CLINICAL REASONING CASES IN NURSING 7TH
EDITION HARDING SNYDER TESTBANK
QUESTIONS AND ANSWERS
Chapter 1.Perfusion
MULTIPLE CHOICE
1. 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
a. is monitored only by the physician.
b. involves the entire body.
c. is decreased with hypertension.
d. 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.
2. 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
a. happens to everyone sooner or later. Dont be concerned about it.
b. can happen from eating a poor diet, so change what you are eating.
c. can happen from arterial changes that impede the blood flow.
d. 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.
3. The patient asks the nurse to explain the sinoatrial node in the heart. The nurses best
response would be, The sinoatrial node
a. provides the heart with the stimulation to beat in a normal rhythm.
b. protects the heart from atherosclerotic changes.
, c. provides the heart with oxygenated blood.
d. 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.
4. 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
a. mental alertness.
b. perfusion.
, c. pain.
d. 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.
5. 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
a. tissue ischemia.
b. brain malformations.
c. intestinal blockage.
d. 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.
6. 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
a. is a normal function of the body, and I dont have to be concerned about it.
b. is monitored by the physician, and I just follow orders.
c. is monitored by vital signs and capillary refill.
d. 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.
7. 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?
a. Blood pressure above the normal range
b. Bounding pedal pulses
, c. Night blindness
d. 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
1. 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
a. with a blood glucose of 350 mg/dL
b. who has been on anticoagulants for 10 days
c. with a hemoglobin of 8.5 g/dL
d. 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.
2. 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?
a. Disorientation and tremors
b. Tachycardia and decreased blood pressure
c. Increased anxiety and irritability
d. 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.
EDITION HARDING SNYDER TESTBANK
QUESTIONS AND ANSWERS
Chapter 1.Perfusion
MULTIPLE CHOICE
1. 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
a. is monitored only by the physician.
b. involves the entire body.
c. is decreased with hypertension.
d. 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.
2. 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
a. happens to everyone sooner or later. Dont be concerned about it.
b. can happen from eating a poor diet, so change what you are eating.
c. can happen from arterial changes that impede the blood flow.
d. 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.
3. The patient asks the nurse to explain the sinoatrial node in the heart. The nurses best
response would be, The sinoatrial node
a. provides the heart with the stimulation to beat in a normal rhythm.
b. protects the heart from atherosclerotic changes.
, c. provides the heart with oxygenated blood.
d. 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.
4. 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
a. mental alertness.
b. perfusion.
, c. pain.
d. 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.
5. 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
a. tissue ischemia.
b. brain malformations.
c. intestinal blockage.
d. 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.
6. 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
a. is a normal function of the body, and I dont have to be concerned about it.
b. is monitored by the physician, and I just follow orders.
c. is monitored by vital signs and capillary refill.
d. 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.
7. 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?
a. Blood pressure above the normal range
b. Bounding pedal pulses
, c. Night blindness
d. 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
1. 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
a. with a blood glucose of 350 mg/dL
b. who has been on anticoagulants for 10 days
c. with a hemoglobin of 8.5 g/dL
d. 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.
2. 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?
a. Disorientation and tremors
b. Tachycardia and decreased blood pressure
c. Increased anxiety and irritability
d. 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.
