NRSG2350: EXAM 3 MASTER DECK

1. A patient has a BP of 90/54 mmHg. Calculate the MAP using (SBP + 2 × DBP) ÷ 3. Is the result concerning?

MAP = (90 + 108) ÷ 3 = 66 mmHg. This is close to the commonly used minimum perfusion target of 65 mmHg. Assess symptoms, perfusion, and trends.

2. A patient has a HR of 110 bpm and a stroke volume of 50 mL. What is the cardiac output?

CO = HR × SV = 110 × 50 = 5,500 mL/min, or 5.5 L/min.

3. A patient has a BP of 160/100 mmHg. Which cardiac workload factor is increased?

Afterload. The left ventricle must pump against greater vascular resistance.

4. A patient with heart failure has increased fluid retention and worsening crackles. Which hemodynamic factor is likely increased?

Preload. Increased ventricular filling and volume can worsen pulmonary congestion in a failing heart.

5. A patient taking lisinopril has a potassium level of 5.8 mEq/L. What complication should the nurse recognize?

Hyperkalemia. ACE inhibitors decrease aldosterone activity, reducing potassium excretion.

6. A patient taking lisinopril develops swelling of the lips and tongue. What is the priority action?

Suspect angioedema. Hold the medication and obtain emergency airway evaluation.

7. A patient taking lisinopril reports a persistent dry cough. What causes this adverse effect?

Accumulation of bradykinin associated with ACE inhibition.

8. A patient taking losartan has a potassium level of 5.6 mEq/L. What should the nurse recognize?

Hyperkalemia. ARBs can decrease aldosterone-mediated potassium excretion.

9. A patient is prescribed metoprolol. The apical pulse is 54 bpm. What should the nurse do?

Check the prescribed hold parameters; withhold if indicated and notify the prescriber. Beta blockers can worsen bradycardia.

10. A patient taking propranolol has a history of asthma. Why is this medication a concern?

Propranolol blocks beta-2 receptors and can cause bronchoconstriction.

11. A patient taking amlodipine develops swollen ankles. What is the likely cause?

Peripheral edema from dilation of arterioles and increased capillary hydrostatic pressure.

12. A patient taking verapamil has a HR of 48 bpm and dizziness. What should the nurse suspect?

Excessive slowing of SA/AV nodal activity. Assess the rhythm and BP, hold according to parameters, and notify the prescriber.

13. A patient receives the first dose of prazosin. Which teaching is most important?

Take the first dose at bedtime as directed and rise slowly because of first-dose orthostatic hypotension.

14. A patient taking furosemide has a potassium level of 2.9 mEq/L. What is the priority concern?

Hypokalemia, which increases the risk of cardiac dysrhythmias. Assess the ECG and notify the prescriber.

15. A patient taking spironolactone also takes lisinopril. Which electrolyte requires close monitoring?

Potassium. Both medications can increase potassium and cause hyperkalemia.

16. A patient with hypertension has a BP of 178/104 mmHg but reports no symptoms. Why is long-term treatment still important?

Chronic hypertension damages blood vessels and organs, increasing the risk of stroke, kidney disease, LVH, and heart failure.

17. A patient with heart failure reports gaining 2 kg (4.4 lb) over two days. What does this most likely indicate?

Fluid retention. A rapid increase in daily weight can occur before obvious edema or worsening shortness of breath.

18. A patient with left-sided heart failure has crackles, dyspnea, and orthopnea. What is causing these findings?

Fluid backs up into the pulmonary circulation, causing pulmonary congestion and impaired gas exchange.

19. A patient with right-sided heart failure has peripheral edema and jugular venous distension. What is the underlying problem?

Systemic venous congestion from impaired right ventricular pumping.

20. A patient with heart failure has an elevated BNP. What does this finding support?

Heart failure or increased ventricular stretch. BNP is released in response to increased cardiac wall stress.

21. A patient is suspected of having heart failure. Which diagnostic test evaluates ejection fraction and cardiac structure?

Echocardiogram. It evaluates cardiac function, chamber size, valves, and ejection fraction.

22. A patient with heart failure has an ejection fraction of 30%. What does this indicate?

Reduced ejection fraction and impaired systolic pumping.

23. A patient taking digoxin reports nausea and seeing yellow halos. What should the nurse suspect?

Digoxin toxicity. Visual changes and GI symptoms are classic warning findings.

24. A patient taking digoxin has a potassium level of 2.8 mEq/L. Why is this dangerous?

Hypokalemia increases the risk of digoxin toxicity because potassium and digoxin compete for binding at the sodium-potassium ATPase.

25. A patient is due for digoxin. The apical pulse is 54 bpm. What should the nurse do?

Hold the dose according to prescribed parameters and notify the prescriber. Digoxin can slow heart rate and AV conduction.

26. A patient with heart failure is prescribed furosemide. Which finding best indicates the medication is working?

Reduced edema, improved breathing, decreased lung crackles, and reduced excess weight from fluid loss.

27. A patient with asthma arrives with wheezing, chest tightness, and an oxygen saturation of 89%. Which medication should the nurse anticipate first for rapid bronchodilation?

Albuterol. It is a short-acting beta-2 agonist used for quick relief of bronchospasm.

28. A patient uses albuterol and reports tremors and a racing heartbeat. What explains these effects?

Beta-2 agonists can cause tremors and stimulate cardiovascular activity, resulting in tachycardia and palpitations.

29. A patient uses albuterol every few hours throughout the day. What does this suggest?

Poor asthma control. Frequent rescue inhaler use requires reassessment of the treatment plan.

30. A patient with asthma has wheezing and uses accessory muscles. After treatment, breath sounds become almost absent. What should the nurse recognize?

Possible severe airflow obstruction or impending respiratory failure. A silent chest is not necessarily improvement.

31. A child with asthma has a peak flow reading of 45% of personal best. Which zone is this?

Red zone. This indicates severe airflow limitation and requires following the emergency asthma action plan.

32. A patient has a peak flow reading of 85% of personal best. Which zone is this?

Green zone. It generally indicates good asthma control.

33. A patient has a peak flow reading of 65% of personal best. Which zone is this?

Yellow zone. The patient should follow the asthma action plan and reassess symptoms.

34. A patient with asthma is prescribed fluticasone. What teaching is most important?

Rinse the mouth and spit after each dose to reduce the risk of oral candidiasis.

35. A patient uses both albuterol and an inhaled corticosteroid. Which should generally be used first when prescribed separately?

Albuterol first to open the airways, followed by the inhaled corticosteroid.

36. A patient taking montelukast reports new depression and unusual mood changes. What should the nurse do?

Report the symptoms promptly. Montelukast has a serious neuropsychiatric warning.

37. A patient with asthma asks whether montelukast can replace albuterol during an attack. What is the correct response?

No. Montelukast is a maintenance/prevention medication, not an immediate rescue bronchodilator.

38. A patient with asthma is prescribed salmeterol alone. What should the nurse recognize?

LABA monotherapy is not appropriate for asthma. A LABA must be used with inhaled corticosteroid therapy.

39. A patient with severe asthma receives albuterol and ipratropium. What is ipratropium's action?

It blocks muscarinic receptors, reducing acetylcholine-mediated bronchoconstriction.

40. A patient with COPD is prescribed tiotropium. What is its primary purpose?

Long-acting maintenance bronchodilation. It is not intended for immediate relief of an acute attack.

41. A patient with COPD has increased dyspnea, sputum production, and worsening cough. What should the nurse suspect?

An acute COPD exacerbation. Assess respiratory status, oxygenation, sputum changes, and mental status.

42. A patient with COPD has an oxygen saturation of 87% and increasing confusion. What is the priority?

Assess airway, breathing, oxygenation, and mental status; administer prescribed oxygen and escalate care. Do not withhold oxygen because of COPD.

43. A patient with COPD is at risk for CO2 retention. Which oxygen saturation range is commonly targeted during an acute exacerbation?

88–92% when prescribed for patients at risk of hypercapnic respiratory failure, with individualization based on clinical status and blood gases.

44. A patient with emphysema has a barrel-shaped chest. What causes this finding?

Air trapping and chronic hyperinflation due to loss of elastic recoil.

45. A patient with chronic bronchitis has a persistent productive cough. What causes the excess mucus?

Chronic airway inflammation and enlargement of mucus-producing glands and goblet cells.

46. A patient with emphysema has reduced gas exchange. What structural change causes this?

Destruction of alveolar walls decreases the surface area available for oxygen and carbon dioxide exchange.

47. A patient with advanced COPD develops peripheral edema and jugular venous distension. What complication should the nurse suspect?

Cor pulmonale, or right-sided heart dysfunction caused by pulmonary hypertension.

48. A patient with COPD has increasing somnolence and confusion. Which complication should the nurse consider?

Hypercapnia and worsening respiratory failure. Assess ventilation and obtain further evaluation.

49. A patient with asthma has severe wheezing after exposure to an allergen. Which three processes contribute to airway narrowing?

Bronchospasm, airway inflammation/edema, and increased mucus production.

50. A patient with asthma asks why cold air triggers symptoms. What is the best explanation?

Cold air can trigger airway hyperresponsiveness and bronchoconstriction.

51. A patient reports chest pressure while walking that resolves after resting for five minutes. Which type of angina is most likely?

Stable angina. It is predictable with exertion and improves with rest or prescribed nitroglycerin.

52. A patient reports new chest pain while sitting at rest. What should the nurse suspect?

Unstable angina or acute coronary syndrome. Rest pain is an emergency finding requiring prompt evaluation.

53. A patient has chest pain at rest with transient ST elevation during the episode. Which type of angina is most likely?

Variant (Prinzmetal) angina, caused by coronary artery spasm.

54. A patient with chest pain is prescribed sublingual nitroglycerin. What should the nurse assess before administration?

Blood pressure and medication history, especially recent use of PDE-5 inhibitors such as sildenafil.

55. A patient takes nitroglycerin and develops a severe headache. What should the nurse explain?

Headache is a common effect caused by vasodilation. Monitor BP and prevent falls from dizziness.

56. A patient took sildenafil earlier and now reports chest pain. Why should nitroglycerin be avoided?

The combination can cause profound hypotension.

57. A patient arrives with crushing chest pain, diaphoresis, and nausea. What is the priority diagnostic test?

Obtain a 12-lead ECG promptly and initiate the acute coronary syndrome evaluation.

58. A patient has chest pain and elevated troponin. What does the elevated troponin indicate?

Myocardial injury. Interpret it with symptoms, ECG findings, and serial results to determine the cause.

59. A patient has persistent ST elevation and chest pain. Which condition should the nurse suspect?

STEMI, an acute coronary occlusion pattern requiring urgent reperfusion evaluation.

60. A patient has chest pain, elevated troponin, and no persistent ST elevation. Which condition is most likely?

NSTEMI, assuming the clinical findings support acute myocardial ischemia.

61. A patient has an ABI of 0.72. What does this result suggest?

Peripheral arterial disease. An ABI of 0.90 or lower is abnormal.

62. A patient has an ABI of 1.55. Is this a normal reassuring result?

No. It may indicate noncompressible calcified arteries; further vascular assessment is needed.

63. A patient reports calf pain while walking that improves with rest. Which condition is most likely?

PAD with intermittent claudication, caused by inadequate arterial blood flow during activity.

64. A patient has a cool foot, weak pedal pulses, and pale skin when elevated. What does this suggest?

Arterial insufficiency from PAD.

65. A patient has unilateral leg swelling, warmth, redness, and tenderness. What should the nurse suspect?

Deep vein thrombosis (DVT). Avoid massaging the leg and arrange prompt evaluation.

66. A patient with a suspected DVT suddenly develops dyspnea and pleuritic chest pain. What complication is most concerning?

Pulmonary embolism. This requires emergency assessment and intervention.

67. A patient has been immobile after surgery. Which DVT risk factor is present?

Venous stasis. Immobility slows venous blood flow and increases clot risk.

68. A patient has chronic venous insufficiency. Which finding is more expected than in PAD?

Dependent edema, aching, warmth, and possible venous ulcers near the medial ankle.

69. A patient has a potassium level of 6.2 mEq/L and peaked T waves. What is the priority concern?

Severe hyperkalemia with risk of life-threatening dysrhythmias. Notify the provider and initiate urgent management.

70. A patient has a potassium level of 2.9 mEq/L and takes furosemide. Which cardiac complication is the patient at risk for?

Dysrhythmias caused by hypokalemia. Assess ECG and replace potassium as prescribed.

71. A patient taking metoprolol has a HR of 48 bpm and dizziness. Which medication effect is most likely?

Negative chronotropic effect: reduced heart rate due to beta-1 blockade.

72. A patient taking verapamil develops a prolonged PR interval and bradycardia. What medication action explains this?

Verapamil slows AV nodal conduction through calcium-channel blockade.

73. A patient taking digoxin develops a new irregular pulse and nausea. What should the nurse suspect?

Possible digoxin toxicity or dysrhythmia. Check apical pulse, ECG, potassium, renal function, and digoxin level as ordered.

74. A patient has a heart rate of 42 bpm. Which intrinsic pacemaker may be controlling the rhythm if the SA node fails?

The AV junction, which has an intrinsic rate of approximately 40–60 bpm.

75. A patient has a ventricular escape rhythm at 30 bpm. What does this indicate?

The ventricles or Purkinje system may be acting as the backup pacemaker; this rate is approximately 20–40 bpm.

76. A patient taking a beta blocker has a prolonged PR interval and dizziness. What conduction problem should the nurse consider?

AV nodal slowing or AV block. Assess ECG, heart rate, BP, and symptoms.

77. A patient taking diphenhydramine needs to drive home. What teaching is most important?

Diphenhydramine can cause drowsiness and impair driving; avoid driving while affected.

78. A patient taking an opioid cough syrup asks whether they can drive. What should the nurse explain?

The medication may cause drowsiness and impair reaction time; avoid driving while taking it.

79. A patient has used oxymetazoline nasal spray several times daily for a week and now has worse congestion. What is the likely cause?

Rebound nasal congestion, also called rhinitis medicamentosa, from prolonged topical decongestant use.

80. A patient taking pseudoephedrine has hypertension and reports palpitations. What should the nurse recognize?

Pseudoephedrine can increase heart rate and blood pressure; assess cardiovascular status and notify the prescriber.

81. A patient with a UTI has dysuria, frequency, and urgency. Which test should the nurse anticipate?

Urinalysis and urine culture to identify infection and the causative organism.

82. A patient with a UTI has a positive nitrite test and WBCs in the urine. What do these findings suggest?

Bacterial UTI. Nitrites support certain gram-negative bacteria, and WBCs indicate inflammation.

83. A patient is prescribed trimethoprim-sulfamethoxazole. Which history is most important to check?

Sulfa allergy. The medication contains sulfamethoxazole.

84. A patient taking trimethoprim-sulfamethoxazole has potassium of 5.7 mEq/L. What should the nurse recognize?

Possible medication-associated hyperkalemia. Monitor potassium and renal function and notify the prescriber.

85. A patient taking nitrofurantoin develops cough, fever, and chest pain. What adverse effect should the nurse suspect?

Pulmonary sensitivity or toxicity. The patient needs prompt evaluation.

86. A patient taking ciprofloxacin reports sudden pain in the Achilles tendon. What should the nurse instruct the patient to do?

Stop strenuous activity and promptly contact the prescriber because fluoroquinolones can cause tendon injury or rupture.

87. A patient taking phenazopyridine notices orange-red urine. What should the nurse explain?

This is an expected medication effect. Phenazopyridine relieves urinary pain but does not treat the infection.

88. A patient with BPH reports hesitancy, weak stream, nocturia, and incomplete emptying. What causes these symptoms?

Enlargement of the prostate compresses the urethra and obstructs urine flow.

89. A patient taking finasteride asks why improvement is taking several weeks. What is the best explanation?

Finasteride reduces DHT and gradually shrinks the prostate; symptom improvement is not immediate.

90. A patient taking tamsulosin feels dizzy when standing. What should the nurse explain?

Tamsulosin relaxes smooth muscle and can cause orthostatic hypotension. Rise slowly and use fall precautions.

91. A patient with renal calculi reports severe flank pain radiating to the groin and hematuria. What is the likely cause?

A kidney stone moving through the urinary tract and irritating the lining.

92. A patient has a 3-mm renal stone and stable vital signs. What treatment may be appropriate?

Hydration as appropriate, pain control, and monitoring for passage. Small stones may pass spontaneously.

93. A patient with renal calculi is prescribed a thiazide diuretic. Why?

Thiazides reduce urinary calcium excretion and can help prevent certain calcium stones.

94. A patient with AKI has urine output of 250 mL/day, increased creatinine, and recent severe vomiting. Which type of AKI is most likely?

Prerenal AKI caused by hypovolemia and reduced kidney perfusion.

95. A patient with AKI has a history of prolonged hypotension and nephrotoxic medication exposure. Which type of AKI should the nurse suspect?

Intrarenal AKI, potentially acute tubular necrosis from ischemic or nephrotoxic injury.

96. A patient with BPH develops urinary retention, hydronephrosis, and rising creatinine. Which type of AKI is most likely?

Postrenal AKI caused by obstruction of urine outflow.

97. A patient with AKI has potassium of 6.1 mEq/L and ECG changes. What is the priority?

Recognize life-threatening hyperkalemia, initiate urgent escalation, and prepare for prescribed treatment.

98. A patient with CKD has fatigue, pallor, and low hemoglobin. What is the likely cause?

Reduced erythropoietin production by damaged kidneys, resulting in decreased red blood cell production.

99. A patient with CKD has edema, hypertension, and crackles. What is the underlying problem?

Fluid retention due to reduced kidney function, potentially causing pulmonary congestion.

100. A patient with CKD has a GFR of 12 mL/min. Which stage should the nurse recognize?

Stage 5 CKD or end-stage renal disease. Dialysis or kidney transplant may be needed depending on the patient's condition.