Healthstream Test questions and answers.docx

  A patient assessment reveals distended neck veins, pulsus paradoxus, and decreased systolic pressure. This assessment is most consistent with: - Correct Answers: cardiac tamponade. The nurse is caring for a patient with severe sepsis and third-degree heart block. The patient is hypotensive. The treatment for this life-threatening rhythm change includes: - Correct Answers: transcutaneous pacing. A patient is admitted to the ICU with suspected cervical spinal cord injury following a motor vehicle accident. The most important nursing intervention for this patient is to: - Correct Answers: immobilize his head. The nurse assesses a patient's chest tube drainage 2 hours following thoracic surgery. The total drainage in the system is 200 mL. The nurse knows that: - Correct Answers: this is an excessive amount of drainage The patient being admitted requires CRRT therapy. The nurse assigned to admit the patient has not been educated on this therapy. The charge nurse adjusts the assignment so that a nurse with 3 years experience in CRRT therapy is assigned to the patient. This type of decision making is an example of: - Correct Answers: the synergy model for patient care. The patient diagnosed with acute tubular necrosis (ATN) and experiencing severe dehydration, sepsis, and pneumonia is now in the polyureic stage of ATN. The most important nursing action is to: - Correct Answers: monitor electrolyte levels and signs of fluid depletion. A patient has an elevated central venous pressure (CVP) measurement. The most likely reason is: - Correct Answers: right heart failure. Diabetes insipidus is usually treated with - Correct Answers: vasopressin. Which physiologic effect is produced by alpha-1 receptors? - Correct Answers: Vasoconstriction The patient experiencing an acute myocardial infarction (AMI) arrived on the unit an hour ago with TPA infusing. Initially, the patient's neurologic exam was normal. The nurse assesses the patient and finds him now disoriented. The next nursing action should be to: - Correct Answers: discontinue the TPA. A patient has cardiomyopathy and is unstable. The nurse understands that the treatment goal is to improve contractility, reduce preload and reduce afterload. The nurse anticipates that medication management will include: - Correct Answers: dobutamine and nitroprusside infusions A continuous drip of a medication is ordered at a rate of 2 mg/min. The standard mixture of this medication to yield a final concentration of 2 mg/mL is 1 g of the medication in 500 mL of IV fluid. At what rate in milliliters per hour should the IV pump be set? - Correct Answers: 60 mL/hr A practitioner has ordered 700 mg of an antibiotic. The medication label states, "Add 5 mL sterile water to 1 g of this medication; 0.5 g = 2 mL." How many milliliters should be given? - Correct Answers: 2.8 mL A practitioner order is written for a continuous infusion of insulin at 3 units/hr; the premixed solution is composed of 100 units of regular U-100 insulin in 100 mL normal saline. At which rate should the infusion run? - Correct Answers: 3 ml/hr A dose of 35 mg of a corticosteroid is ordered to be given IM to treat inflammation. The medication is available as 250 mg/10 mL. How many milliliters should be administered? - Correct Answers: 1.4 ml A practitioner's order prescribes levothyroxine 0.075 mg PO daily. The available medication is levothyroxine 25-mcg tablets. What will the nurse administer? - Correct Answers: 3 tabs The actions of nitroglycerin in the management of angina include - Correct Answers: coronary artery dilation and peripheral venous dilation. The most common cause of right heart failure is: - Correct Answers: left heart failure. The nurse is differentiating between right- and left-sided heart failure in an assigned patient. For right-sided heart failure, the patient presents with edematous extremities, nausea/vomiting, and: - Correct Answers: anorexia. The nurse is assigned to a patient with acute adrenal insufficiency (Addisonian crisis). The practitioner orders the steroids to be discontinued quickly. The nurse knows to question the order because: - Correct Answers: steroids should be withdrawn slowly to allow for pituitary production of ACTH The nurse is caring for a patient who has atrial fibrillation. The patient is attempting to understand why this dysrhythmia developed in him. The nurse educates this patient about his risk factors, including: - Correct Answers: diabetes mellitus. The nurse is assigned a patient who is experiencing chest pain resulting from coronary artery spasms while at rest. The nurse quickly realizes that the patient is suffering from: - Correct Answers: variant (Prinzmetal's) angina. A blood transfusion is: indicated in cases of - Correct Answers: active hemorrhage resulting in shock Prior to administering digoxin to a patient, the nurse assesses the: - Correct Answers: apical pulse for 1 minute. The nurse has a patient who has sustained paroxysmal supraventricular tachycardia (PSVT). The medication that is most effective for treatment is: - Correct Answers: adenosine. A patient with a coronary artery bypass graft (CABG) has a chest tube in place. The nurse suspects an air leak, because the collection unit displays: - Correct Answers: bubbling in the water seal chamber. A patient has been admitted to the telemetry unit with infective endocarditis. During the nursing assessment, the nurse notes the confirmatory findings of petechiae, splinter hemorrhages, and: - Correct Answers: Osler's nodes. A patient reports unrelenting, crushing chest pain; nausea; and dyspnea. The nurse suspects an acute myocardial infarction. What change should the nurse expect to see on the patient's ECG? - Correct Answers: ST-segment elevation During an acute lateral myocardial infarction, changes will be seen in which ECG leads? - Correct Answers: I, aVL, V5, V6 Acute pericarditis is most commonly associated with: - Correct Answers: renal failure. The primary sign that indicates an intraoperative stroke is: - Correct Answers: seizures. Rather than impeding lung blood flow, pulmonary emboli composed of _____________ injure blood vessels and cause acute respiratory distress syndrome (ARDS). - Correct Answers: fat The most common lethal arrhythmia in the first hour of a myocardial infarction- - Correct Answers: v. fib Evaluation of the comprehension of instructions given to a new nurse regarding the QT interval on an ECG strip- - Correct Answers: Beginning of QRS to end of T-wave- less than ó of preceding R-R interval- .4, prolongation leads to torsades The mechanism of action for calcium channel blockers in the treatment of angina - Correct Answers: allows blood vessels to relax and open The primary classifications of physical traits that are manifested by patients with acute onset delirium - Correct Answers: Restlessness, pacing, agitation, mood change, hallucination, uncooperative, reduced motor activity, sluggishness, in a daze Cardiovascular manifestations of adrenal insufficiency- - Correct Answers: low bp, arrhythmias, CHF An imaging test used to confirm the presence of hypercortisolism (Cushing's disease) - Correct Answers: MRI The length of time that digoxin must be held prior to elective cardioversion- - Correct Answers: 24-48 hr The single most important laboratory test in a patient who appears to be intoxicated with ethanol- - Correct Answers: glucose The most accurate test to use in diagnosing sleep apnea - Correct Answers: polysomnography Risk factors that may lead to the development of atrial fibrillation- - Correct Answers: HTN, MI, DAD, Congenital, Thyroid, drugs, abn heart valves, SSS, Pulmonary disease, viral infection, stress, OSA The ECG leads in which changes will be seen during an acute lateral myocardial infarction - Correct Answers: ST segment elevation in anterior leads (V3 and V4) The priority assessment the nurse should make prior to administering digoxin (Lanoxin®) to a patient- - Correct Answers: HR Indications for thrombolytic therapy for acute MI- - Correct Answers: St elevation MI or new left bundle branch block presenting w/in 12 hours of onset of symptoms The guidelines for use of steroids in the patient with acute adrenal insufficiency (Addisonian crisis) - Correct Answers: IVF, Steroids, ACTH test, vasopressors hydrocortisone in divided doses- weaned when stable to prednisolone Neuromuscular manifestations of adrenal insufficiency - Correct Answers: -fatigue, muscle weakness, headache skin hyperpigmentation key features of infective endocarditis - Correct Answers: heart murmur, fever, chills, night sweats, muscle pain, loss of appetite, SOB, chest pain safety profile for the use of combined hormonal contraceptive (CHC) pills by the individual with sickle cell anemia- - Correct Answers: (progesterone only BC pills to decrease incidence of DVT and bone loss) actions of nitroglycerin in the management of angina- - Correct Answers: (dilates arteries and veins in the heart- decreasing the workload of the heart- relaxation of vascular smooth muscle) where the upper extremity limb leads are placed for continuous ECG monitoring- - Correct Answers: (white- right- directly below the clavicle near the shoulder, black-left-directly below the clavicle near the shoulder) The reason that aspirin in high analgesic doses is usually avoided in the treatment of patients with gout- - Correct Answers: (high dose aspirin can alter the blood level of urid acid) The type of antidepressant that can block the reuptake of dopamine when prescribed at higher doses - Correct Answers: -Bupropion(Wellbutrin) ECG leads in which changes will be seen during an acute lateral myocardial infarction - Correct Answers: anterior leads V2-4 & lateral leads 1, AVL, V5-6 etiology of atrial flutter - Correct Answers: (common, abn electrical circuit of upper chambers of the heart that decreases the squeeze-output- can be asymptomatic, caused by birth defects, medications, viruses, metabolic disorders -ie: dehydration) clinical presentation of right-sided heart failure - Correct Answers: (JVD, edema, pleural effusions, fatigue, cool extremities, exercise intolerance, dizziness, syncope, ascites) evaluation of patient understanding of instructions given regarding digoxin administration - Correct Answers: (Teach back- verbalization of understanding- hr 60-100 (1 full min), check levels visions changes) How to correctly administer ear drops to an adult - Correct Answers: (earlobe up and out) The rate at which IV saline should be administered to a patient with diabetic ketoacidosis during the first hour of treatment - Correct Answers: (bolus) The action of dexamethasone when given to patients with thyroid storm - Correct Answers: (inhibit hormone production and decrease peripheral conversion from T4 to T3) The reason that enteric-coated tablets should not be broken - Correct Answers: (may result in the drug being released too early, destroyed by stomach acid or irritating the stomach lining) An important characteristic of acetaminophen - Correct Answers: (raises the body's pain threshold by inhibiting prostaglandin synthesis in the CNS) The thrombolytic drug that is more likely to cause an allergic reaction - Correct Answers: alteplase The length of time the patient should be encouraged to retain a bisacodyl rectal suppository to relieve constipation - Correct Answers: 15 - 20 min most common cardiac valve dysfunction in the United States, often considered a disease of "wear and tear"- - Correct Answers: aortic A continuous drip of a medication is ordered at a rate of 2 mg/min. The standard mixture of this medication to yield a final concentration of 2 mg/mL is 1 g of the medication in 500mL of IV fluid. At what rate in milliliters per hour should the IV pump be set? - Correct Answers: 60 mL/hr A continuous infusion of regular insulin at 7 units/hour has been ordered for a patient with type 1 diabetes mellitus. The pharmacy dispensed a standard insulin infusion containing 100 units of regular U-100 insulin in 100 mL normal saline. At what rate in milliliters per hour should the infusion pump be set? - Correct Answers: 7 mL/hr A practitioner has ordered 700 mg of an antibiotic. The medication label states, "Add 5 mL sterile water to 1 g of this medication; 0.5 g = 2 mL." How many milliliters should be given? - Correct Answers: 2.8 mL In patients who have angina, calcium channel blockers: - Correct Answers: reduce myocardial oxygen consumption. The nurse is assessing neuromuscular deficiency in a patient with adrenal insufficiency and expects to find that the patient has: - Correct Answers: joint/muscle pain. The nurse is caring for a patient who has atrial fibrillation. The patient is attempting to understand why this dysrhythmia developed in him. The nurse educates this patient about his risk factors, including: - Correct Answers: diabetes mellitus. The nurse is differentiating between right- and left-sided heart failure in an assigned patient. For right-sided heart failure, the patient presents with edematous extremities, nausea/vomiting and - Correct Answers: anorexia. A patient is receiving a unit of blood and begins to display signs and symptoms of a transfusion reaction. What primary nursing action should the nurse take? - Correct Answers: Stop the blood transfusion. A patient has been admitted to the telemetry unit with infective endocarditis. During the nursing assessment, the nurse notes the confirmatory findings of petechiae, splinter hemorrhages, - Correct Answers: Osler's nodes During an acute lateral myocardial infarction, changes will be seen in which ECG leads? - Correct Answers: I, aVL, V5, V6 Acute pericarditis is most commonly associated with: - Correct Answers: renal failure. Rather than impeding lung blood flow, pulmonary emboli composed of _____________ injure blood vessels and cause acute respiratory distress syndrome (ARDS). - Correct Answers: fat The mechanically ventilated patient has an increased respiratory rate ranging from 12-24; his oxygen saturation decreased to 90% despite having a non-rebreather at 100%. The patient assessment reveals basilar crackles that were not previously present, high peak airway pressures, and use of accessory muscles. Arterial blood gas reveals pH 7.50, pCO2 32, and pO2 49. Chest X-ray results are significant for diffuse ground-glass opacities. The patient is likely experiencing: - Correct Answers: acute respiratory distress syndrome. The nurse is caring for a patient with severe sepsis and third-degree heart block. The patient is hypotensive. The treatment for this life-threatening rhythm change includes: - Correct Answers: transcutaneous pacing. The patient diagnosed with acute tubular necrosis (ATN) and experiencing severe dehydration, sepsis, and pneumonia is now in the polyureic stage of ATN. The most important nursing action is to: - Correct Answers: monitor electrolyte levels and signs of fluid depletion. A patient is newly intubated. He has normal breath sounds on the right side of his chest, but diminished, distant breath sounds on the left side of his chest. These findings likely indicate: - Correct Answers: intubation in the right mainstem bronchus. Right atrial pressures are obtained in order to assess: - Correct Answers: right ventricular function. Which responses might mechanically ventilated patients on elevated levels of PEEP experience? - Correct Answers: Hypotension A patient has an elevated central venous pressure (CVP) measurement. The most likely reason is - Correct Answers: right heart failure. A patient is experiencing a cardiogenic shock. You understand the goal of treatment focuses on increasing the:Correct Answer: - Correct Answers: cardiac output. The mechanically ventilated patient has increased respiratory rate ranging from 12-24 and oxygen saturation decreased to 90% despite oxygen increase to 100%. The patient assessment reveals basilar crackles that were not previously present, high peak airway pressures, and use of accessory muscles. Arterial blood gas reveals pH 7.50, pCO2 32, and pO2 49. Chest X-ray results are significant for diffuse ground glass opacities. The patient is likely experiencing - Correct Answers: acute respiratory distress syndrome Preload is defined as the: - Correct Answers: stretch produced within the myocardium at the end of diastole. A patient has an elevated central venous pressure measurement. The most likely reason is: - Correct Answers: right heart failure. A patient is experiencing a change in condition. Your assessment is significant for oliguria, jugular vein distention, and dyspnea on exertion. You review laboratory values and notice that the isoenzymes are not elevated. The most likely explanation is that the patient is experiencing: - Correct Answers: congestive heart failure. You are caring for a post-gastrectomy patient. You understand that the patient may have absorption complications primarily as a result of: - Correct Answers: dumping syndrome A 46-year-old patient states that he has had weakness in his lower extremities that has worsened in an ascending manner over the past 3 days. The patient also states he is having difficulty breathing. The nurse is most concerned that this patient is at high risk for respiratory failure caused by: - Correct Answers: Guillain-Barré syndrome A patient has an elevated central venous pressure measurement. The most likely reason is: - Correct Answers: right heart failure. A patient has cardiomyopathy and is unstable. You understand that the treatment goal is to improve contractility, reduce preload, and reduce afterload. You anticipate that medication management will include starting: - Correct Answers: dobutamine and nitroprusside infusions. A patient is newly intubated. He has normal breath sounds on the right side of his chest, but diminished, distant breath sounds on the left side of his chest. These findings likely indicate: - Correct Answers: intubation in the right mainstem bronchus. Which of the following responses might mechanically ventilated patients on elevated levels of PEEP experience? - Correct Answers: hypotension If the pulmonary artery catheter migrates distally and becomes permanently wedged, the patient is at risk for: - Correct Answers: pulmonary infarction.