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Cardiac output

The volume of blood pumped by the heart in 1 minute

Central venous pressure

Indirectly measures right ventricular end diastolic pressure. A measure of volume.

Systemic vascular resistance

Measures resistance to left ventricular ejection. Reflective of vasoconstriction or viscosity.

Pulmonary vascular resistance

Measures resistance to entry of blood into the heart. Reflective of volume.

Pulmonary artery wedge pressure

Reflects left ventricular end diastolic pressure.

complications of a radial arterial line?

Infection, Bleeding, Peripheral neurologic deficit, Thrombus formation

defines cardiac index

The amount of blood pumped through the heart per minute adjusted for an individual's BMI

indication for suctioning in a mechanically ventilated patient?

The patient's respiratory rate is 32

Complications of PEEP

Decreased blood pressure

A patient who has fibromyalgia tells the nurse, "My life feels very chaotic and out of my control. I will not be able to manage if anything else happens". Which response should the nurse make initially?

Tell me more about how your life has been recently

The nurse's initial strategy should be further assessment of the stressors in the patient's life.

The nurse is providing stress management education to a group of elderly women. Which of the following statements, if made by the nurse, would be an accurate description of the effect of stress on the cardiovascular system?

Stress causes increased sympathetic nervous system stimulation, which causes the heart rate to increase and blood vessels to constrict . The result is an increase in blood pressure

A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up". Which response by the nurse is appropriate?

Stressors such as illness cause the release of hormones that increase blood sugar
The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels.

Determination of whether an event is a stressor is based upon a person's...

Perception

The nurse would expect the following findings in a patient as a result of the physiologic effect of stress on the reticular formation.

Inability to sleep the night before starting self-injections of insulin

A patient has a nursing diagnosis of disturbed sensory perception related to sleep deprivation. Which action will the nurse include in the plan of care?

Cluster nursing activities so that the patient has uninterrupted rest periods.

The family members of a patient who has just been admitted to the intensive care unit following an accident with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

Describe the patient's injuries and the care that is being provided

To determine the effectiveness of medications that a patient has received to reduce afterload, which hemodynamic parameter will the nurse monitor?

Systemic vascular resistance (SVR)
Systemic vascular resistance reflects the resistance to ventricular ejection, or afterload.

Following surgery, a patient's central venous pressure (CVP) monitor indicates low pressures. Which action will the nurse anticipate taking?

Increase the IV fluid infusion rate
A low CVP indicates hypovolemia and a need for an increase in the infusion rate.

The ICU charge nurse will determine that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse...

positions the transducer line level with the phlebostatic axis

When monitoring the effectiveness of treatment for a patient with left ventricular failure, the most important information for the nurse to obtain is...

pulmonary artery wedge pressure (PAWP)
PAWP reflects left ventricular end diastolic pressure (or left ventricular preload). Because the patient in left ventricular failure will have a high PAWP, a decrease in this value will be the best indicator of patient improvement. The other values would also provide useful information, but the most definitive measurement of improvement is a drop in PAWP.

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?

The left hand is cooler than the right
The change in temperature of the left hand suggests that blood flow to the left hand is impaired

Which of the following occurs as a result of "counterpulsation" during intraortic baloon pump (IABP) use?

Improved blood flow to the coronoary arteries

While waiting for cardiac transplantation, a patient with severe heart failure has a ventricular assist device implanted. When developing a plan of care, nursing actions should include which one of the following?

Monitoring the surgical incision for signs of infection

When caring for the patient with a pulmonary artery pressure catheter, the nurse notices that the waveform indicates that the catheter is in a wedged position. Which action should the nurse take?

Notify the health care provider
When the catheter is in the wedge position, blood flow past the catheter is obstructed, placing the patient at risk for pulmonary infarction. A health care provider or specially trained nurse should be called to reposition the catheter.

stroke volume?

Stroke volume (SV) + cardiac output / heart rate.

To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care for a patient who requires intubation and mechanical ventilation?

Elevate the head of the bed to 30-45 degrees

When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take first?

Manually ventilate the patient with 100% oxygen
The nurse should ensure maximal patient oxygenation by manually ventilating with a bag-valve-mask system. Offering reassurance to the patient, notifying the health care provider about the need to reinsert the tube, and activating the rapid response team also are appropriate after the nurse has stabilized the patient's oxygenation.

A patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 10cm H2O. Which information indicates that a change in the ventilator settings may be required?

The arterial line shows a blood pressure of 90/46
The hypotension indicates that the high intrathoracic pressure caused by the PEEP may be decreasing venous return and cardiac output (CO).

The nurse notes thick, white respiratory secretions from a patient who is receiving mechanical ventilation. Which intervention will be most effective is resolving this problem.

Add additional water to the patient's enteral feedings
Because the patient's secretions are thick, better hydration is indicated.

Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates a need for suctioning?

The increase in respiratory rate indicates that the patient may have decreased airway clearance and requires suctioning. Suctioning is done when patient assessment data indicate that it is needed, not on a scheduled basis.

Premature ventricular contractions (PVC's) occur while the nurse is suctioning the endotracheal tube. Which action by the nurse is best?

Stop and ventilate the patient with 100% oxygen
Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system stimulation, and the nurse should stop suctioning and ventilate the patient with 100% oxygen.

To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action by the nurse is to...

Use an end-tidal CO2 monitor to check for placement in the trachea
End-tidal CO2 monitors are currently recommended for rapid verification of ET placement. Auscultation for bilateral breath sounds and checking chest expansion also are used, but they are not as accurate as end-tidal CO2 monitoring. A chest x-ray confirms the placement but is done after the tube is secured.

Which assessment finding by the nurse caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicate that the PEEP may need to be decreased?

The patient has subcutaneous emphysema
The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP.

purpose of positive end-expiratory pressure of a patient with ARDS

PEEP prevents the lung air sacs from collapsing during exhalation
By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation.

When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning has been effective?

The patient's PaO2 is 90 mm Hg and the SaO2 is 92%
The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2.

The nurse obtains vital signs for a patient admitted 2 days ago with gram (-) sepsis. His temperature is 101.2 F, BP 90/56, pulse 92, and respiratory rate 32. Which priority action should the nurse take next?

Obtain oxygen saturation using pulse oximetry
The patient's increased respiratory rate in combination with the admission diagnosis of gram-negative sepsis indicates that acute respiratory distress syndrome (ARDS) may be developing. The nurse should check for hypoxemia, a hallmark of ARDS.

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse acticipate?

Lower the positive end-expiratory pressure (PEEP)
Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased.

After receiving a change-of-shift report, which patient will the nurse assess first?

septicemia who has intercostal and suprasternal retractions
suggest the onset of ARDS, which will require rapid interventions such as administration of oxygen and use of positive pressure ventilation.

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider?
Oxygen saturation has dropped to 89% even with the administration of 100% O2 per non-rebreather mask
blood-tinged sputum and scattered crackles
continued temperature elevation

Oxygen saturation has dropped to 89% even with the administration of 100% O2 per non-rebreather mask

A patient with a possible pulmonary embolism complains of chest pain and upon assessment the nurse finds a heart rate of 142, BP 100/60, and respirations 42. The nurse's first action should be to...

Elevate the head of the bed to 45-60 degrees
The patient has symptoms consistent with a pulmonary embolism. Elevating the head of the bed will improve ventilation and gas exchange.

After the nurse has received change-of-shift report about the following four patients, which shold be assessed first?

A 46-year old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath

A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, and coolness in the left leg. The nurse should notify the health care provider and follow-up with which of the following actions?

Keep the patient on bedrest
The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored.

A patient at the clinic says, "I have always taken an evening walk but lately the leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking though". The nurse should proceed with a focused assessment by doing which of the following?

Attempt to palpate the dorsalis pedis and posterior tibial pulses
The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication.

Changes in skin color that occur in response to cold

Raynaud's phenomenon

Tortuous veins on the legs

venous insufficiency

Unilateral leg swelling, redness, and tenderness

venous thromboembolism (VTE)

The nurse performing an assessment with a patient who has chronic peripheral artery disease of the legs and an ulcer on the left great toe would expect to find which of the following?

Prolonged capillary refill in all the toes
Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery.

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective?

The patient exercises indoors during the winter months
Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking aspirin and NSAIDs with Raynaud's phenomenon.

A patient tells the health care provider about experiencing cold, numb fingers when running in the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about diagnostic test for which of the following?

Autoimmune disorders
Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis, and patients should be screened for autoimmune disorders.

While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be supportive of that information?

My legs cramp whenever I walk more than a block
Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication.

Finger pain associated with cold weather

Raynaud's phenomenon.

Swelling associated with prolonged standing

venous disease

When developing a teaching plan for a patient newly diagnosed with peripheral artery disease, which information should the nurse include?

It is important for you to stop smoking cigarettes
Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.

A patient is scheduled for an abdominal aortic aneurysm (AAA) repair. Which of the following events causes the nurse to suspect rupture of the aneurysm ?

The patient complains of sudden, severe back pain

Patients presenting to the Emergency department in hypertensive crisis will most likely experience

Changes in vision
Nausea / vomiting and chest pain
Numbness or weakness

A patient arrives at the Emergency department after checking her BP on the HyVee automatic BP machine. The reading was 200/110 and this is confirmed by a similar reading at the ED. What further information is needed to differentiate between a hypertensive emergency and hypertensive urgency?

The presence of acute symptoms related to hypertension

When the nurse is caring for a patient on the first post-operative day after an abdominal aortic aneurysm (AAA) repair, which assessment finding is most important to communicate to the health care provider?

Loose, bloody stools
may indicate intestinal ischemia or infarction and should be reported immediately because the patient may need an emergency bowel resection.

patient's presentation is consistent with dissecting thoracic aneurysm

complaining of "tearing" chest pain

Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse?

New onset shortness of breath
New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the health care provider.

In planning care and patient teaching for a patient with venous insufficiency, the nurse recognizes that the most important intervention in controlling this condition is...

Applying graduated compression stockings (TEDS)

Which of the following are probable clinical findings in a patient with an acute venous thromboembolism (VTE)?
Mild to moderate calf pain and tenderness
Grossly diminished or absent pedal pulses
Unilateral edema and induration of the thigh
Palpable cord along a superficial varicose vein

Mild to moderate calf pain and tenderness
Unilateral edema and induration of the thigh

A patient with venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why the two medications are necessary. Which of the following statements by the nurse is accurate?

The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation

The health care provider prescribes an infusion of heparin and daily PTT testing for a patient with a venours thromboembolism (VTE). Which of the following will nurse include in the plan of care?

Avoid giving any IM medications to prevent localized bleeding

A 46 year old is diagnosed with thromboangiitis obliterans (Buerger's disease). When planning expected outcomes for the patient, which outcome has the highest priority?

Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease.

A patient who has had severe chest pain for several hours is admitted with a diagnosis of acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI?

Cardiac-specific troponin I or troponin T
Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI).

Three days after a myocardial infarction (MI), the patient develops chest pain that increases while taking a deep breath and is relieved by leaning forward. Which action should the nurse take next?

Auscultate for a pericardial friction rub
The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI.

When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient which of the following?

About the purpose of outpatient Holter monitoring
Holter monitoring is used to determine whether the patient is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur.

Which EKG change is most important for the nurse to convey to the health care provider when caring for a patient with chest pain?

ST segment elevation
The patient is likely to be experiencing an ST-segment-elevation myocardial infarction (STEMI) and immediate therapy with percutaneous coronary intervention (PCI) or fibrinolytic medications is indicated to minimize the amount of myocardial damage.

When caring for a patient with acute coronary syndrome who has returned to the ICU after having baloon angioplasty, the nurse obtains the following assessment information. Which one indicates the need for immediate intervention by the nurse?

Chest pain rated at 8/10
The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse.

The nurse obtains the following data when caring for a patient who experienced an acute myocardial infarction (AMI) 2 days previously. Which information is most important to convey to the health care provider?

Crackles are auscultated bilateraly in the mid-lower lobes
The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme (ACE) inhibitors for the patient.

A patient is admitted to the coronary care unit following a prolonged cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which of the following orders is it most important for the nurse to question?

Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours
Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.

The nurse is caring for a patient who is receving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea . When evaluating the patient response to the medications, which of the following is the best indicator that the treatment has been effective?

Decreased dyspnea with the HOB at 30 degrees
Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees.

IV sodium nitroprusside (Nipride) is ordered for a patient with acute decompensated heart failure (ADHF). Which of the following findings would require the nurse to adjust the nitroprusside?

A systolic BP < 90
Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension.

After receving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first?

A patient who is cool and clammy, with new-onset confusion and restlessness
The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse?
Oxygen saturation of 88%
increase in apical pulse rate
1-kg weight gain
decreases in urine output

Oxygen saturation of 88%
A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient.

A patient with ADHF presents with tachypnea, dyspnea, and an oxygen saturation of 88%. Which of the following is an appropriate priority nursing intervention for this patient?

Place the patient in high Fowler's position with feet dangling
A high fowler's position increases the lung capacity reducing the patient's work of breathing, while dangling promotes venous pooling in the extremities to reduce return to the heart.

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure

PR interval

The P wave represents

depolarization of the atria

P-R interval represents

depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers.

QRS represents

ventricular depolarization

Q-T interval represents

depolarization and repolarization of the entire conduction system.

The nurse notes that a patient's cardiac monitor shows that every other beat has no P wave and has a QRS complex with a wide and bizarre shape. How will she document this rhythm?

Bigeminal PVCs
Bigeminal PVC's or ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.

Pairs of wide QRS complexes are described

couplets

Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?

Serum potassium 2.8
Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this abnormality.

A diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made for a patient with type 2 diabetes who is brought to the emergency room in an unresponsive state. The nurse will anticipate the need to do which of the following priority actions?

Insert a large-bore IV catheter
HHS is initially treated with large volumes of IV fluids to correct hypovolemia.

A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9. Which action prescribed by the health care provider should the nurse take first?
cardiac monitor
admin insulin
urine glu
ketone lvl

Place the patient on a cardiac monitor
Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium.

A diabetic patient is admitted with ketoacidosis and the health care provider writes the following orders. Which order should the nurse implement first?

Infuse 1 liter normal saline per hour
The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids.

When the nurse is assessing a patient who is recovering from an episode of DKA, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take next?

Obtain a glucose reading using a finger stick

The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate?
Myocardial infarction (MI)
immunizations
family history of endocarditis
dentist visits

Have you been to the dentist lately?"

While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. Which of the following is an appropriate intervention by the nurse related to this diagnosis?

Promote rest to decrease myocardial oxygen demand
Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain.

During post-op teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on which of the following?

The need for frequent laboratory blood testing
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve; this will require frequent international normalized ratio (INR) testing.

When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patients says...

"The only risk I have during dental procedures is bleeding because of my anticoagulants"
The greatest risk to a patient who has an artificial valve is the development of infective endocarditits with invasive medical or dental procedures.

Which information obtained by the nurse when assessing a patient admitted with mitral valve regurgitation should be communicated to the health care provider immediately?

The patient has crackles audible to the lung apices
Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics.

A systolic murmur and palpable thrill would be expected in a patient with

mitral regurgitation

most common form of valve disease in the United States?

Mitral valve prolapse

Which of the following are causes of increased ICP?

Stroke and head trauma

A patient has ICP monitoring with an intraventricular catheter. Which of the following is a priority nurisng intervention for this patient?

Aseptic technique to prevent infection

Which of the following is the earliest sign of increased ICP that the nurse can assess?

Decreased level of consciousness

Of the following patients, the nurse recognizes that the one with the highest risk for a stroke is which of the following?

A 70 year-old African American male with hypertension

The warning signs of a stroke include all of the following except...

Respiratory distress

Which of the following types of strokes is not considered an ischemic stroke?
Lacunar
embolic
Intracerebral hemorrhage
thrombotic

Intracerebral hemorrhage

You and your classmates are studying for an Adult Health II exam, when Jena asks Katie "What do you think the answer is to number 16?" Katie does not answer, but stares blankly at Jena. What do you think is going on?

Katie is having an atypical absence seizure
An atypical absence seizure is characterized by a staring spell, peculiar behavior during the seizure, and confusion after the seizure.

When teaching a patient with a seizure disorder about his medication regimen, which of the following priniciples is most important for the nurse to stress?

Stopping the medication abruptly may increase the frequency of seizures

Seizures may be precipitated in which of the following disturbances or imbalances?
Acidosis
Electrolyte imbalances
Alkalosis
Dehydration

Acidosis - not alkalosis, along with electrolyte imbalances, hypoxia, alcohol and barbiturate withdrawal, dehydration, and water intoxication can all precipitate seizure activity.

Which of the following menu choices is an appropriate choice for the client with acute renal failure (ARF)?

Apple
Citrus fruits, bananas, and baked potatoes are all high in potassium, which the patient with ARF is unable to clear.

What is the leading cause of death in acute renal failure (ARF)?

Infection

Which of the following labs are important indicators of renal function to monitor in the client with acute renal failure (ARF)?

BUN & creatinine

A 60 year-old man arrives in the clinic complaining of shortness of breath, a pounding heartbeat, and dyspnea that is unrelieved even with rest. He complains of a persisten cough that gets worse when he lies down. Upon examination, you notice edema in his legs, ankles, and feet as well as pale skin. Which of the types of cardiomyopathy best fit the presentation of this patient?

Dilated cardiomyopathy

Which of the following is not considered a cauastive factor in the development of cardiomyopathy?

Chronic elevation in intracranial pressures

If not managed, cardiomyopathy may lead to all of the following complications except...

Diabetes mellitus

Which of the following is the mnemonic used to educate people about the warning signs of cancer?

CAUTION

basic pathophysiologic definition of cancer?

Cancer is an unchecked proliferation of cells

A client has been newly diagnosed with cancer and asks how severe the disease is. You correctly respond that the TNM staging test will be performed to give a more accurate prognosis. What does the TNM staging criteria evaluate?

Tumor size, nodal involvement, metastasis

Which of the following is the major difference between benign and malignant tumor cells?

Malignant tumors are capable of invasion and metastasis

Which of the following is characteristic of the cancer cell in the initiation phase?

Once initiated, mutation is irreversible

Tumor angiogenesis refers to

Formation of blood vessels within a tumor

events of metastasis

Detach from the primary tumor and enter the circulation
Survive the turbulent ciculation and adhere to the capillary basement membrane
Gain entrance into the organ parenchyma
Respond to a favorable growth environment
Undergo angiogenesis and proliferate

true regarding a cancer cells susceptibility to chemotherapy?

Cells with a high mitotic rate respond well to chemotherapy

A client asks why the chemotherapeutic drugs he has read about online are classified as cell-cycle specific and cell-cycle non-specific. What is the best explanation of these types of chemotherapy?

They are used to describe the cycle of cell activity at which they will have the greatest impact

route by which chemotherapy is most frequently given?

IV

A patient with a T1 spinal cord injury is admitted to the intensive care unit. The nurse will teach the family that

full function of the patient's arms will be retained
The patient with a T1 injury can expect to retain full motor and sensory function of the arms.

Use of only the shoulders is associated with

cervical spine injury.

Loss of respiratory function occurs with

cervical spine injuries

Bradycardia is associated with

injuries above the T6 level.

A patient with paraplegia resulting from a t10 spinal cord injury has a neurogenic bladder. Which action will the nurse include in the plan of care?

Teach the patient how to self-catheterize at regular intervals
Because the patient's bladder is spastic and will empty in response to overstretching of the bladder wall, the most appropriate method is to avoid incontinence by emptying the bladder at regular intervals through intermittent catheterization.

The Credé method is more appropriate for a bladder that is

flaccid, such as occurs with a reflexic neurogenic bladder.

After a 25 year-old patient has returned home following rehabilitation for a spinal cord injury, the home care nurse notes that the spouse is performing many of the activities that the patient had been managing independently during rehab. Which of the following is the most appropriate action?

Develop a plan to increase the patient's independence in consultation with the patient and the spouse
The best action by the nurse will be to involve all the parties in developing an optimal plan of care. Because family members who will be assisting with the patient's ongoing care need to feel that their input is important

In caring for the patient who was admitted 24 hours previously with a C5 spinal cord injury, which nursing action has the highest priority?

Assessment of respiratory rate and depth
Edema around the area of injury may lead to damage above the C4 level, so the highest priority is assessment of the patient's respiratory function.

In caring for a patient who had a spinal cord injury 21 days ago and has a weak cough with loose-sounds secretions, the initial intervention by the nurse should be to

place the hands on the epigastric area and push upward when the patient coughs
Since the cough effort is poor, the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions.

To evaluate the effectiveness of IV methylprednisolone (Solu-medrol) given to a patient with a T4 spinal cord injury, which information is most important for the nurse to obtain?

Leg strength and sensation
The purpose of methylprednisolone administration is to help preserve motor function and sensation. Therefore the nurse will assess this patient for lower extremity function.

A patient with a hisotry of a T2 spinal cord innjury tells the nurse, "I feel awful today. My head is throbbing and I feel sick to my stomach". Which action should the nurse perform first?

The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is occurring.

actions when caring for a trauma patient with a suspected spinal cord injury who is admitted to the emergency department?

Immoblize the patient's head, neck, and spine
Administer 02 using a non-rebreather mask
Monitor cardiac rhythm and blood pressure
Infuse normal saline at 150 ml / hr
Tranfer the patient to radiology for spinal CT

A young adult is hospitalized after an accident that resulted in a complete transection of the spinal cord at the level of C7. The nurse informs the patient that after rehabilitation, the level of function that is most liely to occur is the ability to

Drive a vehicle with hand controls
A patient with injury at the level of C7 to C8 may have the following rehabilitation potential: ability to transfer self to wheelchair; roll over and sit up in bed; push self on most surfaces; perform most self-care; use wheelchair independently; and drive a car with powered hand controls (in some patients);

A 24 year-old patient is hospitalized with the onset of Guillain Barre syndrome. During the illness, the most essential assessment for the nurse to carry out is

Observing respiratory rate and effort
The most serious complication of Guillain-Barré syndrome is respiratory failure, and the nurse should monitor respiratory function continuously.

Which of these nursing actions for a patient with Guillain-Barre' is appropriate for the nurse to delegate to an experinced nursing assistant?
Administration of tube feedings
administration of ordered medications, assessment are skills
PROM

Passive range of motion to the extremities q 8H

A 25 year old female is diagnosed with systemic lupus erythematosis (SLE). Which of the following statements regarding the need for family planning indicates further need for instruction?

"Infertility rarely occurs"
Infertility is a complication of SLE

Which of the following skin conditions is a common finding in patients with systemic lupus erythematosis (SLE)?

Discoid lesions
Discoid lesions, vascular lesions, and a butterfly rash across the nose and cheeks are common skin manifestations.

A patient is receiving intravesical bladder chemotherapy. For which of the following will the nurse monitor?

Hematuria
The adverse effects of intravesical chemotherapy are confined to the bladder.

When reviewing the chart for a patient with cervical cancer, the nurse notes the cancer is stages as Tis (in-situ), N0, M0. The nurse will teach the patient that

The cancer is localized to the cervix
Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time.

A patient with a large stomach tumor that is attached to the liver undergoes a debulking procedure. The nurse explains that the expected outcome of this surgery is

Decrease in tumor size to improve the effects of other interventions
A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective.

A patient with Hodgkin's lymphoma who is undergoing external radiation tells the nurse "I am so tired I can haredly get out of bed in the morning." An appropriate intervention for the nurse to plan is to

Establish a time to take a short walk almost every day
Walking programs are used to keep the patient active without excessive fatigue.

A patient undergoing external radiation has developed a dry desquamation in the treatment area. Which patient statement indicates that the nurse's teaching about management of this reaction has been effective?

"I can buy some aloe vera gel to use on the area"

When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to

Stop the infusion if swelling is observed at the site
Swelling at the site may indicate extravasation, and the IV should be stopped immediately.

A patient who has severe pain associated with terminal liver cancer is being cared for at home by his family members. Which finding by the nurse indicates that teaching regarding pain management has been effective

The patient takes opioids around the clock on a regular schedule with additional doses when breakthrough pain occurs
For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain.

Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action?

Crackles heard at the lower scapular border
Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2; the patient may need oxygen and the nurse should rapidly notify the health care provider.

After receiving change-of-shift report, which of these patients should be seen first?

24 year-old who is receiving neck radiation and has blood oozing from the neck
Since neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first.

The nurse at the clinic is interviewing a 61 year-old woman who is 5 feet 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years.She walks 5 miles on most days and has a glass of wine 2-3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk?

Pap testing
Sunscreen use
Mammography
Colorectal screenin

A female client with a 30 pack year smoking history arives at the clinic for a physical. She admits a chronic cough over several years that has become more productive. You notice that her gait is unsteady, Which of the following diagnoses would you anticipate?

Small cell CA
Small cell CA quickly metastasizes to the bone and brain.

Pathologic fractures may be indicative of

bone mets

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