NUR 2502 MDC 3 FINAL EXAM - CARDIOVASCULAR AND HEMATOLOGY

1. A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? a.Age b.Obesity c.Inactivity d.Dyslipidemia: a.Age 2. A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client? a. Age b. Impaired renal function c. Family history d.Dyslipidemia: d.Dyslipidemia 3. Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? a.A client experiencing depression b.A client diagnosed with kidney disease c.A client of advanced age d.A client with excessive alcohol intake: b.A client diagnosed with kidney disease 4. A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a. Reduce the blood pressure by 20% to 25% within the first hour of treatment. b. Reduce the blood pressure to about 140/80 mm Hg. c. Rapidly reduce the blood pressure so the client will not suffer a stroke. d. Reduce the blood pressure by 50% within the first hour of treatment.: a.Re- duce the blood pressure by 20% to 25% within the first hour of treatment. 5. An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? a. Postural hypertension and resulting injury b. Rebound hypertension c. Sexual dysfunction d. Postural hypotension and resulting injury: d.Postural hypotension and result- ing injury 6. The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? a. Lowering and controlling the blood pressure without adverse effects and without undue cost b. Making sure that the patient adheres to the therapeutic medication regimen c.Instructing the patient to enter a weight loss program and begin an exercise regimen d.Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence: a.Lowering and controlling the blood pressure without adverse effects and without undue cost 7. Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a.Hypertensive emergency b.Hypertensive urgency c.Primary hypertension d.Secondary hypertension: a.Hypertensive emergency 8. The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should the client's heart rate. the client's serum K+ level. the client's urine output. the client.: the client's heart rate. 9. Which diagnostic method is recommended to determine whether left ven- tricular hypertrophy has occurred? a. Echocardiography b.Electrocardiography c. Blood chemistry d. Blood urea nitrogen: a.Echocardiography 10. A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize? a. It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. b. The taste buds never adapt to decreased salt intake. c. There is usually no need to change alcohol consumption for clients with hypertension. d. A person with hypertension should never consume alcohol.: a.It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. 11. A client is admitted to the intensive care unit (ICU) with a diagnosis of hy- pertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? a. Nausea and severe headache b. Chest pain score of 3 (on a scale of 1 to 10) c. Numbness and weakness in the left arm d. Urine output of 40 mL over the past hour: c.Numbness and weakness in the left arm 12. It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine a. increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. c. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. d. decreases circulating blood volume.: ases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. 13. According to the DASH diet, how many servings of vegetables should a person consume each day? a.2 or fewer b.2 or 3 c.4 or 5 d.7 or 8: c.4 or 5 14. The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assess- ment data will assist in determining this complication? (Select all that apply.) a.Heart rate b.Respiratory rate c.Heart rhythm d.Character of apical and peripheral pulses e.Lung sounds: a.Heart rate c.Heart rhythm d.Character of apical and peripheral pulses 15. Primary or essential hypertension accounts for about 95% of all hyperten- sion diagnoses with an unknown etiology. Secondary hypertension accompa- nies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension? ial vasoconstriction ic function um deficit -base imbalance: ial vasoconstriction 16. Which condition(s) indicates target organ damage from untreated/under- treated hypertension? Select all that apply. a. Heart failure b. Retinal damage c.Diabetes d.Hyperlipidemia e.Stroke: a.Heart failure b.Retinal damage e.Stroke 17. A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? a.Purchasing a self-monitoring BP cuff b.Discussing methods for stress reduction c.Advising smoking cessation d.Administering glycemic control: a.Purchasing a self-monitoring BP cuff 18. The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? heral edema -sided heart failure e nary insufficiency: e 19. A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? a. Begin cardiopulmonary resuscitation b. Prepare for endotracheal intubation c. Provide electrical cardioversion d. Administer intravenous epinephrine: a.Begin cardiopulmonary resuscitation 20. The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? oversion b.IV bolus of atropine c.IV bolus of dobutamine rillation: rillation 21. The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? a. Administer an IV bolus of atropine. b. Send the client to the cardiac catheterization laboratory. c. Prepare to client for cardioversion. d. Review the client's medication record.: a.Administer an IV bolus of atropine. 22. The nurse knows that what PR interval presents a first-degree heart block? a.0.14 seconds b.0.16 seconds c.0.18 seconds d.0.24 seconds: d.0.24 seconds 23. The nurse identifies which of the following as a potential cause of prema- ture ventricular complexes (PVCs)? a. Alkalosis b.Hypokalemia c.Hypovolemia d.Bradycardia: b.Hypokalemia 24. The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as l sinus rhythm. tachycardia. ional tachycardia. -degree atrioventricular block.: l sinus rhythm. 25. The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhyth- mias? a. Monitor blood pressure continuously. b. Monitor cardiac rhythm continuously. c. Provide supplemental oxygen. d. Palpate the client's pulse and observe the client's response.: b.Monitor car- diac rhythm continuously. 26. The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? a. Variable heart rate, usually fewer than 90 bpm b.Irregular rhythm c. Delayed conduction, producing a prolonged PR interval d. P waves hidden within the QRS complex: c.Delayed conduction, producing a prolonged PR interval 27. The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? a. "The only difference is the heart rate." b. "The P waves will be shaped differently." c. "The QRS complex will be smaller in sinus bradycardia." d. "The P-R interval will be prolonged in sinus bradycardia.": a."The only differ- ence is the heart rate." 28. A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as a.100 bpm. b.70 bpm. c.80 bpm. d.90 bpm.: d.90 bpm. 29. After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? a.0.05 and 0.1 seconds. b.0.12 and 0.2 seconds. c.0.15 and 0.3 seconds. d.0.25 and 0.4 seconds.: b.0.12 and 0.2 seconds. 30. Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? a. "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." b. "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." c. "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." d. "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers.": a."It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." 31. A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? a. Premature ventricular contraction b.Atrial flutter c. Asystole d. Ventricular fibrillation: b.Atrial flutter 32. A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? a. Sinus tachycardia b.Ventricular tachycardia c. Normal sinus rhythm d. Sinus bradycardia: a.Sinus tachycardia 33. The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a. The client is sedated before the procedure. b. It uses less electrical energy than cardioversion. c. It is a scheduled procedure 1 to 10 days in advance. d. It is used to eliminate ventricular dysrhythmias.: d.It is used to eliminate ventricular dysrhythmias. 34. The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a.Atrial fibrillation b.Ventricular tachycardia c.Atrial flutter d.Ventricular fibrillation: c.Atrial flutter 35. The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a.A client with third-degree heart block b.A client with atrial dysrhythmias c.A new myocardial infarction client d.A client with poor kidney perfusion: b.A client with atrial dysrhythmias 36. A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a.Ventricular fibrillation b.Ventricular tachycardia c.Third-degree heart block d.Atrial fibrillation: a.Ventricular fibrillation 37. A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocar- diogram and administers I.V. morphine. The health care provider also con- siders administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a. Within 24 to 48 hours b. Within 12 hours c. Within 6 hours d. Within 5 to 7 days: c.Within 6 hours 38. The nurse is caring for a client who is having chest pain associated with a myocardial infarction (MI). What medication will the nurse administer intravenously to reduce pain and anxiety? nyl ne sulfate ine sulfate morphone hydrochloride: ine sulfate 39. A nurse is caring for a client who is exhibiting signs and symptoms char- acteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a. Prepare the client for pulmonary artery catheterization. b. Assess the client's level of pain and administer prescribed analgesics. c. Ensure that the client's family is kept informed of the client's status. d. Assess the client's level of anxiety and provide emotional support.: b.Assess the client's level of pain and administer prescribed analgesics. 40. A client with a family history of coronary artery disease reports experienc- ing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? ise avoidance ng cessation xidant supplements d.a protein-rich diet: ng cessation 41. The nurse is assessing a client with severe angina pectoris and electrocar- diogram changes in the emergency room. What is the most important cardiac marker for the client? obin nin te dehydrogenase ine kinase: nin 42. A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? a. Assess blood pressure and administer aspirin b. It is not important to assess the client or to notify the physician c. Assess the client's physical history d. Assess chest pain and administer prescribed drugs and oxygen: d.Assess chest pain and administer prescribed drugs and oxygen 43. The nurse is assessing a client with suspected post-pericardiotomy syn- drome after cardiac surgery. What manifestation will alert the nurse to this syndrome? ardial friction rub hermia ased white blood cell (WBC) count ased erythrocyte sedimentation rate (ESR): ardial friction rub 44. The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond? deposits in the lumen of arteries sterol plugs in the lumen of veins clots in the arteries i in the veins: deposits in the lumen of arteries 45. A patient with coronary artery disease (CAD) is having a cardiac catheter- ization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? a. The patient has had angina longer than 3 years. b. The patient has at least a 70% occlusion of a major coronary artery. c. The patient has compromised left ventricular function. d. The patient has an ejection fraction of 65%.: b.The patient has at least a 70% occlusion of a major coronary artery. 46. A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires im- mediate intervention by the nurse? a. Central venous pressure reading of 1 b. Heart rate 66 bpm c. Blood pressure 110/68 mm Hg d. Pain score 5/10: a.Central venous pressure reading of 1 47. The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. a. Physical inactivity b. Alcohol use c. Elevated blood pressure d. Family history e.Increasing age f.Obesity: a.Physical inactivity b. Alcohol use c. Elevated blood pressure f.Obesity 48. A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? a.Described as crushing and substernal b.Relieved by rest and nitroglycerin c.Associated with nausea and vomiting d. Accompanied by diaphoresis and dyspnea: b.Relieved by rest and nitroglyc- erin 49. The nurse is admitting a client with an elevated creatine kinase-MB isoen- zyme (CK-MB). What is the cause for the elevated isoenzyme? tal muscle damage due to a recent fall rdial necrosis c.I.M. injection ral bleeding: rdial necrosis 50. A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle the prescription was filled 12 months ago. The nurse anticipates which order by the physician? a. Chest x-ray b. Ativan 1 mg orally c. Serum electrolytes d. Nitroglycerin SL: d.Nitroglycerin SL 51. The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? a. ST elevation b. Sinus tachycardia c. Isolated premature ventricular contractions (PVCs) d. Frequent premature atrial contractions (PACs): a.ST elevation 52. The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? a. "What time did your chest pain start today?" b. "Do your parents have heart disease?" c. "What is your pain level on a scale of 1 to 10?" d. "How many sublingual nitroglycerin tablets did you take?": a. "What time did your chest pain start today?" 53. The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a. Decreased venous pressure b.Left ventricular hypertrophy c.Cardiac tamponade d.Hypertension: c.Cardiac tamponade 54. A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? cardiogram ac catheterization l enzyme studies ardiogram: ardiogram 55. A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease? a.Mitral stenosis b.Cardiomyopathy c.Rheumatic fever d.Pericarditis: c.Rheumatic fever 56. The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching? a. "I will take antibiotics before getting my teeth cleaned." b. "I can get my tongue pierced at a store in the shopping mall." c. "I can get a tattoo at a local parlor." d. "I will avoid caffeine, alcohol, and smoking.": d. "I will avoid caffeine, alcohol, and smoking." 57. In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? a. Dilated b.Hypertrophic c.Arrhythmogenic right ventricular d.Restrictive: b.Hypertrophic 58. A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis? a. Chest pain b.Fatigue c.Orthopnea d.Dyspnea: a.Chest pain 59. On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard? a. Low-pitched, rumbling diastolic murmur at the apex of the heart b.Mitral valve click c. Diastolic murmur at the left sternal border of the heart d. High-pitched blowing sound at the apex: a.Low-pitched, rumbling diastolic murmur at the apex of the heart 60. Which instruction should a nurse provide a client with a history of rheumat- ic fever before the client has any dental work done? a. To take aspirin b. To take prophylactic antibiotics c. To take steroids d. To avoid any kind of activity: b.To take prophylactic antibiotics 61. A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response? a. "Antibiotics will prevent vegetative growth on your valves." b. "You are at risk of developing an infection in your heart." c. "Your teeth will not bleed as much if you have antibiotics." d. "This procedure may cause your valve to malfunction.": b."You are at risk of developing an infection in your heart." 62. The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? a. "Do you have a family history of endocarditis?" b. "Have you recently vacationed outside of the United States?" c. "Have you been to the dentist recently?" d. "Do you live with any domesticated animals in your home?": c."Have you been to the dentist recently?" 63. A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed? a.Balloon percutaneous valvuloplasty b.Placement of a xenograft valve c.Placement of an autograft valve d.Antibiotic therapy: a.Balloon percutaneous valvuloplasty 64. Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? a. Allow unrestricted physical activity b. Check regularly for dependent edema c.Administer oxygen d.Maintain bed rest: b.Check regularly for dependent edema 65. The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve pro- lapse? a. Fatigue b.Dizziness c. An extra heart sound d. Syncope: c.An extra heart sound 66. Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis? a.Exercise regimen b.Antihypertensive medication c.Potassium replacement d.Antibiotic therapy: d.Antibiotic therapy 67. A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub. What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? a. The nurse has the client stand during auscultation. b. The nurse asks the client to hold the breath during auscultation. c. The nurse places the client flat for at least 4 minutes. d. There is really no question to ask the client to tell the difference.: b.The nurse asks the client to hold the breath during auscultation. 68. The nurse is administering medications to a client with pericarditis. What medications will be commonly prescribed to treat pericarditis? Select all that apply. ofen isone icine ethacin: ofen isone icine 69. A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? a. Pseudomonas aeruginosa b. Group A, beta-hemolytic streptococcus c. Serratia marcescens d. Staphylococcus aureus: b.Group A, beta-hemolytic streptococcus 70. A nurse is teaching a client about mitral stenosis. What is the key teaching point regarding the disruption to the normal flow of blood through the heart due to mitral stenosis? nary circulation congestion l hypertrophy ased resistance of a narrowed orifice between the left atrium and the left ventricle quate left and right ventricle filling: ased resistance of a narrowed orifice between the left atrium and the left ventricle 71. A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnos- tic test to confirm the client's diagnosis? a. Cardiac catheterization b. Computed tomography c.Echocardiography d.Chest x-ray: c.Echocardiography 72. The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate peri- carditis? ng edema, chest discomfort, and nonspecific ST-segment elevation urine output secondary to left ventricular dysfunction , chest discomfort, and elevated erythrocyte sedimentation rate (ESR) rgy, anorexia, and heart failure: , chest discomfort, and elevated erythrocyte sedimentation rate (ESR) 73. The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericardi- tis? ea ts of constant chest pain ted ESR and CRP ue lasting more than 1 month: ts of constant chest pain 74. A client with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings? a. "I told the patient that this is a normal complication and to take deep breaths." b. "I anticipated this complication and I will call the health care provider right now." c. "I instructed the patient to do coughing and deep breathing and I will reassess in 30 minutes." d. "I placed the patient in a semi-Fowler's position and started an NPO diet."- : b."I anticipated this complication and I will call the health care provider right now." 75. A nurse plans to have an education session with a client with cardiomy- opathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? a. Alternate active periods with rest periods. b.Gradually work up to strenuous activity. c. Avoid all physical and emotional stress. d. Include isometric exercises in the daily routine.: a.Alternate active periods with rest periods. 76. The nurse is teaching a client with heart failure about the ability for the heart to pump out blood. What diagnostic test will measure the ejection fraction of the heart? ardiogram b.MRI nary arterial pressure ar angiography: ardiogram 77. A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? a. Analyze the arterial blood gas. b. Change oxygen delivery to a mask. c.Administer epinephrine. d.Stop all emergency measures.: c.Administer epinephrine. 78. A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing action? a. Administer angiotensin II receptor blockers b.Administer diuretics c.Administer angiotensin-converting enzyme inhibitors d.Assess oxygen saturation: d.Assess oxygen saturation 79. The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? ria ng edema c.S4 ventricular gallop sign ased O2 saturation levels: ng edema 80. A nurse is assessing a client with heart failure. What breath sound is commonly auscultated in clients with heart failure? eal. ion rubs. e crackles. crackles.: crackles. 81. A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema? a. The client says his rings have become tight and are difficult to remove. b. The client says he has been hungry in the evening. c. The client says that he has been urinating less frequently at night. d. The client says he is short of breath when ambulating.: a.The client says his rings have become tight and are difficult to remove. 82. The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure? a. Supraventricular tachycardia b. Sinus tachycardia c. Atrial fibrillation d. First-degree heart block: c.Atrial fibrillation 83. A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? a. Prone with legs elevated on pillows b. Head of the bed elevated 45 degrees and lower arms supported by pillows c. Supine with arms elevated on pillows above the level of the heart d. Head of the bed elevated 30 degrees and legs elevated on pillows: b.Head of the bed elevated 45 degrees and lower arms supported by pillows 84. A new client has been admitted with right-sided heart failure. When assess- ing this client, the nurse knows to look for which finding? a.Jugular venous distention b.Pulmonary congestion c.Dyspnea d.Cough: a.Jugular venous distention 85. While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound? a.a first heart sound (S1). b.a murmur. c.a third heart sound (S3). d.a fourth heart sound (S4).: c.a third heart sound (S3). 86. A client has been prescribed furosemide 80 mg twice daily. The asympto- matic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? a. Notify the health care provider. b.Administer potassium. c. Check the client's potassium level. d. Calculate the client's intake and output.: c.Check the client's potassium level. 87. A client is receiving captopril for heart failure. During the nurse's assess- ment, what sign indicates that the medication therapy is ineffective? a.b radycardia ral hypotension heral edema rash: heral edema 88. A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? a. "My feet are bigger than normal." b. "I don't have the same appetite I used to." c. "I sleep on three pillows each night." d. "My pants don't fit around my waist.": c."I sleep on three pillows each night." 89. Which is a manifestation of right-sided heart failure? a. Increase in forward flow b. Systemic venous congestion c.Paroxysmal nocturnal dyspnea d.Accumulation of blood in the lungs: b.Systemic venous congestion 90. A client with left-sided heart failure reports increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of what condition? a.c ardiogenic shock. -sided heart failure. pulmonary edema. onia.: pulmonary edema. 91. A client with acute pericarditis is exhibiting distended jugular veins, tachy- cardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence? a. The pericardial space is eliminated with scar tissue and thickened pericardi- um. b. The parietal and visceral pericardial membranes adhere to each other, pre- venting normal myocardial contraction. c. Excess pericardial fluid compresses the heart and prevents adequate dias- tolic filling. d. Fibrin accumulation on the visceral pericardium infiltrates into the my- ocardium, creating generalized myocardial dysfunction.: c.Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. 92. The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? a. Avoid the intake of canned fruit and fruit juices. b. Encourage increased intake of vegetables with natural sodium. c.Avoid the intake of processed and commercially prepared foods. d.Encourage increased intake of red meat.: c.Avoid the intake of processed and commercially prepared foods. 93. A nurse is caring for a client with left-sided heart failure. What should the nurse anticipate using to reduce fluid volume excess? a.d iuretics. oagulants. mbolism stockings. n.: tics. 94. The nurse is caring for a client with advanced heart failure. What treatment will be considered after all other therapies have failed? a. implantable cardiac defibrillator (ICD) icular access device ac resynchronization therapy transplant: transplant 95. A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing culosis. exacerbation of chronic obstructive pulmonary disease. pensated heart failure with pulmonary edema. eral pneumonia.: pensated heart failure with pulmonary edema. 96. Which feature is the hallmark of systolic heart failure? a.Pulmonary congestion b. Low ejection fraction (EF) c. Limited activities of daily living (ADLs) d. Basilar crackles: b.Low ejection fraction (EF) 97. A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours? a. Peripheral pulses every 15 minutes after surgery b. Blood pressure every 2 hours c. Color of the leg every 4 hours d. Ankle-arm indices every 12 hours: a.Peripheral pulses every 15 minutes after surgery 98. The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack? a. Take over-the-counter decongestants. b. Avoid situations that contribute to ischemic episodes. c. Avoid fatty foods and exercise. d. Report changes in the usual pattern of chest pain.: b.Avoid situations that contribute to ischemic episodes. 99. Which is a characteristic of arterial insufficiency? a. Aching, cramping pain b. Pulses are present but may be difficult to palpate c.Superficial ulcer d.Diminished or absent pulses: d.Diminished or absent pulses 100. A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gaiter area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a. Trauma b. Arterial insufficiency c. Neither venous nor arterial insufficiency d. Venous insufficiency: d.Venous insufficiency 101. A nurse and physician are preparing to visit a hospitalized client with peripheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details? a. The client's legs awaken him during the night with itching. b. The client's fingers tingle when left in one position for too long. c. The client experiences shortness of breath after walking about 50 feet. d. The client can walk about 50 feet before getting pain in the right lower leg.: c.The client experiences shortness of breath after walking about 50 feet. 102. A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: raging ambulation to prevent pooling of blood. ting the extremity to prevent pooling of blood. ng blood into the deep venous system. ding warmth to the extremity.: ng blood into the deep venous sys- tem. 103. The nurse is assessing a patient two days postoperatively who is sus- pected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow to the lower extremities? a. Apply a heating pad to the patient's abdomen. b. Assist with active range-of-motion (ROM) exercises to the left lower extrem- ity. c. Apply cool compresses to the left lower extremity. d. Administer a diuretic to decrease the edema in the left lower extremity.: - a. Apply a heating pad to the patient's abdomen. 104. You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a.Aneurysm b.Coronary thrombosis c.Atherosclerosis d.Raynaud's disease: c.Atherosclerosis 105. A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? a.Numbness, warm skin temperature, and redness b.Numbness, cool skin temperature, and pallor c.Swelling, warm skin temperature, and drainage d.Redness, cool skin temperature, and swelling: b.Numbness, cool skin temper- ature, and pallor 106. Which of the following is the most common site for a dissecting aneurysm? a. Cervical area b. Thoracic area c. Sacral area d. Lumbar area: b.Thoracic area 107. A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? a. Avoid foods with iodine. b. Refrain from sexual activity for a week. c. Elevate the legs periodically for at least an hour. d. Elevate the legs periodically for at least 15 to 20 minutes.: d.Elevate the legs periodically for at least 15 to 20 minutes. 108. Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a. Intermittent claudication b.Vertigo c. Dizziness d. Acute limb ischemia: a.Intermittent claudication 109. A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a. Increasing blood pressure and monitoring fluid intake and output b.Increasing blood pressure and reducing mobility c. Decreasing blood pressure and increasing mobility d. Stabilizing heart rate and blood pressure and easing anxiety: d.Stabilizing heart rate and blood pressure and easing anxiety 110. A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities? a. Massage the calf muscles if pain occurs. b. Use a heating pad to promote warmth. c.Participate in a regular walking program. d.Keep the extremities elevated slightly.: c.Participate in a regular walking pro- gram. 111. Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a.Elevated blood pressure and rapid respirations b.Decreased pulse rate and blood pressure c.Retrosternal back pain radiating to the left arm d.Increased abdominal and back pain: d.Increased abdominal and back pain 112. A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissec- tion? a. Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute b. Urine output of 15 ml/hour and 2+ hematuria c. Urine output of 150 ml/hour and heart rate of 45 beats/minute d. Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute: d.Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute 113. A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia? a. Pacemaker implantation b. Mace procedure c. Elective cardioversion d.Defibrillation: c.Elective cardioversion 114. The nurse is caring for a client who has premature ventricular contrac- tions. What sign or symptom is observed in this client? a. Nausea b.Fever c.Hypotension d.Fluttering: d.Fluttering 115. A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? a. Vibration under the skin b. Quality of the pulse c. Scar on the chest d. "Spike" on the rhythm strip: d. "Spike" on the rhythm strip 116. A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? rocautery ardiogram roencephalogram rocardiogram: rocardiogram 117. The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a. Low density lipoprotein (LDL), 160 mg/dL b.High-density lipoprotein (HDL), 80 mg/dL c.A ratio of LDL to HDL, 4.5 to 1.0 d.Cholesterol, 280 mg/dL: b.High-density lipoprotein (HDL), 80 mg/dL 118. A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? a.30 minutes b.15 minutes c.60 minutes d.5 minutes: d.5 minutes 119. A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? a. Presence of reperfusion dysrhythmias b. Chest pain 2 of 10 (on a 1-to-10 pain scale) c. Minimal oozing of blood from the IV site d. Altered level of consciousness: d.Altered level of consciousness 120. A middle-aged client presents to the ED reporting severe chest discom- fort. Which finding is most indicative of a possible myocardial infarction (MI)? a. Cool, clammy skin and a diaphoretic, pale appearance b.Intermittent nausea and emesis for 3 days c. Chest discomfort not relieved by rest or nitroglycerin d. Anxiousness, restlessness, and lightheadedness: c.Chest discomfort not re- lieved by rest or nitroglycerin 121. Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? a.Morphine sulfate (Morphine) b.Isosorbide mononitrate (Isordil) c.Nitroglycerin transdermal patch d.Meperidine hydrochloride (Demerol): a.Morphine sulfate (Morphine) 122. A client with a myocardial infarction develops acute mitral valve regurgi- tation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? a. Shortness of breath b.Hypertension c.A loud, blowing murmur d.Tachycardia: a.Shortness of breath 123. A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accu- rate knowledge of neutropenia based on which intervention? a. Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential b. Monitoring the client's breathing and reviewing the client's arterial blood gases c. Monitoring the client's blood pressure and reviewing the client's hematocrit d.Monitoring the client's heart rate and reviewing the client's hemoglobin: - a.Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential 124. The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? a. Observe client for facial droop. b. Observe stools for blood. c. Observe the sputum for signs of blood. d. Observe the gums for bleeding after the client brushes teeth.: b.Observe stools for blood. 125. A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse? a. To detect the evidence of infection such as fever and tachycardia b. To detect the motor strength and stroke-related signs and symptoms c. To detect the evidence of dehydration that might have triggered a sickle cell crisis d. To detect the abnormal sounds suggestive of acute chest syndrome and heart failure: d.To detect the abnormal sounds suggestive of acute chest syndrome and heart failure 126. The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? a. It will determine what type of anemia the patient has. b. It is part of the required assessment information. c. It is important for the nurse to determine what type of foods the patient will eat. d. It may indicate deficiencies in essential nutrients.: d.It may indicate deficien- cies in essential nutrients. 127. A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a. Dyspnea, tachycardia, and pallor b.Nausea, vomiting, and anorexia c. Nights sweats, weight loss, and diarrhea d. Itching, rash, and jaundice: a.Dyspnea, tachycardia, and pallor 128. The nurse is educating a client about iron supplements. The nurse teach- es that what vitamin enhances the absorption of iron? a.A b.C c.D d.E: b.C 129. A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? a. Rubs the site vigorously b. Injects into the deltoid muscle c. Uses a 23-gauge needle d. Employs the Z-track technique: d.Employs the Z-track technique 130. Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? a. Apply prolonged pressure to needle sites or other sources of external bleeding b. Implement neutropenic precautions c.Monitor temperature at least once per shift d.Eliminate direct contact with others who are infectious: a.Apply prolonged pressure to needle sites or other sources of external bleeding 131. The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? a.Direct pressure b.Application of a tourniquet c.Pressure point control d.Elevation of the extremity: a.Direct pressure 132. Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? a. "The child must inherit two defective genes, one from each parent." b. "It is an acquired, not a hereditary disorder." c. "Most likely, the father is the carrier of the gene." d. "The trait is passed down through the mother.": a. "The child must inherit two defective genes, one from each parent." 133. Which of the following is the most common hematologic condition affect- ing elderly patients a. Anemia b.Bandemia c.Thrombocytopenia d.Leukopenia: a.Anemia 134. A client with sickle cell anemia has a l blood smear. hematocrit. l hematocrit. hematocrit.: hematocrit. 135. A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? a. "I'll watch my gums for bleeding when I brush my teeth." b. "I'll report unexplained or severe bruising to my doctor right away." c. "I'll use an electric razor to shave." d. "I'll eat four servings of fresh, dark green vegetables every day.": d."I'll eat four servings of fresh, dark green vegetables every day." 136. The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? a. Do not take medication with orange juice because it will delay absorption of the iron. b. Dilute the liquid preparation with another liquid such as juice and drink with a straw. c. Iron may cause indigestion and should be taken with an antacid such as Mylanta. d. Discontinue the use of iron if your stool turns black.: b.Dilute the liquid preparation with another liquid such as juice and drink with a straw. 137. A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? a. Take an iron supplement with meals to reduce gastric irritation. b. Increase the intake of green, leafy vegetables. c. Decrease the intake of citrus fruits because they interfere with iron absorp- tion. d. Decrease the intake of high-fat red meats, especially organ meats.: b.In- crease the intake of green, leafy vegetables. 138. A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? a. Encourage the client to use a wheelchair. b. Limit visits by family members. c. Maintain accurate fluid intake and output records. d. Use the smallest needle possible for injections.: d.Use the smallest needle possible for injections. 139. A client reports feeling tired, cold, and short of breath at times. Assess- ment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? radiograph b.CBC c.ECG iotic: b.CBC 140. A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? a. Abdominal pain b.Diarrhea c.The onset of a bacterial infection d.Bleeding: c.The onset of a bacterial infection 141. The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? a. Ask the client if he was ever known as Donald A. Smith b. Check with the blood bank first and then administer the blood with their permission c. Refuse to administer the blood d. Administer the unit of blood: c.Refuse to administer the blood 142. The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorp- tion? a. Eating calf's liver with a glass of orange juice b. Eating leafy green vegetables with a glass of water c. Eating apple slices with carrots d. Eating a steak with mushrooms: a.Eating calf's liver with a glass of orange juice 143. A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? a. Limiting the client's intake of oral and IV fluids b. Limit foods that contain folic acid c. Administering and evaluating the effectiveness of opioid analgesics d.Encouraging the client to ambulate immediately: c.Administering and evaluat- ing the effectiveness of opioid analgesics 144. When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? a. Fruits high in vitamin C, such as oranges and grapefruits b. Dairy products c. Beans, dried fruits, and leafy, green vegetables d. Berries and orange vegetables: c.Beans, dried fruits, and leafy, green vegeta- bles 145. A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? a. There is a weak correlation between iron stores and hemoglobin levels. b. There is a strong correlation between iron stores and hemoglobin levels. c. There is an inverse relationship between iron stores and hemoglobin levels. d. There is a strong correlation between iron stores and hemoglobin character- istics.: b.There is a strong correlation between iron stores and hemoglobin levels. 146. Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? a. Apply prolonged pressure to needle sites or other sources of external bleeding b. Monitor temperature at least once per shift c.Implement neutropenic precautions d.Eliminate direct contact with others who are infectious: a.Apply prolonged pressure to needle sites or other sources of external bleeding 147. While assessing a client, the nurse will recognize what as the most obvious sign of anemia? a.Pallor b.Tachycardia c.Jaundice d.Flow murmurs: a.Pallor 148. Which term refers to a form of white blood cell involved in immune response? a.Spherocyte b.Thrombocyte c.Lymphocyte d.Granulocyte: c.Lymphocyte 149. The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? a. Encourage adequate nutrition. b. Increase mobility. c. Provide adequate hydration. d. Promote safety.: d.Promote safety. 150. The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis? a. Polycythemia vera b. Sickle cell disease c. Aplastic anemia d. Pernicious anemia: a.Polycythemia vera 151. The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? a. Chronic myeloid leukemia b. Hodgkin lymphoma c. Multiple myeloma d. Non-Hodgkin lymphoma: c.Multiple myeloma 152. The nurse is assessing several clients. Which client does the nurse de- termine is most likely to have Hodgkin lymphoma? a. The client with painful lymph nodes in the groin. b. The client with enlarged lymph nodes in the neck. c. The client with a painful sore throat. d. The client with painful lymph nodes under the arm.: b.The client with enlarged lymph nodes in the neck. 153. The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? a. "In chronic leukemia, the minority of leukocytes are mature." b. "In acute leukemia there are not many undifferentiated cells." c. "Acute leukemia develops slowly." d. "Chronic leukemia develops slowly.": d. "Chronic leukemia develops slowly." 154. The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? a. Severe thrombocytopenia b. Gradual muscle paralysis c.Debilitating fatigue d.Bone pain in the back of the ribs: d.Bone pain in the back of the ribs 155. A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a.Hypermagnesemia b.Hypernatremia c.Hyperkalemia d.Hypercalcemia: d.Hypercalcemia 156. The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? a. Osteopathic tumors destroy bone causing fractures. b.Osteolytic activating factor weakens bones producing fractures. c.Osteoclasts break down bone cells so pathologic fractures occur. d.Osteosarcomas form producing pathologic fractures.: c.Osteoclasts break down bone cells so pathologic fractures occur. 157. A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? a. Maintain nutrition. b. Address issues of negative body image. c.Administer pain medication. d.Place the client in reverse isolation.: a.Maintain nutrition. 158. A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? a.Monitoring respiratory status b.Balancing rest and activity c.Restricting fluid intake d.Preventing bone injury: d.Preventing bone injury 159. Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? a.Osteoporosis b.Calcified bones c.Increased mobility d.Pathologic fractures: d.Pathologic fractures 160. A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? a. Assess the client's pulse and blood pressure. b. Assess the client's skin. c. Assess the client's hemoglobin and platelets. d. Check the client's history.: c.Assess the client's hemoglobin and platelets. 161. A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? a.Hemolytic anemia b.Polycythemia vera c.Leukemia d.Multiple myeloma: d.Multiple myeloma 162. A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? a. Place a cooling blanket on the client. b. Evaluate the client for potential infection. c.Administer an antitussive. d.Medicate the client to relieve pain.: b.Evaluate the client for potential infection. 163. A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? logic bone fractures. emia. heart failure. ic liver failure.: logic bone fractures. 164. The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection? a. Practice vigilant handwashing. b. Monitor the client's temperature every shift. c. Maintain contact precautions. d. Encourage increased fluid consumption.: a.Practice vigilant handwashing.