NUR 417 Exam 1 textbook Mod. 1-4 Questions With
Complete Solutions
The nurse is caring for a patient admitted with diabetes insipidus
(DI). Which information is most important to report to the
healthcare provider?
1. The patient is confused and lethargic.
2. The patient reports a recent head injury.
3. The patient has a urine output of 400 mL/hr.
4. The patient's urine specific gravity is 1.003.
1. The patient is confused and lethargic.
The patient's confusion and lethargy may indicate hypernatremia
and would be addressed quickly. In addition, patients with DI
compensate for fluid losses by drinking copious amounts of
fluids, but a patient who is lethargic will be unable to drink
enough fluids and will become hypovolemic. A high urine
output, low urine specific gravity, and history of a recent head
injury are consistent with diabetes insipidus, but they do not
require immediate nursing action to avoid life-threatening
complications.
A patient is admitted with diabetes insipidus. Which action will
be appropriate for the registered nurse (RN) to delegate to an
experienced licensed practical/vocational nurse (LPN/VN)?
1. Titrate the infusion of 5% dextrose in water.
,2. Administer prescribed subcutaneous DDAVP.
3. Assess the patient's overall hydration status every 8 hours.
4. Teach the patient to use desmopressin (DDAVP) nasal spray.
2. Administer prescribed subcutaneous DDAVP.
Administration of medications is included in LPN/VN education
and scope of practice. Assessments, patient teaching, and
titrating fluid infusions are more complex skills and would be
done by the RN.
Which hemodynamic parameter best reflects the effectiveness of
drugs that the nurse gives to reduce a patient's left ventricular
afterload?
1. Mean arterial pressure (MAP)
2. Systemic vascular resistance (SVR)
3. Pulmonary vascular resistance (PVR)
4. Pulmonary artery wedge pressure (PAWP)
2. Systemic vascular resistance (SVR)
SVR reflects the resistance to ventricular ejection, or afterload.
The other parameters may be monitored but do not reflect
afterload as directly.
After surgery for an abdominal aortic aneurysm, a patient's
central venous pressure (CVP) monitor indicates low pressures.
Which action would the nurse take?
1. Administer IV diuretic medications.
,2. Increase the IV fluid infusion per protocol.
3. Increase the infusion rate of IV vasodilators.
4. Elevate the head of the patient's bed to 45 degrees.
2. Increase the IV fluid infusion per protocol.
A low CVP indicates hypovolemia and a need for an increase in
the infusion rate. Diuretic administration will contribute to
hypovolemia and elevation of the head or increasing
vasodilators may decrease cerebral perfusion.
The nurse is caring for a patient receiving a continuous
norepinephrine IV infusion. Which finding indicates that the
infusion rate may need to be adjusted?
1. Heart rate is slow at 58 beats/min.
2. Mean arterial pressure (MAP) is 56 mm Hg.
3. Systemic vascular resistance (SVR) is elevated.
4. Pulmonary artery wedge pressure (PAWP) is low.
3. Systemic vascular resistance (SVR) is elevated.
Vasoconstrictors, such as norepinephrine, will increase SVR.
This will increase the work of the heart and decrease peripheral
perfusion. The infusion rate may need to be decreased.
Bradycardia, hypotension (MAP of 56 mm Hg), and low PAWP
are not associated with norepinephrine infusion.
A nurse is caring for a patient whose hemodynamic monitoring
indicates a blood pressure of 92/54 mm Hg, a pulse of 64
beats/min, and an elevated pulmonary artery wedge pressure
, (PAWP). Which intervention prescribed by the health care
provider would the nurse question?
1. Elevate head of bed to 30 degrees.
2. Infuse normal saline at 250 mL/hr.
3. Hold nitroprusside if systolic BP is less than 90 mm Hg.
4. Titrate dobutamine to keep systolic BP is greater than 90 mm
Hg.
2. Infuse normal saline at 250 mL/hr.
The patient's elevated PAWP indicates volume excess in relation
to cardiac pumping ability, consistent with cardiogenic shock. A
saline infusion at 250 mL/hr will exacerbate the volume excess.
The other actions will help to improve cardiac output, which
should lower the PAWP and may raise the BP.
The emergency department (ED) nurse receives report that a
seriously injured patient involved in a motor vehicle crash is
being transported to the facility with an estimated arrival in 5
minutes. Which item would the nurse obtain in preparation for
the patient's arrival?
1. A dopamine infusion
2. A hypothermia blanket
3. Lactated Ringer's solution
4. A 16-gauge IV catheter
4. A 16-gauge IV catheter
Complete Solutions
The nurse is caring for a patient admitted with diabetes insipidus
(DI). Which information is most important to report to the
healthcare provider?
1. The patient is confused and lethargic.
2. The patient reports a recent head injury.
3. The patient has a urine output of 400 mL/hr.
4. The patient's urine specific gravity is 1.003.
1. The patient is confused and lethargic.
The patient's confusion and lethargy may indicate hypernatremia
and would be addressed quickly. In addition, patients with DI
compensate for fluid losses by drinking copious amounts of
fluids, but a patient who is lethargic will be unable to drink
enough fluids and will become hypovolemic. A high urine
output, low urine specific gravity, and history of a recent head
injury are consistent with diabetes insipidus, but they do not
require immediate nursing action to avoid life-threatening
complications.
A patient is admitted with diabetes insipidus. Which action will
be appropriate for the registered nurse (RN) to delegate to an
experienced licensed practical/vocational nurse (LPN/VN)?
1. Titrate the infusion of 5% dextrose in water.
,2. Administer prescribed subcutaneous DDAVP.
3. Assess the patient's overall hydration status every 8 hours.
4. Teach the patient to use desmopressin (DDAVP) nasal spray.
2. Administer prescribed subcutaneous DDAVP.
Administration of medications is included in LPN/VN education
and scope of practice. Assessments, patient teaching, and
titrating fluid infusions are more complex skills and would be
done by the RN.
Which hemodynamic parameter best reflects the effectiveness of
drugs that the nurse gives to reduce a patient's left ventricular
afterload?
1. Mean arterial pressure (MAP)
2. Systemic vascular resistance (SVR)
3. Pulmonary vascular resistance (PVR)
4. Pulmonary artery wedge pressure (PAWP)
2. Systemic vascular resistance (SVR)
SVR reflects the resistance to ventricular ejection, or afterload.
The other parameters may be monitored but do not reflect
afterload as directly.
After surgery for an abdominal aortic aneurysm, a patient's
central venous pressure (CVP) monitor indicates low pressures.
Which action would the nurse take?
1. Administer IV diuretic medications.
,2. Increase the IV fluid infusion per protocol.
3. Increase the infusion rate of IV vasodilators.
4. Elevate the head of the patient's bed to 45 degrees.
2. Increase the IV fluid infusion per protocol.
A low CVP indicates hypovolemia and a need for an increase in
the infusion rate. Diuretic administration will contribute to
hypovolemia and elevation of the head or increasing
vasodilators may decrease cerebral perfusion.
The nurse is caring for a patient receiving a continuous
norepinephrine IV infusion. Which finding indicates that the
infusion rate may need to be adjusted?
1. Heart rate is slow at 58 beats/min.
2. Mean arterial pressure (MAP) is 56 mm Hg.
3. Systemic vascular resistance (SVR) is elevated.
4. Pulmonary artery wedge pressure (PAWP) is low.
3. Systemic vascular resistance (SVR) is elevated.
Vasoconstrictors, such as norepinephrine, will increase SVR.
This will increase the work of the heart and decrease peripheral
perfusion. The infusion rate may need to be decreased.
Bradycardia, hypotension (MAP of 56 mm Hg), and low PAWP
are not associated with norepinephrine infusion.
A nurse is caring for a patient whose hemodynamic monitoring
indicates a blood pressure of 92/54 mm Hg, a pulse of 64
beats/min, and an elevated pulmonary artery wedge pressure
, (PAWP). Which intervention prescribed by the health care
provider would the nurse question?
1. Elevate head of bed to 30 degrees.
2. Infuse normal saline at 250 mL/hr.
3. Hold nitroprusside if systolic BP is less than 90 mm Hg.
4. Titrate dobutamine to keep systolic BP is greater than 90 mm
Hg.
2. Infuse normal saline at 250 mL/hr.
The patient's elevated PAWP indicates volume excess in relation
to cardiac pumping ability, consistent with cardiogenic shock. A
saline infusion at 250 mL/hr will exacerbate the volume excess.
The other actions will help to improve cardiac output, which
should lower the PAWP and may raise the BP.
The emergency department (ED) nurse receives report that a
seriously injured patient involved in a motor vehicle crash is
being transported to the facility with an estimated arrival in 5
minutes. Which item would the nurse obtain in preparation for
the patient's arrival?
1. A dopamine infusion
2. A hypothermia blanket
3. Lactated Ringer's solution
4. A 16-gauge IV catheter
4. A 16-gauge IV catheter
