Adaptive_Quizzing_Med_surg_3

The client is admitted with sinus tachycardia. To treat the dysrhythmia, the nurse will look for potential causes. Which causes will the nurse look for in this client? Select all that apply. Correct1 Anxiety Correct2 Caffeine Correct3 Exercise Correct4 Anemia 5 Hypothermia The dysrhythmia itself is not treated, but the cause is identified and treated appropriately. Causes of sinus tachycardia include hypovolemia, heart failure, anemia, exercise, use of stimulants, fever, sympathetic response to fear or pain. Hypothermia will cause sinus bradycardia. Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. 26%of students nationwide answered this question correctly. View Topics 3. 9 Confidence: Just a guess Stats Issue with this question? 3. A client with a history of heart failure and hypertension is admitted with reports of syncope. Which prescribed medication should the nurse prepare to administer based on the electrocardiogram (ECG) rhythm strip image? 1 Digoxin 2 Enalapril Correct3 Atropine 4 Metoprolol This rhythm strip reflects sinus bradycardia. Sinus bradycardia has PQRST complexes within acceptable limits, but the rate is less than 60 beats per minute. In this strip the PR interval is 0.16, the rhythm is regular, and the rate is 40 beats per minute. Atropine, an anticholinergic that increases the heart rate, is administered when the heart rate is so slow that it causes symptoms. Digoxin is a cardiac glycoside that slows the heart rate. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that slows the heart rate. Metoprolol is a beta blocker that slows the heart rate. 73%of students nationwide answered this question correctly. View Topics 4. 8 Confidence: Pretty sure Stats Issue with this question? 4. A client is in the intensive care unit. The nurse observing the telemetry monitor identifies flattening T waves and peaked P waves. What problem should the nurse consider based on these ECG changes? Correct1 Hypokalemia 2 Hypocalcemia 3 Hyponatremia 4 Hypomagnesemia Flattened or inverted T waves, peaked P waves, depressed ST segments, and elevated U waves are associated with hypokalemia. Prolongation of the QT interval may indicate hypocalcemia. Hyponatremia is not reflected in the heart’s electrical conduction. Although flattening of T waves may occur with hypomagnesemia, the ST segment may be shortened, and the PR and QRS intervals may be prolonged. 78%of students nationwide answered this question correctly. View Topics 5. 3 Confidence: Just a guess Stats Issue with this question? 5. To which assessment findings should the nurse give the highest priority when caring for a client with symptomatic sinus tachycardia? Select all that apply. 1 Anxiety Correct2 Orthopnea 3 Restlessness Correct4 Lightheadedness Correct5 Decreased blood pressure The assessment findings having the highest priority for clients with symptomatic sinus tachycardia are orthopnea (shortness of breath while lying flat), lightheadedness, and decreased blood pressure because these assessments can help to quickly identify the client’s condition and the most effective treatment for it. Anxiety and restlessness are frequently observed in a client with symptomatic sinus tachycardia, but they are not the nurse’s highest priority. 12%of students nationwide answered this question correctly. View Topics 6. 6 Confidence: Nailed it Stats Issue with this question? 6. A nurse attaches electrocardiogram (ECG) leads to a client who is admitted to the hospital for chest pain. When monitoring the ECG strip, the nurse identifies that depolarization of the atria is occurring when which waveform in the illustration is present? Correct1 a 2 b 3 c 4 d Option a reflects the P wave; it represents the electrical impulse starting at the sinus node and spreading throughout the atria (atrial depolarization). Waveform b reflects the QRS complex; it represents depolarization of the ventricles. Option c reflects the T wave; it represents repolarization of the ventricles. Waveform d reflects the U wave; it is believed to reflect late ventricular repolarization or repolarization of the Purkinje fibers; it is sometimes identified in clients with hypokalemia. 67%of students nationwide answered this question correctly. View Topics 7. 9 Confidence: Pretty sure Stats Issue with this question? 7. A client is brought to the emergency department with chest pain. The client asks why an electrocardiogram (ECG) has been prescribed. What does the nurse explain that the ECG will do? Correct1 Indicates acutely impaired blood flow to the heart muscle 2 Detect altered heart sounds 3 Determine the flow of blood to the heart muscle 4 Evaluate the spatial relationship of structures within the heart The ECG waveform can indicate myocardial ischemia or injury as evidenced by ST waveform depression or elevation, respectively. Ischemia or injury is caused by an acute lack of blood flow through the coronary arteries that supply oxygenated blood to the heart muscle. Auscultation can detect various heart sounds. Blood flow to the heart muscle is assessed during a cardiac catheterization. Spatial relationships of structures within the heart are assessed via an echocardiogram. 58%of students nationwide answered this question correctly. View Topics 9. 9 Confidence: Nailed it Stats Issue with this question? 9. A nurse is assessing a client’s ECG reading. The client's atrial and ventricular heart rates are equal at 88 beats per min. The PR interval is 0.14 seconds, and the QRS width is 0.10 seconds. Rhythm is regular with normal P waves and QRS complexes. How will the nurse interpret this rhythm? Correct1 Normal sinus rhythm 2 Sinus tachycardia 3 Sinus bradycardia 4 Sinus arrhythmia Normal sinus rhythm reflects normal conduction of the sinus impulse through the atria and ventricles. Atrial and ventricular rates are the same and range from 60 to 100 beats per minute. Rhythm is regular or essentially regular. PR interval is 0.12 to 0.20 seconds. QRS interval is 0.04 to 0.10 seconds. P and QRS waves are consistent in shape. Sinus tachycardia results when the sinoatrial (SA) node fires faster than 100 beats per minute. Bradycardia is defined as a heart rate less than 60 beats per minute. Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration. The heart rate slightly increases during inspiration and slightly slows during exhalation because of changes in vagal tone. 89%of students nationwide answered this question correctly. View Topics 10. 6 Confidence: Nailed it Stats Issue with this question? 10. What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply. Correct1 The RR intervals are relatively consistent. Correct2 One P wave precedes each QRS complex. 3 The ST segment is higher than the PR interval. 4 Four to eight complexes occur in a 6-second strip. 5 The QRS complex ranges from 0.12 to 0.2 seconds. The consistency of the RR intervals indicates a regular rhythm. A normal P wave before each complex indicates the impulse originated in the sinoatrial (SA) node. Elevation of the ST segment is a sign of cardiac ischemia and unrelated to the rhythm. The number of complexes in a 6-second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100 beats/min. Fewer than six complexes per 6 seconds equals a heart rate less than 60 beats/min. The QRS duration should be less than 0.12 seconds; the PR interval should be 0.12 to 0.2 second. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. ECG # 1 Incorrect Answers: 2 2. 4 Confidence: Nailed it Stats Issue with this question? 2. A client’s monitor shows a PQRST wave for each beat and indicates a rate of 120 beats/minute. The rhythm is regular. What does the nurse conclude that the client is experiencing? Incorrect1 Atrial fibrillation Correct2 Sinus tachycardia 3 Ventricular fibrillation 4 First-degree atrioventricular block The presence of a P wave before each QRS complex indicates a sinus rhythm. A heart rate greater than 100 beats per minute indicates tachycardia. Atrial fibrillation causes an irregular rhythm, and P waves are not identifiable. Ventricular fibrillation is irregular and shows no PQRST configurations. A first-degree atrioventricular block pattern has a prolonged PR interval and is regular. 87%of students nationwide answered this question correctly. View Topics 8. 8 Confidence: Pretty sure Stats Issue with this question? 8. The nurse is interpreting an electrocardiogram rhythm. What part of the electrical pattern represents ventricular contraction? 1 P wave Incorrect2 T wave 3 PR interval Correct4 QRS interval Atrial and ventricular depolarization and repolarization are represented on the electrocardiogram (ECG) as a series of waves: the P wave followed by the QRS complex and the T wave. The first deflection is the P wave associated with right and left atrial depolarization followed by the QRS complex that reflects ventricular depolarization. TPN # 2 Correct Answers: 10 1. 4 Confidence: Pretty sure Stats Issue with this question? 1. Following surgery, total parenteral nutrition is instituted via a central venous infusion. During the fourth hour of the infusion the client complains of nausea, fatigue, and a headache. The hourly urine output is twice the amount of the previous hour. After contacting the primary health care provider, what is the next action the nurse should take? Correct1 Check the serum glucose level. 2 Obtain an oxygen saturation level. 3 Administer a prescribed analgesic. 4 Prepare the client for immediate surgery for possible bowel obstruction. Rapid administration can cause glucose overload, leading to osmotic diuresis and dehydration. There is no indication of hypoxia. Signs of bowel obstruction are not present. The client's headache should disappear with oral fluid replacement; analgesics are not indicated. 79%of students nationwide answered this question correctly. View Topics 2. 0 Confidence: Nailed it Stats Issue with this question? 2. A primary health care provider prescribes total parenteral nutrition for a client with cancer of the pancreas. A central venous access device is inserted. What does the nurse identify as the most important reason for using this type of access? 1 Infection is uncommon. 2 It permits free use of the hands. 3 The chance of the infusion infiltrating is decreased. Correct4 The amount of blood in a major vein helps to dilute the solution. Unless diluted, the highly concentrated solution can cause vein irritation or occlusion. Although it permits free use of the hands, this is not the primary reason for a central line. Infection can occur at any invasive site and requires diligent care to avoid this complication. The chance of the infusion infiltration decreasing is not the primary reason, although the infusion at this site is more secure than a peripheral site and promotes free use of the hands. 45%of students nationwide answered this question correctly. View Topics 3. 6 Confidence: Nailed it Stats Issue with this question? 3. During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? 1 Restart the client's infusion at another site. 2 Slow the rate of the client's infusion of the TPN. Correct3 Interrupt the client's infusion and notify the healthcare provider. 4 Obtain the vital signs and continue monitoring the client's status. The client is experiencing pulmonary edema because of a fluid volume excess. The high concentration of TPN precipitates a fluid shift from the interstitial compartment into the intravascular compartment. Fluid will continue to be infused, which will continue to increase the intravascular volume. 72%of students nationwide answered this question correctly. View Topics 4. 4 Confidence: Just a guess Stats Issue with this question? 4. A client is receiving total parenteral nutrition (TPN) through a central venous access device. The nurse discovers that the TPN bag is empty and the next bag has not been received yet from the pharmacy. What is the most appropriate action for the nurse to take? 1 Perform a finger stick glucose test and call the primary healthcare provider with the results. Correct2 Hang a bag of 10% dextrose at the ordered TPN rate and place an urgent request for the next TPN bag. 3 Discontinue the infusion and flush the IV line with saline solution until the next TPN bag is ready. 4 Hang a bag of 5% dextrose at a keep-open rate and notify the nurse manager of the occurrence. Clients receiving TPN require monitoring of blood glucose because the TPN solution contains a high concentration of dextrose. In response to the highdextrose TPN solution, the pancreas increases production of insulin to meet the glucose demands. In this situation, the current TPN infusion is completed, and the nurse should infuse 10% dextrose to compensate for the loss while the next TPN bag is being prepared. If this action is not taken, the client could experience a profound hypoglycemic reaction. After beginning an infusion of 10% dextrose, the nurse may perform a finger stick glucose test and notify the healthcare provider if the results are abnormal. Discontinuing the infusion and flushing the line until the next TPN bag is ready is not recommended. Starting an infusion of 5% dextrose at keep vein open (KVO) until the next TPN is ready may not prevent hypoglycemia; the nurse manager does not need to be involved unless there is a negative client outcome that results. 59%of students nationwide answered this question correctly. View Topics 5. 4 Confidence: Pretty sure Stats Issue with this question? 5. The nurse is providing postprocedure care for a client who had a central venous access device (CVAD) inserted. Before the CVAD is used, what procedure is performed to verify placement? Correct1 Chest x-ray 2 Flushing the line with heparin 3 Withdrawing blood to ensure patency 4 Chest fluoroscopy The insertion of a central venous catheter (CVC) into the subclavian vein can result in a pneumothorax, which would be seen on a chest x-ray. Indications of a pneumothorax before the chest x-ray would include shortness of breath and anxiety. If the chest x-ray is negative for pneumothorax, the CVC line may be used. The central line should not be flushed until placement is verified. Blood withdrawal is utilized once placement is verified, but is not used to verify initial placement. Fluoroscopy may be used during placement in certain settings, but not for placement verification. 79%of students nationwide answered this question correctly. View Topics 6. 6 Confidence: Pretty sure Stats Issue with this question? 6. A client is to receive total parenteral nutrition (TPN). To administer TPN, which piece of equipment is most important for the nurse to obtain? Correct1 Infusion pump 2 Tall intravenous (IV) pole 3 Clamp taped at the bedside 4 Infusion set delivering 60 drops/mL Hypertonic solution should be administered in an infusion pump for continuous and uniform infusion to prevent hyperosmolar diuresis or fluctuations in glucose. The height of the IV pole is not as significant as the stability needed to safely support the infusion pump. There is no reason to keep a clamp at the bedside. The tubing set should be appropriate for the type of infusion pump being used. 82%of students nationwide answered this question correctly. View Topics 7. 1 Confidence: Just a guess Stats Issue with this question?