Rasmussen NUR2571 Final Exam (Respiratory/Cardiac) EXAM QUESTIONS AND VERIFIED DETAILED A, Exams of Nursing

Download Rasmussen NUR2571 Final Exam (Respiratory/Cardiac) EXAM QUESTIONS AND VERIFIED DETAILED A and more Exams Nursing in PDF only on Docsity! Rasmussen NUR2571 Final Exam (Respiratory/Cardiac) EXAM QUESTIONS AND VERIFIED DETAILED ANSWERS 100% COMPLETE GRADED A+ LATEST 2023-2024 1. A client admitted to the hospital has these arterial blood gas (ABG) results: pH 7.50; PaCO 2 PaCO2 40; HCO − 3 HCO3− 29. Which question should the nurse ask the client to help determine an etiology for these results? a. "Have you had diarrhea lately?" b. "Do you have a history of COPD?" c. "How long have you had nausea and vomiting?" d. "Do you smoke?" – ANS-Answer: C; ABG results reflect elevated pH, indicating alkalosis, and normal PaCO 2 PaCO2 and an increased HCO − 3 , HCO3−, indicating metabolic alkalosis. Vomiting is a common cause of this condition. The presence of diarrhea is associated with metabolic acidosis. COPD is associated with respiratory acidosis. Smoking can be associated with respiratory acidosis if it leads to respiratory disease. 2. A client asks the nurse why beclomethasone was prescribed for his chronic obstructive pulmonary disease (COPD). Which statement by the nurse is most appropriate? a. "Beclomethasone prevents airway dilation." b. "Beclomethasone decreases inflammation, and makes it easier to breathe." c. "Beclomethasone suppresses the immune response." d. "Beclomethasone decreases responsiveness to medications that dilate the airway." – ANS- Answer: B; Beclomethasone is an inhaled corticosteroid that is thought to decrease inflammation and dilate the airway. Preventing airway dilation is undesirable for this client, and the exact opposite action of beclomethasone. The exact mechanism of action is unknown. Beclomethasone, like any other corticosteroid, does suppress the immune response, but this is not the rationale for administration of the medication. Inhaled corticosteroids are thought to increase responsiveness of bronchial smooth muscle to beta-agonist drugs. 3.A client is hospitalized with a diagnosis of pneumonia. Which findings, based on the nurse's knowledge, are indicative of a deteriorating clinical state? Select all that apply. a. Increased respiratory rate b. Tachycardia c. Agitation d. Cyanosis e. Increased urinary output – ANS- Answer: A, B, C, D; Increased respiratory rate, tachycardia, and agitation are early signs of respiratory distress, and can be interpreted by the nurse as deteriorating clinical state. Cyanosis develops later in the progression of respiratory distress, but is still an indication of client deterioration. Increased urinary output is the opposite of what the nurse would expect in a client with respiratory distress whose condition is deteriorating. 4.A client is scheduled for a partial nephrectomy. In teaching the client about postoperative care, the nurse uses which rationale to explain why aggressive measures are needed to prevent atelectasis and pneumonia? a. Nephrectomy involves paralyzing the intercostal muscles. b. Intraoperative surgical contamination of the pulmonary structures is unavoidable. c. The client must be maintained in a flat position for 24 hours. d. The surgery involves an upper abdominal or flank incision. – ANS Answer: D; The proximity of the incision to the muscles involved in breathing and coughing makes the client breathe shallowly and avoid coughing because of the fear of pain. This can lead to atelectasis and pneumonia. The intercostal muscles are not paralyzed by nephrectomy. Pulmonary structures are not contaminated during surgery. The client should be turned and repositioned to reduce the risk of atelectasis and pneumonia. There is no need to lie flat for 24 hours. 5.A client reports nervousness and tremors after beginning drug therapy with salmeterol. Which statement by the nurse is most appropriate? a. "The symptoms are common at first, but decrease over time." b. "Stop taking the medicine because the symptoms will only get worse." c. "Drinking coffee or tea will help decrease the symptoms." d. "Those symptoms indicate a worsening of the disease process." - ANSAnswer: A; Nervousness and tremors might be experienced when salmeterol (a beta-agonist) is newly administered, but they frequently decrease over time. Clients should not terminate medication use without consulting the prescriber. Caffeine would exacerbate the problem. The symptoms are likely related to the medication, and not to the disease process. 6.A client with asthma has a sudden decrease in wheezes.... What does this indicate? - ANSAirways are closing and causing diminished breath sounds. Less ventilation is able to occur. This is NOT good! 7.A client with tuberculosis asks the nurse if visitors will need to wear masks. What response by the nurse is most accurate? a. "Everyone who enters your room must wear a mask to protect themselves from tuberculosis." b. "Masks would not be necessary for visitors who have had tuberculosis before." c. "It is less important for your family to wear masks, since they live in close contact with you." d. "Only visitors who are at risk for tuberculosis need to wear a mask." - ANSAnswer: A; Tuberculosis is highly contagious and spread by inhalation of airborne droplets. Airborne precautions would be initiated, requiring everyone to wear a special particulate respirator fit- tested mask. Individuals who have had tuberculosis in the past can be re-exposed and develop the active form of the disease again. It is just as important for family to wear the appropriate type of mask. The need to wear masks applies to all visitors, not just those at risk for developing tuberculosis. *Decrease BP and HR *Orthostatic hypotension *Contraindicated in clients with asthma/COPD 21.Blood Flow Through the Heart - ANSSVC --> Rt atria --> Tricuspid --> Rt ventricle --> Pulmonic valve --> Lungs --> Lt atria --> Mitral valve --> Lt ventricle --> Aortic valve --> Aorta --> Body 22.Calcium Channel Blockers – ANS-Verapemil Amlodipine Diltiazem *Suppress renin activity *Decrease HR and BP * May affect blood glucose' *Orthostatic hypotension *Preferred choice for black clients 23.CAP, HAP, and VAP? - What are they? Hint: Related to pneumonia acquisition. – ANS-Community Acquired Pneumonia Hospital Acquired Pneumonia Ventilator Acquired Pneumonia - To prevent VAP, mouth care is essential!! 24. COPD – ANS-Chronic Obstructive Pulmonary Disease. Inflammatory lung disease. Results be chronic exposure to irritants such as smoke, pollution, etc. 25. COPD (Patient Education) – ANS-Teach deep breathing techniques and diaphragmatic breathing. Educate patient on O2 safety in the home. - Watch for frayed wires - Do not smoke near oxygen tank - Keep oxygen tank away from extreme heat. (Ovens, heaters, etc.) Receive flu vaccinations to avoid respiratory infection complications. 26.COPD (S/S) - ANSBarrel chest Dyspnea on exertion Activity intolerance Clubbing of the fingers Chronic cough with sputum Diminished breath sounds 27.COPD ABGs - ANSpH ↓ PaO2 ↓ PaCO2⬆ HCO3 ⬆ COPD O2 Saturation Goal - ANSCOPD patients should maintain an O2 of at least 88% Normal patients should be 95%-100% 28.Cor Pulmonale – ANS-Right sided heart failure in relation to COPD complication. Hypoxia Fatigue Enlarged liver Distended neck veins Dependent edema 29.Diastolic Heart Failure – ANS-Ineffective filling of left ventricle due to inability of ventricle to relax. Normal EF because contraction is not affected. Diuretics – ANS-Potassium-Sparing - Spironolactone *Do not consume extra potassium Loop - Furosemide *Monitor electrolytes, use salt substitutes. Thiazide - Hydrochlorothiazide *Monitor electrolytes, use salt substitutes. *These drugs can cause orthostatic hypotension Heart Failure (Nursing Interventions) - ANSAssess for fluid overload - Auscultate lung sounds Strice I/O - Foley? Daily weights - !kg = 1L Elevate HOB to facilitate breathing Administer prescribed medications Heart Failure (Patient Education) - ANSMonitor daily weight - Report increase of 3-5lbs Sodium restrictions Adjust potassium intake accordingly to type of diuretic. Pace physical activity to avoid exertion Heart Failure (Pharmacology) - ANSACEs ARBs Nitrates BABs Digitalis Aspirin therapy CCBs Hematocrit - ANSMale: 42-52% Female: 37-47% Hemoglobin - ANSMale: 14-18 Female: 12-16 Hemophilia (S/S) - ANSDebilitating joint pain Prolonged bleeding Excessive bleeding Hematoms Hematuria Hemophilia (Treatment/Education) - ANSTreatment is targeted at replacing clotting factors VIII or IX. Educate patient that they should wear an identification band. Hemophilia B - ANSFactor IX deficiency Hemophilia C - ANSFactor X deficiency Hemoplilia A - ANSFactor VIII Deficiency Homan's Sign - ANSPain in calf upon dorsiflexion of foot and may indicated thrombophlebitis. In not a rule out for DVT if negative. How are COPD and asthma diagnosed? - ANSPulmonary function tests. LABAs - ANSSameterol Formoterol Used as maintenance to prevent asthma attacks. Left Sided Heart Failure - ANSLeft = Lungs Damage to the left ventricle causes blood to pool resulting in pulmonary congestion. Left Sided HF (S/S) - Left is Lungs - ANSSOB Weak peripheral pulses Tachypnea Dyspnea - Respiratory acidosis Confusion Oliguria - Use heat therapy, NOT cold! Status Asthmaticus - ANSSevere asthma attack that does not respond to standard treatment. Medical emergency!! Systolic Heart Failure - ANSReduced ability of the heart to contract - Remember systolic = pressure generated during contraction. Results in low EF - Heart is not contracting so blood is not ejecting. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) how to administer multiple medications by inhalation. Which statement by the client indicates an understanding of the instruction? Select all that apply. a. "If my symptoms get worse, I can double my dosage." b. "I will wait at least 1 minute between use of my different inhalers." c. "I should consult my prescriber before using over-the-counter medications." d. "I cannot rinse my inhaler equipment because it is not supposed to get wet." e. "I should store my inhaler in the refrigerator door between uses." - ANSAnswer: B, C; The client should wait at least 1 minute between inhalations. OTC products should not be added without consulting the prescriber. Dosages should be taken exactly as prescribed. Inhaler equipment should be cleaned with mild soap, rinsed, and dried daily. The inhaler should be stored at room temperature. Thrombophlebitis - ANSInflammation of a vein as a result of a DVT. Occurs most often in the lower extremeties. Thrombophlebitis (S/S) - ANSSwelling at site Redness Tenderness Edema Asymmetrical swelling Treatment of choice for acute episode of asthma? - ANSSABAs and corticosteroids. True/False Long-Acting Beta Antagonists should be used as an emergency in the situation that the client is having an asthma attack. - ANSFALSE LABAs are PROPHYLACTIC. Should be used daily regardless of asthma activity. Tuberculosis - ANSInfection of the lung by mycobacterium Causes tubercles to form in the lung. Result of repeated close contact with a person who has active TB. Inhaled droplets Tuberculosis (Contact Precautions) - ANSPatient will be placed on airborne precautions. - N95 mask - Negative pressure room - Gown - Gloves Tuberculosis (Treatment) - Monitor what during therapy? - hint: organ damage? - ANSThe combination of isoniazid (INH), rifampin (RIF), pyrazinamide, and ethambutol. These drugs are hard on the liver... Monitor LFTs during therapy! - Do not drink alcohol! - Monitor for S/S of jaundice All four drugs are taken every day for 8 weeks, then maintained with 2 drugs (INH and RIF) for 18 weeks. - Educate on importance of adherence to medication regimen. Vitamin Deficiency Anemias - ANSVitamin A, C, D, and B-12 Folic Acid What should the nurse include when teaching health maintenance strategies to the client with COPD? Select all that apply. a. Yearly influenza immunizations b. Immunization against pneumonia c. Limitation of physical activity d. Oral fluid restriction e. Adequate caloric intake - ANSAnswer: A, B, E; Clients with COPD are highly susceptible to respiratory infections such as influenza, so they should be immunized yearly. Clients with COPD are highly susceptible to respiratory infections such as pneumonia so they should be immunized as prescribed by their healthcare provider. Clients with COPD use a large amount of calories because of labored respiratory function; increased caloric intake is necessary to maintain a healthy weight. Clients with COPD should undergo a progressive rehabilitation program to increase their activity tolerance. Fluid restriction is not needed with COPD unless there is fluid retention from another etiology. Which class of drugs should be avoided in systolic heart failure? a. ACEs b. ARBs c. Thiazide duretics d. CCBs - ANSAnswer: D; Calcium channel blockers can worsen systolic heart failure. Calcium affects muscle contractility.