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Elevate Module 1 Review Quiz | 100% Correct Answers | Verified | Latest 2024 Version, Exams of Clinical Medicine

Stephen F. Austin State University (SFA)Clinical Medicine

Elevate Module 1 Review Quiz | 100% Correct Answers | Verified | Latest 2024 Version

Typology: Exams

2024/2025

Available from 03/19/2025

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Elevate Module 1 Review Quiz | 100% Correct
Answers | Verified | Latest 2024 Version
What clinical manifestation does the nurse expect to see in a client suspected of having hypercalcemia?
1. Tachycardia
2. Positive Chvostek
3. Lethargy
4. Tachypnea
5. Decreased deep tendon reflexes - ✔✔ANS: 3., 5.
3., & 5. Correct: Hypercalcemia is a condition in which the calcium level in blood is above normal. Too
much calcium in blood can weaken bones, create kidney stones, and interfere with heart and brain
function. Hypercalcemia is usually a result of overactive parathyroid glands. Other causes include cancer,
some medications, and taking too much of calcium and vitamin D supplements. Signs and symptoms of
hypercalcemia range from nonexistent to severe. Lethargy and decreased deep tendon reflexes are two
manifestations of hypercalcemia.
1. Incorrect: Bradycardia rather than tachycardia is seen with hypercalcemia. Remember - muscles are
sedated.
2. Incorrect: A Negative Chvostek will be seen with hypercalcemia. It will be positive in hypocalcemia.
4. Incorrect: Hypercalcemia will result in a decreased, rather than increased respiratory rate.
A client has been admitted with a diagnosis of septic shock and has been successfully intubated. The
nurse performs and documents a rapid assessment. Which information from the assessment requires
the most immediate action by the nurse?
Vital Signs: Blood Pressure 92/54 mmHg, Heart Rate 116 bpm, Respiratory Rate 22 breaths/min,
Temperature 103F (39.4C), Oxygen Saturation 91%.
Documentation: Heart tones irregular, distant. Face flushed and warm. Extremities cool and mottled.
Radial pulses faintly palpable. Pedal pulses non-palpable. Denies chest pain. Endotracheal tube taped in
place via oropharynx. Right anterior and posterior lung sounds clear. Unable to hear left lung sounds.
Grimaces with light abdominal palpation over pelvic bone. Urine amber and cloudy with red streaks. 100
mL urine output in foley catheter bag. Opens eyes and moves to command. Pupils equal, round, and
react to light.
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Download Elevate Module 1 Review Quiz | 100% Correct Answers | Verified | Latest 2024 Version and more Exams Clinical Medicine in PDF only on Docsity!

Elevate Module 1 Review Quiz | 100% Correct

Answers | Verified | Latest 2024 Version

What clinical manifestation does the nurse expect to see in a client suspected of having hypercalcemia?

  1. Tachycardia
  2. Positive Chvostek
  3. Lethargy
  4. Tachypnea
  5. Decreased deep tendon reflexes - ✔✔ANS: 3., 5. 3., & 5. Correct: Hypercalcemia is a condition in which the calcium level in blood is above normal. Too much calcium in blood can weaken bones, create kidney stones, and interfere with heart and brain function. Hypercalcemia is usually a result of overactive parathyroid glands. Other causes include cancer, some medications, and taking too much of calcium and vitamin D supplements. Signs and symptoms of hypercalcemia range from nonexistent to severe. Lethargy and decreased deep tendon reflexes are two manifestations of hypercalcemia.
  6. Incorrect: Bradycardia rather than tachycardia is seen with hypercalcemia. Remember - muscles are sedated.
  7. Incorrect: A Negative Chvostek will be seen with hypercalcemia. It will be positive in hypocalcemia.
  8. Incorrect: Hypercalcemia will result in a decreased, rather than increased respiratory rate. A client has been admitted with a diagnosis of septic shock and has been successfully intubated. The nurse performs and documents a rapid assessment. Which information from the assessment requires the most immediate action by the nurse? Vital Signs: Blood Pressure 92/54 mmHg, Heart Rate 116 bpm, Respiratory Rate 22 breaths/min, Temperature 103F (39.4C), Oxygen Saturation 91%. Documentation: Heart tones irregular, distant. Face flushed and warm. Extremities cool and mottled. Radial pulses faintly palpable. Pedal pulses non-palpable. Denies chest pain. Endotracheal tube taped in place via oropharynx. Right anterior and posterior lung sounds clear. Unable to hear left lung sounds. Grimaces with light abdominal palpation over pelvic bone. Urine amber and cloudy with red streaks. 100 mL urine output in foley catheter bag. Opens eyes and moves to command. Pupils equal, round, and react to light.
  1. Lung assessment findi - ✔✔ANS: 1.
  2. Correct: Look at the clues: Endotracheal tube taped in place via oropharynx. Right anterior and posterior lung sounds clear. Unable to hear left lung sounds. The ET tube is likely down in the right main stem bronchus. This means the left lung is not being oxygenated.
  3. Incorrect: The BP is above 90 systolic, so the vital organs are still being perfused. The nurse will definitely keep monitoring, but this is not the priority.
  4. Incorrect: The second priority is to treat the infection that is likely the cause of the temperature elevation. But take care of that airway first.
  5. Incorrect: This is the likely cause of the sepsis, but the priority is to fix the airway problem. Based on the results of the arterial blood gases (ABGs), what imbalance does the nurse understand the client to be exhibiting? ABGs: pH - 7. PaO2 - 95% PaCO2 - 49 HCO3 - 30
  6. Respiratory acidosis compensated
  7. Respiratory acidosis partially compensated
  8. Metabolic acidosis compensated
  9. Metabolic acidosis partially compensated - ✔✔ANS: 1.
  10. Correct: The pH is normal but is on the acidic side of normal. The PaCO2 is elevated, causing acid formation. The HCO3 is alkalotic and is increased to buffer the acid. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now normal.
  11. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low.
  12. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low.
  1. Incorrect: A negative Chvostek's sign is a good thing. It would be positive if the calcium level is low. An intravenous infusion of 0.9% normal saline is prescribed at a rate of 1000 mL in 12 hours. The tubing has a drop factor of 15. How many drops per minute (gtts/min) are delivered? Round your answer to the nearest whole number. Provide your answer using numbers and decimal points only. - ✔✔ANS: 21 The formula used to calculate drop rates is the total number of milliliters divided by the total number of minutes multiplied by the drop factor. In this circumstance, the minutes portion must be figured first, that is, 12 hours equals 720 minutes. Then, dividing 1000 by 720 equals 1.38888889. This is multiplied by the drop factor, which is 15. Multiplying 15 by 1.38888889 equals 20.83, which rounds to 21. A client arrives at the emergency department after being removed from a burning building. The nurse suspects carbon monoxide poisoning when the client exhibits which signs and symptoms?
  2. Almond odor to breath
  3. Blurred Vision
  4. Dull headache
  5. Excess salivation
  6. Respirations 10 - ✔✔ANS: 2., 3., 5. 2.,3. & 5. Correct: Not enough oxygen is getting to the vital organs, such as the brain and heart, so blurred vision, a dull headache and respiratory depression can occur.
  7. Incorrect: An almond odor to the breath is a manifestation of cyanide poisoning.
  8. Incorrect: Excessive salivation can be seen with ingestion of acids or alkalis. The client has pustules on the arm from intravenous drug abuse. The microbiology laboratory informs the nurse that the client's cultures are growing methicillin-resistant Staphylococcus aureus (MRSA). Which action would the nurse take?
  9. Cover the pustules to prevent drainage.
  10. Implement contact precautions immediately.
  11. Instruct the client on the importance of hand hygiene.
  12. Inform the client to wear a mask when ambulating in the hall.
  13. Instruct visitors to wash hands before entering the client's room. - ✔✔ANS: 1., 2., 3., 5.

1., 2., 3. & 5. Correct: The pustules should be covered with a dressing, because MRSA is transmitted via contact! It is important that the nurse implement these interventions in order to prevent the spread of infection. The number one way to prevent the spread of infection is handwashing. That includes the client, staff, and visitors. If the client refuses to follow instructions, then isolation precautions are warranted.

  1. Incorrect: The client is placed on contact precautions not droplet precautions. The client would not need to wear a mask since the infection is not transmitted via the respiratory system. The nurse is caring for a client 8 hours post colectomy who is receiving 40% humidified oxygen. ABG results are: pH= 7.30, pO2= 91, pCO2= 50, HCO3= 24. Based on this information, which nursing action should the nurse initiate?
  2. Reposition the client every 2 hours.
  3. Request respiratory therapy to perform postural drainage and percussion.
  4. Increase oxygen percentage.
  5. Initiate incentive spirometry.
  6. Assess mental status. - ✔✔ANS: 1., 4., 5. 1., 4., & 5. Correct: If you had just a colectomy, would you be taking nice deep breaths? No. So what would you be retaining? CO2, which makes your pCO2 go up and your pH go down. These interventions will help improve gas exchange.
  7. Incorrect: Requesting postural drainage and percussion form respiratory therapy would not be the best nursing action to address the problem of retaining CO2.
  8. Incorrect: How is oxygen going to help this client? It's not until they get rid of what? CO2. And the only way to rid of the CO2 is coughing and deep breathing. An agitated client arrives in the emergency department reporting fatigue, diarrhea, and swelling in the legs. Current health history includes cirrhosis. Current medications include spironolactone 25 mg by mouth every morning. What acid/base imbalance does the nurse anticipate for this client?
  9. Respiratory acidosis
  10. Respiratory alkalosis
  11. Metabolic acidosis
  12. Metabolic alkalosis - ✔✔ANS: 4.
  13. Correct: This client's condition indicates metabolic alkalosis. Reduced volume of blood in the arteries can come from both a weakened heart and from cirrhosis of the liver. A reduced blood flow impairs the body's ability to remove the alkaline bicarbonate ions.
  1. Respiratory acidosis
  2. Metabolic alkalosis
  3. Respiratory alkalosis
  4. Uncompensated
  5. Partially compensated
  6. Fully compensated - ✔✔ANS: 4., 5. 4., & 5. Correct: The blood gases confirm respiratory alkalosis. Why? The pH is 7.46 (normal 7.35-7.45). This pH indicates alkalosis since it is high. Which other chemical says alkalosis? The PaCO2 of 32 (normal 35 - 45) is low which indicates alkalosis. The HCO3 is normal. This means that the client is in uncompensated respiratory alkalosis.
  7. Incorrect: The blood gases confirm respiratory alkalosis. The Bicarb is normal, so the problem is not metabolic.
  8. Incorrect: The blood gases confirm respiratory alkalosis. The PaCO2 of 32 (normal 35-45) is low which indicates alkalosis. For this client to be in respiratory acidosis, the PaCO2 would be greater than 45.
  9. Incorrect: The blood gases confirm respiratory alkalosis. The Bicarb is normal, so the problem is not metabolic.
  10. Incorrect: Compensation has not begun because the bicarb is normal. To compensate the bicarb would need to decrease to bring the pH down to normal.
  11. Incorrect: Fully compensated would occur if the pH is normal with abnormal CO2 and bicarb. A nurse is caring for a client who is on bed rest following admission to the hospital two days ago with a diagnosis of new onset heart failure. While evaluating the client's progress, what assessment findings would indicate to the nurse that further treatment is required?
  12. CVP 5 mmHg
  13. Persistent cough
  14. 4.4 kg weight loss in 24 hours
  15. Ventricular gallop
  16. Urinary output 160 mL/8 hrs
  17. S2 heart sound - ✔✔ANS: 2., 4., 5. 2., 4., & 5. Correct: These are all signs of fluid volume excess seen with heart failure. So further treatment is necessary.
  18. Incorrect: This is a normal CVP value, which would indicate the client is improving.
  1. Incorrect: A weight loss of 4.4 kg in 24 hours is a good thing. Excess fluid is being removed from the body.
  2. Incorrect: S1 and S2 are normal heart sounds. An elderly, confused client with dehydration is admitted to the medical unit. Which intervention would be appropriate for the RN to delegate to the LPN?
  3. Perform a physical assessment.
  4. Start an IV of NS with KCL 20 mEq at 50 mL/hr.
  5. Insert a urinary catheter.
  6. Weigh the client. - ✔✔ANS: 3.
  7. Correct: The LPN can insert a urinary catheter.
  8. Incorrect: This is a new client admit. The RN should perform the physical assessment.
  9. Incorrect: The RN should start an initial IV with a potassium supplement.
  10. Incorrect: This can best be accomplished by the unlicensed assistive personnel (UAP), it can be done by LPN but not best use of resources. The nurse is reviewing morning laboratory results for multiple clients. Which client laboratory results should the nurse immediately report to the Healthcare provider?
  11. Client with chronic obstructive pulmonary disease (COPD) and a PCO2 of 50 mm Hg.
  12. Diabetic client with fasting blood sugar of 145 mg/dL (8.0 mmol/L).
  13. Cardiac client on furosemide with potassium of 3.1mEq/L (3.1 mmol/L).
  14. Client with sepsis and total white blood cell count of 16,000 mm3.
  15. Client following a thyroidectomy with calcium level of 8.0 mg/dL (2 mmol/L). - ✔✔ANS: 3., 5.
  16. & 5. Correct: Although all the laboratory results are outside of standard accepted levels, two particular clients are the most concerning. The cardiac client's potassium level of 3.1 is extremely concerning, since normal potassium levels should be between 3.5-5.0 mEq/L. Hypokalemia can cause muscle weakness and heart arrhythmias, such as PVC's. Secondly, after the client's thyroidectomy, their calcium level is 8. mg/dl (normal 9.0-10.5 mg/dl), indicating possible removal of parathyroid glands. Because hypocalcemia places the client at risk for seizures or laryngospasms as well as arrhythmias, the primary healthcare provider needs to be notified immediately so that corrective therapy can be initiated.
  17. Incorrect: While this client's PCO2 of 50 is elevated (normal is 35-45 mm Hg), this is neither unexpected or unusual for an individual with COPD. This client will frequently experience elevated levels of PCO2; therefore, the nurse should just continue monitoring for any changes in respiratory status.
  1. Incorrect: If the ABGs indicated that compensation had not begun (uncompensated) then the CO would be normal. Since it is high, the lungs are attempting to compensate for the metabolic alkalosis retaining more acid (Decrease breathing to hold on to acid).
  2. Incorrect: Full compensation does not occur until the pH is normal. The pH is still abnormal here. The client presents to the emergency department with nausea, vomiting and anorexia for the last few days. As the nurse connects the client to a cardiac monitor, the client becomes unresponsive, without a pulse. The nurse the rhythm. What action should the nurse take first?
  3. Defibrillate at 200 joules
  4. Administer amiodarone IV 150 mg over 10 minutes
  5. Infuse 500 mL NS with 40 mEq KCL (40 mmol/L) at 100 mL/hour
  6. Begin 2 person cardiopulmonary resuscitation - ✔✔ANS: 1.
  7. Correct: The client has become unresponsive and does not have a pulse. The monitor is showing Ventricular tachycardia. The first action with pulseless V-tach is defibrillation.
  8. Incorrect: Amiodarone is the first action if the client has a pulse with short runs of V-tach.
  9. Incorrect: KCL is needed but we need to treat the short run of v-tach first.
  10. Incorrect: Start CPR after defibrillating if a pulse is not acquired. A nurse educator has completed an educational program on interpreting arterial blood gases (ABGs). The educator recognizes that education was successful when a nurse selects which set of ABGs as compensated respiratory alkalosis?
  11. pH - 7.35, PaCO2 - 45, HCO3 - 22
  12. pH - 7.45, PaCO2 - 32, HCO3 - 20
  13. pH - 7.46, PaCO2 - 34, HCO3 - 26
  14. pH - 7.48, PaCO2 - 44, HCO3 - 28 - ✔✔ANS: 2.
  15. Correct: This set of ABGs indicate compensated respiratory alkalosis. The pH is normal, but on the alkalotic side of normal (normal 7.35-7.45; perfect is 7.4). Both the PaCO2 is low, indicating alkalosis, so it matches the alkalotic pH. The bicarb are abnormal at 20 which indicates acidosis. The bicarb is low to get rid of base. Compensation has occurred.
  16. Incorrect: These are normal ABGs.
  17. Incorrect: This set of ABGs indicates uncompensated respiratory alkalosis. Compensation has not occurred as the pH is still abnormal and the bicarb is still normal.
  1. Incorrect: This set of ABGs indicates uncompensated metabolic alkalosis. The pH is abnormally high (alkalosis). The PaCO2 is normal and the HCO3 are abnormally high (alkalosis). The pH and the HCO3 are both are alkalotic. So we have uncompensated metabolic alkalosis. A nurse is caring for a client that is lethargic and has the following ABGs: pH = 7.33, PaCO2 = 49, HCO3 = 26, O2 = 92%. What medication could have contributed to these blood gases?
  2. Furosemide
  3. Chloral hydrate
  4. Heroin
  5. Methadone
  6. Methylphenidate
  7. Tramadol - ✔✔ANS: 2., 3., 4., 6. 2., 3., 4., & 6. Correct: Yes. These medications typically decrease the respiratory rate, causing respiratory acidosis.
  8. Incorrect: No. Diuretics do not affect breathing patterns.
  9. Incorrect: No. Ritalin (methylphenidate) is a central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. It does not generally cause a problem with the respiratory system. The nurse is caring for a client admitted to the unit with heart failure. Upon entering the room, the nurse notes that the client is agitated, gasping for air, and attempting to sit up. The client states "I can't get my breath". What actions should the nurse take?
  10. Elevate the head of the bed to sitting position
  11. Dangle client's legs over side of the bed
  12. Initiate oxygen at 2 liters per nasal cannula
  13. Initiate IV of lactated ringers
  14. Administer morphine 2 mg IV - ✔✔ANS: 1., 2., 3., 5. 1., 2., 3., & 5. Correct: What are you worried about? The client has heart failure and is now agitated, gasping for air and trying to sit up. The client is in acute distress, likely from pulmonary edema. The first thing the nurse should do is to sit the client up. This allows for better chest expansion, thereby improving pulmonary capacity. By dangling the legs, blood is pooling in the periphery. This decreases the circulating blood volume so that the heart does not have to work as hard and blood will then go in a forward direction rather than going backward to the lungs. Oxygen increases available oxygen for myocardial uptake to combat effects of hypoxia. Morphine decreases vascular resistance and venous return,

potassium is lost (urine) or shifted into the cell in exchange for hydrogen in an attempt to correct alkalosis.

  1. Incorrect: The client is already breathing rapidly, which is the problem and blowing off too much carbon dioxide. The client needs to slow down breathing, by taking slow, deep breaths.
  2. Incorrect: The client does not have an oxygen problem; they have a CO2 problem. Their O2 is normal. A client is being treated for fluid volume deficit with D5W, oral hydration, and management of viral symptoms. Which client data would indicate to the nurse that treatment has been successful?
  3. BP 120/70 lying; 98/68 standing
  4. Bounding pulses
  5. One day weight gain of 5 kg
  6. Urine specific gravity of 1.
  7. Serum sodium 145 mEq (145 mmol/L) - ✔✔ANS: 4., 5. 4., & 5. Correct: With fluid volume deficit, the specific gravity can be expected to be abnormally high. This urine specific gravity is normal. This is a normal sodium level.
  8. Incorrect: The systolic BP has dropped more than 20 mm Hg from lying to standing. This is considered orthostatic hypotension and indicates that the client is still in a fluid volume deficit.
  9. Incorrect: A bounding pulse is an indication of fluid volume excess. We have given the client too much fluid.
  10. Incorrect: This weight gain for one day is way too much. This indicates that we have put the client into fluid volume excess, which is a problem. A client arrives at the emergency department (ED) after sustaining a high-voltage electrical injury. Which interventions should the nurse initiate in the ED?
  11. Determine body surface area injured using the Lund and Browder Method.
  12. Draw blood for cardiac enzymes.
  13. Infuse Lactated Ringers to maintain hourly urine output between 75-100 mL/hr.
  14. Obtain 12 lead electrocardiogram (EKG).
  15. Remove nonadherent clothing. - ✔✔ANS: 2., 3., 4., 5. 2., 3., 4 & 5. Correct: These are correct interventions for the nurse to initiate when caring for a client who has sustained a high-voltage electrical injury. Remember, electricity kills vessels, nerves, and organs. So the heart can be damaged. We need to assess damage by drawing blood for cardiac enzymes, and by

obtaining a 12 lead EKG. Large-bore IV access and large-volume fluid resuscitation is important in patients with anything more than a very minor low-voltage injury. Fluids should be titrated to produce adequate urine output (75 to 100 mL/hr in adults or 1 mg/kg/hr in children). Remove nonadherent clothing so that proper inspection and care can be provided.

  1. Incorrect: The Lund and Browder method would not be used for an electrical injury. Visual examination is not predictive of burn size and severity with an electrical burn injury. The community health nurse has been educating a group of college students living in a dormitory about receiving an immune globulin (IG) injection for hepatitis A virus (HAV). Which statement made by the students would indicate to the nurse that further teaching is necessary?
  2. Immune globulin contains antibiotics that destroy the HAV, preventing infection.
  3. Immune globulin protection is permanent, so no other injection is required.
  4. Common side effects of the injection include soreness and swelling around the injection site.
  5. The sooner you get a shot of IG after being exposed to HAV, the greater the likelihood of protection from the virus.
  6. Crowded living environments such as dormitories place people at risk for HAV. - ✔✔ANS: 1., 2. 1., & 2. Correct: Immune globulin contains antibodies that destroy the HAV, preventing infection. IG protection is only temporary, lasting about 3 months.
  7. Correct:This is a correct statement about immune globulin for Hepatitis A, indicating that teaching has been effective.
  8. Correct:This is a correct statement about immune globulin for Hepatitis A, indicating that teaching has been effective.
  9. Correct: This is a correct statement about immune globulin for Hepatitis A, indicating that teaching has been effective.