemoglobin, 8.0 g/dL (80 mmol/L) 2. Sodium, 145 mEq/L (145 mmol/L) 3. Serum creatinine, 0.8 mg/dL (70.6 mcmol/L) 4. Platelets, 210,000 cells/mm3 (210 × 109 /L) 43. The nurse receives a telephone call from the postanesthesia care unit, stating that a client is being transferred to the surgical unit. The nurse plans to take which action first on arrival of the client? 1. Assess the patency of the airway. 2. Check tubes or drains for patency. 3. Check the dressing to assess for bleeding. 4. Assess the vital signs to compare with preoperative measurements. 44. The nurse is reviewing a surgeon’s prescription sheet for a preoperative client that states that the client must be nothing by mouth (NPO) after midnight. The nurse needs to call the surgeon to clarify that which medication would be given to the client and not withheld? 1. Prednisone 2. Ferrous sulfate 3. Cyclobenzaprine 4. Conjugated estrogen ALLERGY 1. You are a nurse starting an IV antibiotic to a patient to treat a severe infection. During infusion, the patient is having a severe allergic reaction. Select all the appropriate interventions for this patient: 1. Slow down the antibiotic infusion 2. Call a rapid response. 3. Place the patient on oxygen 4. Prepare for the administration of Epinephrine a. 1, 2 and 3 c. 2 and 3 b. 2, 3 and 4 d. 3 and 4 2. You're assessing a patient's knowledge on how to use their EpiPen in case of an anaphylactic reaction. You're using an EpiPen trainer device to teach the patient. What demonstrated by the patient shows the patient knows how to administer the medication? Select all that apply: 1. The patient injects the medication in the subq tissue of the abdomen. 2. The patient massages the site after injection. 3. The patient administers the injection through the clothes. 4. The patient aspirates before injecting the medication. a. 1, 2 and 3 c. 2 and 3 b. 2, 3 and 4 d. 3 and 4 3. Nurse John received a patient in the ER for allergy skin testing. Which nursing interventions are most appropriate? Select all that apply. 1. Record site, date, and time of the test. 2. Give the client a list of potential allergens if identified. 3. Estimate the size of the wheal and document the finding. 4. Tell the client to return to have the site inspected only if there is a reaction. 5.Have the client wait in the waiting room for at least 1 to 2 hours after injection. a. 1, 2 and 3 c. 1 and 2 b. 2, 3 and 4 d. 3 and 4 4. A male patient was taking morphine when suddenly he had a severe anaphylactic reaction after receiving the medication. The nurse would take which actions? Select all that apply. 1. Administer oxygen. 2. Quickly assess the client’s respiratory status. 3. Document the event, interventions, and client’s response. 4. Leave the client briefly to contact a primary health care provider (PHCP). 5. Keep the client supine regardless of the blood pressure readings. 6. Start an intravenous (IV) infusion of D5W and administer a 500-mL bolus. a. 1, 2 and 4 c. 1, 2 and 3 b. 1, 2, 3, 5 and 6 d. 1, 2, 3, 4 and 5 5. While doing your rounds, you noticed that the patient in 3320 is having a sudden and severe anaphylactic reaction to a medication. The patient's blood pressure is 80/50, heart rate 125, and oxygen saturation 85%. Audible wheezing is noted along with facial redness and swelling. As the nurse you know that the first initial treatment for this patient's condition is? a. IV Diphenhydramine c. IM Epinephrine b. IV Normal Saline Bolus d. Nebulized Albuterol 6. You received a patient in the ER due to a bee sting. The patient is in anaphylactic shock. This type of anaphylactic reaction is known as a? a. Type I Hypersensitivity Reaction b. Type II Hypersensitivity Reaction c. Type III Hypersensitivity Reaction d. Type IV Hypersensitivity Reaction 7. The patient has a severe allergy to eggs and mistakenly consumed a spiced chicken egg wrap. The patient is given Epinephrine intramuscularly. As the nurse, you know this medication will have an effect on the body? a. It will prevent a recurrent attack. b. It will cause vasoconstriction and decrease the blood pressure. c. It will help dilate the airways. d. It will help block the effects of histamine in the body. 8. You're providing care to a patient in anaphylactic shock. What is NOT a typical medical treatment for this condition, and if ordered the nurse should ask for an order clarification? a. IV Diphenhydramine b. Epinephrine c. Corticosteroids d. Isotonic intravenous fluids e. IV Furosemide 9. What is the MOST important step a nurse can take to prevent anaphylactic shock in a patient? a. Assessing, documenting, and avoiding all the patient allergies. b. Administering Epinephrine c. Administering Corticosteroids d. Establishing IV access 10. A patient is having an anaphylactic reaction to an IV medication. What is the FIRST action the nurse should take? a. Administer Epinephrine c. Stop the medication b. Call a Rapid Response d. Administer a breathing treatment 11. What is the BEST position for a patient in anaphylactic shock? a. Lateral recumbent c. High Fowler's b. Supine with legs elevated. d. Semi-Fowler’s 12. The nurse is providing teaching for a client on dietary intake and anaphylaxis. Which food should the nurse identify that trigger anaphylaxis in a sensitized individual (Select all that apply) 1. Fish 2. Coconut oil 3. Milk 4. Chocolate 5. Grains a. 4 and 5 c. 3, 4 and 5 b. 1, 2 and 3 d. 2 and 3 13. You are the nurse taking care of a patient who is on a course of oral steroids more than once a year for the treatment of asthma related to allergens. Which alternative therapy should the nurse anticipate being prescribed for the client to avoid the frequent use of steroids? a. Immunotherapy c. Plasmapheresis b. Omalizumab d. Antihistamines 14. For which allergy will the nurse teach the parents that a child with spina bifida is at increased risk? a. Drug allergy c. Latex allergy b. Contact dermatitis d. Food allergy 15. You are taking care of a patient treated for hemolytic disease. Which statement shows the nurse's understanding of the cause of the disease? a. "Neutrophils attempt to phagocytize the RBCs." b. "antibodies bound with an antigen activate the cascade destroying the RBCs." c. "Complement activation causes the release of inflammatory chemical mediators resulting in RBC destruction." d. "Endogenous antigens stimulate a type II reaction resulting in lysis of the RBC." 16. You are taking care of a patient with SLE who is being treated with immunosuppressant drugs and corticosteroids. Which precautions should you provide this client? Select all that apply. prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care? A. Institute seizure precautions. B. Reorient to time and place PRN. C. Monitor intake and output. D. Place on cardiac monitor. 3. A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is: A. Activity intolerance related to fatigue and inactivity. B. Impaired skin integrity related to itching and skin sloughing. C. Social isolation related to embarrassment about the effects of SLE. D. Impaired social interaction related to lack of social skills. 4. A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of: A. Rheumatoid factor. B. Anti-Smith antibody (Anti-Sm). C. Antinuclear antibody (ANA). D. Lupus erythematosus (LE) cell prep. 5. Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says: A. "I should expect to have a low fever all the time with this disease." B. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." C. "I should try to ignore my symptoms as much as possible and have a positive outlook." D. "I can expect a temporary improvement in my symptoms if I become pregnant." 6. A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question? A. Naproxen (Aleve) 200 mg BID B. Give measles-mumps-rubella (MMR) immunization C. Draw anti-DNA titer D. Famotidine (Pepcid) 20 mg daily 7. A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the following is one of the initial characteristic sign of systemic lupus erythematous? A. Weight gain B. Subnormal temperature C. Elevated red blood cell count D. Rash on the face across the bridge of the nose 8. The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is: A. A local rash that occurs as a result of allergy B. A disease caused by overexposure to sunlight C. An inflammatory disease of collagen contained in connective tissue D. A disease caused by the continuous release of histamine in the body 9. The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the health care provider's prescriptions. Which of the following medications would the nurse expect to be prescribed? A. Antibiotic B. Antidiarrheal C. Corticosteroid D. Opioid analgesic 10. A nurse is collecting data on a client who complains of fatigue, weakness, malaise, muscle pain, joint pain at multiple sites, anorexia, and photosensitivity. Systematic lupus erythematosus (SLE) is suspected. The nurse further checks for which of the following that is also indicative of the presence of SLE? A. Emboli B. Ascites C. Two hemoglobin S genes D. Butterfly rash on cheeks and bridge of nose 11. Which client is at the highest risk for systemic lupus erythematous (SLE)? A. An Asian male B. A white female C. An African-American male D. An African-American female 12. The nurse monitors a patient to have Systemic Lupus Erythematosus. Which of the following symptoms is characteristic of this diagnosis? A. Increased T-cell count B. Scaley, inflamed rash on shoulders, neck, and face C. Swelling of the extremities D. Decreased erythrocyte sedimentation rate (ESR) 13. In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes: A. Circulating immune complexes formed from IgG autoantibodies reacting with IgG B. An autoimmune T-cell reaction that results in destruction of the deep dermal skin layer C. Immunologic dysfunction leading to chronic inflammation in the cartilage and muscles D. The production of a variety of autoantibodies directed against components of the cell nucleus 14. A female patient's complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient's following statements demonstrates the need for further teaching about the disease? A. "I'll try my best to stay out of the sun this summer." B. "I know that I probably have a high chance of getting arthritis." C. "I'm hoping that surgery will be an option for me in the future." D. "I understand that I'm going to be vulnerable to getting infections." 15. The pathophysiology of systemic lupus erthematosus (SLE) is characterized by: A. Destruction of nucleic acids and other self-proteins by autoantibodies B. Overproduction of collagen that disrupts the functioning of internal organs C. Formation of abnormal IgG that attaches to cellular antigens, activating complement D. Increased activity of T-suppressor cells with B-cell hypoactivity, resulting in an immunodeficiency 16. A patient with newly diagnosed SLE asks the nurse how the disease will affect her life. The best response by the nurse is: A. You can plan to have a near-normal life since SLE rarely causes death B. It is difficult to tell because to disease is so variable in its severity and progression C. Life span is shortened somewhat in people with SLE, but the disease can be controlled with long- term use of corticosteroids 26. A client with a history of systemic lupus erythematosus (SLE) anxiously states, "My chest hurts when I lie down. I think it is from coughing so much. Please sit me up." Which condition should the nurse first suspect? 1. Thrombocytopenia 2. Pericarditis 3. Myocardial infarction 4. Anemia 27. The nurse is caring for a pregnant client with systemic lupus erythematosus (SLE). Which neonatal complication related to maternal lupus should the nurse anticipate the fetus to be tested for during the second trimester of pregnancy? 1. Renal anomalies 2. Congenital heart block (CHB) 3. Anemia 4. Liver involvement 28. An older adult client is experiencing an acute episode of systemic lupus erythematosus (SLE). Which primary concern should the nurse consider when administering newly prescribed medications? 1. Renal function 2. Cardiovascular function 3. Respiratory function 4. Neurological function 29. The nurse is teaching a client newly diagnosed with systemic lupus erythematosus (SLE). Which information should the nurse include in the client's teaching? 1. Using high-dose birth control pills 2. Using only acetaminophen for pain relief 3. Avoiding large crowds 4. Increasing daily sun exposure 30. The nurse is reviewing medications ordered for a newly admitted female client with systemic lupus erythematosus (SLE). Which medication order should the nurse question? 1. Immunosuppressive 2. Oral contraceptive 3. Antineoplastic 4. Corticosteroid 31. The nurse is caring for a client with systemic lupus erythematosus (SLE) who presents with pain and discomfort. Which treatment option should the nurse anticipate? (Select all that apply.) 1. Corticosteroids 2. Increasing sun exposure 3. Moderate exercise 4. Proper nutrition 5. NSAIDs 32. Which laboratory test is used in the diagnosis of systemic lupus erythematosus (SLE)? (Select all that apply.) 1. Urinalysis 2. Anti-DNA antibody testing 3. Erythrocyte sedimentation rate (ESR) 4. Triglyceride levels 5. Complete blood count (CBC) 33. The nurse is teaching a new colleague the effects of drugs used for clients with systemic lupus erythematosus (SLE). Which statement by the colleague indicates the need for further teaching? 1. "Thrombosis prevention is a positive side effect with aspirin therapy." 2. "Corticosteroid therapy can cause cushingoid effects." 3. "If a cytotoxic agent is prescribed, infection may occur." 4. "When the client is on aspirin therapy, I should monitor for renal toxicity." 34. A client diagnosed with systemic lupus erythematosus (SLE) presents with fatigue, joint pain, oral ulcers, and a red rash over the face and upper trunk. Which collaborative therapy should the nurse expect to implement? 1. Corticosteroid therapy 2. Antibiotic therapy 3. Surgical drainage of affected joints 4. Physical therapy to improve mobility 35. The nurse is planning care for an adolescent client with systemic lupus erythematosus (SLE). Which nursing diagnosis is a special consideration for this client? 1. Memory, Impaired 2. Fluid Volume: Imbalanced, Risk for 3. Body Image, Disturbed 4. Infection, Risk for 36. In a community setting, the nurse is providing care to a client who was recently diagnosed with systemic lupus erythematosus (SLE). Which is the goal of care for this client? (Select all that apply.) 1. Maintaining skin integrity 2. Reducing pain 3. Limiting fluid intake 4. Reducing inflammation 5. Preventing infection 37. The nurse is admitting a client with systemic lupus erythematosus (SLE) for an upper respiratory infection. Which nursing goal is the priority? 1. The client can verbalize the importance of oral care. 2. The client demonstrates proper hand hygiene. 3. The client can verbalize skin care needs to reduce the risk of altered skin integrity. 4. The client can verbalize the impact of the diagnosis to the healthcare provide 38. The nurse is providing teaching for a client diagnosed with systemic lupus erythematosus (SLE) experiencing alterations in skin integrity. Which client statement indicates effective teaching? 1. "I will apply sunscreen immediately prior to going outdoors." 2. "I will cover the lesions on my head with a wig." 3. "I will use fluorescent lighting." 4. "I will limit the use of cosmetics. 39. The nurse is caring for a client with exacerbation of systemic lupus erythematosus (SLE). Which statement by the nurse is accurate? "The client is at risk for a micronutrient deficiency." 1. The client is at risk for a micronutrient deficiency." 2. "The client is at risk for weigh gain." 3. "The client is at risk for a macronutrient deficiency." 4. "The client is at risk for weight loss." ACUTE RESPIRATORY DISTRESS SYNDROME 1. The nurse has placed the intubated client with acute respiratory distress syndrome (ARDS) in prone position for 30 minutes. Which of the following would require the nurse to discontinue prone positioning and return the client to the supine position? Select all that apply. ■ 1. The family is coming in to visit. ■ 2. The client has increased secretions requiring frequent suctioning. ■ 3. Myocardial infarction. ■ 4. Pulmonary embolus. 10. Which of the following interventions should the nurse anticipate in a client who has been diagnosed with acute respiratory distress syndrome (ARDS)? ■ 1. Tracheostomy. ■ 2. Use of a nasal cannula. ■ 3. Mechanical ventilation. ■ 4. Insertion of a chest tube. 11. Which of the following conditions can place a client at risk for acute respiratory distress syndrome (ARDS)? ■ 1. Septic shock. ■ 2. Chronic obstructive pulmonary disease. ■ 3. Asthma. ■ 4. Heart failure. 12. Which one of the following assessments is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client? ■ 1. Assessing the client’s skin color. ■ 2. Monitoring the respiratory rate. ■ 3. Verifying the amount of cuff inflation. ■ 4. Auscultating breath sounds bilaterally 13. Which of the following nursing interventions would promote effective airway clearance in a client with acute respiratory distress? ■ 1. Administering oxygen every 2 hours. ■ 2. Turning the client every 4 hours. ■ 3. Administering sedatives to promote rest. ■ 4. Suctioning if cough is ineffective. 14. Which of the following complications is associated with mechanical ventilation? ■ 1. Gastrointestinal hemorrhage. ■ 2. Immunosuppression. ■ 3. Increased cardiac output. ■ 4. Pulmonary emboli. 15. A client is admitted to the emergency department with a headache, weakness, and slight confusion. The physician diagnoses carbon monoxide poisoning. What should the nurse do first? ■ 1. Initiate gastric lavage. ■ 2. Maintain body temperature. ■ 3. Administer 100% oxygen by mask. ■ 4. Obtain a psychiatric referral 16. A confused client with carbon monoxide poisoning experiences dizziness when ambulating to the bathroom. The nurse should: ■ 1. Put all four side rails up on the bed. ■ 2. Ask the unlicensed personnel to place restraints on the client’s upper extremities. ■ 3. Request that the client’s roommate put the call light on when the client is attempting to get out of bed. ■ 4. Check on the client at regular intervals to ascertain the need to use the bathroom. 17. Which of the following are expected outcomes for a client with pulmonary disease? ■ 1. A relatively matched ventilation-to-perfusion ratio. ■ 2. A low ventilation-to-perfusion ratio. ■ 3. A high ventilation-to-perfusion ratio. ■ 4. An equal PaO2 and PaCO2 ratio. 18. Following an unrestrained motor vehicle crash, a client presents to an emergency department with multiple injuries, including chest trauma. A physician notifies the care team that the client has progressed to acute respiratory distress syndrome (ARDS) and requests that the family be updated on the client’s condition. The nurse should plan to discuss with the family that: 1. the condition generally stabilizes with positive prognosis. 2. the client can be discharged with home oxygen. 3. the condition is always fatal. 4. the condition is highly life-threatening and that end-of-life concerns should be addressed. 19. A nurse observes for early manifestations of acute respiratory distress syndrome (ARDS) in a client being treated for smoke inhalation. Which signs indicates the possible onset of ARDS in this client? 1. Cough with blood-tinged sputum and respiratory alkalosis 2. Decrease in both white and red blood cell counts 3. Diaphoresis and low SaO2 unresponsive to increased oxygen administration 4. Hypertension and elevated PaO2 20. The unlicensed assistive personnel (UAP) is bathing the client diagnosed with acute respiratory distress syndrome (ARDS). The bed is in a high position with the opposite side rail in the low position. Which action should the nurse implement? 1. Demonstrate the correct technique for giving a bed bath. 2. Encourage the UAP to put the bed in the lowest position. 3. Instruct the UAP to get another person to help with the bath. 4. Provide praise for performing the bath safely for the client and the UAP. 21. The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first? 1. Confirm that the ventilator settings are correct. 2. Verify that the ventilator alarms are functioning properly. 3. Assess the respiratory status and pulse oximeter reading. 4. Monitor the client’s arterial blood gas results 22. The nurse suspects the client may be developing ARDS. Which assessment data confirm the diagnosis of ARDS? 1. Low arterial oxygen when administering high concentration of oxygen. 2. The client has dyspnea and tachycardia and is feeling anxious. 3. Bilateral breath sounds clear and pulse oximeter reading is 95%. 4. The client has jugular vein distention and frothy sputum. 23. The client who smokes two (2) packs of cigarettes a day develops ARDS after a neardrowning. The client asks the nurse, “What is happening to me? Why did I get this?” Which statement by the nurse is most appropriate? 1. “Most people who almost drown end up developing ARDS.” 2. “Platelets and fluid enter the alveoli due to permeability instability.” 3. “Your lungs are filling up with fluid, causing breathing problems.” 4. “Smoking has caused your lungs to become weakened, so you got ARDS.” 24. Which assessment data indicate to the nurse the client diagnosed with ARDS has experienced a complication secondary to the ventilator? 1. The client’s urine output is 100 mL in four (4) hours. ■ 1. Hugging an HIV-positive sexual partner without using barrier precautions. ■ 2. Inhaling cocaine. ■ 3. Sharing food utensils with an HIV-positive person without proper cleaning of the utensils. ■ 4. Having sexual intercourse with an HIV positive person without using a condom. 3. A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The expected outcome of AZT is to: ■ 1. Destroy the virus. ■ 2. Enhance the body’s antibody production. ■ 3. Slow replication of the virus. ■ 4. Neutralize toxins produced by the virus 4. Women who have human papillomavirus (HPV) are at risk for development of: ■ 1. Sterility. ■ 2. Cervical cancer. ■ 3. Uterine fi broid tumors. ■ 4. Irregular menses. 5. The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a client with human immunodeficiency virus (HIV) infection is that it: ■ 1. Is an acquired immunodeficiency virus (AIDS)–defining illness. ■ 2. Is curable only after 1 year of antiviral therapy. ■ 3. Leads to cervical cancer. ■ 4. Causes severe electrolyte imbalances 6. In educating a client about human immunodeficiency virus (HIV), the nurse should take into account the fact that the most effective method known to control the spread of HIV infection is: ■ 1. Premarital serologic screening. ■ 2. Prophylactic treatment of exposed people. ■ 3. Laboratory screening of pregnant women. ■ 4. Ongoing sex education about preventive behaviors. 7. A male client with human immunodeficiency virus (HIV) infection becomes depressed and tells the nurse: “I have nothing worth living for now.” Which of the following statements would be the best response by the nurse? ■ 1. “You are a young person and have a great deal to live for.” ■ 2. “You should not be too depressed; we are close to finding a cure for AIDS.” ■ 3. “You are right; it is very depressing to have HIV.” ■ 4. “Tell me more about how you are feeling about being HIV-positive.” 8. The typical chancre of syphilis appears as: ■ 1. A grouping of small, tender pimples. ■ 2. An elevated wart. ■ 3. A painless, moist ulcer. ■ 4. An itching, crusted area. 9. The nurse is interviewing a client with newly diagnosed syphilis. In order to prevent the spread of the disease, the nurse should focus the interview by: ■ 1. Motivating the client to undergo treatment. ■ 2. Obtaining a list of the client’s sexual contacts. ■ 3. Increasing the client’s knowledge of the disease. ■ 4. Reassuring the client that records are confidential 10. Benzathine penicillin G, 2.4 million units I.M., is prescribed as treatment for an adult client with primary syphilis. The nurse should administer the injection in the: ■ 1. Deltoid. ■ 2. Upper outer quadrant of the buttock. ■ 3. Quadriceps lateralis of the thigh. ■ 4. Midlateral aspect of the thigh 11. A priority nursing diagnosis for a client with primary syphilis is: ■ 1. Deficient knowledge related to lack of information about the mode of transmission. ■ 2. Pain related to cutaneous skin lesions on palms and soles. ■ 3. Ineffective tissue perfusion related to a bleeding chancre. ■ 4. Disturbed body image related to alopecia. 12. An 18-year-old female college student is seen at the university health center. She undergoes a pelvic examination and is diagnosed with gonorrhea. Which of the following responses by the nurse would be best when the client says that she is nervous about the upcoming pelvic examination? ■ 1. “Can you tell me more about how you’re feeling?” ■ 2. “You’re not alone. Most women feel uncomfortable about this examination.” ■ 3. “Do not worry about Dr. Smith. He’s a specialist in female problems.” ■ 4. “We’ll do everything we can to avoid embarrassing you.” 13. When educating a female client with gonorrhea, the nurse should emphasize that for women gonorrhea: ■ 1. Is often marked by symptoms of dysuria or vaginal bleeding. ■ 2. Does not lead to serious complications. ■ 3. Can be treated but not cured. ■ 4. May not cause symptoms until serious complications occur. 14. Which of the following groups has experienced the greatest rise in the incidence of sexually transmitted diseases (STDs) over the past two decades? ■ 1. Teenagers. ■ 2. Divorced people. ■ 3. Young married couples. ■ 4. Older adults. 15. A 16-year-old sexually active male client comes to the clinic with a complaint of burning on urination and a milky discharge from the urethral meatus. Documentation on the client’s chart should include which of the following information? Select all that apply. ■ 1. History of unprotected sex (sex without a condom). ■ 2. Length of time since symptoms presented. ■ 3. History of fever or chills. ■ 4. Presence of any enlarged lymph nodes on examination. ■ 5. Names and phone numbers of all sexual contacts. ■ 6. Allergies to any medications. 16. A 19-year-old male client is diagnosed with a chlamydial infection. Azithromycin (Zithromax) 1 g is ordered. The supply of azithromycin is in 250-mg tablets. How many tablets should the nurse administer? tablets. 4 tablets 17. A female client with gonorrhea informs the nurse that she has had sexual intercourse with her boyfriend and asks the nurse, “Would he have any symptoms?” The nurse responds that in men the symptoms of gonorrhea include: ■ 1. Impotence. 3. Damage to the cervix from the infection resulted in closure of the cervix such that sperm are blocked from entering the uterus. 4. Ovulation is no longer occurring because the infection damaged the woman’s ovaries and less estrogen is being secreted 27. Which statement made by a client receiving treatment for a sexually transmitted disease indicates a need for teaching? 1. “I should abstain from sexual intercourse while receiving treatment for chlamydia.” 2. “I plan to use latex rather than a nonlatex condom because there is less likelihood of the condom breaking.” 3. “For the genital warts, I should apply podophyllin resin 10% solution carefully to each wart, and then wash it off in 1 to 4 hours.” 4. “There is no cure for genital herpes; I should take the analgesic to control my pain and the antiviral medication to shorten the course of the infection.” 28. A nursing student approaches an instructor following a needlestick to the finger from a needle used for an injection with a known HIV-positive client. Which instructor statement is most accurate? 1. Postexposure prophylaxis will need to be started within 1 to 2 hours. 2. HIV antibody testing will need to be done in 6 weeks and then again in 3 months. 3. At the end of the clinical shift, you should make an appointment to see your health-care provider. 4. Flush immediately with water for 10 minutes and cover with a bandage and glove. 29. A client is diagnosed with Pneumocystis carinii pneumonia (PCP) secondary to AIDS. Upon assessment for the specific symptoms of PCP, the nurse should expect to find: 1. dyspnea, fever, nonproductive cough, and fatigue. 2. weight loss, night sweats, persistent diarrhea, and hypothermia. 3. dysphagia, yellow-white plaques in the mouth, and sore throat. 4. lung crackles, chest pain, and small, painless purple-blue skin lesions. 30. A client diagnosed with HIV, has a CD4-positive T-lymphocyte count of 160 µL. A nurse evaluates that interventions have been most effective when which outcome is achieved? 1. Soft formed stools daily 2. Skin integrity nonintact 3. Free of opportunistic diseases 4. Current weight maintained or gaining weight 31. A nurse is teaching a client and the family members about protection measures when the client, diagnosed with AIDS, returns home. Which instruction indicates that the nurse is unclear about the disease transmission? 1. “Disinfect items in your home, using a bleach solution of 1 part bleach to 10 parts of water.” 2. “Dispose of contaminated items, except sharps, by placing them in a plastic bag then in the garbage.” 3. “Use separate dishes and silverware and wash them with soap and water or place them in the dishwasher.” 4. “Wearing gloves, clean body fluid spills with soap and water, and then disinfect the area with bleach solution. 32. The occupational health nurse is preparing a class regarding sexually transmitted diseases (STDs) for employees at a manufacturing plant. Which high-risk behavior information should be included in the class information? 1. Engaging in oral or anal sex decreases the risk of getting an STD. 2. Using a sterile needle guarantees the client will not get an STD. 3. The more sexual partners, the greater the chance of developing an STD. 4. If a condom is used, the client will not get a sexually transmitted disease 33. The female client diagnosed with human papillomavirus (HPV) asks the nurse, “What other problems can HPV lead to?” Which statement is the most appropriate response by the nurse? 1. “HPV is transmitted during sexual intercourse.” 2. “HPV infection can cause cancer of the cervix.” 3. “It has been known to lead to ovarian problems.” 4. “Regular Pap smears can help prevent problems.” 34. The male client presents to the public health clinic complaining of joint pain and malaise. On assessment, the nurse notes a rash on the trunk, palms of the hands, and soles of the feet. Which action should the nurse implement next? 1. Determine if the client has had a chancre sore within the last two (2) months. 2. Ask the client how many sexual partners he has had in the past year. 3. Refer the client to a dermatologist for a diagnostic work-up. 4. Have the client provide a clean voided midstream urine specimen. 35. The nurse is caring for a young adult client who has been diagnosed with gonorrhea. Which statement reflects an understanding of the transmission of sexually transmitted diseases? 1. Only lower socioeconomic income people are at risk for gonorrhea and syphilis. 2. The longer a client waits to become sexually active, the greater the risk for an STD. 3. Females can transmit infectious diseases more rapidly than males. 4. If a client is diagnosed with an STD, the client should be evaluated for other STDs. 36. The young female client is admitted with pelvic inflammatory disease secondary to a chlamydia infection. Which discharge instruction should be taught to the client? 1. The client will develop antibodies to protect against a future infection. 2. This infection will not have any long-term effects for the client. 3. Both the client and the sexual partner must be treated simultaneously. 4. Once the infection subsides, the pain will go away and not be a problem. 37. The nurse is assessing a male client for symptoms of gonorrhea. Which data support the diagnosis? 1. Presence of a chancre sore on the penis. 2. No symptoms. 3. A CD4 count of less than 200. 4. Pain in the testes and scrotal edema. 38. The nurse is working in a health clinic. Which disease is required to be reported to the public health department? 1. Pelvic inflammatory disease. 2. Epididymitis. 3. Syphilis. 4. Ectopic pregnancy. 39. The nurse is planning the care of a client diagnosed with pelvic inflammatory disease secondary to an STD. Which collaborative diagnosis is appropriate for this client? 1. Risk for infertility. 2. Knowledge deficit. 3. Fluid volume deficit. 4. Noncompliance 40. Which laboratory test should the nurse expect for the client to rule out the diagnosis of syphilis? 1. Vaginal cultures. 2. Rapid plasma reagin card test (RPR-CT). 3. Gram-stained specimen of the urethral meatus. ■ 2. Frequency and burning on urination. ■ 3. Flank pain and nausea. ■ 4. Hematuria. 7. The client asks the nurse, “How did I get this urinary tract infection?” The nurse should explain that in most instances, cystitis is caused by: ■ 1. Congenital strictures in the urethra. ■ 2. An infection elsewhere in the body. ■ 3. Urinary stasis in the urinary bladder. ■ 4. An ascending infection from the urethra. 8. The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which would be the nurse’s best approach? ■ 1. Arrange a meeting with the client, her husband, the physician, and the nurse. ■ 2. Insist that the client talk with her husband because good communication is necessary for a successful marriage. ■3. Talk first with the husband alone and then with both of them together to share the husband’s reactions. ■ 4. Spend time with the client addressing her concerns and then stay with her while she talks with her husband. 9. The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse’s instructions? ■ 1. “I will place ice packs on my perineum.” ■ 2. “I will take hot tub baths.” ■ 3. “I will drink a cup of warm tea every hour.” ■ 4. “I will void every 5 to 6 hours.” 10. The client with cystitis is given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by: ■ 1. Releasing formaldehyde and providing bacteriostatic action. ■ 2. Potentiating the action of the antibiotic. ■ 3. Providing an analgesic effect on the bladder mucosa. ■ 4. Preventing the crystallization that can occur with sulfa drugs. 11. When teaching the client with a urinary tract infection about taking phenazopyridine hydrochloride (Pyridium), the nurse should tell the client to expect: ■ 1. Bright orange-red urine. ■ 2. Incontinence. ■ 3. Constipation. ■ 4. Slight drowsiness. 12. A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply. ■ 1. “Take the medication on an empty stomach.” ■ 2. “Your urine may become brown in color.” ■ 3. “Increase your fluid intake.” ■ 4. “Take the medication until your symptoms subside.” ■ 5. “Take the medication with an antacid to decrease gastrointestinal distress.” 13. Nitrofurantoin (Macrodantin), 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/5 mL. How many milliliters should the nurse administer for each dose? _ mL 15 mL 14. Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? ■ 1. “I can usually go 8 to 10 hours without needing to empty my bladder.” ■ 2. “I take a tub bath every evening.” ■ 3. “I wipe from front to back after voiding.” ■ 4. “I drink a lot of water during the day.” 15. To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine? ■ 1. Wearing cotton underpants. ■ 2. Increasing citrus juice intake. ■ 3. Douching regularly with 0.25% acetic acid. ■ 4. Using vaginal sprays. 16. The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: ■ 1. Twice as much fluid as usual. ■ 2. At least 1 quart more than usual. ■ 3. A lot of water, juice, and other fluids throughout the day. ■ 4. At least 3,000 mL of fluids daily 17. A client is diagnosed with acute pyelonephritis. Which of the following instructions should the nurse provide to the client about managing the disease? ■ 1. “Urinate frequently because the bacteria that cause acute pyelonephritis reach the kidneys by means of an infection that progresses upward from lower in the urinary tract.” ■ 2. “Taking frequent bubble baths will decrease the likelihood of further episodes of pyelonephritis.” ■ 3. “You should take antibiotics for the rest of your life to prevent urinary tract infections.” ■ 4. “By decreasing your fluid intake, you will decrease the need for frequent urination and the irritating effect of urine in your ureter.” 18. Which of the following symptoms would most likely indicate that the client has pyelonephritis? ■ 1. Ascites. ■ 2. Costovertebral angle (CVA) tenderness. ■ 3. Polyuria. ■ 4. Nausea and vomiting 19. Which of the following factors would put the client at increased risk for pyelonephritis? ■ 1. History of hypertension. ■ 2. Intake of large quantities of cranberry juice. ■ 3. Fluid intake of 2,000 mL/day. ■ 4. History of diabetes mellitus. 20. To assess the client’s rental status, the nurse should monitor which of the following laboratory tests? Select all that apply. ■ 1. Serum sodium ■ 2. Potassium levels. ■ 3. Arterial blood gases ■ 4. Hemoglobin. ■ 5. Serum blood urea nitrogen ■ 6. Creatinine levels. 3. The client will maintain normal renal function. 4. The client will have clear lung sounds 31. The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1. The blood urea nitrogen is 15 mg/dL. 2. The creatinine level is 1.2 mg/dL. 3. The glomerular filtration rate is 40 mL/min. 4. The 24-hour creatinine clearance is 100 mL/min. 32. The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3. In three (3) months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections. NEPHROLITHIASIS (RENAL CALCULI) 1. A client has renal colic due to renal lithiasis. What is the nurse’s first priority in managing care for this client? ■ 1. Do not allow the client to ingest fluids. ■ 2. Encourage the client to drink at least 500 mL of water each hour. ■ 3. Request the central supply department to send supplies for straining urine. ■ 4. Administer an opioid analgesic as prescribed. 2. A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6° F (38.1° C). Which of the following would be a priority outcome for this client? ■ 1. Prevention of urinary tract complications. ■ 2. Alleviation of nausea. ■ 3. Alleviation of pain. ■ 4. Maintenance of fluid and electrolyte balance. 3. The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for this procedure, the nurse should explain to the client that: ■ 1. Fluid and food will be withheld the morning of the examination. ■ 2. A tranquilizer will be given before the examination. ■ 3. An enema will be given before the examination. ■ 4. No special preparation is required for the examination. 4. In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. The nurse should assess the client further for signs of: ■ 1. Nephritis. ■ 2. Referred pain. ■ 3. Urine retention. ■ 4. Additional stone formation. 5. Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? ■ 1. Applying moist heat to the flank area. ■ 2. Administering meperidine (Demerol). ■ 3. Encouraging high fluid intake. ■ 4. Maintaining complete bed rest. 6. A client who has been diagnosed with renal calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? ■ 1. Report hematuria to the physician. ■ 2. Strain the urine carefully. ■ 3. Administer meperidine (Demerol) every 3 hours. ■ 4. Apply warm compresses to the flank area. 7. The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which of the following measures would be most important for the nurse to include in pretest preparation? ■ 1. Ensuring adequate fluid intake on the day of the test. ■ 2. Preparing the client for the possibility of bladder spasms during the test. ■ 3. Checking the client’s history for allergy to iodine. ■ 4. Determining when the client last had a bowel movement. 8. After an intravenous pyelogram (IVP), the nurse should anticipate incorporating which of the following measures into the client’s plan of care? ■ 1. Maintaining bed rest. ■ 2. Encouraging adequate fluid intake. ■ 3. Assessing for hematuria. ■ 4. Administering a laxative. 9. A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: ■ 1. Irrigate the catheter with 30 mL of normal saline every 8 hours. ■ 2. Ensure that the catheter is draining freely. ■ 3. Clamp the catheter every 2 hours for 30 minutes. ■ 4. Ensure that the catheter drains at least 30 mL/ hour. 10. Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery? ■ 1. Encourage the client to ambulate every 2 to 4 hours. ■ 2. Offer 3 to 4 oz of a carbonated beverage periodically. ■ 3. Encourage use of a stool softener. ■ 4. Continue I.V. fluid therapy 11. The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician? ■ 1. Temperature, 99.8° F (37.7° C). ■ 2. Urine output, 20 mL/hour. ■ 3. Absence of bowel sounds. ■ 4. A 2″ × 2″ area of serosanguineous drainage on the flank dressing. 12. A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client’s discharge teaching plan? ■ 1. Increase daily fluid intake to at least 2 to 3 L. ■ 2. Strain urine at home regularly. ■ 3. Eliminate dairy products from the diet. ■ 4. Follow measures to alkalinize the urine. 13. Because a client’s renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? ■ 1. Milk, apples, tomatoes, and corn. 23. The client diagnosed with renal calculi is scheduled for lithotripsy. Which post procedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client’s postprocedural vital signs. 24. Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. “I should increase my fluid intake, especially in warm weather.” 2. “I should eat foods containing cocoa and chocolate.” 3. “I will walk about a mile every week and not exercise often.” 4. “I should take one (1) vitamin a day with extra calcium.” 25. Which intervention is most important for the nurse to implement for the client diagnosed with rule- out renal calculi? 1. Assess the client’s neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client’s creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview. 26. The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client’s urine. 27. The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3 . 28. The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs. ACUTE RENAL FAILURE 1. A client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should? ■ 1. Assess the dialysis access for a bruit and thrill. ■ 2. Insert an indwelling urinary catheter and drain all urine from the bladder. ■ 3. Ask the client to turn toward the left side. ■ 4. Warm the solution in the warmer. 2. A client has been admitted with acute renal failure. What should the nurse do? Select all that apply. ■ 1. Elevate the head of the bed 30 to 45 degrees. ■ 2. Take vital signs. ■ 3. Establish an I.V. access site. ■ 4. Call the admitting physician for orders. ■ 5. Contact the hemodialysis unit. 3. Which of the following is the most common initial manifestation of acute renal failure? ■ 1. Dysuria. ■ 2. Anuria. ■ 3. Hematuria. ■ 4. Oliguria. 4. A client developed shock after a severe myocardial infarction and has now developed acute renal failure. The client’s family asks the nurse why the client has developed acute renal failure. The nurse should base the response on the knowledge that there was: ■ 1. A decrease in the blood flow through the kidneys. ■ 2. An obstruction of urine flow from the kidneys. ■ 3. A blood clot formed in the kidneys. ■ 4. Structural damage to the kidney resulting in acute tubular necrosis. 5. The client’s blood urea nitrogen (BUN) concentration is elevated in acute renal failure. What is the likely cause of this finding? ■ 1. Fluid retention. ■ 2. Hemolysis of red blood cells. ■ 3. Below-normal metabolic rate. ■ 4. Reduced renal blood flow. 6. The client’s serum potassium level is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate (Kayexalate). This drug acts to: ■ 1. Increase potassium excretion from the colon. ■ 2. Release hydrogen ions for sodium ions. ■ 3. Increase calcium absorption in the colon. ■ 4. Exchange sodium for potassium ions in the colon. 7. A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for: ■ 1. Cardiac arrest. ■ 2. Pulmonary edema. ■ 3. Circulatory collapse. ■ 4. Hemorrhage 8. A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to: ■ 1. Act as a diuretic. ■ 2. Reduce demands on the liver. ■ 3. Help maintain urine acidity. ■ 4. Prevent the development of ketosis. 9. The client with acute renal failure asks the nurse for a snack. Because the client’s potassium level is elevated, which of the following snacks is most appropriate? ■ 1. A gelatin dessert. ■ 2. Yogurt. ■ 3. An orange. ■ 4. Peanuts. 1. Diabetes mellitus. 2. Hypotension. 3. Aminoglycosides. 4. Benign prostatic hypertrophy. 21. The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting. 4. Decreased urine-specific gravity. 5. Increased serum creatinine level. 22. The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood. 3. Assess the client for leg cramps. 4. Prepare the client for dialysis 23. The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by three (3) levels on a 1-to-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia. 24. The client diagnosed with ARF is admitted to the intensive care department and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet. 2. A low-fat and low-cholesterol diet. 3. A high-carbohydrate and restricted-protein diet. 4. A regular diet with six (6) small feedings a day. 25. The client diagnosed with ARF is placed on bedrest. The client asks the nurse, “Why do I have to stay in bed? I don’t feel bad.” Which scientific rationale supports the nurse’s response? 1. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart. 4. Bedrest aids in reduction of peripheral and sacral edema. 26. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate? 1. Collect a clean voided midstream urine specimen. 2. Evaluate the client’s eight (8)-hour intake and output. 3. Assist in checking a unit of blood prior to hanging. 4. Administer a cation-exchange resin enema. 27. The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV. 2. Take vital signs. 3. Place client on telemetry. 4. Assess abdominal dressing 28. The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn the client in this condition. 4. Explain this is normal and do not do anything for the client. 29. The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin. 2. Calcium gluconate. 3. Regular insulin. 4. Osmotic diuretic. CHRONIC KIDNEY FAILURE 1. 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 lb in 1 day. Based on these data, which of the following nursing diagnoses is appropriate? ■ 1. Excess fluid volume related to the kidney’s inability to maintain fluid balance. ■ 2. Ineffective breathing pattern related to fluid in the lungs. ■ 3. Ineffective tissue perfusion related to interrupted arterial blood flow. ■ 4. Ineffective therapeutic regimen management related to lack of knowledge about therapy 2. What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic renal failure? ■ 1. The danger of hemorrhage is high. ■ 2. It cannot correct severe imbalances. ■ 3. It is a time-consuming method of treatment. ■ 4. The risk of contracting hepatitis is high. 3. A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply. ■ 1. Drink fluids before eating solid foods. ■ 2. Have limited amounts of fluids only when thirsty. ■ 3. Limit activity. ■ 4. Keep all dialysis appointments. ■ 5. Eat smaller, more frequent meals. 4. The dialysis solution is warmed before use in peritoneal dialysis primarily to: ■ 1. Encourage the removal of serum urea. ■ 2. Force potassium back into the cells. ■ 3. Add extra warmth to the body. ■ 4. Promote abdominal muscle relaxation. 5. Which of the following assessments would be most appropriate for the nurse to make while the dialysis solution is dwelling within the client’s abdomen? ■ 1. Assess for urticaria. ■ 2. Observe respiratory status. ■ 2. High-calcium, high-potassium, high-protein. ■ 3. Low-protein, low-sodium, low-potassium. ■ 4. Low-protein, high-potassium. 16. The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which one of the following strategies would be most useful? ■ 1. Help the client to accept that sexual activity will be decreased. ■ 2. Suggest using alternative forms of sexual expression and intimacy. ■ 3. Tell the client to plan rest periods after sexual activity. ■ 4. Suggest that the client avoid sexual activity to prevent embarrassment 17. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: ■ 1. Is relatively low in cost. ■ 2. Allows the client to be more independent. ■ 3. Is faster and more efficient than standard peritoneal dialysis. ■ 4. Has fewer potential complications than standard peritoneal dialysis 18. The client asks about diet changes when using continuous ambulatory peritoneal dialysis (CAPD). Which of the following would be the nurse’s best response? ■ 1. “Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique.” ■ 2. “Diet restrictions are the same for both CAPD and standard peritoneal dialysis.” ■3. “Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant.” ■ 4. “Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly.” 19. A client is receiving continous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the following signs of peritoneal infection? ■ 1. Cloudy dialysate fluid. ■ 2. Swelling in the legs. ■ 3. Poor drainage of the dialysate fluid. ■ 4. Redness at the catheter insertion site. 20. The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? 1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. 2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. 3. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. 4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately 21. The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2. The client who does not have a palpable thrill or auscultated bruit. 3. The client who is complaining of being exhausted and is sleeping. 4. The client who did not take antihypertensive medication this morning. 22. The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, one (1) week ago. Which complaint by the client indicates the need to notify the health-care provider? 1. The client complains of flu-like symptoms. 2. The client complains of being tired all the time. 3. The client reports an elevation in his blood pressure. 4. The client reports discomfort in his legs and back. 23. The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? 1. Low self-esteem. 2. Knowledge deficit. 3. Activity intolerance. 4. Excess fluid volume 24. The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement? 1. Teach the client to carry heavy objects with the right arm. 2. Perform all laboratory blood tests on the left arm. 3. Instruct the client to lie on the left arm during the night. 4. Discuss the importance of not performing any hand exercises 25. The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic? 1. “You cannot just quit your dialysis. This is not an option.” 2. “You’re angry at not being on the list, and you want to quit dialysis?” 3. “I will call your nephrologist right now so you can talk to the HCP.” 4. “Make your funeral arrangements because you are going to die.” 26. The nurse is discussing kidney transplants with clients at a dialysis center. Which population is less likely to participate in organ donation? 1. Caucasian. 2. African American. 3. Asian. 4. Hispanic. 27. The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? 1. Place the client in the Trendelenburg position. 2. Turn off the dialysis machine immediately. 3. Bolus the client with 500 mL of normal saline. 4. Notify the health-care provider as soon as possible. 28. The nurse caring for a client diagnosed with CKD writes a client problem of “noncompliance with dietary restrictions.” Which intervention should be included in the plan of care? 1. Teach the client the proper diet to eat while undergoing dialysis. 2. Refer the client and significant other to the dietitian. 3. Explain the importance of eating the proper foods. 4. Determine the reason for the client not adhering to the diet. 29. The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? 1. Inability to auscultate a bruit over the fistula. 1. “Are you experiencing any left flank pain?” 2. “Do you like to drink cranberry, prune, or tomato juice?” 3. “Have you had a history of chronic urinary tract infections (UTIs)?” 4. “How often do you eat organ meats, poultry, fish, and sardines?” 10. A nurse is admitting a client with a diagnosis of renal calculi to a hospital nursing unit. Which nursing action should be performed first? 1. Encourage the client to increase oral fluids 2. Obtain supplies to measure and strain all urine 3. Assess the severity and location of the client’s pain 4. Obtain consent for an extracorporeal shock wave lithotripsy (ESWL) 11. Which nursing actions should a nurse plan in the care of a client immediately after extracorporeal shock wave lithotripsy (ESWL)? SELECT ALL THAT APPLY. 1. Measure and strain all urine 2. Keep the client NPO for 24 hours 3. Check for ecchymosis on the flank of the affected side 4. Assess the incision to see if it is clean, dry, and intact 5. Remove the stent if one has been placed before or during ESWL 12. Which interventions should a nurse include when caring for a female client experiencing new onset urge urinary incontinence? SELECT ALL THAT APPLY. 1. Take the client to the bathroom every 4 hours 2. Administer diuretics at supper time so the bladder is empty at night 3. Turn on the water or flush the toilet to assist the client to void 4. Space fluids at regular intervals during the day and limit fluids after the dinner hour 5. Instruct the client on insertion of vaginal weights which are to be worn throughout the day 13. A nurse reviews the laboratory report of a client with acute renal failure (ARF) and notes that the serum potassium level is 6.8 mEq/L. Which medication should the nurse plan to administer specifically to protect the heart from the high potassium levels? 1. Erythropoietin 2. Regular insulin 3. 50% dextrose 4. Calcium gluconate 14. A nurse evaluates that a client is in the recovery phase of acute renal failure (ARF). Achievement of which outcomes supports the nurse’s conclusion? SELECT ALL THAT APPLY. 1. Increased urine specific gravity 2. Increased serum creatinine level 3. Decreased serum potassium level 4. Absence of nausea and vomiting 5. Absence of muscle twitching 15. After a diagnosis of chronic renal failure, a client was started on epoetin alfa (Epogen®). Which finding should a nurse expect when evaluating the desired therapeutic effectiveness of the medication? 1. Decrease in serum creatinine levels (SCr) 2. Increase in white blood cells (WBCs) 3. Increase in serum hematocrit (Hct) 4. Decrease in blood pressure (BP) 16. A client with a diagnosis of end-stage renal disease states to a nurse, “I don’t think I want to be on dialysis anymore; it’s just too painful for me.” What is the most appropriate response by the nurse? 1. “Why do you think you will be unable to stay on dialysis?” 2. “You feel that dialysis is painful for you. Tell me more about that.” 3. “It really isn’t hard to stay on dialysis. Remember you can sleep during the dialysis run.” 4. “You need to stay on dialysis to avoid getting worse. You could die if you don’t go to dialysis regularly 17. Which notation should a nurse document as an appropriate outcome in the plan of care for a client with chronic renal failure? 1. Consumption of three large meals daily without nausea 2. Daily weight gain of no more than 3 pounds 3. Reduced serum albumin levels within 1 week 4. Absence of bleeding 18. A nursing assistant reports to a nurse that a client diagnosed with chronic renal failure has “white crystals” and dry, itchy skin. Based on this information, the nurse should instruct the nursing assistant to: 1. apply the prescribed antipruritic cream to the client’s skin. 2. offer the client a glass of warm milk to drink. 3. bathe the client in tepid water. 4. assess the client’s serum creatinine levels. 19. Which nursing assessment is most accurate in determining the patency of a client’s newly placed left forearm internal arteriovenous (AV) fistula for hemodialysis? 1. Feeling for a bruit on the left forearm 2. Palpating for a thrill over the fistula 3. Aspirating blood from the fistula every 8 hours 4. Checking the client’s distal pulses and circulation 20. A nurse is initiating peritoneal dialysis for a client with renal failure. During the infusion of the dialysate, the client reports abdominal pain. Which intervention by the nurse is most appropriate? 1. Stopping the dialysis 2. Slowing the infusion 3. Asking if the client is constipated 4. Explaining that the pain will subside after a few exchanges 21. The spouse of a client who has been on hemodialysis for the past 5 years, calls a clinic because the client has stopped eating, is taking long naps, and refuses to talk with the spouse. A nurse interprets that the client is most likely experiencing: 1. depression. 2. displacement. 3. noncompliance. 4. activity intolerance. 22. A nurse is concerned that a client receiving peritoneal dialysis may be experiencing peritonitis. Which finding noted on the nurse’s assessment supported this concern? 1. Abdominal numbness 2. Cloudy dialysis output 3. Radiating sternal pain 4. Decreased white blood cells ACUTE CORONARY SYNDROMES 1. A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this client at this time? ■ 3. Prevent kidney failure. ■ 4. Treat potential cardiac arrhythmias. 12. A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders should the nurse question? ■ 1. Call for urine output < 30 mL/hour for 2 consecutive hours. ■ 2. Metoprolol (Lopressor) 5 mg I.V. push. ■ 3. Prepare for a pulmonary artery catheter insertion. ■ 4. Titrate Dobutamine (Dobutrex) to keep systolic BP > 100. 13. If the client who was admitted for myocardial infarction (MI) develops cardiogenic shock, which characteristic sign should the nurse expect to observe? ■ 1. Oliguria. ■ 2. Bradycardia. ■ 3. Elevated blood pressure. ■ 4. Fever 14. The physician orders continuous I.V. nitroglycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following? ■ 1. Obtaining an infusion pump for the medication. ■ 2. Monitoring blood pressure every 4 hours. ■ 3. Monitoring urine output hourly. ■ 4. Obtaining serum potassium levels daily. 15. When teaching the client with myocardial infarction (MI), the nurse explains that the pain associated with MI is caused by: ■ 1. Left ventricular overload. ■ 2. Impending circulatory collapse. ■ 3. Extracellular electrolyte imbalances. ■ 4. Insufficient oxygen reaching the heart muscle 16. While caring for a client who has sustained a myocardial infarction (MI), the nurse notes eight premature ventricular contractions (PVCs) in 1 minute on the cardiac monitor. The client is receiving an I.V. infusion of 5% dextrose in water (D5 W) and oxygen at 2 L/minute. The nurse’s first course of action should be to: ■ 1. Increase the I.V. infusion rate. ■ 2. Notify the physician promptly. ■ 3. Increase the oxygen concentration. ■ 4. Administer a prescribed analgesic. 17. Which of the following is an expected outcome for a client on the second day of hospitalization after a myocardial infarction (MI)? The client: ■ 1. Has severe chest pain. ■ 2. Can identify risk factors for MI. ■ 3. Agrees to participate in a cardiac rehabilitation walking program. ■ 4. Can perform personal self-care activities without pain. 18. Which of the following is an expected outcome when a client is recieving an I.V. administration of furosemide? ■ 1. Increased blood pressure. ■ 2. Increased urine output. ■ 3. Decreased pain. ■ 4. Decreased premature ventricular contractions 19. After a myocardial infarction, the hospitalized client is taught to move the legs while resting in bed. This type of exercise is recommended primarily to help: ■ 1. Prepare the client for ambulation. ■ 2. Promote urinary and intestinal elimination. ■ 3. Prevent thrombophlebitis and blood clot formation. ■ 4. Decrease the likelihood of pressure ulcer formation. 20. Which of the following reflects the principle on which a client’s diet will most likely be based during the acute phase of myocardial infarction? ■ 1. Liquids as desired. ■ 2. Small, easily digested meals. ■ 3. Three regular meals per day. ■ 4. Nothing by mouth. 21. The nurse is assessing clients at a health fair. Which client is at greatest risk for coronary artery disease? ■ 1. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago. ■ 2. A 43-year-old male with a family history of CAD and cholesterol level of 158. ■ 3. A 56-year-old male with an HDL of 60 who takes atorvastatin (Lipitor). ■ 4. A 65-year-old female who is obese with an LDL of 188 22. A 58-year-old female with a family history of CAD is being seen for her annual physical exam. Fasting lab test results include: Total cholesterol 198; LDL cholesterol 120; HDL cholesterol 58; Triglycerides 148; Blood sugar 102; and C-reactive protein (CRP) 4.2. The health care provider informs the client that she will be started on a statin medication and aspirin. The client asks the nurse why she needs to take these medications. Which is the best response by the nurse? ■ 1. “The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a lowfat diet.” ■ 2. “The triglycerides are elevated and will not return to normal without these medications.” ■ 3. “The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications ordered.” ■ 4. “The medications are not indicated since your lab values are all normal.” 23. If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by: ■ 1. Explaining how the old behavior leads to poor health. ■ 2. Withholding praise until the new behavior is well established. ■ 3. Rewarding the client whenever the acceptable behavior is performed. ■ 4. Instilling mild fear into the client to extinguish the behavior. 24. Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: ■ 1. Control chest pain. ■ 2. Reduce coronary artery vasospasm. ■ 3. Control the arrhythmias associated with MI. ■ 4. Revascularize the blocked coronary artery. 25. After the administration of t-PA, the assessment priority is to: ■ 1. Observe the client for chest pain. ■ 2. Monitor for fever. ■ 3. Monitor the 12-lead electrocardiogram (ECG) every 4 hours. ■ 4. Monitor breath sounds ■ 1. A change in the pattern of her pain. ■ 2. Pain during sexual activity. ■ 3. Pain during an argument with her husband. ■ 4. Pain during or after an activity such as lawn-mowing. 36. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to: ■ 1. Open and dilate blocked coronary arteries. ■ 2. Assess the extent of arterial blockage. ■ 3. Bypass obstructed vessels. ■ 4. Assess the functional adequacy of the valves and heart muscle. 37. The client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) to treat angina. Priority goals for the client immediately after PTCA should include: ■ 1. Minimizing dyspnea. ■ 2. Maintaining adequate blood pressure control. ■ 3. Decreasing myocardial contractility. ■ 4. Preventing fluid volume deficit 38. Which of the following is not a risk factor for the development of atherosclerosis? ■ 1. Family history of early heart attack. ■ 2. Late onset of puberty. ■ 3. Total blood cholesterol level greater than 220 mg/dL. ■ 4. Elevated fasting blood glucose concentration. 39. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tab?lets, 0.3 mg given sublingually. This drug’s principal effects are produced by: ■ 1. Antispasmodic effects on the pericardium. ■ 2. Causing an increased myocardial oxygen demand. ■ 3. Vasodilation of peripheral vasculature. ■ 4. Improved conductivity in the myocardium 40. A client has a throbbing headache when nitroglycerin is taken for angina. The nurse should instruct the client that: ■ 1. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect. ■ 2. Nitroglycerin should be avoided if the client is experiencing this serious side effect. ■ 3. Taking the nitroglycerin with a few glasses of water will reduce the problem. ■ 4. The client should lie in a supine position to alleviate the headache. 41. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? ■ 1. Take one tablet every 2 to 5 minutes until the pain stops. ■ 2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. ■ 3. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after three tablets. ■ 4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician. 42. A client with angina has been taking nifedipine. The nurse should teach the client to: ■ 1. Monitor blood pressure monthly. ■ 2. Perform daily weights. ■ 3. Inspect gums daily. ■ 4. Limit intake of green leafy vegetables HEART FAILURE 1. Captopril (Capoten), furosemide (Lasix), and metoprolol (Toprol XL) are ordered for a client with systolic heart failure. The client’s blood pressure is 136/82 and the heart rate is 65. Prior to medication administration at 9 a.m., the nurse reviews the following lab tests (see chart). Which of the following should the nurse do first? ■ 1. Administer the medications. ■ 2. Call the physician. ■ 3. Withhold the captopril. ■ 4. Question the metoprolol dose 2. A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to: ■ 1. Decrease circulatory overload. ■ 2. Improve the myocardial workload. ■ 3. Prevent thrombus formation. ■ 4. Regulate cardiac rhythm 3. A client has a history of heart failure and has been taking several medications, including furosemide (Lasix), digoxin (Lanoxin) and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first degree atrioventricular block. The nurse should assess the client for signs of which condition? ■ 1. Hyperkalemia. ■ 2. Digoxin toxicity. ■ 3. Fluid deficit. ■ 4. Pulmonary edema. 4. A nurse is assessing a client with heart failure. The nurse should assess the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply. ■ 1. Ventricular hypertrophy. ■ 2. Parasympathetic nervous stimulation. ■ 3. Renin-angiotensin-aldosterone system. ■ 4. Jugular venous distention. ■ 5. Sympathetic nervous stimulation 14. The nurse should teach the client that signs of digoxin toxicity include which of the following? ■ 1. Rash over the chest and back. ■ 2. Increased appetite. ■ 3. Visual disturbances such as seeing yellow spots. ■ 4. Elevated blood pressure. 15. The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate that the client has a: ■ 1. Low sodium level. ■ 2. High glucose level. ■ 3. High calcium level. ■ 4. Low potassium level. 16. Which of the following foods should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? ■ 1. Apples. ■ 2. Tomato juice. ■ 3. Whole wheat bread. ■ 4. Beef tenderloin 17. A client receiving a loop diuretic should be encouraged to eat which of the following foods? Select all that apply. ■ 1. Angel food cake. ■ 2. Banana. ■ 3. Dried fruit. ■ 4. Orange juice. ■ 5. Peppers. 18. The nurse finds the apical impulse below the fifth intercostal space. The nurse suspects: ■ 1. Left atrial enlargement. ■ 2. Left ventricular enlargement. ■ 3. Right atrial enlargement. ■ 4. Right ventricular enlargement 19. The nurse is admitting a 68-year-old male to the medical floor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first? ■ 1. Assess respiratory status. ■ 2. Draw blood for laboratory studies. ■ 3. Insert a Foley catheter. ■ 4. Weigh the client 20. The nurse’s discharge teaching plan for the client with heart failure should stress the importance of which of the following? ■ 1. Maintaining a high-fiber diet. ■ 2. Walking 2 miles every day. ■ 3. Obtaining daily weights at the same time each day. ■ 4. Remaining sedentary for most of the day 21. When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply. ■ 1. Becoming increasingly short of breath at rest. ■ 2. Weight gain of 2 lb or more in 1 day. ■ 3. High intake of sodium for breakfast. ■ 4. Having to sleep sitting up in a reclining chair. ■ 5. Weight loss of 2 lb in 1 day HYPERTENSION 1.Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: ■ 1. Decrease in heart rate. ■ 2. Lessening of fatigue. ■ 3. Improvement in blood sugar levels. ■ 4. Increase in urine output 2. A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? Select all that apply. ■ 1. Dry mouth. ■ 2. Hyperkalemia. ■ 3. Impotence. ■ 4. Pancreatitis. ■ 5. Sleep disturbance. 3. A client with hypertensive emergency is being treated with sodium nitroprusside (Nipride). In a dilution of 50 mg/250 mL, how many micro?grams of Nipride are in each milliliter? _______ mcg. 4. In teaching the hypertensive client to avoid orthostatic hypotension, the nurse should emphasize which of the following instructions? Select all that apply. ■ 1. Plan regular times for taking medications. ■ 2. Arise slowly from bed. ■ 3. Avoid standing still for long periods. ■ 4. Avoid excessive alcohol intake. ■ 5. Avoid hot baths. 5. An industrial health nurse at a large printing plant finds a male employee’s blood pressure to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25 lb overweight and has smoked a pack of cigarettes daily for more than 20 years. The client’s physician prescribes atenolol (Tenormin) for the hypertension. The nurse should instruct the client to: ■ 1. Avoid sudden discontinuation of the drug. ■ 2. Monitor the blood pressure annually. ■ 3. Follow a 2-g sodium diet. ■ 4. Discontinue the medication if severe headaches develop 6. The nurse teaches a client, who has recently been diagnosed with hypertension, about dietary restrictions: a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client’s needs? ■ 1. Mixed green salad with blue cheese dressing, crackers, and cold cuts. ■ 2. Ham sandwich on rye bread and an orange. 1. The physician has prescribed amiodarone (Cordarone) for a client with cardiomyopathy. The nurse should monitor the client’s rhythm to determine the effectiveness of the medication in controlling: ■ 1. Sinus node dysfunction. ■ 2. Heart block. ■ 3. Severe bradycardia. ■ 4. Life-threatening ventricular dysrhythmias 2. A 25-year-old has been diagnosed with hypertrophic cardiomyopathy. The nurse should assess the client for: ■ 1. Angina. ■ 2. Fatigue and shortness of breath. ■ 3. Abdominal pain ■ 4. Hypertension DAVISS CARDIAC SAGOL 1. A nurse is evaluating the blood pressure (BP) results for multiple clients with cardiac problems on a telemetry unit. Which BP reading suggests to the nurse that the client’s mean arterial pressure (MAP) is abnormal and warrants notifying the physician? 1. 94/60 mm Hg 2. 98/36 mm Hg 3. 110/50 mm Hg 4. 140/78 mm Hg 2. At 0730 hours, a nurse receives a verbal order for a cardiac catheterization to be completed on a client at 1400 hours. Which action should the nurse initiate first? 1. Initiate NPO (nothing per mouth) status for the client. 2. Teach the client about the procedure. 3. Start an intravenous (IV) infusion of 0.9% NaCl. 4. Ask the client to sign a consent form. 3. A nurse assesses a client who has just returned to a telemetry unit after having a coronary angiogram using the left femoral artery approach. The client’s baseline blood pressure (BP) during the procedure was 130/72 mm Hg and the cardiac rhythm was a normal sinus throughout. Which assessment finding should indicate to the nurse that the client may be experiencing a complication? 1. BP 144/78 mm Hg 2. Pedal pulses palpable at +1 3. Left groin soft with 1 cm ecchymotic area 4. Apical pulse 132 beats per minute (bpm) with an irregular-irregular rhythm 4. A client experiences cardiac arrest at home and is successfully resuscitated. Following placement of an implantable cardioverter-defibrillator (ICD), a nurse is evaluating the effectiveness of teaching for the client. Which statement, if made by the client, indicates that further teaching is needed? 1. “The ICD will monitor my heart activity and provide a shock to my heart if my heart goes into ventricular fibrillation again.” 2. “When I feel the first shock I should tell my family to start cardiopulmonary resuscitation (CPR) and call 911.” 3. “I am fearful of my first shock since my friend stated his shock felt like a blow to the chest.” 4. “I will need to ask my physician when I can resume driving because some states disallow driving until there is a 6-month discharge-free period.” 5. A nurse is teaching a client newly diagnosed with chronic stable angina. Which instructions should the nurse incorporate in the teaching session on measures to prevent future angina? SELECT ALL THAT APPLY. 1. Increase isometric arm exercises to build endurance. 2. Wear a face mask when outdoors in cold weather. 3. Take nitroglycerin before a stressful situation even though pain is not present. 4. Perform most exertional activities in the morning. 5. Avoid straining at stool. 6. Eliminate tobacco use. 6. A nurse collects the following assessment data on a client who has no known health problems: blood pressure (BP) 135/89 mm Hg; body mass index (BMI) 23; waist circumference 34 inches; serum creatinine 0.9 mg/dL; serum K 4.0 mEq/L; low-density lipoprotein (LDL) cholesterol 200 mg/dL; high-density lipoprotein (HDL) cholesterol 25 mg/dL; and triglycerides 180 mg/dL. Which order from the client’s health- care provider should the nurse anticipate? 1. 1,500-calorie regular diet. 2. No added salt, twice low saturated fat, low-potassium diet. 3. Hydrochlorothiazide (HydroDIURIL®) 25 mg daily. 4. Atorvastatin (Lipitor®) 20 mg daily. 7. A nurse is instructing a client diagnosed with coro?nary artery disease about care at home. The nurse determines that teaching is effective when the client states: SELECT ALL THAT APPLY. 1. “If I have chest pain, I should contact my physician immediately.” 2. “I should carry my nitroglycerin in my front pants pocket so it is handy.” 3. “If I have chest pain, I stop activity and place one nitroglycerin tablet under my tongue.” 4. “I should always take three nitroglycerin tablets, 5 minutes apart.” 5. “I plan to avoid being around people when they are smoking.” 6. “I plan on walking on most days of the week for at least 30 minutes.” 8. A client admitted with a diagnosis of acute coronary syndrome calls for a nurse after experiencing sharp chest pains that radiate to the left shoulder. The nurse notes, prior to entering the client’s room, that the client’s rhythm is sinus tachycardia with a 10-beat run of premature ventricular contractions (PVCs). Admitting orders included all of the following interventions for treating chest pain. Which should the nurse implement first? 1. Obtain a stat 12-lead electrocardiogram (ECG). 2. Administer oxygen by nasal cannula. 3. Administer sublingual nitroglycerin. 4. Administer morphine sulfate intravenously 9. A nurse is assessing a client diagnosed with an anterior-lateral myocardial infarction (MI). The nurse adds a nursing diagnosis to the client’s plan of care of decreased cardiac output when which finding is noted on assessment? 1. One-sided weakness 2. Presence of an S4 heart sound 3. Crackles auscultated in bilateral lung bases 4. Vesicular breath sounds over lung lobe 10. A nurse increases activity for a client with an admit?ting diagnosis of acute coronary syndrome. Which symptoms experienced by the client best support a nursing diagnosis of activity intolerance? 1. Pulse rate increased by 15 beats per minute during activity 2. Blood pressure (BP) 130/86 mm Hg before activity; BP 108/66 mm Hg during activity 3. Increased dyspnea and diaphoresis relieved when sitting in a chair 4. A mean arterial pressure (MAP) of 80 following activity 11. After an inferior-septal wall myocardial infarction, which complication should a nurse suspect when noting jugular venous distention (JVD) and ascites? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Ruptured septum NCLEX PRACTICE QUESTIONS CARDIAC 1) Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease? 1. Decrease anxiety 2. Enhance myocardial oxygenation 3. Administer sublingual nitroglycerin 4. Educate the client about his symptoms 2) Medical treatment of coronary artery disease includes which of the following procedures? 1. Cardiac catherization 2. Coronary artery bypass surgery 3. Oral medication therapy 4. Percutaneous transluminal coronary angioplasty 3) Which of the following is the most common symptom of myocardial infarction (MI)? 1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations 4) Which of the following symptoms is the most likely origin of pain the client described as knifelike chest pain that increases in intensity with inspiration? 1. Cardiac 2. Gastrointestinal 3. Musculoskeletal 4. Pulmonary 5) Which of the following blood tests is most indicative of cardiac damage? 1. Lactate dehydrogenase 2. Complete blood count (CBC) 3. Troponin I 4. Creatine kinase (CK) 6) What is the primary reason for administering morphine to a client with an MI? 1. To sedate the client 2. To decrease the client’s pain 3. To decrease the client’s anxiety 4. To decrease oxygen demand on the client’s heart 7) Which of the following conditions is most commonly responsible for myocardial infarction? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis 4. Renal failure 8) Which of the following complications is indicated by a third heart sound (S3)? 1. Ventricular dilation 2. Systemic hypertension 3. Aortic valve malfunction 4. Increased atrial contractions 9) After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricupsid valve malfunction 10) What is the first intervention for a client experiencing MI? 1. Administer morphine 2. Administer oxygen 3. Administer sublingual nitroglycerin 4. Obtain an ECG 11) Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Narcotics 4. Nitrates 12) What is the most common complication of an MI? 1. Cardiogenic shock 2. Heart failure 3. arrhythmias 4. Pericarditis 13) With which of the following disorders is jugular vein distention most prominent? 1. Abdominal aortic aneurysm 2. Heart failure 3. MI 4. Pneumothorax 14) Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights? 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec) 15) Which of the following symptoms is most commonly associated with left-sided heart failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension 16) In which of the following disorders would the nurse expect to assess sacral edema in a bedridden client? 1. Diabetes 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure 17) Which of the following symptoms might a client with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia 18) Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractibility? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Diuretics 4. Inotropic agents 19) Stimulation of the sympathetic nervous system produces which of the following responses? 1. Bradycardia 2. Tachycardia 3. Hypotension 4. Decreased myocardial contractility 33) Which of the following tests is used most often to diagnose angina? 1. Chest x-ray 2. Echocardiogram 3. Cardiac catherization 4. 12-lead electrocardiogram (ECG) 34) Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress and anxiety 4. Reduction of associated risk factors 35) Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking? 1. Sit the client down 2. Get the client back to bed 3. Obtain an ECG 4. Administer sublingual nitroglycerin 36) Myocardial oxygen consumption increases as which of the following parameters increase? 1. Preload, afterload, and cerebral blood flow 2. Preload, afterload, and renal blood flow 3. Preload, afterload, contractility, and heart rate. 4. Preload, afterload, cerebral blood flow, and heart rate. 37) Which of the following positions would best aid breathing for a client with acute pulmonary edema? 1. Lying flat in bed 2. Left side-lying 3. In high Fowler’s position 4. In semi-Fowler’s position 38) Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia 39) Which of the following is a compensatory response to decreased cardiac output? 1. Decreased BP 2. Alteration in LOC 3. Decreased BP and diuresis 4. Increased BP and fluid retention 40) Which of the following actions is the appropriate initial response to a client coughing up pink, frothy sputum? 1. Call for help 2. Call the physician 3. Start an I.V. line 4. Suction the client 41) Which of the following terms describes the force against which the ventricle must expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload 42) Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle 43) An 18-year-old client who recently had an URI is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis? 1. Erythema marginatum, subcutaneous nodules, and fever 2. Tachycardia, finger clubbing, and a load S3 3. Dyspnea, cough, and palpitations 4. Dyspnea, fatigue, and synocope 44) A client admitted with angina compains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? 1. Activate the resuscitation team 2. Open the client’s airway 3. Check for breathing 4. Check for signs of circulation 45) A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client? 1. Anxiety 2. Ineffective tissue perfusion; cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management 46) A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client’s medical history included DM, HTN, and heart failure. Which of the following disorders should the nurse suspect? 1. Pulmonary edema 2. Pneumothorax 3. Cardiac tamponade 4. Pulmonary embolus 47) The nurse coming on duty receives the report from the nurse going off duty. Which of the following clients should the on-duty nurse assess first? 1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a respiratory rate of 21 breaths a minute. 2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order. 3. The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV heparin. 4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV diltiazem (Cardizem). 48) When developing a teaching plan for a client with endocarditis, which of the following points is most essential for the nurse to include? 1. “Report fever, anorexia, and night sweats to the physician.” 2. “Take prophylactic antibiotics after dental work and invasive procedures.” 3. “Include potassium rich foods in your diet.” 4. “Monitor your pulse regularly.” 49) A nurse is conducting a health history with a client with a primary diagnosis of heart failure. Which of the following disorders reported by the client is unlikely to play a role in exacerbating the heart failure? 1. Recent URI 2. Nutritional anemia 3. Peptic ulcer disease 4. A-Fib 50) A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician’s office. The nurse would plan on having which of the following medications readily available for use?