Test Bank for Clinical Reasoning Cases in Nursing 8th Edition by
Harding and Snyder (STUVIA)
Chapter 1. Perfusion
,MULTIPLE CHOICE
1. The professional nurse is explaining to a student professional nurse about impaired central
perfusion. The professional nurse knows the student understands this problem when the student
states, Central perfusion
a. is monitored only by the physician.
b. involves the entire body.
c. is decreased with hypertension.
d. is toxic to the cardiac system.
CORRECT CHOICE✔✔ B
Central perfusion does involve the entire body as all organs are supplied with oxygen and vital
nutrients. The physician does not control the bodys ability for perfusion. Central perfusion is not
decreased with hypertension. Central perfusion is not toxic to the cardiac system.
2. A client was diagnosed with hypertension. The client asks the professional nurse how this
disease could have happened to them. The nurses best response is Hypertension
a. happens to everyone sooner or later. Dont be concerned about it.
b. can happen from eating a poor diet, so change what you are eating.
c. can happen from arterial changes that impede the blood flow.
d. happens when people do not exercise, so you should walk every day.
CORRECT CHOICE✔✔ C
Hardening of the arteries from atherosclerosis can cause hypertension in the client.
Hypertension does not happen to everyone. Changing the clients diet and exercising may be a
positive life change, but these answers do not explain to the client how the disease could have
happened.
3. The client asks the professional nurse to explain the sinoatrial node in the heart. The nurses
best responsewould be, The sinoatrial node
a. provides the heart with the stimulation to beat in a normal rhythm.
b. protects the heart from atherosclerotic changes.
c. provides the heart with oxygenated blood.
d. protects the heart from infection.
CORRECT CHOICE✔✔ A
The sinoatrial node is the natural pacemaker of the heart, and it assists the heart to beat in a
normal rhythm. The sinoatrial node does not protect from atherosclerotic changes or infection,
and it does not directly provide the heart with oxygenated blood.
4. The client is brought to the emergency department after a motor vehicle accident. The client is
diagnosed with internal bleeding. The nurses primary concern is to monitor for
a. mental alertness.
b. perfusion.
, c. pain.
d. reaction to medications.
CORRECT CHOICE✔✔ B
Perfusion is the correct answer, because with internal bleeding, the professional nurse should monitor vital
signs to be sure perfusion is happening. Mental alertness, pain, and medication reactions are
important but not the primary concern.
5. A clients serum electrolytes are being monitored. The professional nurse notices that the
potassium levelis low. The professional nurse knows that the client should be observed for
a. tissue ischemia.
b. brain malformations.
c. intestinal blockage.
d. cardiac dysthymia.
CORRECT CHOICE✔✔ D
Cardiac dysthymia is a possibility when serum potassium is high or low. Tissue ischemia, brain
malformations, or intestinal blockage do not have a direct correlation to potassium irregularities.
6. A professional nurse is explaining to a student professional nurse about perfusion.
The professional nurse knows the student understands the concept of perfusion when the
student states, Perfusion
a. is a normal function of the body, and I dont have to be concerned about it.
b. is monitored by the physician, and I just follow orders.
c. is monitored by vital signs and capillary refill.
d. varies as a person ages, so I would expect changes in the body.
CORRECT CHOICE✔✔ C
The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows
the professional nurse to know if perfusion is adequate to maintain vital organs. The
professional nurse does have to be concerned about perfusion. Perfusion is not only monitored
by the physician but the professional nurse too.Perfusion does not always change as the
person ages.
7. The professional nurse is conducting a client assessment. The client tells the professional
nurse that he has smokedtwo packs of cigarettes per day for 27 years. The professional nurse
may find which data upon assessment?
a. Blood pressure above the normal range
b. Bounding pedal pulses
c. Night blindness
d. Reflux disease
CORRECT CHOICE✔✔
A
Smokers have a constriction of the blood vessels due to the tar and nicotine in cigarettes. This
constriction may lead to hypertension. Bounding pulses, night blindness, and reflux disease do
not have a direct link to smoking.
Chapter 2.Gas Exchange
MULTIPLE CHOICE
, 1. The professional nurse is assigned a group of clients. Which client would the professional
nurse identify as being at increased risk for impaired gas exchange? A client
a. with a blood glucose of 350 mg/dL
b. who has been on anticoagulants for 10 days
c. with a hemoglobin of 8.5 g/dL
d. with a heart rate of 100 beats/min and blood pressure of 100/60
CORRECT CHOICE✔✔ C
The hemoglobin is low (anemia), therefore the ability of the blood to carry oxygen is decreased.
High blood glucose and/or anticoagulants do not alter the oxygen carrying capacity of the blood.
A heart rate of 100 beats/min and blood pressure of 100/60 are not indicative of oxygen carrying
capacity of the blood.
2. The professional nurse is reviewing the clients arterial blood gas results. The PaO2 is 96 mm
Hg, pH is 7.20, PaCO2 is 55 mm Hg, and HCO3 is 25 mEq/L. What would the professional
nurse expect to observe onassessment of this client?
a. Disorientation and tremors
b. Tachycardia and decreased blood pressure
c. Increased anxiety and irritability
d. Hyperventilation and lethargy
CORRECT CHOICE✔✔ A
The client is experiencing respiratory acidosis ( pH, and PaCO2 ) which may be manifested by
disorientation, tremors, possible seizures, and decreased level of consciousness. Tachycardia
and decreased blood pressure are not characteristic of a problem of respiratory acidosis.
Increased anxiety and hyperventilation will cause respiratory alkalosis, which is manifested by
an increase in pH and a decrease in PaCO2.
3. The professional nurse would identify which client as having a problem of impaired
gas exchangesecondary to a perfusion problem? A client with
a. peripheral arterial disease of the lower extremities
b. chronic obstructive pulmonary disease (COPD)
c. chronic asthma
d. severe anemia secondary to chemotherapy
CORRECT CHOICE✔✔ A
Perfusion relates to the ability of the blood to deliver oxygen to the cellular level and return the
carbon dioxide to the lung for removal. COPD and asthma are examples of a ventilation
problem. Severe anemia is an example of a transport problem of gas exchange.
4. The professional nurse is assessing a clients differential white blood cell count. What
implications wouldthis test have on evaluating the adequacy of a clients gas exchange?
a. An elevation of the total white cell count indicates generalized inflammation.
b. Eosinophil count will assist to identify the presence of a respiratory infection.
c. White cell count will differentiate types of respiratory bacteria.
d. Level of neutrophils provides guidelines to monitor a chronic infection.
Harding and Snyder (STUVIA)
Chapter 1. Perfusion
,MULTIPLE CHOICE
1. The professional nurse is explaining to a student professional nurse about impaired central
perfusion. The professional nurse knows the student understands this problem when the student
states, Central perfusion
a. is monitored only by the physician.
b. involves the entire body.
c. is decreased with hypertension.
d. is toxic to the cardiac system.
CORRECT CHOICE✔✔ B
Central perfusion does involve the entire body as all organs are supplied with oxygen and vital
nutrients. The physician does not control the bodys ability for perfusion. Central perfusion is not
decreased with hypertension. Central perfusion is not toxic to the cardiac system.
2. A client was diagnosed with hypertension. The client asks the professional nurse how this
disease could have happened to them. The nurses best response is Hypertension
a. happens to everyone sooner or later. Dont be concerned about it.
b. can happen from eating a poor diet, so change what you are eating.
c. can happen from arterial changes that impede the blood flow.
d. happens when people do not exercise, so you should walk every day.
CORRECT CHOICE✔✔ C
Hardening of the arteries from atherosclerosis can cause hypertension in the client.
Hypertension does not happen to everyone. Changing the clients diet and exercising may be a
positive life change, but these answers do not explain to the client how the disease could have
happened.
3. The client asks the professional nurse to explain the sinoatrial node in the heart. The nurses
best responsewould be, The sinoatrial node
a. provides the heart with the stimulation to beat in a normal rhythm.
b. protects the heart from atherosclerotic changes.
c. provides the heart with oxygenated blood.
d. protects the heart from infection.
CORRECT CHOICE✔✔ A
The sinoatrial node is the natural pacemaker of the heart, and it assists the heart to beat in a
normal rhythm. The sinoatrial node does not protect from atherosclerotic changes or infection,
and it does not directly provide the heart with oxygenated blood.
4. The client is brought to the emergency department after a motor vehicle accident. The client is
diagnosed with internal bleeding. The nurses primary concern is to monitor for
a. mental alertness.
b. perfusion.
, c. pain.
d. reaction to medications.
CORRECT CHOICE✔✔ B
Perfusion is the correct answer, because with internal bleeding, the professional nurse should monitor vital
signs to be sure perfusion is happening. Mental alertness, pain, and medication reactions are
important but not the primary concern.
5. A clients serum electrolytes are being monitored. The professional nurse notices that the
potassium levelis low. The professional nurse knows that the client should be observed for
a. tissue ischemia.
b. brain malformations.
c. intestinal blockage.
d. cardiac dysthymia.
CORRECT CHOICE✔✔ D
Cardiac dysthymia is a possibility when serum potassium is high or low. Tissue ischemia, brain
malformations, or intestinal blockage do not have a direct correlation to potassium irregularities.
6. A professional nurse is explaining to a student professional nurse about perfusion.
The professional nurse knows the student understands the concept of perfusion when the
student states, Perfusion
a. is a normal function of the body, and I dont have to be concerned about it.
b. is monitored by the physician, and I just follow orders.
c. is monitored by vital signs and capillary refill.
d. varies as a person ages, so I would expect changes in the body.
CORRECT CHOICE✔✔ C
The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows
the professional nurse to know if perfusion is adequate to maintain vital organs. The
professional nurse does have to be concerned about perfusion. Perfusion is not only monitored
by the physician but the professional nurse too.Perfusion does not always change as the
person ages.
7. The professional nurse is conducting a client assessment. The client tells the professional
nurse that he has smokedtwo packs of cigarettes per day for 27 years. The professional nurse
may find which data upon assessment?
a. Blood pressure above the normal range
b. Bounding pedal pulses
c. Night blindness
d. Reflux disease
CORRECT CHOICE✔✔
A
Smokers have a constriction of the blood vessels due to the tar and nicotine in cigarettes. This
constriction may lead to hypertension. Bounding pulses, night blindness, and reflux disease do
not have a direct link to smoking.
Chapter 2.Gas Exchange
MULTIPLE CHOICE
, 1. The professional nurse is assigned a group of clients. Which client would the professional
nurse identify as being at increased risk for impaired gas exchange? A client
a. with a blood glucose of 350 mg/dL
b. who has been on anticoagulants for 10 days
c. with a hemoglobin of 8.5 g/dL
d. with a heart rate of 100 beats/min and blood pressure of 100/60
CORRECT CHOICE✔✔ C
The hemoglobin is low (anemia), therefore the ability of the blood to carry oxygen is decreased.
High blood glucose and/or anticoagulants do not alter the oxygen carrying capacity of the blood.
A heart rate of 100 beats/min and blood pressure of 100/60 are not indicative of oxygen carrying
capacity of the blood.
2. The professional nurse is reviewing the clients arterial blood gas results. The PaO2 is 96 mm
Hg, pH is 7.20, PaCO2 is 55 mm Hg, and HCO3 is 25 mEq/L. What would the professional
nurse expect to observe onassessment of this client?
a. Disorientation and tremors
b. Tachycardia and decreased blood pressure
c. Increased anxiety and irritability
d. Hyperventilation and lethargy
CORRECT CHOICE✔✔ A
The client is experiencing respiratory acidosis ( pH, and PaCO2 ) which may be manifested by
disorientation, tremors, possible seizures, and decreased level of consciousness. Tachycardia
and decreased blood pressure are not characteristic of a problem of respiratory acidosis.
Increased anxiety and hyperventilation will cause respiratory alkalosis, which is manifested by
an increase in pH and a decrease in PaCO2.
3. The professional nurse would identify which client as having a problem of impaired
gas exchangesecondary to a perfusion problem? A client with
a. peripheral arterial disease of the lower extremities
b. chronic obstructive pulmonary disease (COPD)
c. chronic asthma
d. severe anemia secondary to chemotherapy
CORRECT CHOICE✔✔ A
Perfusion relates to the ability of the blood to deliver oxygen to the cellular level and return the
carbon dioxide to the lung for removal. COPD and asthma are examples of a ventilation
problem. Severe anemia is an example of a transport problem of gas exchange.
4. The professional nurse is assessing a clients differential white blood cell count. What
implications wouldthis test have on evaluating the adequacy of a clients gas exchange?
a. An elevation of the total white cell count indicates generalized inflammation.
b. Eosinophil count will assist to identify the presence of a respiratory infection.
c. White cell count will differentiate types of respiratory bacteria.
d. Level of neutrophils provides guidelines to monitor a chronic infection.
