Older Adult Final

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1, 2, 4

Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? Select all that apply

  1. How to monitor and record daily weight

  2. Symptoms of worsening heart failure

  3. Purpose of chronic antibiotic theraphy

  4. How to read food labels for sodium content

  5. Importance of stopping exercise if heart rate increases

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4

The nurse is reviewing the laboratory results for a client with an elevated cholesterol level who is taking atorvastatin. Which result is most important to discuss with the health care providers?

  1. Serum potassium is 3.4 mEq/L

  2. Blood Urea Nitrogen(BUN) is 9 mg/L

  3. Aspartate aminotransferase (AST) is 30 units/L

  4. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL

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2

A client who has just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be MOST useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol?

1.Creatine kinase MB level 2.Troponin I level 3.Myoglobin level 4.C-reactive protein level

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3

The emergency department nurse is caring for a client who was just admitted with left anterior chest pain, possible acute myocardial infarction(MI). Which action will the nurse take FIRST?

1.Insert an IV 2. Auscultate heart sounds 3. Administer sublingual nitroglycerin after checking vital sign 4. Draw blood for troponin I measurement

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3

The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which laboratory value will be MOST important to monitor?

  1. Sodium level

  2. Blood glucose level

  3. Potassium level

  4. Alkaline phosphatase level

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1

At 10:00 AM, a hospitalized client receives a new order for transesophageal echocardiography (TEE) as soon as possible. Which action will the nurse take FIRST?

  1. Put the client on NPO status

  2. Teach the client about the procedure

  3. Insert an IV int he client's forearm

  4. Attach the client to a cardiac monitor

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3

During a home visit to an 88-year-old client who is taking digoxin 0.25mg/day to treat heart failure and atrial fibrillation, the nurse obtains this assessment information. Which finding is MOST important to communicate to the health care provider?

  1. Apical pulse 68 beats/min and irregular

  2. Digoxin taken with meals

  3. Vision that is becoming "fuzzy"

  4. Lung crackles that clear after coughing

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4

The nurse is preparing to administer the following medications to a client with multiple health problems who have been hospitalized with deep vein thrombosis. Which medication is MOST important to double-check based on the laboratory result every day?

  1. Furosemide 40mg IV

  2. Famotidine 20mg IV

  3. Digoxin 0.25mg PO

  4. Warfarin 2.5 mg PO

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2

A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be MOST useful to monitor?

  1. Serum potassium

  2. B-type natriuretic peptide

  3. Blood urea nitrogen

  4. Hematocrit

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2

Signs of right -sided heart failure include

  1. a low cardiac output

  2. signs of fluid retension

  3. dyspnea

  4. elevated pulmonary venous pressure

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1

Signs of left-heart failure include

  1. a low cardiac output

  2. an elevated pulmonary artery pressure

  3. ascites

  4. fluid retention with edema

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2

Impaired blood flow to the extremities is caused by which of the following common disorders?

  1. Raynaud disease

  2. Peripheral vascular disease

  3. Polycythemia

  4. Buerger's disease

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1

A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of heart failure and peripheral arterial disease (PAD). At present, the client is unable to stand or ambulate due to pain in the lower extremity. Based on his medical history, the nurse should implement measures to prioritize the prevention of what complications?

  1. Deep vein thrombosis

  2. Urinary frequency

  3. Peripheral edema

  4. Skin breakdown

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4

The nurse enters the room of the patient diagnosed with CHF. The patient is lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement FIRST to immediately relieve the symptoms. ?

  1. Sponge the patient’s forehead

  2. Obtain a pulse oximetry reading

  3. Take the patient’s vital signs 4.Assist the patient to an upright position

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4

ou receive a morning report on your patient with CHF and are told that you are to administer Lasix 40 mg IV to your patient at 0800 and 1800. The morning labs have just been received and they are: Sodium 148, BNP 600, Potassium 3.0, Creat 1.2 and BUN 10. The night RN reports bilateral pitting edema of +3. Which of the following nursing interventions is PRIORITY?

1.Administer the Lasix as ordered 2. Notify the physician of the BNP level 3.Assess the patient for edema 4.Hold the dose of Lasix and notify the physician about the potassium level

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3

A client has been diagnosed with heart failure that has not yet responded to treatment. What breath sound should the nurse expect to assess on auscultation?

  1. Expiratory wheezes

  2. Inspiratory wheezes

  3. crackles

  4. Rhonci

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1

Mrs. Hart is admitted with Heart Failure and is receiving furosemide (Lasix), a loop diuretic to reduce edema. The nurse should observe for the following lab disorder:

  1. hypokalemia

  2. hypocalemia

  3. hypoglycemia

  4. hyperkalemia

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4

Diagnostic tests for congestive heart failure include……

1.venography and echocardiogram 2. arteriography and electrocardiogram(ECG) 3. echocardiogram only 4. echocardiogram, chest x-ray, electrocardiogram (ECG)

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2

Examination of a patient in a supine position reveals jugular veins distended from the base of the neck to the angle of the jaw. This finding indicates:

  1. Increased venous return.

  2. Right-sided heart failure

  3. Increased pulmonary artery capillary pressure.

  4. Left-sided heart failure.

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4

Your client with CHF gained three pounds more since yesterday. You should……

  1. document it on the chart

  2. reassure the client that he must have eaten too much yesterday

  3. administer another dose of diuretic

  4. notify the physician

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3

A 50-year-old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and a sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease (PAD) that need to be modified are:

  1. weight and diet

  2. activity level and diet 3.tabaco use and high blood pressure

  3. sedentary lifestyle and high blood pressure

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3

Rest pain is a manifestation of PAD that occurs due to a chronic:

  1. vasospasm of small cutaneous arteries in the feet.

  2. increase in retrograde venous blood flow in the legs. 3.decrease in arterial blood flow to the nerves of the feet. 4.decrease in arterial blood flow to the leg muscles during exercise.

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3

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to

1.elevate the leg to promote venous return. 2.start anticoagulant therapy with IV heparin. 3.notify the physician of the change in peripheral perfusion 4.place the bed in reverse Trendelenburg to promote perfusion.

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1, 3, 4, 6

A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient’s health history? Select all that apply:

  1. Diabetes Mellitus

  2. Being female

  3. high cholesterol

  4. Uncontrolled hypertension

  5. Varicose vein

  6. smoking

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3

Your patient is diagnosed with Buerger’s Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing?

1.Low fat diet 2.Blood glucose control 3.Smoking cessation 4. Blood glucose control

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1, 3

A patient is diagnosed with Raynaud’s Disease. Which explanations below most accurately describe this condition? Select all that apply:

1.Raynaud’s Disease is triggered by cold temperatures or stress. 2.Raynaud’s Disease occurs due to a vasospasm of the peripheral veins 3.Raynaud’s Disease affects the toes, fingers, and sometimes the ears and nose. 4.Raynaud’s Disease is prevented by glucose control.

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True

True or False: Peripheral arterial disease leads to a decrease in rich oxygenated blood being delivered to the lower extremities, which leads to ischemia and necrosis of skin tissue.

True False

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3

The MOST common cause of peripheral arterial disease is?

  1. Diabetes Mellitus

  2. Deep vein thrombosis 3.Atherosclerosis 4.Pregnancy

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3

Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient’s symptoms, the nurse will position the lower extremities in the?

1.Dependent position 2.Horizontal position 3.Elevated position above heart level 4. Knee-flexed position

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1, 3, 4

You’re assessing a patient’s health history for peripheral vascular disease. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease? Select all that apply:

1.“I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain.” 2.“If I stand or sit too long my legs start to feel heavy and achy.” 3. “It hurts to elevate my legs.” 4.“Sometimes when I’m walking my legs start to cramp and tingle to the point where I can’t walk until the pain goes away.”

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4

Your patient has a severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks:

1.cyanotic; rubor 2.rubor; pallor 3.cyanotic, pallor 4.pallor; rubor

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2, 3

A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply:

1.Elevate the lower extremities below heart level frequently 2.Application of compression stockings 3.Limit long periods of standing and sitting 4.Use the knee-flexed position while lying in bed

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1, 4

Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply:

1.Thick, tough 2. Thin, Scaly 3.Hairless 4.Brown pigmented

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2

Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to?

1.Assess the surgical site for excessive drainage 2.Assess and grade lower extremity pulses bilaterally 3.Apply compression stockings 4.Elevate the lower extremity above heart level

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2

You’re providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient?

  1. “It is important I quit smoking.”

  2. “To prevent my feet and legs from getting too cold at night, I will use a heating pad.

  3. “A walking program would be beneficial in treatment of my PAD.”

  4. “I will avoid wearing tight socks or shoes.”

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3

The client was dx with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client?

1.Take Imodium, and anti diarrheal, OTC for diarrhea 2.Limit exercise for several weeks until a tolerance is achieved 3.The stools may be very dark, and this can mask blood 4.Eat only red meats and organ meats for protein

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1

The nurse is admitting a 24-year-old American American female client with a dx of rule-out anemia. The client has a hx of gastric bypass surgery for obesity 4 years ago. Current assessment findings include a height of 5'5, wt. 75 kg, P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed?

1.Vitamin B12 deficiency 2.Folic acid deficiency 3.Iron deficiency 4.Iron deficiency

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1

The client is being admitted with Folic acid deficiency anemia. Which would be the most appropriate referral?

1.Alcoholics anonymous 2.Leukemia society of America 3. hematologist 4.A dietician

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3

The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse?

1.The client dx with iron-deficiency anemia who is prescribed iron supplements 2.The client dx with pernicious anemia who is receiving vitamin B12 IM 3.The client dx with aplastic anemia who has developed pancytopenia 4.The client dx with renal disease who has deficiency of erythropoietin

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1

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching?

1."Pernicious anemia is caused by not consuming enough Vitamin B12." 2."Pernicious anemia causes the red blood cells to appear very large and oval." 3."Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." 4."A red, smooth tongue can be a sign of pernicious anemia."

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4

A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder?

  1. Intravenous

  2. orally

  3. Through a central line

  4. intramuscular

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2

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime?

1."I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." 2."Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." 3. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." 4."When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

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False

True or False: The least common type of anemia is iron-deficiency anemia.

True False

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3

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

1.Yellow-tinged sclerae 2.Shiny, smooth tongue 3.Numbness of the extremities 4.Gum bleeding and tenderness

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1

Which of the following blood components is decreased in anemia?

1.Erythrocytes 2.Granulocytes 3. Leukocytes 4.Platelets

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2

A client with poorly controlled diabetes has developed end-stage kidney injury and consequent anemia. When reviewing this client's treatment plan, the nurse should anticipate the use of what drug?

1.Magnesium sulfate 2.Epoetin alfa 3. Low-molecular weight heparin 4.Vitamin K

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3

An older client with a history of arthritis has fallen after an episode of dizziness. Laboratory data reveal anemia and stool positive for occult blood. Which assessment question would be most appropriate for the nurse to ask to ascertain the client's health situation?

1."Do you take any medication for high blood pressure?" 2."What herbal remedies or supplements do you use regularly?" 3."Do you take aspirin for the treatment of pain or inflammation?" 4."Does your family doctor ask you to get regularly scheduled blood work?"

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3

Which nursing assessment finding supports the possible diagnosis of deep vein thrombosis (DVT)?

1.Complaint of spasm in the leg 2.Dull, achy, pale extremity 3.Unilateral swelling of the calf, pain, warmth in extremity 4. fever, burning sensation in extremity

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2

An older adult client who is status post a right hip total arthroplasty is found to have a DVT in the right lower leg. The nurse is assessing the client and finds them to be restless, complaining a dyspnea, a heart rate of 110 beats/min and a respiratory rate of 24 breaths/min. What problem does the nurse suspect the client is experiencing?

1.an anxiety attack 2.pulmonary embolus 3.myocardial infarction 4.compartment syndrome

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2

The heart is composed of three layers. the middle layer is composed of specialized cell, called myocytes, responsible for conducting the system blood pumping action. What is this layer called?

  1. Endocardium

  2. Myocardium

  3. Epicardium

  4. Pericardium

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1

What is the accessory valve structure that is attached to between Chordae tendinase and inside ventricle walls that contract during ventricle systolic phage?

1.Papillary muscles 2.chordae tendineae 3, Mitral valve 4. Tricuspid valve

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2

Which is NOT explaining cardiac output?

1.Normal 4-8 L/min 2. Amount of blood pumped by each ventricle in 60 minute​ 3.HR x stroke volume 4. SV=EDV( End diastolic volume 120ml)-ESV (end systolic volume 50ml)=stroke volume 70ml.​

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1

What area of the heart's electrical conduction is known as the "pacemaker" of the heart?

  1. SA node

  2. AV node 3.Purknije Fibers 4.Bundle of His

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True

True or False: Depolarization of the heart muscle is when the muscle contracts and repolarization is when the heart muscle rests.

True False

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1

What is the correct sequence of electrical conduction of the heart?

1.SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers 2.AV node, internodal pathways, SA node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers 3. SA node, internodal pathways, AV node, Purkinje Fibers, Right and Left Bundle Branch, Bundle of His 4.None of the options are correct

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1, 3, 4, 5, 6

Select all the signs and symptoms a patient can experience with the stimulation of the sympathetic nervous system: Select all that apply

1.Tachycardia 2.Hypotension 3.Hyperglycemia 4. Dilated pupils 5. Sweating 6.Bronchodilation 7. Excessive salivation

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1, 3, 4

Select all the signs and symptoms a patient can experience when the stimulation of the parasympathetic nervous system: Select all that apply:

1.Bradycardia 2.Dilated pupils 3.Bronchoconstriction 4.Constrict pupils 5.Dry mouth 6.Slow digestion

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2, 3

What are some side effects of adrenergic antagonist drugs (sympatholytic): select all that apply

1.Tachycardia 2. Bradycardia 3.Cronchoconstriction 4.Bronchodilation

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3

A patient with chronic heart failure who has been following a low-sodium diet tells the nurse at the clinic about a 5-pound weight gain in the last 3 days. The nurse's first action will be to:

1.ask the patient to recall the dietary intake for the last 3 days because there may be hidden sources of sodium in the patient's diet. 2.instruct the patient in a low-calorie, low-fat diet because the weight gain has likely been caused by excessive intake of inappropriate foods. 3.assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring. 4.educate the patient about the use of diuretic therapy because it is likely that the patient will need medications to reduce the hypervolemia.

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2

The nurse is caring for a patient with heart failure. While auscultating heart sounds of this patient, the nurse hears an extra heart sound immediately after the second heart sound (S2). How would the nurse document this?

  1. A first heart sound (S1) 2

  2. A third heart sound (S3)

  3. A fourth heart sound (S4)

  4. A murmur

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4

When cardiac output is insufficient, compensatory mechanisms are activated. which compensatory mechanism is not included in this initial compensatory mechanism?

  1. Ventricular dilation (Starling's law)

  2. Increased heat rate

  3. Stimulation of renin-angiotensin mechanism

  4. Decreased heart rate

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4

What is NOT a sign and symptom of initial LEFT heart failure?

  1. Dyspnea

  2. Orthopnea

  3. Apical pulse displaced L

  4. Dependent edema

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1

The most significant etiology for chronic obstructive pulmonary disease (COPD) is:

1.Tobacco use 2.Chronic bronchitis 3.Exposure to carcinogens in the workplace 4.Emphysema

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2

A nurse is organizing a support group for older individuals with COPD in the community. The nurse knows that which of the following individuals is most likely to have COPD?

1.A 75-year-old Hispanic male who is a retired truck driver and never smoked 2.A 72-year-old non-Hispanic white female who never worked outside of the home and is a former smoker 3. A 67-year-old African American male who is a retired physician 4.A 70-year-old Asian woman who is a retired college professor

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3

Chronic Obstructive Pulmonary Disease (COPD) consists of a group of diseases including all of the following except:

1.Chronic bronchitis 2.Asthma 3. Pneumonia 4.Emphazema

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2

The daughter of an older patient with chronic bronchitis says to the nurse, “I don’t understand why my father has not been prescribed antibiotics for his bronchitis. The last time I had bronchitis I got antibiotics.” The nurse considers the following when formulating a response:

  1. Antibiotics tend to be less effective in older adults than in younger adults 2

  2. Antibiotics are not prescribed in chronic bronchitis since the cause is usually not bacterial

  3. The routine use of antibiotics is controversial because the causal role of bacterial infection is often not clear

  4. Normal age-related decreases in immune response delay the presentation of classic symptoms

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3

A nurse is giving a presentation at a community center about chronic bronchitis. Which of the following information should the nurse include as effective for preventing this disorder?

1.Maintenance of ideal weight 2.Annual influenza immunization 3.Smoking cessation 4.Regular moderate exercise

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1

A student nurse is providing education to a group of older adults about emphysema. What should the student include in the teaching? Emphysema is:

  1. The destruction of the walls of the alveoli with a non-productive cough

  2. An inflammatory disease of the airways that lasts for 3 months

  3. An infection in the airways that lasts for 2 years

  4. An inflammatory disease with frequent respiratory infections

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2

A client has active TB. Which of the following symptoms will he exhibit?

  1. Chest and lower back pain

  2. Chills, fever, night sweats, and hemoptysis

  3. Fever of more than 104*F and nausea

  4. Headache and photophobia

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1, 2, 4, 5

You're providing discharge teaching to a patient who was admitted with asthma. You discussed the EARLY warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient:

1.Easily fatigued with physical activity 2.Reduced peak flow meter reading 3.Cyanosis 4.Wheezing with activity 5.Nighttime coughing 6. No relief with short-acting bronchodilator inhaler

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2, 4

A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise? Select all that apply

  1. Avoid warming up before exercise.

  2. Administer a short-acting beta agonist before exercise

  3. Administer a short-acting beta agonist after exercise

  4. Avoid exercising when experiencing a respiratory illness

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2

A patient received a nebulizer of Albuterol. What is a side effect of this medication?

  1. Bradycardia

  2. Tachycardia

  3. Drowsiness

  4. Feeling cold

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1

Which of the following medications is useful in treating heart failure symptoms due to its ability to prevent coronary artery vasospasm and reduce preload and afterload thus decreasing myocardial oxygen demand?

1 Nitroglycerin 2 Dopamine 3.Hydrochlorothiazide 4. Metoprolol

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2

The nurse working in a cardiac care unit is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume. The nurse recognizes that afterload is increased when there is ...

1 Arterial vasodilation 2 Arterial vasoconstriction 3.Venous vasoconstriction 4.Venous vasodilation

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2

Afterload is defined as…

1.Inotropic state of the heart 2.The pressure against which the left ventricle ejects 3. Amount of blood in the ventricle at the end of diastole 4.The pressure against which the left atrium ejects

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2

Which statement below best describes the term cardiac preload?

1The pressure the ventricles stretch at the end of systole 2 The amount the ventricles stretch at the end of diastole. 3.The pressure the ventricles must work against to pump blood out of the heart. 4 The strength of the myocardial cells to shorten with each beat.

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1, 3

What two factors are used to calculate cardiac output? Select all that apply:

1 Heart rate 2. Blood pressure 3.Stroke Volume 4. Mean arterial pressure

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2

A patient with hypovolemic shock is given IV fluids. IV fluids will help _______ cardiac output by ________

  1. decrease; decreasing preload

  2. increase, increasing preload

  3. increase, decreasing afterload

  4. decrease, increasing contractility

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2, 3, 4

Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume (cardiac output):

1 Heart rate 2. Preload 3. Contractility 4. Afterload 5 Blood pressure

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2

A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will?

1 Decrease the patient’s blood pressure and increase cardiac afterload 2 Decrease the patient’s blood pressure and decrease cardiac afterload 3 Decrease the patient’s blood pressure and increase cardiac preload 4 Increase the patient’s blood pressure but decrease cardiac output

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1, 2, 5

What conditions below can result in an increased cardiac afterload? Select all that apply:

1 Vasoconstriction 2 Aortic stenosis 3 Vasodilation 4 Dehydration 5 Pulmonary Hypertension

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1

A nurse is preparing a presentation on ethics for a group of nursing assistants working at local long-term and acute care facilities. Which example would be most appropriate to use to describe the ethical principle of beneficence?

1 The nurses at a local hospital answer clients' call buttons quickly and deliberately. 2 An incompetent part-time nursing aide is fired, leaving a less than full staff 3 The staff of a nursing home closes residents' doors before the body of a deceased resident is wheeled out 4 The charge nurse documents all reported incidents at the end of the shift

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1

A nurse is providing care to a 71-year-old client who is in the late stages of cancer and who has painful bone metastases. The client is nonresponsive but groans and grimaces intermittently. The nurse is drawing up a breakthrough dose of morphine for the client, but a colleague cautions that, "Sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage." The colleague's statement prioritizes which ethical principle?

1 Nonmaleficence 2 Justice 3 Beneficence 4 Fidelity

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4

An investigation into reports of substandard care on the subacute geriatric unit of an acute care facility has been undertaken. Which event would support malpractice on the part of the nursing staff?

1 A client with a documented history of seizures was left with the bed lowered and with upper 2 bedrails are in place. 2 A client was sent for a colonoscopy, the client had given written consent for the procedure. 3 A client with a diagnosis of vascular dementia was found wandering in the hall outside the unit. 4 A client who was immobile was not turned over during the night shift and developed a pressure ulcer on the coccyx.

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3

When going to the hospital, which forms should patients be encouraged to bring with them in case end of life care becomes an ethical or legal issue?

1 Euthanasia 2 Organ donor card 3 Advance directives 4 Do not resuscitate (DNR)

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2

The nurse recognizes the value of hospice care in promoting quality of life and the end of life. Which of the following older adult patients reflects an eligibility requirement for hospice care?

1 A patient who is immobilized due to injuries and unable to afford specialized nursing care 2 A patient who has experienced a stroke and been given 3 months to live 3 A patient with cancer who is living with uncontrolled persistent pain 4 A patient with acquired immunodeficiency syndrome (AIDS) who lacks family support to provide needed care

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2

The admissions department at a local hospital is registering a male older adult for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this client?

1 “Advance directives are not legal documents, so you have nothing to worry about.” 2 “Advance directives are limited only to health care instructions and directives.” 3 Your finances cannot be managed without an advance directive.” 4 “Advance directives are implemented when you become incapacitated, and then you will use a living will to allow the state to manage your money.”

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2

A do not resuscitate order (DNR) is a specific type of advanced directive. If the patient’s code status is not immediately known, and the patient is found with no pulse and no respirations. What should the nurse do first?

1 Call the doctor, call the code alert 2 Call the code alert, call the doctor 3 Check your other patents 4 Call the family

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2

The nurse is caring for a dying patient with an advanced directive stating Do Not Resusictate and Do Not Intubate. During the next assessment the nurse finds the client to have Cheyene- Stokes respirations and pale/blueish skin tone. There is no family at the bedside at this time. What should the nurse do next?

1 Call a code blue (condition A), as the client is in distress 2 Call the client's family, as the client is actively dying 3 Start CPR, as the client is likely going into cardiac arrest 4 Apply oxygen because the client is cyanotic

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2

One difference between palliative care and hospice care is:

1 Palliative care was founded by Dame Cicely Saunders 2 Palliative care begins at the initial phase of the disease and focusses on symptom management 3 Palliative care is only for those with terminal illness and <6 months to live 4 Palliative care withholds pain medications until pain is intractable

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91

1

The daughter of a patient who has a chronic illness that has reached the terminal phase talks about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care?

1 “I know that palliative care is only available to people who have 6 months or less to live. That is really hard to cope with.” 2 “My mom still can be actively treated while receiving palliative care.” 3 “I understand that the palliative care team is made up of health care professionals of all different disciplines, not just doctors and nurses.” 4 “The goal of palliative care is to prevent or to minimize suffering.”

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92

1

A dying client begins to experience restlessness, inability to pay attention and complete tasks they are typically able to do as well as attempting to get out of bed and remove their IV site. What is the best intervention for this client?

1 Ask a family member to sit with the client 2 Administer an anxiolytic as ordered 3 Apply soft wrist restraints 4 Avoid interaction with the client

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93

1

An older patient who was just diagnosed with a terminal disease states, “All my life I attended church, but I am still worried about what will happen after death.” The nurse’s best response is which of the following?

1 “The unknown may be frightening. Do you want to talk about this?” 2 “Religious people know that God is a good God.” 3 “People who have had near-death experiences say it is peaceful.” 4 “You must feel good about attending church most of your life.”

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94

4

______________is the stage of grief in which the client may refuse treatment for a disease for which they are diagnosed.

1 Anger 2. Bargaing 3. Depression 4 Denial

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95

2

A patient you are caring for has just been diagnosed with terminal cancer. You hear your pateint saying "God, if you let me live, I will go to church every day". This is an example of which stage of grief identified by Dr. Kubler-Ross?

1 Denial 2 Bargaining 3 Acceptance 4 Anger

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96

3

How do older adults deal with loss and grief?

1 Shock 2 Denial 3 Physical Symptoms and immobilization 4 Expressing verbally that they feel depressed

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97

1

Loss of health, spouse and independence are examples of a transition of aging. Correctly identify the stages of grief in order which are identified by Dr. Kubler-Ross:

1 Denial, Anger, Bargaining, Depression, Acceptance 2 Depression, Anger, Denial, Bargaining, Acceptance 3 Denial, Bargaining, Acceptance, Anger, Depression 4 Anger, Denial, Bargaining, Depression, Acceptance

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98

3

Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse?

1 “I get so frustrated because my father used to be so competent and now cannot even feed himself.” 2 “Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills.” 3 “My dad wanders at night and I can’t be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep. 4 “Mom asks me to do everything for her, but I think it is better is she keeps on doing as much as she is capable of and that is what I tell her.”

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99

2

The nurse is reviewing the medical record of a 72-year-old client admitted for treatment of a myocardial infarction. The client has a history of hypertension and heart failure. During the night, the client voided four times. Upon reviewing the client medication regimen, which medication would the nurse identify as being implicated in the client’s nocturia?

1 Nitroglycerin patch 2 Thiazide diuretic 3 Angiotensin-converting enzyme (ACE) inhibitor 4 Morphine sulfate

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100

1

Which of the following conditions precipitate heart failure in older adults?

1 coronary artery disease, hypertension, smoking 2 benign prostatic hypertrophy,myocardial infarction, obesity 3 hypertensive heart disease, macular degeneration, diabetes 4 hyperthyroidism, family history of heart failure, glaucoma

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