Cardiac
A nurse is educating a client on the importance of anticoagulant adherence following a diagnosis of CAD. The client is questioning the nurse as to why they need to take this medication. The nurse should explain the client is more susceptible to complications such as ____ due to this disease process.
Blood clots
Narrowed passageways due to atherosclerosis can cause pooling of the blood, forming blood clots that can be dislodged to other places including the heart (causing an MI) or the lung (PE).
A client is being discharged from the hospital with the expectation in which he will complete peritoneal dialysis at home multiple times a day. The nurse discharging him has educated him that which form of drainage may be indicative of the complication peritonitis?
Cloudy fluid
This type of fluid is indicative of infection or inflammation and can be a sign of the peritoneal cavity, also known as peritonitis.
A nurse is caring for a vented patient who has a diagnosis of ARDS. When reviewing provider orders, the nurse recognizes an order for nitrous oxide. The nurse should understand that nitrous oxide was prescribed for what reason?
A nurse is caring for a patient in the emergency room that has suspected pancreatitis. The nurse should recognize that the doctor should have the client placed under which diet order?
A. NPO
B. Clear liquids
C. Low fat
D. Full liquids
A. NPO
The nurse should recognize that the first line treatment for pancreatitis is to rest the pancreas. This involves the nothing by mouth diet as this will decrease the release of digestive enzymes, blocking autodigestion and the inflammatory process of pancreatitis.
The nurse is educating a client that is pregnant over the risk of DIC. When the client explains what is happening in the body, she explains that the blood is doing what in the form of 2 key pathophysiology indicators?
Massive clotting followed by massive bleeding.
Endothelial damage causes a disruption in the coagulation pathway, causing the release of thrombin and fibrinogen. This causes clots to be formed in a continuous loop, using clotting factors that are unavailable once bleeding occurs.
A nurse is reviewing a telemetry strip sent by the telemetry tech for a second opinion on a patient's rhythm. The nurse notes a regular PQRST complex but identifies a 100+ BPM rate. The nurse should identify this rhythm as which cardiac rhythm?
Sinus Tachycardia
The patient has a regular rhythm, but it is just too fast. This condition is typically caused by a pain response, fluid volume loss, or anxiety.
A nurse is caring for a client who has been diagnosed with stage 3 chronic kidney disease. The nurse should suspect this client has a GFR of which of the following ranges?
A. 90-100
B. 45-59
C. 15-44
D. 15 and under
B. 45-59
45-59% functionality is defined as stage 3 kidney failure and is referred to as mild to moderate functional damage. The kidneys are only filtering about half of what they are supposed to filter per minute.
The nurse should recognize that there are many indicators for late-stage ARDS that typically occur before ventilation. Name 3 manifestations
Changes in mental status - Ammonia levels to the brain are on the rise, and cause changes in mental status.
Tachycardia- the heart attempts to compensate for oxygenated blood lack in circulation
Cyanosis/pallor - poor perfusion is occurring
Diaphoresis - due to increased metabolic demand.
Refractory Hypoxemia - need increased FIO2 that is not responded to, O2 levels continue to drop
Hypercapnia - lungs can't breathe off as much CO2 due to decreased compliance
A nurse had just finished assessing a client with the following symptoms including RUQ pain that radiates and worsens after a meal, diaphoresis, and belching from the mouth. The nurse should recognize that these findings are consistent with which of the following disease processes?
A. Cholecystitis
B. Pancreatitis
C. Hepatitis A
D. Cirrhosis
A. Cholecystitis
The nurse should recognize that the gallbladder is located in the RUQ of the abdomen and causes increased pain especially after eating a high fat meal due to the contraction of the gallbladder to release bile. This signals a pain response which results in sweating. Undigested fats also leads to Gi upset, and the result of gas - belching.
A nurse is observing the lab values for someone who is suspected of having DIC. For each of the following lab values should the nurse expect an increase of decrease from baseline labs?
1. D-dimer
2. Fibrinogen
3. CBC/ platelets
4. PT/aptt
D-dimer - increase as fibrinolysis occurs, this protein typically occurs once a clot is broken down.
Fibrinogen - decrease as clotting factors are used more rapidly in this disease process
CBC/platelets - decreased as bleeding occurs
PT/aptt - increased as it takes longer for forms to clot due to the diminished clotting factors.
A nurse on a cardiology floor is caring for a patient who has cardiac muscle damage from a past MI. When reviewing the telemetry strip, the nurse notes a widened QRS complex of >0.12 seconds, and a hidden/unidentifiable P wave. The nurse should identify the client is in which rhythm or is "throwing" which cardiac abnormality?
PVC's
This rhythm is typically cause by cardiac muscle damage, lung problems, or electrolyte imbalances. The client may experience palpitations and sleep disturbances, as well as shortness of breath or chest pain.
A nurse is educating a client with AKI about lifestyle modifications that should occur during treatment for this disease process. The nurse should include all of the following except:
A. Continue metformin therapy for diabetes
B. Do not take over the counter NSAIDS without consulting your doctor first.
C. Monitor your weight at the same time, with the same scale, and same clothes daily. Report a gain of 3 pounds in a day.
D. Change positions slowly when laying to sitting and sitting to standing.
A. Continue metformin therapy for diabetes
Metformin excretion can be impaired due to lack of filtration from the kidneys. This can make metformin toxicity occur and potential hypoglycemia. The client should consider other therapies such as insulin while going through treatment for AKI and lowers risk of hypoglycemia.
A nurse is preparing to administer a paralytic agent to a vented patient. Before administration, the nurse notices that the sedation has been discontinued by the provider. The nurse decides to withhold the administration of the paralytic agent. What is the rationale for her actions?
The nurse recognizes that a paralytic agent without a sedative will increase stress and anxiety in the patient. This may lead to increased respiratory distress, and poorer patient prognosis. Paralytics should not be given to awake patients. Remember, their mind is still awake even if a paralytic is administered.
A nurse is completing continuing education credits for her annual license renewal and is learning about hepatitis. The nurse should recognize that which of the following types of hepatitis involves annual screening due to the lack of testing for this disease in blood products before 1992?
A. Hepatitis B
B. Hepatitis D
C. Hepatitis C
D. Hepatitis A
C. Hepatitis C
Before 1992 a lack of screening for hepatitis C in blood products persisted, putting clients that received blood products before 1992 at increased risk for developing this disease.A nurse is preparing to administer Cryoprecipitate to a client who has DIC. The nurse should recognize this therapy is given for which of the following reasons?
A. Works to thin the blood
B. Promotes an increase in fibrinogen in circulating blood
C. Decreases fibrinogen production
D. This medication is not used for DIC
B. Promotes an increase in fibrinogen in circulating blood
Cryoprecipitate is taken from thawing blood product and is rich in fibrinogen, which helps with clotting for hemorrhage.