Question 1

For which patient might the nurse use the nursing diagnosis of Risk for Ineffective Renal Tissue Perfusion?

Accepted Answer

A)  Patient with hypertension who is noncompliant with medication administration 
B)  Patient with angina who takes nitroglycerine when experiencing chest pain 
C)  Patient diagnosed with pneumonia, becoming short of breath with activity 
D)  Patient with a hemorrhagic stroke secondary to head trauma 
A)  Patient with hypertension who is noncompliant with medication administration 
B)  Patient with angina who takes nitroglycerine when experiencing chest pain 
C)  Patient diagnosed with pneumonia, becoming short of breath with activity 
D)  Patient with a hemorrhagic stroke secondary to head trauma

Question 2

The nurse plans to maintain hydration for the patient at risk for thrombus formation.What evaluation finding is an indicator that the intervention is successful?

Accepted Answer

A)  The patient denies pain in the lower legs. 
B)  The patient denies chest pain or difficulty breathing 
C)  Urine output exceeds 1,500 mL per 24-hour period. 
D)  There is a weight gain of 5 pounds within 24 hours. 
A)  The patient denies pain in the lower legs. 
B)  The patient denies chest pain or difficulty breathing 
C)  Urine output exceeds 1,500 mL per 24-hour period. 
D)  There is a weight gain of 5 pounds within 24 hours.

Question 3

A patient diagnosed with hypertension is taking an angiotensin-converting enzyme (ACE)inhibitor.When planning care,which of the following outcomes would be appropriate for the patient?

Accepted Answer

A)  BP will be lower than 135/85 on all occasions. 
B)  BP will be normal after 2 to 3 weeks on medication. 
C)  Patient will not experience dizziness on rising. 
D)  Urine output will increase to at least 50 mL/hr. 
A)  BP will be lower than 135/85 on all occasions. 
B)  BP will be normal after 2 to 3 weeks on medication. 
C)  Patient will not experience dizziness on rising. 
D)  Urine output will increase to at least 50 mL/hr.

Question 4

The nurse administers a beta-adrenergic agent to a patient with congestive heart failure.What assessment findings would indicate the drug was working?

Accepted Answer

A)  Heart rate changes from 92 beats/min to 76 beats/min. 
B)  Cardiac monitor shows narrowing of the QRS segment. 
C)  There is tingling in the fingers and toes. 
D)  There is increased urine output. 
A)  Heart rate changes from 92 beats/min to 76 beats/min. 
B)  Cardiac monitor shows narrowing of the QRS segment. 
C)  There is tingling in the fingers and toes. 
D)  There is increased urine output.

Question 5

The nurse is providing teaching for a weight loss group on the cardiac dangers of obesity.Which statement,if made by the nurse,would be incorrect?

Accepted Answer

A)  "Obesity increases the risk of atherosclerosis." 
B)  "Obesity increases the risk of hypertension." 
C)  "Obesity can reduce pumping action of the heart." 
D)  "Tissue perfusion is diminished by obesity." 
A)  "Obesity increases the risk of atherosclerosis." 
B)  "Obesity increases the risk of hypertension." 
C)  "Obesity can reduce pumping action of the heart." 
D)  "Tissue perfusion is diminished by obesity."

Question 6

The nurse is assessing a patient who is complaining of chest pain,clutching his chest,and is short of breath.Which assessment question would be appropriate for the nurse to ask?

Accepted Answer

A)  "Please describe your pain, its location, and what you've done to treat it." 
B)  "Does the pain radiate to your arm, jaw, or shoulder?" 
C)  "What are your current medications including supplements or vitamins?" 
D)  "What is your medical history beginning with most recent?" 
A)  "Please describe your pain, its location, and what you've done to treat it." 
B)  "Does the pain radiate to your arm, jaw, or shoulder?" 
C)  "What are your current medications including supplements or vitamins?" 
D)  "What is your medical history beginning with most recent?"

Exam 37: Circulation

For which patient might the nurse use the nursing diagnosis of Risk for Ineffective Renal Tissue Perfusion?

The nurse plans to maintain hydration for the patient at risk for thrombus formation.What evaluation finding is an indicator that the intervention is successful?

A patient diagnosed with hypertension is taking an angiotensin-converting enzyme (ACE)inhibitor.When planning care,which of the following outcomes would be appropriate for the patient?

The nurse administers a beta-adrenergic agent to a patient with congestive heart failure.What assessment findings would indicate the drug was working?

The nurse is providing teaching for a weight loss group on the cardiac dangers of obesity.Which statement,if made by the nurse,would be incorrect?

The nurse is assessing a patient who is complaining of chest pain,clutching his chest,and is short of breath.Which assessment question would be appropriate for the nurse to ask?

Evolution of Nursing Thought Action

Critical Thinking: Nursing Process

Nursing Process: Assessment

Nursing Process: Diagnosis

Nursing Process: Planning Outcomes

Nursing Process: Planning Interventions

Nursing Process: Implementation Evaluation

Evidence-Based Practice: Theory Research

Life Span: Infancy Through Middle Adulthood

Life Span: Older Adults

Experiencing Health Illness

Stress Adaptation

Psychosocial Health Illness

The Family

Culture Ethnicity

Spirituality

Loss,Grief, Dying

Documenting Reporting

Teaching Learning

Measuring Vital Signs

Communication Therapeutic Relationships

Health Assessment

Promoting Asepsis Preventing Infection

Promoting Safety

Facilitating Hygiene

Administering Medications

Nutrition

Urinary Elimination

Bowel Elimination

Sensation,Perception, Cognition

Pain

Physical Activity Mobility

Sexual Health

Sleep and Rest

Skin Integrity-Wound Healing

Oxygenation

Fluids,Electrolytes, Acidbase Balance

Perioperative Care

Leading Managing

Nursing Informatics

Promoting Health

Community-Home Health Nursing

Ethics Values

Legal Accountability

Holistic Healing

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