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Ati nur 211 med surg quiz
Total Questions : 28
Showing 10 questions, Sign in for moreA nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?
A nurse is preparing for the admission of client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client?
A nurse is assessing a toddler who has heart failure. Which of the following findings should the nurse expect?
A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse's priority?
0950:
Awake, alert, oriented x3. Skin warm and dry. Lung sounds clear, heart sounds regular. Bowel sounds normoactive in all 4 quadrants. Denies chest pain or shortness of breath. No edema noted to lower extremities. Oxygen intact at 2 L per nasal cannula. Ambulates to bathroom to void without shortness of breath.
1045:
Reports chest pain rated as 6 on a scale of 0 to 10 with radiation of pain to left jaw and arm. Skin cool and slightly diaphoretic. Respirations labored. Tachypneic. Oxygen administered at 2 L per nasal cannula. Lung sounds clear. Provider notified. New prescriptions received.
0950:
- Temperature 37° C (98.6° F)
- Heart rate 88/min
- Respiratory rate 18/min
- Blood pressure 130/76 mm Hg
- Oxygen saturation 96%
1045:
- Temperature 37° C (98.6° F)
- Heart rate 110/min
- Respiratory rate 22/min
- Blood pressure 140/92 mm Hg
- Oxygen saturation 94%
ECG: Sinus tachycardia with ST elevation noted in all leads with occasional premature ventricular contractions (PVCs)
1045:
Troponin 0.04 ng/mL (less than 0.03 ng/mL)
Troponin T 0.3 ng/mL (less than 0.1 ng/mL)
Creatine kinase-MB 550 U/L (20 to 200 U/L)
Myoglobin 120 mcg/L (less than 90 mcg/L)
A nurse is caring for a client who has coronary artery disease.
For each potential provider's prescription, click to specify if the prescription is a priority or non-priority for the client.
Explanation
Priority:
Aspirin 160 mg PO STAT: Aspirin is an antiplatelet that helps limit clot propagation and reduce infarct size. It should be administered immediately during suspected MI.
Prepare for cardiac catheterization: Cardiac catheterization is used to visualize coronary arteries and assess blockage. Early cath lab evaluation is vital for treatment planning.
Morphine 8 mg IV STAT: Morphine helps relieve chest pain, reduce anxiety, and decrease myocardial oxygen demand, which is crucial in acute MI management.
Prepare for PCI: PCI is the definitive treatment for ST-elevation myocardial infarction (STEMI) and should be performed promptly to restore perfusion.
Non-Priority:
Captopril 12.5 mg PO TID: Although ACE inhibitors are part of long-term management for CAD and heart failure, they are not a priority during the acute phase of MI.
Atenolol 50 mg BID: Beta-blockers can be beneficial, but initiating oral atenolol in an unstable patient with evolving MI should be deferred until the acute event is stabilized.
A nurse in an emergency department is planning care for a client who is having an acute myocardial infarction (MI). The nurse should plan to administer which of the following medications after the initial acute phase to manage the client's pain and anxiety?
0900:
History of present illness:
Client presents to the emergency department reporting acute onset of back pain that started this morning. Client reports pain as 8 on a scale of 0 to 10. Client also reports feeling dizzy and weak.
Past medical history: Diabetes mellitus type 2, hypertension
Surgical history: Appendectomy at age 23 years
Family history:
Father: History of prostate cancer
Mother: Died of "old age"
Diagnostic Results
Provider Prescriptions
0900:
- Blood pressure 136/84 mm Hg
- Heart rate 111/min
- Respiratory rate 20/min
- Temperature 37° C (98.6° F)
0920:
- Blood pressure 150/86 mm Hg
- Heart rate 120/min
- Respiratory rate 24/min
- Temperature 37° C (98.6° F)
A nurse is caring for a client in the emergency department.
Which of the following interventions should the nurse expect when planning care for this client? (Select All that Apply.)
A nurse is caring for a client who has an elevated potassium level and is on a cardiac monitor. The nurse is aware that hyperkalemia may be associated with changes to the T-wave. On the graphic, point and click on the area of the electrocardiogram (ECG) that represents the T-wave. (Selectable areas, or "Hot Spots," can be found by moving your cursor over the artwork until the cursor changes appearance, usually into a hand. Click only on the Hot Spot that corresponds to your answer.)
Explanation
The T-wave on an electrocardiogram (ECG) represents the repolarization of the ventricles. In cases of hyperkalemia, T-waves may appear tall and peaked, which is an important characteristic to identify.
A nurse is providing care for a client who experienced a myocardial infarction prior to a cardiac arrest. Which of the following laboratory tests will identify early injury to the cardiac muscle?
A nurse is planning to teach a community group about preventative measures for heart disease. Which of the following recommendations should the nurse include in the teaching plan? (Select All that Apply.)
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