Test Bank for Clinical Reasoning Cases in
Nursing 7th Edition Harding Snyder||Complete
guide||Rated A++||latest!!
Chapter 1.Perfusion
MULTIPLE CHOICE
• The nurse is explaining to a student nurse about impaired central perfusion. The
nurse knows the student understands this problem when the student states, Central
perfusion
• is monitored only by the physician.
• involves the entire body.
• is decreased with hypertension.
• is toxic to the
cardiac system. ANS: B
Central perfusion does involve the entire body as all organs are supplied with oxygen and vital
nutrients. The physician does not control the bodys ability for perfusion. Central
perfusion is not decreased with hypertension. Central perfusion is not toxic to the
cardiac system.
• A patient was diagnosed with hypertension. The patient asks the nurse how this
disease could have happened to them. The nurses best response is Hypertension
• happens to everyone sooner or later. Dont be concerned about it.
• can happen from eating a poor diet, so change what you are eating.
• can happen from arterial changes that impede the blood flow.
• happens when people do not exercise, so you should
walk every day. ANS: C
Hardening of the arteries from atherosclerosis can cause hypertension in the patient.
Hypertension does not happen to everyone. Changing the patients diet and
exercising may be a positive life change, but these answers do not explain to the
patient how the disease could have happened.
• The patient asks the nurse to explain the sinoatrial node in the heart. The nurses
best response would be, The sinoatrial node
• provides the heart with the stimulation to beat in a normal rhythm.
• protects the heart from atherosclerotic changes.
• provides the heart with oxygenated blood.
• protects the heart
from infection. ANS: A
The sinoatrial node is the natural pacemaker of the heart, and it assists the heart to beat in a
,normal rhythm. The sinoatrial node does not protect from atherosclerotic changes
or infection, and it does not directly provide the heart with oxygenated blood.
• The patient is brought to the emergency department after a motor vehicle
accident. The patient is diagnosed with internal bleeding. The nurses primary
concern is to monitor for
• mental alertness.
• perfusion.
• pain.
• reaction to
medications. ANS: B
Perfusion is the correct answer, because with internal bleeding, the nurse should monitor vital
signs to be sure perfusion is happening. Mental alertness, pain, and medication
reactions are important but not the primary concern.
• A patients serum electrolytes are being monitored. The nurse notices that the
potassium level is low. The nurse knows that the patient should be observed for
• tissue ischemia.
• brain malformations.
• intestinal blockage.
• cardiac dysthymia. ANS: D
Cardiac dysthymia is a possibility when serum potassium is high or low. Tissue ischemia, brain
malformations, or intestinal blockage do not have a direct correlation to potassium irregularities.
• A nurse is explaining to a student nurse about perfusion. The nurse
knows the student understands the concept of perfusion when the student
states, Perfusion
• is a normal function of the body, and I dont have to be concerned about it.
• is monitored by the physician, and I just follow orders.
• is monitored by vital signs and capillary refill.
• varies as a person ages, so I would expect
changes in the body. ANS: C
The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows
the nurse to know if perfusion is adequate to maintain vital organs. The nurse does
have to be concerned about perfusion. Perfusion is not only monitored by the
physician but the nurse too. Perfusion does not always change as the person ages.
• The nurse is conducting a patient assessment. The patient tells the nurse that
he has smoked two packs of cigarettes per day for 27 years. The nurse may find
which data upon assessment?
• Blood pressure above the normal range
• Bounding pedal pulses
• Night blindness
, • Reflux disease ANS: A
Smokers have a constriction of the blood vessels due to the tar and nicotine in cigarettes. This
constriction may lead to hypertension. Bounding pulses, night blindness, and reflux
disease do not have a direct link to smoking.
Chapter 2.Gas Exchange
MULTIPLE CHOICE
• The nurse is assigned a group of patients. Which patient would the nurse
identify as being at increased risk for impaired gas exchange? A patient
• with a blood glucose of 350 mg/dL
• who has been on anticoagulants for 10 days
• with a hemoglobin of 8.5 g/dL
• with a heart rate of 100 beats/min and blood
pressure of 100/60 ANS: C
The hemoglobin is low (anemia), therefore the ability of the blood to carry oxygen is decreased.
High blood glucose and/or anticoagulants do not alter the oxygen carrying capacity
of the blood. A heart rate of 100 beats/min and blood pressure of 100/60 are not
indicative of oxygen carrying capacity of the blood.
• The nurse is reviewing the patients arterial blood gas results. The PaO2 is 96
mm Hg, pH is 7.20, PaCO2 is 55 mm Hg, and HCO3 is 25 mEq/L. What would
the nurse expect to observe on assessment of this patient?
• Disorientation and tremors
• Tachycardia and decreased blood pressure
• Increased anxiety and irritability
• Hyperventilation and lethargy ANS: A
The patient is experiencing respiratory acidosis ( pH, and PaCO2 ) which may be
manifested by disorientation, tremors, possible seizures, and decreased level of
consciousness. Tachycardia and decreased blood pressure are not characteristic of
a problem of respiratory acidosis.
Increased anxiety and hyperventilation will cause respiratory alkalosis, which is
manifested by an increase in pH and a decrease in PaCO2.
• The nurse would identify which patient as having a problem of impaired
gas exchange secondary to a perfusion problem? A patient with
• peripheral arterial disease of the lower extremities
• chronic obstructive pulmonary disease (COPD)
• chronic asthma
• severe anemia secondary to
chemotherapy ANS: A
Perfusion relates to the ability of the blood to deliver oxygen to the cellular level and return the
, carbon dioxide to the lung for removal. COPD and asthma are examples of a
ventilation problem. Severe anemia is an example of a transport problem of gas
exchange.
• The nurse is assessing a patients differential white blood cell count. What
implications would this test have on evaluating the adequacy of a patients gas
exchange?
• An elevation of the total white cell count indicates generalized inflammation.
• Eosinophil count will assist to identify the presence of a respiratory infection.
• White cell count will differentiate types of respiratory bacteria.
• Level of neutrophils provides guidelines to monitor a chronic infection.
ANS: A
Elevation of total white cell count is indicative of inflammation that is often due to
an infection. Upper respiratory infections are common problems in altering a
patients gas exchange.
Eosinophil cells are increased in an allergic response. Neutrophils are more indicative of an
acute inflammatory response. White cells do not assist to differentiate types of respiratory
bacteria.
Monocytes are an indicator of progress of a chronic infection.
• The acid-base status of a patient is dependent on normal gas exchange. Which
patient would the nurse identify as having an increased risk for the development
of respiratory acidosis? A patient with
• chronic lung disease with increased carbon dioxide retention
• acute anxiety, hyperventilation, and decreased carbon dioxide retention
• decreased cardiac output with increased serum lactic acid production
• gastric drainage with increased removal
of gastric acid ANS: A
Respiratory acidosis is caused by an increase in retention of carbon dioxide, regardless of the
underlying disease. A decrease in carbon dioxide retention may lead to respiratory
alkalosis. An increase in production of lactic acid leads to metabolic acidosis.
Removal of an acid (gastric secretions) will lead to a metabolic alkalosis.
• Which patient would the nurse identify as being at an increased risk for
altered transport of oxygen? A patient with
• hemoglobin level of 8.0
• bronchoconstriction and mucus
• peripheral arterial disease
• decreased
thoracic expansion ANS:
A
Altered transportation of oxygen refers to patients with insufficient red blood cells to transport
Nursing 7th Edition Harding Snyder||Complete
guide||Rated A++||latest!!
Chapter 1.Perfusion
MULTIPLE CHOICE
• The nurse is explaining to a student nurse about impaired central perfusion. The
nurse knows the student understands this problem when the student states, Central
perfusion
• is monitored only by the physician.
• involves the entire body.
• is decreased with hypertension.
• is toxic to the
cardiac system. ANS: B
Central perfusion does involve the entire body as all organs are supplied with oxygen and vital
nutrients. The physician does not control the bodys ability for perfusion. Central
perfusion is not decreased with hypertension. Central perfusion is not toxic to the
cardiac system.
• A patient was diagnosed with hypertension. The patient asks the nurse how this
disease could have happened to them. The nurses best response is Hypertension
• happens to everyone sooner or later. Dont be concerned about it.
• can happen from eating a poor diet, so change what you are eating.
• can happen from arterial changes that impede the blood flow.
• happens when people do not exercise, so you should
walk every day. ANS: C
Hardening of the arteries from atherosclerosis can cause hypertension in the patient.
Hypertension does not happen to everyone. Changing the patients diet and
exercising may be a positive life change, but these answers do not explain to the
patient how the disease could have happened.
• The patient asks the nurse to explain the sinoatrial node in the heart. The nurses
best response would be, The sinoatrial node
• provides the heart with the stimulation to beat in a normal rhythm.
• protects the heart from atherosclerotic changes.
• provides the heart with oxygenated blood.
• protects the heart
from infection. ANS: A
The sinoatrial node is the natural pacemaker of the heart, and it assists the heart to beat in a
,normal rhythm. The sinoatrial node does not protect from atherosclerotic changes
or infection, and it does not directly provide the heart with oxygenated blood.
• The patient is brought to the emergency department after a motor vehicle
accident. The patient is diagnosed with internal bleeding. The nurses primary
concern is to monitor for
• mental alertness.
• perfusion.
• pain.
• reaction to
medications. ANS: B
Perfusion is the correct answer, because with internal bleeding, the nurse should monitor vital
signs to be sure perfusion is happening. Mental alertness, pain, and medication
reactions are important but not the primary concern.
• A patients serum electrolytes are being monitored. The nurse notices that the
potassium level is low. The nurse knows that the patient should be observed for
• tissue ischemia.
• brain malformations.
• intestinal blockage.
• cardiac dysthymia. ANS: D
Cardiac dysthymia is a possibility when serum potassium is high or low. Tissue ischemia, brain
malformations, or intestinal blockage do not have a direct correlation to potassium irregularities.
• A nurse is explaining to a student nurse about perfusion. The nurse
knows the student understands the concept of perfusion when the student
states, Perfusion
• is a normal function of the body, and I dont have to be concerned about it.
• is monitored by the physician, and I just follow orders.
• is monitored by vital signs and capillary refill.
• varies as a person ages, so I would expect
changes in the body. ANS: C
The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows
the nurse to know if perfusion is adequate to maintain vital organs. The nurse does
have to be concerned about perfusion. Perfusion is not only monitored by the
physician but the nurse too. Perfusion does not always change as the person ages.
• The nurse is conducting a patient assessment. The patient tells the nurse that
he has smoked two packs of cigarettes per day for 27 years. The nurse may find
which data upon assessment?
• Blood pressure above the normal range
• Bounding pedal pulses
• Night blindness
, • Reflux disease ANS: A
Smokers have a constriction of the blood vessels due to the tar and nicotine in cigarettes. This
constriction may lead to hypertension. Bounding pulses, night blindness, and reflux
disease do not have a direct link to smoking.
Chapter 2.Gas Exchange
MULTIPLE CHOICE
• The nurse is assigned a group of patients. Which patient would the nurse
identify as being at increased risk for impaired gas exchange? A patient
• with a blood glucose of 350 mg/dL
• who has been on anticoagulants for 10 days
• with a hemoglobin of 8.5 g/dL
• with a heart rate of 100 beats/min and blood
pressure of 100/60 ANS: C
The hemoglobin is low (anemia), therefore the ability of the blood to carry oxygen is decreased.
High blood glucose and/or anticoagulants do not alter the oxygen carrying capacity
of the blood. A heart rate of 100 beats/min and blood pressure of 100/60 are not
indicative of oxygen carrying capacity of the blood.
• The nurse is reviewing the patients arterial blood gas results. The PaO2 is 96
mm Hg, pH is 7.20, PaCO2 is 55 mm Hg, and HCO3 is 25 mEq/L. What would
the nurse expect to observe on assessment of this patient?
• Disorientation and tremors
• Tachycardia and decreased blood pressure
• Increased anxiety and irritability
• Hyperventilation and lethargy ANS: A
The patient is experiencing respiratory acidosis ( pH, and PaCO2 ) which may be
manifested by disorientation, tremors, possible seizures, and decreased level of
consciousness. Tachycardia and decreased blood pressure are not characteristic of
a problem of respiratory acidosis.
Increased anxiety and hyperventilation will cause respiratory alkalosis, which is
manifested by an increase in pH and a decrease in PaCO2.
• The nurse would identify which patient as having a problem of impaired
gas exchange secondary to a perfusion problem? A patient with
• peripheral arterial disease of the lower extremities
• chronic obstructive pulmonary disease (COPD)
• chronic asthma
• severe anemia secondary to
chemotherapy ANS: A
Perfusion relates to the ability of the blood to deliver oxygen to the cellular level and return the
, carbon dioxide to the lung for removal. COPD and asthma are examples of a
ventilation problem. Severe anemia is an example of a transport problem of gas
exchange.
• The nurse is assessing a patients differential white blood cell count. What
implications would this test have on evaluating the adequacy of a patients gas
exchange?
• An elevation of the total white cell count indicates generalized inflammation.
• Eosinophil count will assist to identify the presence of a respiratory infection.
• White cell count will differentiate types of respiratory bacteria.
• Level of neutrophils provides guidelines to monitor a chronic infection.
ANS: A
Elevation of total white cell count is indicative of inflammation that is often due to
an infection. Upper respiratory infections are common problems in altering a
patients gas exchange.
Eosinophil cells are increased in an allergic response. Neutrophils are more indicative of an
acute inflammatory response. White cells do not assist to differentiate types of respiratory
bacteria.
Monocytes are an indicator of progress of a chronic infection.
• The acid-base status of a patient is dependent on normal gas exchange. Which
patient would the nurse identify as having an increased risk for the development
of respiratory acidosis? A patient with
• chronic lung disease with increased carbon dioxide retention
• acute anxiety, hyperventilation, and decreased carbon dioxide retention
• decreased cardiac output with increased serum lactic acid production
• gastric drainage with increased removal
of gastric acid ANS: A
Respiratory acidosis is caused by an increase in retention of carbon dioxide, regardless of the
underlying disease. A decrease in carbon dioxide retention may lead to respiratory
alkalosis. An increase in production of lactic acid leads to metabolic acidosis.
Removal of an acid (gastric secretions) will lead to a metabolic alkalosis.
• Which patient would the nurse identify as being at an increased risk for
altered transport of oxygen? A patient with
• hemoglobin level of 8.0
• bronchoconstriction and mucus
• peripheral arterial disease
• decreased
thoracic expansion ANS:
A
Altered transportation of oxygen refers to patients with insufficient red blood cells to transport
