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Portage Learning Pathophysiology NURS 231 BIOD
331 Final Exam & module 1-10 exams All Versions
Latest Update A grade
The alarm on the patient spent a leader is going off and indicating
a low-pressure alarm. Which of the following should the nurse
do first?
a) lower the head of bed and suction The patient
b) check for disconnected tubing
c) stat page the respiratory therapist
d) begin to ventilate the patient with the Ambu bag - . . ANSWER
✓✓ b) check for disconnected tubing
* lower the head of the bed instruction to patient with high-
pressure alarm. If cufflink or lack of spontaneous breathing then
page RT. If can't determine the cause then begin to ventilate
patient with Ambubag
The charge nurse in the intensive care unit is overseeing care for
a group of clients. The nurse is especially vigilant in
collaboration with the primary nurse and interprofessional team
in assessing for ARDS in which of these clients?
a) Client with acute kidney failure
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b) Client with aspiration pneumonia
c) Client with atrial fibrillation
d) Client with DKA - . . ANSWER ✓✓ b) Client with aspiration
pneumonia
*Acute Respiratory Distress Syndrome is characterized by
widespread inflammation in the lungs. Aspiration of acidic
gastric contents promotes inflammation and is a risk for ARDS.
*Clients with DKA may develop metabolic acidosis, but do not
typically ARDS, which develops as a result of lung injury. Atrial
fibrillation does not cause lung injury unless embolization
occurs. Acute kidney failure results in metabolic acidosis, not in
acute lung injury.
The client in the cardiac care unit has had a large myocardial
infarction. How does the nurse recognize onset of left ventricular
failure?
a) Expectoration of yellow sputum
b) Pedal edema
c) Urine output of 1500 mL on the preceding day
d) Crackles in the lung fields - . . ANSWER ✓✓ d) Crackles in the
lung fields
*Manifestations of left ventricular failure and pulmonary edema
are noted by listening for crackles and identifying their locations
in the lung fields.
,3|Page
*A urine output of 1500 mL is normal. Edema is a sign of right
ventricular heart failure. Yellow sputum indicates the presence
of white blood cells and possible infection.
"critical rescue" assessment criteria for patients experiencing
stroke/TBI to detect increased intracranial pressure and/or
hypertension - . . ANSWER ✓✓ *ABC's are priority (w/in 10
minutes); Neuro assessment , LOC/cognition, GCS, call rapid
response
Early signs:
-headache
-N/V
-blurry vision/visual disturbances
-SOB
-seizures (also late)
-chest pressure
-change LOC
Late:
-elevated BP
-bradycardia
-cerebral vasodilation
-seizures
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-cushings triad
-increased systolic, widened pulse pressure
-irregular resp
1. The student nurse studying shock understands that the
common manifestations of this condition are directly related to
which problems? (Select all that apply.)
a. Anaerobic metabolism
b. Hyperglycemia
c. Hypotension
d. Impaired renal perfusion
e. Increased perfusion - . . ANSWER ✓✓ a. Anaerobic
metabolism
c. Hypotension
The common manifestations of shock, no matter the cause, are
directly related to the effects of anaerobic
metabolism and hypotension. Hyperglycemia, impaired renal
function, and increased perfusion are not
manifestations of shock.
1) What is the formula for MAP?
2) What's the normal?
3) What is pts MAP that has BP of 120/80?
Portage Learning Pathophysiology NURS 231 BIOD
331 Final Exam & module 1-10 exams All Versions
Latest Update A grade
The alarm on the patient spent a leader is going off and indicating
a low-pressure alarm. Which of the following should the nurse
do first?
a) lower the head of bed and suction The patient
b) check for disconnected tubing
c) stat page the respiratory therapist
d) begin to ventilate the patient with the Ambu bag - . . ANSWER
✓✓ b) check for disconnected tubing
* lower the head of the bed instruction to patient with high-
pressure alarm. If cufflink or lack of spontaneous breathing then
page RT. If can't determine the cause then begin to ventilate
patient with Ambubag
The charge nurse in the intensive care unit is overseeing care for
a group of clients. The nurse is especially vigilant in
collaboration with the primary nurse and interprofessional team
in assessing for ARDS in which of these clients?
a) Client with acute kidney failure
,2|Page
b) Client with aspiration pneumonia
c) Client with atrial fibrillation
d) Client with DKA - . . ANSWER ✓✓ b) Client with aspiration
pneumonia
*Acute Respiratory Distress Syndrome is characterized by
widespread inflammation in the lungs. Aspiration of acidic
gastric contents promotes inflammation and is a risk for ARDS.
*Clients with DKA may develop metabolic acidosis, but do not
typically ARDS, which develops as a result of lung injury. Atrial
fibrillation does not cause lung injury unless embolization
occurs. Acute kidney failure results in metabolic acidosis, not in
acute lung injury.
The client in the cardiac care unit has had a large myocardial
infarction. How does the nurse recognize onset of left ventricular
failure?
a) Expectoration of yellow sputum
b) Pedal edema
c) Urine output of 1500 mL on the preceding day
d) Crackles in the lung fields - . . ANSWER ✓✓ d) Crackles in the
lung fields
*Manifestations of left ventricular failure and pulmonary edema
are noted by listening for crackles and identifying their locations
in the lung fields.
,3|Page
*A urine output of 1500 mL is normal. Edema is a sign of right
ventricular heart failure. Yellow sputum indicates the presence
of white blood cells and possible infection.
"critical rescue" assessment criteria for patients experiencing
stroke/TBI to detect increased intracranial pressure and/or
hypertension - . . ANSWER ✓✓ *ABC's are priority (w/in 10
minutes); Neuro assessment , LOC/cognition, GCS, call rapid
response
Early signs:
-headache
-N/V
-blurry vision/visual disturbances
-SOB
-seizures (also late)
-chest pressure
-change LOC
Late:
-elevated BP
-bradycardia
-cerebral vasodilation
-seizures
, 4|Page
-cushings triad
-increased systolic, widened pulse pressure
-irregular resp
1. The student nurse studying shock understands that the
common manifestations of this condition are directly related to
which problems? (Select all that apply.)
a. Anaerobic metabolism
b. Hyperglycemia
c. Hypotension
d. Impaired renal perfusion
e. Increased perfusion - . . ANSWER ✓✓ a. Anaerobic
metabolism
c. Hypotension
The common manifestations of shock, no matter the cause, are
directly related to the effects of anaerobic
metabolism and hypotension. Hyperglycemia, impaired renal
function, and increased perfusion are not
manifestations of shock.
1) What is the formula for MAP?
2) What's the normal?
3) What is pts MAP that has BP of 120/80?
