Exam 4 Flashcards by Qurissa Dodds

The nurse has instructed the client on the use of a metered-dose inhaler. Which instruction should the nurse include in the client education?

A. Explain the need to wait 30 seconds before taking a second dose of medication.

B. Train the client to monitor the respiratory rate for 1 minute after taking the medication.

C. Tell the client to exhale immediately after inhaling the medication.

D. Teach the client to push the top of the medication canister while taking a deep breath

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After administering an inhaled medication via a metered-dose inhaler, the nurse asks the client to take which action?

A. Take in a deep breath.

B. Spit out excess medication.

C. Rinse and gargle with water.

D. Clear the throat forcefully.

C. Rinse and gargle with water.

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The nurse is caring for a client for whom the health care provider has prescribed a metered-dose inhaler medication and the client expresses concern about possible side effects. Which systemic effects would the nurse advise the client may occur with this medication? Select all the apply.

A. orthopnea

B. tachycardia

C. tachypnea

D. irritation of mucous membranes

E. palpitations

B. tachycardia
D. irritation of mucous membranes
E. palpitations

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The nurse has educated a client about the use of a prescribed metered-dose inhaler. What actions should the client learn to perform prior to inhaling the metered dose? Select all that apply.

A. Cough up respiratory tract secretions.

B. Blow the nose.

C. Cough and deep breathe 5 times.

D. Drink 8 oz of water.

E. Rinse the mouth.

A. Cough up respiratory tract secretions.
B. Blow the nose.

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The nurse is teaching the client how to correctly use a metered-dose inhaler with a spacer. The prescription is for two puffs of the medication. Which client action displays understanding of the education?

A. Exhaling immediately after administration of each puff

B. Refraining from shaking the canister before and between puffs

C. Placing the mouthpiece of the inhaler in the mouth

D. Administering 2 puffs of the medication in rapid succession

C. Placing the mouthpiece of the inhaler in the mouth

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The client with chronic obstructive pulmonary disease uses an albuterol metered-dose inhaler at home. The client asks how to use the newly prescribed dry powder inhaler. What does the nurse explain to the client?

A. “The dry powder inhaler only delivers medication when you inhale.”

B. “A dry powder inhaler will feel empty when it needs to be replaced.”

C. “A dry powder inhaler can be used on a schedule or just as needed.”

D. “The dry powder inhaler delivers puff of medication into the air.”

A. “The dry powder inhaler only delivers medication when you inhale.”

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The client completes use of the dry powder inhaler. What action must the nurse perform after use of this medication?

A. Obtain the client’s blood glucose level.

B. Assist the client to rinse out the mouth.

C. Instruct the client about use of the medication.

D. Assess the client’s lung sounds.

B. Assist the client to rinse out the mouth.

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The nurse administers a dry powder dose inhaler to a client. The nurse stops and teaches the client when the client makes which statement?

A. “I usually don’t need help. I don’t think you have to watch me.”

B. “I think the medication in these inhalers has gotten expensive.”

C. “I have used this inhaler once or twice a day for 2 or 3 years.”

D. “My allergies are not bothering me. I do not need the inhaler.”

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The nurse administers a dry powder inhaler to a client. The client takes this medication at home. What action does the nurse take?

A. Teach the client how to use the inhaler using step-by-step instructions.

B. Instruct the client on differences between home and in-hospital inhalers.

C. Ask the client to use the normally prescribed inhalers from home.

D. Have the client use the inhaler while the nurse prepares other medications.

A. Teach the client how to use the inhaler using step-by-step instructions.

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After the client inhales a dose from a dry powder inhaler, which action does the nurse instruct the client to take next?

A. Exhale the breath slowly and evenly.

B. Rinse mouth out with water and spit.

C. Wait 1 minute before inhaling again.

D. Hold breath for 5 to 10 seconds.

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The nurse is administering an inhaled medication via a small-volume nebulizer to a client. What indicates that the medication is being administered correctly?

A. A fine mist forms in the air.

B. A cloud of powder appears between the canister and mouth.

C. Air is felt coming through the tubing.

D. The client begins to cough forcefully

A. A fine mist forms in the air.

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After administering an inhaled medication via a small-volume nebulizer, which action should the nurse have the client do?

A. Blow the nose forcefully.

B. Rinse and gargle with tap water.

C. Perform deep-breathing and coughing exercises.

D. Remain still for approximately 5 minutes.

B. Rinse and gargle with tap water.

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The nurse is administering a medication using a small-volume nebulizer. What would the nurse instruct the client to do?

A. Have the client inhale slowly and deeply through the mouth.

B. Depress the canister as the client begins to exhale slowly.

C. Tell the client to breathe normally.

D. Place the mouthpiece about 1 to 2 in (2.5 to 5 cm) from the mouth.

A. Have the client inhale slowly and deeply through the mouth.

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The nurse will be administering an inhaled medication via a small-volume nebulizer to a client. What would the nurse have the client do first?

A. Rinse and gargle with tap water.

B. Remain still for approximately 5 minutes.

C. Encourage client to blow the nose and cough up secretions.

D. Perform deep-breathing and coughing exercises.

C. Encourage client to blow the nose and cough up secretions.

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The nurse has educated the client on the use and reasons for using inhaled medications via a small-volume nebulizer. Which statements by the client indicate that education has been effective? Select all that apply.

A. “The nebulizer propels droplets into the nose.”

B. “Drops improve ventilation and oxygenation.”

C. “Drops are introduced into the nostril by a dropper.”

D. “Fine mist is inhaled deep into the lower respiratory tract.”

E. “Medication can be delivered through mouthpiece or mask.”

B. “Drops improve ventilation and oxygenation.”
D. “Fine mist is inhaled deep into the lower respiratory tract.”
E. “Medication can be delivered through mouthpiece or mask.”

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The nurse explains to a client with a history of asthma why the health care provider has prescribed an incentive spirometer to be used postoperatively. What is the therapeutic effect of using this device?

A. It allows the client to take shallow breaths after surgery.

B. It teaches the client to take deep breaths after surgery.

C. It helps the client to relax after surgery.

D. It helps the client to cough and remove mucous from the lungs.

B. It teaches the client to take deep breaths after surgery.

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The nurse is preparing to teach a client how to perform incentive spirometry. Which concepts should the nurse include?

A. The client should forcefully exhale into the incentive spirometer and continue to exhale until unable to continue.

B. Incentive spirometry provides visual reinforcement for deep breathing.

C. Proper, frequent use of incentive spirometry can improve pulmonary circulation.

D. Oxygen saturation is expected to decrease during the first few minutes of incentive spirometry.

B. Incentive spirometry provides visual reinforcement for deep breathing.

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The nurse is teaching a postoperative client how to use an incentive spirometer. What type of complication may be avoided with the proper use of this device?

A. Pneumonia.

B. Pulmonary embolism.

C. Pressure injuries.

D. Skin infection.

A. Pneumonia.

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The nurse observes the client’s correct use of the incentive spirometer when what occurs?

A. The client does not rest between inhalations into the incentive spirometry tube.

B. The client blows forcefully several times into the incentive spirometry tube.

C. The client takes slow, deep inhalations into the incentive spirometry tube 5 to 10 times per hour.

D. The client takes quick, short breaths in and out of the incentive spirometry tube.

C. The client takes slow, deep inhalations into the incentive spirometry tube 5 to 10 times per hour.

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The nurse is correct when placing the postoperative client in which position for the client to perform incentive spirometry exercises?

A. Fowler’s

B. prone

C. Trendelenburg

D. side-lying

A. Fowler’s

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A nurse is caring for a client who has spontaneous respirations and needs to have oxygen administered at a FiO2 of 100%. Which oxygen delivery system should the nurse use?

A. Nonrebreather mask

B. Simple mask

C. Venturi mask

D. Nasal cannula

A. Nonrebreather mask

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The nurse is inserting a nasal cannula into the client’s nostrils to improve oxygenation. To correctly insert the curved prongs of the cannula, what would the nurse do?

A. Insert only one prong and adjust airflow into one nostril at a time.

B. Follow the angle of the nose with the prongs pointed upward.

C. Follow the angle of the nose with the prongs outside the nostrils.

D. Follow the angle of the nose with the prongs pointed downward.

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The nurse is caring for a client who is receiving continuous oxygen at 3 L/minute via nasal cannula. The client’s oxygen saturation has consistently been 94% to 96%, but suddenly drops to 86% as the nurse palpates the client’s abdomen. The client denies respiratory difficulty or other distress. Which is a likely reason for the client’s decreasing oxygen saturation?

A. The nurse has inadvertently stepped on the client’s oxygen tubing, occluding the flow of oxygen.

B. The client’s appendix has ruptured.

C. The client has developed a pulmonary embolism and has a ventilation-perfusion mismatch.

D. The client is holding his or her breath.

A. The nurse has inadvertently stepped on the client’s oxygen tubing, occluding the flow of oxygen.

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A nurse is caring for a client receiving oxygen at 2 liters per minute via nasal cannula. During the morning assessment, the nurse notes reddened areas at the top of the ears and neck. What actions should the nurse take? Select all that apply.

A. Initiate a nonrebreather mask to prevent further skin breakdown.

B. Request a consult by a skin care team to determine further actions.

C. Apply padding to the tubing that goes over the ears and loosen neck tubing.

D. Cushion the entire length of the nasal cannula tubing to prevent skin breakdown.

E. Loosen the nasal cannula tubing to ensure the tubing is not too tight.

B. Request a consult by a skin care team to determine further actions.
C. Apply padding to the tubing that goes over the ears and loosen neck tubing
E. Loosen the nasal cannula tubing to ensure the tubing is not too tight.

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A health care provider prescribes oxygen for a client at 4 liters per minute via a nasal cannula after an initial pulse oximeter reading of 88% on room air. Which is the priority client assessment that the nurse should make prior to administering the oxygen? A. apical heart rate and rhythm B. blood pressure and pulse C. respiratory rate and effort D. skin alterations and edema

C. respiratory rate and effort

The nurse is setting up the equipment needed to deliver oxygen to a postsurgical client via a nasal cannula. After connecting the nasal cannula to the oxygen source and flow meter, what is the next action the nurse should perform? A. Assess the client's respiratory rate and effort. B. Insert the nasal cannula into the client's nostrils. C. Adjust the flow rate to the prescribed amount. D. Instruct client to breathe through the nose with the mouth closed.

C. Adjust the flow rate to the prescribed amount.

The nurse is caring for five clients on a busy medical floor. Which tasks can the nurse delegate to unlicensed assistive personnel (UAP)? Select all that apply. A. Administering initial oxygenation to a client with a pulse oximeter reading of 88%. B. Ambulating in the hall a client who always uses portable oxygen via nasal cannula. C. Applying a face mask to a client with a pulse oximeter reading of 90% on nasal cannula. D. Bathing and shaving of a client on continuous oxygen at 2 liters per minute via nasal cannula. E. Reapplying the nasal cannula after the client dislodges it during repositioning.

B. Ambulating in the hall a client who always uses portable oxygen via nasal cannula. D. Bathing and shaving of a client on continuous oxygen at 2 liters per minute via nasal cannula. E. Reapplying the nasal cannula after the client dislodges it during repositioning.

The health care provider prescribes oxygen to be administered to a client via a mask with an oxygen flow rate of 10 liters per minute. To accommodate meals, what would the nurse do? A. Loosen the face mask so that the client can bring food to the mouth under the mask. B. Deliver oxygen via nasal cannula during meals, replacing the mask after the client eats. C. Remove the mask during meals and then replace as soon as client is finished eating. D. Change the client to a liquid diet through a straw while receiving oxygen via a mask.

B. Deliver oxygen via nasal cannula during meals, replacing the mask after the client eats.

As prescribed by the health care provider, the nurse has set up an oxygen mask with a reservoir to deliver oxygen to a client with pneumonia. What would the nurse do, prior to putting the mask on the client? A. Roll up the oxygen bag to remove air trapped inside. B. Place powder around the edges of the mask. C. Allow the reservoir bag to fill up with oxygen. D. Adjust the elastic straps on the mask.

C. Allow the reservoir bag to fill up with oxygen.

A nurse is educating a client on the use of continuous oxygen. The nurse asks the client, "What is the advantage of using an oxygen mask versus a nasal cannula?" The nurse confirms that the education has been effective if the client states: A. "There is less damage done to my nasal passages." B. "The air is humidified with a mask prior to being delivered." C. "There is less chance of my skin breaking down with the mask." D. "I will have a greater concentration of oxygen delivered."

D. "I will have a greater concentration of oxygen delivered."

The nurse is applying an oxygen mask prescribed for a client with bronchial pneumonia. What would the nurse do to prevent skin breakdown in the area where the mask is placed? A. Sprinkle powder around the edges of the mask prior to placing it. B. Place cotton balls under the edges of the entire face mask. C. Adjust all the elastic straps to fit the mask loosely on the face. D. Place gauze pads under the elastic strap at pressure points.

D. Place gauze pads under the elastic strap at pressure points.

The nurse is caring for a client receiving oxygen at a rate of 8 liters per minute via face mask. While monitoring the client for skin irritation, what is the best action by the nurse? A. Remove the mask and dry the skin every 2 to 3 hours. B. Lift up the mask and dry the skin every 4 to 5 hours. C. Change the mask oxygen delivery system to a nasal cannula. D. Continue to monitor for skin irritation as there is no breakdown.

A. Remove the mask and dry the skin every 2 to 3 hours.

A nurse must deliver oxygen at a concentration of 85% to an infant. Which delivery device would be most appropriate for an infant? A. Nasal cannula B. Venturi mask C. Oxygen hood D. Simple mask

C. Oxygen hood

A nurse is caring for multiple clients on a busy medical unit. Which client would require the nurse to use surgical asepsis and don personal protective equipment (PPE) during care? A. a client with pneumonia who is receiving oxygen via a face mask B. a client with bronchitis who needs nasopharyngeal suctioning C. a client with chronic obstructive pulmonary disease who is receiving oxygen via a nasal cannula D. a client with lung cancer who needs a continuous pulse oximeter

B. a client with bronchitis who needs nasopharyngeal suctioning

A nurse is caring for a client with chronic obstructive pulmonary disease that requires frequent nasopharyngeal suctioning. After putting on the face shield and sterile gloves, but before picking up the catheter, the nurse's dominant hand touches the bedside table. What should the nurse do? A. Restart the procedure from the first step to prevent contamination. B. Ask a different nurse to bring a new pair of sterile gloves and catheter to the bedside. C. Stop and change into a new pair of sterile gloves before picking up the catheter. D. Continue the nasopharyngeal suctioning procedure, because the catheter is still sterile.

C. Stop and change into a new pair of sterile gloves before picking up the catheter.

A nurse is suctioning a client's airway with a nasopharyngeal catheter. During the suctioning, the client is gagging and seems likely to vomit. What should the nurse do? Select all that apply. A. Move finger from suction and wait until emesis has passed, then continue. B. Continue suctioning to prevent the emesis from entering the airway. C. Push the catheter forward about 5 cm and continue to suction the client. D. Remove the catheter to avoid entering the esophagus inadvertently. E. Turn the client to the side and elevate the head of bed to prevent aspiration

A. Move finger from suction and wait until emesis has passed, then continue. B. Continue suctioning to prevent the emesis from entering the airway. D. Remove the catheter to avoid entering the esophagus inadvertently. E. Turn the client to the side and elevate the head of bed to prevent aspiration

The nurse is suctioning the nasopharyngeal airway of a client and notices that the secretions coming out are tinged with blood. What would the nurse do? A. Remove suction, check placement of catheter, and resume suctioning after 30 seconds. B. No interventions are necessary as this is a normal finding upon suctioning. C. Stop suctioning, replace oxygen, check vital signs, and notify health care provider. D. Notify the health care provider immediately because this is a life-threatening situation.

C. Stop suctioning, replace oxygen, check vital signs, and notify health care provider.

The nurse has finished suctioning the airways of a client with cystic fibrosis. What personal protective equipment (PPE) would the nurse remove first? A. gown B. mask C. gloves D. face shield

C. gloves

The nurse has finished suctioning the airways of a client with bronchial pneumonia. What would the nurse do first when disposing of the catheter and supplies? A. Place supplies in the appropriate trash receptacle. B. Place the catheter in a small, red biohazard bag. C. Wrap the catheter around a gloved hand and remove gloves. D. Remove all personal protective equipment (PPE).

C. Wrap the catheter around a gloved hand and remove gloves.

The nurse is preparing to suction the nasopharyngeal airway of a client admitted with chronic obstructive pulmonary disease. What would the nurse do? A. Cover suction opening while inserting the catheter. B. Cover the suction opening prior to inserting the catheter. C. Suction intermittently only while in the pharyngeal area. D. Apply suction when withdrawing the catheter.

D. Apply suction when withdrawing the catheter.

A nurse is suctioning a client with a congested airway. The nurse has just removed the catheter from the client's naris and knows that the client will need additional suctioning. What would the nurse do next? A. Insert the catheter into the sterile saline solution to flush it. B. Flush the entire catheter with water from a sterile bottle. C. Place the catheter in a biohazard bag and open another catheter kit. D. Lubricate the catheter 2 to 3 inches (5 to 7.5 cm) before reinserting it.

A. Insert the catheter into the sterile saline solution to flush it.

A nurse is caring for a client with end-stage lung cancer and who requires nasopharyngeal suctioning. As the nurse is preparing to insert the catheter into the naris, the tip touches the client's cheek. What should the nurse do? A. Adjust the catheter and use the other naris to suction. B. Stop the suctioning procedure and get a new catheter. C. Ask a different nurse to come in and suction the client. D. Continue the current nasopharyngeal suctioning procedure.

B. Stop the suctioning procedure and get a new catheter.

A nurse is caring for five clients on a busy surgical unit. Which tasks can the nurse delegate to the unlicensed assistive personnel (UAP)? Select all that apply. A. Provide nasopharyngeal suctioning for a client who was admitted with lung cancer. B. Perform oropharyngeal suctioning for a client who was admitted with a stroke. C. Complete oral hygiene for a client admitted with recurrent falls and dementia. D. Feeding lunch to a client admitted with new bilateral upper extremity fractures. E. Obtain the initial vital signs for a client who is being admitted with acute appendicitis.

B. Perform oropharyngeal suctioning for a client who was admitted with a stroke. C. Complete oral hygiene for a client admitted with recurrent falls and dementia. D. Feeding lunch to a client admitted with new bilateral upper extremity fractures.

A nurse is preparing to insert an oropharyngeal airway into a client with a decreased level of consciousness and increased oral secretions. What equipment will the nurse need to bring to the bedside? Select all that apply. A. sterile water B. oropharyngeal airway C. suction equipment D. face shield E. sterile gloves

B. oropharyngeal airway C. suction equipment D. face shield

The health care provider has prescribed an oropharyngeal airway for a client with a decreased level of consciousness. The health care provider has noted gurgling respirations and the client's tongue is in the posterior pharynx. The client vomits as the airway is inserted. Which actions should the nurse take? Select all that apply. A. Provide oral suctioning and mouth care. B. Raise the head of the bed to 90 degrees. C. Remove oropharyngeal airway. D. Position client onto the side immediately. E. Assess for bleeding in the mouth.

A. Provide oral suctioning and mouth care. C. Remove oropharyngeal airway. D. Position client onto the side immediately.

The nurse is preparing to insert an oropharyngeal airway into an unconscious client. What would the nurse do first? A. Assess the client's ability to protect the airway. B. Auscultate the client's bilateral lung sounds. C. Monitor the amount and consistency of oral secretions. D. Check for any loose teeth or recent oral surgery.

A. Assess the client's ability to protect the airway.

A nurse is preparing to insert a nasopharyngeal airway in a client. Before doing so, however, the nurse assesses the client and reviews the client's health record. Which findings would contraindicate insertion of the airway? Select all that apply. A. Clenched teeth B. Enlarged tongue C. Frequent nasopharyngeal suctioning required D. Traumatic brain injury E. Deviated septum F. Recent nasal surgery

D. Traumatic brain injury E. Deviated septum F. Recent nasal surgery

When giving your patient supplemental oxygen what is the target range for saturation levels?

94% to 98%

When giving supplemental oxygen to a patient who has COPD what do you want their oxygen saturations at?

88% to 92%

You always use humidification when patients have a ______ or ______ ______.

Tracheostomy or artificial airway.

NEVER use a simple face mask with less than 5 L/min due to

Carbon dioxide retention

Purpose of Bronchodilators

To open narrowed airways

Purpose of corticosteroids

To reduce inflammation in the airways

Purpose of mucolytic agents

To liquefy or loosen secretions

Which of the following complications is indicated by a third heart sound? A. Ventricular dilation B. Systemic hypertension C. Aortic valve malfunction D. Increased atrial contraction

A. Ventricular dilation

Which of the following actions is the first priority of care for a patient exhibiting signs and symptoms of CAD? A. Decrease anxiety B. Enhance myocardial oxygenation C. Administer sublingual nitroglycerin D. Educate the patient about his symptoms

B. Enhance myocardial oxygenation

Where does gas exchange happen?

The alveoli

When _______ production is reduced, the lungs become stiff, and the alveoli ______.

Surfactant; collapse

______ is the amount of gas going into the alveoli ready for gas exchange.

Ventilation

______ is the amount of blood flow to the alveoli prepared for gas exchange.

Perfusion

Inspiration is the _____ phase and expiration is the _____ phase.

Active; passive

_____ is the movement of gas or particles from areas of higher pressure or concentration to areas of lower pressure or concentration.

Diffusion

What is atelectasis?

It's the incomplete lung expansion or the collapse of alveoli.

_______ _______ (breathing) refers to the movement of air into and out of the lungs.

Pulmonary ventilation

Respiration involves gas exchange between the atmospheric air in the _____ and _____ in the capillaries.

Alveoli; blood

______ is the process by which oxygenated capillary blood passes through body tissue.

Perfusion

Oxygen and carbon dioxide must move through the ______ as part of the ______ process.

Alveoli; oxygenation

What is the lower airway also known as?

Tracheobronchial tree

What is the lower airways main function?

Condition of air, mucociliary clearance, and production of pulmonary surfactant.

The right lung has ___ lobes and the left has ____ lobes.

3 lobes; 2 lobes

_____ reduces the surface tension between the moist membranes of the alveoli, preventing their collapse.

Surfactant

The _____ pleura covers the lungs, and the _____ pleura lines the thoracic cavity.

Visceral; parietal

What is cilia?

Microscopic hair-like projections.

_____ propels trapped materials and accompanying mucus toward the upper airway so they can be removed by coughing.

Cilia

Pressure within the pleural space (intrapleural pressure) is always ____.

Subatmospheric (a negative pressure)

______ is about getting fresh air into your lungs, and _____ is about making sure that the oxygen from your blood gets to all the parts of your body.

Ventilation; perfusion

Cardiac biomarkers will let us know about _____ damage within the heart muscles.

Tissue

______ measures the volume of air in liters, exhaled or inhaled by a patient over time. It evaluates the lung function in airway obstruction through respiratory mechanics.

Spirometry

_____ _____ flow rate refers to the point of the highest flow during forced expiration.

Peak expiratory

How could you promote comfort for a patient in respiratory distress?

- Make sure the patient is in a proper position such as high fowlers. - Maintain adequate fluid intake (1.5-2 L daily). - Provide humidified air.

The nurse is preparing to provide hygiene care to a client with hypoxia. Into what position will the nurse place the client? A. Supine B. Prone C. High Fowler's D. Trendelenburg

C. High fowler's

The nurse is caring for a client with emphysema. When teaching the client pursed-lip breathing, the nurse will include which instructions? Select all that apply. A. Inhale slowly through the nose for a count of three. B. Keep abdominal muscles in a relaxed state. C. Shape the lips as if you were about to blow a whistle. D. Over time, begin to increase the length of the exhale. E. Exhale slowly through pursed lips. F. Ensure that the exhale lasts twice as long as the inhale.

A. Inhale slowly through the nose for a count of three. C. Shape the lips as if you were about to blow a whistle. D. Over time, begin to increase the length of the exhale. E. Exhale slowly through pursed lips. F. Ensure that the exhale lasts twice as long as the inhale.

Incentive spirometers are used to teach the patient.....

how to take in a slow, deep inspiration.

A normal CO2 during an asthma attack may be a signal for....

Impending respiratory failure.

What is a peak flow meter?

This measures the highest airflow during a forced expiration.

The atriums of the heart create ____ pressure and the ventricles produce the ___ pressure.

Low; high

Arteries carry blood ____ from the heart and veins carry the blood ____ the heart.

Away; toward

_____ _____ is the amount of blood pumped by each ventricle in liters per minute.

Cardiac output

How do you calculate cardiac output?

HR x Stroke volume

What is stroke volume?

The amount of blood ejected in one contraction.

____ is the amount the ventricles stretch at the end of diastole. (End diastolic volume)

Preload

Explain contractility.

It's the ability of the cardiac muscle to shorten in response to an electrical impulse.

What heavily effects contraction?

Calcium.

____ is the pressure the ventricles must work against to open the semilunar valves to pump blood out of the heart.

Afterload

Mr. Jones is a 78 year old male who was admitted with severe dehydration. The doctor orders a 1L bolus stat. The nurse knows that the fluid will help [1] cardiac output by [2]. A. Increase ; decreasing afterload B. Increase; increasing preload C. Decrease; increasing contractility D. Decrease; decreasing preload

B. Increase; increasing preload

Ms. Smith's primary care physician is concerned that she may be experiencing decreased cardiac output. The nurse knows that stroke volume plays an important part in cardiac output. What factors influence stroke volume? (select all that apply) A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure

B. Preload C. Contractility D. Afterload

The sympathetic nervous system (fight or flight) will _____ BP and HR.

Increase

Parasympathetic nervous system will make your HR ______.

Decrease

Cardiac output = ?

Blood pressure

MAP needs to be ____ than ____ to perfuse kidneys and other organs.

Greater than 60.

Factors that affect blood pressure include.....

- Circulating volume - Diameter of arterioles - Strength of contraction - Heart rate

Preload can increase when you have _____ valves and ____.

Regurgitative; hypervolemia

Afterload increases when you have ____ and ____.

HTN; vasoconstriction

Afterload = ?

Pressure

A low calcium can cause ____ and high calcium can cause _____.

Bradycardia; tachycardia

What type of diet should a patient with hypertension follow?

Dash diet (low sodium low fat).

What is primary (essential) hypertension?

High BP without a cause. (More common)

What is secondary hypertension?

High BP with a cause. Example: Chronic kidney disease).

Decrease in elasticity can cause ____.

Hypertension

Albuterol is a ________.

Bronchodilator

How does albuterol affect the sympathetic nervous system (fight or flight)?

Increase in HR and depth of RR.

What are the side effects of albuterol?

Tachycardia, shakiness, nausea, headache.

Theophylline is a ______.

Bronchodilator

What is the onset of theophylline?

1 to 6 hours.

What are the side effects of theophylline?

Respiratory arrest, nausea, headache, tachycardia.

Theophylline is not for _______.

Emergencies.

What is the onset of zafirlukast?

Rapid

Zafirlukast is a ____ - ____ medication used for ____ ____.

Long-term; chronic asthma.

Budesonide is an inhaled ____.

Steriod

What does budesonide affect?

Mast cell stabilizers and leukotriene.

What should you instruct the patient to do after taking budesonide?

Rinse mouth with water to prevent thrush.

Which medications do you give 15 to 30 minutes before exercise?

Bronchodilators

Mast cell stabilizers are ____.

Steroids.

Loop diuretics are the number one treatment for ____.

CHF

What do loop diuretics do?

Blocks reabsorption of potassium.

When should you not give loop diuretics?

If potassium is outside of normal limits.

What do dilators do?

Open blood vessels.

When giving a dilator what should you teach your patient?

To change positions slowly.

What do calcium channel blockers do?

Calms the heart and lowers HR and BP.

Contractility increases....

Dilators decrease....

Which of the following classes of meds maximizes cardiac performance in patients with heart failure by increasing ventricular contractility? A. Beta-adrenergic blockers B. Calcium channel blockers C. Diuretics D. Inotropic agents

D. Inotropic agents

Stimulation of the sympathetic nervous system produces which of the following responses? A. Bradycardia B. Tachycardia C. Hypotension D. Decreased myocardial contractility

B. Tachycardia

In which of the following types of cardiomyopathy does cardiac output remain normal? A. Dilated B. Hypertrophic C. Obliterative D. Restrictive

B. Hypertrophic

Which of the following conditions is the predominant cause of angina? A. Increased preload B. Decreased preload C. Coronary artery spasm D. Inadequate oxygen supply to the myocardium

D. Inadequate oxygen supply to the myocardium

Myocardial oxygen consumption increases as which of the following parameters increases? A. Preload, afterload, and cerebral blood flow. B. Preload, afterload, and renal blood flow. C. Preload, afterload, contractility, and HR. D. Preload afterload, cerebral blood flow, and HR.

C. Preload, afterload, contractility, and HR.

Which of the following is a compensatory response to decreased cardiac output? A. Decreased BP B. Alteration in LOC C. Decreased BP and diuresis D. Increased BP and fluid retention

D. Increased BP and fluid retention

Which of the following terms describes the force against which the ventricle must expel blood? A. Afterload B. Cardiac output C. Overload D. Preload

A. Afterload

The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects: A. Left atrial enlargement. B. Left ventricular enlargement. C. Right atrial enlargement. D. Right ventricular enlargement.

B. Left ventricular enlargement.

The nurse is providing continuous tube feeding for a client. At what angle should the head of the bed be set during the feeding?

30 to 45 degrees Rationale: The head of the bed should be elevated at 30 to 45 degrees to minimize the possibility of aspiration into the trachea. Clients considered high risk of aspiration should be assisted to at least a 45-degree position.

What should the nurse advise the client to do following tube feeding?

Sit up for 1 hour. Rationale: the nurse should have the client sit up for at least 30 minutes to 1 hour to decrease the risk of backflow or aspiration if any reflux or vomiting should occur.

The charge nurse is observing a new nurse care for a client who is receiving continuous feeding through a nasogastric feeding tube. Which action by the new nurse requires the charge nurse to intervene?

The new nurse places the client in the left lateral recumbent position. Rationale: the clients head should be elevated 30 to 45 degrees.

The nurse is using a large syringe to administer an intermittent feeding to a client who has a nasogastric feeding tube. Which method should the nurse use to increase the flow rate of the formula?

Raise the height of the syringe. Rationale: syringe feeding are infused via gravity. Raising the syringe will increase the rate of infusion

When monitoring a client with a continuous tube feeding, how often should the nurse confirm placement of the tube?

Every 4 to 6 hours

The nurse is administering an intermittent tube feeling using a gravity set-up and open bag feeding system. After checking the tube placement, which action would the nurse take next?

Check the residual (the amount of feeding left in the stomach from the last feeding)

A nurse enters a client’s room to perform tube feeding. Which nursing action should be performed first?

Aspirate stomach contents and check pH

The nurse has finished aspirating the gastric contents before administering a prefilled, continuous feeding. At this point in the procedure, how much sterile water would the nurse use to flush the tube?

30 mL

The nurse is preparing to administer an intermittent feeding to a client who has a nasogastric feeding tube. Place the following steps in the correct order. A. Aspirate all gastric contents B. Flush the tube with 30 mL of water C. Position the client with the head of the bed elevated to 30 to 45 degrees D. Administer the feeding E. Verify correct tube placement F. Verify that residual volume is less than 200 mL

C, E, A, F, B, D

The nurse is administering an intermittent tube feeding using a gravity set-up and open feeding bag system. At what level should the nurse place the feeding bag on the pole?

12 in (30cm) above the stomach

The nurse provides the client with a gravity feeding via a gastronomy tube. Which action is correct?

Allow the feeding to infuse slowly from the feeding bag

The nurse is unable to aspirate the gastric contents and realizes the tube is clogged. Which action is correct?

Connect a syringe filled with warm water to the feeding tube and flush it out using gentle pressure

The nurse is educating a postoperative client about gastric tubes. The client asks, “Why do I need to have a gastric tube?” How should the nurse respond?

“To help consume sufficient nutrition”

The client with a gastric tube is prescribed a delayed-release tablet. Which are appropriate actions for the nurse? Select all that apply. A. Split the medication before administering B. Crush the medication before administering. C. Check the drug guide D. Hold the medication E. Call the health care provider for prescription

C, D, E *delayed-response medications can not be split or crushed

The nurse cares for a client with a gastric tube in place. Which actions does the nurse perform? Select all that apply. A. Insert a large syringe to decompress the stomach when the client reports nausea B. Supply the client with parenteral nutrition C. Give liquid stool softener and crushed pain medication through the tube as needed D. Administer one can of nutritional formula every 4 hours as prescribed

A, C, D

The nurse is required to give a prescribed medication via a gastric tube. The medication is in tablet form. What should the nurse do fist?

Check the drug administration guide to see if the medication can be crushed

The nurse is administering medications to a client via a gastric tube. After administering the last dose of medication, how much water should the nurse flush through the gastric tube?

30 to 60 mL

The client is receiving several medications via a gastric tube. How much water should the nurse flush between the medications? A. 30 to 60 mL B. 5-10 mL C. 15-25 mL D. 65-75 mL

B. 5-10 mL

A client with COPD has been prescribed an inhaled bronchodilator. Which technique should the nurse implement in ensuring safe and competent delivery of the medication?

Use a spacer or extender with the metered dose inhaler

A client is prescribed a corticosteroid after having an acute asthma attack. What education should the nurse provide to the client regarding this medication? A. Weigh yourself each night prior to going to bed B. Increase sodium intake C. The medication will cause drowsiness D. Monitor blood pressure and blood glucose levels

D. Monitor blood pressure and blood glucose levels Rationale: blood sugar and blood pressure may rise when taking corticosteroids

A health care provider has prescribed oxygen to be delivered at 10 L/min for a client who does not have a tracheostomy. Which oxygen delivery devices would the nurse consider using? Select all that apply. A. Simple mask B. Venturi mask C. Nonrebreather mask D. T-piece E. High flow nasal cannula

A, C Rationale: a Venturi mask accommodates 4-6 L/min and a high flow nasal cannula accommodates 30-60 L/min. T-piece is irrelevant since the client does not have a tracheotomy

The nurse provides care to a client which COPD experiencing hypoxia. Which assessment requires the nurse to immediately report the findings to the health care provider? A. Wheezing B. Decreased level of consciousness C. Frequent coughing D. Cyanosis

B. Decreased level of consciousness

Place the steps of using an incentive spirometer in order. A. Hold breathe for 4 seconds B. Exhale normally C. Seal the lips around the mouthpiece D. Note the goal for inspiration E. Inhale slowly until desired volume reached F. Remove mouthpiece and breathe normally

D, B, C, E, A, F

A nurse is caring for a client who breathes very shallowly and has been reporting severe back pain. What suggestion could the nurse make to help the client breathe efficiently? A. Encourage the client to take deep breaths B. Instruct the client in pursed lip breathing technique C. Inform the client about nasal strips D. Teach the client diaphragmatic breathing

A. Encourage the client to take deep breaths

The nurse is monitoring a client who is receiving oxygen via a nonrebreather mask at 12 L/min. What actions by the nurse will promote the best outcomes for the client? Select all that apply. A. Maintain flow rate so that the reservoir bag collapses only slightly during inspiration B. Use petroleum jelly around the nose and mouth to prevent drying effects C. Take the mask of frequently to allow the client breaks D. Check that the valves and rubber flaps are functioning properly E. Monitor SpO2 with pulse oximeter

A, D, E

The nurse is monitoring a client with continuous pulse oximetry. Which actions by the nurse are important to obtain accurate results? Select all that apply. A. Correlate the pulse oximeter readings with heart rate B. Use the forehead sensor if cardiac output is low C. Assess client for factors affecting circulation. D. Prepare the client to have an arterial line inserted E. Determine if client has any pre-existing conditions that effect oxygen saturation F. Observe the monitor for the respiratory rate

A, B, E

The nurse is caring for a client receiving oxygen via nasal cannula. The client becomes cyanotic with a pulse ox. reading of 91%. What is the most appropriate step the nurse should take? A. Increase oxygen flow rate B. Elevate the head of the bed C. Assess lung sounds D. Assess oxygen tubing connection

D. Assess oxygen tubing connection

The nurse is observing the UAP perform oropharyngeal suctioning on a client. Which action requires the nurse to intervene? A. The UAP suctions for 10 seconds B. The UAP advances the catheter approximately 5 to 6 inches to reach the pharynx C. The UAP applies lubricant to the first 2 to 3 inches of the catheter D. The UAP allows 30 seconds to 1 minute intervals between suctioning

B. The UAP advances the catheter 5 to 6 inches to reach the pharynx Rationale: when performing oropharyngeal suctioning the catheter should be inserted 3 to 4 inches to reach the pharynx. During nasopharyngeal suctioning the catheter is inserted 5 to 6 inches to reach the pharynx

Which actions should the nurse perform when inserting an oropharyngeal airway? Select all that apply. A. Use an airway that reaches from the nose to the back angle of the jaw B. Wash hands and put on PPE as indicated C. Position client flat on their back laying to the side D. Insert the airway with the curved tip pointing down the base of the mouth E. Rotate the airway 180 degrees as it passes the uvula F. Remove airway for a brief period every 4 hours or according to facility policy

B, E, F

A nurse assessing a client’s respiratory effect notes that the client is breathing 8 shallow breaths/min. Which action best meets the patients immediate oxygen needs? A. Suction the clients upper airway B. Administer prescribed bronchodilator C. Use a bag and mask D. Administer oxygen via nonrebreather

C. Use a bag and mask

Which factors indicate a nurse should stop delivery of breaths via a manual resuscitation bag and mask device? Select all that apply. A. The client returns to spontaneous breathing at 15 breaths/min B. The client has been intubated and is connected to a mechanical ventilator C. The health care provider has ended the cardiopulmonary resuscitation effort D. The clients oxygen saturation has improved to 95% during use of the device E. Another nurse has begun compressions at 100 per minute

A, B, C

______ prevents pressure changes and the exchange of gas by diffusion in the lungs.

Atelectasis

What are the common symptoms for hypoxia?

Dyspnea, elevated BP with a small pulse pressure, increased RR and HR, pallor, and cyanosis.

Hypoxia is often caused by _____.

Hypoventilation

The atria _____ blood from ____.

Receive; veins

The ventricles force blood ____ the heart through _____.

out of; arteries

Parasympathetic stimulation of the SA and AV nodes by the vagus nerve _______ HR.

Decreases

______ can lead to a lowered level of arterial carbon dioxide.

Hyperventilation

_____ _____ ____ are the most accurate way to diagnose respiratory disorders.

Pulmonary function tests

Low flow nasal cannula can go from ___ to ____ L/min.

1-6

What is the max L/min on high flow nasal cannula?

Low flow simple mask can go from ___ to ___ L/min

5-8

Low flow nonrebreather mask can go from _____ to ___ L/min

10-15

High-flow venturi mask can go from ___ to ___ L/min

4-6

____ _____ _____ is a drug that prevents the release of inflammatory and bronchoconstricting substances from mast cells.

Mast cell stabilizer

Afterload is increased by arterial vasoconstriction, which leads to decreased ____ ____.

Stroke volume

Afterload is reduced leads to increased ___ ___.

Stroke volume

Increased contractility results in increased ____ ___.

Stroke volume

The heart can achieve an increase in stroke volume if ____ is increased, if ____ is increased, and if ____ is decreased.

Preload, contractility, and afterload.

The percentage of the end-diastolic blood volume that is ejected with each heartbeat is called _____ ____.

Ejection fraction

Contractility is enhanced by......

Circulating catecholamine, sympathetic neuronal activity, and certain medications such as digoxin and dopamine.

What is systemic vascular resistance?

The resistance of the systemic BP to left ventricular ejection.

The resistance of the pulmonary BP to right ventricular ejection is called

Pulmonary vascular resistance.

In geriatric patients, the size of the heart increases due to ____, which reduces the ____ of blood that the chambers can hold.

Hypertrophy; volume

is high blood pressure with no identifiable cause.

Primary or essential hypertension.

high blood pressure from an identified cause such as kidney disease.

Secondary hypertension.

What is a hypertensive emergency?

When the blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

What is hypertensive urgency?

When the BP is severely elevated but there is no evidence of organ damage.

What is the first BP medication you give to African Americans?

Calcium-channel blockers

130-139/80-89 is _____

Prehypertension

What is stage 1 hypertension?

140-159/90-99

What is stage 2 hypertension?

>160/>100

The DASH diet can lower the ____ BP by 11-16 mm Hg

Systolic

How can you increase preload?

Fluids or stimulating the sympathetic nervous system

How can you decrease preload?

Diuretics or vasodilation medications

Afterload is affected by vascular ____.

resistance

If there is increased vascular resistance it will ____ afterload.

Increase

Pulmonary HTN and aortic stenosis can increase ____.

Afterload

Blood going into the right side of the heart is from the ______.

Body.

What does ABCDDD stand for?

- Ace & Arbs - Beta-blockers - Calcium channel blockers - Digoxin - Dilators - Diuretics

Ace & Arbs affect.....

Beta-blockers affect....

BP and HR

Calcium channel blockers affect.....

BP and HR

Digoxin affect...

Dilators and diuretics affect your.....

Aces and Arbs block the _____ hormone.

aldosterone

Ace is the ____ choice.

first

Arbs are the ____ choice.

Second

Ace =

-pril (dry cough)

-sartans =

Arbs

-lol =

Beta blockers

-dipine =

Calcium channel blockers

-Nitro =

Dilators

-ide =

Diuretics

What do beta blockers inhibit in the RAAS system?

Renin

What do Arbs inhibit in the RAAS system?

Angiotensin 2

What do Aces inhibit in the RAAS system?

Ace enzyme

What does angiotensin 2 do?

Raise BP

Aces and Arbs ____ BP.

Lower

Aces and Arbs are _____ sparing.

Potassium

What does "triple A" mean with Aces and Arbs?

- Antihypertensive - Avoid babies - Abundant potassium

Beta blockers are ____ sparing.

Potassium

What does the "think the 4 b's" mean for beta blockers?

- Bradycardia - Breathing / bronchospasm - Bad HF - Blood sugar

What does "think CCB" me for Calcium channel blockers?

- Count HR and BP - Change positions slowly - Bad HF

Calcium channel blockers _____ the heart and ____ HR and BP.

Calms; lowers

Which medication makes you have deep, strong contractions in the heart?

Digoxin

What does "think ATP" mean for digoxin?

- Apical pulse - Toxic - Potassium levels (high K+ will increase risk for toxicity.

What do dilators treat?

HF, stroke, HTN, MI

Diuretics are the #1 treatment for.......

What does "think 3 d's" mean for diuretics?

- Decreases BP - Drains the fluid (urination) - Dehydrates (dries body)

High potassium will cause peaked ____ wave and an ____ elevation.

T; ST

Low potassium means ___ depression

The nurse is caring for a client with Impaired Gas Exchange. While performing a physical assessment, the nurse is likely to find which data? A. Low blood pressure B. High temperature C. High respiratory rate D. Decreased pulse rate

C. High respiratory rate

A client has edema of the feet and ankles along with crackles in the lower lobes and a frothy, productive cough. The nursing care plan will address implications of what medical diagnosis? A. Congestive heart failure B. Myocardial infarction C. Pulmonary embolism D. Lung cancer

A. Congestive heart failure

At what age is the sensorimotor stage?

0-2 years old

The preoperational stage is from what ages?

2-7 years old.

At what age is the concrete operational stage?

7-11 years old

At what age is the formal operational stage?

11-15 years

What is stage 1 of Erikson's developmental stages?

Basic trust vs mistrust 1-2 years.

What is stage 2 of Erikson's developmental stages?

Autonomy vs Shame and Doubt 2-3 years old.

What is stage 3 of Erikson's developmental stages?

Initiative vs guilt 3 - 5 years old.

What is stage 4 of Erikson's developmental stages?

Industry vs inferiority 6 - 12 years old.

What is stage 5 of Erikson's developmental stages?

Identity vs role confusion 13 - 20 years old.

What is stage 6 of Erikson's developmental stages?

Intimacy vs isolation 18 - 25 years old.

What is stage 7 of Erikson's developmental stages?

Generativity vs Stagnation 25 - 65 years old.

What is stage 8 of Erikson's developmental stages?

Ego integrity vs Despair 65 - death.

Doxazosin is a _____ blocker.

Alpha

Diltiazem is a ____ ____ blocker.

Calcium channel blocker

Omeprazole is a _____ - _______ inhibitors.

Proton-pump

What are the side effects of omeprazole?

Dizziness, drowsiness, headache, chest pain, itching, rash, constipation, diarrhea.

Exam 4 Flashcards

(260 cards)