227 Quizzes + Kaltura Questions Flashcards by Ang Yang

What is one of the most common signs of early COPD?

morning cough, incr production of mucous/sputum, SOBOE

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If HCP suspects pt has COPD, which diagnostic test provides best indication that pt is experiencing persistent airflow limitation?

pulmonary function tests, FEV1/FVE

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What is most important to include in COPD exercise teaching plan?

if dyspnea doesn’t resolve 5 mins after exercising, take short-acting bronchodilator

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What intervention recommended to copd pt to prevent most common cause of AECOPD?

immunization for influenza + pneumococcus (b/c most common AECOPD cause = resp infections)

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What does empirical therapy for pneumonia mean?

theory based on HCP observation + experience when actual causative organism is unknown

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what stage of pneumonia is characterized by massive dilation of capillaries, and alveoli filled w/ organisms, neutrophils, rbcs, and fibrin?

red hepatization

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A nurse teaches a client with COPD to watch for signs of cor pulmonale and right-sided heart failure. What symptoms should the client be instructed to report to his healthcare provider?

peripheral edema

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what should nurse do first if pt w/ copd reports feeling anxious about how difficult it is to breathe?

teach how to effectively use pursed lip breathing

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a pt w/ severe COPD develops cor pulmonale. what is this complication caused by?

hypoxia in alveoli causes constriction of pulmonary blood vessels

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pt has right lower lobe pneumonia. Nurse ausculates right lower lobe, what should they hear?

bronchial breath sounds –> bronchial breath sounds carry over areas of consolidation bc consodilated tissue carries bronchial sounds to peripheral lung fileds
- will also have crackles in affected areas from fluid in interstitium + alveoli

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Pneumonia with pulmonary consolidation in right lower lung –> what findings and what would be least consistent?

clinical manifestations: shallow, rapid respirations, pleuritic cp, bronchial breath sounds over area of consolidation, cough, fever, dyspnea, sputum

NOT stridor - obstructed airway @ supraglottis, glotti, subglottis, or trachea

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tracheostomy compared to endotracheal tube:

(in terms of weaning)

tracheostomy allows pt to be weaned from ventilator sooner + more easily

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Which of the following statements is correct about the tracheostomy cuff?
* When the cuff is inflated, it keeps the inner cannula in place
* When the cuff is inflated, it helps to prevent aspiration of gastric contents into the client’s lungs
* The cuff should be inflated to a high pressure to maintain a tight seal in the trachea
* The cuff needs to be inflated while the client is being weaned from a ventilator

when cuff is inflated, it prevents aspiration of gastric contents into pt’s lungs

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Which of the following findings meet the criteria on the IH Early Warning Signs poster, to call the doctor or
the critical care outreach team?
* Heart rate 110 beats/minute
* Oxygen saturation 91% with high-flow supplemental oxygen at 30%
* Respiratory rate 28 breaths/minute
* Drop in systolic blood pressure of 25 mm Hg below the client’s baseline

RR 28/minute

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What are the clinical manifestations of respiratory failure?

incr RR
incr WOB
use of accessory muscles to breathe
decr o2 sat
cyanosis
anxiety

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clinical manifestations of pneumothorax

chest pain
dyspnea
elevated RR
decr spo2

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What is mucous plugging caused by?

lack of humidity in inhaled air –> secretions thick + sticky

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f a client with a tracheostomy has a weak, ineffective cough, thick secretions, restlessness, and a decreasing oxygen saturation level, what intervention should the nurse implement?

Change his tracheostomy dressing
Deflate the cuff on his tracheostomy
Suction his tracheostomy
Administer supplemental oxygen via nasal prongs

suction tracheostomy

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A nurse notices that a client with a chest tube is dyspneic and his trachea appears to be shifted to the left side of his neck. What problem should the nurse suspect?

Hemothorax
Air embolism
Pulmonary embolism
Tension pneumothorax

tension pneumothorax

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what does it mean if fluid in h2o seal chamber fluctuates with each breath?

the tube is functioning correctly, “tidaling”

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What health conditions can lead to pleural effusion?

HF
lung cancer
liver failure
lung abscess

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A nurse is monitoring a client with a chest tube. The client has a low-grade fever, chest pain, and the drainage in the chest tube appears to be thick, greenish, and purulent. What condition should the nurse recognize the client to have?

empyema

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when should a nurse be able to anticipate that a chest tube in pt recovering from a pneumothorax will be removed?

there is no longer any bubbling in h2o seal chamber

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A nurse performs a head-to-toe assessment on a client with a chest tube who recently had cardiothoracic surgery. The nurse has a lot of difficulty hearing the client’s heart sounds and documents that the heart sounds are “muffled”. The nurse also finds that the client has tachycardia and dyspnea. What condition should the nurse suspect?

cardiac tamponade
- d/t fluid accumulation in pericardial space –< decr CO)
- manifestations: muffled heart sounds, hypotension, incr jugular venous distension

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Two days after placement of a pleural chest tube, the tube is accidently pulled out of the chest wall. What should the nurse do FIRST?

apply 3-sided occlusive dressing

Which clinical manifestations should warn a nurse that a client is experiencing a partial or complete airway obstruction? Select all that apply.

- suprasternal and intercostal retractions - stridor - use of accessory muscles - wheezing, restlessness, tachycardia - cyanosis

A nurse finds that a client with a tracheostomy is in respiratory distress, demonstrating anxiety, dyspnea, cyanosis, and increased work of breathing. The nurse can hear the sound of secretions moving in the client's airway as he breathes; but the nurse can't find any tracheostomy supplies at the client's bedside. What should the nurse do FIRST?

remove inner cannula and replace with new one asap

purpose of cuff on trachestomy tube?

to prevent aspirations of oropharyngeal secretions

A nurse responds to a Code Blue call, and finds a client with a laryngectomy has gone into respiratory arrest. The nurse should anticipate that the resuscitation team will:

place bag-valve-mask over pt's stoma and attempt to ventilate

The nurse is caring for a client with a tracheostomy. In the morning, when the nurse is performing the safety check at the client’s bedside, which supply/equipment MUST be available at the client’s bedside?

obturator

According to Diabetes Canada, what is the FIRST-LINE treatment recommended for a woman diagnosed with gestational diabetes (GDM)?  Oral antihyperglycemics, such as metformin  Insulin therapy  Diet and exercise  Bedrest

diet + exercise

What statement is TRUE about the significance of ketones in the urine of a diabetic client? *  An excessive amount of ketones in the blood can result in metabolic alkalosis *  Clients with type 2 diabetes should test their urine for ketones when they are feeling sick *  Ketones are produced when fatty acids are broken down for energy *  Ketones are produced when a diabetic client becomes hypoglycemic and they are unable to use * glucose for energy

ketones are produced when fatty acids are broken down for energy

Which of the following client teaching information is MOST important for the healthcare provider to communicate with Cecile? *  Blood glucose levels are unlikely to change after delivery of the baby *  A post-partum oral glucose tolerance test (OGTT) will be performed 6 weeks after delivery *  Exercise should be avoided during the last month of pregnancy *  Monitoring of blood glucose can stop immediately after the baby is delivered

OGTT will be performed 6 weeks after delivery

The diabetic educator suspects the Somogyi effect when Cecile reports that her 0700 blood glucose reading is usually about 15.0 mmol/L. What advice should the nurse give to Cecile? * “Set your alarm and check your blood glucose level at 0300” * “Administer a larger dose of long-acting insulin at bedtime” * “Avoid snacking at bedtime” * “Reduce your intake of carbohydrates during the day”

set alarm and check bg at 0300

Which symptoms are MOST TYPICAL of prediabetes?  No obvious symptoms  Excessive hunger, thirst, and urination  Recent, sudden weight loss and malaise  Shakiness, dizziness, and sweating

- no obvious symptoms

Which of the following classes of medications acts primarily by increasing the production of insulin by the pancreas?  Biguanides (e.g. metformin)  Alpha-glucosidase inhibitors (e.g. acarbose)  Sulphonylureas (e.g. glyburide)  SGLT2 inhibitors (e.g. canagliflozin)

sulfonylureas

Which of the following diabetic clients with hypoglycemia is most UNLIKELY to respond to treatment with glucagon? * Elderly client with hypoglycemia unawareness * Client with a history of alcoholic liver cirrhosis * Type 1 diabetic client who is receiving insulin aspart 3 times a day on a sliding scale * Client with a history of diabetic nephropathy

history of alcholic liver cirrhosis - liver converts glycogen to glucose - serious alc use --> malnourishment

Bert’s arterial blood gas test demonstrates METABOLIC ACIDOSIS WITH FULL COMPENSATION. What lab test is consistent with this diagnosis? * pH = 7.37 * pH = 7.30 * HCO3 = 24 mmol/L * HCO3 = 32 mmol/L

ph 7.37

If a client develops diabetic ketoacidosis (DKA), what clinical manifestation should alert the nurse that the client’s body is compensating for the underlying acid-base imbalance? * Slow, shallow respirations * Rapid, deep respirations * High volumes of dilute urine * Fruity or acetone odour to the breath

rapid, deep respirations - Kussmaul's respirations

What is the TARGET blood pressure for people with diabetes and hypertension? * 120/70 mm Hg * 130/80 mm Hg * 135/85 mm Hg * 140/90 mm Hg

130/80 mm Hg

What test should diabetic clients receive yearly, to detect the onset of diabetic nephropathy? * Urine test for microalbuminuria (MAU) * Urine dipstick test for ketones * Blood test for aspartate transaminase (AST) * Ultrasonography of the kidney

- urine test for microalbuminuria (MAU)

If Bert develops diabetic neuropathy in his feet, what medication is MOST LIKELY to be prescribed to manage the pain and burning sensation? * Morphine * Diclofenac topical cream * Acetaminophen * Pregabalin

pregabalin

Which test is the best independent predictor of future foot ulcers and lower-extremity amputation in a diabetic client? * Ankle-brachial index (ABI) * Hemoglobin A1c * Microalbuminuria * Testing for sensation with a 10 g Semmes-Weinstein monofilament

testing for sensation with 10g semmes-weinstein monofilament

How should the ophthalmologist explain diabetic retinopathy to Bert? * Diabetes causes the lens of the eye to become opaque * Diabetes causes inflammation of the optic nerve which may result in vision loss * Diabetes causes blood vessels in the eye to leak blood or plasma, causing a loss of vision * Diabetes causes excess fluid to build up in the eye, causing increased pressure within the eye that damages vision

diabetes cause bld vessels in eye to leak plasma or blood, causing loss of vision esp if macula involved

Brenda asks the nurse, “Does my ulcerative colitis increase my risk for developing cancer?” What is the nurse’s best response? *  “Yes, people who have had UC for more than 15 years have an increased risk for pancreatic cancer” *  “Yes, people who have had UC for more than 10 years have an increased risk for colorectal cancer” *  “No, there is no evidence that UC increases your risk for cancer” *  “Although UC does not cause cancer, some of the drugs used to treat this disease may increase your * risk for cancer”

yes, people who've had UC for more than 10 years have incr risk for colorectal cancer

What part of the GI tract is MOST commonly affected by Crohn’s disease?  Duodenum  Jejunum  Terminal ileum and colon  Rectum

terminal ileum + colon

What blood test result could indicate that a malnourished client is experiencing a negative nitrogen balance? *  Decreased serum creatinine *  Elevated serum urea *  Decreased alkaline phosphatase *  Elevated troponin

elevated serum urea

Jill knows that Jane has a low BMI and a low serum albumin level. Which of the following assessment findings should Jill expect to find? *  Pitting edema *  Food allergies *  Restlessness *  Hypertension

pitting edema

If a client with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal- smelling urine, and the urine is cloudy and contains strings of mucous, the nurse recognizes that this complication is a result of: *  Perianal irritation from frequent diarrhea *  Impaired immune response to infectious micro-organisms *  High urobilinogen levels due to biliary obstruction *  Fistula formation between the bowel and bladder

fistula formation between bowel and bladder

A client’s TPN infusion is due to finish at 1800. If a new bag of TPN is not available, and the infusion is suddenly stopped, what complication is MOST likely to develop in the next few hours? *  Hypoalbuminemia *  Hypovolemia *  Hypocholesterolemia *  Hypoglycemia

hypoglycemia

A nurse is reviewing the results of a hemoglobin A1C (Hgb A1C) test with a client who has type 2 diabetes. What is the target for an ideal Hgb A1C goal in most diabetic clients?

7% or less

Soon after starting the enteral feeding, Jane develops severe diarrhea. What intervention is most likely to help solve this problem? *  Slow the rate of the tube feed *  Switch to a low-fibre enteral feed solution *  Refrigerate the enteral feed solution prior to administration *  Administer metoclopramide twice daily

slowing rate of tube feed

A nurse is preparing to administer medications to a client with an enteral feed. Which of the following medications can the nurse administer through the feeding tube? *  Bulk-forming laxative *  Amoxicillin oral suspension *  Controlled-release hydromorphone *  Enteric coated aspirin

amoxicillin oral suspension - can be diluted w/ h2o

A nurse makes a medication error and accidentally administers 20 units of Aspart insulin to a diabetic client, instead of the prescribed 2 units of Aspart insulin. The nurse recognizes that this client will need to be closely monitored until the effects of the insulin wear off. What is the duration of action for Aspart insulin?

3-4 h

A nurse is providing discharge teaching for a client hospitalized with an exacerbation of inflammatory bowel disease (IBD). Since the client also has a history of type 2 diabetes mellitus (T2DM), the client asks how often he should check his blood glucose levels when he gets home? According to the Diabetes Canada websiteLinks to an external site. (the SMBG Recommendation Tool), how often should the nurse tell the client to test their blood glucose based on the following characteristics? Most recent hemoglobin A1C = 6.5% Current prescription for gluburide New prescription for prednisone

2+ time / day

A nurse teaches a client with inflammatory bowel disease (IBD) that a newly prescribed medication is a targeted treatment that will bind to, and block, specific proteins in the body that are involved in the disease process. The nurse explains that the drug is administered as an injection and the goal of treatment is to induce remission. What drug is the nurse describing?

adalimumab, anti-TNF agent - monoclonal antibody treatment - for mod-severe IBD, to induce or maintain remission

A nurse is caring for a client with Crohn’s disease who has a permanent ileostomy. During the abdominal assessment, what should the nurse expect to see?

stoma in LRQ of abdomne, continuously draining liquid stool

What blood test is most characteristic of a client with prolonged malnutrition?

decr serum albumin - liver doesn't have building blocks to produce albumin + pre-albumin when malnourished

What lab test result should alert a nurse that a client may be developing refeeding syndrome?

- low serium phosphorous level

A nurse is caring for a client receiving total parenteral nutrition (TPN). The nurse checks the client’s capillary blood glucose at 06:00 and finds it to be 9.4 mmol/L. What should the nurse do?

take no action, continue to monitor pt - TPN continuosuly = below 10 mmol/L = okay

William’s physician asks him about any health conditions that could cause secondary hypertension. An example of such a condition is: *  Reflex syncope *  Obstructive sleep apnea *  Intoxication or abuse of benzodiazepine medications *  Diabetic autonomic neuropathy

obstructive sleep apnea

The cardiologist schedules William to have a coronary angiography. The purpose of this test is to: *  Record the electrical activity in the heart and analyze any rhythm disturbances *  Evaluate the patency of the coronary arteries and the location of any blockages due to atherosclerotic * plaques *  Show the structure of the heart walls, sow the direction and flow of blood through the heart * chambers, and measure ejection fraction *  A radioactive isotope is injected, the radioactive uptake is recorded, showing myocardial contractility, * perfusion, and acute cell injury

evaluate patency of coronary arteries + location of any blockages d/t atherosclerotic plaque

William says that he saw a television commercial about a new blood pressure drug, and asks how Aliskiren works? *  It blocks the conversion of angiotensinogen to angiotensin I *  It enhances the effect of natriuretic peptide hormones *  It is a long-acting diuretic that blocks reabsorption of NaCl in the kidney *  It reduces systemic vascular resistance by promoting direct arterial vasodilation

- blocks conversion of angiotensinogen to angiotensin I

The physician recognizes that William's age (52) and sex (male) are both risk factors for coronary artery disease (CAD). What is another major risk factor for CAD? *  A low serum homocysteine level *  A history of diabetes mellitus *  Elevated serum high-density lipoprotein (HDL) levels *  Presence of an abdominal aortic aneurism

DM - close link b/t cvd + dm

What is the most common cause of a hypertensive crisis? *  Excessive psychological and/or emotional stress *  Fluid overload *  Physical exertion *  Not taking prescribed antihypertensive medications

not taking prescribed antiHTN medications

In what position should the nurse place a client who is experiencing an exacerbation of left-sided heart failure? *  Supine, with the feet elevated *  Trendelenburg position *  Lateral position *  Fowler’s position

fowler's position, HOB raised --> gravity helps lungs expand + better movement of diaphragm

When the nurse teaches William about using nitroglycerin spray, what common side effect should the nurse warn him about? *  Dry cough *  Blurry vision *  Pounding headache *  Peptic ulcer

pounding headache

When the heart begins to fail, how does the body compensate? *  Reduce preload *  Reduce heart rate *  Increase muscle mass of the heart *  Increase blood flow and diuresis

incr muscle mass of heart

What should the nurse understand about an elevated BNP level in a client with heart failure? *  BNP is produced by the kidneys in response to decreased blood flow through the glomeruli *  BNP is produced by the ventricles of the heart in response to excessive stretching of the heart muscle * cells *  BNP is produced by the pituitary gland in response to decreased osmolality of the blood *  BNP is produced by the vascular endothelium in response to stimulation of the carotid baroreceptors

BNP prod by ventricles in response to stretching of heart muscle cells (often result of incr bv)

What’s the most common cause of heart failure with reduced ejection fraction? *  COPD *  Coronary artery disease *  Venous thromboembolism *  Patent ductus arteriosus (PDA)

CAD

If a client with acute decompensated heart failure receives an IV infusion of dobutamine, the nurse should understand that the primary action of this drug is to: *  Increase contractility of the heart *  Reduce systemic venous return *  Promote diuresis *  Block the effects of the renin-angiotensin-aldosterone system

- incr contractility of heart

What is the most likely reason that he’d be sitting bolt upright in bed, dyspneic and unable to speak in full sentences, with audible respiratory crackles and frothy pink sputum? *  Pulmonary edema *  Pneumothorax *  Acute angina *  Pericarditis

pulmonary edema

A client with advanced atherosclerosis experiences severe leg pain, even while sitting or lying down. This is most characteristic of:  Intermittent claudication  Thrombophlebitis  Critical limb ischemia  Varicose veins

critical limb ischemia

What does it mean if a nurse finds that a client has an ankle-brachial index (ABI) of 0.40?  Chronic venous insufficiency  Venous thromboembolism  Calcified and non-compressible arteries  Severe arterial ischemia

severe arterial ischemia

What is the MOST important risk factor for developing peripheral arterial disease? *  Use of corticosteroid medications *  Repetitive lower limb injury *  Smoking *  Hepatic steatosis

smoking

If a nurse reads in a client’s chart that he has a “fusiform aneurysm”, what does that mean? *  There is a symmetrical bulge in the wall of the artery *  There is a bulge in only one side of the artery *  This is not a true aneurysm, because it does not involve all three layers of the artery *  There is a bulge in the artery caused by a tear in the intima, allowing blood to flow between the layers * of the artery

spindle-shaped, symmetrical bulge in wall of artery

What clinical manifestation indicates acute arterial ischemia in an extremity?  Warmth  Edema  Loss of sensation in the extremity  Capillary refill < 2 seconds in the extremity

loss of sensation

Which of the following clients has experienced a thrombotic stroke? * Client with atherosclerotic disease develops a blockage in an artery within the brain * Client with atrial fibrillation has a blood clot that travels to the brain, lodges in an artery, and blocks blood flow * Client with hypertension has a ruptured artery within the brain, putting pressure on brain tissue and reducing blood flow * Client with head trauma has a ruptured vein within the brain, putting pressure on brain tissue and reducing blood flow

client w/ atherosclerotic disease develops blockage in artery within brain

If blood tests show that a client with an acute stroke has severe liver disease, and the client will be receiving a thrombolytic drug, such as t-PA, there is an: * Increased risk of thromboembolism during treatment * Increased risk of bleeding during treatment * Increased risk for infection during treatment * Increased risk of anaphylaxis during treatment

incr risk for bleeding - liver = make clotting factors, impaired = cannot make clotting factors

If a client has an ischemic stroke, but is not eligible to receive a thrombolytic, what other treatment might be an option? * Balloon angioplasty with the placement of a stent * Carotid endarterectomy * Continuous infusion of intravenous heparin * Endovascular thrombectomy with a stent retriever

endovascular thrombectomy with stent retreiver

After a stroke, if a client understands what the nurse is saying, and knows what he wants to say, but can’t find the right words to make a sentence, the client has: * Expressive aphasia * Receptive aphasia * Anomic aphasia * Global aphasia

expressive aphasia

What does it mean if after a stroke, a client initially has flaccid muscles on the right side; but 48 hrs later, the muscles start to show spasticity with exaggerated reflexes? * The client’s condition is deteriorating and losing muscle function * The client’s condition is improving and beginning to regain muscle function * The client is developing thromboemboli in the affected limbs * The client is developing hypercalcemia due to prolonged immobility

improving, beginning to regain muscle function

A client develops homonymous hemianopia after an acute ischemic stroke. What knowledge will guide the nurse’s care for this client? * The client will probably have a preference for foods high in salt * The client will probably forget the names of foods * The client will probably only eat the food on half of the plate * The client will probably be unable to swallow liquids

will only eat half of plate --> can only see half of plate

After a subarachnoid hemorrhage, clients often experience vasospasm in the brain. What medication is used to prevent this complication? *  Oral nimodipine *  Intravenous labetolol *  Oral ramipril *  Intravenous nitroglycerine

oral nimodipine - ccb

In a client at risk for stroke, what blood lipid test indicates that the client is MEETING their cholesterol treatment goals? * Total cholesterol = 5.12 mmol/L * LDL cholesterol = 2.56 mmol/L * HDL cholesterol = 1.36 mmol/L * Triglycerides = 5.78 mmol/L

total cholesterol = 5.12 --> want < 5.15

Which factor has the strongest influence on causing arteries in the brain to DILATE, increasing blood flow to the brain? *  Elevated blood glucose levels *  Elevated blood pH *  Elevated levels of oxygen in the blood *  Elevated levels of carbon dioxide in the blood

elevated co2 levels

A nurse is reviewing the doctor’s orders for a client with a hemorrhagic stroke. Which order for IV fluids should the nurse QUESTION? *  Normal saline *  Hypertonic saline *  5% dextrose in water *  Intravenous mannitol

D5W - hypotonic, will shift water from vascular space into cells of body --> swelling

If a hemorrhagic stroke damages the pituitary gland and causes SIADH, what clinical manifestations should the nurse watch for? *  Hypokalemia, dysrhythmias, and reduced glomerular filtration rate *  Hypernatremia and low urine osmolality *  Oliguria, confusion, and low serum osmolality *  High urine output and high serum osmolality

oliguria, confusion, low serum osmolality

If a client with a head injury develops an epidural hematoma, where is the blood accumulating? *  Outside of the membrane (dura mater) surrounding the brain *  Between the dura mater and the arachnoid membrane *  Below the dura mater that surrounds the brain *  Inside the brain tissue (parenchyma)

outside membrane surrounding brain

A nurse is caring for a client with a ventriculostomy drain. At what level should the nurse place the zero line on the drain / transducer? *  Level with the client’s heart *  Level with the client’s ear *  Level with the client’s nares *  Level with the tip of the client’s chin

level with pt's ears (tragus)

What statement is true about the pharmacokinetics and pharmacodynamics of ORAL cannabis? *  Drug effects or oral cannabis peak in 5-10 minutes *  Oral cannabis has a duration of action of 6-8 hours *  Bioavailability of oral cannabis is decreased when taken with a fatty meal *  When taken orally, most cannabis metabolism occurs in the kidneys

oral cannabis has duration of 6-8h, peak 1-2h

Which client would be the most appropriate to receive a prescription for medical cannabis? *  23-year old male client with a history of acute leukemia *  28-year old pregnant client with a history of multiple sclerosis *  45-year old male client with diabetic peripheral neuropathy *  55-year old female client with a history of chronic stable angina

45 with diabetic peripheral neuropathy

If a nurse is caring for a client with a basilar skull fracture, what intervention should the nurse AVOID? *  Insertion of a nasogastric tube *  Administration of greater than 6 L/min supplemental oxygen *  Insertion of a urinary catheter *  Administration of analgesics

interstion of nasogastric tube

What is the maximum amount of medical cannabis that a client may possess at any time? *  5 grams *  5 day supply *  150 grams *  There is no maximum limit now that cannabis is legal

150g or 30-day supply, which ever one is less

What is an example of a serious “red flag” drug interaction with cannabis? *  Cannabis inhibits the metabolism of warfarin, causing increased INR and increased risk of bleeding *  Cannabis speeds up metabolism of benzodiazepines like lorazepam and reduces their effects *  Cannabis increases serum concentration of acetaminophen and increases the risk for toxicity and liver * damage *  Cannabis increases clearance of ramipril and reduces its effectiveness which may elevate blood * pressure

Cannabis inhibits the metabolism of warfarin, causing increased INR and increased risk of bleeding

What prescription medication is synthetic cannabinoid that may be prescribed to treat chemotherapy- induced nausea and vomiting? *  Ondansetron *  Anandamide *  Cannabidiol *  Nabilone

nabilone

While reviewing safety measures with cannabis, Delia teaches Rudy about the 4-6-8 rule. What does this rule state?

no driving 4h after inhaling, 6 after ingesting, 8 if feeling high

If a client is a heavy chronic user of cannabis, how long can metabolites of THC be detected in a urine drug test (UDT)?  1-2 days  4-5 days  7-10 days  Up to 6 weeks

up to 6 weeks

How long does it typically take for symptoms of cannabis withdrawal to start?  2-4 hours  6-12 hours  1-2 days  5-7 days

1-2 days

What is another example of a treatment that may be effective for cannabis use disorder?  Electroconvulsive therapy (ECT)  Hypnotherapy  Low-dose naltrexone therapy  Motivational enhancement therapy (MET)

MET - goal-oriented, client-centred counselling style that helps reduce ambivalence + incr motivation to change behaviour

who are most likely to have atypical presentation (nausea, weakness, dyspnea) of cardiac symptoms caused by acute coronary syndrome?

women, older adults, diabetic

A nurse is caring for a client with a history of angina who reports 8/10 chest pain. The client states, “This feels worse than usual – it feels like someone is squeezing my chest”. The client’s vital signs are: HR 120 beats/min BP 105/78 mm Hg RR 24 breaths/min O2 sat 96% on room air

- obtain order to draw serum troponin level - obtain order for ecg - administer prn nitroglycerin

A 75 year old client has had uncontrolled hypertension for many years which has led to peripheral vascular disease and chronic kidney disease (with a resulting GFR of 32). The nurse recognizes that with drug treatment, the target systolic blood pressure for this client should be ____________ mm Hg

120

how does endocrine system act to regulate bp?

decr in BP causes adrenal glands to secrete epinephrine

Amlodipine is prescribed for a client with newly diagnosed Prinzmetal’s (variant) angina. When teaching the client, what information should the nurse tell the client about the amlodipine?

it will decr spasm of coronary arteries

An echocardiogram is performed on a client being evaluated for heart failure. Upon reviewing the results, the nurse reads that the client has an ejection fraction of 56%. What does this value indicate?

normal ejection fraction

clinical manifestations of pulmonary edema?

- cough with pink, frothy sputum - rapid RR (> 30/min) - use of accessory muscles to breath - skin cool, clammy, pale from vasoconstriction by stimulation of SNS - dyspnea, orthopnea

A client is admitted to hospital following a motor vehicle collision. His medical history indicates he was diagnosed with a medium-sized abdominal aortic aneurysm that has been managed with medications for the past three years. What manifestation should warn the nurse that the aneurysm has ruptured?

hypotension, abdominal/back pain, tachycardia, fainting, loss of consciousness

A nurse takes a client’s health history and finds that the client experiences lower leg pain after walking. If the client sits down and rests, the pain usually disappears within 5-10 minutes. The physical assessment shows that the client’s legs have shiny, dry skin and the pedal pulses are difficult to palpate. What do these signs and symptoms indicate?

peripheral arterial disease w/ intermittent claudication

A client is receiving a continuous intravenous infusion of unfractionated heparin for acute arterial ischemia. Upon reviewing laboratory test results, the nurse finds that the client’s platelet count is 62 x 109/L. What should the nurse recognize?

may be developing heparin-induced thrombocytopenia (HIT)

A client is diagnosed with acute arterial ischemia of the right leg. What medication should the nurse expect will initially be prescribed for this client?

thrombolytic (e.g., tPA)

A nurse is caring for a client who has had multiple transient ischemic attacks (TIAs) over the past few years. What diagnostic test would be most helpful in identifying a client's future risk for an ischemic stroke?

carotid duplex ultrasound - can evaluate atherosclerotic disease in carotid arteries

main causes of subrachnoid hemorrhage?

- use of illicit drugs, e.g., cocaine - rupture of cerebral (berry) aneurysm - arteriovenous malformation - trauma

A nurse is caring for a client admitted to hospital with a head injury. Upon checking the client's vital signs, the nurse finds the client has a blood pressure of 197/105 mm Hg. Through the process of autoregulation, how does the brain respond to an increase in systemic blood pressure?

constrict cerebral arteries

A nurse is caring for a client who has experienced an intracerebral hemorrhage. On assessment, the nurse finds that the client’s systolic blood pressure has increased by 30 mm Hg, the heart rate has decreased to 50 beats/minute, and the respirations are becoming irregular. What complication should the nurse recognize is MOST likely to be occurring?

brain herniation

A nurse is caring for a client with a traumatic head injury resulting from a motor vehicle collision. Since the client is unconscious and unresponsive, the nurse repositions the client in bed every two hours. When the nurse gently rolls the client onto her back, she demonstrates the following posture (below). What number should the nurse record as this client's total Glascow Coma Score (GCS)?

5 eyes opening = 1 (no response) verbal response = 1 (no response) motor response = 3 (abnormal flexion)

A client with a head injury is being cared for in the intensive care unit. The client is on a mechanical ventilator, and the rate and volume have been set to maintain mild hyperventilation. How will the nurse identify if this treatment has been effective?

reduce ICP - cause constriction of cerebral blood vessels --> reduce intracranial pressure

In contrast to opioids, cannabinoids are unlikely to cause respiratory depression and death because:

very few CB1 receptors in brainstem

A nurse is completing a history and physical assessment on a client being admitted to hospital with chest pain. The client reports taking clopidogrel and also states that he smokes marjuana on a daily basis. What serious drug interaction should the nurse recognize occurs between cannabis and clopidogrel?

reduced protection against cardiovascular events (e.g., MI)

According to the BC College of Nurses and Midwives (BCCNM) and the Canadian Nurses' Protective Society (CNPS), what conditions need to be in place for the nurse to administer the medical cannabis in a hospital setting? Select all that apply.

- pt must have valid prescription or medical order for medical cannabis - employer permits nurses to administer medical cannabis - nurse must have sufficient pharmacological knowledge about cannabis + its actions - nurse must have reliable means of authenticating substance + determining dosage