Lab values
Normal blood pH level range
7.35-7.45
The nurse is caring for a patient scheduled to undergo a mitral valve replacement. The nurse should monitor for which complication of mitral stenosis?
A. Pulmonary Hypertension
B. Respiratory alkalosis
C. Left sided heart failure
D. Myocardial infacrtion
Pulmonary Hypertension
• Mitral stenosis impedes blood flow from the left atrium to the left ventricle of the heart. This creates increased pulmonary vascular resistance, causing pulmonary hypertension
• Other complications of mitral stenosis include edema, right-sided heart failure, and reduced cardiac output
The nurse is educating a client with emphysema who requires oxygen use at home via a nasal cannula. The nurse instructs the client not to exceed which flow rate?
A. 2 L/min
B. 4 L/min
C. 6 L/min
D. 10 L/min
A. 2 L/min
With emphysema, respiratory drive is triggered by low oxygen levels because of long-standing hypercapnia.
Increasing the oxygen flow rate past 2 L/min may diminish the client’s respiratory drive. The following is provided for reference:
The nurse is instructing a client with AIDS on how to prevent foodborne illnesses. Due to the client’s immunocompromised state, which of the following does the nurse instruct the client to avoid?
A. Sushi
B. Pasteurized milk
C. Peeled fruit
D. Tap water
A. Sushi
Clients with AIDS should avoid raw and undercooked fish and animal products because they typically have higher bacterial contamination. Unpasteurized milk should also be avoided, and fruit should be peeled to avoid contamination.
Tap water is clean in most US cities and is safe for a client with AIDS.
A nurse is caring for a patient who suffered a right-sided CVA. What is an expected finding?
Impulsivity
left sided hemiplegia
Impaired judgement
left sided neglect
Normal White Blood Cell Count (WBC)
4,500-11,000
A patient is admitted to the hospital for an acute exacerbation of heart failure. The nurse questions the patient about his medical and social history. Which of the following would not contribute to this patient's exacerbation?
A. Hyperthyroidism
B. Irritable Bowel Syndrome
C. Anemia
D. chronic NSAID use
B - Irritable bowel syndrome is not known to cause CHF exacerbations
• Chronic congestive heart failure can easily exacerbate and decompensate. This commonly results from infections, arrhythmias, hypertension, anemia, hyperthyroidism, inadequate diet, and medications such as NSAIDs
The nurse is providing discharge instructions to a client recently diagnosed with sarcoidosis. What does the nurse explain as the cause of sarcoidosis?
A. Bacteria
B. Silica dust
C. Asbestos
D. Unknown
D. Unknown
The cause of sarcoidosis remains unknown. It is believed that genetically susceptible people have an alteration to the immune response after exposure to infectious, occupational, or environmental agents.
Sarcoidosis is characterized by abnormal collections of chronic inflammatory cells that form nodules in multiple organs, including the lungs.
The nurse is preparing to administer human immune globulin to a client. What does the nurse explain to the client about these types of vaccines?
A. Are inactive toxic compounds that cause illness.
B. Have decreased potency to facilitate active immunity.
C. Are obtained from pooled human blood and provide antibodies to several diseases.
D. Consist of killed microbes that provide active immunity.
C. Are obtained from pooled human blood and provide antibodies to several diseases.
Immune globulin is a sterile solution of antibodies obtained from a pool of human blood. It is administered as protection against infectious diseases, but immunity is temporary.
A nurse is making her initial rounds. When she enters the room of a patient who is suffering from severe brain trauma, she sees the patient with a rigid extension of all extremities. The patient's forearms are hyper-pronated and the feet are plantar flexed. What positioning is the patient exhibiting
A. Decorticate
B. Decerebrate
C. Supine
D. Opisthotonic
B. Decerebrate
• Decerebrate positioning is characterized by rigidity in all four extremities with hyper-pronation of the forearms and plantar-flexion of the feet (toes pointed). It usually indicates more severe brain damage than decorticate positioning
• Patients who are suffering from severe brain trauma may exhibit involuntary responses, namely decorticate and decerebrate positioning
Opisthotonic positioning is when the patient shows arching of the back and neck. This may be seen in conjunction with decerebrate posturing
Normal Platelet count (PLT)
150,000 - 400,000
A patient recovering from a myocardial infarction has been in bed for 6 days. The patient now complains of calf pain. The nurse should first:
A. Assess the calf for redness, heat, and swelling
B. Massage the calf to relieve the muscle cramp.
C. Observe the patient walking.
D. Administer pain medication as ordered.
A - Assess the calf for redness, heat and swelling
• Due to the time spent in bed and inactive, the patient is at high risk for the development of a deep vein thrombosis (DVT). Pain in the calf, redness or heat, and swelling in the affected extremity are signs of a DVT
• Diagnostic tests that help diagnose a DVT include a D-dimer test to confirm the presence of fibrin degradation products from a clot, venous ultrasound, venography to visualize the clot with contrast, or less commonly MRI or CT
The nurse is caring for a client who just underwent a bronchoscopy. The nurse should do which intervention?
A. Confirm the return of the gag reflex before advancing diet.
B. Administer veruronium IV.
C. Encourage large amounts of oral fluids.
D. Administer midazolam IV for conscious sedation.
A. Confirm the return of the gag reflex before advancing diet.
The client’s gag reflex must return to normal before allowing oral intake. The procedural sedation may have impaired the gag reflex, which places the client at risk for aspiration.
A client is diagnosed with iron deficiency anemia. The provider prescribes ferrous sulfate. Which of the following is a contraindication for ferrous sulfate therapy?
A. Pregnancy
B. Old age.
C. Cirrhosis
D. Ulcerative colitis
D. Ulcerative colitis
Ferrous sulfate causes significant gastrointestinal effects and can worsen preexisting conditions such as ulcerative colitis, peptic ulcer disease, and enteritis. Other contraindications include hemochromatosis, infectious kidney disease, and a hypersensitivity to iron.
Generally, iron is considered safe during pregnancy. Iron should be used with caution in the elderly, but this is not an absolute contraindication.
A 25-year-old patient was admitted with a complete C7 transection of the spinal cord injury. What must the nurse include in the care plan of this patient during the immediate post-injury period?
A. Diaphragmic pacing.
B. Prevention of autonomic dysreflexia.
C. Ventilatory support
D. Bladder and bowel training.
C. Ventilatory support
• The possible need for ventilatory support must be included in the care plan since edema above the area of the lesion can cause respiratory depression or arrest
• Spinal cord injuries commonly occur among young adult males between 15 and 25 years old due to motor vehicular accidents, diving in shallow water, or sports injuries
• Quadriplegia that causes paralysis of all four extremities can occur in cervical injuries involving C1-C8, and respiratory paralysis in lesions above C6
Name the test that measures your blood sugar levels over the past 3 months and what value is considered normal
hbA1c or A1C
Normal <5.7Diabetic > 6.4
The nurse assesses a client with arterial insufficiency reporting lower leg pain when walking up the stairs, but states that it is relieved by rest. The nurse suspects the client has what condition?
A. Raynaud's Syndrome
B. Vasospasms
C. Lazarus syndrome
D. Intermittent claudication
D. Intermittent claudication
• Claudication means "lameness" and intermittent claudication refers to a cramp-like pain in the leg muscles after a predictable amount of physical activity. It is caused by poor circulation to the extremities because the muscles in the legs (usually the calves) are not getting adequate oxygen to meet increased demands during periods of activity.
A middle-age client in the surgical ward has a blood pressure of 128/72 mm Hg, a heart rate of 125 beats/min, a respiratory rate of 32 breaths/min, and a temperature of 99.1° F (37.28° C). The client reports severe shortness of breath. What does the nurse assess first?
A. Pupil reactivity.
B. Breath sounds.
C. Heart sounds.
D. Peripheral circulation
B. Breath sounds
The clinical findings suggest a pulmonary embolism or other acute pulmonary problems. A change in breath sounds will give the nurse more information regarding the client’s situation
A nurse is reviewing the results of genetic testing of an adult female client with sickle cell disease, noting that HbS indicates sickle cell disease, HbAS indicates sickle cell trait, and HbA indicates normal hemoglobin. When are the client and her male spouse at the lowest risk of having a child with sickle cell disease?
A. The client and her spouse are HbAS.
B. The client is HbS and her spouse is HbA.
C. The client is HbAS and her spouse is HbS.
D. The client and her spouse are HbS.
B. The client is HbS and her spouse is HbA.
Sickle cell trait is autosomal recessive (ie, two copies of a gene must be present for a disease or trait to develop). If the female parent is HbS (sickle cell disease) and the male parent is HbA (normal hemoglobin), then there is a 0% chance of having a child with sickle cell disease because only one copy of the gene is present.
When two copies of the gene are present, the percent chance of developing the disease or trait is dependent on whether the gene is dominant (indicates disease) or recessive (indicates trait). HbS indicates sickle cell disease, so it is dominant; HbAS indicates the trait for sickle cell disease, so it is recessive.
A nurse is assessing a patient for hemorrhage after he underwent a transsphenoidal hypophysectomy. Which of the following signs may be present?
A. Bloody stool.
B. Bradycardia
C. Petechiae of the face
D. Frequent swallowing
D. Frequent swallowing
A hypophysectomy is the surgical removal of the pituitary gland due to a tumor. It is commonly removed transsphenoidally, or through the nose
• The nasal passages are generally packed after this surgery, and blood draining from the sinuses into the mouth and throat can cause the patient to frequently swallow
When testing for Cholesterol which lipoprotein is considered the "bad" fat and what is its normal value range
Low density lipoprotein (LDL)
<130 mg/dl
The nurse is auscultating the heart of a patient with congestive heart failure. The nurse hears an extra sound with a very low pitch, immediately after the second heart sound (S2). The nurse interprets this as:
A. A split S1
B. A split S2
C. A diastolic murmur
D. A third heart sound (s3)
D. A third heart sound (s3)
• S3 occurs immediately after S2. It has a very low pitch and has been described as a "gallop" or vibration. It can occur normally in people under 40 and in athletes. Later in life, it may indicate heart failure (ventricular dysfuncion) and/or fluid overload
What is this lung sound and what does it indicate?
Stridor
Croup
epiglottis
upper airway narrowing after intubation
foreign body aspirations
Airway edema from allergic reactions
The nurse is caring for a client immediately following a kidney transplant. When the client starts to develop a hyperacute rejection, what should the nurse prepare the client for?
A. Bone marrow transplant.
B. Removal of the kidney.
C. Administration of high-dose prednisone.
D. Administration of high-dose cyclosporine.
B. Removal of the kidney.
A hyperacute rejection manifests immediately and can lead to systemic inflammatory response syndrome (SIRS) if not treated right away. It can only be treated by removal of the organ.
Acute rejection occurs in all transplants to some degree unless immunosuppression is achieved. It can occur one week to several years after the transplant and is treated with immunosuppression, antibodies, or a bone marrow transplant.
Chronic rejection is usually considered untreatable except for retransplant. Inhaled cyclosporine is believed to delay or prevent chronic rejection.
A patient came into the clinic due to an eye problem. Which of the following is a correct method to assess the function of the patient's cranial nerve II (optic nerve)?
A. Use a Snellen chart.
B. Use a penlight and check the pupils for reactivity.
C. Note any nystagmus by testing the extraocular movements.
D. Use a feather to check for corneal reflex.
A. Use a Snellen chart.
• Cranial nerve II, the optic nerve, has a sensory function that carries impulses for vision. It travels to the cerebrum, where visual impulses are perceived and interpreted
• Damage to the optic nerve would affect vision, and the effects would depend on the location of the lesion. Homonymous hemianopsia means a person may not see things on either the left or the right side of the visual field. Bitemporal hemianopsia results in difficulty seeing things in the outer visual field
• Use a Snellen chart to assess for visual acuity and to check the function of cranial nerve II, the optic nerve. Another test to check this nerve would be checking the visual field in the four quadrants