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CARDIOVASCULAR SYSTEM ​ Anatomy of the heart heart- hollow, muscular organ located in the center of the thorax, where it occupies the space between the lungs (mediastinum) and rests on the diaphragm. 3 layers of the heart 1.​ Endocardium or inner layer- consists of endothelial tissue and l...

CARDIOVASCULAR SYSTEM ​ Anatomy of the heart heart- hollow, muscular organ located in the center of the thorax, where it occupies the space between the lungs (mediastinum) and rests on the diaphragm. 3 layers of the heart 1.​ Endocardium or inner layer- consists of endothelial tissue and lines, the inside of the heart and valves. 2.​ Myocardium or middle layer- made up of muscle fibers and it is responsible for pumping action 3.​ Epicardium or exterior layer Pericardium- encased in a thin, fibrous sac Heart Chambers- The pumping action of the heart is accomplished by the rhythmic relaxation and contraction of the muscular walls of its two top chambers (atria) and two bottom chambers (ven-tricles). Heart Valves- The four valves in the heart permit blood to flow in only one direction. -The valves, which are composed of thin leaflet fibrous tissue, open and close in response to the movement of blood and pressure changes within the chambers. two types of valves 1.​ atrioventricular (AV)- it separates the atria from the ventricles. 2.​ semilunar valves- composed of 3 leaflets, shaped like half-moon. Closed during diastole Coronary arteries supply arterial blood to the heart. Perfused during diastole. Myocardial ischemia (inadequate oxygen supply) Myocardium- is the middle, muscular layer of the atrial and ventricular walls. ​ composed of specialized cells(myocytes) ECG readings Bicuspid Valve- Separates the right and left atria Sinoatrial node- Is located at the juncture of the superior vena cava and the right atrium Parietal Pericardium- Supports the heart in the mediastinum Pulmonic Valve-Sits between the right ventricle and the pulmonary artery Pulmonary artery- Distributes venous blood to the lungs Atrioventricular node- Is embedded in the right atrial wall near the tricuspid valve Situational Questions; Chapter 21 1. The nurse is caring for a patient with a diag. nosis of pericarditis. Where does the nurse identify that the inflammation is located? a The thin fibrous sac encasing the heart b. The inner lining of the heart and valves c. The heart's muscle fibers d. The exterior layer of the heart 2. The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How will the nurse document this finding? a. S1 b. S2 c. S3 d. S4 3. The nurse is performing an assessment of the patient's heart. Where will the nurse locate the apical pulse if the heart is in a normal position? a. Left second intercostal space at the midclavicular line b. Right second intercostal space at the midclavicular line c. Right third intercostal space at the midcla-vicular line d. Left fifth intercostal space at the midcla-vicular line 4. A patient's heart rate is observed to be 140 bpm on the monitor. Which complication should the nurse closely monitor the patient for? a. Myocardial ischemia b. A pulmonary embolism c. Right-sided heart failure d. A stroke 5. The nurse is administering a beta-blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? a. Diltiazem b Metoprolol c. Amiodarone d. Propafenone 6. The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse identify that the impulse arises from? a. The AV node b. The Purkinje fibers c.sinoatrial node d. The ventricles 7. The nurse is assessing a patient's electrocar-diogram (ECG). Which phase does the nurse identify as the resting phase before the next depolarization? a. Phase 1 b. Phase 2 c. Phase 3 d. Phase 4 8. The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for which condition? a. Pulmonary embolism b. Myocardial infarction c. Pericarditis d. Heart failure 9. The nurse is educating a patient at risk for atherosclerosis. Which nonmodifiable risk factors does the nurse identify for the patient? a. Stress b. Obesity c. Positive family history d. Hyperlipidemia 10. The nurse is assessing a patient's blood pressure. Which does the nurse document as the difference between the systolic and the diastolic pressures? a. Pulse pressure b. Auscultatory gap c. Pulse deficit d. Korotkoff sound 11. The nurse is assessing a patient who reports feeling "lightheaded." Who obtains orthostatic vital signs, which does the nurse report to the health care provider as a significant finding? a. A heart rate of 20 bpm above the resting rate b. An unchanged systolic pressure c. An increase of 10 mm Hg blood pressure reading d. An increase of 5 mm Hg in diastolic pressure 12. The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. Which information should the nurse provide to the CNA about the use of a cuff that is too small for a patient? a. The result will be falsely decreased b. The results will be falsely elevated. c. It will give an accurate reading. d. It will be significantly different with each reading. 13. A patient is going through menopause and asks the nurse about estrogen replacement. for its cardioprotective benefits. Which is the best response by the nurse? For its cardioprotective benefits. Which is the best response by the nurse? a. "That's a great idea. You don't want to have a heart attack." b. "Replacement of estrogen will protect a woman after she goes into menopause." c. “Estrogen is actually potentially harmful and is no longer a recommended therapy." d. "You need to research it and determine what you want to do." Chapter 22 1. A patient comes to the emergency depart- ment reporting chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respi- ratory rate 26, and an oxygen saturation of 98%. Which rhythm on the monitor will the nurse view? a. Sinus bradycardia b. Ventricular tachycardia c. Normal sinus rhythm d. Sinus tachycardia 2. The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. Which will the nurse exam- ine to determine this part of the analysis? a. PP interval b QT interval C. RR interval d. TP interval 3. The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 bpm and "sawtooth" P waves with an atrial rate of approximately 300 bpm. How does the nurse interpret this rhythm? a. Atrial fibrillation b. Atrial flutter c. Ventricular tachycardia d. Ventricular fibrillation 4. A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit diagnosed with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. Which is the nurse's analysis of this rhythm? a.Atrial flutter b. Ventricular flutter c. Sinus tachycardia d. Nonparoxysmal junctional tachycardia 5. A patient with hypertension has newly diag- nosed atrial fibrillation. Which medication does the nurse anticipate administering to prevent the complication of atrial thrombi? a. Adenosine b. Amiodarone c.Warfarin d. Atropine 6. The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unre- sponsive, without a pulse, and a flat line on the monitor. Which is the first action by the nurse? a. Begin cardiopulmonary resuscitation(CPR). b. Administer epinephrine. c. Administer atropine 0.5 mg. d. Defibrillate with 360 J (monophasic defibrillator). 7. The nurse is defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much pad- dle pressure should the nurse apply when defibrillating? a. 5 to 10 lb b. 10 to 15 lb c. 15 to 20 lb d. 20 to 25 lb 8. A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibril- lation. Which choice would be best to sense and terminate these episodes? a.Implantable cardioverter defibrillator (ICD) b. Pacemaker c. Atropine d. Epinephrine 9. The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. Which characteristics of this rhythm does the nurse identify? a. A variable heart rate, usually fewer than 60 bpm b. An irregular rhythm c. Delayed conduction, producing a pro- longed PR interval d. P waves hidden with the QRS complex 10. The nurse is assessing vital signs in a patient with a permanent pacemaker. Which will the nurse document about the pacemaker? a. Date and time of insertion b. Location of the generator c. Model number d. Pacer rate 11. A patient has had an ICD inserted. Which will the nurse be sure to include in the edu- cation of this patient prior to discharge? (Select all that apply.) a. Avoid magnetic fields such as metal detection booths. b. Call for emergency assistance if feeling dizzy. c. Record events that trigger a shock sensation. d. The patient may have a throbbing pain that is normal. e. The patient will have to schedule monthly chest x-rays to make sure the device is patent. 12. A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continu- ous hiccups as the patient states, "I thought this was normal." Which does the nurse identify is occurring with this patient? a. Fracture of the lead wire b. Lead wire dislodgement c. Faulty generator d. Sensitivity is too low 13. A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. Which will the nurse interpret this rhythm to be? a. Ventricular tachycardia b. Atrial fibrillation c. Third-degree heart block d. Ventricular fibrillation 14. A patient has a persistent third-degree heart block and has had several periods of syncope. Which priority treatment will the nurse prepare for the patient? a. Insertion of a pacemaker b. Administration of atropine c. Administration of epinephrine d. Insertion of an ICD 15. A patient has had several episodes of recurrent tachyarrhythmias over the last 5 months and medication therapy has not been effective. Which procedure will the nurse prepare the patient for? a. Insertion of an ICD b. Insertion of a permanent pacemaker c. Catheter ablation therapy d. Maze procedure Chapter 23 1. The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin. Which results indicate the medication is having the desired outcome? a. 160 to 190 mg/dL b. 210 to 240 mg/dL c. 250 to 275 mg/dL d. 280 to 300 mg/dL 2. The nurse is discussing risk factors for devel- oping coronary artery disease (CAD) with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a. Cholesterol, 280 mg/dL b. Low-density lipoprotein (LDL), 160 mg/dL c.High-density lipoprotein (HDL), 80 mg/dL d. A ratio of LDL to HDL, 4.5 to 1.0 3. The nurse is educating a patient regarding a new prescription for propranolol. Which statement made by the patient indicates that further education is needed? a. "If I am not experiencing chest pain, I can discontinue the use of propranolol." b. "Since I am diabetic, I need to monitor my glucose levels as prescribed." c. "This will help decrease the incidence of chest pain prior to exercises." d. "I may experience an increase in tired- ness and dizziness when first starting the medication." 4. The nurse is educating the patient about the administration of nitroglycerin prior to being discharged from the hospital. Which information should the nurse include in the instructions? a. Take a nitroglycerin tablet and if the pain is not relieved, drive to the nearest emer- gency department. b. Take two nitroglycerin tablets, and if the pain is not relieved, go to the emergency department. c. Take a nitroglycerin tablet and repeat every 5 minutes if the pain is not relieved until a total of three are taken. If pain is not relieved, activate the emergency medical system. d. Take two nitroglycerin tablets every 10 minutes until a total of six tablets are taken. If pain is not relieved, activate the emergency medical system. 5. The nurse administers propranolol hydro- chloride to a patient with a heart rate of 64 bpm. One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. Which medication should the nurse prepare to administer to elevate the heart rate? a. Digoxin b.Atropine sulfate c. Protamine sulfate d. Sodium nitroprusside 6. The nurse is administering diltiazem to a patient who has symptomatic sinus tachycar- dia at a rate of 132 bpm. Which is the antici- pated action of the drug for this patient? a.Decreases the sinoatrial node automaticity. b. Increases the atrioventricular node conduction. c. Increases the heart rate. d. Creates a positive inotropic effect. 7. Which ECG finding(s) does the nurse observe in a patient who has had a myocardial infarction (MI)? (Select all that apply.) a. An absent P wave b. An abnormal Q wave c.CT-wave inversion d. ST-segment elevation e. Prolonged PR interval 8. The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How will the nurse describe the pain that may be experienced during an MI? (Select all that apply.) a. It is relieved by rest and inactivity. b. It is substernal in location. C.It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms. e. It subsides after taking nitroglycerin. 9. The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). Which cardiac-specific isoen- zyme does the nurse observe for myocardial cell damage? a. Alkaline phosphatase b. Creatine kinase (CK-MB) c. Myoglobin d. Troponin 10. The nurse is caring for a patient who is expe- riencing chest pain associated with a myo- cardial infarction (MI). Which medication will the nurse administer intravenously to reduce pain and anxiety? a. Meperidine hydrochloride b. Hydromorphone hydrochloride c. Morphine sulfate d. Codeine sulfate 11. A patient with coronary artery disease (CAD) is having a cardiac catheterization. Which indicator is present for the patient to have a percutaneous transluminal coronary angio- plasty (PTCA)? a. The patient has compromised left ventric- ular function. b. The patient has had angina longer than 3 years. c. The patient has at least a 70% occlusion of a major coronary artery. d. The patient has an ejection fraction of 65%. 12. The nurse is assessing a postoperative patient who had a percutaneous transluminal cor- onary angioplasty (PTCA). Which potential complications should the nurse monitor for? (Select all that apply.) a Abrupt closure of the artery b. Arterial dissection C.Coronary artery vasospasm d. Aortic dissection e. Nerve root pressure 13. A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. Which type of electrolyte imbalance should the nurse assess the patient for? a. Calcium b. Magnesium c. Potassium d. Sodium 14. A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). Which complication should the nurse monitor for that is associated with an alter- ation in preload? a. Cardiac tamponade b. Elevated central venous pressure c. Hypertension d. Hypothermia 15. A patient who had coronary artery bypass graft (CABG) is exhibiting signs of cardiac failure. Which nursing actions would be appropriate for this patient? (Select all that apply.) A.Administration of furosemide B.Administration of digoxin C.Administration of milrinone d. Preparation of the patient for dialysis e. Administration of nitroprusside Chapter 24 1. A patient at the clinic describes shortness of breath, periods of feeling "lightheaded," and feeling fatigued despite a full night's sleep. The nurse obtains vital signs and auscultates a systolic click. Which will the nurse suspect from the assessment findings? a. Mitral valve prolapse b. Mitral regurgitation c. Aortic stenosis d. Aortic regurgitation 2. The nurse is educating a patient about the care related to a new diagnosis of mitral valve prolapse. Which statement made by the patient demonstrates understanding of the education? a. "I will avoid caffeine, alcohol, and smoking." b. "I will take antibiotics before getting my teeth cleaned." c. "I shouldn't get a tattoo but I can get my tongue pierced." d. "This disorder will progress and I will need a heart transplant." 3. The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. Which rhythm does the nurse identify on the electrocardio- gram (ECG)? a. First-degree atrioventricular block b. Ventricular tachycardia c. Atrial fibrillation d. Sinus arrhythmia 4. The nurse is performing an assessment for a patient with suspected mitral valve regurgita- tion. Which type of murmur does the nurse correlate with this diagnosis? a Mitral click b.High-pitched blowing sound at the apex c. Low-pitched diastolic murmur at the apex d. Diastolic murmur at the left sternal border 5. The nurse is assessing a patient and palpates a pulse with quick, sharp strokes that suddenly collapse. The nurse determines that this type of pulse is diagnostic for which disorder? a. Mitral insufficiency b. Tricuspid insufficiency C.Tricuspid stenosis d.Aortic regurgitation 6. A patient has been diagnosed with fused mitral leaflets, causing a backward flow of blood. Which type of procedure will the nurse prepare the patient for that is com- monly performed for this issue? a. Annuloplasty b.Commissurotomy c. Valve replacement d. Chordoplasty 7. A patient has received a heterograft or a tricuspid valve replacement. Which statement made by the patient demonstrates under- standing of the valve replacement? a. "The xenograft will last for the rest of my life, at least 20 years." b. "I will have to take an antirejection drug for the duration of the xenograft." c."I will not take long-term anticoagulation because I want to get pregnant." d. "My valve comes from a cadaver." 8. A patient is admitted with suspected cardio- myopathy. Which diagnostic test would be most helpful with the identification of this disorder? a. Serial enzyme studies b. Cardiac catheterization c.Echocardiogram d. Phonocardiogram 9. A patient has had a successful heart transplant for end stage heart disease. Which immunosuppressant will be necessary for this patient to take to prevent rejection? a. Nifedipine b.Cyclosporine c. Verapamil d. Vancomycin 10. A patient is diagnosed with rheumatic endo- carditis. Which bacterium is the nurse aware causes this inflammatory response? a) Group A, beta-hemolytic streptococcus b. Pseudomonas aeruginosa c. Serratia marcescens d. Staphylococcus aureus 11. A patient admitted to the hospital is suspected to have rheumatic endocarditis. Which diag- nostic test does the nurse prepare the patient for? a. Throat culture b. Echocardiogram c. Electrocardiogram d. Complete blood count 12. The nurse identifies that a patient has a characteristic symptom of pericarditis. Which symptom does the nurse recognize as significant for this diagnosis? a. Dyspnea b. Constant chest pain c. Fatigue lasting more than 1 month d. Uncontrolled restlessness 13. A patient is admitted with a diagnosis of pericarditis. When reviewing the prescrip- tions for the patient, which medication will the nurse question and discuss with the health care provider? a. Colchicine b.Indomethacin C.Ibuprofen d. Prednisone 14. The nurse is caring for a patient diagnosed with pericarditis. Which serious complica- tion should this patient be monitored for? a. Cardiac tamponade b. Decreased venous pressure c. Hypertension d. Left ventricular hypertrophy 15. The nurse is obtaining a history from a patient diagnosed with hypertrophic car- diomyopathy. Which information obtained from the patient is indicative of this form of cardiomyopathy? a. A history of alcoholism b. A history of amyloidosis c. A parent has the same disorder d. A long-standing history of hypertension Chapter 25 1. The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with increased physical activ- ity. Under which New York Heart Association classification does the nurse understand this patient is categorized? a. I B. II c. III d. IV 2. The nurse observes that a patient has 2+ pitting edema in the lower extremities. Which will this indicate to the nurse regarding fluid retention? a. A weight gain of 4 lb b. A weight gain of 6 lb c. A weight gain of 8 lb d. A weight gain of 10 lb 3. A patient has been experiencing an increase in shortness of breath and fatigue. The health care provider has prescribed a diag- nostic test in order to determine which type of heart failure the patient is having. Which diagnostic test does the nurse prepare the patient for? a. A chest x-ray b. An echocardiogram c. An electrocardiogram d. A ventriculogram 4. A patient is seen in the emergency depart- ment (ED) with heart failure secondary to dilated cardiomyopathy. Which key diagnos- tic test does the nurse assess to determine the severity of the patient's heart failure? a. Blood urea nitrogen (BUN) b. Complete blood count (CBC) c.B-type natriuretic peptide (BNP) d. Serum electrolytes 5. A patient has missed two doses of digitalis. Which laboratory results would indicate to the nurse that the patient is within thera- peutic range? a. 0.25 mg/mL b. 4.0 mg/mL C.2.0 mg/mL d. 3.2 mg/mL 6. A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. Which clinical manifestations correlate with the left-sided heart failure identified by the nurse when performing an assessment? (Select all that apply.) a. Jugular vein distention b. Ascites C.Pulmonary crackles D. Dyspnea e. Cough 7. The nurse is assigned to care for a patient with heart failure. Which classification of medication does the nurse administer that will improve symptoms as well as increase survival? a. Angiotensin-converting enzyme inhibitor (ACE) b. Calcium channel blocker c. Diuretic d. Bile acid sequestrants 8. A patient taking an ACE inhibitor has devel- oped a dry, hacking cough. Because of this side effect, the patient no longer wants to take that medication. Which medication having similar hemodynamic effects does the nurse identify the health care provider will likely prescribe? a Valsartan b. Furosemide c. Metoprolol d. Isosorbide dinitrate 9. A patient with severe pulmonary edema is intubated by the respiratory therapist. Which priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? a. Observe for mist in the endotracheal tube. b. Listen for breath sounds over the epigastrium. c.Call for a chest x-ray. d. Attach a pulse oximeter probe and obtain values. 10. A patient is prescribed an aldosterone antag- onist for the treatment of heart failure. Which finding by the nurse indicates that the medication will be withheld and the health care provider notified? a. A BUN of 9 mg/dL b. A hemoglobin level of 14.6 g/dL c. A potassium level of 3.8 mEq/L d. A creatinine level of 3.2 mg/dL 11. The nurse hears the alarm sound on-the telemetry monitor and observes a flat line. The patient is found unresponsive, without a pulse, and no respiratory effort. Which action will the nurse perform first? a. Administer epinephrine 1:10,000 10-mL IV push. b. Deliver breaths with a bag-valve mask. C.Defibrillate the patient with 360 J. d. Call for help and begin chest compressions. 12. The nurse is preparing to administer furose- mide to a patient with heart failure. Which action(s) will the nurse perform prior to administering the medication? (Select all that apply.) A.Check the potassium level. b. Assess for signs of volume depletion. c.Monitor the creatinine level. (d) Assess lung sounds. e. Check the AST and ALT levels. 13. The nurse is preparing to administer hydral- azine and isosorbide dinitrate. When obtaining vital signs, the nurse notes that the blood pressure is 90/60 mm Hg. Which is the priority action by the nurse? a. Hold the medication and call the health care provider. b. Administer the medication and check the blood pressure in 30 minutes. c. Administer a saline bolus of 250 mL and then administer the medication. d. Administer the hydralazine and hold the isosorbide dinitrate. 14. A patient seen in the clinic has been diag- nosed with stage A heart failure (according to the staging classification of the American College of Cardiology [ACC]). Which educa- tion will the nurse provide to this patient? a. Information about ACE inhibitors and risk factor reduction b. Information about diuretic therapy and risk factor reduction c. Information about beta-blockers, ACE inhibitors, and diuretics d. Information about implantable cardioverter/defibrillators 15. The health care provider writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. Which medication does the nurse administer? a. Digoxin b. Valsartan c. Metolazone d. Carvedilol Chapter 26 1. Which factor is most important in regulating the caliber of blood vessels, determining the resistance to flow? a. Hormonal secretion b. Independent arterial wall activity c. The influence of circulating chemicals d. The sympathetic nervous system 2. The nurse assesses a patient with suspected acute venous insufficiency. Which clinical manifestations indicates this condition to the nurse? (Select all that apply.) a Cool and cyanotic skin b.Initial absence of edema c.Sharp pain that may be relieved by the elevation of the extremity d. Full superficial veins e. Brisk capillary refill of the toes 3. The nurse is caring for a patient with periph- eral arterial insufficiency. Which interventions will the nurse suggest to help relieve leg pain during rest? a. Elevating the limb above heart level b./Lowering the limb so that it is dependent c. Massaging the limb after application of cold compresses d. Placing the limb in a plane horizontal to the body 4. A patient is exhibiting signs of a thoracic aortic aneurysm. Which diagnostic test(s) will the nurse prepare the patient for? (Select all that apply.) a Computed tomography b. Transesophageal echocardiography c.X-ray d. Electroencephalogram e. Electrocardiogram (ECG) 5. A client is exhibiting signs of an abdominal aortic aneurysm. Which assessment data will the nurse correlate with a diagnosis of abdominal aortic aneurysm? (Select all that apply.) a. A pulsatile abdominal mass b. Low back pain c. Lower abdominal pain d. Decreased bowel sounds e. Diarrhea 6. A patient with impaired renal function is scheduled for a multidetector computed tomography (MDCT) scan. Which preproce- dural medication will the nurse administer to this patient? a Oral N-acetylcysteine b. Oral iodine c. Dipyridamole d. Epinephrine 7. A patient is having an angiography to detect the presence of an aneurysm. After the con- trast is administered by the interventionist, the patient reports nausea and difficulty breathing. Which medication is a priority to administer at this time? a. Metoprolol b. Epinephrine c. Hydrocortisone d. Cimetidine 8. The nurse is assisting a patient with periph- eral arterial disease to ambulate in the hall- way. Which will the nurse include in the education of the patient during ambulation? a. "As soon as you feel pain, we will go back and elevate your legs." b. "If you feel pain during the walk, keep walking until the end of the hallway is reached." c."Walk to the point of pain, rest until the pain subsides, then resume ambulation." d. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room." 9. The nurse is assessing a patient 2 days post- operatively, who is suspected of having deep vein obstruction. The patient reports pain in the left lower extremity and there is a 2-cm difference in the right and left leg circum- ference. Which intervention will the nurse provide to promote arterial flow to the lower extremities? a. Administer a diuretic to decrease the edema in the left lower extremity. b. Assist with active range of motion (ROM) exercises to the left lower extremity. c. Apply cool compresses to the left lower extremity. d.Apply a heating pad to the patient's abdomen. 10. The nurse is monitoring a patient taking anticoagulation therapy. Which therapeutic range of the international normalized ratio (INR) indicates that the medication is having the desired effect? a. 2.0 to 3.0 b. 4.0. to 5.0 c. 5.0 to 6.0 d. 7.0 to 8.0 11. The nurse is caring for a patient who has started anticoagulant therapy with warfarin. When does the nurse determine that thera- peutic benefits will begin? a. Within 12 hours b. Within the first 24 hours c. In 2 days d. In 3 to 5 days 12. The nurse is caring for a patient with venous insufficiency. Which will the nurse assess the patient's lower extremities for? a. Rubor b. Cellulitis c. Dermatitis d.Ulceration 13. The nurse is educating a patient with chronic venous insufficiency about prevention of com- plications related to the disorder. Which will the nurse include in the information given to the patient? (Select all that apply.) a. Avoid constricting garments. b. Elevate the legs above the heart level for 30 minutes every 2 hours. c. Sit as much as possible to rest the valves in the legs. d. Sleep with the foot of the bed elevated about 6 inches. e. Sit on the side of the bed and dangle the feet. 14. The health care provider prescribed a Tegapore dressing to treat a venous ulcer. Which will the nurse determine the ABI will be if the circulatory status is adequate? a. 0.10 b. 0.25 c. 0.35 d.0.50 15. A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. Which option for treatment is available to increase diffusion of oxygen to the hypoxic wound? a. Surgical debridement b. Enzymatic debridement c. Hyperbaric oxygen d. Vacuum-assisted closure device 16. The nurse is performing wound care for a patient with a necrotic sacral wound. The prescribed treatment is isotonic saline solu- tion with fine mesh gauze and a dry dressing to cover. Which type of debridement is the nurse performing? a.Surgical debridement b. Nonselective debridement c. Enzymatic debridement d. Selective debridement Chapter 27 1. A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking the blood pressure at home and has reported a systolic pressure of 158 and a diastolic pressure of 64. Which do these findings indicate to the nurse? a.Isolated systolic hypertension b.Secondary hypertension c. Primary hypertension d. Hypertensive urgency 2. The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, which may be observed related to hypertension? a. Cataracts b. Glaucoma c.Retinal detachment d.Papilledema 3. A patient with hypertension is waking up sev- eral times a night to urinate. Which laboratory studies will the nurse assess that may indicate pathologic changes in the kidneys due to hypertension? (Select all that apply.) a.. Creatinine b) Blood urea nitrogen (BUN) c. Complete blood count (CBC) d. Urine for culture and sensitivity e. AST and ALT 4. A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The health care provider orders a chest x-ray, which reveals an enlarged heart. Which diagnostic test does the nurse prepare the patient for to determine left ventricular enlargement? a. Cardiac catheterization b. Echocardiography c. Stress test d. Tilt table test 5. A patient with hypertension has maintained a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide and atenolol. Which treatment plan will the nurse educate the patient about? a. Continue the medication and reduce dietary sodium. b. Discontinue the hydrochlorothiazide and atenolol and continue to reduce sodium intake. c. Gradually reduce the hydrochlorothiazide and atenolol and continue reduction of sodium intake. d. Gradually reduce the atenolol and continue the hydrochlorothiazide. 6. A patient is taking amiloride and lisinopril for the treatment of hypertension. Which laboratory studies should the nurse monitor while the patient is taking these two medica- tions together? a. Magnesium level b. Potassium level c. Calcium level d. Sodium level 7. A patient has severe coronary artery disease (CAD) and hypertension. Which medication prescription should the nurse consult with the health care provider about that is contra- indicated for a patient with severe CAD? a:Clonidine b. Amiloride c. Bumetanide d. Methyldopa 8. A patient has been diagnosed with prehyper- tension and is encouraged to exercise regu- larly and begin a weight loss program. After which period of time does the nurse inform the patient to return for a follow-up visit? a. 2 months b. 6 months c.1 year d. 2 years 9. The nurse is assessing the blood pressure for a patient with hypertension and does not hear an auscultatory gap. Which outcome may be documented in this circumstance? a. A low diastolic reading b. A high systolic pressure reading c.A normal reading d.A high diastolic or low systolic reading 10. The nurse is performing an assessment for a patient to determine the effects of hyperten- sion on the heart and blood vessels. Which specific assessment data will assist in deter- mining this complication? (Select all that apply.) a Heart rate b. Respiratory rate c.Heart rhythm d. Character of apical and peripheral pulses e. Lung sounds 11. The nurse is planning the care of a patient admitted to the hospital with hypertension. Which objective will help to meet the needs of this patient? a Lower and control the blood pressure without adverse effects and undue cost. b. Make sure that the patient adheres to the therapeutic medication regimen. c. Instruct the patient to enter a weight loss program and begin an exercise regimen. d. Schedule the patient for all follow-up visits and makes phone calls to the home to ensure adherence. 12. A patient informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hyperten- sion." Which education will the nurse provide to the patient regarding this statement? a. If dietary sodium isn't restricted, the patient will be unable to control the blood pressure and will be at risk for stroke. b. The patient can speak to the healthcare pro- vider about increasing the dosage of medica- tion instead of reducing the added salt. c.It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. d. The patient should use other methods of flavoring foods. 13. A patient is flying overseas for 1 week for business and packed antihypertensive med. ications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, which condition becomes a concern? a. Isolated systolic hypertension b.Rebound hypertension c. Angina d. Left ventricular hypertrophy 14. A patient is brought to the emergency department reporting a "bad headache" and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. Which is the therapeu- tic goal for reduction of the mean blood pressure? a) Reduce the blood pressure by 20% to 25% within the first hour of treatment. b. Reduce the blood pressure to about 140/80 mm Hg. c. Rapidly reduce the blood pressure so the patient will not suffer a stroke. d. Reduce the blood pressure by 50% within the first hour of treatment. 15. A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 mm Hg but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. Which situation does the nurse identify this patient is experiencing? a. Hypertensive emergency b. Primary hypertension c.Secondary hypertension d. Hypertensive urgency HEMATOLOGIC FUNCTION Chapter 28 1. The patient has a deficiency in the leukocyte responsible for cell-mediated immunity. Which findings in the white blood cell count will the nurse identify that correlate with this deficiency? a. Basophils b. Monocytes c. Plasma cells d.T lymphocytes 2. An older adult patient presents to the clinic. reporting feeling "exhausted all the time." The nurse will assess which laboratory values that commonly associate with this patient's symptoms? a. WBC count b.RBC count c. Thrombocyte count d. Levels of plasma proteins 3. A nurse is caring for a patient having a bone marrow aspiration with biopsy. Which complication will the nurse monitor for? a. Hemorrhage b. Infection c. Shock d. Splintering of bone fragments 4. A patient with chronic kidney disease is identified as having anemia. Which labora- tory test results will the nurse likely observe? a.Decreased level of erythropoietin b. Decreased total iron-binding capacity c. Increased mean corpuscular volume d. Increased reticulocyte count 5. A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? a. A high number of pregnancies can increase the risk of reaction. b. If the patient has never been pregnant, it increases the risk of reaction. c. Obtaining information about gravidity and parity is routine information for all female patients. d. If the patient has been pregnant, she may have developed allergies. 6. A patient will need a blood transfusion for the replacement of blood loss from the gas- trointestinal tract. The patient states, "That stuff isn't safe!" Which response by the nurse will be the best? a. "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." b. "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." c. "I understand your concern. The blood is carefully screened but is not completely risk free." d. "You will have to decide if refusing the blood transfusion is worth the risk to your health." 7. A patient with chronic anemia has had many blood transfusions over the last 3 years. Which type of transfusion reaction will the nurse monitor for that is commonly found in patients who frequently receive blood transfusions? d a. Allergic reactions b. Acute hemolytic reaction c.Circulatory overload d. Febrile nonhemolytic reactions 8. The nurse is administering a blood transfu- sion to a patient over 4 hours. After 2 hours, the patient reports chills and has a fever of 101°F, an increase from a previous tempera- ture of 99.2°F. Which does the nurse identify the patient is experiencing? a. The patient is having an allergic reaction to the blood. b. The patient is experiencing vascular collapse. c. The patient is having a decrease in tissue perfusion from a shock state. b d. The patient is having a febrile nonhemo- lytic reaction. 9. The nurse is administering two units of packed RBCs to an older adult patient with a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. Which action by the nurse is a priority? (Select all that apply.) a. Continue the infusion but slow the rate down. b Place the patient in an upright position with the feet dependent. c.Administer diuretics as prescribed. d.Discontinue the transfusion. e.Administer oxygen. 10. A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. Which type of aggressive therapy will the patient receive to prevent death from the injury? (Select all that apply.) a. Performance of serial chest x-rays B.Supplemental oxygen c.Provision of intravenous fluid support d. Intubation and mechanical ventilation e. Intra-aortic balloon pump 11. A patient who has long-term packed RBC 2910 transfusions develops symptoms of iron toxicity that affect liver function. Which orb immediate treatment will the nurse prepare the patient for that may help prevent organ damage? a.Iron chelation therapy b. Oxygen therapy c. Therapeutic phlebotomy d. Anticoagulation therapy 12. A patient develops a hemolytic reaction to a blood transfusion. Which priority actions will the nurse perform? (Select all that apply.) a. Administer diphenhydramine. b. Begin iron chelation therapy. c.Obtain appropriate blood specimens. d.Collect a urine sample to detect hemoglobin. e.Document the reaction according to policy. 13. The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. Which position will the nurse place the patient in? a. Lateral position with one leg flexed b. Lithotomy position c. Supine with head of the bed elevated 30 degrees d. Jackknife position 14. A patient with chronic kidney disease has chronic anemia. Which pharmacologic alter- native to blood transfusion may be used for this patient? a.GM-CSF b. Erythropoietin c.Eltrombopag d. Thrombopoietin 15. A patient is undergoing plateletpheresis at the outpatient clinic. Which does the nurse identify as the most likely clinical disorder the patient is being treated for? a.Essential thrombocythemia b. Extreme leukocytosis c. Sickle cell disease d. Renal transplantation Chapter 29 1. The nurse is assessing a patient who reports feeling "constantly tired and very weak." The patient reports a very sore tongue, and upon observing the patient's oral cavity, the nurse notices the tongue is beefy red. Which type of anemia do these findings correlate with? a. Iron deficiency anemia b Megaloblastic anemia c. Sickle cell disease d. Aplastic anemia 2. The nurse observes a coworker eating ice frequently. The nurse encourages the coworker to have an examination and diag- nostic workup with the health care provider because frequently eating ice may indicate which type of anemia? a.Iron deficiency anemia b. Megaloblastic anemia c. Sickle cell disease d. Aplastic anemia 3. The nurse is performing an assessment for a patient with anemia admitted to the hospital for the administration of blood transfusions. Why would the nurse need to include a nutritional assessment for this patient? a. It is part of the required assessment information. b. It is important for the nurse to determine what type of foods the patient will eat. c.It may indicate deficiencies in essential nutrients. d. It will determine what type of anemia the patient has 4. The nurse is assessing a patient who is a strict vegetarian. Which type of anemia is this patient at greatest risk for? a. Iron deficiency anemia b. Aplastic anemia c.Megaloblastic anemia d. Sickle cell disease 5. A patient describes numbness in the arms and hands with a tingling sensation and fre- quent stumbling when walking. Which vita- min deficiency does the nurse identify may contribute to some of these symptoms? a. Thiamine b. Folate c. B12 d. Iron 6. The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. Which can the nurse inform the patient will enhance the absorption? a.Eating calf's liver with a glass of orange juice b. Eating leafy green vegetables with a glass of water c. Eating apple slices with carrots d. Eating a steak with mushrooms 7. A patient with end-stage kidney disease (ESKD) develops anemia. When reviewing the laboratory studies, which finding is significant in this stage of anemia? a. Potassium level of 5.2 mEq/L b. Magnesium level of 2.5 mg/dL c. Calcium level of 9.4 mg/dL d. Creatinine level of 6 mg/100 mL 8. A patient with end-stage kidney disease (ESKD) is taking recombinant erythropoietin for the treatment of anemia. Which labora- tory study will be obtained at least monthly related to this medication? a. Potassium level b. Creatinine level c.Hemoglobin level d. Folate levels 9. A patient who had gastric bypass surgery 3 years ago is experiencing fatigue.. The patient takes pantoprazole for the treatment of frequent heartburn. Which type of anemia is this patient at risk for? a. Aplastic anemia b. Iron deficiency anemia c. Sickle cell disease d. Pernicious anemia 10. The nurse is preparing the patient for a test to determine the cause of vitamin B12 defi- ciency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive B12- Which test is the patient being prepared for? a. Bone marrow aspiration b.Schilling test c. Bone marrow biopsy d. Magnetic resonance imaging (MRI) study 11. Which patient assessed by the nurse is iden- tified as most likely to be affected by sickle cell disease? a. A 14-year-old African American boy b. A 26-year-old Eastern European Jewish woman c. An 18-year-old Chinese woman d. A 28-year-old Israeli man 12. A patient with sickle cell disease, brought to the emergency department by a parent, has a fever of 101.6°F, heart rate of 116, a respiratory rate of 32, and bilateral wheezes. Which do these findings indicate to the nurse? a. Pneumocystis pneumonia b.Acute chest syndrome c. An exacerbation of asthma d. Pulmonary edema 13. A patient with sickle cell disease is to begin treatment with hydroxyurea. Which edu- cation does the nurse provide about the benefits of treatment with this medication? (Select all that apply.) a.Fewer painful episodes of sickle cell crisis b.Lower incidence of acute chest syndrome c.Decreased need for blood transfusions d. Decreased need for other analgesic medications e. Ability to reverse the damage done from sickling of cells 14. A patient with sickle cell disease comes to the emergency department reporting severe pain in the back, right hip, and right arm. Which action is important for the nurse to perform? a. Administer aspirin. b. Administer ibuprofen. c. Start an intravenous line with dextrose 5% in 0.24 normal saline. d. Begin oxygen at 2 L/min. 15. A patient is taking prednisone 60 mg/day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1500 mm³. Which will the nurse monitor the patient for? a. The onset of a bacterial infection b. Bleeding c. Abdominal pain d. Diarrhea Chapter 30 1. A patient with acute myeloid leukemia (AML) is having aggressive chemotherapy to attempt to achieve remission and is aware that hospitalization will be necessary for several weeks. Which type of therapy will the nurse educate the patient about? a. Induction therapy b. Supportive therapy c. Antimicrobial therapy d. Standard therapy 2. A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation ther- apy. Which complication will recognize the donor's lymphocytes as foreign and set up reactions to attack the foreign host? a. Acute respiratory distress syndrome b. Graft-versus-host disease c. Remission d. Bone marrow depression 3. The nurse is performing an assessment for a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. Which laboratory study will the nurse be most concerned about? a. WBC count of 4200 cells/mcL b. Hematocrit of 38% c. Platelet count of 9000/mm3 d. Creatinine level of 1.0 mg/dL 4. A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm³. Which will the nurse cautiously monitor this patient for? a. Abdominal cramps b. Hypotension c. Seizure activity d. Infection 5. The nurse is caring for a patient with acute myeloid leukemia (AML) with high uric acid levels. Which medication administered by the nurse will prevent crystallization of uric acid and stone formation? a.Allopurinol b. Filgrastim c. Hydroxyurea d. Asparaginase 6. The nurse is caring for a patient with chronic myeloid leukemia (CML) taking imatinib mesylate. In which phase of the leukemia is this medication most useful to induce remission? a.Chronic b. Transformation c. Accelerated d. Blast crisis 7. The nurse is educating a patient taking imatinib mesylate for treatment of leukemia. Which will the nurse be sure to include when educating the patient about the best way to take the medication that will opti- mize absorption? a. Take the medication with a source of vitamin C to enhance absorption. b. Take antacids if needed for gastrointes- tinal (GI) upset 2 hours after taking the medication. c. Take medication with food to enhance absorption. d. Take the medication with acetaminophen to prevent decreased absorption and GI upset. 8. Which patient assessed by the nurse is at greatest risk for the development of myelo- dysplastic syndromes (MDSs)? a. A 24-year-old female taking oral contraceptives b. A 40-year-old patient with a history of hypertension c. A 52-year-old patient with acute kidney injury d. A 72-year-old patient with a history of cancer 9. The nurse is administering packed RBC transfusions for a patient with MDS. The patient has had several transfusions and is likely to receive several more. Which is a pri. ority for the nurse to monitor related to the transfusions? a. Creatinine and blood urea nitrogen (BUN) levels b. Iron levels c. Magnesium levels d. Potassium levels 10. The nurse is assessing a patient with poly. cythemia vera. Which skin assessment data will the nurse identify as a normal finding for this patient? a. Pale skin and mucous membranes b. Bronze skin tone c. Ruddy complexion d. Jaundice skin and sclera 11. A patient with polycythemia vera has a high RBC count and is at risk for the development of thrombosis. Which treatment is important to reduce blood viscosity and to deplete the patient's iron stores? a. Blood transfusions b. Radiation c. Chelation therapy d. Phlebotomy 12. A patient with polycythemia vera reports severe itching. Which triggers does the nurse know can cause this symptom? (Select all that apply.) a.Temperature change b.Allergic reaction to the RBC increase c.Alcohol consumption d.Exposure to water of any temperature e. Aspirin 13. The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Because this patient is at risk for the develop- ment of a second malignancy, which educa- tion is beneficial for the nurse to discuss to reduce the risk factors? (Select all that apply.) a. Reduce exposure to excessive sunlight. b. Smoking cessation. c. Decrease alcohol intake. d. Decrease intake of antipyretic medications such as acetaminophen. e. Decrease fat intake. 14. A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, which laboratory studies will the nurse monitor to determine effectiveness? a. Leukocyte and platelet count b. BUN and creatinine levels c. Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels d. Hemoglobin and hematocrit 15. The nurse is caring for a patient who will begin taking long-term bisphosphonate therapy. Why is it important for the nurse to encourage the patient to receive a thorough evaluation of dentition, including panoramic dental x-rays? a. The patient is at risk for tooth decay. b. The patient will develop gingival hyperplasia. c.The patient can develop osteonecrosis of the jaw. d. The patient can develop loosening of the teeth. IMMUNOLOGIC FUNCTION Chapter 31 1. A patient arrives at the clinic reporting a very sore throat and a fever of 100.8°F. A rapid strep test returns a positive result and the patient is given a prescription for an antibiotic. How did the streptococcal organ- ism gain access to the patient to cause this infection? a. Through the mucous membranes of the throat b. Through the skin c. Breathing in airborne dust d. Being outside in the cold weather and decreasing resistance 2. A patient develops an infection while on vacation in Central America and is now taking the antibiotic chloramphenicol. Which complications of the medication will the patient be monitored for? a. Eosinophilia b. Neutropenia c. Aplastic anemia d. Hypoprothrombinemia 3. An older adult patient who is postmeno- pausal informs the nurse that she believes she has developed another urinary tract infection (UTI). Which risk factors do female patients in this age group have that increase the incidence of UTIs? (Select all that apply.) a. Residual urine b. Urinary incontinence c. Estrogen deficiency d. Decreased function of the thyroid gland e. Dry mucous membranes of the vagina 4. The nurse is caring for an older adult patient hospitalized with cellulitis of the right lower extremity. Why is it imperative that the nurse continually assess the physical and emotional status of this patient? a. Older patients are at risk for developing dementia. b. The patient will not respond to the antibiotic treatment as well as a younger patient would. c. Early recognition and management of factors influencing immune response may decrease morbidity and mortality. d. Older adult patients develop depression and suicidal tendencies when they are faced with chronic illness. 5. The nurse is caring for a patient in the hospi- tal who is receiving a vitamin D supplement. Which education will the nurse provide to indicate the importance of this vitamin supplement? (Select all that apply.) a. Vitamin D deficiency is associated with increased risk of common cancers. b. Vitamin D deficiency is associated with increased risk of autoimmune disease. c. Vitamin D deficiency is associated with increased risk of congenital anomalies. d. Vitamin D deficiency is associated with increased risk of inflammatory disorders. e. Vitamin D deficiency is associated with increased risk of celiac disease. 6. An older adult patient develops a sacral pressure ulcer. Which will the nurse assess in order to ensure adequate wound healing and prevent poor outcomes for this patient? (Select all that apply.) a. The patient's ability to perform self- wound care b. Nutritional status c. Caloric intake d. Quality of food ingested e. The amount of carbohydrates the patient ingests 7. The nurse is caring for a female patient with an exacerbation of systemic lupus erythema- tosus. Which does the nurse determine is the reason that females tend to develop autoim- mune disorders more frequently than men? a. Androgen tends to enhance immunity. b. Estrogen tends to enhance immunity. c. Testosterone tends to enhance immunity. d. Leukocytes are increased in females. 8. The nurse is obtaining a history from a patient with severe psoriasis. Which question is the most important to ask this patient to determine a genetic predisposition? a. "How did you know you developed this disease?" b. "Does anyone in your family have more than one autoimmune disease?" c. "How many children do you have?" d. "Does your spouse or significant other have an autoimmune disease?" 9. A patient has developed kidney failure and is discussing options with the healthcare pro- vider for treatment. Which laboratory finding does the nurse identify that correlates with the kidney failure? a. A deficiency in circulating lymphocytes b. A deficiency in phosphorus c. Decreased amount of WBCS d. Increased amount of macrophages 10. A patient sustained severe partial-thickness burns to the face and trunk. The stressors associated with this patient's major injury have caused which immune process to occur? a. Cortisol is released from the adrenal cortex, which contributes to immunosuppression. b. Circulating lymphocytes will cause lymph node enlargement and altered lymph drainage. c. T lymphocytes are stimulated and produce antibodies. d. With the help of macrophages, B lympho- cytes recognize the antigen of a foreign invader. 11. When obtaining a health history from a patient with possible abnormal immune function, which question will be a priority for the nurse to ask? a. "Have you ever been treated for a sexually transmitted infection?" b. "When was your last menstrual period?" c. "Do you have abdominal pain or discomfort?" d. "Have you ever received a blood transfusion?" 12. A patient tells the nurse, "I can't believe I have ineffective immune function and am getting sick again. I exercise rigorously and compete regularly." Which is the best response by the nurse? a. "Something must be seriously wrong. You should not be getting sick since you are so healthy." b. "Maybe you need to stop exercising so much. It can't be good for you." c. "It is possible that you are immunocompromised and may have HIV." d. "Rigorous exercise can cause negative effects on immune response.' 13. The nurse is performing a physical assess- ment for a patient at the clinic and palpates enlarged inguinal lymph nodes on the left. Which assessment data will the nurse document? (Select all that apply.) a. Location b. Size c. Consistency d. Reports of tenderness e. Temperature 14. The nursing instructor is discussing the development of human immunodeficiency virus (HIV) disease with the students. Which will the instructor inform the class about helper T cells? a. They are activated on recognition of anti- gens and stimulate the rest of the immune system. b. They attack the antigen directly by altering the cell membrane and causing cell lysis. c. They have the ability to decrease B-cell production. d. They are responsible for recognizing antigens from previous exposure and mounting an immune response. 15. A patient is being treated in the intensive care unit for sepsis related to ventilator- associated pneumonia. The patient is taking large doses of three different antibiotics. Which severe outcome will the nurse monitor for in the lab studies? a. Leukocytosis b. Bone marrow suppression c. Oral thrush d. Rash Chapter 32 1. A patient is infected with HIV after sharing needles with another IV drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus usually within how many weeks after infection? a. 1 to 2 weeks b. 3 to 6 weeks c. 3 to 12 weeks d. 6 to 18 weeks 2. An older adult female states to the nurse, "I am experiencing vaginal dryness since I have been sexually active again. I can't use barrier protection because it makes it worse." Which education will the nurse provide to the patient? a. Use a lambskin condom instead of latex. b. This is common in postmenopausal women, and there are creams that can be used, and a latex condom should be used. c. Because the patient is older, it is not likely that she will acquire HIV. d. She should abstain from sex because she is at greatest risk for acquiring HIV. 3. A patient develops gastrointestinal (GI) bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." Which is the best response by the nurse? a. "I understand what you mean, you can never be sure if the blood is tainted." b. "I understand your concern. The blood is screened very carefully for different viruses as well as HIV." c. "If you don't have the blood transfusions, you may not make it through this episode of bleeding." d. "No one has gotten HIV from blood in a long time. You have to have the transfusion." 4. A new graduate is working at the hospital in the acute care unit. The preceptor observes the nurse emptying a patient's wound drain without gloves on. Which information will the preceptor discuss about standard precautions? a. Standard precautions should be used with all patients to reduce the risk of transmis- sion of bloodborne pathogens. b. Standard precautions should be used only with patients who are HIV positive to reduce the risk of transmission of the HIV virus. c. It is only necessary to use gloves when you are emptying reservoirs that have body fluids in them. d. If you are careful and do not expose your- self to blood or body fluids, it is not nec- essary to use gloves all the time. 5. A patient with HIV has been on antiretrovi- ral therapy (ART) for 6 months. The patient comes to the clinic with home medications, and the nurse observes that there are too many pills in the container. Which factors are associated with nonadherence to ART? (Select all that apply.) a. Lives alone b. Active substance abuse c. Taking other medication d. Depression e. Lack of social support 6. A patient is on ART for the treatment of HIV. Which does the nurse determine is an adequate CD4+ count to determine the effectiveness of treatment for a patient per year? a. 1 mm³ to 10 mm³ b. 10 mm³ to 20 mm³ c. 20 mm³ to 45 mm³ d. 50 mm³ to 150 mm³ 7. A patient who had unprotected sex with an HIV-infected partner arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. Which stage does the nurse iden- tify the patient is in? a. Primary infection b. Secondary infection c. Tertiary infection d. Latent infection 8. A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for this sexually transmitted infection (STI), which will be done for this patient? a. Test for HIV without informing the patient. b. Test for HIV, requiring the patient to sign a permit. c. Inform the patient that it would be beneficial to test for HIV. d. Administer treatment for the STI and discharge the patient. 9. A patient with HIV develops a nonproduc- tive cough, shortness of breath, a fever of 101°F, and an O₂ saturation of 92%. Which infection caused by Pneumocystis jirovecii does the nurse monitor the patient for? a. Mycobacterium avium complex (MAC) b. Pneumocystis pneumonia c. Tuberculosis d. Community-acquired pneumonia 10. A patient with acquired immune deficiency syndrome (AIDS) informs the nurse of diffi- culty eating and swallowing, and shows the nurse white patches in the mouth. Which complication related to AIDS does the nurse identify has developed? a. Mycobacterium avium complex (MAC) b. Wasting syndrome c. Kaposi sarcoma d. Candidiasis 11. While caring for a patient with Pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. Which condi- tion correlates with this assessment finding? a. Molluscum contagiosum b. Tuberculosis of the skin c. Kaposi sarcoma d. Seborrheic dermatitis 12. The nurse receives a phone call at the clinic from the family member of a patient with AIDS. The family member states that the patient started "acting funny" after report- ing headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. Which response by the nurse is best? a. "The patient probably has a case of flu, and you should give Tylenol." b. "The patient may have cryptococcal men- ingitis and will need to be evaluated by the physician." c. "This is one of the side effects from antiretroviral therapy and will require changing the medication." d. "The patient probably has Pneumocystis pneumonia and will need to be evaluated by the physician." 13. A patient is diagnosed with Pneumocystis pneumonia. Which medication does the nurse educate the patient about for treatment? a. TMP-SMZ b. Cephalexin c. Azithromycin d. Garamycin 14. A patient with AIDS is having a recurrence of 10 to 12 loose stools a day. Which medication may help this patient to control the chronic diarrhea? a. Octreotide b. Rifaximin c. Bismuth subsalicylate d. Atropine diphenoxylate 15. The nurse is discussing sex with a patient recently diagnosed with HIV. The patient states, "As long as I have sex with another person who is already infected, I will be okay." Which is the best response by the nurse? a. "You should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infec- tion in both you and your partner." b. "Yes; because you are already infected, it won't make a difference if you have sex with a person who is HIV positive." c. "I am not sure why you would want to have sex with another person who is HIV positive. That person may have another sexually transmitted infection." d. "If you have sex with another person who is HIV positive, you will develop AIDS sooner." Chapter 33 1. The nurse is preparing to administer a medication that has an affinity for H₁ receptors. Which medication would the nurse administer? a. Diphenhydramine b. Omeprazole c. Cimetidine d. Ranitidine 2. An infant is born to a mother who had no prenatal care during her pregnancy. Which type of hypersensitivity reaction does the nurse determine may have occurred? a. Bacterial endocarditis b. Rh-hemolytic disease c. Lupus erythematosus d. Rheumatoid arthritis 3. While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of which percentage of the total leukocyte count? a. 1% to 3% b. 3% to 4% c. 5% to 10% d. 15% to 40% 4. A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch and is suspected to be experiencing an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? a. 2 hours b. 6 hours c. 12 hours d. 24 hours 5. A patient is experiencing an allergic reaction after receiving a dose of penicillin. Which signs and symptoms will the nurse look for in the patient's initial assessment? a. Dyspnea, bronchospasm, and/or laryngeal edema b. Hypotension and tachycardia c. The presence and location of pruritus d. The severity of cutaneous warmth and flushing 6. The nurse is educating a patient with allergic rhinitis about how the condition is induced. Which factors should the nurse include in the education on this topic? a. Airborne pollens or molds b. Ingested foods c. Parenteral medications d. Topical creams or ointments 7. A patient has a sensitivity to ragweed and tells the nurse that it comes at the same time every year. When does the patient typically notice the symptoms? a. Early spring b. Early fall c. Summer d. Midwinter 8. A patient asks the nurse if it would be all right to take an over-the-counter antihis- tamine for the treatment of a rash. Which symptoms will the nurse educate the patient is a major side effect of antihistamines? a. Diarrhea b. Anorexia c. Palpitations d. Sedation 9. The nurse is administering a sympathomimetic drug to a patient. Which areas of concern does the nurse have when administering this drug? (Select all that apply.) a. Causes bronchodilation. b. Constricts integumentary smooth muscle. c. Dilates the muscular vasculature. d. Causes bronchoconstriction. e. Causes laryngospasm. 10. The nurse is administering injected allergens for "hyposensitization," which may produce harmful systemic reactions. Prior to adminis- tering these allergens, what medication will the nurse have at the bedside? a. Phenergan hydrochloride b. Pentazocine c. Epinephrine d. Meclizine hydrochloride 11. A patient was seen in the clinic for hyper- tension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. Which medication pre- scribed is most likely responsible for the reaction? a. Beta-blocker b. Angiotensin-converting enzyme (ACE) inhibitor c. Angiotensin receptor blocker d. Vasodilator 12. A patient has been diagnosed with an allergy to peanuts. Which item is a priority for this patient to carry at all times? a. A medical alert bracelet b. An H, blocker c. An EpiPen d. An oral airway 13. A patient has had a "stuffy nose" and obtained Afrin nasal spray. Which education should the nurse provide to the patient in order to prevent "rebound congestion"? a. Be sure to use the Afrin for at least 10 days to ensure the stuffiness is gone. b. Use the medication every 4 hours to prevent congestion from recurring. c. Drink plenty of fluids. d. Only use the Afrin for 3 to 4 days once every 12 hours. 14. A patient was seen in the clinic 3 days previ- ously for allergic rhinitis and was given a pre- scription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. Which is the best response by the nurse? a. "You need to come back to the clinic to get a different medication since this one is not working for you." b. "You may be immune to the effects of this medication and will need something else in its place." c. "The full benefit of the medication may take up to 2 weeks to be achieved." d. "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." 15. What education should the nurse provide to the patient taking long-term corticosteroids? a. The patient should not stop taking the medication abruptly and should be weaned off the medication. b. The patient should take the medica- tion only as needed and not take it unnecessarily. c. Corticosteroids are relatively safe drugs with very few side effects. d. The patient should discontinue using the drug immediately if weight gain is observed. Chapter 34 1. A patient is seen in the office for reports of joint pain, swelling, and a low-grade fever. Which laboratory studies reviewed by the nurse indicate a positive diagnosis of RA? (Select all that apply.) a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) c. Red blood cell (RBC) count of 130 mg/dL e. Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L 2. A patient has a serum study that is positive for the rheumatoid factor. Which does the nurse identify is the significance of this test result? a. The test results are diagnostic for Sjögren's syndrome. b. The test results are diagnostic for systemic lupus erythematosus. c. The test results are specific for rheumatoid arthritis. d. The test results are suggestive of rheuma- toid arthritis. 3. The nurse is caring for a patient who presents with the symptom of blanching of fingers when exposed to cold. Which rheumatic disorder does the nurse prepare to assess the patient for? a. Ankylosing spondylitis b. Raynaud's phenomenon c. Reiter syndrome d. Sjögren's syndrome 4. A patient is suspected of having myositis. The nurse prepares the patient for which procedure that will confirm the diagnosis? a. Bone scan b. Computed tomography (CT) c. Magnetic resonance imaging (MRI) d. Muscle biopsy 5. The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and which symptoms should be reported. Which COX-2 inhibitor is the nurse educating the patient about? a. Ibuprofen b. Celecoxib c. Piroxicam d. Tolmetin sodium 6. A patient is prescribed a DMARD that is successful in the treatment of rheumatoid arthritis (RA) but has side effects, including retinal eye changes. Which medication does the nurse educate the patient about? a. Azathioprine b. Diclofenac c. Hydroxychloroquine d. Aurothioglucose 7. A patient with an acute exacerbation of arthritis is temporarily confined to bed. Which position will the nurse recommend to prevent flexion deformities? a. Prone b. Semi-Fowler c. Side-lying with pillows supporting the shoulders and legs d. Supine with pillows under the knees 8. A patient comes to the clinic with an inflamed wrist. How will the nurse splint the joint to immobilize it? a. Slight dorsiflexion b. Extension c. Hyperextension d. Internal rotation 9. A patient arrives at the clinic with reports of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. Which laboratory test will the nurse prepare the patient for to identify the cause? a. Uric acid level b. Hemoglobin c. Potassium level d. Erythrocyte sedimentation rate 10. The nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. Which foods will the nurse encourage the patient to avoid? a. Baked chicken b. Steak c. Asparagus d. Pineapple 11. The nurse is assessing a patient with a diag- nosis of scleroderma. Which clinical manifes- tations of scleroderma does the nurse assess? (Select all that apply.) a. Decreased ventilation owing to lung scarring b. Dysphagia owing to hardening of the esophagus c.Dyspnea owing to fibrotic cardiac tissue d. Productive cough e. Butterfly-shaped rash on the face 12. A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, which will the laboratory results reveal? a. Glycosuria b. Hyperuricemia c. Hyperproteinuria d. Ketonuria 13. A patient is being placed on a purine- restricted diet. Which food should be suggested by the nurse? a. Dairy products b. Organ meats c. Raw vegetables d. Shellfish 14. A patient is taking nonsteroidal anti-inflam- matory drugs (NSAIDs) for the treatment of osteoarthritis. Which education should the nurse give the patient about the medication? a. Take the medication on an empty stomach in order to increase effectiveness. b. Since the medication is able to be obtained over the counter, it has few side effects. c.Take the medication with food to avoid stomach upset. d. Inform the primary provider if there is ringing in the ears. 15. The nurse is educating a patient that is pre- scribed adalimumab for the treatment of psoriatic arthritis. Which statement made by the patient indicates that further education is required? a. "I will receive a tuberculin skin test prior to beginning this medication." b. "I will administer this medication in the muscle of my leg every 2 weeks." c. "If I have a fever, I won't administer the medication and will notify my health care provider." d. "I should avoid large crowds and protect myself from infections." METABOLIC FUNCTION Chapter 42 1. The nurse is assessing a patient with android obesity. Which risk factors will the nurse consider during the assessment of this patient? (Select all that apply.) a. Previous diagnosis of hyperthyroidism b. A diagnosis of hypertension c. A history of coronary artery disease d. A diagnosis of type 2 diabetes e. A history of multiple sclerosis 2. The nurse is providing education for a patient with obesity about caloric reduction. Which calorie deficit should the nurse recommend daily from the baseline? a. 100 to 250 calories b. 250 to 400 calories C. 500 to 1000 calories d. 1000 to 1500 calories 3. The nurse is educating a patient with obesity about weight loss with healthy dietary hab- its. Which statement made by the patient indicates that further education is required? a. "I need to adopt a diet heavy with plant- based food items." b. "The DASH diet will help me lose weight and maintain the weight loss." c. "In addition to dietary adjustments, I should exercise daily." d. "The only way I will be successful is if I purchase a commercial diet plan." 4. A patient is prescribed antiobesity medica- tions to assist with a 75-lb weight loss goal. Which statement made by the patient indi- cates further education is needed? a. "Since I will be taking this medication, I won't have to change my dietary habits." b. "The weight loss medication may have unfavorable side effects." c. "Once I stop taking the medication, I may gain some or all of the weight back." d. "I will exercise daily and be sure to drink plenty of fluids." 5. The nurse is preparing a patient for a bariatric surgical procedure that will result in diminishing gastric contraction, limit ghrelin secretion, and decrease pancreatic enzyme secretion. Which procedure is the nurse preparing the patient for? a. Intragastric balloon therapy b. Vagal blocking therapy c. Sleeve gastrectomy d. Roux-en-Y gastric bypass 6. A patient that will undergo bariatric surgery asks the nurse when they will be allowed to eat after surgery. Which is the best response by the nurse? a. "You will most likely be able to have clear liquids within 24 to 48 hours." b. "You will not feel like eating anything for about 1 week." c. "You will be able to have some clear liquids when you return from surgery." d. "You will be started on a bland diet within 24 hours." 7. After bariatric surgery, the nurse is positioning the patient in the bed. Which position best promotes comfort and emptying of the stomach? å. Left lateral Sims position b. High-Fowler position c. Prone position d. Low-Fowler position 8. An older adult patient with morbid obesity had Roux-en-Y gastric bypass surgery. On postoperative day 2, the patient reports abdominal pain, and the nurse assesses a temperature of 102°F, heart rate of 126, and an elevated white blood cell count. Based on the assessment data, which does the nurse suspect is occurring with this patient? a. The patient is experiencing dumping syndrome. b. An anastomotic leak has occurred from the bypass surgery. c. The patient is dehydrated from lack of fluids. d. The patient likely has a small bowel obstruction. 9. The nurse is caring for a patient after Roux-en-Y bypass surgery for the treatment of morbid obesity. In order to prevent perni- cious anemia, which prescribed medication will the nurse educate the patient about? a. Taking over-the-counter multivitamins daily b. Taking iron preparations orally once a month c.The administration of vitamin B12 injections monthly d. Taking oral thiamine tablets daily 10. A patient who recently had bariatric surgery states, "I feel ashamed at the way I look because of the sagging skin everywhere. I may have looked heavier." Which is the best response by the nurse? a. "You should have been informed that this could occur after weight loss." b. "It is better than being overweight and so unhealthy." c. "This isn't anything that can be fixed, so you will just have to adjust to the sagging skin." d."These feelings are understandable and not unusual. Let me give you support group information." Chapter 43 1. The nurse is educating a patient with cirrho- sis about the importance of maintaining a low-sodium diet. Which statement made by the patient indicates that the education is effective? a. "Peanut butter will be a good option for me since it will also add protein." b. "Fresh fruit like the pear I ate for lunch will be a low-sodium option." c. "It's alright if I just have a couple of hot dogs with ketchup at dinner." d. "Canned soup is a light meal that will be low in calories and healthy." 2. The nurse is caring for a patient with ascites as a result of hepatic dysfunction. Which intervention will the nurse provide to deter- mine if the ascites is increasing? (Select all that apply.) a. Measure urine output every 8 hours. b. Assess and document vital signs every 4 hours. c. Measure abdominal girth daily. d. Perform daily weights. e. Monitor the number of bowel movements per day. 3. The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. Which diuretic may be prescribed that spares potassium and pre- vents hypokalemia? a. Furosemide b. Spironolactone c. Acetazolamide d. Bumetanide 4. The nurse is caring for a patient with ascites due to cirrhosis of the liver. Which position does the nurse determine will activate the renin-angiotensin-aldosterone and sympa- thetic nervous system and decrease respon- siveness to diuretic therapy? a. Prone b. Supine c. Left-lateral Sims' A d. Upright 5. A patient is scheduled for a diagnostic paracentesis, but when coagulation stud- ies are reviewed, the nurse observes results outside of normal parameters. How will the nurse proceed with preparation for the paracentesis? a. An ultrasound-guided paracentesis will be performed. b. The procedure will be canceled until the laboratory results are within normal parameters. c. The paracentesis will be performed at the bedside. d. The nurse will administer packed red blood cells (RBCs) prior to the paracentesis. 6. The nurse is caring for a patient with ascites. Which intervention will the nurse perform to correct the decrease in effective arte- rial blood volume that will lead to sodium retention? a. Administer diuretic therapy. b. Assist with a therapeutic paracentesis. c. Infuse platelets. d. Infuse albumin. 7. The nurse provides care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler position. Which is the nurse's priority assessment of this patient? a. Respiratory assessment related to increased thoracic pressure b. Urinary output related to increased sodium retention. c. Peripheral vascular assessment related to immobility d: Skin assessment related to increase in bile salts 8. A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long will the nurse withhold food and fluids? a. For 2 hours after the last dose of medica- tion is given b. Until the gag reflex returns c. Until the patient expresses thirst d. For 6 hours after the procedure 9. A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. Which first-line pharmacologic therapy will the nurse prepare to administer to control the bleeding from the varices? a. Vasopressin b. Epinephrine c. Octreotide d. Glucagon 10. A patient with bleeding esophageal varices has had pharmacologic therapy with oct- reotide and endoscopic therapy with esopha- geal varices banding but continues to bleed. Which procedure will the nurse prepare for that will lower portal pressure? a. Transjugular intrahepatic portosystemic shunting (TIPS) b. Administration of vasopressin c. Sclerotherapy d. Balloon tamponade 11. The nurse is educating a patient being treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. Which statement made by the patient indicates that the patient under- stands the education? a. "I will decrease the amount of fats in my diet." b. "I need to eat foods that are high in potassium." c. "I need to decrease the amount of protein in my diet." d. "It is necessary to increase the amount of magnesium in my diet." 12. The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. How will the nurse document this finding? a. Constructional apraxia b. Fetor hepaticus c. Ataxia d. Asterixis 13. The nurse is administering lactulose to decrease the ammonia level in a patient who has hepatic encephalopathy. Which will the nurse carefully monitor for that may indicate a medication overdose? a. Watery diarrhea b. Vomiting c. Ringing in the ears d. The presence of asterixis 14. A patient with severe chronic liver dysfunc- tion comes to the clinic with bleeding of the gums and blood in the stool. Which vitamin deficiency does the nurse identify the patient may be experiencing? a. Riboflavin deficiency b. Folic acid deficiency c. Vitamin A deficiency d. Vitamin K deficiency 15. A patient must begin receiving the hepatitis B series of injections. The patient asks when the next two injections should be admin- istered. Which is the best response by the nurse? a. "You must have the second one in 2 weeks and the third in 1 month." b. "You must have the second one in 1 month and the third in 6 months." c. "You must have the second one in 6 months and the third in 1 year." d. "You must have the second one in 1 year and the third the following year." Chapter 44 1. A patient is diagnosed with gallstones in the bile ducts. Which laboratory result will the nurse review that is indicative of this disorder? a. Serum ammonia concentration of 90 mg/dL b. Serum albumin concentration of 4.0 g/dL c.Serum bilirubin level greater than 1.0 mg/dL d. Serum globulin concentration of 2.0 g/dL 2. A patient is admitted to the hospital with a possible common bile duct obstruction. Which symptoms assessed by the nurse are indicators of this problem? (Select all that apply.) a. Amber-colored urine b. Clay-colored feces c. Pruritus d. Jaundice e. Pain in the left upper abdominal quadrant 3. A patient is admitted to the hospital with possible cholelithiasis. Which test will the nurse prepare the patient for to confirm diagnosis? a. X-ray b. Oral cholecystography c. Cholecystography d. Ultrasonography 4. A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxy- cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. Which is the best answer by the nurse? a. 1 to 2 months b. 3 to 5 months c. 6 to 8 months d. 6 to 12 months 5. A patient is diagnosed with mild acute pancreatitis. Which condition is characteristic of this disorder? a. Edema and inflammation b. Pleural effusion c. Sepsis d. Disseminated intravascular coagulopathy 6. The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. When performing a health his- tory, which statement made by the patient is likely the reason that the patient came to the acute care facility? a. "I was having severe pain in the abdomen." b. "I have had a temperature of 99.5°F for several days." c. "My skin started looking a little yellow." d. "I started losing some of my short-term memory." 7. The nurse will assess for an important early indicator of acute pancreatitis. Which prolonged and elevated level would the nurse identify as an early indicator? a. Serum calcium b. Serum lipase c. Serum bilirubin d. Serum amylase 8. When caring for the patient with acute pancreatitis, pain relief measures are essential. Which nursing actions will be provided? (Select all that apply.) a. Encourage bed rest to decrease the metabolic rate. b. Assist the patient into the prone position. c.Withhold oral feedings to limit the release of secretion. d. Administer parenteral opioid analgesics as prescribed. e. Administer prophylactic antibiotics. 9. A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. Which will the nurse identify as an indicator for insulin defi- ciency in this patient? (Select all that apply.) a. An abnormal glucose tolerance b. Glucosuria c. Hyperglycemia d. Elevated lipase level e. Hypoglycemia 10. A nurse will monitor blood glucose levels for a patient diagnosed with hyperinsulinism. Which blood value does the nurse identify as inadequate to sustain normal brain function? a. 30 mg/dL b. 50 mg/dL c. 70 mg/dL d. 90 mg/dL 11. The nurse is caring for a patient with acute pancreatitis. The patient has a prescription for an anticholinergic medication. Which education will the nurse provide about the reason the patient is taking the medication? a. To decrease metabolism b. To depress the central nervous system and increase the pain threshold c.To reduce gastric and pancreatic secretions d. To relieve nausea and vomiting 12. The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. Which type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? a. Low-sodium, high-potassium, low-fat diet b. High-carbohydrate, high-protein, low-fat diet c. Low-carbohydrate, high-potassium diet d. High-carbohydrate, low-protein, low-fat diet 13. The nurse is caring for a patient with acute pancreatitis. Which action can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? a. Frequent change of positions b. Placing the patient in the prone position c. Perform chest physiotherapy d. Suction the patient every 4 hours 14. A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. Which is the major concern for this patient? a. The patient requires more pain medication. b. The patient is developing a paralytic ileus. C. The patient has developed peritonitis. d. The patient has developed kidney disease. 15. The nurse is caring for a patient with chronic pancreatitis. When observing the stool of the patient, which indication does the nurse have that fat absorption is impaired? a. The stools are streaked with blood. b. The stools are frothy and foul smelling. c. The stools are pale and pencil thin. d. The stools are watery. 16. A patient undergoes a laparoscopic cholecys- tectomy for the treatment of cholelithiasis and is discharged several hours later. The patient calls the nurse and reports pain in the right shoulder. Which is the best response by the nurse? a. "You need to have someone bring you back to the hospital immediately since this is a complication of the procedure." b. "This is due to the gas used to insufflate the abdomen and you can use a heating pad for 15 to 20 minutes every hour." c. "The health care provider will need to insert a drain since there may be an accumulation of fluid in the abdominal cavity." d. "Sometimes during a laparoscopic cho- lecystectomy, the liver is lacerated and causes bleeding, but it will stop on its own." Chapter 45 1. A patient is receiving levothyroxine for pro- longed hypothyroidism. Which will the nurse inform the patient to monitor for closely? a. Angina b. Depression c. Mental confusion d. Hypoglycemia 2. A patient comes to the clinic reporting severe thirst and drinking up to 10 L of cold water daily. The nurse observes that the patient's urine looks like water. Which diag- nostic test does the nurse identify the health care provider will prescribe for diagnosis? a. Complete blood count (CBC) b. Fluid deprivation test c. Urine specific gravity d. Thyroid-stimulating hormone (TSH) test 3. A patient is exhibiting signs of hyperthyroid- ism. Which clinical manifestations reported by the patient correlate with this diagnosis? (Select all that apply.) a. A pulse rate slower than 90 bpm b. An elevated systolic blood pressure c. Muscular fatigability d. Weight loss e. Intolerance to cold 4. The nurse is caring for a patient with hyper- thyroidism who suddenly develops symptoms related to thyroid storm. Which symptoms does the nurse identify are indicative of this emergency? a. Heart rate of 62 b. Blood pressure 90/58 mm Hg c.Oxygen saturation of 96% d.Temperature of 102°F 5. A patient is experiencing a thyroid storm. Which medication will the nurse administer to reverse the effects of the excess thyroid hormone? (Select all that apply.) a. Acetaminophen b.Iodine c.Propylthiouracil d. Synthetic levothyroxine e. Dexamethasone 6. The nurse assesses a patient with an obvious goiter. Which type of deficiency does the nurse identify as the most likely cause of the goiter? a. Thyrotropin b. Iodine c. Thyroxine d. Calcitonin 7. The nurse is assisting a patient with hyper- thyroidism to choose breakfast items. Which breakfast items are the best choice for the nurse to recommend? a. Cereal with milk and bananas b. Fried eggs and bacon c. Orange juice and toast d. Pork sausage and cranberry juice 8. A patient is suspected of having a pheochro- mocytoma and is having diagnostic tests performed in the hospital. Which symptoms does the nurse identify as most significant for a patient with this disorder? a. Blood pressure varying between 120/86 and 240/130 mm Hg b. Heart rate of 56 to 64 bpm c. Shivering d. Reports of nausea 9. A patient is diagnosed with overactivity of the adrenal medulla. Which epinephrine value does the nurse identify as a positive diagnostic indicator for overactivity of the adrenal medulla? a. 50 pg/mL b. 100 pg/mL c. 100 to 300 pg/mL d. 450 pg/mL 10. The nurse is caring for a patient with hyper. parathyroidism and observes a calcium level of 16.2 mg/dL.. Which action(s) does the nurse prepare to provide to reduce the calcium level? (Select all that apply.) a. Administration of calcitonin b. Administration of calcium carbonate c.Intravenous isotonic saline solution in large quantities d. Monitoring the patient for fluid overload e. Administration of a bronchodilator 11. A patient is prescribed desmopressin for the treatment of diabetes insipidus. Which ther- apeutic response does the nurse determine the patient will experience? a. A decrease in blood pressure b. A decrease in blood glucose levels c. A decrease in urine output d. A decrease in appetite 12. The nurse auscultates a bruit over the thyroid glands. Which is the significance of this finding? a. The patient may have hypothyroidism. b. The patient may have thyroiditis. c. The patient may have hyperthyroidism. d. The patient may have Cushing's disease. 13. A patient with a history of hypothyroidism is admitted to the intensive care unit uncon- scious and with a temperature of 95.2°F. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. Which do these findings indicate to the nurse? a. Thyroid storm b. Myxedema coma c. Diabetes insipidus d. Syndrome of inappropriate antidiuretic hormone (SIADH) 14. The nurse on the telemetry floor is caring for a patient with long-standing hypothyroid- ism who has been taking synthetic thyroid hormone replacement sporadically. Which is a priority that the nurse will monitor for this patient? a. Symptoms of acute coronary syndrome b. Dietary intake of foods with saturated fats c. Symptoms of pneumonia d. Heat intolerance 15. A patient taking corticosteroids for exacerba- tion of Crohn's disease comes to the clinic and informs the nurse of the desire to stop taking them because of the increase in acne and moon face. Which education will the nurse provide regarding these symptoms? a. The symptoms are permanent side effects of the corticosteroid therapy. b. The moon face and acne will resolve when the medication is tapered off. c. Those symptoms are not related to corticosteroid therapy. d. The dose of the medication must be too high and should be lowered. 16. A patient has been taking tricyclic antide- pressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. Which will the nurse carefully monitor when caring for this patient? (Select all that apply.) a. Strict intake and output b. Neurologic function c. Urine and blood chemistry d. Liver function tests e. Signs of dehydration Chapter 46 1. A patient is diagnosed with type 1 diabetes. Which clinical characteristics does the nurse determine will likely be associated with this patient? (Select all that apply.) a.Ketosis prone b. Little endogenous insulin c. Obesity at diagnoses d. Younger than 30 years of age e. Older than 65 years of age 2. When the nurse is caring for a patient with type 1 diabetes, which clinical manifestation would be a priority to closely monitor? a. Hypoglycemia b. Hyponatremia c. Ketonuria d. Polyphagia 3. A female patient with diabetes who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/wk, approxi- mately what will her daily caloric intake be? a. 1000 calories b. 1200 calories c. 1500 calories d. 1800 calories 4. The nurse is preparing to administer interme- diate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a. NPH b. Iletin II c. Humalog d. Glargine 5. An older adult patient with diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." Which does the nurse understand is most likely the reason for the decrease in tempera- ture sensation? a. A faulty heater b. Autonomic neuropathy c. Peripheral neuropathy d. Sudomotor neuropathy 6. The nurse is caring for a patient with an abnormally low blood glucose concentration. Which glucose level will the nurse observe when assessing laboratory results? a. Lower than 50 to 60 mg/dL b. Between 60 and 80 mg/dL c. Between 75 and 90 mg/dL d. 95 mg/dL 7. A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydra- tion. Which potential complication from rehydration will the nurse monitor for? a. Hypokalemia b. Hyperkalemia c. Hyperglycemia d. Hyponatremia 8. The nurse is assessing a patient with nonpro- liferative (background) retinopathy. When examining the retina, what will the nurse expect to assess? (Select all that apply.) a. Leakage of fluid or serum (exudates) b. Microaneurysms c. Focal capillary single closure d. Detachment e. Blurred optic discs 9. A nurse is caring for a patient with diabetes who has a diagnosis of nephropathy. What will the nurse expect the urinalysis report to indicate? a. Albumin b. Bacteria c. Red blood cells d. White blood cells 10. The nurse is preparing to administer insu- lin to a patient with type 1 diabetes in the morning prior to a surgical procedure. Which percentage of the usual morning dose of insulin will the nurse administer preoperatively? a. 10% to 20% b. 25% to 40% c.50% to 60% d. 85% to 90% 11. An older adult patient is in the hospital with urosepsis. The patient begins to experience an altered level of consciousness, profound dehydration, and hypotension. Which con- dition does the nurse suspect the patient is experiencing? a. Systemic inflammatory response syndrome b. Hyperglycemic hyperosmolar syndrome c. Multiple-organ dysfunction syndrome d. Diabetic ketoacidosis 12. The nurse is preparing to administer IV flu- ids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. Which prescription for fluids will the nurse infuse for this patient? a. D5W b. 0.9% normal saline c. 0.45% normal saline d. Ds normal saline 13. A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. Which step will be taken into consideration prior to making the meal plan? a. Make sure that the patient is aware that quantity of foods will be limited. b. Ensure that the patient understands that some favorite foods may not be allowed on the meal plan. c.