ex 1 sata Flashcards
Patient with hypovolemia is restless and anxious. The skin is cool and pale, pulse is thready at a rate of 135 beats/min. blood pressure is 92/50 mm HG. Respirations are 32 respirations/min. What actions does the nurse take? (SATA)
a. Obtain a stat order for an IV normal saline bolus.
b. Administer supplemental oxygen.
c. Notify the Rapid Response Team.
d. Place the patient in a semi-Fowler’s position.
e. Call a “code blue.”
a. Obtain a stat order for an IV normal saline bolus.
b. Administer supplemental oxygen.
c. Notify the Rapid Response Team.
The nurse is teaching a patient who is at risk for venous thromboembolism (VTE). The patient is currently asymptomatic and is living in the community. What interventions does the nurse instruct the patient to do to minimize the risk of VTE? (Select all that apply.) SATA
a. Avoid oral contraceptives.
b. Drink adequate fluids to avoid dehydration.
c. Exercise the legs during long periods of bedrest or
sitting.
d. Arise early in the morning for ambulation.
e. Use a venous plexus foot pump.
a. Avoid oral contraceptives.
b. Drink adequate fluids to avoid dehydration.
c. Exercise the legs during long periods of bedrest or
sitting.
the nurse is caring for a patient diagnosed with acute coronary syndromes. which manifestations indicate cardiogenic shock (sata)
A. Cold, clammy skin with poor peripheral pulses
B. Urine output less than 0.5-1 mL/kg/hr
C. Bradycardia and hypotension
D. Systolic BP less than 90 mm Hg or 30 mm Hg less than the patient’s baseline
E. Agitation, restlessness, or confusion
F. Tachypnea and crackles
A. Cold, clammy skin with poor peripheral pulses
B. Urine output less than 0.5-1 mL/kg/hr
D. Systolic BP less than 90 mm Hg or 30 mm Hg less than the patient’s baseline
E. Agitation, restlessness, or confusion
F. Tachypnea and crackles
Which hormones are released in response to decreased mean arterial pressure (MAP)?SATA
aldosterone,angiotensin II, atrial natriuretic peptide ,
renin, adh, epi, aldosterone,
A patient is being evaluated for thrombolytic therapy. What are absolute contraindications for this procedure? (select all that apply) SATA
a. Ischemic stroke within 3 months
b. pregnancy
c. Suspected aortic aneurysm
d. major trauma in the last 12 months
e. Intracranial hemorrhage
f. Malignant intracranial neoplasm
ACEF
A patient is receiving beta blocker therapy for treatment of MI. What does the nurse monitor for in relation to this therapy? (select all) SATA
b. hypotension
c. decreased level of consciousness
d. chest discomfort
BCD
A patient with a history of congestive obstructive pulmonary disease (COPD) presents with chest pain and signs of atrial flutter. The patient’s vital signs are blood pressure 65/40, temperature 99.0 °F, heart rate 135 beats per minute, and respiratory rate 25 respirations per minute. Which actions would the nurse take?(Select all that apply.) SATA
a. Administer warfarin according to orders
b. Prepare the patient for an echocardiogram
c. Administer beta-blocker according to orders
d. Prepare the patient for an electrical cardioversion
e. Administer a dose of IV narcotic pain medication
a. Administer warfarin according to orders
d. Prepare the patient for an electrical cardioversion
e. Administer a dose of IV narcotic pain medication
Which conditions would put a patient at risk for hypovolemic shock? SATA
A. Spinal cord injury
B. Myocardial infarction
C. Urinary tract infection
D. Excessive hemorrhaging
E. Prolonged vomiting and diarrhea said this
D. Excessive hemorrhaging
E. Prolonged vomiting and diarrhea said this
. The patient has decreased oxygenation and impaired tissue perfusion. Which clinical manifestations are evidence of onset of the non-progressive or compensatory stages of shock? SATA (Select all that apply.)
a. Decreased urine output
b. Low-grade fever
c. Narrowing pulse pressure
d. Decreased heart rate
e. Increased heart rate
ACE
traditionally, what medications will most likely be ordered for a patient with atrial fibrillation SATA a Diltiazem hydrochloride (Cardizem) b. Furosemide (Lasix) c. Heparin d. Enoxaparin (Lovenox) e. Sodium warfarin (Coumadin) f. Metoprolol
a Diltiazem hydrochloride (Cardizem)
c. Heparin
d. Enoxaparin (Lovenox)
e. Sodium warfarin (Coumadin)
f. Metoprolol
The nurse is assessing a patient at risk for left ventricular failure and inadequate organ perfusion. Which signs and symptoms signal decreased cardiac output? (select all that apply) SATA
a. change in orientation or mental status
b. urine output less than 1mL/kg/hr or less than 30 mLs/hr
d. cool, clammy extremities with decrease or absent pulses
e. unusual fatigue
f. recurrent chest pain
identify appropriate interventions for a patient experiencing inadequate oxygenation and tissue perfusion as a result of coronary artery disease. (Select all that apply.) SATA
A. Notify the physician.
B. Administer Tylenol for pain.
C. Maintain or initiate an IV line.
D. Apply oxygen via nasal cannula.
E. Encourage interaction with family.
F. Administer nitroglycerin sublingually.
ACDF
the registered nurse is assessing the patient’s blood pressure. what actions does the nurse deem necessary SATA
Which clinical manifestations are reflections of sustained tachydysrhythmias and bradydysrhythmias? SATA Weakness and fatigue Dyspnea Decreased urine output Chest pain
Weakness and fatigue
Dyspnea
Decreased urine output
Chest pain
a patient arrives in the emergency department 3 hours after the onset of chest pain. the standard of care for this patient includes: SATA
Morphine
Oxygen
Nitroglycerin
Aspirin
