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Complex Adult Health Exam II
Complex Adult Health Exam II
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1
Which findings are the early signs of hypovolemic shock due to compensatory efforts?
delayed cap refill
pallor
Anxiety
BP 110/70
Restlessness
bradycardia
2
CRRT is preferred for critically ill clients w/ fluid vol overload. Why's CRRT preferred over intermittent hemodialysis?
IHD can result in multi system organ failure
IHD can lead to severe hemodynamic instability
IHD may lead to severe hypertension
IHD may worsen fluid overload
3
priority action?
Anticipate an order to administer IV dobutamine
prepare for cardiopulmonary resuscitation
Furosemide was effective: document
readings are inaccurate: zero transducer
4
what is the normal central venous pressure (CVP) range?
2-12 mmHg
2-8 mmHg
6-12 mmHg
6-8 mmHg
5
which findings are consistent with with Addison's disease?
Severe headache
hyponatremia
Hyperpigmentation of skin
hypoglycemia
Tachycardia
Hypokalemia
6
how much fluid is administered over first 8 hours of fluid resuscitation?
75% calculated fluid
30% Calculated fluid
50% calculated fluid
7
top 3 priority findings?
Bilateral lower lobe crackles
28 mL urine output in the past hour
Dyspnea
fatigue
8
A PT can generally compensate for a fluid loss of up to 15% of total blood volume (750mL)
True
False
9
A nurse is triaging four clients in the emergency room. Which client is most at risk of developing obstructive shock?
a pt with bacterial meningitis
a pt who has been vomitting w/ diarrhea for a week
a pt who is tachy w/ PVCs
A pt with a pulmonary embolism
10
client has a mean arterial pressure of 120 mmHg with an intracranial pressure of 42 mmHg. what is the CVP?
162
84
78
36
11
what is priority to reduce risk in patients with arterial lines?
restrain the extremity to reduce movement
obtain x ray to confirm placement
apply a pressure dressing over the line
ensure al tubing connections are secure
12
PT admitted to the intensive care unit in Addisonian crisis. Which laboratory assessment findings are anticipated?
K 6.1 mEq/L
Tachycardia
pH 7.28
Bicarbonate 18 mEq/L
glucose 50 mg/dl
Na 130 mEq/L
13
For which clients should the nurse plan to complete a focused assessment for end-stage liver disease (ESLD)?
70yo with htn and exposure to severe acute respiratory syndrome coronavirus
57yo with nonalcoholic fatty liver disease and unexplained weight loss
63-year-old smoker with COPD who drinks 6 beers a wee
16yo girl with a history of CF in her first well-woman check-up
14
PT with hypothyroid after thyroidectomy is in the ed after stopping levothyroxine therapy last year. Which findings?
decreased LOC progressing to coma
hyperthermia & an signs of heart failure
laryngeal stridor and vocal hoarsness
Exophthalmos and cardiac dysrhythmias
15
A client is seen in the emergency department with bright red, profuse hematemesis. Nurse’s initial priority?
Insert an indwelling urinary catheter and nasogastric tube
Perform a gastric lavage with cool tap water.
Perform a focused nursing assessment of the client’s status.
Establish an intravenous (IV) site with a large-gauge catheter.
16
for ESLD. Which abnormal laboratory result should the nurse anticipate in the PT EHR
Decreased magnesium level
Increased ammonia level
increased creatinine level
Increased calcium level
17
The ____ gland is responsible for the production and release of antidiuretic hormone (ADH)
Adrenal
pituitary
18
Anticipated findings? continued
Mixed venous o2 sat 40%
CVP 11 mmHg
Cardiac output 3.0 L/min
PAWP 5 mmHg
CVP 2 mmHg
Central Venous o2 sat 70%
19
was treatment effective?
no, contact provider
no call RRT
yes but still remains hemodynamically abnormal
Yes
20
what findings should be anticipated?
Bilateral crackles in the lungs
Poor skin turgor
Hepatomegaly
JVD
21
what is the parkland formula for fluid resuscitation?
TBSA x 4 mL x Lb
TBSA x 4 mL x KG
22
In fluid volume deficit, urine specific gravity is increased
True
False
23
what medication is given in replacement of ADH (for pts with ADH deficiency)
vasopressin
desmopressin
furosemide
nifedipine
24
a pt has been stung by a bee, which findings are clinical manifestations of anaphylactic shock?
flushed skin
wheezing
Stridor
decreased LOC
Bounding pulses
30 RR
25
cause of seizure?
Viral infection has led to septic shock.
Hypovolemia causes decreased cerebral perfusion.
The client has an underlying seizure disorder
Administration of sodium-free fluids causes cerebral cellular swelling.
26
PT with ARDS. Which factor contributes to fluid retention during mechanical ventilation?
Increased release of atrial natriuretic factor
Increased insensible water loss via the airway
Decreased release of antidiuretic hormone (ADH)
Decreased renal perfusion with release of renin
27
What is normal pulmonary arterial wedge pressure (PAWP) range?
2 to 8 mmHg
6 to 12 mmHg
6 to 8 mmHg
2 to 12 mmHg
28
PT diagnosed with thyroid cancer and underwent a thyroidectomy 12 hours ago. findings that indicate acute thyrotoxicosis
Hypothermia
Hyperthermia
Dyspnea
Bradycardia
Mental confusion
29
After initial treatment of pt w/ profuse bright-red hematemesis, which lab indicates management has been effective
Urinary output 20 mL/hour
Urine-specific gravity 1.040
Blood urea nitrogen (BUN) decreased from 40 to 25 mg/dL
Hematocrit 38%
30
In fluid volume overload, urine specific gravity is increased
False
True
31
ADH causes cells to _____ water
Reabsorb
Release
32
CRRT is a temporary measure to remove fluid from patients who are hemodynamically unstable
True
False
33
ADH casues renal cells to reabsorb water. This action ___ urine output, concentrating the urine while diluting the ___
decreases, urine
increases, blood
increases, urine
decreases, blood
34
a pt w/ a hx of Addison’s who's undergo hip replacement. Which ismost likely to prevent acute adrenal insufficiency?
Instruct the client about use of an incentive spirometer.
Ensure adequate hydration prior to surgery.
Insert an indwelling urinary catheter.
Administer a supplemental dose of IV hydrocortisone before surgery.
35
A pt has a prescription for iv dobutamine. Which type of shock is treated by this medication?
Distributive
Cardiogenic
Hypovolemic
Obstructive
36
first action?
sit the head of the bed up to 30 degrees
Give 2mg iv morphine
Turn the clients to the right side
Insert a straight cath
37
PT with a small gastrointestinal (GI) bleed from a peptic ulcer. The nurse should anticipate which stool characteristic?
brown formed stool
occult blood in stool
melena
stool with bright red blood
