PN3 Exam 3 2023 UPDATE {SCORED 98%}

PN3 Exam 3 2023 UPDATE {SCORED 98%} 1) Which of the following interventions are appropriate for a client experiencing hypovolemic shock (SATA) A) Increase IV fluid delivery per order B) Monitor vital signs C) Monitor hemoglobin and hematocrit levels D) Admin oxygen per protocol E) Reposition the client to a high-fowlers position 2) What laboratory values does the nurse recognize as an indicatory of acute heart injury? A) Increase CK-MB and Troponin B) Decrease CK-MB and Troponin C) Increase CK with low levels of CK-MB D) Increase levels of myoglobin and Troponin 3) Which of the following actions would the nurse perform to assess the patency of arteriovenous shunt site? (SATA) A) Positive bruit B) Palpable thrill C) Abdominal dressing D) Normal blood pressure E) Pedal pulses 4) The nurse is planning care for a clients diagnosed with DIC. Which of the following is priority? A) Assess for clinical manifestations of hypoxia and decreased oxygen B) Assess for clinical manifestations of edema C) Assess for clinical manifestations of clotting D) Assess for clinical manifestations of bleeding 5) A patient returning from the cardiac catheterization lab following an acute MI has a slight increase in the following results: BUN 22 to 30; Creatinine 1.0 to 1.2; HGB 14 to 15.5; Glucose 89 to 95. Based on this information the nurse will anticipate an order for which of the following interventions from the health care provider? A) Begin a nitroglycerine infusion B) Administer a diuretic C) Schedule patient for hemodialysis D) Administer a fluid bolus 6) A client diagnosed with chronic renal failure asked the nurse. “What the difference between hemodialysis and peritoneal dialysis? Which of the following statements best explain the difference? A) Hemodialysis uses a graft or a fistula and pumps blood through a semipermeable membrane in a hemodialyzer as the filter. Peritoneal dialysis uses the peritoneal lining of the abdominal cavity as the filter. B) There are different dietary requirements for hemodialysis and peritoneal dialysis C) hemodialysis and peritoneal dialysis use different equipment D) Hemodialysis is done 3X a week and lasts 3-4 hours; peritoneal dialysis is done daily 7) When assessing a patient in shock, the nurse recognizes that the hemodynamics of shock include? A) Normal cardiac output and normal blood pressure. B) Increase in central venous pressure in hypovolemic shock C) Increase in systemic vascular resistance in septic shock D) Variations in cardiac output and decreased systemic vascular resistance in septic shock 8) The nurse is caring for a client with Addison's disease. Expected laboratory findings would include which of the following? A) Decreased cortisol levels, low fasting glucose, hyponatremia, hyperkalemia B) Elevated cortisol levels, hyperglycemia, hypernatremia, hypokalemia C) Elevated antidiuretic hormone levels, hyponatremia, hyperglycemia, decrease lymphocyte count D) Decrease antidiuretic hormone levels, hypernatremia, hypocalcemia 9) A nurse in an emergency department is caring for a client who reports substernal chest pain and dyspnea. The client is vomiting and diaphoretic. Which of the following laboratory tests are used to diagnose a myocardial infarction? A) Troponin I B) Creatinine C) Amylase D) Plasma low-density protein 10) A nurse provides teaching to a client with a history of chronic stable angina and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching for this medication? A) “I’ll dial 911 and take three nitroglycerin tablets 5 minutes apart.” B) I'll dial 911 if is still have pain after four nitroglycerine tablets over 20 minutes C) I'll dial 911 when I have pain and then ill take all 3 nitroglycerine tablets at once D) I'll dial 911 if one nitroglycerine tablet does not resolve my pain, and then take up to 4 more tablets 3 minutes apart while waiting. 11) The client with chronic renal failure has been prescribes a restricted potassium diet. Which of the following snacks is the most appropriate for the client? A) Orange juice B) Banana C) Dried dates D)Applesauce 12) The nurse is caring for a client with new onset of elevated BUN and creatinine, oliguria, hypotension, and diarrhea for one week. The nurse suspects which disease process? A) Acute renal failure B)Hepatic encephalopathy C) Pyelonephritis D) End-stage renal disease 13) A client presents with the following vital signs: BP 90/60, temp 38.3C (101F), HR 116, RR 24. The client has a post-op abdominal incision that is warm and red. Which state of shock is this client in? A) Anaphylactic B) Hypovolemic C) Septic D) Neurogenic 14) The nurse place a client on telemetry following a diagnosis of anterior wall MI. What findings are expected with this EKG tracing? (SATA) A) ST segment elevation B) An abnormal Q wave C) Prolonged P-R interval D) T-wave inversion E) An absent P wave 15) A client is experiencing a bee sting before arrival to the emergency department with difficulty breathing, a sign of hypoxia, and hypotension. The nurse realizes these are signs of anaphylactic shock. Which of the following should the nurse implement first? A) Raise the clients' feet and legs B) Administer epinephrine 1mg/mL concentration, 0.3 to 0.5 mL IM C) Start an IV and administer 0.9%sodium chloride D) Access the airway and apply oxygen per protocol 16) A client complains of weight gain, has thin extremities, a "buffalo hump," and a protruding abdomen. The nurse realizes this client is most likely to be diagnosed with which disease process? A) Cushing's syndrome B) Cretinism C) Addison's disease D) Pheochromocytoma 17) A patient received tissue plasminogen activator (TPA) after a myocardial infarction and now is on intravenous infusion of heparin. The patient's spouse asks why the patient needs this medication. What response by the nurse is best? A) "The heparin keeps that artery from getting blocked again" B) "Tissue plasminogen activator clots the blood" C) " The tissue plasminogen activator didn't dissolve the entire blood clot" D) "Heparin keeps the blood as thin as possible for a long period" 18) A client is scheduled is scheduled for a left-sided femoral heart catheterization. Which of the following should the nurse educate the client in preparation for this diagnostic test? A) The diagnostic test utilizes magnetic resonance images B) Clients can move during and after the diagnostic test C) General anesthesia is used for the procedure D) The diagnostic test utilizes dye injected into the femoral blood vessel while X-Ray images obtained 19) A nurse is caring for a client who has hypovolemic shock. Which of the following should the nurse recognize as an expected finding? A) Oliguria B) Hypertension C) Bradypnea D) Flushing of the skin 20) Which of the following medications is a vasodilator administered sublingual and absorbed through the mucus membrane? A) Atenolol B) Benazepril C) Nitroglycerine D) Clopidogrel 21) What types of shock are included in distributive shock? (SATA) A) Anaphylactic B) Neurogenic C) Hypovolemic D) Septic E) Cardiogenic 22) The nurse is caring for a client with suspected severe sepsis bundle within the first three hours. Which of the following are nursing interventions for a client with severe sepsis? (SATA) A) Administer broad-spectrum antibiotics per order B) Draw and analyze serum lactate levels C) Obtain blood cultures before administering antibiotics D) Administer isolated crystalloids intravenously for hypotension E) Infuse nitrates intravenously for hypotension 23) A nurse is planning care for a client following cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take? A) Educate the patient on the post-discharge restrictions B) Instruct the client to remain on bed rest for 2-6 hours after the procedure C) Apply a soft knee brace to prevent bending of the affected extremity D) Access the peripheral circulation (CMS) checks with vital signs to the affected limb 24) A client is diagnosed with acute renal failure. Which of the following diagnostic studies will the nurse be the most concerned with? A) Serum blood glucose and Hemoglobin A1C B) Serum uric acid level C) Serum potassium level D) Urine drug toxicology screening and chloride level 25) A client has a blood pressure of 134/ 84 mmHg and a triglyceride level of 220 mg/dL. The nurse would identify these clinical manifestations as which of the following? A) A prehypertensive blood pressure and high triglyceride level. hypertension B) An optimal blood pressure and triglyceride level C) A normal triglyceride level with a prehypertensive blood pressure D) Stage three hypertension and a high triglyceride level 26) A nurse is caring for a client who reports a new onset of severe chest pain. Which of the following actions should the nurse take to determine if the client is experiencing a myocardial infarction? A) Perform a 12-lead ECG B) Notify the rapid response team C) Check the clients blood pressure D) Assess and provide intravenous (IV) access 27) A nurse is caring for a client that is recovering from a kidney transplant. Which medication would the nurse identify as nephrotoxic? A) Vancomycin B) Cyclosporin C) Azathioprine D) Prednisone 28) Your patient is diagnosed with an acute coronary syndrome and a heparin drip has been ordered that reads "administer a heparin bolus of 50/units/kg over 15 minutes with a maximum dose of 4,500 units." You note that the patient has a documented weight of 220lbs. On hand is a vial of heparin that reads "5.000 units per 2mL." How many mL's will you administer? 1.8 if it asks to round, then its 2 mL 29) The nurse is assessing a client with progression of septic shock. The nurse assesses the following clinical manifestations petechia, excessive clotting and hypoxemia? A) Disseminated intravascular coagulation (DIC). B) Anemia C) Neutropenia D) Thrombocytopenia 30) Emergency care of the client in Addisonian crisis includes which of the following? A) Hydrocortisone sodium IV bolus B) Potassium chloride IVPB C) Dextrose 25 gm IVP D) Desmopressin IV 31) Following a traumatic brain injury, a client is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). The finding for this client would include which of the following? (SATA) A) Oliguria B) Fluid volume excess C) Hypernatremia D) Hyponatremia E) Dehydration 32) A client is diagnosed with cardiac tamponade from pericarditis. Which of the following is the client at high risk for developing? A) Cariogenic shock B) Septic shock C) Hypovolemic shock D) Obstructive shock 33) A client is admitted with newly diagnosed pheochromocytoma. The nurse monitors for which signs/symptoms associated with this tumor? A) Hypertension B) Fluid volume deficits C) Elevated cortisol levels D) Bradycardia 34) A nurse is caring for several clients at risk for shock. Which laboratory value requires the nurse to notify the health care provider? A) Lactic acid (lactate) 54 mmol/L B) WBC 11,000/mm3 C) Creatinine 0.9 mg/dl D) Sodium 145 mEq/L 35) A nurse is caring for a client diagnosed with ST- elevation myocardial infarction (STEMI). The nurse anticipates which of the following interventions would the nurse give first? A) Aspirin B) Morphine Sulfate C) Oxygen D) Nitrates 36) A patient with Cushing's syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? A) Urinary output B) Weight C) Electrolyte levels D) Blood glucose 37) The nurse caring for a client in the hospital on chemotherapy. The nurse identifies which of the following risk factors that place the client at higher risk for septic shock. (SATA) A) Immunosuppression B) Impaired skin integrity C) Malnutrition with Dehydration D) Compliance with antibiotic therapy E) Overhydration 38) With progressive renal failure, when the synthesis of vitamin D becomes impaired, the impairment contributes to which of the following abnormalities? A) Hypercalcemia and hypophosphatemia B) Hypocalcemia and hyperkalemia C) Hypercalcemia and bone loss D) Hypocalcemia and bone loss 39) In triage, a client presents with chest pressure, moist skin, and mild shortness of breath. A 12- lead electrocardiogram (ECG) is done and shows elevation in the ST segment in two leads. The nurse suspects this client is experiencing which cardiac dysrhythmia? A) ST-elevation myocardial infarction (STEMI) B) Ventricular fibrillation C) Non-ST segment elevation myocardial infarction D) Atrial flutter 40) In septic shock, infectious organisms enter the blood stream and cause widespread inflammation due to the infection escaping local control. This is defined as which of the following? A) Systemic Inflammatory response syndrome B) Multiple organ dysfunction syndrome C) Acute respiratory distress syndrome D) Disseminated intravascular coagulation 41) A nurse prepares a client for coronary artery bypass graft surgery. The client states, “ I am afraid I might die.” What is the nurses best therapeutic response? A) “Tell me more about your concerns with the surgery.” B) "What support systems do you have to assist you at home?" C) "I'm sorry you feel this way; so that you know, there is a very low risk of death D) "Would you like to speak to a Chaplin before surgery?" 42) A nurse is caring for a client with suspected septic shock. Which of the following clinical manifestations would the nurse identify in septic shock? (SATA) A) Heart rate of 110 beat per minute B) elevated lactic acid (lactate) levels C) WBC count of 13000/mm D) Temperature of 98.6 E) Respiratory rate of 16 breaths per minute 43) A client tells the nurse he is “so thirsty” that he has already consumed four pitchers of water. The client’s urine output is 3500 mL in 8 hours. The client is recovering from surgery on the pituitary gland serum glucose is 140 gm/dl. What endocrine disorder is the client most likely experiencing? A) Diabetes insipidus B) SIADH C) Diabetes Mellitus D) Myxedema 44) What medication would the nurse administer first to a client in anaphylactic shock? A) Epinephrine B) Albuterol C) Diphenhydramine D) Methylprednisolone 45) A client diagnosed with chronic renal failure is prescribed a low protein diet. What statement defines this rationale? A) Protein in broken down and converted to urea, which is filtered by the kidney B) Protein sources are of low biological value C) Protein increases calcium and sodium levels D) Deficit protein metabolism breaks down muscle tissue 46) A nurse works at a community center for older adults. What self- management measure can the nurse teach the clients to prevent hypovolemic shock? A) Drink fluids on a regular schedule B) Wear long sleeves in the winter C) Take medication as prescribed D) Seek attention for any laceration 47) After the nurse provides a client diagnosed with acute renal failure with kayexalate 30 grams by mouth, and the client begins to experience frequent loose bowel movements. Which of the following does this clients response indicate to the nurse? A) The client is experiencing a response that is indicative of successful treatment. B) The client needs to receive sodium bicarbonate C) The client needs an additional dose of kayexalate D) The client needs to be treated with insulin and dextrose 48) Which of the following is the leading cause of heart pump failure in cardiogenic shock? A) Myocardial infarction B) Renal failure C) Pulmonary embolism D) Pulmonary hypertension 49) A client is admitted to the intensive care unit with cardiogenic shock. The provider orders dobutamine drip via an infusion pump. Order: dobutamine 400 mg in 250 ml D5W to infuse at 6 mcg/kg/min. The client weighs 80 kg. Calculate the flow rate in ml/hr? (Record answer as a whole number, do not use trailing zero) 18 50) Following a motor vehicle accident, a client presents with a thoracic injury. The clients' clinical manifestations include loss of mean arterial pressure (MAP), HR 58 BPM, diminished deep tendon reflexes, and poor perfusion. The nurse would identify this as what type of shock. A) Neurogenic shock B) Hypovolemic shock C) Septic shock D) Cardiogenic shock