NURS 231 / NURS 231 FINAL EXAM (Latest 2021 / 2022): Multidimensional Care IV / MDC 4 - Rasmussen 2021

NURS 231 / NURS 231
FINAL EXAM (Latest
2021 / 2022):
Multidimensional Care
IV / MDC 4 - Rasmussen
2021


A patient is receiving dobutamine [Dobutrex] as a continuous infusion
in the immediate postoperative period. The patient also is receiving a
diuretic. What adverse drug reactions are possible in this patient?
(select all that apply)
a)Angina
b)Hypotension
c)Dysrhythmias
d)Oliguria
e)Tachycardia - ANSWER-a)Angina
c)Dysrhythmias
e)Tachycardia
RATIONALE*Is a beta1 aderenergic agonist; general anesthetics can
increase the likelihood of dysrhythmias. Dobutamine elevates BP by
increasing CO. Diuretics complement the beneficial effects of
dobutamine on the kidney, so urine output would be increased, not
decreased.
A patient who has severe sepsis is receiving an intravenous normal
saline infusion. She weighs 78 kgs. Which of the following is an
indicator that the therapeutic goal has been met?
a) 250 mL of urine in the past 6 hours
b) Arterial blood pressure is 90/42
c) Central Venous Pressure is 2 mm Hg
d) Patient's heart rate is 101 - ANSWER-a) 250 mL of urine in the past 6
hours
RATIONALE*Fluid resuscitation goals in sepsis are: MAP > 65, UO . 0.5
mL/kg/hr, and/or CVP 8-12 mm Hg.
The nurse is preparing to administer lisinopril (Zestril) to a patient with
acute coronary syndrome. Which of the following findings should
prompt the nurse to hold the medication and consult the healthcare
provider?
a) Serum sodium level 134
b) Serum potassium 5.6
c) Heart rate 58
d) Blood pressure 125/78 - ANSWER-b) Serum potassium 5.6
RATIONALE*ACE inhibitors can cause/exacerbate hyperkalemia.
The nurse is caring for a patient who is in hypovolemic shock following
an extensive burn injury. What is the intravenous fluid of choice for this
patient in the emergent phase of treatment?
a) Lactated Ringers
b) 0.45 NS with 20 mEq potassium chloride
c) Fresh Frozen Plasma
d) 5% Dextrose in saline - ANSWER-a) Lactated Ringers
RATIONALE*Isotonic solutions (crystalloids) are used to restore fluid
volume in patients with shock. Lactated Ringers is isotonic. Normal
saline is also isotonic.
The client on a ventilator is assessed for untoward responses to the
therapy. Which of the following would indicate a possible complication
of ventilator therapy?
a) Blood pressure has increased 5mmHg in the last 24 hours
b) Lung sounds absent on one side.
c) Forceful cough periodically
d) Broncho-vesicular breath sounds throughout peripheral lung fields. -
ANSWER-b) Lung sounds absent on one side.
RATIONALE*This may indicate a pneumothorax--a complication caused
by barotrauma.
The nurse is caring for Mrs. B, who has a pulmonary embolus. She is
started on a heparin drip and 4 hours later the aPTT is 70 seconds (lab
control or "normal" value is 40 secs). The nurse should:
a) Notify the provider and request an order for warfarin (Coumadin).
b) Notify the provider and request a decrease in the heparin dose.
c) Continue the present order for heparin.
d) Hold the heparin and notify the physician. - ANSWER-c) Continue the
present order for heparin.
RATIONALE*The aPTT is therapeutic for a heparinized patient with a PE.
A therapeutic aPTT for a heparinized patient is 1.5-2x the "normal" or
"control" value. Review also the heparin protocol calculations. We did
an example on the PE case study.