MEDCONNOISSEURLIBRARIES.COMn
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MEDCONNOISSEURLIBRARIES.COMn
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, MEDCONNOISSEURLIBRARIES.COMn
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ClinicalnReasoningnCasesninnNursingn7thnEditionnHardingnSnydernTestnBankn
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Chaptern1.nPerfusionn
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MULTIPLEnCHOICEn
1. Thennursenisnexplainingntonanstudentnnursenaboutnimpairedncentralnperfusion.nThennursenkno
wsnthenstudentnunderstandsnthisnproblemnwhennthenstudentnstates,nCentralnperfusionn
a. isnmonitorednonlynbynthenphysician.n
b. involvesnthenentirenbody.n
c. isndecreasednwithnhypertension.n
d. isntoxicntonthencardiacnsystem.n
ANS:nBn
Centralnperfusionndoesninvolventhenentirenbodynasnallnorgansnarensuppliednwithnoxygennandnvitalnnut
rients.nThenphysicianndoesnnotncontrolnthenbodysnabilitynfornperfusion.nCentralnperfusionnisnnotndecr
easednwithnhypertension.nCentralnperfusionnisnnotntoxicntonthencardiacnsystem.n
2. Anpatientnwasndiagnosednwithnhypertension.nThenpatientnasksnthennursenhownthisndiseasenco
uldnhavenhappenedntonthem.nThennursesnbestnresponsenisnHypertensionn
a. happensntoneveryonensoonernornlater.nDontnbenconcernednaboutnit.n
b. cannhappennfromneatingnanpoorndiet,nsonchangenwhatnyounareneating.n
c. cannhappennfromnarterialnchangesnthatnimpedenthenbloodnflow.n
d. happensnwhennpeoplendonnotnexercise,nsonyounshouldnwalkneverynday.n
ANS:nCn
Hardeningnofnthenarteriesnfromnatherosclerosisncanncausenhypertensionninnthenpatient.n
Hypertensionndoesnnotnhappenntoneveryone.nChangingnthenpatientsndietnandnexercisingnmaynbenanpo
sitivenlifenchange,nbutnthesenanswersndonnotnexplainntonthenpatientnhownthendiseasencouldnhavenhapp
ened.n
3. Thenpatientnasksnthennursentonexplainnthensinoatrialnnodeninnthenheart.nThennursesnbestnrespo
nsenwouldnbe,nThensinoatrialnnoden
a. providesnthenheartnwithnthenstimulationntonbeatninnannormalnrhythm.n
b. protectsnthenheartnfromnatheroscleroticnchanges.n
c. providesnthenheartnwithnoxygenatednblood.n
d. protectsnthenheartnfromninfection.n
ANS:nAn
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Thensinoatrialnnodenisnthennaturalnpacemakernofnthenheart,nandnitnassistsnthenheartntonbeatninnan
normalnrhythm.nThensinoatrialnnodendoesnnotnprotectnfromnatheroscleroticnchangesnorninfection,nan
dnitndoesnnotndirectlynprovidenthenheartnwithnoxygenatednblood.n
4. Thenpatientnisnbroughtntonthenemergencyndepartmentnafternanmotornvehiclenaccident.nThenpat
ientnisndiagnosednwithninternalnbleeding.nThennursesnprimarynconcernnisntonmonitornforn
a. mentalnalertness.n
b. perfusion.n
c. pain.n
d. reactionntonmedications.n
ANS:nBn
Perfusionnisnthencorrectnanswer,nbecausenwithninternalnbleeding,nthennursenshouldnmonitornvitaln
signsntonbensurenperfusionnisnhappening.nMentalnalertness,npain,nandnmedicationnreactionsnareni
mportantnbutnnotnthenprimarynconcern.n
5. Anpatientsnserumnelectrolytesnarenbeingnmonitored.nThennursennoticesnthatnthenpotassiumnle
velnisnlow.nThennursenknowsnthatnthenpatientnshouldnbenobservednforn
a. tissuenischemia.n
b. brainnmalformations.n
c. intestinalnblockage.n
d. cardiacndysthymia.n
ANS:nDn
Cardiacndysthymianisnanpossibilitynwhennserumnpotassiumnisnhighnornlow.nTissuenischemia,nbrainnm
alformations,nornintestinalnblockagendonnotnhavenandirectncorrelationntonpotassiumnirregularities.n6.n
Annursenisnexplainingntonanstudentnnursenaboutnperfusion.nThennursenknowsnthenstudentnunderstands
nthenconceptnofnperfusionnwhennthenstudentnstates,nPerfusionn
a. isnannormalnfunctionnofnthenbody,nandnIndontnhaventonbenconcernednaboutnit.n
b. isnmonitorednbynthenphysician,nandnInjustnfollownorders.n
c. isnmonitorednbynvitalnsignsnandncapillarynrefill.n
d. variesnasnanpersonnages,nsonInwouldnexpectnchangesninnthenbody.n
ANS:nCn
Thenbestnmethodntonmonitornperfusionnisntonmonitornvitalnsignsnandncapillarynrefill.nThisnallowsnthen
nursentonknownifnperfusionnisnadequatentonmaintainnvitalnorgans.nThennursendoesnhaventonbenconcern
ednaboutnperfusion.nPerfusionnisnnotnonlynmonitorednbynthenphysiciannbutnthennursentoo.n
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Perfusionndoesnnotnalwaysnchangenasnthenpersonnages.n
7.nThennursenisnconductingnanpatientnassessment.nThenpatientntellsnthennursenthatnhenhasnsmokedntwon
packsnofncigarettesnperndaynforn27nyears.nThennursenmaynfindnwhichndatanuponnassessment?n
a. Bloodnpressurenaboventhennormalnrangen
b. Boundingnpedalnpulsesn
c. Nightnblindnessn
d. Refluxndiseasen
ANS:nAn
Smokersnhavenanconstrictionnofnthenbloodnvesselsnduentonthentarnandnnicotineninncigarettes.nThisncon
strictionnmaynleadntonhypertension.nBoundingnpulses,nnightnblindness,nandnrefluxndiseasendonnotnha
venandirectnlinkntonsmoking.n
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Chaptern2.GasnExchangen
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MULTIPLEnCHOICEn
1. Thennursenisnassignednangroupnofnpatients.nWhichnpatientnwouldnthennursenidentifynasnbeingn
atnincreasednrisknfornimpairedngasnexchange?nAnpatientn
a. withnanbloodnglucosenofn350nmg/dLn
b. whonhasnbeennonnanticoagulantsnforn10ndaysn
c. withnanhemoglobinnofn8.5ng/dLn
d. withnanheartnratenofn100nbeats/minnandnbloodnpressurenofn100/60n
ANS:nCn
Thenhemoglobinnisnlown(anemia),nthereforenthenabilitynofnthenbloodntoncarrynoxygennisndecreased.n
Highnbloodnglucosenand/ornanticoagulantsndonnotnalternthenoxygenncarryingncapacitynofnthenblood.n
Anheartnratenofn100nbeats/minnandnbloodnpressurenofn100/60narennotnindicativenofnoxygenncarryingnc
apacitynofnthenblood.n
2. Thennursenisnreviewingnthenpatientsnarterialnbloodngasnresults.nThenPaO2nisn96nmmnHg,npHni
sn7.20,nPaCO2nisn55nmmnHg,nandnHCO3nisn25nmEq/L.nWhatnwouldnthennursenexpectntonobservenonn
assessmentnofnthisnpatient?n
a. Disorientationnandntremorsn
b. Tachycardianandndecreasednbloodnpressuren
c. Increasednanxietynandnirritabilityn
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MEDCONNOISSEURLIBRARIES.COMn
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, MEDCONNOISSEURLIBRARIES.COMn
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ClinicalnReasoningnCasesninnNursingn7thnEditionnHardingnSnydernTestnBankn
n
Chaptern1.nPerfusionn
n
MULTIPLEnCHOICEn
1. Thennursenisnexplainingntonanstudentnnursenaboutnimpairedncentralnperfusion.nThennursenkno
wsnthenstudentnunderstandsnthisnproblemnwhennthenstudentnstates,nCentralnperfusionn
a. isnmonitorednonlynbynthenphysician.n
b. involvesnthenentirenbody.n
c. isndecreasednwithnhypertension.n
d. isntoxicntonthencardiacnsystem.n
ANS:nBn
Centralnperfusionndoesninvolventhenentirenbodynasnallnorgansnarensuppliednwithnoxygennandnvitalnnut
rients.nThenphysicianndoesnnotncontrolnthenbodysnabilitynfornperfusion.nCentralnperfusionnisnnotndecr
easednwithnhypertension.nCentralnperfusionnisnnotntoxicntonthencardiacnsystem.n
2. Anpatientnwasndiagnosednwithnhypertension.nThenpatientnasksnthennursenhownthisndiseasenco
uldnhavenhappenedntonthem.nThennursesnbestnresponsenisnHypertensionn
a. happensntoneveryonensoonernornlater.nDontnbenconcernednaboutnit.n
b. cannhappennfromneatingnanpoorndiet,nsonchangenwhatnyounareneating.n
c. cannhappennfromnarterialnchangesnthatnimpedenthenbloodnflow.n
d. happensnwhennpeoplendonnotnexercise,nsonyounshouldnwalkneverynday.n
ANS:nCn
Hardeningnofnthenarteriesnfromnatherosclerosisncanncausenhypertensionninnthenpatient.n
Hypertensionndoesnnotnhappenntoneveryone.nChangingnthenpatientsndietnandnexercisingnmaynbenanpo
sitivenlifenchange,nbutnthesenanswersndonnotnexplainntonthenpatientnhownthendiseasencouldnhavenhapp
ened.n
3. Thenpatientnasksnthennursentonexplainnthensinoatrialnnodeninnthenheart.nThennursesnbestnrespo
nsenwouldnbe,nThensinoatrialnnoden
a. providesnthenheartnwithnthenstimulationntonbeatninnannormalnrhythm.n
b. protectsnthenheartnfromnatheroscleroticnchanges.n
c. providesnthenheartnwithnoxygenatednblood.n
d. protectsnthenheartnfromninfection.n
ANS:nAn
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Thensinoatrialnnodenisnthennaturalnpacemakernofnthenheart,nandnitnassistsnthenheartntonbeatninnan
normalnrhythm.nThensinoatrialnnodendoesnnotnprotectnfromnatheroscleroticnchangesnorninfection,nan
dnitndoesnnotndirectlynprovidenthenheartnwithnoxygenatednblood.n
4. Thenpatientnisnbroughtntonthenemergencyndepartmentnafternanmotornvehiclenaccident.nThenpat
ientnisndiagnosednwithninternalnbleeding.nThennursesnprimarynconcernnisntonmonitornforn
a. mentalnalertness.n
b. perfusion.n
c. pain.n
d. reactionntonmedications.n
ANS:nBn
Perfusionnisnthencorrectnanswer,nbecausenwithninternalnbleeding,nthennursenshouldnmonitornvitaln
signsntonbensurenperfusionnisnhappening.nMentalnalertness,npain,nandnmedicationnreactionsnareni
mportantnbutnnotnthenprimarynconcern.n
5. Anpatientsnserumnelectrolytesnarenbeingnmonitored.nThennursennoticesnthatnthenpotassiumnle
velnisnlow.nThennursenknowsnthatnthenpatientnshouldnbenobservednforn
a. tissuenischemia.n
b. brainnmalformations.n
c. intestinalnblockage.n
d. cardiacndysthymia.n
ANS:nDn
Cardiacndysthymianisnanpossibilitynwhennserumnpotassiumnisnhighnornlow.nTissuenischemia,nbrainnm
alformations,nornintestinalnblockagendonnotnhavenandirectncorrelationntonpotassiumnirregularities.n6.n
Annursenisnexplainingntonanstudentnnursenaboutnperfusion.nThennursenknowsnthenstudentnunderstands
nthenconceptnofnperfusionnwhennthenstudentnstates,nPerfusionn
a. isnannormalnfunctionnofnthenbody,nandnIndontnhaventonbenconcernednaboutnit.n
b. isnmonitorednbynthenphysician,nandnInjustnfollownorders.n
c. isnmonitorednbynvitalnsignsnandncapillarynrefill.n
d. variesnasnanpersonnages,nsonInwouldnexpectnchangesninnthenbody.n
ANS:nCn
Thenbestnmethodntonmonitornperfusionnisntonmonitornvitalnsignsnandncapillarynrefill.nThisnallowsnthen
nursentonknownifnperfusionnisnadequatentonmaintainnvitalnorgans.nThennursendoesnhaventonbenconcern
ednaboutnperfusion.nPerfusionnisnnotnonlynmonitorednbynthenphysiciannbutnthennursentoo.n
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Perfusionndoesnnotnalwaysnchangenasnthenpersonnages.n
7.nThennursenisnconductingnanpatientnassessment.nThenpatientntellsnthennursenthatnhenhasnsmokedntwon
packsnofncigarettesnperndaynforn27nyears.nThennursenmaynfindnwhichndatanuponnassessment?n
a. Bloodnpressurenaboventhennormalnrangen
b. Boundingnpedalnpulsesn
c. Nightnblindnessn
d. Refluxndiseasen
ANS:nAn
Smokersnhavenanconstrictionnofnthenbloodnvesselsnduentonthentarnandnnicotineninncigarettes.nThisncon
strictionnmaynleadntonhypertension.nBoundingnpulses,nnightnblindness,nandnrefluxndiseasendonnotnha
venandirectnlinkntonsmoking.n
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Chaptern2.GasnExchangen
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MULTIPLEnCHOICEn
1. Thennursenisnassignednangroupnofnpatients.nWhichnpatientnwouldnthennursenidentifynasnbeingn
atnincreasednrisknfornimpairedngasnexchange?nAnpatientn
a. withnanbloodnglucosenofn350nmg/dLn
b. whonhasnbeennonnanticoagulantsnforn10ndaysn
c. withnanhemoglobinnofn8.5ng/dLn
d. withnanheartnratenofn100nbeats/minnandnbloodnpressurenofn100/60n
ANS:nCn
Thenhemoglobinnisnlown(anemia),nthereforenthenabilitynofnthenbloodntoncarrynoxygennisndecreased.n
Highnbloodnglucosenand/ornanticoagulantsndonnotnalternthenoxygenncarryingncapacitynofnthenblood.n
Anheartnratenofn100nbeats/minnandnbloodnpressurenofn100/60narennotnindicativenofnoxygenncarryingnc
apacitynofnthenblood.n
2. Thennursenisnreviewingnthenpatientsnarterialnbloodngasnresults.nThenPaO2nisn96nmmnHg,npHni
sn7.20,nPaCO2nisn55nmmnHg,nandnHCO3nisn25nmEq/L.nWhatnwouldnthennursenexpectntonobservenonn
assessmentnofnthisnpatient?n
a. Disorientationnandntremorsn
b. Tachycardianandndecreasednbloodnpressuren
c. Increasednanxietynandnirritabilityn
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