MedSurg fluids and electrolytes practice quiz 1

1/8/2016 Guided Learning #1: NURS 4390 01 16WQ Adult Health Theory

https://seattleu.instructure.com/courses/1557406/quizzes/2291906 1/10

Guided Learning #1Due Jan 8 at 8pm Points 15 Questions 15Available Jan 4 at 7:30am - Jan 8 at 8pm 5 days Time Limit None

Attempt History

Attempt Time Score

LATEST Attempt 1 2301 minutes 10.35 out of 15

Score for this quiz: 10.35 out of 15Submitted Jan 7 at 9:52pmThis attempt took 2301 minutes.

0.6 / 1 ptsQuestion 1

A client with obesity diagnosed with pulmonary embolism (PE). Whatassessment data would the nurse expect to find? Selct all that apply.

Increased respiratory rate Correct!

Increased respiratory rate would be likely as the client tries to meet the body's oxgyen demand

Diminished lung sounds Correct!

When the chest is full of air as it is in chronic lung disease, lung and heartsounds will likely be diminished.

Bradycardia

non-productive cough You Answered

Increased hemoglobin Correct Answer

Expiratory wheezing Correct!

Productive cough Correct!

https://seattleu.instructure.com/courses/1557406/quizzes/2291906/history?version=1



1 / 1 ptsQuestion 2

The nurse analyzes the results of a patient's arterial blood gas (ABG). Whatfinding would require immediate action?

The partial pressure of oxygen in arterial bood (PaO2) is 59 mmHg

Correct!

The bicarbonate level (HCO3) is 31 mEq/L

The arterial oxygen saturation (SaO2) is 90%

The partial pressure of CO2 in arterial blood (PaCO2) is 31 mmHg

0 / 1 ptsQuestion 3

A client with chronic obstructive pulmonary disease (COPD) is admitted forpneumonia. The client is restless. The nurse identifies a diagnosis of impaired gasexchange. Which intervention is most effective in promoting adequate gasexchange?

Administer morphine 1-2 mg intravenously as prescribed

Maintain intravenous normal saline infusion at prescribed rate of125 mL/hr

Position head of bed in semi-Fowler's position You Answered

Positioning the client in high, rather than semi-Fowler's, position wouldbe more effective in relieving difficulty breathing.

Administer oxygen using Venturi mask as prescribed Correct Answer

1 / 1 ptsQuestion 4



A client with a left pleural effusion undergoes a thoracentesis and 900 mL ofexcess pleural fluid is removed. Which of these manifestations, if noted on thepost-procedure assessment, should the nurse report to the health care providerimmediately?

Client complains of 6/10 pain at the needle insertion site

Respiratory rate 24/min, pulse oximetry 94% on oxygen at 2Lnasal cannula

Aysmmetrical chest expansion and decreased breath sounds onthe left

Correct!

Decreased chest expansion with inspiration and breath sounds on theaffected side, tachypnea, tracheal deviation to the opposite side, andhyperresonance (air) on the affected side are manifestations of a tensionpneumothorax. These should be reported immediately.

Blood pressure of 100/65 (mean arterial pressure 77 mm Hg)

1 / 1 ptsQuestion 5

The nurse is caring for a client with a chest tube to evaluate a hemothorax after amotor vehicle accident. The drainage has been consistently 25-50 mL for themajority of the shift. However, over the past 2 hours there has been no drainage.What actions should the nurse take? Select all that apply.

Reposition the client Correct!

If a client has been in one position for a prolonged period, drainage mayaccumulate and a position change may facilitate drainage.

Instruct the client to cough and deep breathe Correct!

Coughing and deep breathing facilitates drainage.

Increase amount of suction

Auscultate breath sounds Correct!



Ausculatating breath sounds helps the nurse detect whether breath sounds are audible in all lung fields, potentially indicating that the lung as re-expanded and there is no more drainage.

Milk the chest tube

1 / 1 ptsQuestion 6

Which teaching instructions should the nurse provide to a client with advancedchronic obstructive pulmonary disease (COPD)? Select all that apply.

Take iron to improve anemia

Follow a low-calorie diet

Use an incentive spirometer Correct!

Incentive spirometry gives the client visual feedback and encouragementto take deep breaths. It is used routinely to prevent postoperativeatelectasis. In COPD, the pathopysiology involves structural changes andpermanent airflow limitations that result in trapped air. The client needshelp to expel the air, not get more air into the lungs.

Report increased sputum Correct!

The client with COPD typically will have some mucus producation andcough at baseline. However, the presence of increased dyspnea,increased sputum volume, or sputum purulence indicates bacterialinfection would benefit from antibiotics.

Obtain a pneumococcal vaccine Correct!

The current recommendations are that clients with COPD, regardless ofage, should receive the pneumococcal vaccine. Clients should alsoreceive a yearly influenza virus vaccine.

0 / 1 ptsQuestion 7

The nurse is providing discharge instructions on the proper use of prescribed short-acting beta agonist (SABA) and inhaled corticosteriod (ICS) metered-dose inhalers(MDI) to a client with newly diagonsed asthma. Which instructions should the



nurse include? Select all that apply.

"Use the albuterol inhaler first if needed, then the beclomethasoneinhaler."

Correct Answer

"Omit the beclomethasone if the albuterol is effective."

"Use the beclomethasone inhaler first, then the albuterol, ifneeded."

You Answered

When both MDIs are to be taken at the same time, clients are instructed to take the SABA first to open the airways and then the ICS to provide better delivery of the medication. It is important form the nurse to clarify indications and sequencing as the SABA is a rescue drug taken on an asneeded basis and not always taken with the ICS.

"Take the albuterol inhaler apart and wash it after every use."

"Rinse your mouth well after using the beclomethasone inhalerand do not swallow the water."

Correct!

When using ICS MDI, small particles of the medication are deposited andcan impact the tongue and mouth. Rinsing the mouth and throat wellafter the MDI and not swallowing the water are recommended to helpprevent a Candida infection (thrush) (white spots on the tongue, buccalmucosa, and throat), a common side effect of ICSs. The use of a spacerwith the inhaler can also decrease the risk of developing thrush.

1 / 1 ptsQuestion 8

The clinic nurse is assessing the client's understanding of the tiotripium that hasbeen prescribed for chronic obstructive pulmonary disease (COPD). Whichstatement indicates that the client has a correct understanding of this medication?

"I have been taking tiotropium every time I have difficultybreathing."



"Tiotropium helps control my COPD by reducing inflammation inmy airway."

"I need to rinse my mouth out with water after taking tiotropium."

"A capsule holds the powered medication that I have to put in aspecial inhaler."

Correct!

Tiotriopium (Spirva) is a long-acting, 24-hour, anticholinergic inhaledmedication used to control COPD and is administered most commonlyusing a capsule-inhaler system called the HandiHaler. The poweredmedication dose is contained in a capsule. The client places the capsulein the inhaler device and pushes a button on the side ofthe device whichmakes a hole in the capsule. As the client inhales the powder isdisperesed through the hole. It is important to teach the client how toadminister the medication prior to the first dose, emphasizing that thecapsules should be be swallowed that that the button on the inhaler mustbe pushed to allow for the medication dispersion.

1 / 1 ptsQuestion 9

A client with stable chronic obstructive pulmonary disease (COPD) has beenprescirbed extended-release oral theophylline for the past 2 years. The nursereviews the serum laboratory results. Which value would the nurse report to thehealth care provider immediately?

Theophylline level 23.6 mcg/mL Correct!

Theophylline is a long-acting, slow-release methylxanthinebronchodilator that relaxes bronchial smooth muscles, improvescontractility of the diaphragm, and facilitates mucus transport by the cilia.

Methylxanthines (aminophylline, theophylline) are sometimesadministered in additon to first-line drugs (eg, beta agonists,anticholinergics, corticosteriods) to prevent and treat reversiblebronchospasm in clients with long-standing COPD.

Theophylline has a narrow therapeutic index, and toxicity can occur fromacculumation by reduced clearance or decreased metabolism.Medications, diet, underlying disease, and smoking can affect plasmatheophylline clearance. To provide the desired effect of the drug and limitside effects, serum theophylline levels are monitored periodically (every 6months) to maintain a target blood level of 10-20 mcg/mL. In some casessymptom management may be attained at a lower target range (8-15mcg/mL).



Theophylline level 10.4 mcg/mL

Theophylline 15.3 mcg/mL

Theophylline level 18.0 mcg/mL

0.75 / 1 ptsQuestion 10

A client with a history of degenerative arthritis is being discharged home followingexacerbation of chronic obstructive pulmonary disease (COPD). After reviewingthe discharge medications, the nurse should educate the client about whichtopics? View the following discharge instructions:

Discharge medications

Albuteral: 2 puffs, every 4-6 hours as needed

Prednosine: 40 mg orally, daily

Naproxen: 220 mg orally, twice daily

Tiotropium: 1 capsule inhaled, daily

Select all that apply.

The albuterol canister should not be shaken before use

Dryness of the mouth and throat may occur Correct Answer

Notify the health care provider (HCP) if stools are black and tarry

Correct!

Glucocorticoids such as prednisone, taken in combination with aspirin ornon-steriodal anti-inflammatory drugs (NSAIDS), can increase the risk forgastrointestinal ulceration and bleeding The client should report thepresence of black, tarry stools (melena) to the health care provider as thiscould indicate a GI bleed.

Ringing in the ears may occur Correct!

Ringing in the ears is more commonly seen with salicylates such asaspirin.

Tiotropium capsules should not be swallowed Correct!

Tiotropium capsules should not be swallowed. These capsules areplaced inside the inhaler device.



1 / 1 ptsQuestion 11

The nurse is caring for client with acute respiratory distress secondary to chronicobstructive pulmonary disease (COPD). Blood pressure is 146/86 mm Hg, pulse is110/min, and respirations are 32/min. The respiratory therapiest administersnebulized albuterol as prescribed. One hour after the treatment, the nurseassesses which finding that indicates the drug is producing the therapueticeffect?

Respiratory rate of 24/min Correct!

Albuterol (Proventil) is a short-acting inhaled beta-2 agonist used tocontrol airway obstruction caused by COPD.The therapeutic effect isrelaxaion of the smooth muscles of the airways, which results inimmediate bronchodilation. Bronchodilation decreased airwayresistance, facilitates mucus drainage, decreases the work of breathing,and increases oxygnenation. As a result of these actions, the respiratoryrate will decrease and peak flow will be increased (if tested).

Tremor

Heart rate of 120/min

Constricted pupils


A client with acute dyspnea is scheduled for a computed tomography (CT) scan.Which information obtained by the nurse is a priority to communicate to the healthcare provider before the CT? Select all that apply.

Creatinine level of 1.5 mg/dL Correct Answer

Oxygen saturation of 90% You Answered

Allergy to shellfish Correct!

Aplical pulse of 104

Respiratory rate of 30 You Answered




A client in metabolic alkalosis is admitted to the emergency department, and pulseoximetry (SpO2) indicates that the oxygen saturation is 93%. Which action shouldthe nurse take next?

Administer bicarbonate

Complete a head-to-toe assessment

Obtain repeat arterial blood gas (ABG) You Answered

Place the patient on high-flow oxygen Correct Answer


A client with right lower-lobe pneumonia has been treated with IV antibiotics for 3days. Which assessment data obtained by the nurse indicates that the treatementhas been effective?

Increased tactile fremitus is palpable over the right chest

The client coughs up small amounts of green mucus

Bronchial breath sounds are heard at the right base

The client's white blood cell (WBC) count is 9,000/ LCorrect!


A client with chronic obstructive pulmonary disease (COPD) has a nursingdiagnosis of impaired breathing pattern related to anxiety. Which nursing action ismost appropriate to include in the plan of care?

Suggest the use of over-the-counter sedatives

Discuss a high protein, high-calorie diet with the client

Teach the client how to effectively use pursed lip breathing Correct!



Titrate oxygen to keep saturation at least at 90%

Quiz Score: 10.35 out of 15

MedSurg fluids and electrolytes practice quiz 1

Documents

Transcript of MedSurg fluids and electrolytes practice quiz 1