NP 3 Flashcards by Sharahveille Sombrio

Situation: patient Giselle, a 69 year, old female, arrives at the emergency department with retrosternal chest pain radiating to her left arm dyspnea and cold climate skin with the symptoms, beginning less than three hours ago. The physician suspected an acute myocardial infarction (MI)

Initial labs in credit card of biomarkers to confirm the diagnosis for patient Giselle. Which of the following is the most Carjac specific enzyme indicating myocardial injury?
A. Hydroxybutyrate Dehydrogenase
B. Troponin
C. Creatinine Phosphokinase
D. Lactic Dehydrogenase

Ratio:
B. Most specific laboratory marker (protein)
A. Liver and RBC
D. Liver and muscle injury/ hemolysis

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Which of the following lab results is least specific to myocardial tissue injury and may be elevated in non-cardiac condition?
A. CK- MB
B. Aspartate aminotransferase
C. Lactate dehydrogenase
D. Alanine aminotransferase

Ratio: a primary found in the liver—> hepatic injury

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Nurse Jhong records Giselle’s temperature at 104°F during the initial assessment. Understanding the physiologic effects of hyperthermia on the cardiovascular system, which of the following clinical manifestations is most likely to be observed as a compensatory response?
A. Precordial pain due to increased myocardial workload
B. Dyspnea as a result of pulmonary vascular congestion
C. Increased pulse rate from hypothalamic stimulation of sympathetic activity
D. Elevated blood pressure due to periphera vasoconstriction

Ratio: Fever (cause vasodilation)—> hypothalamus—> SNS —> tachycardia—> increased O2 and nutrients tissues
A. Chest pain — indicative of angina
B. Irrelevant
D. Walang dahilan na magkaroon ng vasoconstriction

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Ratio: intravenous morphine can cause vasodilation para hindi ma hirapan ang puso natin
C. NSAIDS

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During a cardiac catheterization procedure, the cardiologist identifies a critical stenosis at the origin of the left coronary artery, just proximal to its bifurcation. Based on the vascular anatomy, which of the following myocardial territories is at the greatest risk for ischemia if perfusion is compromised at this level?
A. Right atrium and the inferior wall of the left ventricle
B. Posterior interventricular septum and lateral right ventricle
C. Anterior wall of the left ventricle and the lateral wall of the left ventricle
D. SA node and the posterior wall of the left atrium

Stenosis—> narrowing at the origin of the left coronary artery.

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Which of the following nursing interventions would be considered least appropriate least appropriate for Patient Giselle during the first 24-48 hours post-MI?
A. Encourage the patient to use a bedpan for bowel elimination instead of ambulating to the tollet
B. Position patient in a semi-Fowler’s position to reduce preload and enhance oxygenation
C. Administer oxygen via nasal cannula as prescribed to improve myocardial oxygen delivery
D. Encourage high-fiber foods to promote bowel regularity and reduce Valsalva maneuver during defecation

Ratio: instead of bed pad used a bed commode —> maneuver
Goals: 1. To reduced cardiac work load
2. Prevent complications
3. Maintain oxygenation

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Nurse Jhong is teaching Patient Giselle who is recovering from a myocardial infarction (MI) about the pathophysiology behind the pain experienced during the event. Which of the following best explains the underlying mechanism of ischemic cardiac pain during an MI?
A. Increased workload on the left ventricle
B. Impending circulatory system failure
C. Disruption in the balance of electrolytes outside of the heart cells
D. Lack of adequate oxygen supply to the heart muscle tissue

Decreased O2 —> ischemia —> build up metabolites (lactic acid) —> that stimulate pain receptors

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Which of the following features in the patient presentation would make acute myocardial infarction (MI) less likely and suggest an alternative diagnosis?
Pain that resolves with rest and positioning
B. Chest pain persisting more than 30 minutes with radiation to the back
C. Pain described as crushing, unrelieved by nitroglycerin
D. Intense fear with feeling of impending doom

Ratio: its an angina

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Situation: Nurse Jeidy is evaluating a 59 year old male patient who presents to the emergency department with a chief complaint of intermittent chest pain. He described the pain as pressure-like, with episodes occurring at rest, often during the early morning hours, lasting about 20 minutes requiring multiple doses of nitroglycerin. During one episode, his ECG demonstrates transient ST-segment elevation on ECG with cardiac enzymes within the normal limits.

Based on the Nurse Jeidy’s assessment, which type of angina is most likely suspected?
A. Preinfarction Angina
B. Crescendo Angina
C. Vasospastic Angina
D. Intractable Angina

Ratio: called as variant angina
A & B — unstable —> increased frequency; not relieved by rest or meds.
D. Difficult to manage — chronic, not responding to meds

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Which of the following clinical findings would most clearly distinguish preinfarction angina from stable angina?
A. Chest pain lasting more than 20 minutes at rest with increased frequency
B. Chest pain reproducibly triggered by physical exertion
C. Chest pain relieved within 5 minutes of nitroglycerin administration
D. Absence of troponin elevation, despite chest pain

Ratio:
B&C: stable angina
D. Not related to angina

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Nurse Jeidy notes inconsistent response to nitroglycerin. Which data point should she prioritize to determine the underlying cause of this inconsistency?
A. Patient’s adherence to prescribed medication timing and storage conditions
B. Frequency and duration of angina episodes prior to
C. Patient’s level of anxiety and emotional triggers during angina episodes
D. Presence of other comorbid conditions

Ratio: Nitroglycerin— (1) original container —> dark, tight cap
(2) protective from heat
(3) room temp
(4) check expiration date

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Nurse Jeidy is evaluating another patient who reports chest pain when walking more than 2 blocks on level ground, with marker limitation of activity. Based on the Canadian Cardiovascular Society (CCS) classification, which angina class best describes this patient’s condition?
A. Class I
B. Class II
C. Class III
D. Class IV

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Situation: Nurse Will is working in a telemetry unit at Joel Linga Hospital, monitoring multiple high risk cardiovascular patients, His responsibilities include interpreting 12 lead ECGs, responding to telemetry alerts, and managing patients with both acute and chronic cardiac arrhythmias.

One of Nurse Will’s patients is a 60-year-old adult with a heart rate of 48 bpm. The ECG shows a regular rhythm, normal P waves before each QRS complex, a PR interval of 0.16 seconds, and a normal QRS duration. The patient reports. dizziness and lightheadedness. Which of the following best describes this rhythm and the appropriate nursing action?
A. Atrial fibrillation, provide oxygen therapy
B. Supraventricular Tachycardia, provide vagal stimulation and administer Adenosine (Adenocard)
C. Normal sinus rhythm with physiological QRS and T
wave changes, continue routine monitoring
D. Sinus bradycardia, administer atropine 0.5 to 1.0 mg to block vagal stimulation

Ratio: if it blocked it will increase our heart rate

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The patient’s PR interval comprises of seven small boxes on the ECG graph. What does the this indicates?
A. A normal finding
B. A problem with ventricular depolarization
C. A disturbance in the repolarization of the atria
D. A problem with conduction from the SA node to the ventricular cells

Ratio: delayed conduction SA — first degree blocked
1 small box = 0.04 secs.
7 x 0.04 =0.28 0.28 secs
Normal PR INTERVAL: 0.12- 0.20
Ratio: we have a prolonged PR interval
B. QRS Complex
C. T wave

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A 73 year-old male with a history of ischemic heart disease now presents with palpitations and mild shortness of breath. A telemetry strip reveals a narrow QRS tachyarrhythmia with a ventricular rate of 150 bpm. The rhythm is regular, and sawtooth-like waves are noted between QRS complexes especially visible in leads II, III, and aVF. Blood pressure is 124/78 mmHg, and the patient is alert. Which of the following is the most appropriate initial intervention?
A. Immediate synchronized cardioversion at 300 J
B. Administration of IV amiodarone to chemically cardiovert the rhythm
C. Initiate rate control with IV diltiazem to slow. AV conduction
D. Administer adenosine rapid IV push and call the physician

Ratio: sawtooth- like waves — Atrial Flutter
Stability:
* Stable Atrial Flutter —> goal is to control the rate—> slow AV conduction by giving (CCB)/diltiazem
- BP is normal
- Pt awake
* Unstable Atrial Flutter —> cardioversion
-hypotension
- chest pain
- pulmonary edema
- ALOC

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A 58-year-old patient is also being monitored. The ECG reveals that the P waves precede each QRS complex until one P wave is not followed by a QRS, PR intervals progressively lengthen with each beat until a beat is dropped, The ORS complex is narrow and normal in shape. Which of the following best described this cardiac rhythm?
A. First Degree AV Block
B. Second Degree AV Block, Type I
e. Second Degree AV Block, Type II
D. Third Degree AV Block

Ratio:
A. PR is prolonged, no beat
C. PR interval is constant, sudden drop of QRS
D. NO RELATIONSHIP of P and QRS waves

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A 48-year-old female complaints of intermittent chest discomfort during exertion. She requests an ECG for evaluation. Which of the following ECG findings most specifically suggests ongoing myocardial ischemia rather than infarction or other cardiac pathology?

A. Development of pathologic Q waves in leads II, III, and aVF
B. T wave inversion in contiguous leads during a pain episode
C. Persistent ST segment elevation in anterior leads D.
Widened QRS complex greater than 120 ms with bundle branch block pattern

Ratio: Ongoing MI
A. Prior infarction or old MI
C. Indication of acute MI
D. Conduction abnormality

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While on his way home from Joel Linga Hospital, Nurse Will notices a middle aged man unconscious on the sidewalk. The man is unresponsive, pulseless, and apneic. Nurse Will initiates CPR. According to the latest AHA Basic Life Support (BLS) guidelines, which of the following best describes the correct quality of chest compressions for this adult victim?
A. Push hard and fast, compressing at least 50 mm at a rate of 100-120 compressions per minute
B. Push hard and fast, compressing at least 50 in at a rate of 100-120 compressions per minute
C. Push hard and fast, compressing at least 2.5 cm at a rate of 80-100 compressions per minute
D. Push hard and fast, compressing at least 2.5 in at a rate of 80-100 compressions per minute

Ratio: its should be 2 inches

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Emergency Rescue arrives and connects the unconscious male to the cardiac monitor, which reveals an extremely irregular rhythm with no discernible QRS complexes and a ventricular rate exceeding 300 beats per minute. Which of the following best describes the underlying cardiac event and the most appropriate immediate management?
A. Ventricular fibrillation; initiate immediate defibrillation and activate emergency services.
B. Ventricular tachycardia; administer intravenous beta-blockers and observe.
C. Asystole; begin immediate cardiopulmonary resuscitation (CPR) and prepare for transcutaneous pacing.
D. Atrial fibrillation with rapid ventricular response; control ventricular rate with calcium channel blockers.

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Situation: Franz is a 64 year old male with history of chronic hypertension was admitted after reporting persistent pulsating sensation in his abdomen. His blood pressure is 180/100 mmHg, placing him at increased risk for rupture. After an emergency endovascular repair, Nurse Glen monitors him post operatively.

Franz is at risk for compromised circulation. Which physiological mechanism ensures that blood flows unidirectionally through the cardiovascular system?
A. Sympathetic vasomotor tone
B. Resistance gradients in tissues
C. Pressure difference between arteries and veins
D. Gravity-assisted circulation

Ratio: higher pressure at the arteries and lower pressure at the veins.

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In normal cardiovascular physiology, which of the following best describes how fluid moves across the capillary walls?
A. Hydrostatic pressure at the venous end of the capillary pushes fluid into the surrounding tissues
B. Osmotic pressure at the arterial end overcomes hydrostatic pressure, pulling fluid back into the capillary
C. Hydrostatic pressure at the arterial end pushes fluid out into the tissues, while osmotic pressure at the venous end pulls fluid back into the capillary
D. Capillary permeability is the only factor that affects movement of fluid between the capillaries and the tissues

Ratio: Hydrostatic Pressure—> pushing force
Osmotic pressure—> pulling pressure

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Following endovascular repair of his abdominal aortic aneurysm, Franz develops localized vasospasm near the graft site, increasing vascular resistance. If arterial pressure remains unchanged, what is the most likely. impact on regional blood flow to surrounding tissues?
A. Flow increases
B. Flow decreases
C. Flow remains unchanged
D. Flow reverses direction

Ratio: increased vascular resistance—> the blood vessels are narrowed.

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Based on Poiseuille’s law, which of the following has the most significant impact on vascular resistance within the circulatory system?
A. Blood vessel length.
B. Blood vessel radius.
C. Blood viscosity
D. Arterial pressure.

Ratio: because vasoconstriction can affect our blood flow that can cause in decreased in the blood flow.

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Which of the following is an inaccurate nursing intervention post operatively for Franz?
A. Limit elevation of the head of the bed to 45 degrees
B. Evaluate intake and urinary output every hour for signs of renal perfusion compromise
C. Inspect the abdominal incision site regularly for erythema and local infection
D. Assess peripheral pulses proximal to the graft site

Ratio: it should be distal not proximal to the graft site —> adequate perfusion of blood.

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Which of the following clinical signs or symptoms would be least consistent with an unruptured abdominal aortic aneurysm and may suggest an alternative diagnosis? A. A pulsatile, midline abdominal mass palpable on deep palpation B. A systolic bruit auscultated over the periumbilical area C. Hyperactive bowel sounds in all quadrants D. A subjective sensation of a "pounding heartbeat" in the abdomen while lying down

C. Ratio: GIT Issue (diarrhea, bowel obstruction) possible of dumpling syndrome

Which of the following best explains the underlying structural abnormality present in all types of aneurysms, regardless of their cause? A. Degeneration of the tunica media layer B. Thickening of the intima due to atherosclerosis C. Loss of endothelial cell integrity in the tunica adventitia D. Calcification of the arterial wall causing rigidity

A. Ratio: the tunica media is elastic — weakened—> dilation

Cardiovascular risk increases with cigarette smoking. Franz, a chain smoker, reports that he has been smoking 5 cigarette sticks per day for 6 years, and 10 sticks per days for 2 years. Compute for the pack years. A. 2 year and 3 months B. 2 years and 6 months C. 3 years and 9 months D. 3 years and 1 month

B. Computation: For 6 years: (5 sticks / 20 sticks) x 6 years = 1.5 pack years For 2 years: (10 sticks / 20 sticks) x 2 years = 1 pack (1.5 pack years + 1 pack year) = 2.5 pack years

RHEUMATIC FEVER/ RHEUMATIC HEART DISEASE Situation: Mara is an 8 year old with a history of partially treated streptococcal pharyngitis, presents with low grade fever, tachypnea, and polyarthritis involving large joints. On physical exam, erythema marginatum and small, painless nodules are noted over her elbows and knees. Laboratory tests reveal elevated erythrocyte sedimentation rate (ESR), positive C-reactive protein (CRP), and an elevated anti-streptolysin O (ASO) titer. The following does not meet the criteria for the diagnosis of acute rheumatic fever A. Polyarthritis, erythema marginatum, elevated ASO titer B. Fever, polyarthralgia, elevated ASO titer, prolonged PR interval C. Subcutaneous nodules, erythema marginatum, elevated CRP D. Tachypnea, low-grade fever, positive throat culture for Group A streptococcus

D. Ratio: Jones criteria = 2 major signs , 1 major signs + 2 minor

Maria is now exhibiting involuntary, irregular, jerking movement of the face and extremities. Which of the following is the most appropriate immediate intervention? A. Place the patient in a semi Fowlers position and notify the physician. B. Administer corticosteroid to reduce inflammation. C. Initiate seizure precautions D. Reassure the family that it is temporary, then notify the physician

C. Ratio: involuntary movements or chorea— risk for injury/ falls

Which of the following nursing actions is the priority to prevent cardiac complications? A. Emphasize the importance of strict compliance with prescribed antibiotics, even if symptoms improve B. Encourage the client to maintain a low-fat diet to reduce inflammation C. Teach the family that anti-inflammatory medications are only needed if fever recurs D. Advise the client to limit physical activity permanently to avoid heart damage

Which finding most strongly would strongly indicate the development of rheumatic heart disease? A. New systolic murmur detected on auscultation B. Additional elevation of ASO titer and CRP levels C. Presence of erythema marginatum D. Migratory polyarthritis involving large joints and small joints

A. Ratio: heart involvement B. Inflammation C. Skin D. Joint

Situation: Aris, a 23-vear-old female, is admitted with complaints of progressive fatique, dizziness upon standing, and shortness of breath on exertion. Her labs reveal a hemoglobin level of 7.5 g/dL, hematocrit of 23%, and serum iron below normal. She reports frequently skipping meals frequently due to intensive studying for the Philippine Nursing Licensure Exam Based on current presentation and labs, which nursing diagnosis should take the highest priority? A. Risk for cardiopulmonary compromise related to severely decreased hemoglobin levels B. Imbalanced nutrition: less than body requirements related to iron deficiency C. Fatigue related to metabolic demands of the body and diminished red blood cell count D. Ineffective tissue perfusion related to reduced oxygen carrying capacity of the blood

D. Ratio: need oxygen

Aris becomes increasingly confused and unsteady on her feet during ambulation. What is the priority nursing intervention for this patient? A. Keep bedside rails up and call bell in close reach B. Provide a darkened, quiet room C. Have the family stay with the patient, then notify the physician D. Question the patient about possible causes of anemia

A. Ratio: at risk for fall, priority: safety

During a focused physical assessment of Aris, who has now confirmed severe anemia, which finding is of the most concern to the nurse? A. Anorexia. B. Bone pain C. Hepatomegaly D. Dyspnea at rest

D. Ratio: severe hypoxia

Aris is also suspected to have pernicious anemia due to chronic nutritional deficiency and plans to confirm it using Schilling's test. Which specimen should the nurse prepare to collect A. 24 - hour urine specimen B. B Blood by venipuncture C. Stool Specimen D. Arterial Blood Gas

A. Ratio: Schilling’s test —> Oral Vit. B12 —> absorbed by body —> excreted through urine

Situation: Martina is admitted with bruising, bleeding gums, and heavy menstrual flow. Her labs show platelet count of 35,000/mm3, and she's diagnosed with Idiopathic Thrombocytopenic Purpura (ITP). 36. Nurse Precious is caring for Martina. Which of the following findings requires immediate intervention? A. Petechiae on the legs B. Bleeding gums after brushing C. Platelet count of 34,000/mm D. New onset confusion and headache

D. Ratio: confusion (ALOC —> hemorrhage) —> Intraventricular hemorrhage

Which of the following patients is at greatest risk for Martina s condition A. A patient with chronic liver disease and portal hypertension B. A patient receiving erythropoietin therapy C. A patient with hypercalcemia D. A patient on diuretics for heart failure

A. Ratio: decrease clotting factor (Prothrombin) Portal hypertension— Splenic sequestration—> platelets trap in spleen

A platelet transfusion is ordered for Martina. Nurse Precious should question this order under which condition? A. The patient has active GI bleeding B. The platelet count is 4,000/mm3 with no active bleeding C. The thrombocytopenia is due to ITP D. The patient is pre-op for emergency appendectomy

C. Ratio: ITP- autoimmune disease- destroys platelets

Nurse Precious reviews Martina's bone marrow biopsy. Which finding would be most expected in chronic ITP? A. Decreased megakaryocytes B. Increase megakaryocytes C. Increased lymphocytes D. Decreased reticulocytes

B. Ratio: production of platelets

Martina is being closely monitored. Which action is most important for the nurse to implement? A. Administering blood products as indicated to manage bleeding B. Limiting patient's ambulatory activities C. Removing oral crusting and scabs with a soft brush q8h D. Monitoring the patient for headaches, vertigo, or confusion

D. Ratio: headache, vertigo or confusion is a sign of intraventricular hemorrhage intracranial bleeding

While receiving a unit of packed RBCs, Martina develops chills and backache. Nurse Precious notes chest rash. Which of the following is an incorrect intervention? A. Returns blood bag, tubing, attached labels, and transfusion record to the nurse's station B. Changes the IV tubing but keeps the IV line open with normal saline C. Stops the transfusion immediately D. Prepare to administer emergency medications as prescribed, and performs cardiopulmonary resuscitation if needed

Martina has a platelet count of 50,000/pL. What initial treatment should Nurse Precious anticipate? A. Splenectomy B. Corticosteroids C. Administration of platelets D. Immunosuppressive therapy

B. Ratio: caused of immunosuppression —> increase production of platelets

Nurse Precious is preparing Martina for a splenectomy. Which statement should be included in the pre-op teaching? A. "You will need to take aspirin daily to reduce clot risk” B. "You must receive certain vaccines at least 2-3 weeks before surgery." C. "You will not need any follow-up after the surgery." D. "This surgery guarantees a cure from ITP."

B Ratio: No spleen —> risk for sepsis Spleen is important it traps the bacteria

Martina asks, "Why can't I take ibuprofen for my joint pain?" What is Nurse Precious' best response? "Ibuprofen will cause your spleen to enlarge." B. "It can cause your platelet count to increase too quickly “ C. "Ibuprofen interferes with platelet function and increases bleeding risk." D. "It has no effect on platelets, but can lower your hemoglobin”

C. Ratio: taking NSAIDs inhibits platelets functions

After splenectomy, which lab result would Nurse Precious expect to find in Martina? A. Decreased RBCS B. Decreased WBCs C. Increased platelets D. Increased immunoglobulins

Situation: You are a nurse caring for a 198 lbs, patient who presents with sudden onset dysprea, chest pain, and hemoptysis. The patient has a history of recent total hip arthroplasty and prolonged immobility due to a long flight. The healthcare team suspects a massive pulmonary embolism. Which of the following is most likely to occur as a result of thrombus obstructing a pulmonary artery or its branches in this. patient? A. Increased pulmonary vascular resistance and right ventricular strain B. Decreased alveolar dead space and improved gas exchange C. Reduced pulmonary arterial pressure and enhanced right ventricular performance D. Decreased systemic blood pressure and reduced right ventricular workload

A. Ratio: increase work load

What should be your initial treatment for the patient with suspected pulmonary embolism? A. Administer intravenous antibiotics B. Administer supplemental oxygen C. Start immediate anticoagulation therapy D. Perform chest physiotherapy as indicated

Which of the following is the primary goal in the emergency management of massive pulmonary embolism (PE)? A. To reduce pulmonary vascular resistance and decrease systemic blood pressure B. To stabilize the cardiopulmonary system C. To increase heart rate and cardiac output to enhance circulation D. To correct metabolic acidosis in order to address hypoxemia

B. Priority: to maintain the oxygenation and perfusion

The patient is experiencing pleuritic chest pain. Which of the following nursing interventions is most appropriate to improve the natient's comfort and respiratory function? A. Administer supplemental oxygen and encourage deep breathing exercises B. Position the patient in a flat, supine position to reduce respiratory distress C. Provide a semi-Fowler's position and encourage frequent repositioning D. Limit patient movement to avoid exacerbating pain and discomfort

C. Ratio: it promotes lung expansion

The patient with massive PE now requires a slow infusion of dobutamine (Dobutrex) to manage hypotension. The recommended dosage for dobutamine is 2.5 to 10 mcg/kg/min. The desired infusion rate - 5 mcg/kg/min. How many milligrams of dobutamine should you administered per A. 0.25 mg of dobutamine per minute B. 0. 35 mg of dobutamine per minute C. 0. 45 mg of dobutamine per minute D. 0. 55 mg of dobutamine per minute

C. Computation: Convert lbs—> kg = 198 lbs —> 90 kg Formula: Dose in mg/ min= (dose in mcg/kg/min x wt in kg) / 1000 = 5 mcg/kg/min x 90) = 450 mcg/min = 450 mcg/ min / 1000 = 0.45 mg/min

Situation: Keila, a patient in the ICU, was intubated and placed on mechanical ventilation. As her condition improved, the ventilator settings were gradually adjusted based on her ABG results and spontaneous breathing effort. You are the ICU nurse assigned to monitor her respiratory status and ventilator support. You review Keila's ventilator waveform and note that the airway pressure never returns to zero at end-expiration. She is breathing spontaneously, and there are no mandatory breaths delivered. What mode is being used? A. Controlled Mechanical Ventilation (CMV) B. Assist-Control Ventilation (A/C) C. Pressure Support Ventilation (PS) D. Continuous Positive Airway Pressure (CPAP)

The physician adjusts the ventilator to deliver a set number of breaths, but allows Keila to take spontaneous breaths of varying volumes in between. What ventilator mode is now A. Pressure Support Ventilation (PS) B. Assist-Control Ventilation (A/C) C. Synchronized Intermittent Mandatory Ventilation (SIMV) D. Continuous Positive Airway Pressure (CPAP)

During a critical event earlier in her ICU stay, Keila was deeply sedated and unable to initiate spontaneous breaths. All her breaths were preset and machine-delivered, with no ability to trigger the ventilator. What mode was most likely used during this time? A. Assist Control Ventilation (A/C) B. Synchronized Intermittent Mandatory Ventilation (SIMV) C. Pressure Support, Ventilation (PS) D. Controlled Mechanical Ventilation (CMV)

Keila is being evaluated for weaning from mechanical ventilation. Which of the following values indicates she meets the vital capacity requirement for weaning? A. 8 mL/kg B. 12 mL/kg C. 18 mL/kg D. 20 mL/kg

You are tasked to assess Keila's readiness to wean using Rapid Shallow Breathing Index, calculate her RSBI given respiratory rate of 33 breaths per minute, and tidal volume of 8 ml/kg. She weighs 121 lbs. A. 75 breaths/ min/L B. 85 breaths/ min/L C. 95 breaths/ min/L D. 100 breaths/ min/L

Based on Keila's calculated Rapid Shallow Breathing Index (RSBI) of 75, how should the nurse Interpret this finding? A. Indicates readiness for successful weaning B. Suggests high risk for weaning failure C. Inconclusive; additional tests required D. Requires continued monitoring before proceeding

Another patient, Sab, has been successfully weaned from mechanical ventilation and is now being weaned from oxygen. Which of the following arterial blood gas (ABG) findings would indicate that the patient requires supplemental oxygen while on room air? A. Pa02 = 80 mm Hg B. PaO2 = 95 mm Hg C. Pa02 = 68 mm Hg D. Pa02 = 102 mm Hg

You are now caring for a patient with an endotracheal tube (ETT). It is important to monitor cuff pressure to prevent complications. Which of the following is the correct frequency and pressure range for cuff monitoring? A. Check cuff pressure every 24 hours and maintain pressure between 10-15 mm Hg B. Check cuff pressure every 8 to 12 hours and maintain pressure between 20 to 25 mm Hg C. Check cuff pressure every 4 hours and maintain pressure between 15 to 20 mm Hg D. Check cuff pressure every 12 to 24 hours and maintain pressure between 30 to 35 mm Hg

Which of the following is the primary risk associated with high cuff pressure in an endotracheal tube? A. Increased risk of aspiration pneumonia B. Tracheal bleeding, ischemia, and pressure necrosis C. Improved ventilation and oxygenation D. Increased risk of hypoxia and aspiration

What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper A. A tracheostomy is easier and safer to perform in emergencies B. An endotracheal tube causes more damage to the trachea over time. C. A tracheostomy provides better comfort and allows increased mobility. D. An endotracheal tube increases the risk of lung infections.

Situation: Nurse Mika is assigned to care for a patients in the Dialysis Unit. The physician ordered immediate hemodialysis to some patients. Which statement best describes the primary function of the dialyzer during hemodialysis? A. It increases urine output by stimulating renal tubules. B. It promotes red blood cell production by filtering erythropoietin. C. It filters waste products, excess fluids, and electrolytes across a semipermeable membrane. D. It directly replaces nephrons to restore full kidney function.

A patient undergoing hemodialysis is noted to have a gradual decline in serum urea levels. Which physiologic principle best explains the mechanism by which urea is cleared from the bloodstream during dialysis? A. Osmosis through a high solute concentration in the dialysate B. Diffusion along a concentration gradient from blood to dialysate C. Ultrafiltration driven by blood hydrostatic pressure D. Active transport of urea via carrier proteins across the dialyzer membrane

One patient asked Nurse Mika "How do doctors determine how advanced my kidney problem is?" Which of the following should the nurse emphasize as the most accurate indicator of CKD Staging. A. The amount of urine passed over 24 hours B. The estimated glomerular filtration rate (eGFR) C. The presence of neurologic changes such as confusion or irritability D. The combined levels of serum creatinine and blood urea nitrogen (BUN)

A patient has an estimated glomerular filtration rate (eGFR) of 42 mL/min/1.73 m2. Based on this value, how should the nurse classify the stage of chronic kidney disease (CKD)? A. Stage 2 B. Stage 3a C. Stage 3b D. Stage 4

During dialysis, what best describes the principle of osmosis as it contributes to fluid balance? A. Movement of water toward an area with higher solute concentration across a semipermeable membrane B Passive movement of solutes like potassium and sodium into the bloodstream C. Active removal of fluid driven by solute concentration in the dialysate D. Hydrostatic pressure forces solutes from blood to dialysate to maintain equilibrium

What best explains ultrafiltration during hemodialysis? A. Solute diffusion through a semipermeable membrane to achieve electrolyte balance B. Fluid movement from dialysate into the bloodstream due to osmotic gradient C. Movement of fluid across a semipermeable membrane due to a pressure gradient D. Active pumping of electrolytes from blood to dialysate

Situation: As part of the interdisciplinary team, Nurse Mika is assigned to monitor a critically ill patient undergoing Continuous Renal Replacement Therapy (CRRT). Which statement best describes Continuous Arteriovenous Hemofiltration (CAVH)? A. It filters only fluid, not solutes, using the patients arterial pressure. B. It requires a blood pump to circulate blood through the dialyzer. C. It uses venous pressure to create a filtration gradient. D. It eliminates solutes by using a dialysate concentration gradient.

What advantage does Continuous Arteriovenous Hemodialysis (CAVHD) have over CAVH? A. It eliminates the need for a hemofilter. B. It uses a blood pump for better pressure control. C. It allows for solute removal using a concentration gradient via dialysate. D. It does not require arterial or venous access.

What is a key benefit of Continuous Venovenous Hemofiltration (CWH) compared to CAVH? A. It uses the arterial system for blood pressure generation. B. B It does not require arterial access and is better tolerated hemodynamically. C. It removes toxins more rapidly due to dialysate use. D. It must be initiated by dialysis staff, not nurses.

In Continuous Venovenous Hemodialysis (CVVHD), how are solutes such as urea removed from the patient's blood? A. Through pressure gradient only B. By osmosis through the dialyzer membrane C. By using a dialysate to create a concentration gradient D. Through ultrafiltration only

The patient receiving hemodialysis through a left forearm arteriovenous fistula complains of coldness, numbness, and decreased sensation in the left hand. On assessment, the Nurse Mika notes pallor and a diminished radial pulse. Which complication does the nurse most strongly suspect? A. Venous thrombosis related to poor outflow from the fistula B. Arterial steal syndrome due to diversion of blood flow from the distal extremity C. Infection of the fistula site resulting in peripheral vascular compromise D. Compartment syndrome from fluid infiltration around the access site.

The patient with acute kidney injury is considering now whether to use peritoneal dialysis (PD). Which statement accurately describes the mechanism of peritoneal dialysis (PD)? A. The dialyzer acts as a membrane for ultrafiltration of blood B. A PD catheter filters blood directly through the abdominal wall C. The peritoneum acts as a semipermeable membrane that allows solutes and fluid to move into the dialysate D. The kidneys are bypassed by infusing heparin directly into the bloodstream.

Which of the following is a contraindication for peritoneal dialysis? A. Peritonitis B. Diabetes mellitus C. Controlled hypertension D. Peritonitis E. Chronic anemia

What is the preferred site for PD catheter insertion and why? A. 3 to 5 in on the upper right quadrant; close to liver for vascular access B. 3 to 5 cm below the umbilicus; avascular and less fascial resistance C. 4 to 6 cm above the right flank; avascular and easier access for emergency insertion D. Directly over the umbilicus; best drainage angle and less fascial resistance

What is the function of the Dacron cuffs used in PD catheter placement? A. To minimize peritoneal backflow by sealing the membrane lining the abdominal cavity B. To anchor the catheter subcutaneously, allowing fibrous tissue ingrowth that helps prevent infection C. To enhance dialysate dispersion by increasing intraperitoneal surface tension D. To regulate intraperitoneal pressure and fluid inflow through a manual access valve

What is the effect of increasing the glucose concentration in the dialysate solution during peritoneal dialysis? A. It increases osmotic pull by decreasing effective solute load in the peritoneal cavity. B. It increases oncotic pressure, enhancing fluid shift into the dialysate C. It creates hypotonic environment, increasing fluid shift from capillaries into the dialysate. D. It increases osmotic pressure, enhancing fluid shift into the dialysate

One infusion or fill, dwell, and drain is considered one exchange cycle in peritoneal dialysis. Which statement best explains why the nurse should avoid extending the dwell time beyond the prescribed limit? A. Prolonged dwell time reduces dialysate absorption, causing hypotension. B. Extending dwell time improves clearance of toxins but delays fluid removal. C. Longer dwell time increases the risk of dialysate leakage and herniation D. Excessive dwell time allows more glucose absorption increasing the risk for hyperglycemia.

A nurse is caring for a patient on peritoneal dialysis. During the exchange, the nurse notes that the dialysate outflow is brown in color. Which of the following complications should the nurse suspect? A. Vascular Access Injury B. Peritonitis C. Bladder perforation D. Bowel perforation

A patient undergoing peritoneal dialysis reports abdominal discomfort. The nurse inspects the dialysate outflow and notes that it appears cloudy with a yellowish tinge. Which of the following assessments should take highest priority? A. Ask the patient if they have had any recent urinary tract symptoms B. Assess for signs of bladder distention or hematuria C. Monitor vital signs and assess for rebound tenderness D. Document the outflow and reassure the patient this is a normal finding

A patient undergoing peritoneal dialysis (PD) for acute kidney injury suddenly develops tachycardia, hypotension, and decreased urine output. Which of the following is the most Tikely cause of these findings? A. Hyperkalemia due to insufficient potassium clearance during dialysis B. Peritonitis leading to systemic infection and inflammatory response C. Dialysate leakage causing abdominal discomfort and local fluid shift D. Hypovolemia resulting from excessive ultrafiltration during PD

Situation: Nurse Jem is caring for several patients admitted for renal calculi. As part of her responsibilities, she assess pain symptoms, reviews imaging findings, and provides dietary, pharmacologic, and hydration guidance as part of discharge education. While assessing a patient currently passing a renal calculus through the ureter, which symptom should Nurse Jem expect the patient to describe? A. A long-standing history of urinary tract infections B. Dull flank pain localized to the costovertebral area C. Intense, colicky pain radiating from the back to the groin D. Bladder fullness accompanied by urinary urgency and frequency

One of Nurse Jem's patients reports flank pain and visible blood in the urine. Imaging shows a radiopaque stone in the proximal ureter. Based on prevalence and clinical characteristics, which type of stone is most likely? A. Cystine stones B. Calcium oxalate stones C. Uric acid stones D. Calcium phosphate stones

Nurse Jem is reviewing the chart of a 36-year-old female patient who presents with intermittent flank pain, low-grade fever, and dysuria. Imaging shows a large renal calculus occupying much of the renal pelvis. Urinalysis reveals alkaline pH, and the urine culture is positive. The patient is also overweight. Which type of stone is most likely involved? A. Cystine stone B. Struvite stone C. Uric acid stone D. Calcium phosphate stone

During discharge teaching, Nurse Jem is counseling Mr. Bim, recently treated for calcium oxalate stones. Which advice best reflects current dietary recommendations for preventing recurrence? A. Strictly avoid calcium-containing foods B. Increase sodium intake to dilute urinary crystals C. Maintain adequate calcium intake and limit sodium and animal protein D. Increase intake of oxalate reach food such as spinach and rhubarb to aid digestion

Situation: A set of nurses is caring for patients with oncologic conditions. The following questions apply. Which surgical approach is most appropriate for a woman with BRCA1 mutation and no evidence of malignancy? A. Curative surgery B. Palliative surgery C. Prophylactic surgery D. Cytoreductive surgery

A patient with thyroid cancer is treated with oral iodine-131. What best explains why the patient is a radiation hazard to others during this therapy? A. The isotope is sealed and embedded in tissue B. The radioactive material circulates in body fluids C. The radiation solely targets cancer cells D. The treatment uses low-energy alpha particles

Why is brachytherapy for real estate cancer considered immortal localized form of treatment compared to teletherapy? A. It delivers high doses to surrounding tissues. B. It uses high- penetrating gamma rays only C. It places radiation sources in direct contact with tumor D. It does not require radiation safety precautions

Why is radiation delivered in multiple small doses rather that one large dose? A. To ensure all normal cells are killed B. To activate the immune system C. To reduce the total radiation dose needed D. To maximize cancer cell kill while allowing normal tissue repair

A patient reports fatigue and aversion to red meat after teletherapy for breast cancer. What is the most likely cause? A. Hypoxia in irradiated tissues B. Metastasis to the gastrointestinal tract C. Radiation-induced liver enzyme activation D. Metabolites from dying cells altering taste and increasing energy demand

A patient receiving sealed brachytherapy asks if they can have visitors. What is the most appropriate response? A. "Yes, but only family over 18 should visit, and visits should be limited” B. "Yes, but you must be in isolation because your excreta are radioactive” C. "Yes, and you are safe to be around anyone since your body is sealed” D. "No visitors are allowed until all radiation is cleared from your body."

What is the main purpose of second-look surgery in oncology ? A. To confirm metastatic spread B. To assess residual disease after initial therapy C. To relieve obstruction or pain D. To debulk tumors in advanced cancer

During teletherapy, what principle explains the reduced radiation dose with increasing distance from the source? A. Attenuation coefficient B. Inverse square law C. Absorptive index D. Radiation decay constant

A patient is receiving intensity-modulated radiation therapy (IMRT). What advantage does this technique offer? A. It delivers a single high-dose beam to the tumor B. It implants radioactive material in the tumor C. It reduces radiation treatment sessions to one D. It divides the beam into many smaller beams to minimize healthy tissue damage

A patient receiving ondansetron reports dizziness upon standing. What is the most appropriate nursing intervention? A. Reassure the patient that this is expected and needs no action B. Encourage the patient to increase fluid intake to combat bradycardia C. Instruct the patient to change positions slowly to avoid falls D. Recommend discontinuation of the drug due to hypotension

A nurse prepares to give palonosetron 0.25 mg IV. When should it be administered for maximum efficacy? A. Immediately after chemotherapy B. 2 hours before chemotherapy C. At bedtime the night before chemotherapy D. As a single dose 30 minutes before chemotherapy

Which patient would most likely require an alternate form of birth control when receiving aprepitant? A. A male patient taking metoclopramide B. A postmenopausal woman receiving granisetron C. A premenopausal woman using oral contraceptives D. A female patient taking dexamethasone only

What is the most appropriate nursing instruction for a patient taking metoclopramide for CINV? A. Avoid driving and operating heavy machinery B. Take this medication on an empty stomach C. Report constipation immediately D. Take with antacids to enhance absorption

A patient receiving dexamethasone IV for nausea is experiencing hypertension. What is the mechanism behind this effect? A. Corticosteroids - included sodium retention B. Dopaminergic stimulation C. Blockade of histamine receptors D. Increased serotonin activity

99. Why is lorazepam particularly useful in managing anticipatory nausea in chemotherapy patients? A. It blocks serotonin receptors B. It directly affects the chemoreceptor trigger zone C. It enhances GABA activity D. It neutralizes gastric acid

What should the nurse monitor in a patient receiving aprepitant and warfarin concurrently? A. Serum potassium levels B. INR levels before and after therapy C. Liver enzyme elevation D. Onset of constipation

NP 3 Flashcards

(101 cards)