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BUNDLE OF PATHOPHYSIOLOGY TEST BANK QUESTION AND ANSWER 2023
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Egan's Chapter 14 Test Bank Question with answers rated A+
ANS: C The primary goal of acid-base homeostasis is to maintain which of the following? a. Normal HCO3- b. Normal PCO2 c. Normal pH d. Normal PO2 ... [Show More] ANS: B What is the normal arterial blood pH range? a. 7.25 to 7.35 b. 7.35 to 7.45 c. 7.45 to 7.55 d. 7.55 to 7.65 ANS: B Which of the following is a volatile acid of physiologic significance? a. Hydrochloric b. Carbonic c. Phosphoric d. Lactic ANS: D What are the major mechanisms responsible for maintaining a stable pH despite massive CO2 production? 1. Isohydric buffering 2. Gastrointestinal secretion 3. Pulmonary ventilation a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C Fixed acids are produced primarily from the catabolism of which of the following? a. Carbohydrates b. Fats c. Proteins d. Simple sugars ANS: B What is the primary buffer system for fixed acids? a. Cl- b. HCO3- c. Phosphate d. Plasma proteins ANS: B By comparison, how much fixed acid is produced in any given period compared to the volatile acid CO2? a. Approximately the same amount b. Less fixed than volatile c. More fixed than volatile d. CO2 is not a volatile acid ANS: C Which of the following statements about the equilibrium constant of an acid is true? a. The equilibrium constant of a weak acid is large. b. The equilibrium constant of a strong acid is small. c. The equilibrium constant of a weak acid is small. d. The more an acid ionizes, the smaller is the equilibrium constant. ANS: B A solution that resists large changes in pH upon addition of an acid or a base best describes which of the following? a. Acid-base excretor b. Buffer solution c. Catabolic regulator d. Homeostatic control ANS: C When a strong acid is added to the bicarbonate buffer system, what is the result? a. Strong base and neutral salt b. Strong acid and neutral salt c. Weak acid and neutral salt d. Weak acid and basic salt ANS: D Which of the following are components of the body's nonbicarbonate buffer system? 1. Hemoglobin 2. Plasma proteins 3. Organic phosphates 4. Inorganic phosphates a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 1, 2, 3, and 4 ANS: A What is the sum of all blood buffers in 1 L of blood? a. Buffer base b. Base excess c. Standard bicarbonate d. Base deficit ANS: C Why is the bicarbonate buffer system considered an open buffer system? a. As the major blood and body buffer system, it is open by definition. b. It operates only in the extracellular fluid, avoiding cell closure. c. Its acid (carbonic acid) is converted to CO2 and removed. d. Its chemical reactions occur very quickly. ANS: A Why is a buffer system such as phosphate considered a closed system? a. All the components remain in the system. b. It has limited utility in buffering acids. c. Its ability to buffer volatile acids is incomplete. d. Once its buffer level is established, it will never change. ANS: D What factor would limit the ability of the H2CO3/HCO3- buffer system to perform efficiently? a. Temperature rise of more than 3° C b. Inadequate amount of 2,3-DPG in the blood c. Increased production of nonvolatile acids d. Lungs failing to excrete adequate levels of CO2 ANS: A Which buffer system has the greatest capacity? a. Bicarbonate b. Hemoglobin c. Phosphates d. Plasma proteins ANS: B What effect does hyperventilation have on the closed buffer systems? a. It causes them to bind with more H+. b. It causes them to release more H+. c. It has no effect on them at all. d. It increases the affinity of the closed buffer system. ANS: D [H+] can be determined by the use of which factors? 1. HCO3- 2. H2CO3 3. Inorganic phosphorus 4. PaO2 a. 1, 2, and 3 only b. 2 and 3 only c. 4 only d. 1 and 2 only ANS: B A patient has a PCO2 of 80 mm Hg. What is the concentration of dissolved CO2 (in mmol/L) in the blood? a. 1.2 mmol/L b. 2.4 mmol/L c. 24 mmol/L d. 40 mmol/L ANS: D Of what use is the Henderson-Hasselbalch equation for a clinician? a. It can guide therapeutic decision for critically ill patients. b. It establishes the baseline values for buffer enhancement treatments. c. Given H2CO3 and CO2 values, the pH can be computed. d. It allows validation of the reported values on a blood gas report. ANS: D What drives the bicarbonate buffer systems enormous ability to buffer acids? a. The fact that H2CO3 is a strong buffer b. The Henderson-Hasselbalch equation c. The large amounts of 2,3-DPG in red blood cells d. Ventilation continually removing CO2 from system ANS: A Of the nonbicarbonate buffer systems, which one is the most important? a. Hemoglobin b. Inorganic phosphates c. Organic phosphates d. Plasma proteins ANS: B Which of the following systems is primarily responsible for the buffering of fixed acids? a. Ammonia b. HCO3- c. Hb d. Phosphate ANS: A Which of the following acts as the "first-line" or immediate defense against the accumulation of H+ ions? a. Blood buffer system b. GI tract c. Renal system d. Respiratory system ANS: B Which of the following organ systems assist in acid excretion? 1. Kidneys 2. Liver 3. Lungs a. 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: A In regard to acid excretion by the body, which of the following statements are true? 1. If one system fails, the other can help compensate. 2. The kidneys can only remove fixed acids. 3. The kidneys can quickly remove acid. 4. The lungs can quickly remove acid. a. 1, 2, and 4 only b. 2 and 3 only c. 4 only d. 1 and 4 only ANS: D The majority of the acid the body produces in a day is excreted through the lungs as CO2. What happens to the H+ ions? a. They are bound to Hb. b. They bind to phosphate. c. They form carbamino compounds. d. They bind to an OH-forming H2O. ANS: A Which organ system actually excretes H+ from the body? a. Kidneys b. Liver c. Lungs d. Spleen ANS: A If the blood PCO2 is high, the kidneys will do which of the following? a. Excrete more H+ and reabsorb more HCO3-. b. Excrete less H+ and reabsorb more HCO3-. c. Excrete less H+ and reabsorb less HCO3-. d. Excrete more H+ and reabsorb less HCO3-. ANS: A Normally which of the following occur when the kidneys eliminate H+? 1. Sodium ions (and water) are reabsorbed. 2. HCO3- is reabsorbed in proportion to the H+ excreted. 3. Bicarbonate buffer capacity is restored. a. 1, 2, and 3 b. 1 and 3 only c. 2 only d. 2 and 3 only ANS: A What is the role of carbonic anhydrase in the kidneys? a. It drives the recovery of HCO3- and excretion of H+. b. It is the catalyst for the hamburger phenomenon. c. It promotes the excretion of CO2 in the urine. d. It promotes the loss of fluids in congestive heart failure. ANS: A What effect does hyperventilation have on HCO3– recovery in the kidneys? a. Less H+ excretion, greater HCO3– loss b. No effect as these involve two independent systems. c. Vicious cycle of worsening alkalemia as hyperventilation stimulates increased HCO3– retention. d. Escalating retention of other buffer bases along with HCO3–. ANS: C What is the limiting factor for H+ excretion in the renal tubules? a. Excessive amounts of Cl- b. Excessive amounts of HCO3- c. Insufficient buffers d. Insufficient sodium ANS: D Which of the following mechanisms helps to eliminate excess H+ via the kidneys? 1. Reabsorption of HCO3- 2. Phosphate buffering 3. Ammonia buffering a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: B Which of the following is/are true about the relationship between chloride (Cl-) and bicarbonate HCO3- in acid-base balance? 1. For each Cl- ion excreted into the urine, the blood gains an HCO3- ion. 2. Blood Cl- and HCO3- ion levels are reciprocally related. 3. People with chronically high CO2 tend to have low blood Cl- levels. 4. Activation of the NH3 buffer system enhances Cl- gain and HCO3 loss. a. 2 and 3 only b. 1, 2, and 3 only c. 2 only d. 2, 3, and 4 only ANS: C Which organ system maintains the normal level of HCO3- at 24 mEq/L? a. Liver b. Lung c. Renal d. Spleen ANS: B According to the Henderson-Hasselbalch equation, the pH of the blood will be normal as long as the ratio of HCO3- to dissolved CO2 is which of the following? a. 10:1 b. 20:1 c. 24:1 d. 30:1 ANS: C The numerator of the Henderson-Hasselbalch (H-H) equation (HCO3-) relates to which of the following? a. Blood concentration of nonbicarbonate buffers b. Excretion of volatile acid by the lungs c. Renal buffering and excretion of fixed acids d. Respiratory component of acid-base balance ANS: C According to the Henderson-Hasselbalch equation, the blood pH will rise (alkalemia) under which of the following conditions? 1. The buffer capacity increases. 2. The volatile acid (CO2) increases. 3. The volatile acid (CO2) decreases. 4. The buffer capacity decreases. a. 1 only b. 3 only c. 1 and 3 only d. 2 and 4 only ANS: D When does a state of alkalemia exist? 1. The HCO3-/CO2 ratio exceeds 20:1. 2. The blood pH exceeds 7.45. 3. The blood PCO2 exceeds 54 mm Hg. a. 2 and 3 only b. 1, 2, and 3 c. 3 only d. 1 and 2 only ANS: C What is the primary chemical event in respiratory acidosis? a. Decrease in blood CO2 levels b. Decrease in blood HCO3- levels c. Increase in blood CO2 levels d. Increase in blood HCO3- levels ANS: D What is the primary chemical event in metabolic alkalosis? a. Decrease in blood CO2 levels b. Decrease in blood HCO3- levels c. Increase in blood CO2 levels d. Increase in blood HCO3- levels ANS: B What is a normal response of the body to a failure in one component of the acid-base regulatory mechanism? a. Autoregulation b. Compensation c. Correction d. Homeostasis ANS: D Compensation for respiratory acidosis occurs through which of the following? a. Decrease in blood CO2 levels b. Decrease in blood HCO3- levels c. Increase in blood CO2 levels d. Increase in blood HCO3- levels ANS: B Compensation for metabolic acidosis occurs through which of the following? a. Increase in blood CO2 levels b. Decrease in blood CO2 levels c. Decrease in blood HCO3- levels d. Increase in blood HCO3- levels ANS: C A patient has a bicarbonate concentration of 36 mEq and a PCO2 of 60 mm Hg. What is the approximate pH? a. 7.2 b. 7.3 c. 7.4 d. 7.5 ANS: A Which of the following accurately describes compensation for acid-base disorders? a. Kidneys take hours to days to compensate for respiratory disorders. b. Lungs take hours to days to compensate for metabolic disorders. c. Renal compensation is always complete. d. Respiratory compensation is always complete. ANS: B A patient with a measured plasma HCO3- concentration of 24 mmol/L has an episode of acute hypoventilation, with the PCO2 rising from 40 to 70 mm Hg. What do you predict will happen acutely to the plasma HCO3- concentration? a. HCO3- will remain unchanged. b. HCO3- will rise to approximately 27 to 28 mmol/L. c. HCO3- will fall to approximately 20 to 21 mmol/L. d. HCO3- will rise to approximately 54 to 55 mmol/L. ANS: B A patient has a pH of 7.49. How would you describe this? a. Acidemia b. Alkalemia c. Not sufficient information to determine d. Normal acid-base status ANS: C An increase in the H+ ion concentration [H+] of the blood due only to an increase in the arterial PCO2 (hypercapnia) best describes which of the following? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: D An ABG result shows the pH to be 7.56 and the HCO3- to be 23 mEq/L. Which of the following is the most likely disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: A An ABG result shows pH of 7.35, PaCO2 of 30 mm Hg, and HCO3- of 18 mEq/L. Which of the following is the patient's most likely primary disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: A An ABG result shows pH of 7.35, PaCO2 of 30 mm Hg, and HCO3- of 18 mEq/L. What compensatory measure has the body taken to at least partially compensate for the acid-base disorder? a. Blown off CO2 b. Retained HCO3- c. Retained H+ d. Not enough information to determine ANS: A Which of the following clinical findings would you expect in a fully compensated respiratory acidosis? 1. Elevated HCO3- 2. pH below 7.35 3. pH between 7.35 and 7.39 4. Elevated PO2 a. 1 and 3 only b. 2 and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: A Causes of respiratory acidosis in patients with normal lungs include which of the following? 1. Neuromuscular disorders 2. Spinal cord trauma 3. Anesthesia 4. Use of incentive spirometry a. 1, 2, and 3 only b. 4 only c. 2, 3, and 4 only d. 1 and 3 only ANS: B In the face of uncompensated respiratory acidosis, which of the following blood gas abnormalities would you expect to encounter? 1. Decreased pH 2. Increased HCO3- 3. Increased PCO2 4. Increased pH a. 1, 2, and 4 only b. 1 and 3 only c. 3 only d. 2, 3, and 4 only ANS: B How is acute respiratory acidosis accomplished? a. By increasing HCO3- reabsorption b. By increasing alveolar ventilation c. By decreasing HCO3- reabsorption d. By decreasing alveolar ventilation ANS: D A decrease in the H+ ion concentration [H+] of the blood caused by a low PaCO2 best describes which of the following? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: C What is the most common cause of respiratory alkalosis? a. Anxiety b. Central nervous system depression c. Hypoxemia d. Pain ANS: B Which of the following are potential causes of respiratory alkalosis? 1. Anxiety 2. Central nervous system depression 3. Hypoxemia 4. Pain a. 1, 2, and 3 only b. 1, 3, and 4 only c. 1 and 4 only d. 1, 2, 3, and 4 ANS: B What condition or treatment could cause iatrogenic respiratory alkalosis? a. Central nervous system stimulation b. Mechanical hyperventilation c. Severe hypoxemia d. Vagal stimulation ANS: B Which of the following are signs and symptoms of acute respiratory alkalosis? 1. Convulsions 2. Depressed reflexes 3. Dizziness 4. Paresthesia a. 1, 2, and 4 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B Compensation for respiratory alkalosis occurs through which of the following? a. Renal excretion of H+ b. Renal excretion of HCO3- c. Renal excretion of NH4+ d. Renal reabsorption of HCO3- ANS: D In a patient with partially compensated respiratory alkalosis, which of the following blood gas abnormalities would you expect to encounter? 1. Decreased pH 2. Decreased HCO3- 3. Decreased PCO2 4. Increased pH a. 1, 2, and 4 b. 1 and 3 c. 3 only d. 2, 3, and 4 ANS: B A patient who has fully compensated respiratory acidosis becomes severely hypoxic. If her lungs are not too severely compromised, what might her gases now appear to be? a. Fully compensated metabolic acidosis b. Fully compensated metabolic alkalosis c. Fully compensated respiratory alkalosis d. No change ANS: D Metabolic acidosis may be caused by: 1. an increase in fixed (nonvolatile) acids. 2. an increase in blood carbon dioxide (CO2). 3. excessive loss of bicarbonate (HCO3-). a. 1 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C What is a normal anion gap range? a. 3 to 5 mEq/L b. 6 to 8 mEq/L c. 9 to 14 mEq/L d. 24 to 26 mEq/L ANS: B A patient has an anion gap of 21 mEq/L. Based on this information, what can you conclude? 1. There is an abnormal excess of unmeasured anions in the plasma. 2. The patient probably has metabolic acidosis. 3. The concentration of fixed acids is decreased. a. 2 only b. 1 and 2 only c. 1 and 3 only d. 3 only ANS: A What explains the lack of an increased anion gap seen in metabolic acidosis caused by HCO3- loss? a. For each HCO3- ion lost, a Cl- ion is reabsorbed by the kidney. b. For each HCO3- ion lost, the body produces another to replace it. c. HCO3- is not a measured anion, so its loss does not affect the anion gap. d. Replacement of HCO3- occurs by ammonia ions which are also anions. ANS: C What are some causes of metabolic acidosis with an increased anion gap? 1. Diarrhea 2. Ketoacidosis 3. Lactic acidosis 4. Renal failure a. 2 and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 3, and 4 only ANS: B Which of the following is/are cause(s) of hyperchloremic metabolic acidosis? 1. Hyperalimentation 2. Methanol intoxication 3. Severe diarrhea 4. NH4Cl administration a. 2 only b. 1 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: B What is the main compensatory mechanism for metabolic acidosis? a. Excretion of HCO3- b. Hyperventilation c. Hypoventilation d. Retention of CO2 ANS: A In a patient with Kussmaul's respirations, what acid-base disturbance would you expect to see? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: D What is the treatment for severe metabolic acidosis? a. Charcoal b. Insulin c. Glucose d. NaHCO3- infusion ANS: A Primary metabolic alkalosis is associated with which of the following? a. Gain of buffer base b. Gain in fixed acids c. Low blood CO2 levels d. Diabetic crisis ANS: A Which of the following is/are cause(s) of metabolic alkalosis? 1. Diuretics 2. Hyperkalemia 3. Hypochloremia 4. Vomiting a. 1, 3, and 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 2 only ANS: A What would be an example of an iatrogenic cause of metabolic alkalosis? a. Gastric suction b. High-salt diet c. Discontinuing the patient's diuretics d. Vomiting ANS: D What is the kidneys' most important function? a. Acid-base balance b. Chloride maintenance c. HCO3- maintenance d. Sodium maintenance ANS: B What compensates for a metabolic alkalosis? a. Hyperventilation b. Hypoventilation c. Renal excretion of HCO3- d. Renal retention of H+ ANS: A Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.43, PCO2 = 39 mm Hg, HCO3- = 25.1 mEq/L a. Acid-base status within normal limits b. Fully compensated metabolic acidosis c. Fully compensated respiratory alkalosis d. Partially compensated metabolic acidosis ANS: A Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.62, PCO2 = 41 mm Hg, HCO3- = 40.9 mEq/L a. Acute (uncompensated) metabolic alkalosis b. Acute (uncompensated) respiratory alkalosis c. Fully compensated metabolic alkalosis d. Partially compensated metabolic alkalosis ANS: C Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.43, PCO2 = 20 mm Hg, HCO3- = 12.6 mEq/L a. Acute (uncompensated) respiratory alkalosis b. Fully compensated metabolic acidosis c. Fully compensated respiratory alkalosis d. Partially compensated respiratory alkalosis ANS: C Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 6.89, PCO2 = 24 mm Hg, HCO3- = 4.7 mEq/L a. Acute (uncompensated) metabolic acidosis b. Acute (uncompensated) respiratory acidosis c. Partially compensated metabolic acidosis d. Partially compensated respiratory acidosis ANS: A Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.08, PCO2 = 39 mm Hg, HCO3- = 11.8 mEq/L a. Acute metabolic acidosis b. Acute respiratory acidosis c. Partially compensated metabolic acidosis d. Partially compensated respiratory acidosis ANS: B Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.28, PCO2 = 53 mm Hg, HCO3- = 25.8 mEq/L a. Acute metabolic acidosis b. Acute respiratory acidosis c. Partially compensated metabolic acidosis d. Partially compensated respiratory acidosis ANS: B Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.38, PCO2 = 21 mm Hg, HCO3- = 11.7 mEq/L a. Acute metabolic acidosis b. Fully compensated metabolic acidosis c. Partially compensated metabolic acidosis d. Fully compensated respiratory alkalosis ANS: C Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.35, PCO2 = 68 mm Hg, HCO3- = 34.3 mEq/L a. Acute respiratory acidosis b. Combined metabolic and respiratory acidosis c. Fully compensated respiratory acidosis d. Fully compensated metabolic alkalosis ANS: D Correction of metabolic alkalosis may involve which of the following? 1. Restoring normal fluid volume 2. Administering acidifying agents 3. Restoring normal K+ and Cl− levels a. 3 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: D In order to eliminate the influence of PCO2 changes on plasma HCO3- concentrations, what additional measures of the metabolic component of acid-base balance can be used? a. HCO3- b. Hemoglobin content c. Henderson-Hasselbalch equation d. Standard bicarbonate [Show Less]
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Pathophysiology Chapter 12- Test Bank Questions Already passed 2023
Which of the following actions causes the atrioventricular (AV) valves to close? A) Increased intraventricular pressure B) Depolarization at the AV node ... [Show More] C) Ventricular relaxation and backflow of blood D) Contraction of the atria A When stroke volume decreases, which of the following could maintain cardiac output? A) Decreased peripheral resistance B) Increased heart rate C) Decreased venous return D) General vasodilation B Which of the following describes the pericardial cavity? A) It contains sufficient fluid to provide a protective cushion for the heart. B) It is a potential space containing a very small amount of serous fluid. C) It is lined by the endocardium. D) It is located between the double-walled pericardium and the epicardium. B Which of the following factors greatly improves venous return to the heart during strenuous exercise? A) Rapid emptying of the right side of the heart B) Forceful action of the valves in the veins C) Contraction and relaxation of skeletal muscle D) Peristalsis in the large veins C The function of the baroreceptors is to: A) stimulate the parasympathetic or sympathetic nervous system at the sinoatrial (SA) node as needed. B) adjust blood pressure by changing peripheral resistance. C) sense a change in blood oxygen and carbon dioxide levels. D) signal the cardiovascular control center of changes in systemic blood pressure. D The normal delay in conduction through the AV node is essential for: A) preventing an excessively rapid heart rate. B) limiting the time for a myocardial contraction. C) allowing the ventricles to contract before the atria. D) completing ventricular filling. D Which of the following is a result of increased secretion of epinephrine? A) Increased heart rate and force of contraction B) Decreased stimulation of the SA node and ventricles C) Vasoconstriction in skeletal muscles and kidneys D) Vasodilation of cutaneous blood vessels A Which of the following causes increased heart rate? A) Stimulation of the vagus nerve B) Increased renin secretion C) Administration of beta-blocking drugs D) Stimulation of the sympathetic nervous system D The term preload refers to: A) volume of venous return. B) peripheral resistance. C) stroke volume. D) cardiac output. A Cardiac output refers to: A) the amount of blood passing through either of the atria. B) the volume of blood ejected by a ventricle in one minute. C) the volume of blood ejected by each ventricle in a single contraction. D) the total number of heartbeats in one minute. B Vasodilation in the skin and viscera results directly from: A) decreased blood pressure. B) increased parasympathetic stimulation. C) relaxation of smooth muscle in the arterioles. D) increased stimulation of alpha-adrenergic receptors. C Which of the following are predisposing factors to thrombus formation in the circulation? 1. Decreased viscosity of the blood 2. Damaged blood vessel walls 3. Immobility 4. Prosthetic valves A) 1, 3 B) 2, 4 C) 1, 3, 4 D) 2, 3, 4 D A partial obstruction in a coronary artery will likely cause: A) pulmonary embolus. B) hypertension. C) angina attacks. D) myocardial infarction. C Cigarette smoking is a risk factor in coronary artery disease because smoking: A) reduces vasoconstriction and peripheral resistance. B) decreases serum lipid levels. C) promotes platelet adhesion. D) increases serum HDL levels. C The term arteriosclerosis specifically refers to: A) development of atheromas in large arteries. B) intermittent vasospasm in coronary arteries. C) degeneration with loss of elasticity and obstruction in small arteries. D) ischemia and necrosis in the brain, kidneys, and heart. C A modifiable factor that increases the risk for atherosclerosis is: A) leading a sedentary lifestyle. B) being female and older than 40 years of age. C) excluding saturated fats from the diet. D) familial hypercholesterolemia. A An atheroma develops from: A) a torn arterial wall and blood clots. B) accumulated lipids, cells, and fibrin where endothelial injury has occurred. C) thrombus forming on damaged walls of veins. D) repeated vasospasms. B Low-density lipoproteins (LDL): A) promote atheroma development. B) contain only small amounts of cholesterol. C) transport cholesterol from cells to the liver for excretion. D) are associated with low intake of saturated fats. A Factors that may precipitate an angina attack include all of the following EXCEPT: A) eating a large meal. B) engaging in an angry argument. C) taking a nap. D) shoveling snow on a cold, windy day. C When comparing angina with myocardial infarction (MI), which statement is true? A) Both angina and MI cause tissue necrosis. B) Angina often occurs at rest; MI occurs during a stressful time. C) Pain is more severe and lasts longer with angina than with MI. D) Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not. D The basic pathophysiology of myocardial infarction is best described as: A) cardiac output that is insufficient to meet the needs of the heart and body. B) temporary vasospasm that occurs in a coronary artery. C) total obstruction of a coronary artery, which causes myocardial necrosis. D) irregular heart rate and force, reducing blood supply to coronary arteries. C Typical early signs or symptoms of myocardial infarction include: A) brief, substernal pain radiating to the right arm, with labored breathing. B) persistent chest pain radiating to the left arm, pallor, and rapid, weak pulse. C) bradycardia, increased blood pressure, and severe dyspnea. D) flushed face, rapid respirations, left-side weakness, and numbness. B The most common cause of a myocardial infarction is: A) an imbalance in calcium ions. B) an infection of the heart muscle. C) atherosclerosis involving an attached thrombus. D) a disruption of the heart conduction system. C Which of the following confirms the presence of a myocardial infarction? A) A full description of the pain, including the sequence of development B) The presence of elevated serum cholesterol and triglycerides C) Serum isoenzymes released from necrotic cells and an ECG D) Leukocytosis and elevated C-reactive protein C The size of the necrotic area resulting from myocardial infarction may be minimized by all of the following EXCEPT: A) previously established collateral circulation. B) immediate administration of thrombolytic drugs. C) maintaining maximum oxygen supply to the myocardium. D) removing the predisposing factors to atheroma development. D [Show Less]
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Ch 32 Personality Disorder Test Bank Question with complete solution
1. During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the mos... [Show More] t appropriate nursing statement to address this behavior? A. You are very disrespectful. You need to learn to control yourself. B. I understand that you are angry, but this behavior will not be tolerated. C. What behaviors could you modify to improve this situation? D. What anti-personality-disorder medications have helped you in the past? ANS: B The appropriate nursing statement is to reflect the clients feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism. Antidepressants and anxiolytics are used for symptom relief; however, there are no specific medications targeted for the treatment of a personality disorder. 2. A client diagnosed with antisocial personality disorder comes to a nurses station at 11:00 p.m., requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate? A. Go ahead and use the phone. I know this pending divorce is stressful. B. You know better than to break the rules. Im surprised at you. C. It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow. D. The decision to divorce should not be considered until you have had a good nights sleep. ANS: C The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. Because of the probability of manipulative behavior in this client population, it is imperative to maintain consistent application of rules. 3. A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? A. Provide objective evidence that violence is unwarranted. B. Initially restrain the client to maintain safety. C. Use clear, calm statements and a confident physical stance. D. Empathize with the clients paranoid perceptions. ANS: C The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude avoids escalating the aggressive behavior and provides the client with a feeling of safety and security. It may also be beneficial to have sufficient staff on hand to present a show of strength. 4. A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data? A. Compulsive personality disorder B. Schizotypal personality disorder C. Histrionic personality disorder D. Manic personality disorder ANS: C The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention. 5. A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? A. Allow the clients to apply the democratic process when developing unit rules. B. Maintain consistency of care by open communication to avoid staff manipulation. C. Allow the client spokesperson to verbalize concerns during a unit staff meeting. D. Maintain unit order by the application of autocratic leadership. ANS: B The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients diagnosed with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors. 6. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? A. Being firm, consistent, and empathetic, while addressing specific client behaviors B. Promoting client self-expression by implementing laissez-faire leadership C. Using authoritative leadership to help clients learn to conform to societal norms D. Overlooking inappropriate behaviors to avoid promoting secondary gains ANS: A The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals diagnosed with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting. 7. Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? A. A physically healthy client who is dependent on meeting social needs by contact with 15 cats B. A physically healthy client who has a history of depending on intense relationships to meet basic needs C. A physically healthy client who lives with parents and relies on public transportation D. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security ANS: C A physically healthy adult client who lives with parents and relies on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior. 8. A pessimistic client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of suffering in silence. Which underlying cause of this clients personality disorder should a nurse recognize? A. Nurturance was provided from many sources, and independent behaviors were encouraged. B. Nurturance was provided exclusively from one source, and independent behaviors were discouraged. C. Nurturance was provided exclusively from one source, and independent behaviors were encouraged. D. Nurturance was provided from many sources, and independent behaviors were discouraged. ANS: B Nurturance provided from one source and discouragement of independent behaviors can attribute to the etiology of dependent personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy. 9. Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply? A. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. B. Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, whereas clients diagnosed with avoidant personality disorder do not. C. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. D. Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, whereas clients diagnosed with avoidant personality disorder remain based in reality. ANS: A The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, whereas clients diagnosed with schizoid personality disorder prefer to be alone. Avoidant personality disorder is characterized by an extreme sensitivity to rejection, which leads to social isolation. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships. 10. During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered? A. I really dont have a problem. My family is inflexible, and every relative is out to get me. B. I am so excited about working with you. Have you noticed my new nail polish, Ruby Red Roses? C. I spend all my time tending my bees. I know a whole lot of information about bees. D. I am getting a message from the beyond that we have been involved with each other in a previous life. ANS: D The nurse should assess that a client who states that he or she is getting a message from the beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The individual experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life. 11. A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? A. Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling. B. Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs. C. They tend to develop few relationships because they are strongly independent but generally maintain deep affection. D. They pay particular attention to details, which can frustrate the development of relationships. ANS: B The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having shallow, fleeting interpersonal relationships that serve their dependency needs. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior. These individuals also have difficulty maintaining long-lasting relationships. 12. Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? A. Altered thought processes R/T increased stress B. Risk for suicide R/T loneliness C. Risk for violence: directed toward others R/T paranoid thinking D. Social isolation R/T inability to relate to others ANS: D An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are unsociable. 13. When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? A. The use of highly lethal methods to commit suicide B. The use of suicidal gestures to evoke a rescue response from others C. The use of isolation and starvation as suicidal methods D. The use of self-mutilation to decrease endorphins in the body ANS: B The nurse should expect that a client diagnosed with borderline personality disorder might use suicidal gestures to evoke a rescue response from others. Repetitive, self-mutilative behaviors are common in clients diagnosed with borderline personality disorders. These behaviors are generated by feelings of abandonment following separation from significant others. 14. Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder? A. As the day shift nurse leaves the unit, the client suddenly hugs the nurses arm and whispers, The night nurse is evil. You have to stay. B. As the day shift nurse leaves the unit, the client suddenly hugs the nurses arm and states, I will be up all night if you dont stay with me. C. As the day shift nurse leaves the unit, the client suddenly hugs the nurses arm, yelling, Please dont go! I cant sleep without you being here. D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, I cut myself because you are leaving me. ANS: D The clients statement I cut myself because you are leaving me reflects impulsive behavior that is commonly associated with the diagnosis of borderline personality disorder. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others. 15. Which nursing diagnosis should be prioritized when providing care to a client diagnosed with paranoid personality disorder? A. Risk for violence: directed toward others R/T suspicious thoughts B. Risk for suicide R/T altered thought C. Altered sensory perception R/T increased levels of anxiety D. Social isolation R/T inability to relate to others ANS: A The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T suspicious thoughts. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that may result in hostile actions to protect self. They are often tense and irritable, which increases the likelihood of violent behavior. 16. Using a behavioral approach, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder? A. Seclude the client when inappropriate behaviors are exhibited. B. Contract with the client to reinforce positive behaviors with unit privileges. C. Teach the purpose of antianxiety medications to improve medication compliance. D. Encourage the client to journal feelings to improve awareness of abandonment issues. ANS: B The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change. 17. A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? A. You really dont have to go by that schedule. Id just stay home sick. B. There has got to be a hidden agenda behind this schedule change. C. Who do you think you are? I expect to interact with the same nurse every Saturday. D. You cant make these kinds of changes! Isnt there a rule that governs this decision? ANS: D The nurse should identify that a client diagnosed with obsessive-compulsive personality disorder would have a difficult time accepting change. This disorder is characterized by inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules. 18. Looking at a slightly bleeding paper cut, the client screams, Somebody help me, quick! Im bleeding. Call 911! A nurse should identify this behavior as characteristic of which personality disorder? A. Schizoid personality disorder B. Obsessive-compulsive personality disorder C. Histrionic personality disorder D. Paranoid personality disorder ANS: C The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals diagnosed with this disorder tend to be self-dramatizing, attention seeking, over-gregarious, and seductive. 19. Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? A. Interpreting the compliment as a secret code used to increase personal power B. Feeling the compliment was well deserved C. Being grateful for the compliment but fearing later rejection and humiliation D. Wondering what deep meaning and purpose are attached to the compliment ANS: C The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the comment but would fear later rejection and humiliation. Individuals with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations. 20. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? A. The client experiences unwanted, intrusive, and persistent thoughts. B. The client experiences unwanted, repetitive behavior patterns. C. The client experiences inflexibility and lack of spontaneity when dealing with others. D. The client experiences obsessive thoughts that are externally imposed. ANS: C The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very serious and formal and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules. 21. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? A. A client diagnosed with antisocial personality disorder B. A client diagnosed with borderline personality disorder C. A client diagnosed with schizoid personality disorder D. A client diagnosed with paranoid personality disorder ANS: B The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilative behaviors. Most gestures are designed to evoke a rescue response. [Show Less]
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Ricci Chapter 20 - Test Bank - 4th Edition Question well answered 2023
1. The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching... [Show More] was successful? A. "I'll basically follow the same diet that I was following before I became pregnant." B. "Because I need extra protein, I'll have to increase my intake of milk and meat." C. "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." D. "I'll adjust my diet and insulin based on the results of my urine tests for glucose." Answer: C Rationale: In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the woman will probably need to make adjustments in her diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy. 2. A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? A. congenital anomalies B. incompetent cervix C. placenta previa D. placental abruption (abruptio placentae) Answer: A Rationale: A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or placental abruption (abruptio placentae). 3. A nurse is conducting a review class for a group of perinatal nurses working at the local clinic. The clinic sees a high population of women who are HIV positive. After discussing the recommendations for antiretroviral therapy with the group, the nurse determines that the teaching was successful when the group identifies which rationale as the underlying principle for the therapy? A. reduction in viral loads in the blood B. treatment of opportunistic infections C. adjunct therapy to radiation and chemotherapy D. can cure acute HIV/AIDS infections Answer: A Rationale: Drug therapy is the mainstay of treatment and is important in reducing the viral load as much as possible. Antiretroviral agents do not treat opportunistic infections and are not adjunctive therapy. There is no cure for HIV/AIDS. 4. Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? A. marijuana B. alcohol C. heroin D. cocaine Answer: D Rationale: Cocaine use produces vasoconstriction, tachycardia, and hypertension in both the mother and fetus. The effects of marijuana are not yet fully understood. Alcohol ingestion would lead to cognitive and behavioral problems in the newborn. Heroin is a central nervous system depressant. 5. When teaching a class of pregnant women about the effects of substance use during pregnancy, the nurse would include which effect? A. low-birthweight infants B. excessive weight gain C. higher pain tolerance D. longer gestational periods Answer: A Rationale: Substance use during pregnancy is associated with low birth weight infants, preterm labor, abortion, intrauterine growth restriction, abruptio placentae, neurobehavioral abnormalities, and long-term childhood developmental consequences. Excessive weight gain, higher pain tolerance, and longer gestational periods are not associated with substance use. 6. A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? A. "You'll probably have a cesarean birth to prevent exposing your newborn." B. "Antibodies cross the placenta and provide immunity to the newborn." C. "Wait until after the infant is born, and then something can be done." D. "Antiretroviral medications are available to help reduce the risk of transmission." Answer: D Rationale: Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The goal of therapy is to reduce the viral load as much as possible; this reduces the risk of transmission to the fetus. Decisions about the method of birth should be based on the woman's viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors. The newborn is at risk for HIV because of potential perinatal transmission. Waiting until after the infant is born may be too late. 7. When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? A. monthly visits until 32 weeks, then bi-monthly visits B. bi-monthly visits until 28 weeks, then weekly visits C. monthly visits until 20 weeks, then bi-monthly visits D. bi-monthly visits until 36 weeks, then weekly visits Answer: B Rationale: For the woman with chronic hypertension, antepartum visits typically occur every 2 weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal surveillance. 8. A woman with a history of asthma comes to the clinic for evaluation for pregnancy. The woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen for asthma, which medication would the nurse identify as problematic for the woman now that she is pregnant? A. ipratropium B. albuterol C. salmeterol D. Prednisone Answer: D Rationale: Oral corticosteroids such as prednisone are not preferred for the long-term treatment of asthma during pregnancy. Inhaled steroids are the choice for maintenance medications to reduce inflammation that leads to bronchospasm. Common ones prescribed include beclomethasone and salmeterol. Rescue agents such as albuterol or ipratropium provide immediate symptomatic relief by reducing acute bronchospasm. 9. A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about her prescribed iron supplement, which statement indicates successful teaching? A. "I should take my iron with milk." B. "I should avoid drinking orange juice." C. "I need to eat foods high in fiber." D. "I'll call the primary care provider if my stool is black and tarry." Answer: C Rationale: Iron supplements can lead to constipation, so the woman needs to increase her intake of fluids and high-fiber foods. Milk inhibits absorption and should be discouraged. Vitamin Ccontaining fluids such as orange juice are encouraged because they promote absorption. Ideally the woman should take the iron on an empty stomach to improve absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman should take it with meals. Iron typically causes the stool to become black and tarry; there is no need for the woman to notify her primary care provider. 10. The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? A. wide, large eyes B. thin upper lip C. protruding jaw D. elongated nose Answer: B Rationale: Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities. 11. After teaching a group of nurses working at the women's health clinic about the impact of pregnancy on the older woman, which statement by the group indicates that the teaching was successful? A. "The majority of women who become pregnant over age 35 experience complications." B. "Women over the age of 35 who become pregnant require a specialized type of assessment." C. "Women over age 35 and are pregnant have an increased risk for spontaneous abortions." D. "Women over age 35 are more likely to have a substance use disorder." Answer: C Rationale: Whether childbearing is delayed by choice or by chance, women starting a family at age 35 or older are not doing so without risk. Women in this age group may already have chronic health conditions that can put the pregnancy at risk. In addition, numerous studies have shown that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension, postpartum hemorrhage, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restriction, low Apgar scores, and surgical births (Dillion et al. 2019). However, even though increased age implies increased complications, most women today who become pregnant after age 34, have healthy pregnancies and healthy newborns. Nursing assessment of the pregnant woman over age 35 is the same as that for any pregnant woman. Women of this age have the same risk for a substance use disorder as any other age group. 12. A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum? A. syphilis B. gonorrhea C. chlamydia D. HPV Answer: B Rationale: Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the newborn from birth through an infected birth canal. Infection with syphilis can cause congenital syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the newborn. Exposure to HPV during birth is associated with laryngeal papillomas. 13. A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A. rubella B. hepatitis B C. cytomegalovirus D. parvovirus B19 Answer: C Rationale: Although rubella, hepatitis B, and parovirus B19 can affect pregnant women and their fetuses, cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. CMV is the leading cause of congenital infection, with morbidity and mortality at birth and sequelae. Each year approximately 1% to 7% of pregnant women acquire a primary CMV infection. Of these, about 30% to 40% transmits infection to their fetuses. 14. A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate? A. "The caffeine in coffee has been linked to birth defects." B. "Caffeine has been shown to restrict growth in the fetus." C. "Caffeine is a stimulant and needs to be avoided completely." D. "If you keep your intake to less than 200 mg/day, you should be okay." Answer: D Rationale: The effect of caffeine intake during pregnancy on fetal growth and development is still unclear. A recent study found that caffeine intake of no more than 200 mg/day during pregnancy does not affect pregnancy duration and the condition of the newborn. Birth defects have not been linked to caffeine consumption, but maternal coffee consumption decreases iron absorption and may increase the risk of anemia during pregnancy. It is not known if there is a correlation between high caffeine intake and miscarriage due to lack of sufficient studies. 15. A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which signs would the nurse assess? Select all that apply. A. low whimpering cry B. hypertonicity C. lethargy D. excessive sneezing E. overly vigorous sucking F. tremors Answer: B, D, F Rationale: Signs and symptoms of withdrawal, or neonatal abstinence syndrome, include: irritability, hypertonicity, excessive and often high-pitched crying, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures. 16. A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which aspects? Select all that apply. A. peer pressure to become sexually active B. rise in teen birth rates over the years. C. Asian Americans as having the highest teen birth rate D. loss of self-esteem as a major impact E. about half occurring within a year of first sexual intercourse Answer: A, D Rationale: Adolescent pregnancy has emerged as one of the most significant social problems facing our society. Early pregnancies among adolescents have major health consequences for mothers and their infants. The latest estimates show that approximately 1 million teenagers become pregnant each year in the United States, accounting for 13% of all U.S. births, but the rates have been declining in the last several years. Teen birth rates in the United States have declined but remain high,especially among African American and Hispanic teenagers and adolescents in southern states. The most important impact lies in the psychosocial area as it contributes to a loss of self-esteem, a destruction of life projects, and the maintenance of the circle of poverty. Moreover, about half of all teen pregnancies occur within 6 months of first having sexual intercourse. About one in four teen mothers under age 18 have a second baby within 2 years after the birth of the first baby. 17. A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. The nurse would emphasize the need to avoid which medication at this time? A. hydroxychloroquine B. nonsteroidal anti-inflammatory drugs C. glucocorticoid D. methotrexate Answer: D Rationale: Methotrexate is contraindicated during pregnancy. For rheumatoid arthritis, medications are limited to hydroxychloroquine, glucocorticoids, and NSAIDS. 18. A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which measure would the nurse include as a priority? A. frequent handwashing B. immunization C. prenatal screening D. antibody titer screening Answer: A Rationale: Most women are asymptomatic and do not know they have been exposed to CMV. Prenatal screening for CMV infection is not routinely performed. Since there is no therapy that prevents or treats CMV infections, nurses are responsible for educating and supporting childbearing-age women at risk for CMV infection. Stressing the importance of good handwashing and use of sound hygiene practices can help to reduce transmission of the virus. There is no immunization for CMV. Antibody titer levels would be useful for identifying women at risk for rubella. 19. A pregnant woman comes to the clinic for her first evaluation. The woman is screened for hepatitis B (HBV) and tests positive. The nurse would anticipate administering which agent? A. HBV immune globulin B. HBV vaccine C. acylcovir D. valacyclovir Answer: A Rationale: If a woman tests positive for HBV, expect to administer HBV immune globulin. The newborn will also receive HBV vaccine within 12 hours of birth. Acyclovir or valacyclovir would be used to treat herpes simplex virus infection. 20. After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which foods as being good sources of iron in her diet? Select all that apply. A. dried fruits B. peanut butter C. meats D. milk E. white bread Answer: A, B, C Rationale: Foods high in iron include meats, green leafy vegetables, legumes, dried fruits, whole grains, peanut butter, bean dip, whole-wheat fortified breads, and cereals. 21. A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that the woman is achieving good glucose control based on which result? A. 88 mg/dL B. 100 mg/dL C. 110 mg/dL D. 120 mg/dL Answer: A Rationale: For a pregnant woman with diabetes, the ADA and ACOG recommend maintaining a fasting blood glucose level below 95 mg/dL, with postprandial levels below 140 mg/dL at 1 hour, below 120 mg/dL at 2 hours. 22. A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes? A. stability of the woman's emotional and psychological status B. degree of blood glucose control achieved during the pregnancy C. reduction in retinopathy risk by frequent ophthalmologic evaluations D. control of blood urea nitrogen (BUN) levels for optimal kidney function Answer: B Rationale: Therapeutic management for the woman with diabetes focuses on tight glucose control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional and psychological status is highly variable and may or may not affect the pregnancy. Evaluating for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that the mother enters the pregnancy in an optimal state. [Show Less]
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Pathophysiology Chapter 1- Test Bank Question with complete solution 2023
Which of the following would be the most likely cause of an iatrogenic disease? A) An inherited disorder B) A combination of specific etiological factors... [Show More] C) An unwanted effect of a prescribed drug D) Prolonged exposure to toxic chemicals in the environment C The manifestations of a disease are best defined as the: A) subjective feelings of discomfort during a chronic illness. B) signs and symptoms of a disease. C) factors that precipitate an acute episode of a chronic illness. D) early indicators of the prodromal stage of infection. B The best definition of the term prognosis is the: A) precipitating factors causing an acute episode. B) number of remissions to be expected during the course of a chronic illness. C) predicted outcome or likelihood of recovery from a specific disease. D) exacerbations occurring during chronic illness. C Which of the following is considered a systemic sign of disease? A) Swelling of the knee B) Fever C) Pain in the neck D) Red rash on the face B Etiology is defined as the study of the: A) causes of a disease. B) course of a disease. C) expected complications of a disease. D) manifestations of a disease. A A type of cellular adaptation in which there is a decrease in cell size is referred to as: A) hypertrophy B) metaplasia C) anaplasia D) atrophy D A change in a tissue marked by cells that vary in size and shape and show increased mitotic figures would be called: A) metaplasia B) atrophy. C) dysplasia D) hypertrophy. C A deficit of oxygen in the cells usually due to respiratory or circulatory problems is called: A) apoptosis. B) ischemia C) hypertrophy D) necrosis B When a group of cells in the body dies, the change is called: A) ischemia. B) gangrene C) hypoxia D) necrosis. D Rigorous weight lifting/body building regimens may result in the skeletal muscle cells undergoing: A) hypertrophy. B) dysplasia. C) atrophy. D) regeneration. A The term cancer refers to: A) dysplasia. B) hyperplasia. C) metaplasia. D) malignant neoplasm. D To which of the following does the term apoptosis refer? A) Increased rate of mitosis by certain cells B) Ischemic damage to cells C) Liquefaction of necrotic tissue D) Preprogrammed cell self-destruction D Which of the following statements is TRUE? A) Alteration of DNA does not change cell function. B) Damaged cells may be able to repair themselves. C) All types of cells die at the same rate. D) Mild ischemia causes immediate cell death. B Caseation necrosis refers to an area where: A) cell proteins have been denatured. B) cell are liquefied by enzymes. C) dead cells form a thick cheesy substance. D) bacterial invasion has occurred. C Routine application of sun block to skin would be an example of: A) an iatrogenic cause of cancer. B) a preventive measure. C) a precipitating factor. D) a predisposing condition. B A circumstance that causes a sudden acute episode of a chronic disease to occur is termed: A) latent stage. B) predisposing factor. C) incidence. D) precipitating factor D The term homeostasis refers to: A) the causative factors in a particular disease. B) maintenance of a stable internal environment. C) a condition that triggers an acute episode. D) a collection of signs and symptoms. B Which term is used to describe a new and secondary or additional problem that arises after the original disease has been established? A) Symptoms B) Occurrence C) Manifestations D) Complication D Pathophysiology involves the study of: A) the structure of the human body. B) the functions of various organs in the body. C) functional or structural changes resulting from disease processes. D) various cell structures and related functions. C Which of the following is the best definition of epidemiology? A) The science of tracking the occurrence and distribution of diseases B) The relative number of deaths resulting from a particular disease C) Identification of a specific disease through evaluation of signs and symptoms D) The global search for emerging diseases A Which of the following can cause cell injury or death? 1. Hypoxia 2. Exposure to excessive cold 3. Excessive pressure on a tissue 4. Chemical toxins A) 1, 2 B) 2, 4 C) 1, 3, 4 D) 1, 2, 3, 4 D All of the following are part of the Seven Steps to Health EXCEPT: A) follow cancer screening guidelines. B) use sun block agents whenever exposed. C) participate in strenuous exercise on a regular daily basis. D) choose high fiber, lower fat foods. C The term disease refers to: A) the period of recovery and return to a normal healthy state. B) a deviation from the normal state of health and function. C) the treatment measures used to promote recovery. D) a basic collection of signs and symptoms. B A collection of signs and symptoms, often affecting more than one organ or system, that usually occur together in response to a certain condition is referred to as a (an): A) acute disease. B) multiorgan disorder. C) syndrome. D) manifestation. C [Show Less]
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Chapter 2- Test Bank Question and answer 2023
Where was Canada's first universal health insurance program implemented? A Manitoba in 1957 B Canada in 1967 C Prince Edward Island in 1867 D Saska... [Show More] tchewan in 1947 D What was the purpose of the Canada Health Act (1984)? A Provide the provinces with more legal authority B Provide direction for cash contributions made by the federal government for essential medical services C Establish a national drug plan so that every citizen has access to the medicines they need D Increase access to care based on ability to pay B What Act has as its cornerstones publicly administered, comprehensive, universal, portable, and accessible? A Hospital Insurances and Diagnostic Services Act B Constitution Act C Canada Health Act D American Medicare Act C What were the primary objectives of Canadian health care policy according to the Canada Health Act (1984)? Select all that apply. A Facilitate reasonable access to health services B Protect the health care system from privatization C Restore stable health care funding to the federal government D Protect, promote, and restore the physical and mental well-being of the residents of Canada A, D The Canada Health Act (1984) has been successful in ensuring all Canadians have access to the health care they need, regardless of their ability to pay or where they live. Which of the following is true of the Canada Health Act? Select all that apply. A It is held up as a symbol of the values that represent Canada B It articulates a social contract that defines health care as a basic right C It penalizes provinces that oppose the public health aspects of the act D It reflects the values of social justice, equity, and community A, B, D Which model dominated public and political thinking about health during the time that the Canadian Medicare System was created in 1957? A Healthy lifestyle model B Socio-environmental model C Biomedical model D Health promotion model C Which document was considered revolutionary by the global community and led to a reconceptualization of health promotion? A The Lalonde Report B The Declaration of Alma Ata C The Ottawa Charter D The Social Determinants of Health A Contemporary nurses are demonstrating power in a number of ways including which of the following? Select all that apply. A The authority that comes with the possession of knowledge ("knowledge is power") B Legal power that is associated with the legitimatization of nursing roles (e.g., nurse practitioner) C Changed self-perceptions to accept one's own ideas or the ideas of other nursing leaders instead of those imposed by others D More involvement in the political process, labour unions, and organizational lobbying efforts A, B, C, D Which of the following statements is true of how nurses use power? Select all that apply. A Nurses exert power through the language they use in nurse-client interactions B Nurses address power imbalances in the micro politics of social rituals C Nurses address power imbalances in the structural underpinnings that reinforce and perpetuate power relations D Nurses address power imbalances by addressing issues of health inequity through health policy A, B, C, D What are the four determinants of health identified in the Lalonde Report (1974)? A Socio-environmental, biomedical, disease prevention, and health promotion B Gender, culture, working conditions, and education C Biological, emotional, spiritual, and psychological D Environment, lifestyle, human biology, and healthcare system D [Show Less]
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Pathophysiology Chapter 2- Test Bank Question 100% correct
1. While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. ... [Show More] The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. increased right atrial pressure. d. incompetent jugular vein valves. c. increased right atrial pressure. The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis. 2. The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 pounds in 24 hours b. Hourly urine output greater than 60 mL c. Reduction in patient complaints of chest pain d. Reduced dyspnea with the head of bed at 30 degrees d. Reduced dyspnea with the head of bed at 30 degrees Because the patients major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred, but are not as specific to evaluating this patients response. 3. Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. Need to begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually. 4. IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute. c. a systolic BP <90 mm Hg. Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy. 5. A patient who has chronic heart failure tells the nurse, I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating! The nurse will document this assessment finding as a. orthopnea. b. pulsus alternans. c. paroxysmal nocturnal dyspnea. d. acute bilateral pleural effusion. c. paroxysmal nocturnal dyspnea. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period. 6. During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of feeling too tired to get out of bed. Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion. a. activity intolerance related to fatigue. The patients statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems. 7. The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is applied when any chest pain develops. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. d. an additional pillow can help her sleep if she is feeling short of breath at night. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an as needed basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by further elevating the head of the bed. 8. When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. eggs and other high-protein foods. d. milk, yogurt, and other milk products. d. milk, yogurt, and other milk products. Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000-mg sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction. 9. The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute. c. notify the health care provider if nausea develops. Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption. 10. While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the water pill with the heart pill. When planning for the patients discharge the nurse will facilitate a a. consult with a psychologist. b. transfer to a long-term care facility. c. referral to a home health care agency. d. arrangements for around-the-clock care. c. referral to a home health care agency. The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patients home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as a psychologist consult, long-term care, or around-the-clock home care. 11. Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. b. b-adrenergic blockers. c. calcium channel blockers. d. angiotensin-converting enzyme (ACE) inhibitors. d. angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and b-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The b- adrenergic blockers are not used as initial therapy for new onset heart failure. 12. A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most appropriate? a. Because you have diabetes, you would not be a candidate for a heart transplant. b. The choice of a patient for a heart transplant depends on many different factors. c. Your heart failure has not reached the stage in which heart transplants are needed. d. People who have heart transplants are at risk for multiple complications after surgery. b. The choice of a patient for a heart transplant depends on many different factors. Indications for a heart transplant include end-stage heart failure (Stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Diabetic patients who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, this response does not address the patients question. 13. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram c. B-type natriuretic peptide B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure. Elevated BNP indicates a probable or very probable diagnosis of heart failure. A twelve-lead electrocardiogram, arterial blood gases, and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP. 14. Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide slowly before stopping. d. Teach patient about home use of the drug. a. Monitor blood pressure frequently. Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension. Because the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nesiritide does not require titration and is used for ADHF but not in a home setting. 15. A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. I will be sure to take the medication with food. b. I will need to eat more potassium-rich foods in my diet. c. I will call for help when I need to get up to use the bathroom. d. I will expect to feel more short of breath for the next few days. c. I will call for help when I need to get up to use the bathroom. Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of b-adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating. 16. A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. Furosemide (Lasix) 60 mg b. Captopril (Capoten) 25 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg d. Carvedilol (Coreg) 3.125 mg Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. The other medications are appropriate for the patient with ADHF. 17. A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation. c. Auscultate the breath sounds. This patients severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patients volume status and also should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority. 18. A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurses priority action will be to a. have the patient recall the dietary intake for the last 3 days. b. ask the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of restricting dietary sodium. c. assess the patient for clinical manifestations of acute heart failure The 5-pound weight gain over 3 days indicates that the patients chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated. 19. A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurses priority action will be to a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min. a. give IV morphine sulfate 4 mg. Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea. 20. After receiving change-of-shift report on a heart failure unit, which patient should the nurse assessfirst? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62 a. A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has wet-cold clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion. 21. Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/minute d. Urine output of 50 mL over 2 hours a. Oxygen saturation of 88% A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require nursing actions, but the low oxygen saturation rate requires the most immediate nursing action. 22. A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days c. Serum potassium level 3.0 mEq/L after 1 week of therapy Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions), and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patients heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium 23. An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue c. Blood pressure (BP) of 88/42 mm Hg The patients BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of b-adrenergic blockade, but the rate of 56 is not unusual with - adrenergic blocker therapy. b-Adrenergic blockade initially will worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs. 24. A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patients blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure >90 mm Hg. c. Monitor the patients blood pressure and heart rate every hour. An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive medications, and monitoring for serious complications such as extravasation require RN level education and scope of practice. [Show Less]
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Ch 13 Crisis Intervention Test Bank Question well answered 2023
1. Crises occur when an individual: A. Is exposed to a precipitating stressor B. Perceives a stressor to be threatening C. Has no support system D. E... [Show More] xperiences a stressor & perceives coping strategies to be ineffective Answer: D 2. Amanda's mobile home was destroyed in a tornado. She received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. What is this type of crisis called? A. Crisis resulting from traumatic stress B. Maturational/developmental crisis C. Dispositional crisis D. Crisis of anticipated life transitions Answer: A 1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. ANS: D The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance. 2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis ANS: B The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or inability to assume personal responsibility. 3. A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this clients crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6. ANS: D The nurse should identify that a realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific, measurable, realistic, and contain a time frame. 4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations ANS: C The priority nursing diagnosis for this client is Risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes on the basis of potential safety risk to the client and/or others. Nursing diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is determined to be potential. 5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. Are you currently thinking about harming yourself? B. Why do you want to harm yourself? C. Have you thought about the consequences of your actions? D. Who is your emergency contact person? ANS: A The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should prioritize safety by assessing the client for thoughts of self-harm. 6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior. ANS: D The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client and does not reinforce appropriate behavior. 7. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. You've really been helpful. Can I count on you for continued support? B. I don't work out anymore. C. I'm really glad I didn't go home. It would have been hard to come back. D. I carry mace when I jog. It makes me feel safe and secure. ANS: D The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. 8. A despondent client, who has recently lost her husband of 30 years, tearfully states, Ill feel a lot better if I sell my house and move away. Which nursing reply is most appropriate? A. I'm confident you know what's best for you. B. This may not be the best time for you to make such an important decision. C. Your children will be terribly disappointed. D. Tell me why you want to make this change. ANS: B During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. The nurse should also assist the client in determining whether any changes are realistic and if timing of change is appropriate. This response encourages the client to think through what may be an impulsive decision. 9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers. ANS: B The nurse should assess that tense facial expressions and body language may indicate that a clients anger is escalating. The nurse should conduct a thorough assessment of the clients past and current violent behaviors and develop interventions for de-escalation. 10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger ANS: C The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst is to process feelings and concerns related to the witnessed intervention. 11. Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? Select all that apply. A. Tell me what happened. B. What coping methods have you used, and did they work? C. Describe to me what your life was like before this happened. D. Lets focus on the current problem. E. Ill assist you in selecting functional coping strategies. ANS: A, B, C In the assessment phase, the nurse should gather information regarding the precipitating stressor and the resulting crisis. Focusing on the current problem and selecting functional coping strategies are nursing interventions rath [Show Less]
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Pathophysiology Chapter 2- Test Bank Question rated A+
Insensible fluid loss refers to water lost through: A) perspiration only. B) feces only. C) perspiration and expiration. D) urine and feces. C ... [Show More] When the osmotic pressure of the blood is elevated above normal, water would shift from the: A) blood into the cells. B) interstitial compartment into the cells. C) interstitial compartment into the blood. D) cells into the interstitial compartment. C Which of the following would result from a deficit of plasma proteins? A) Increased osmotic pressure B) Decreased osmotic pressure C) Increased hydrostatic pressure D) Decreased hydrostatic pressure B Which of the following would cause edema? A) Decreased capillary hydrostatic pressure B) Increased capillary osmotic pressure C) Decreased capillary permeability D) Increased capillary permeability D Which of the following would likely be related to an elevated hematocrit reading? A) Fluid excess B) Fluid deficit C) Increased sodium level D) Decreased erythrocytes B Which of the following is a typical sign of dehydration? A) Rapid, strong pulse B) Low hematocrit C) Increased urine output D) Rough oral mucosa D Which of the following terms refers to a combination of decreased circulating blood volume combined with excess fluid in a body cavity? A) Dehydration B) Third-spacing C) Hypovolemia D) Water retention B Which of the following is the primary cation in the extracellular fluid? A) Sodium B) Potassium C) Calcium D) Iron A Which of the following is a common cause of hyponatremia? A) Loss of the thirst mechanism B) Excessive sweating C) Excessive aldosterone secretion D) Prolonged period of rapid, deep respirations B Which of the following is a common effect of both hypokalemia and hyperkalemia? A) Skeletal muscle twitch and cramps B) Oliguria C) Elevated serum pH D) Cardiac arrhythmias D Choose the correct effect of increased parathyroid hormone. A) Increased movement of calcium ions into the bones B) Increased activation of vitamin D C) Increased absorption of calcium from the digestive tract D) Decreased reabsorption of calcium in the kidneys C Which of the following results from hypocalcemia? 1. Low serum phosphate levels 2. Nausea and constipation 3. Skeletal muscle twitch and spasms 4. Weak cardiac contractions A) 1, 2 B) 1, 4 C) 2, 3 D) 3, 4 D Which of the following causes tetany? A) Increased permeability of nerve membranes due to low serum calcium B) Excess calcium ions in skeletal muscle due to excess parathyroid hormone (PTH) C) Excess calcium ions inside somatic nerves as a result of neoplasms D) Increased stimulation of the nerves in the cerebral cortex A [Show Less]
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AP Gov Test Bank Chapter 7 Question with correct solution 2023
1) High-tech politics refers to A) a politics in which the behavior of citizens and policymakers is shaped by technology. B) a proposal for direct de... [Show More] mocracy through the use of telephone voting. C) a futuristic society in which politics is controlled by computers, freeing people for more honorable pursuits. D) the use of cable television to broadcast the workings of the government. E) the ability of government to observe the behavior of citizens through electronic means. A) a politics in which the behavior of citizens and policymakers is shaped by technology. 2) A media event is A) a news event deemed of such importance to break into regular programming on television and radio. B) a gathering of people working in the media industry, often an awards ceremony. C) some newsworthy occurrence covered by reporters of the various media. D) staged primarily for the purpose of being covered by the press. E) a setup by the media to ambush or embarrass a prominent person. D) staged primarily for the purpose of being covered by the press. 3) A ________ is staged by a campaign primarily for the purpose of being covered on television and in the press. A) media event B) TV commercial C) political incident D) ʺGet Out the Voteʺ effort E) political play A) media event 4) Media events are A) spontaneous occurrences such as train wrecks or assassinations that we normally think of as news. B) monopolized by political elites. C) purposely staged events held in front of the media. D) spontaneous events used to enhance image. E) ineffective when used by political radicals. C) purposely staged events held in front of the media. 5) Purposely staged activities held in front of the media are called A) trial balloons. B) media events. C) political dramas. D) press conferences. E) news. B) media events. 6) Approximately ________ of presidential campaign spending is for TV ads. A) 40 percent B) 20 percent C) 60 percent D) 80 percent E) 90 percent C) 60 percent 7) According to the text, Ronald Reaganʹs presidency was characterized by A) more concern and energy devoted to the presidentʹs media appearances than in any other administration. B) a number of spontaneous media appearances by the president designed to take advantage of his Hollywood experience. C) considerable animosity between the media and the administration. D) Reaganʹs frequent false statements which were later documented by reporters to be either errors or deliberate lies. E) attempts to avoid media appearances by the president. A) more concern and energy devoted to the presidentʹs media appearances than in any other administration. 8) News management in the Reagan White House operated on each of the following principles EXCEPT A) talk about the issues you want to talk about. B) control the flow of information. C) expand reportersʹ access to the president. D) revving helicopter engines so the president would not be able to hear reportersʹ questions and not have to answer them. E) stay on the offense. C) expand reportersʹ access to the president. 9) Up until the presidency of Franklin Roosevelt, A) reporters did not ask presidents questions, they simply reported what presidents did. B) presidents held daily press conferences. C) presidents held private chats with reporters in a very informal setting rather than hold public press conferences. D) reporters submitted their questions to presidents in writing. E) reporters had fireside chats with presidents in the White House. D) reporters submitted their questions to presidents in writing. 10) The first president to manipulate media politics with many press conferences and fireside chats successfully was A) Ronald Reagan. B) Franklin Roosevelt. C) Lyndon Johnson. D) Abraham Lincoln. E) John F. Kennedy. B) Franklin Roosevelt. 11) In what was a very different era, the press chose not to point out to readers or to photograph the fact that President ________ was confined to a wheelchair. A) Warren Harding B) Harry Truman C) Dwight Eisenhower D) Lyndon Johnson E) Franklin Roosevelt E) Franklin Roosevelt 12) Why did President Roosevelt become silent during the last minute of a radio address during a reelection campaign? A) Political pranksters from the Republican party disabled the power supply to the radio station. B) He wanted to reduce the size of his opponentʹs audience. C) The radio station director disliked the positions Roosevelt was taking and cut him off. D) He talked for so long that he lost his voice. E) The radio station cut him off because he had exceeded his time limit. B) He wanted to reduce the size of his opponentʹs audience. 13) Which president held one thousand press conferences, far more than any other? A) John F. Kennedy B) Richard Nixon C) Ronald Reagan D) Franklin Roosevelt E) Bill Clinton D) Franklin Roosevelt 14) When the First Amendment was written guaranteeing freedom of the press, A) the penny press was prevalent. B) there was virtually no daily press in this country. C) only the largest cities had a daily press. D) the press was owned by the government. E) the telegraph was revolutionizing the newspaper industry and stimulating the rapid spread of daily newspapers throughout the country. B) there was virtually no daily press in this country. 15) Prior to the 1930s, A) press conferences were held twice a week. B) the president was rarely directly questioned by the media. C) the media was dominated by a few influential newspapers. D) image-building was essentially built around radio broadcasting. E) the president catered to the local, rather than the national, press. B) the president was rarely directly questioned by the media. 16) The first president to successfully utilize media politics was A) Ronald Reagan. B) Richard Nixon. C) George Washington. D) Abraham Lincoln. E) Franklin Roosevelt. E) Franklin Roosevelt. 17) Which of the following statements about Franklin Roosevelt and the news media is FALSE? A) Roosevelt used presidential wrath to warn reporters off material he did not want covered. B) The press revered Roosevelt. C) Roosevelt knew how to feed the right story to the right reporter. D) The press often reported on Rooseveltʹs health and confinement to a wheelchair. E) none of the above D) The press often reported on Rooseveltʹs health and confinement to a wheelchair. 18) The cozy relationship between politicians and the press in the twentieth century lasted until A) the Iranian Hostage Crisis. B) World War II. C) the commercialization of television. D) the beginning of Franklin Rooseveltʹs presidency. E) the Vietnam War and Watergate. E) the Vietnam War and Watergate. 19) The use of detective-like reporting methods to unearth scandals is known as A) yellow journalism. B) trial balloons. C) scientific journalism. D) investigative journalism. E) print journalism. D) investigative journalism. 20) The cozy relationship between politicians and the press ended when A) the Vietnam War and Watergate soured the press on government. B) the press discovered John F. Kennedy in a compromising situation with a woman other than his wife. C) Franklin Roosevelt chastised the news reports he deemed inaccurate. D) Ronald Reagan began to manipulate the press to his advantage. E) Abraham Lincoln nationalized major Union newspapers during the Civil War. A) the Vietnam War and Watergate soured the press on government. 21) Todayʹs news people work in an environment of ________ toward government. A) friendship B) cynicism C) hostility D) trust E) acceptance B) cynicism 22) At the turn of the century, newspaper magnates Joseph and William Randolph Hearst ushered in the era of A) yellow journalism. B) nickel tabloids. C) newspaper chains. D) penny press. E) political advertising. A) yellow journalism. 23) The first daily newspaper in America was A) the Associated Press established in 1841. B) The New York Times established in 1800. C) printed in Philadelphia in 1783. D) the Colonial Gazette printed in 1607. E) Common Sense printed in 1776. C) printed in Philadelphia in 1783. 24) Since Kennedy, A) news coverage of presidential candidates has become increasingly less favorable. B) the news media have reduced their coverage of presidential candidates. C) the amount of news coverage of presidential candidates has increased dramatically. D) coverage of issues in presidential campaigns has increased dramatically. E) emphasis of campaign reporting has changed dramatically from ʺwhyʺ to a simpler, descriptive ʺwhatʺ format. A) news coverage of presidential candidates has become increas [Show Less]
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