Adult Health Exam 1-Questions

During the postoperative care of a 76-year-old patient, the nurse monitors the patient’s intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because

a. older adults have an impaired thirst mechanism and need reminding to drink fluids.

b. older adults are more likely than younger adults to lose extracellular fluid during surgeries.

c. water accounts for a greater percentage of body weight in the older adult than in younger adults.

d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults.

D

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is (recognize)

a. osmosis.

b. diffusion.

c. active transport.

d. facilitated diffusion.

A

An older adult is admitted to the medical unit with GI bleeding. Assessment findings that occur with fluid volume deficit include (select all that apply)

a. weight loss.

b. dry oral mucosa.

c. full bounding pulse.

d. engorged neck veins.

e. orthostatic

f. hypotension.

g. increased central venous pressure.

A, B, E

The nursing care for a patient with hyponatremia and fluid volume excess includes

a. fluid restriction.

b. administration of hypotonic IV fluids.

c. administration of a cation-exchange resin.

d. placement of an indwelling urinary catheter.

A

The nurse should be alert for which manifestations in a patient receiving a loop diuretic?

a. Restlessness and agitation

b. Paresthesias and irritability

c. Weak, irregular pulse and poor muscle tone

d. Increased blood pressure and muscle spasms

C

The typical fluid replacement for the patient with a fluid volume deficit is

a. dextran.

b. 0.45% saline.

c. lactated Ringer’s solution.

d. 5% dextrose in 0.45% saline.

C

Which actions would the nurse prioritize when admitting a patient to the PACU?

a. Assess the surgical site, noting presence and character of drainage.

b. Assess the amount of urine output and the presence of bladder distention.

c. Assess for airway patency and quality of respirations and obtain vital signs.

d. Review results of intraoperative laboratory values and medications received.

C

A person who lives at a high altitude may normally have an increased Hgb and RBC count because

a. high altitudes cause vascular fluid loss, leading to hemoconcentration.

b. hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis.

c. the function of the spleen in removing old RBCs is impaired at high altitudes.

d. impaired production of platelets leads to proportionally higher red cell counts.

B

A patient with cancer arising from granulocytic cells in the bone marrow will have

a. a risk for bleeding.

b. altered oxygenation.

c. decreased production of antibodies.

d. decreased phagocytosis of bacteria.

D

In a severely anemic patient, the nurse would expect to find

a. cyanosis and hypertension.

b. pulmonary edema and fibrosis.

c. dyspnea and increased heart rate.

d. dysrhythmias and expiratory wheezing.

C

The nursing management of a patient in sickle cell crisis includes (select all that apply)

a. monitoring CBC.

b. optimal pain management and O2 therapy.

c. blood transfusions if needed and iron chelation.

d. rest as needed and deep vein thrombosis prophylaxis.

e. administration of IV iron and diet high in iron content.

A, B, C, D

A complication of the hyperviscosity of polycythemia is

a. thrombosis.

b. cardiomyopathy.

c. pulmonary edema.

d. disseminated intravascular coagulation (DIC).

A

A defect in which BP-regulating mechanisms can result in the development of hypertension? (select all that apply)

a. Release of norepinephrine

b. Secretion of prostaglandins

c. Stimulation of the sympathetic nervous system

d. Stimulation of the parasympathetic nervous system

e. Activation of the renin-angiotensin-aldosterone system

A, C, E

Which item in a patient history would the nurse recognize as a modifiable risk factor for the development of hypertension?

a. Low-calcium diet

b. Excess alcohol use

c. Family history of hypertension

d. Consumption of a high-protein diet

B

Which information would the nurse apply to a teaching plan for a patient with hypertension?

a. All patients with elevated BP need drug therapy

b. Obese persons must achieve a normal weight to lower BP.

c. It is not necessary to limit salt in the diet if taking a diuretic.

d. Lifestyle modifications are needed for persons with elevated BP.

D

Which consideration would the nurse include in the management of the older adult with hypertension?

a. Preventing primary hypertension from converting to secondary hypertension

b. Recognizing that the older adult is less likely to adhere to the drug therapy regimen than a younger adult

c. Ensuring that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption

d. Using a precise technique in assessing the BP of the patient because of the possible presence of orthostatic hypertension

D

A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy would the nurse expect?

a. Drug therapy will be needed because the BP has not reached the goal.

b. BP monitoring should continue for 3 months to confirm a diagnosis of hypertension.

c. Lifestyle changes are less important since they were not effective, and drugs will be started.

d. More changes in the patient’s lifestyle are needed for a longer time before starting drug therapy.

A

A patient is admitted to the hospital in a hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategies would the nurse anticipate? (select all that apply)

a. Measuring hourly urine output

b. Continuous BP monitoring with an arterial line

c. Decreasing the MAP by 50% within the first hour

d. Maintaining bed rest and giving tranquilizers to lower the BP

e. Assessing the patient for signs of heart failure and changes in mental status

A, B, E

Which statements accurately describe heart failure with preserved ejection fraction (HFpEF)? (select all that apply)

a. Uncontrolled hypertension is a primary cause.

b. Left ventricular ejection fraction may be within normal limits.

c. The pathophysiology involves ventricular relaxation and filling.

d. Multiple evidence-based therapies have been shown to decrease mortality.

e. Therapies focus on symptom control and treatment of underlying conditions.

A, B, C, E

The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Which drug action is expected? (select all that apply)

a. Raises the heart rate

b. Dilates renal blood vessels

c. Increases heart contractility

d. Acts as a selective β-agonist

e. Increases systemic vascular resistance

C, D

A patient with chronic heart failure and atrial fibrillation is treated with low-dose digitalis and a loop diuretic. Which actions would the nurse take to prevent complications of this drug combination? (select all that apply)

a. Monitor serum potassium levels.

b. Teach the patient how to take a pulse rate.

c. Keep an accurate measure of intake and output.

d. Withhold digitalis if the pulse rhythm is irregular.

e. Teach the patient about diet potassium restrictions.

A, B

Which findings would the nurse expect when assessing a patient with infective endocarditis? (select all that apply)

a. Retinal hemorrhages

b. Splinter hemorrhages

c. Presence of Osler’s nodes

d. Painless nodules over bony prominences

e. Erythematous macules on the palms and soles

A, B, C, E

Which intervention is a priority in nursing management of a patient with myocarditis?

a. Providing meticulous skincare

b. Assuring tight glycemic control

c. Administering antibiotic prophylaxis

d. Monitoring oxygenation and ventilation

D

A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to assistive personnel (AP)? (select all that apply)

a. Obtain and record daily weight.

b. Determine apical-radial pulse rate.

c. Observe for overt signs of bleeding.

d. Teach the patient how to avoid bruising and bleeding.

e. Obtain and record vital signs, including pulse oximetry.

A, C, E

A 50-year-old woman who weighs 95 kg has a history of high blood pressure, high sodium intake, tobacco use, and sedentary lifestyle. Which is the most important risk factor for peripheral artery disease (PAD) to address in the nursing plan of care?

a. Salt intake

b. Tobacco use

c. Excess weight

d. Sedentary lifestyle

B

Which information would the nurse include when explaining the cause of rest pain with PAD?

a. Vasospasm of cutaneous arteries in the feet

b. Decrease in blood flow to the nerves of the feet

c. Increase in retrograde venous perfusion to the lower legs

d. Constriction in blood flow to leg muscles during exercise

B

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. Which action would the nurse take first?

a. Notify the HCP of the change in perfusion.

b. Start anticoagulant therapy with IV heparin.

c. Elevate the leg to improve the venous return.

d. Position the patient in reverse Trendelenburg.

A

Which patient is at highest risk for venous thromboembolism (VTE)?

a. a. A 62-year-old man with spider veins who is having arthroscopic knee surgery

b. b. A 32-year-old woman who smokes, takes oral contraceptives, and is planning a long flight

c. A 26-year-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor

d. d. An active 72-year-old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia

B

Which clinical findings would the nurse expect in a person with an acute lower extremity VTE? (select all that apply)

a. Pallor and coolness of foot and calf

b. Mild to moderate calf pain and tenderness

c. Grossly decreased or absent pedal pulses

d. Unilateral edema and induration of the thigh

e. Palpable cord along a superficial varicose vein

B, D

Which treatment would the nurse anticipate for an otherwise healthy person with an initial VTE?

a. IV argatroban as an inpatient

b. IV unfractionated heparin as an inpatient

c. Subcutaneous unfractionated heparin as an outpatient

d. Subcutaneous low-molecular-weight heparin as an outpatient

D

The nurse is planning care and teaching for a patient with venous leg ulcers. Which patient action is the most important in healing and control of this condition?

a. Following activity guidelines.

b. Using moist environment dressings.

c. Taking horse chestnut seed extract daily.

d. Applying graduated compression stockings.

D

During the respiratory assessment of an older adult, the nurse would expect to find (select all that apply)

a. a vigorous reflex cough.

b. increased chest expansion.

c. increased residual volume.

d. decreased lung sounds at base of lungs.

e. increased anteroposterior (AP) chest diameter.

C, D, E

When auscultating the chest of an older patient in mild respiratory distress, it is best to

a. begin listening at the apices.

b. begin listening at the lung bases.

c. begin listening on the anterior chest.

d. ask the patient to breathe through the nose with the mouth closed.

B

Which respiratory assessment finding does the nurse interpret as abnormal?

a. Inspiratory chest expansion of 1 inch

b. Symmetric chest expansion and contraction

c. Resonance (to percussion) over the lung bases

d. Bronchial breath sounds in the lower lung fields

D

The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test?

a. Thoracentesis

b. Bronchoscopy

c. Pulmonary angiography

d. Sputum culture and sensitivity

A