A&E II Exam 2 Questions and answers
Newest Rated A+ 100% PASS
The home care nurse visits a patient with chronic heart failure who is taking digoxin and furosemide. The
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patient complains of nausea and vomiting. Which action is most appropriate for the nurse to take?
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
A:Perform a dipstick urine test for protein. II! II! II! II! II! II!
B:Notify the health care provider immediately. II! II! II! II! II!
C: Have the patient eat foods high in potassium.
II! II! II! II! II! II! II! II!
D:Ask the patient to record a weight every morning.
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B: Notify the health care provider immediately.
II! II! II! II! II! II!
A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
spironolactone, and enalapril. Which assessment should the nurse complete to best evaluate the
II! II! II! II! II! II! II! II! II! II! II! II! II!
patient’s response to these drugs?
II! II! II! II! II!
A: Observe skin turgor
II! II! II!
B: Auscultate lung sounds
II! II! II!
C: Measure blood pressure
II! II! II!
D: Review intake and output
II! II! II! II!
B: Auscultate lung sounds
II! II! II!
Left = Lungs II! II!
While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a.decreased fluid volume. II! II!
b.jugular vein atherosclerosis. II! II!
c.increased right atrial pressure. II! II! II!
d.incompetent jugular vein valves. II! II! II!
c.increased right atrial pressure. II! II! II!
The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patient sitting at a 45-degree angle reflects increased right atrial pressure.
II! II! II! II! II! II! II! II! II! II! II! II!
JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
caused by incompetent jugular vein valves or atherosclerosis.
II! II! II! II! II! II! II! II!
,We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
indicator that the treatment has been effective?
II! II! II! II! II! II! II!
a.Weight loss of 2 pounds in 24 hours II! II! II! II! II! II! II!
b.Hourly urine output greater than 60 mL II! II! II! II! II! II!
c.Reduction in patient complaints of chest pain II! II! II! II! II! II!
d.Reduced dyspnea with the head of bed at 30 degrees II! II! II! II! II! II! II! II! II!
d.Reduced dyspnea with the head of bed at 30 degrees II! II! II! II! II! II! II! II! II!
Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
cardiac output has occurred, but are not as specific to evaluating this patient's response.
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
an ejection fraction of 33%?
II! II! II! II! II!
a.Need to begin an aerobic exercise program several times weekly
II! II! II! II! II! II! II! II! II!
b.Use of salt substitutes to replace table salt when cooking and at the table
II! II! II! II! II! II! II! II! II! II! II! II! II!
c.Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
II! II! II! II! II! II! II! II!
d.Importance of making an annual appointment with the primary care provider II! II! II! II! II! II! II! II! II! II!
c.Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
II! II! II! II! II! II! II! II!
The core measures for the treatment of heart failure established by The Joint Commission indicate that
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
failure.
II!
Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
not usually recommended because of the risk of hyperkalemia, and the patient will need to see the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
primary care provider more frequently than annually.
II! II! II! II! II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
,IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a.ventricular ectopy. II!
b.a dry, hacking cough.
II! II! II!
c.a systolic BP <90 mm Hg.
II! II! II! II! II!
d.a heart rate <50 beats/minute.
II! II! II! II!
c.a systolic BP <90 mm Hg.
II! II! II! II! II!
Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension.
II! II! II! II! II! II! II! II! II! II! II! II! II!
Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
increased ventricular ectopy.
II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a.orthopnea.
b.pulsus alternans. II!
c.paroxysmal nocturnal dyspnea. II! II!
d.acute bilateral pleural effusion. II! II! II!
c.paroxysmal nocturnal dyspnea. II! II!
Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
alternansis the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates
II! II! II! II! II! II! II! II! II! II! II! II! II!
that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
period.
II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
ankle edema, a 2-kg weight gain over the past 2 days, and complains of “feeling too tired to get out of
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
bed.” Based on these data, the best nursing diagnosis for the patient is
II! II! II! II! II! II! II! II! II! II! II! II! II!
, a.activity intolerance related to fatigue. II! II! II! II!
b.disturbed body image related to weight gain. II! II! II! II! II! II!
c.impaired skin integrity related to ankle edema. II! II! II! II! II! II!
d.impaired gas exchange related to dyspnea on exertion. II! II! II! II! II! II! II!
a.activity intolerance related to fatigue. II! II! II! II!
The patient's statement supports the diagnosis of activity intolerance. There are no data to support the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
other diagnoses, although the nurse will need to assess for other patient problems.
II! II! II! II! II! II! II! II! II! II! II! II! II!
The nurse working on the heart failure unit knows that teaching an older female patient with newly
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
diagnosed heart failure is effective when the patient states that
II! II! II! II! II! II! II! II! II! II!
a.she will take furosemide (Lasix) every day at bedtime.
II! II! II! II! II! II! II! II!
b.the nitroglycerin patch is applied when any chest pain develops.
II! II! II! II! II! II! II! II! II!
c.she will call the clinic if her weight goes from 124 to 128 pounds in a week.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
d.an additional pillow can help her sleep if she is feeling short of breath at night.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
c.she will call the clinic if her weight goes from 124 to 128 pounds in a week.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
Teaching for a patient with heart failure includes information about the need to weigh daily and notify the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week. Nitroglycerin
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
should be used daily, not on an "as needed" basis. Diuretics should be taken earlier in the day to avoid
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
than just compensating by further elevating the head of the bed.
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When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
explains that foods to be restricted include
II! II! II! II! II! II! II!
a.canned and frozen fruits. II! II! II!
b.fresh or frozen vegetables. II! II! II!
c.eggs and other high-protein foods.
II! II! II! II!
d.milk, yogurt, and other milk products.
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d.milk, yogurt, and other milk products.
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Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for
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patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
have very high levels of sodium and are not appropriate for a 2000-mg sodium diet. The other foods listed
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
have minimal levels of sodium and can be eaten without restriction.
II! II! II! II! II! II! II! II! II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
Newest Rated A+ 100% PASS
The home care nurse visits a patient with chronic heart failure who is taking digoxin and furosemide. The
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patient complains of nausea and vomiting. Which action is most appropriate for the nurse to take?
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
A:Perform a dipstick urine test for protein. II! II! II! II! II! II!
B:Notify the health care provider immediately. II! II! II! II! II!
C: Have the patient eat foods high in potassium.
II! II! II! II! II! II! II! II!
D:Ask the patient to record a weight every morning.
II! II! II! II! II! II! II! II!
B: Notify the health care provider immediately.
II! II! II! II! II! II!
A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
spironolactone, and enalapril. Which assessment should the nurse complete to best evaluate the
II! II! II! II! II! II! II! II! II! II! II! II! II!
patient’s response to these drugs?
II! II! II! II! II!
A: Observe skin turgor
II! II! II!
B: Auscultate lung sounds
II! II! II!
C: Measure blood pressure
II! II! II!
D: Review intake and output
II! II! II! II!
B: Auscultate lung sounds
II! II! II!
Left = Lungs II! II!
While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a.decreased fluid volume. II! II!
b.jugular vein atherosclerosis. II! II!
c.increased right atrial pressure. II! II! II!
d.incompetent jugular vein valves. II! II! II!
c.increased right atrial pressure. II! II! II!
The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patient sitting at a 45-degree angle reflects increased right atrial pressure.
II! II! II! II! II! II! II! II! II! II! II! II!
JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
caused by incompetent jugular vein valves or atherosclerosis.
II! II! II! II! II! II! II! II!
,We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
indicator that the treatment has been effective?
II! II! II! II! II! II! II!
a.Weight loss of 2 pounds in 24 hours II! II! II! II! II! II! II!
b.Hourly urine output greater than 60 mL II! II! II! II! II! II!
c.Reduction in patient complaints of chest pain II! II! II! II! II! II!
d.Reduced dyspnea with the head of bed at 30 degrees II! II! II! II! II! II! II! II! II!
d.Reduced dyspnea with the head of bed at 30 degrees II! II! II! II! II! II! II! II! II!
Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
cardiac output has occurred, but are not as specific to evaluating this patient's response.
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
an ejection fraction of 33%?
II! II! II! II! II!
a.Need to begin an aerobic exercise program several times weekly
II! II! II! II! II! II! II! II! II!
b.Use of salt substitutes to replace table salt when cooking and at the table
II! II! II! II! II! II! II! II! II! II! II! II! II!
c.Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
II! II! II! II! II! II! II! II!
d.Importance of making an annual appointment with the primary care provider II! II! II! II! II! II! II! II! II! II!
c.Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
II! II! II! II! II! II! II! II!
The core measures for the treatment of heart failure established by The Joint Commission indicate that
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
failure.
II!
Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
not usually recommended because of the risk of hyperkalemia, and the patient will need to see the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
primary care provider more frequently than annually.
II! II! II! II! II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
,IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a.ventricular ectopy. II!
b.a dry, hacking cough.
II! II! II!
c.a systolic BP <90 mm Hg.
II! II! II! II! II!
d.a heart rate <50 beats/minute.
II! II! II! II!
c.a systolic BP <90 mm Hg.
II! II! II! II! II!
Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension.
II! II! II! II! II! II! II! II! II! II! II! II! II!
Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
increased ventricular ectopy.
II! II! II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a.orthopnea.
b.pulsus alternans. II!
c.paroxysmal nocturnal dyspnea. II! II!
d.acute bilateral pleural effusion. II! II! II!
c.paroxysmal nocturnal dyspnea. II! II!
Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
alternansis the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates
II! II! II! II! II! II! II! II! II! II! II! II! II!
that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
period.
II!
We have an expert-written solution to this problem!
II! II! II! II! II! II! II!
During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
ankle edema, a 2-kg weight gain over the past 2 days, and complains of “feeling too tired to get out of
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
bed.” Based on these data, the best nursing diagnosis for the patient is
II! II! II! II! II! II! II! II! II! II! II! II! II!
, a.activity intolerance related to fatigue. II! II! II! II!
b.disturbed body image related to weight gain. II! II! II! II! II! II!
c.impaired skin integrity related to ankle edema. II! II! II! II! II! II!
d.impaired gas exchange related to dyspnea on exertion. II! II! II! II! II! II! II!
a.activity intolerance related to fatigue. II! II! II! II!
The patient's statement supports the diagnosis of activity intolerance. There are no data to support the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
other diagnoses, although the nurse will need to assess for other patient problems.
II! II! II! II! II! II! II! II! II! II! II! II! II!
The nurse working on the heart failure unit knows that teaching an older female patient with newly
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
diagnosed heart failure is effective when the patient states that
II! II! II! II! II! II! II! II! II! II!
a.she will take furosemide (Lasix) every day at bedtime.
II! II! II! II! II! II! II! II!
b.the nitroglycerin patch is applied when any chest pain develops.
II! II! II! II! II! II! II! II! II!
c.she will call the clinic if her weight goes from 124 to 128 pounds in a week.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
d.an additional pillow can help her sleep if she is feeling short of breath at night.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
c.she will call the clinic if her weight goes from 124 to 128 pounds in a week.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
Teaching for a patient with heart failure includes information about the need to weigh daily and notify the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week. Nitroglycerin
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and
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should be used daily, not on an "as needed" basis. Diuretics should be taken earlier in the day to avoid
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nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather
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than just compensating by further elevating the head of the bed.
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When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse
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explains that foods to be restricted include
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a.canned and frozen fruits. II! II! II!
b.fresh or frozen vegetables. II! II! II!
c.eggs and other high-protein foods.
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d.milk, yogurt, and other milk products.
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d.milk, yogurt, and other milk products.
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Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for
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patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses,
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have very high levels of sodium and are not appropriate for a 2000-mg sodium diet. The other foods listed
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have minimal levels of sodium and can be eaten without restriction.
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We have an expert-written solution to this problem!
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