Exam III Flashcards
A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hypernatremia B. Hyperuricemia C. Hypercalcemia D. Hyperchloremia
B. Hyperuricemia (notify provider of any swelling or tenderness of joints)
A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. What goals should the nurse include?
The client will walk for 30 min 5 days a week.
A nurse is providing discharge instructions for a client who has congestive heart failure. What statement made by the client indicates to the nurse that the teaching was effective?
A. I will read food labels and limit my sodium to 4 grams per day.
B. I should use naproxen to manage discomfort.
C. I plan to slow down if I am tired the day after exercising.
D. I will take my diuretic before sleep and drink fluids during the day.
C. “I plan to slow down if I am tired the day after exercising”
A nurse is providing teaching about a heart healthy diet to a group of clients with hypertension. What statements by one of the clients indicates a need for further teaching.
A. I may eat 10 ounces of lean protein each day.
B. Fresh fruits make a good snack option.
C. I will replace table salad with dried herbs.
D. I may thicken gravies with cornstarch as I cook.
A. I may eat 10 ounces of lean protein each day.
A nurse is providing teaching about the Mediterranean diet to a client who has a new diagnosis of hypertension. What statement by the client indicates a need for further teaching?
A. I will limit my intake of red meat to twice weekly.
B. I can have dairy in moderate portions daily.
C. I can have fish two times a week.
D. I can drink wine in moderation.
A. I will limit my intake of red meat to twice weekly.
A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. What instruction should the nurse provide?
A. Weigh weekly to monitor therapeutic effect.
B. Take the medication on an empty stomach.
C. Take the medication early in the day.
D. Muscle pain is an expected adverse effect.
C. Take the medication early in the day.
A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tab. How many tablets should the nurse administer per dose?
0.5
A nurse is caring for an older adult client who has left-sided heart failure. What assessment finding should the nurse expect? A. Frothy sputum B. Dependent edema C. Nocturnal polyuria D. Jugular distention
A. Frothy sputum (LS heart failure reduces cardiac output and raises pulmonary venous pressure. Manifestations: hacking cough, frothy sputum, wheezing, fatigue, weakness)
A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. What finding should the nurse expect?
A. Decreased brain natriuretic peptide (BNP)
B. Elevated central venous pressure (CVP)
C. Increased pulmonary artery wedge pressure (PAWP)
D. Decreased specific gravity
B. Elevated central venous pressure (CVP)
A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. What action should the nurse take FIRST?
A. Check the client’s vital signs.
B. Request a dietitian consult.
C. Suggest that the client rests before eating the meal.
D. Request an order for an antiemetic.
A. Check the client’s vital signs.
A nurse is caring for a client who is taking lisinopril. What outcome indicates a therapeutic effect of the medication? A. Decreased BP B. Increase of HDL cholesterol C. Prevention of bipolar manic episodes D. Improved sexual function
A. Decreased BP
A nurse is caring for a client who has a prescription for digoxin 0.25mg PO daily. The amount available is digoxin 0.125 mg tab. The clients current vital signs are: BP 144/96, HR 54/min, RR 18/min, temp 98.6’F. What action should the nurse take?
Withhold the digoxin dose for decreased pulse rate. (when a HR is less than 60 bpm then notify the provider before giving)
A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include?
A. You should expect brown-colored urine.
B. You should avoid grapefruit juice.
C. You should monitor for ringing in the ears.
D. You should take the medication in the morning.
B. You should avoid grapefruit juice. (grapefruit inhibits the drug-metabolizing enzyme CYP3A4 slowing simvastatin metabolism)
A nurse is monitoring a client who is on telemetry. What finding on the ECG strip should the nurse recognize as a normal sinus rhythm?
A. The P wave falls before the QRS complex
B. The T wave is in the inverted position
C. The PR interval measures 0.22 seconds
D. The QRS duration is 0.20 seconds
A. The P wave falls before the QRS complex
A nurse is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. What instruction should the nurse include?
A. Take this medication before bedtime.
B. Monitor for leg cramps.
C. Avoid grapefruit juice.
D. Reduce intake of potassium-rich foods.
B. Monitor for leg cramps. (signs of hypokalemia, i.e. fatigue, tachycardia, leg cramps, muscle weakness)
A nurse is caring for a client who has hypertension and is afraid to take his blood pressure medication. What nursing statement is an example of therapeutic communication of reflection?
A. You seem upset about taking your BP medication.
B. Why do you feel afraid to take your medication?
C. You won’t get better until you take your medication.
D. Did your symptoms occur before or after you took the medication?
A. You seem upset about taking your BP medication.
A nurse in a clinic is caring for a client who has recently begun taking Warfarin. The nurse is reviewing potential drug and food interaction risks and should instruct the client to avoid which of the following foods? A. Cabbage B. Cantaloupe C. Green beans D. White beans
A. Cabbage (rich in vitamin K)
A nurse is providing teaching to a client who has a new prescription for lisinopril. What statement by the nurse indicates an understanding of the teaching?
A. I should increase my intake of potassium-rich foods.
B. I should expect to have facial swelling when taking this medication.
C. I should take this medication with food.
D. I should report a cough to my provider.
D. I should report a cough to my provider.
A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which condition? A. Asthma B. Glaucoma C. Depression D. Migraines
A. Asthma
A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. What instructions should the nurse provide?
A. Do not use salt substitutes while taking this medication.
B. Take the medication with food.
C. Count your pulse rate before taking the medication.
D. Expect to gain weight while taking this medication.
A. Do not use salt substitutes while taking this medication. (is an ACE inhibitor and can cause hyperkalemia due to potassium retention by kidneys)
A nurse is assessing a client who is taking lisinopril to treat hypertension. What finding is a priority to report? A. Dry cough B. Swelling of the tongue C. Nausea D. Nasal congestion
B. Swelling of the tongue
A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. What statement by the client indicates an understanding of the teaching?
A. Now I will not have to diet to lose weight.
B. With the new medication, I should experience fewer side effects.
C. I will not have to do anything different because it is the same medication.
D. The extra letters after the name of medication means it is a stronger dose.
B. WIth the new medication, I should experience fewer side effects.
A nurse is teaching a client who has a new prescription for captopril. What instructions should the nurse include in the teaching?
A. Monitor for a cough.
B. Hold medication for heart rate less than 60/min.
C. Take this medication with food.
D. Avoid grapefruit juice.
A. Monitor for a cough.
A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. What finding should the nurse investigate further?
A. Diet-controlled Type 2 diabetes mellitus.
B. A history of left-sided heart failure.
C. A concurrent prescription for tadalafil.
D. Recently treated bilateral pneumonia.
B. A history of left-sided heart failure.
A nurse is teaching a client who has hypertension and a new prescription for atenolol. What finding should the nurse include as adverse effects of this medication? A. Bradycardia B. Tremor C. Cough D. Constipation
A. Bradycardia
A nurse is providing dietary teaching for a client who has chronic obstructive pulmonary disease. What instructions should the nurse include?
A. Eat 3 large meals each day.
B. Limit water intake with meals.
C. Reduce protein intake.
D. Use a bronchodilator a hour before eating.
B. Limit water intake with meals.
A nurse is assessing a client who has hypoxia. What finding should the nurse expect? A. Bradypnea B. Somnolence C. Pallor D. Tachycardia
D. Tachycardia
A nurse is assessing a client who has postoperative atelectasis and is hypoxic. What manifestation should the nurse expect? A. Bradycardia B. Bradypnea C. Lethargy D. Intercostal retractions
D. Intercostal retractions (due to body working harder to draw more oxygen into the lungs)
A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. What action should the nurse take?
A. Attach a humidifier bottle to the base of the flow meter.
B. Remove the nasal cannula while the client eats.
C. Secure the oxygen tubing to the bed sheet near the clients head.
D. Apply petroleum jelly to the nares as needed to sooth mucous membranes.
A. Attach a humidifier bottle to the base of the flow meter.
A nurse is developing a plan of care for a client who has COPD. The nurse should include what intervention in the plan?
A. Restrict the clients fluid intake to less than 2 L/day.
B. Provide the client with a low-protein diet.
C. Have the client use the early-morning hours for exercise and activity.
D. Instruct the client to use pursed-lip breathing.
D. Instruct the client to use pursed-lip breathing (this lengthens the expiratory phase of respiratory and increases pressure in airway during exhalation)
A nurse is caring for a client who has returned to the unit following a surgical procedure. The clients oxygen saturation is 85%. What action should the nurse take FIRST?
A. Administer oxygen at 2 L/min.
B. Administer prescribed analgesic medication.
C. Encourage coughing and deep breathing.
D. Raise the head of the bed.
D. Raise the head of the bed.
A nurse is auscultating a clients lung sounds and identifies crackles in the left lower lobe. What intervention should the nurse take?
A. Repeat auscultation after asking the client to breath deeply and cough.
B. Instruct the client to limit fluid intake to less than 2,000 mL/day.
C. Prepare to administer antibiotics.
D. Place the client on bed rest in semi-Fowler’s position.
A. Repeat auscultation after asking the client to breathe deeply and cough.
A nurse is assessing a client who is 2 days postoperative and auscultates bilateral breath sounds, but absent breath sounds in the bases. The nurse should suspect what postoperative complication? A. Atelectasis B. Pneumonia C. Pulmonary embolism D. Arterial thrombus
A. Atelectasis
A nurse is assessing a client who has COPD. The nurse should expect the clients chest to be what shape? A. Pigeon B. Funnel C. Kyphotic D. Barrel
D. Barrel
A nurse is caring for a client who has pneumonia. What action should the nurse take to promote thinning of respiratory secretions.
A. Encourage the client to ambulate frequently.
B. Encourage coughing and deep breathing.
C. Encourage the client to increase fluid intake.
D. Encourage regular use of the incentive spirometer.
C. Encourage the client to increase fluid intake. (1,500-2,000 mL/day promotes liquefaction and thinning of pulmonary secretions, improving clients ability to cough and remove secretions)
