Med Surg TB Chapter 34 Flashcards


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1

While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. What does this finding indicate?

A) Decreased fluid volume

B) Jugular vein atherosclerosis

C) Increased right atrial pressure

D) Incompetent jugular vein valves

Answer: C

2

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective?

A) Weight loss of 2lb in 24 hours

B) Hourly urine output greater than 60 mL

C) Reduced dyspnea with the head of bed at 30 degrees

D) Patient denies experiencing chest pain or chest pressure

Answer: C

3

Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)?

A) Need to begin aerobic exercise program several times weekly

B) Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors

C) Use of salt substitute to replace table salt when cooking and at the table

D) Importance of making an annual appointment with the health care provider

Answer: B

4

IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. Which reassessment finding during the first hours of administration indicates that the nurse should decrease the rate of nitroprusside infusion?

A) Ventricular ectopy

B) Dry, hacking cough

C) Systolic BP below 90 mm Hh

D) Heart rate below 50 beats/min

Answer: C

5

A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" How should the nurse document this finding?

A) Orthopnea

B) Pulsus alternans

C) Paroxysmal nocturnal dyspnea

D) Acute bilateral pleural effusion

Answer: C

6

Which statement by a patient with newly diagnosed heart failure indicates to the nurse that teaching was effective?

A) "I will take furosemide (Lasix) every day just before bedtime."

B) "I will use the nitroglycerin patch whenever I have chest pain."

C) "I will use an additional pillow if I am short of breath at night."

D) "I will call the clinic if my weight goes up 3 pounds in a week."

Answer: D

7

When teaching a patient with heart failure on a 2000-mg sodium diet, which foods should the nurse recommend limiting?

A) Chicken and eggs

B) Canned and frozen foods

C) Yogurt and milk products

D) Fresh or frozen vegetables

Answer: C

8

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide. Which instruction should the nurse include?

A) Limit dietary sources of potassium.

B) Take the hydrochlorothiazide at bedtime.

C) Notify the health care provider if nausea develops.

D) Take the digoxin if the pulse is below 60 beats/min.

Answer: C

9

While admitting an 82-year-old patient with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." What should the nurse include in the discharge plan?

A) Consult with a psychologist.

B) Transfer to a long-term care facility.

C) Referral to a home health care agency.

D) Arrangements for around-the-clock care.

Answer: C

10

Following an acute myocardial infarction, a previously healthy 63-year-old develops heart failure. What medication topic should the nurse anticipate including in discharge teaching?

A) B-Adrenergic blockers

B) Calcium channel blockers

C) Digitalis and potassium therapy regimen

D) Angiotensin-converting enzyme (ACE) inhibitors

Answer: D

11

A 53-year-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is an option. Which response is accurate?

A) "Your heart failure has not reached the end stage yet."

B) "You could not manage the multiple complications of that surgery."

C) "The suitability of a heart transplant for you depends on many factors."

D) "Because you have diabetes, you would not be a heart transplant candidate."

Answer: C

12

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure?

A) Serum troponin

B) Arterial blood gasses

C) B-type natriuretic peptides

D) 12-lead electrocardiogram

Answer: C

13

Which action should the nurse include in the plan of care for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)?

A) Monitor blood pressure frequently.

B) Encourage patient to ambulate in room.

C)Teach patient to drink at least 3 liters of fluid daily.

D) Titrate nesiritide dose down slowly before stopping.

Answer: A

14

A patient with chronic heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective?

A) "I plan to take the medication with food."

B) "I should eat more potassium-rich foods."

C) "I will call for help when I need to get up to use the bathroom."

D) "I can expect to feel more short of breath for the next few days."

Answer: C

15

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving?

A) captopril (Capoten) 25mg

B) furosemide (Lasix) 60 mg

C) digoxin (Lanoxin) 0.125 mg

D) carvedilol (Coreg) 3.125 mg

Answer: D

16

A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action should the nurse take first?

A) Auscultate the abdomen.

B) Check the capillary refill.

C) Auscultate the breath sounds.

D) Ask about the patient's allergies.

Answer: C

17

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-lb weight gain in the past 3 days. What is the nurse's priority action?

A) Teach the patient about restricting dietary sodium.

B) Assess the patient for manifestations of acute heart failure.

C) Ask the patient about the use of prescribed medications.

D) Have the patient recall the dietary intake for the past 3 days.

Answer: B

18

A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient. Which action should the nurse take first?

A) Give PRN IV morphine sulfate 4 mg.

B) Give PRN IV diazepam (Valium) 2.5 mg.

C) Increase nitroglycerine infusion by 5 mcg/min.

D) Increase dopamine infusion by 2 mcg/kg/min.

Answer: A

19

After receiving a change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first?

A) A patient who reported dizziness after receiving the first dose of captopril.

B) A patient who has new-onset confusion and restlessness and cool, clammy skin.

C) A patient who is receiving oxygen and has crackles bilaterally in the lung bases.

D) A patient who is receiving IV nesiritide (Natrecor), with a blood pressure of 100/62.

Answer: B

20

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires most immediate action by the nurse?

A) O2 saturation of 88%

B) Weight gain of 1 kg (2.2 lb)

C) Heart rate of 106 beats/min

D) Urine output of 50 mL over 2 hours

Answer: A

21

A patient who has heart failure has recently started taking digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider?

A) Presence of 1+ to 2+ edema in the feet and ankles

B) Palpable liver edge 2 cm below the ribs on the right side

C) Serum potassium level 3.0 mEq/L after 1 week of therapy

D) Weight increase from 120 pounds to 122 pounds over 3 days

Answer: C

22

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider?

A) 2+ bilateral pedal edema

B) Heart rate of 52 beats/min

C) Report of increased fatigue

D) Blood pressure (BP) of 88/42 mm Hg

Answer: D

23

A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

A) Teach the patient the reasons for remaining on bed rest.

B) Change the peripheral IV site according to agency policy.

C) Monitor the patient's blood pressure and heart rate every hour.

D) Titrate the dobutamine to keep the systolic blood pressure >90 mm Hg.

Answer: C

24

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first?

A) Patient who is taking carvedilol (Coreg) and has a heart rate of 58.

B) Patient who is taking digoxin and has a potassium level of 3.1 mEq/L.

C) Patient who is taking captopril and has a frequent nonproductive cough.

D) Patient who is taking isosorbide dinitrate/hydralazine (BiDil) abd has a headache.

Answer: B