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Quarter 3 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Which hormones are released in response to decreased mean arterial pressure (MAP)?

A

Renin
ADH
Aldosterone
epinephrine

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2
Q

Which condition results in blood vessels that d. are normally partially constricted?

A

sympathetic tone

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3
Q

The patient has decreased oxygenation and impaired tissue perfusion. Which clinical manifestations are evidence of onset of the nonprogressive or compensatory stages of shock?

A

decreased urine output
narrowing pulse pressure
increased heart rate
increased sodium re absorption

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4
Q

Which statement about the systemic effects of shock is correct?

a. The liver is essentially unaffected, but liver enzymes may be lower than normal.
b. The current heart rate and blood pressure indicate the cardiac system is at baseline.
c. The brain and neurologic system can withstand 10-15 minutes of severe hypoperfusion.
d. The kidneys can tolerate hypoxia and anoxia up to 1 hour without permanent damage.

A

D

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5
Q

Which patients are at risk for shock related to fluid shifts?

A 
Severely malnourished patient
 Patient with kidney disease
Patient with a large wound
Patient with ascites
Patients with MAJOR burns
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6
Q

A young woman comes to the emergency department (ED) with lightheadedness and “a feeling of impending doom.” Pulse is 110 beats/min; respirations are 30/min; and blood pressure is 140/90 mm Hg. Which factors does the nurse ask about that could contribute to shock? S

A

Recent accident or trauma
Prolonged diarrhea or vomiting
possible pregnancy
use of over the counter medication

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7
Q

specific causes or risk factors for cardiogenic shock?

A

Myocardial infarction
Ventricular dysrhythmias
Cardiomyopathy

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8
Q

A patient has cardiac dysrhythmias and pul- monary problems as a result of receiving the first dose of a new IV antibiotic. The nurse recognizes that this represents what type of shock?

A

Anaphylactic

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9
Q

A patient with head trauma was treated for a

cerebral hematoma. After surgery, this patient is at risk for what type of shock

A

Neural-induced distributive

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10
Q

The nursing student takes the morning blood pressure of a postoperative patient, and the reading is 90/50 mm Hg. What does the student do next?

A

Report the reading to the primary nurse as a possible sign of hypovolemia.
Assess the patient for subjective feelings of dizziness or shortness of breath.
Check the patient’s chart for trends in morning vital sign readings.
Notify the instructor to verify the signifi- cance of the finding.

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11
Q

A patient at risk for shock has had some small, subtle changes in behavior within the past hour. How does the nurse evaluate the patient’s mental status throughout the night?

A

Periodically attempt to awaken the patient and document how easily he or she is aroused.

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12
Q

For which indications would the nurse be prepared to administer a colloid product?

A

hemorrhagic shock
peripheral tissue hypoxia
restore osmotic pressure
increase hematocrit and hemoglobin levels

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13
Q

The nurse is caring for a patient at risk for hypovolemic shock. What is the first sign of hypovolemic shock the nurse should monitor?

A

Increasing heart rate

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14
Q

A patient is brought to the emergency depart- ment (ED) with a gunshot wound. What are the early signs of hypovolemic shock the nurse should monitor?

A

Increase in heart rate
Increase in respiratory rate
Decreased MAP of 10-15 mm Hg

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15
Q

The unlicensed assistive personnel (UAP) reports repeatedly and unsuccessfully trying to take a patient’s blood pressure with the electronic and manual devices. The nurse notes that the patient’s apical pulse is ele- vated and the patient is at risk for hypovole- mic shock. What is the best method for the nurse to determine the systolic blood pressure?

A

Apply the manual cuff and palpate for the

systolic

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16
Q

The nurse identifies signs and symptoms of internal hemorrhage in a postoperative patient. What is included in the care of this patient for hypovolemic shock?

A

Elevate the feet with the head flat or elevated 30 degrees.
Monitor vital signs every 5 minutes until they are stable.
Provide oxygen therapy.
Ensure IV access.

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17
Q

A young trauma patient is at risk for hypovo- lemic shock related to occult hemorrhage. What baseline indicator allows the nurse to recognize the early signs of shock?

A

pulse rate

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18
Q

Which statement about assessment of skin during shock is accurate

A

For a patient with dark skin, pallor or
cyanosis is best assessed in the oral
mucous membranes

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19
Q

A patient in hypovolemic shock is receiving sodium nitroprusside to enhance myocardial perfusion. What is an important nursing assessment when administering this drug?

A

Assess blood pressure at least every
15 minutes because systemic vasodilation
can cause hypotension.

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20
Q

A patient with hypovolemic shock is receiving an infusion of dopamine. Which nursing interventions are essential when a patient is receiving this drug?

A

Take the blood pressure at least every 15 minutes.
Monitor urine output every hour.
Assess the patient for chest pain.
Check the infusion site every 30 minutes for extravasation.
Ask a patient receiving this drug about headaches.

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21
Q

Which IV therapy results in the greatest increase in oxygen-carrying capacity for a patient with hypovolemic shock

A

Packed red cells

The teacher says NS or LR though?

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22
Q

Which change in the skin is an early indica- tion of hypovolemic shock?

A

Pallor or cyanosis in the mucous

membranes

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23
Q

The nurse is caring for an older adult patient at risk for shock. What is an early sign of shock in this patient?

A

Restlessness

24
Q

The nurse is caring for a patient with sepsis. What is a late clinical manifestation of shock?

A

Decrease in blood pressure

25
Q

the nurse is caring for a patient with septic shock. Which therapy specific to the manage- ment of septic shock for this patient does the nurse anticipate will be used?

A

antibiotics

26
Q

Which laboratory value indicates the begin- ning of severe sepsis even before other symptoms are evident?

A

Decreased level of activated protein C

27
Q

The nurse is preparing a teaching session for a patient at risk for septic shock. Which topics does the nurse include in this teaching?

A

Wash hands frequently using antimicrobial soap.
Avoid large crowds or gatherings where people might be ill.
Do not share eating utensils
Wash toothbrushes in a dishwasher.

28
Q

The home health nurse is visiting a frail older adult patient at risk for sepsis because of failure to thrive and immunosuppression. What does the nurse assess this patient for?

A

Signs of skin breakdown and presence of redness or swelling
Cough or any other symptoms of a cold or the flu
Appearance and odor of urine, and pain or burning during urination
Availability and type of facilities for handwashing
General cleanliness of the patient’s home

29
Q

The patient has been diagnosed with sepsis. Following the sepsis resuscitation bundle, which interventions should the nurse expect within the first 3 hours?

A

Obtain serum lactate level.
Draw blood cultures.
Administer broad-spectrum antibiotics

30
Q

Which statements about the transmission of HIV are true?

A 
Those with recent HIV infection and high
viral load are very infectious.
Those with end-stage HIV and no drug
therapy are very infectious.
An undetectable viral load requires greater
or multiple exposures
31
Q

The HIV-positive patient tells the nurse that his HIV-negative partner will be using preex- posure prophylaxis (PrEP) emtricitab. Which statement indicates to the nurse the need for additional teaching about this drug?

A

“Once we start using emtricitab I will no longer need to use a condom.”

32
Q

Which age-related change increases the likelihood that the older adult will develop the infection after an HIV exposure?

A

Decline in the overall efficiency of the

immune system

33
Q

A patient is diagnosed with Pneumocystis jiroveci pneumonia. Which signs/symptoms does the nurse expect to find when assessing the patient?

A

Dyspnea, tachypnea, persistent dry cough, and fever

34
Q

A patient who has HIV/AIDS and tuberculosis (TB) was recently started on the combination antiretroviral therapy (cART) regimen. The TB symptoms worsen and the nurse informs the health care provider, who makes the diagnosis of immune reconstitution inflammatory syndrome (IRIS). Which therapy is the pro- vider most likely to order to treat IRIS?

A

Corticosteroids

35
Q

The health care provider tells the nurse that a patient has Jarisch-Herxheimer reaction. Which interventions does the nurse anticipate?

A

Analgesics and antipyretics

36
Q

A patient is diagnosed with late tertiary syphilis. In addition to benign lesions of the skin and mucous membranes, what other findings does the nurse expect to see documented in the patient’s record?

A

Cardiovascular syphilis

37
Q

A patient reports a possible exposure to syphilis. Which screening tests are typically done first?

A

Venereal Disease Research Laboratory
serum test and the more sensitive rapid
plasma reagin

38
Q

Which sexually transmitted diseases are reportable to the local health authorities in every state?

A 
Chlamydia 
Gonorrhea 
Syphilis
Chancroid 
Human immunodeficiency virus
39
Q

The nurse is talking to a group of college stu- dents about safer sex practices. What recom- mendations are included as safer sex practices?

A

Use a latex or polyurethane condom for genital and anal intercourse.
Practice abstinence.
Decrease the number of sexual partners.

40
Q

A female patient is prescribed azithromycin 1 g orally in a single dose for the treatment of Chlamydia trachomatis. What additional information does the nurse give the patient about treatment issues?

A

Abstain from sex for 7 days from the start

date of treatment.

41
Q

The nurse is performing a history and physical on the male patient who suspects exposure to a sexually transmitted disease. Which symptom is the most common in the male with chlamydia?

A

Urethritis

42
Q

What is the most common symptom that leads a patient with pelvic inflammatory disease to seek medical health care?

A

Lower abdominal pain

43
Q

A patient with pelvic inflammatory disease is on bedrest with bathroom privileges. What position is best for the patient while on bedrest?

A

Semi-Fowler’s

44
Q

The nurse is counseling a patient who is expe- riencing recurrent outbreaks of genital herpes. What suggestions for symptomatic treatment does the nurse include?

A

Oral analgesics, sitz baths, and increased oral fluid intake

45
Q

A patient is diagnosed with Condylomata acuminata. What are the desired outcomes of management for this patient?

A

Remove the warts and treat the symptoms.

46
Q

Which woman has the greatest risk for pelvic inflammatory disease?

A

24-year-old who smokes and has multiple sexual partners

47
Q

A patient had podophyllin treatment for Con- dylomata acuminata. For which sign/symptom does the nurse tell the patient to return for further treatment?

A

Infection at the site

48
Q

For which patient would a test of cure be recommended after treatment is completed?

A

Patient is treated for gonorrhea with

cefixime.

49
Q

A young woman discovers she has chlamydia after going to her health care provider for a routine Pap smear and pelvic exam. She is re- luctant to accept the diagnosis because she is asymptomatic and “does not have any money for unnecessary treatment right now.” What is the nurse’s best response?

A

Talk to the woman about her financial

situation and help her find resources

50
Q

A patient with a sexually transmitted disease freely admits to being a commercial sex worker. In talking to this patient, the nurse recognizes that she has not disclosed a true name, address, or partner contact information. What is the best treatment strategy to use with this patient?

A

Administer a one-dose course of treatment

and dispense a box of condoms.

51
Q

Which factors increase the risk for pelvic in- flammatory disease?

A

Age younger than 26 years
Multiple sexual partners
Smoking
History of chlamydia or gonococcal infection
Intrauterine device placed within the previous 3 weeks

52
Q

The nurse is reviewing laboratory results for a patient with pelvic inflammatory disease. Which lab results does the nurse expect to see?

A

Elevation in white blood cell count

Elevation in erythrocyte sedimentation rate

Elevation of C-reactive protein

Cervical infection with Neisseria
gonorrhoeae or Chlamydia trachomatis

53
Q

The nurse is teaching a group of high school students about the use of condoms. What information does the nurse include?

A

Keep condoms (especially latex) in a cool, dry place out of direct sunlight.

Do not use condoms if package is damaged or if they are brittle or discolored.

Make sure that lubricants are water-based.

54
Q

Which group has the greatest risk for contracting primary and secondary syphilis

A

Men who have sex with men

55
Q

A young patient has been diagnosed with gonorrhea. What additional testing should be offered to this patient because of possible concurrent infections?

A 
Syphilis
Chlamydia 
Hepatitis B
Hepatitis C
HIV infection

Quarter 3 (5 decks)

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