CU 6: Hemodynamic and Cardio Physiology PDF

CU 6: Hemodynamic and Cardio Physiology is the most likely explanation for Mr. August's weak and rapid pulse? 1. Mr. Jones is experiencing shortness of breath and edema in his lower extremities. His vital A. Hypovolemia Due to Int...

CU 6: Hemodynamic and Cardio Physiology is the most likely explanation for Mr. August's weak and rapid pulse? 1. Mr. Jones is experiencing shortness of breath and edema in his lower extremities. His vital A. Hypovolemia Due to Internal Bleeding signs are as follows: BP 100/60 mmHg, HR 110 B. Cardiac Tamponade bpm, RR 24 breaths/min. His oxygen C. Pulmonary Embolism saturation is 90% on room air. What is the most D. Anxiety likely cause of Mr. Jones' shortness of breath? Rationale: Aortic dissection can lead to internal A. Pulmonary Embolism bleeding and hypovolemia, causing a weak and B. Pneumonia rapid pulse. C. Fluid Overload in the Lungs D. Anxiety 5. Ms. Gray has a history of bradycardia and syncope. Her pacemaker is programmed to Rationale: Heart failure often leads to fluid deliver electrical impulses to her heart when her buildup in the lungs, causing shortness of heart rate falls below a certain threshold. What breath. is the primary function of a pacemaker? 2. Ms. Smith presents with chest pain radiating A. To Increase Heart Rate to her left arm. Her EKG shows ST-segment B. To Decrease Heart Rate elevation. Her vital signs are BP 130/80 C. To Regulate Heart Rhythm mmHg, HR 100 bpm, RR 18 breaths/min. What D. To Increase Blood Pressure is the most important intervention for Ms. Smith at this time? Rationale: Pacemakers are used to regulate heart rhythm by delivering electrical impulses A. Administer Aspirin to the heart when its natural pacemaker is not B. Administer Oxygen functioning properly. C. Obtain a Chest X-ray D. Prepare for Immediate Cardiac 6. Mr. Bartolomeo 50, was admitted for a heart Catheterization valve replacement. Mr. Bartolomeo has a history of aortic stenosis. He is scheduled for a Rationale: ST-segment elevation is a hallmark heart valve replacement surgery. What is the of an acute myocardial infarction, requiring primary hemodynamic effect of aortic stenosis? immediate intervention to open the blocked coronary artery. A. Increased Left Ventricular Afterload B. Decreased Left Ventricular Preload 3. Mr. Davis is on digoxin for his atrial C. Increased Right Ventricular Afterload fibrillation. He complains of nausea and D. Decreased Right Ventricular Preload fatigue. His vital signs are BP 110/70 mmHg, HR 50 bpm, RR 16 breaths/min. What is the Rationale: Aortic stenosis increases resistance most likely explanation for Mr. Davis' to blood flow from the left ventricle to the aorta, symptoms? increasing left ventricular afterload. A. Digoxin Toxicity 7. A patient in the ICU is experiencing a sudden B. Hypokalemia drop in blood pressure after standing up. As the C. Infection nurse, you recall that preload is affected by D. Dehydration body position. Which action would most likely help increase preload in this patient? Rationale: Digoxin toxicity can cause nausea, fatigue, and bradycardia. A. Encourage Deep Breathing Exercises B. Place the Patient in a Standing Position 4. Mr. August presents with sudden, severe C. Lay the Patient in a Supine Position chest pain radiating to his back. His vital signs D. Administer Antihypertensive Medication are BP 100/60 mmHg, HR 120 bpm, RR 22 breaths/min. His pulse is weak and rapid. What Rationale: Laying supine increases venous B. Homeostatic Mechanisms return, improving preload and stabilizing blood C. Depolarization pressure D. Repolarization 8. During a cardiology consultation, a patient 12. What is the standard PAC? complains of dizziness and palpitations. After reviewing their history, the doctor suspects a A. 6.5 fluid imbalance in the heart. What diagnostic B. 7.5 tool would be most appropriate to monitor this C. 8.5 patient’s fluid balance? D. 9.5 A. Electrocardiogram (ECG) 13. What area of the heart’s electrical B. Pulmonary Artery Catheter (PAC) conduction is known as the “pacemaker” of C. Arterial Catheter the heart? D. Echocardiogram A. SA node Rationale: PAC is used to monitor B. AV node cardiopulmonary pressures and assess fluid C. Purkinje Fibers balance D. Bundle of His 9. A patient is undergoing heart surgery, and the 14. Which of the following is also known as surgeon notes that the heart continues to beat the mitral valve? even after it is disconnected from nervous system input. Which property of the heart A. Bicuspid allows it to keep contracting? B. Tricuspid C. Pulmonic A. Automaticity D. Aortic Semilunar Valve B. Contractility C. Excitability 15. Which law states that "the greater the D. Conductivity stretch, the greater the force of the next contraction"? Rationale: Automaticity allows the heart to A. Newton's Law of Motion generate impulses and contract independently B. Boyle's Law of nervous input C. Frank-Starling Law D. Hilton's Law 10. A nurse is caring for a patient with congestive heart failure. The patient's blood Rationale: Frank-Starling Law is the right pressure is elevated, and the nurse knows this answer. Newton's Law of Motion is the three increases the pressure the heart must overcome laws describing the relationship between to pump blood. Which factor is primarily being objects and forces acting upon them. Boyle's affected in this scenario? Law is a basic law in chemistry describing the behavior of a gas held at a constant temperature. A. Preload Hilton's Law is the observation that in the study B. Stroke volume of anatomy, the nerve supplying the muscles C. Afterload extending directly across and acting at a given D. Ejection fraction joint not only supplies the muscle but also innervates the joint and the skin overlying the Rationale: Elevated blood pressure increases muscle. afterload, making it harder for the heart to pump blood 16. It refers to the volume of blood that is ejected during systole 11. What is the study of the interrelationships and movement of the blood flow? A. Cardiac Output B. Stroke Volume A. Hemodynamics C. Preload D. Afterload C. Quivering P-Waves D. Widened Qrs 17. It is the most severe type of heart block. It means there’s a complete failure of the Rationale: Multiple ectopic sites cause electrical signals to pass from the atria to the quivering of ventricles and no discernible ventricles. waves on the ECG A. Bundle Branch Block CU7: Cardiovascular Problem B. Atrial Fibrillation C. Third-Degree Heart Block 21. A patient presents to the emergency room D. Sinus Arrhythmia reporting chest pain. They state their chest pain occurs with activity and that it subsided after Rationale: Because the SA node still controls taking nitro-glycerine. In addition, the patient the atrial contractions, none of the impulses states the pain lasted for 8 minutes. Based on reach the ventricles. As a result, the ventricles the patient’s signs and symptoms, what type of use their backup pacemaker (a slower, angina may the patient be experiencing? unreliable rhythm), leading to bradycardia (slow heart rate). A. Unstable Angina B. Variant Angina 18. Second-degree heart block type 2 is the C. Stable Angina electrical signal that’s going from the Atria to D. Microvascular Angina the ventricles getting progressively slower until it doesn’t stimulate the ventricles to contract. Rationale: Stable angina happens with This results in the ventricular rhythm being exertion is short-lived and is relieved with rest irregular and the ventricular rate. or nitro-glycerine, which is what the patient is A. The first statement is true, the second reporting. Therefore, this may be a case of statement is false stable angina. B. The first statement is false, and the second statement is true 22. A patient is experiencing crushing chest C. Both statements are true pain, nausea, vomiting, and diaphoresis. The D. Both statements are false ECG shows ST segment depression. Troponin levels are positive. Based on these findings, Rationale: Second-degree heart block type 1 is what type of condition may be present? the PR interval that is going to gradually start lengthening. So, whenever you look at that A. NSTEMI rhythm, you’re going to notice that the P wave B. STEMI is getting further and further away from the C. Unstable Angina QRS complex. Then all of a sudden, there’s a P D. Variant Angina wave but a missing QRS complex. And the cycle is just going to repeat itself. Rationale: (non-ST-segment Elevation) is a type of heart attack. It occurs when a 19. Where can u see the quivering P-waves? partial blockage of a coronary artery presents. The ST segment is NOT elevated, but it can be A. Pvc depressed. In addition, troponin levels will be B. Afib elevated. C. Vfib D. V-Tach 23. The left anterior descending coronary artery provides blood supply to the left ventricle, front Rationale: The erratic electrical impulses cause of the septum and part of the right ventricle. the atria to quiver, creating a fibrillating waveform with a loss of P waves. A. True B. False 20. What is the appearance of ECG in VFib? A. Wavy Rationale: the LAD (left anterior descending B. Straight artery) provides blood supply to the left ventricle, front of the septum, and collateral medication circulation to the right ventricle. 27. A patient who has diabetes will be started on 24. You're providing education to a patient who Metoprolol for the medical management of will be undergoing a heart catheterization. coronary artery disease. Which of the following Which statement by the patient requires you to will you include in your discharge teaching re-educate the patient about this procedure? about this medication? A. “The Brachial Artery is Most Commonly A. Check Your Heart Rate Regularly Because Used Metoprolol Can Cause an Irregular Heart Rate. For This Procedure.” B. Check Your Glucose Regularly Because This B. “A Dye Is Injected into The Coronary Medication Can Cause Hyperglycemia. Arteries C. Check Your Blood Pressure Regularly To Assess for Blockages." Because this Medication Can Cause C. “Not All Patients Who Have a Heart Hypertension. Catheterization Will Need a Stent Placement.” D. Check Your Glucose Regularly Because This D. “I Will Not Be Completely Asleep and Will Medication Can Mask the Typical Signs And Be Symptoms Of Hypoglycemia. Able To Breathe on My Own During The Procedure.” Rationale: This patient needs to be educated to check their glucose levels regularly because Rationale: The femoral or radial artery is used this medication can mask the typical signs and during a heart cath... not the brachial. symptoms of hypoglycemia. This is very important since the patient is diabetic. 25. A patient reports having crushing chest pain that radiates to the jaw. You administer 28. You're educating a patient about the causes sublingual nitro-glycerine and obtain a 12-lead of a myocardial infarction. Which statement by EKG. Which of the following EKG findings the patient indicates they misunderstood your confirms your suspicion of a possible teaching and requires you to re-educate them? myocardial infarction? A. Coronary Artery Dissection Can Happen A. Absent Q Wave Spontaneously And Occurs More in Women. B. Qrs Widening B. The Most Common Cause of a Myocardial C. Absent P-Wave Infarction Is a Coronary Spasm from Illicit D. St Segment Elevation Drug Use Or Hypertension. Rationale: This is a common finding on an EKG C. Patients Who Have Coronary Artery Disease when a patient has a myocardial Are At High Risk for Developing a Myocardial infarction due to muscle damage. Infarction. D. Both A And B Are Incorrect. 26. A patient taking Zocor is reporting muscle pain. You are evaluating the patient’s lab work Rationale: The Most Common Cause Of A and note that which of the following findings Myocardial Infarction is A CORONARY could cause muscle pain? ARTERY DISEASE...Not Coronary Spasm Which Is Uncommon A. Elevated Potassium Level B. Elevated Cpk (Creatine Kinase Level) 29. A patient is 36 hours status post a C. Decreased Potassium Level myocardial infarction. The patient is starting to D. Decreased Cpk (Creatine Kinase Level) complain of chest pain when they lay flat or cough. You note on auscultation of the heart a Rationale: Zocor a statin medication used for grating, harsh sound. What complication is this lowering cholesterol can cause increased CPK patient most likely suffering from? levels which will lead to a patient experiencing muscle pain. Therefore, CPK levels must be A. Cardiac Dissection monitored while a patient is taking this B. Ventricular Septum Rupture C. Mitral Valve Prolapse 32. Coronary artery disease is D. Pericarditis A. A buildup of plaque in the arteries that carry Rationale: A complication of a myocardial blood to the heart infarction is PERICARDITIS, especially 24-36 B. Sometimes called hardening of the heart’s hours post MI. This is because of neutrophils arteries being present at the site which causes C. The leading cause of death in the U.S. for inflammation. men and women D. All of the above 30. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours Rationale: Coronary artery disease (CAD) and is being admitted to your unit for overnight involves plaque buildup, is often referred to as observation. From the options below, what is hardening of the arteries, and is a leading cause the most IMPORTANT information to know of death in the U.S. about this patient at this time? 33. A condition in which the ventricles cannot A. Troponin Result and When the Next pump forcefully enough to send blood out to Troponin Level Is Due to Be Collected meet the metabolic needs of the body is called? B. Diet Status C. Last Consumption of Caffeine A. Heart failure D. Ck Result and When the Next Ck Level Is B. Coronary artery disease Due to Be Collected C. Angina pectoris D. Myocardial infarction Rationale: The keywords in this question are "Chest pain" and "been in the ER for 5 hours". Rationale: This condition specifically refers to The patient should have already had one the heart’s inability to pump effectively to meet troponin level drawn since it starts to elevate 2- the body’s needs. 4 hours after injury and has been in the ER for 5 hours. Therefore, it is essential you know 34. A patient who is going to get a cardiac what the level is and when the next level is due. catheterization is receiving instruction from If the patient's chest pain is caused by a you. Which of the patient's statements calls for myocardial event the troponin levels will trend you to remind them of this procedure? upward. Troponin levels are usually ordered every 6 hours x 3. CK results are not as specific A. "The brachial artery is most commonly used as troponin levels. This question wanted to for this procedure." know the MOST important, and the troponin B. "A dye is injected into the coronary arteries level for this patient/when it is drawn next is to assess for blockages." MOST important. Diet status and last C. "Not all patients who have a heart consumption of caffeine are things the nurse catheterization will need a stent placement." needs to know but not the MOST important.] D. "I will not be completely asleep and will be able to breathe on my own during the 31. What is an important factor for matching a procedure." donor kidney to a recipient? Rationale: The femoral artery is typically used A. The recipient's favorite color. for cardiac catheterization, not the brachial. B. Blood type and tissue compatibility. C. The donor's height. 35. A patient calls the cardiac clinic you are D. The recipient's age. working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed Rationale: Matching blood type and tissue for chest pain, but the chest pain is not relieved. compatibility between the donor and recipient What do you educate the patient to do next? is essential to minimize the risk of rejection and A. Take another dose of Nitroglycerin in 5 ensure a successful transplant. minutes. B. Call 911 immediately C. Lie down and rest to see if that helps with C. Echocardiogram relieving the pain D. Electrocardiogram (ECG) D. Take two doses of Nitroglycerin in 5 minutes Rationale: If chest pain persists after three Rationale: An ECG is commonly used to doses of nitroglycerin, it indicates a potentially identify the location of myocardial damage serious condition, and emergency help should based on the electrical activity of the heart. be sought. 40. A 54-year-old woman experiences chest 36. Michael has been diagnosed with coronary pain that occurs intermittently during physical artery disease and his doctor recommends exertion but subsides with rest. She describes lifestyle changes to manage his condition. the pain as a squeezing sensation in her chest Which of the following is the best initial step that occasionally radiates to her left arm. What for Michael to take type of angina is this patient most likely experiencing? A. Start lifting heavy weights to build strength A. Variant Angina B. Engage in regular aerobic exercises like B. Stable Angina walking or swimming C. Nocturnal Angina C. Skip meals to lose weight quickly D. Post-infarction Angina D. Ignore the diagnosis and wait for symptoms to appear Rationale: This type of angina occurs predictably with exertion and is relieved by rest, Rationale: Regular aerobic exercise is crucial fitting the patient’s description. for managing coronary artery disease and improving cardiovascular health. CU8: Altered Gastrointestinal and Liver 37. Emily is at risk for cardiovascular disease Function due to her family history. What is the most important lifestyle change she can make to 41. For a patient with gastroesophageal variceal reduce her risk? bleeding, you should expect the physician to A) Eating a high-fat diet order which medication? B) Avoiding physical activity to prevent stress on the heart A. Vasopressin (Pitressin) C) Quitting smoking and limiting alcohol intake B. Pantoprazole (Protonix) D) Only exercising once a week C. Glucagon (GlucaGen) D. Sucralfate (Carafate) Rationale: These changes significantly reduce cardiovascular risk, especially for individuals Rationale: A vasoconstrictor, such as with a family history. vasopressin (Pitressin) or octreotide (Sandostatin), is used to treat variceal bleeding. 38. Which of the following blood tests is most indicative of cardiac damage? 42. A nurse is assessing a client who has A. Troponin I pancreatitis. Which of the following actions B. Complete blood count (CBC) should the nurse take to assess the presence of C. Creatine kinase (CK) Cullen's sign? D. Lactate dehydrogenase A. Tap Lightly at The Costovertebral Margin on Rationale: This biomarker is specific to cardiac The Client's Back muscle damage, making it the most indicative B. Palpate the Rlq of heart damage. C. Inspect the Skin Around The Umbilicus D. Auscultate the Area Below the Scapula 39. Which of the following diagnostic tools is most commonly used to determine the location Rationale: Cullen's sign is indicated by a bluish- of myocardial damage? gray discoloration in the periumbilical area. A. Cardiac catheterization B. Cardiac enzymes 43. What should a nurse assess regularly in a Rationale: Melena (black stools) is usually patient with liver cirrhosis to monitor for indicative of an upper GI bleed. potential complications? 47. A patient with cirrhosis presents with A. Blood Glucose Levels Only jaundice. What causes the yellowish B. Skin Integrity Only discoloration of the skin and eyes? C. Mental Status and Coagulation Profile D. Respiratory Rate Only A. Bile salt deficiency B. Increased levels of urea Rationale: Regular assessment of mental status C. Elevated bilirubin levels and coagulation profile is critical in patients D. Inflammation of the bile ducts with liver cirrhosis due to the risk of hepatic encephalopathy and bleeding disorders Rationale: Jaundice occurs when there is an resulting from impaired liver function. accumulation of bilirubin, a byproduct of red blood cell breakdown. The liver’s inability to 44. Which nursing diagnosis is most process or excrete bilirubin due to damage appropriate for a patient with liver cirrhosis results in its buildup in the bloodstream. related to malnutrition? 48. What condition is characterized by A. Risk for Injury inflammation of the liver, often caused by viral B. Imbalanced Nutrition: Less Than Body infections, alcohol, or autoimmune reactions? Requirements C. Impaired Skin Integrity A. Cholecystitis D. Ineffective Breathing Pattern B. Hepatitis C. Pancreatitis Answer B Rationale: "Imbalanced nutrition: D. Gastritis less than body requirements" is appropriate as patients with liver cirrhosis often experience Rationale: Hepatitis refers to inflammation of malnutrition due to poor dietary intake, the liver, which can be caused by various malabsorption, and increased metabolic factors, including viral infections (e.g., demands Hepatitis A, B, C), chronic alcohol use, or autoimmune processes. 45. A patient with liver cirrhosis is admitted with confusion, jaundice, and abdominal 49. What is the normal liver span? distension. Which finding indicates worsening A. 8-13cm liver failure? B. 2-3cm C. 15-20cm A. Asterixis (hand-flapping tremor). D. 6-12cm B. Hyperactivity. C. Clear urine. Rationale: The normal liver span is typically D. Absence of jaundice. between 6-12cm. This measurement refers to the distance between the upper and lower Rationale: Asterixis is a classic sign of hepatic borders of the liver when it is palpated or felt encephalopathy, indicating worsening liver during a physical examination. A liver span failure. outside of this range may indicate an abnormality or pathology in the liver. 46. A patient reports black, tarry stools. The nurse understands this is most likely due to 50. A nurse is caring for a patient with liver bleeding from: cirrhosis. Which of the following is the most appropriate nursing consideration when A. Lower GI tract managing this patient? B. Upper GI tract C. Liver A. Encourage a high-protein diet to promote D. Rectum healing. B. Monitor for signs of ascites and manage fluid 53. Which statement is TRUE about electrode balance carefully. placement for a 12-Lead ECG/EKG? C. Suggest daily exercise to increase muscle strength. A. The electrode for V1 is placed at the 4th ICS D. Provide NSAIDs for pain management as left of the sternum needed. B. The electrode for V3 is placed at the 2nd ICS right of the sternum. Rationale: Patients with liver cirrhosis often C. The electrode for V6 is placed at the 5th ICS experience complications related to fluid right of the axillary line. imbalance, such as ascites (abdominal fluid D. The electrode for V2 is placed at the 4th ICS accumulation), which can lead to respiratory left of the sternum. distress and discomfort. Monitoring for ascites and managing fluid balance is crucial, as fluid Rationale: This is the only true statement about overload can worsen symptoms and potentially electrode placement. The other statements are lead to other complications like hepatic false. The electrode for V3 is placed at the encephalopathy. midpoint between V2 and V4. V6's electrode is placed level with V5 at the left midaxillary line. 51. ou are caring for a patient with Diabetic V1's electrode is placed at the 4th ICS to the Ketoacidosis with a physician’s order of 0.9 right of the sternum. Normal Saline IV and 10 units of regular insulin IV. You will hold the insulin IV if you notice the 54. In which phase of acute kidney injury does following: the glomerular filtration rate (GFR) begin to stabilize and recover? A. Potassium level of 2.3 B. Blood glucose of 635 mg/dL A. Initial phase C. Oliguria B. Maintenance phase D. Hematuria C. Recovery phase D. Progressive phase Rationale: When insulin is given, it helps take potassium back into the cell which will cause Rationale: In the recovery phase of acute potassium blood levels to fall. With a low kidney injury, the GFR begins to improve, and potassium level, the patient will be at risk of kidney function starts to return to normal, hypokalemia. Remember that insulin is only to though it may take several months to years for be given when the patient’s potassium level is full recovery. at 3.3 or greater. 55. Which of the following treatments uses the 52. Which heart valve connects the right atrium patient’s peritoneum to filter waste products? and right ventricle? A. Intermittent Hemodialysis (IHD) A. tricuspid B. Continuous Renal Replacement Therapy B. pulmonic (CRRT) C. bicuspid (mitral) C. Continuous Ambulatory Peritoneal D. aortic Dialysis (CAPD) D. Renal Transplant Rationale: This valve connects the right atrium and right ventricle. It is one of the two Rationale: atrioventricular valves. The other AV valve is CAPD involves the use of the patient's the bicuspid (mitral) valve, which connects the peritoneal membrane as a natural filter to left atrium and left ventricle. The pulmonic and remove waste products from the blood, making aortic valves are semilunar valves. The it a type of peritoneal dialysis. pulmonic valve connects the right ventricle to the pulmonary artery, and the aortic valve 56. Which of the following is NOT a common connects the left ventricle to the aorta. cause of chronic renal failure? A. Hypertension B. Diabetes mellitus C. Acute tubular necrosis promote comfort. D. Kidney stones C. Administer IV fluids as ordered to maintain blood pressure. Rationale: Chronic renal failure is commonly D. Encourage oral intake to prevent caused by long-term conditions such as dehydration. hypertension and diabetes. Acute tubular necrosis is usually associated with acute kidney Rationale: Acute pancreatitis can lead to injury, not chronic renal failure. hypovolemia and low blood pressure due to fluid shifts. IV fluid administration is the 57. A nurse is educating a patient about liver priority to stabilize blood pressure and prevent cirrhosis. Which of the following statements shock. Pain relief (Option A) is important but best defines cirrhosis? comes after stabilizing the patient’s hemodynamic status. A. An acute infection of the liver caused by viruses or bacteria. CU9: Metabolic Emergencies B. A chronic liver condition characterized by irreversible scarring and impaired liver 61. A patient presents with Kussmaul function. respirations, fruity breath, and a blood glucose C. A temporary condition where liver enzymes of 600 mg/dL. What complication is suspected? are elevated but return to normal. A. Hyperosmolar Hyperglycemic Syndrome. D. A congenital disorder causing liver B. Diabetic Ketoacidosis. inflammation and swelling. C. Hypoglycemia. D. Metabolic alkalosis. Rationale: Cirrhosis is a chronic, progressive liver disease that leads to extensive liver tissue Rationale: Kussmaul respirations and fruity scarring and affects liver function. breath are characteristic signs of DKA, a serious diabetic complication. 58. A patient with ascites due to liver cirrhosis is at risk for skin breakdown. Which of the 62. A 70-year-old patient with diabetes presents following interventions should the nurse with confusion, extreme thirst, and a blood prioritize? glucose of 780 mg/dL. No ketones are present. Which condition is suspected? A. Encourage frequent ambulation to reduce fluid accumulation. A. Diabetic Ketoacidosis. B. Perform meticulous skin care and reposition B.Hyperosmolar Hyperglycemic Syndrome the patient every 2 hours. (HHS). C. Limit protein intake to prevent ammonia C.Hypoglycemia. buildup in the blood. D. Syndrome of Inappropriate Antidiuretic D. Increase fluid intake to prevent dehydration. Hormone (SIADH). Rationale: Patients with ascites are prone to Rationale: HHS presents with hyperglycemia, skin breakdown due to fluid accumulation and dehydration, and absence of ketones, typically abdominal distension, which can put pressure in older adults with Type 2 diabetes. on the skin and increase risk for pressure ulcers. Repositioning and good skin care help prevent 63. A client is admitted to a hospital with a breakdown. diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A 60. A patient with acute pancreatitis presents continuous intravenous infusion of short-acting with severe epigastric pain radiating to the insulin is initiated, along with intravenous back, nausea, and vomiting. Vital signs reveal rehydration with normal saline. The serum blood pressure of 90/60 mm Hg and heart rate glucose level is now 240 mg/dL. The nurse of 110 bpm. What is the priority nursing action? would next prepare to administer which item? A. Provide pain relief with prescribed analgesics. A. Ampule Of 50% Dextrose B. Place the patient in a supine position to B. Nph Insulin Subcutaneously C. Intravenous Fluids Containing Dextrose 66. What is the main cause of lactic acidosis? D. Phenytoin (Dilantin) For the Prevention of Seizures A. Hypoxia B. Hyperventilation Rationale: During management of DKA, when C. Dehydration the blood glucose level falls to 250 to 300 D. Renal failure mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood Rationale: Lactic acidosis primarily results glucose level of about 250 mg/dL, or until the from inadequate oxygenation (hypoxia), which client recovers from ketosis. Fifty percent leads to anaerobic metabolism and increased dextrose is used to treat hypoglycemia. NPH lactate production. insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for 67. Which electrolyte imbalance is most DKA. associated with acute tumor lysis syndrome (TLS)? 64. A client is brought to the emergency department in an unresponsive state, and a A. Hypocalcemia and Hyperphosphatemia diagnosis of hyperglycemic hyperosmolar state B. Hypermagnesemia and Hypernatremia (HHS) is made. The nurse would immediately C. Hypokalemia and Hypophosphatemia prepare to initiate which anticipated healthcare D. Hypercalcemia and Hypophosphatemia provider's prescription Rationale: TLS occurs when cancer cells break A. Endotracheal Intubation down rapidly, releasing intracellular contents. B. 100 Units of Nph Insulin This leads to hyperkalemia, C. Intravenous Infusion of Normal Saline hyperphosphatemia, and hypocalcemia (due to D. Intravenous Infusion of Sodium Bicarbonate phosphate binding with calcium). It can cause acute kidney injury and cardiac complications. Rationale: The primary goal of treatment in the hyperglycemic hyperosmolar state (HHS) is 68. What is the primary concern in a patient to rehydrate the client to restore fluid volume with a thyroid storm? and correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered A. Hypothermia and Hypotension in diabetic ketoacidosis (DKA) and begins with B. Severe Hyperthermia and Cardiovascular an IV infusion of normal saline. Regular Collapse insulin, not NPH insulin, would be C. Hyperglycemia with Fluid Overload administered. The use of sodium bicarbonate to D. Bradycardia and Respiratory Depression correct acidosis is avoided because it can precipitate a further drop in serum potassium Rationale: A thyroid storm is a medical levels. Intubation and mechanical ventilation emergency caused by excess thyroid hormones, are not required to treat HHS. leading to hyperthermia, tachycardia, and 65. In a patient undergoing surgery who has potential cardiovascular collapse. Management high blood sugar, metabolic acidosis, and includes antithyroid drugs, beta-blockers, and ketones present in urine, what condition is supportive care. likely? A.Hypoglycemia 69. A patient with a history of type 1 diabetes is B. Hyperosmolar Hyperglycemic Non-Ketotic admitted to the emergency department with Syndrome severe abdominal pain, vomiting, and deep, C. Diabetic Ketoacidosis labored breathing. The nurse notes the patient’s D. Sepsis breath has a fruity odor, and the blood glucose level is 540 mg/dL. Based on these findings, Rationale: The presence of high blood sugar what is the priority nursing action? along with metabolic acidosis and ketones in urine strongly indicates diabetic ketoacidosis A. Administer a dose of regular insulin as (DKA), which occurs due to insulin deficiency prescribed. B. Administer an antiemetic to control A. Frequent urination vomiting. B. Unexplained weight loss C. Begin fluid resuscitation with normal saline. C. Blurred vision D. Prepare the patient for immediate D. Sudden increase in muscle mass hemodialysis. Rationale: Common symptoms of diabetes Rationale: The patient is exhibiting signs of mellitus include frequent urination, diabetic ketoacidosis (DKA), a metabolic unexplained weight loss, and blurred vision. A emergency in type 1 diabetes characterized by sudden increase in muscle mass is not a hyperglycemia, dehydration, and metabolic symptom of diabetes. acidosis. Priority care in DKA includes rehydration, which helps reduce blood glucose 73. What is the primary function of insulin in levels and reverses dehydration. Administering the body? IV fluids with normal saline is the initial A. To increase blood sugar levels intervention to stabilize the patient before B. To help cells absorb glucose for energy starting insulin therapy. C. To break down fat for energy D. To regulate protein metabolism 70. A patient with chronic heart failure is experiencing dyspnea and fatigue. The nurse Rationale: Insulin is a hormone produced by the notes +2 pitting edema in the patient's ankles. pancreas that allows cells to take in glucose Based on this assessment, which nursing from the bloodstream and use it for energy. intervention should the nurse prioritize? Without enough insulin, blood sugar levels remain elevated. A. Encourage increased fluid intake to promote hydration. 74. Which of the following tests is commonly B. Elevate the patient’s legs when seated to used to diagnose diabetes mellitus? reduce edema. A. Blood pressure test C. Ambulate the patient frequently to prevent B. Complete blood count (CBC) blood clots. C. Fasting blood glucose test D. Limit the patient’s sodium intake to 3 grams D. Cholesterol test per day. Rationale: A fasting blood glucose test Rationale: In patients with heart failure, measures the amount of sugar in the blood after elevating the legs helps promote venous return, fasting (not eating) for at least 8 hours. It is one reducing edema by facilitating fluid movement of the primary tests used to diagnose diabetes. back into circulation. This is particularly important for patients with pitting edema in the 75. Which lifestyle modification is most lower extremities. effective in managing Type 2 diabetes? 71. Which of the following is the primary cause A. Reducing physical activity of Type 1 diabetes? B. Increasing sugar intake A. Obesity C. Regular exercise and a balanced diet B. Insulin resistance D. Skipping meals C. Autoimmune destruction of pancreatic beta cells Rationale: Managing Type 2 diabetes typically D. High sugar intake involves lifestyle changes such as regular physical activity and eating a healthy, balanced Rationale: Type 1 diabetes occurs when the diet to help control blood sugar levels and body's immune system attacks and destroys the improve insulin sensitivity. insulin-producing beta cells in the pancreas. This leads to little or no insulin production, 76. A client with type 1 diabetes mellitus who requiring insulin therapy. takes NPH daily in the morning calls the nurse to report recurrent episodes of hypoglycemia 72. Which of the following is NOT a common with exercising. symptom of diabetes mellitus? Which statement by the client indicates an D. Assessment finding of crackles throughout adequate understanding of the peak action of the lung fields. NPH insulin and exercise? A. "I should not exercise since I am taking Rationale: Remember that when administering insulin." a hypertonic solution, you have to do this very B. "The best time for me to exercise is after slowly and watch for volume overload. breakfast." Hypertonic solutions pull fluid from the cell C. "The best time for me to exercise is mid to (which is already water-intoxicated) and place late afternoon." it back into the vascular system, therefore, D. "NPH is a basal insulin, so I should exercise crackles in the lungs are a sign there is too much in the evening." fluid in the body and the heart cannot compensate so the fluid is backing up into the Rationale: Exercise is an important part of lungs. This would require intervention. diabetes management. It promotes weight loss, decreases insulin resistance, and helps control 79. Which condition is characterized by the blood glucose levels. A hypoglycemic reaction excessive release of antidiuretic hormone may occur in response to increased exercise, so (ADH)? clients should exercise either an hour after A. DKA mealtime or after consuming a 10- to 15-g B. HHS carbohydrate snack, and they should check their C. Syndrome of Inappropriate Antidiuretic blood glucose level before exercising. Hormone (SIADH) D. Diabetes Mellitus 77. A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for Rationale: SIADH involves the excessive the treatment of hyperglycemia. What is the release of ADH, leading to water retention, appropriate intervention to decrease the client's dilutional hyponatremia, and an imbalance of anxiety? electrolytes. A. Administer a sedative. B. Convey empathy, trust, and respect toward 80. A hallmark sign of SIADH is: the client. C. Ignore the signs and symptoms of anxiety, A. Hyperglycemia anticipating that they will soon disappear. B. Hyponatremia D. Make sure that the client is familiar with the C. Hypernatremia correct medical terms to promote understanding D. Acidosis of What is happening. Rationale: SIADH is marked by water Rationale: Anxiety is a subjective feeling of retention, which dilutes sodium levels in the apprehension, uneasiness, or dread. The blood, leading to hyponatremia (low sodium appropriate intervention is to address the concentration). client's feelings related to the anxiety. Administering a sedative is not the most CU10: Management and Clients with Renal appropriate intervention and does not address Problems the source of the client's anxiety. The nurse should not ignore the client's anxious feelings. 81. What is the most common cause of prerenal Anxiety needs to be managed before acute kidney injury? meaningful client education can occur. A. Direct Damage to Kidney Tissue 78. A patient with SIADH is undergoing IV B. Fluid Depletion treatment of a hypertonic IV solution of 3% C. Obstruction in The Urinary Tract saline and IV Lasix. Which of the following D. Infection nursing findings requires intervention? A. Sodium level of 136. Rationale: Prerenal acute kidney injury is B. Patient reports urinating more frequently. primarily caused by factors that reduce blood C. Potassium level of 5.0. flow to the kidneys, with fluid depletion being the most common. A. Continuous Renal Replacement Therapy (CRRT) 82. In which phase of acute kidney injury does B. Intermittent Hemodialysis (IHD) the GFR stabilize? C. Continuous Ambulatory Peritoneal Dialysis (CAPD) A. Initial Phase D. Hemofiltration B. Maintenance Phase C. Recovery Phase Rationale: CAPD utilizes the peritoneal cavity D. Pre-Injury Phase for dialysis, allowing for continuous fluid exchange. Rationale: During the maintenance phase, the GFR continues to decrease and then stabilizes 87. What monitoring is essential for a patient before recovery begins. with acute kidney injury? 83. Which of the following is a common cause A. Daily Blood Glucose Levels of chronic renal failure? B. Serum Electrolyte Laboratory Values C. Blood Pressure Only A. Dehydration D. Pulse Oximetry B. Hypertension C. Acute tubular necrosis Rationale: Serum electrolyte laboratory values D. Urinary obstruction Rationale: Monitoring serum electrolytes is crucial to assess kidney function and prevent Rationale: Chronic renal failure is often caused complications. by long-term conditions like diabetes and hypertension. 88. Which stage of chronic renal failure is characterized by uremic syndrome? 84. At which stage of chronic renal failure do patients typically start to show clinical and A. Stage 1 laboratory signs? B. Stage 2 C. Stage 4 A. Stage 1 D. Stage 5 B. Stage 2 C. Stage 3 Rationale: Stage 5 indicates kidney failure, D. Stage 4 where the patient experiences uremic syndrome due to severe loss of renal function. Rationale: Stage 3 is characterized by moderate loss of kidney function, leading to clinical and 89. What is a critical nursing intervention for laboratory signs patients undergoing dialysis? 85. What is the primary goal of treatment in A. Encourage a high-protein diet acute kidney injury? B. Limit fluid intake as prescribed C. Increase physical activity A. Kidney Transplantation D. Administer all medications orally B. Correcting the Underlying Cause C. Initiating Dialysis Immediately Rationale: Patients on dialysis often have D. Increasing Fluid Intake restrictions on fluid intake to prevent overload, as their kidneys cannot excrete excess fluid. Rationale: Treatment focuses on addressing the specific cause of the acute injury to restore 90. Which condition can lead to post-renal kidney function. acute kidney injury? 86. Which dialysis method uses the patient's A. Diabetes Mellitus peritoneum as a semi-permeable membrane? B. Heart failure C. Urinary tract obstruction D. Dehydration  94. A 55-year-old male patient is admitted with Rationale: Post-renal injury occurs due to a massive GI bleed. The patient is at risk for obstructions in the urinary tract that prevent what type of acute renal failure? urine drainage, leading to kidney damage. A. Post-renal 91. he client has been diagnosed with ARF, and B.Intra-renal the nurse is developing a plan of care for them. C.Pre-renal Which of the following statements best D. Intrinsic renal describes the client's outcome? Rationale: Pre-renal injury is due to decreased A. Electrolytes are within normal limits. perfusion to the kidneys secondary to a cause B. Monitor intake and output every shift. (massive GI bleeding…patient is losing blood C. Administer enemas to decrease volume). This leads to a major decrease in hyperkalemia kidney function because the kidneys are D. Decrease of pain by three (3) levels on a 1- deprived of nutrients to function and the to-10 scale. amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where Rationale: Renal failure causes an imbalance of the nephrons become damaged. electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client 95. You're assessing morning lab values on a outcome is electrolytes within normal limits. female patient who is recovering from a myocardial infarction. Which lab value below 92. A client with chronic renal failure has a requires you to notify the physician? serum potassium level of 6.8 mEq/L. What should the nurse assess first? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min A. Blood Pressure C.BUN 20 mg/dL B. Respirations D.Blood pH 7.40 C. Temperature D. Pulse Rationale: A normal creatinine clearance level in a female should be 85-125 mL/min (95-140 Rationale: An elevated serum potassium level mL/min males). A creatinine clearance level may lead to life-threatening cardiac indicates the amount of blood the kidneys can arrhythmias, which the nurse can detect make per minute that contains no amounts of immediately by palpating the pulse. creatinine in it. Therefore, the kidneys should be able to remove excessive amounts of it from 93. A client who has been treated for chronic the bloodstream. A patient who has experienced renal failure is ready for discharge. The nurse a myocardial infarction is at risk for pre-renal should reinforce which dietary instruction? acute injury due to decreased cardiac output to the kidneys from a damaged heart muscle (the A. Be sure to eat meat at every meal heart isn’t able to pump as efficiently because B. Eat plenty of bananas of ischemia). All the other lab values are C. Increase your carbohydrate intake normal. D. Drink plenty of fluids and use a salt substitute. 96. Which patient below is NOT at risk for developing chronic kidney disease? Rationale: Extra carbohydrates are needed to prevent protein catabolism. In client with CRF A. A 58 year old female with uncontrolled unrestricted intake of potassium, protein, hypertension. sodium, and fluid may lead to a dangerous B. A 69 year old male with diabetes mellitus. accumulation of electrolytes and protein C. A 45 year old female with polycystic ovarian metabolic products such as amino acids and disease. ammonia D. A 78 year old female with an intrarenal injury. 97. A patient with stage 4 chronic kidney follows: Stage 1: Kidney damage with normal disease asks what type of diet they should renal function GFR >90 ml/min but with follow. You explain the patient should follow: proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months A. Low protein, low sodium, low potassium, or more); Stage 3: Mild-to-severe loss of renal low phosphate diet function GFR 30-59 mL/min; Stage 4: Severe B. High protein, low sodium, low potassium, loss renal function GFR 15-29 mL/min; Stage high phosphate diet 5: End stage renal disease GRF less 15 mL/min C. Low protein, high sodium, high potassium, high phosphate diet 100. Which type of dialysis is commonly used D. Low protein, low sodium, low potassium, for critically ill patients who cannot tolerate high phosphate diet rapid fluid shifts? Rationale: The patient should follow this type of diet because protein breaks down into urea A. Continuous Ambulatory Peritoneal Dialysis (remember patients will have increased urea (CAPD) levels), low sodium to prevent fluid retention, B. Intermittent Hemodialysis (IHD) low potassium to prevent hyperkalemia C. Continuous Renal Replacement Therapy (remember glomerulus isn't filtering out (CRRT) potassium/phosphate as it should), and low D. Renal Transplant phosphate to prevent hyperphosphatemia. Rationale: CRRT is a slow, continuous form of 98. A patient with Stage 5 CKD is experiencing dialysis used mainly for critically ill patients, as extreme pruritus and has several areas of it is gentler on the body and avoids rapid fluid crystallized white deposits on the skin. As the shifts, which can be harmful to unstable nurse, you know this is due to excessive patients. amounts of what substance found in the blood? A. Calcium B. Urea C. Phosphate D. Erythropoietin Rationale: This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this as well. 99. A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as? A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5 Rationale: This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as