Adult health practice questions
A client is in the preoperative holding area prior to an emergency coronary artery bypass graft (CABG). The client is yelling at family members and tells the doctor to "just get this over with" when asked to sign the consent form. What action by the nurse is best?
- Ask the family members to wait in the waiting area. - Inform the client that this behavior is unacceptable. -Stay out of the room to decrease the client's stress levels. - Tell the client that anxiety is common and that you can help.
what area of the heart's electrical conduction is known as the "pacemaker" of the heart
- SA node - bundle of his - purkinije fibers - AV node
a nurse teaches clients at a community center about risks for dehydration. which client is at greatest risk for dehydration?
- a 76 year old who is cognitively impaired - a 36 year old who is prescribing long term steroid therapy - an 83 year old with congestive heart failure - a 55 year old receiving hypertonic IV fluids
a nurse prepares to defibrillate a patient who is in ventricular fibrillation. Which priority intervention would the nurse perform prior to defibrillating this patient?
- administer 1 mg of intravenous epinephrine - ensure that everyone is clear of contact with the patient and the bed - make sure that the defibrillator is set to the synchronous mode - test the equipment by delivering a smaller shock at 100 J
A nurse cares for a patient with atrial fibrillation who reports fatigue when completing activities of daily living. what interventions would the nurse implement to address this patient's concerns?
- administer oxygen therapy at 2 L per nasal cannula - schedule periods of exercise and rest during the day - provide the patient with a sleeping pill to stimulate rest - ask unlicensed assistive personnel to help bathe the patient
after trying to modify her lifestyle to control her primary hypertension, the patient recently was placed on medication. All of the medications listed below could be used but which category of medication would the nurse most likely expect the patient to be started on initially?
- angiotensin receptor blockers (ARBS) - alpha beta blocker - calcium channel blocker - thiazide diuretic
A nurse is caring for a client who exhibits dehydration- induced confusion. what intervention should the nurse implement first?
- apply oxygen by mask or nasal cannula - measure intake and output every 4 hours - increase the IV flow rate to 250 mL/hr - place the client in a high- fowler's position
the patient is admitted for heart failure with edema and neck vein distention. what is the most reliable way to monitor fluid gain or loss in this patient?
- assess skin turgor and condition of mucous membranes - check for pitting edema in lower extremities - accurate I&O every 8 hours - weigh daily at the same time using the same scales
during discharge teaching, the patient asks the nurse how long he will need to take the daily diuretic medication for his essential/ primary hypertension. the nurse correctly responds that his medication
- can be skipped only if he is having no symptoms - will need to be taken every day as prescribed - needs to be adjusted by him according to his daily BP readings - should be discontinued when his BP is consistently 120/80
a nurse cares for a patient who is on a cardiac monitor. The monitor displayed the rhythm shown below. what action would the nurse take first?
- cardiovert the patient with a biphasic defibrillator - administer amiodorone bolus followed by a drip - assess airway, breathing, and circulation - begin cardiopulmonary resuscitation (CPR)
the nurse is caring for a patient who is undergoing cardiac testing at the outpatient heart institute. which diagnostic test would be the best indicator to evaluate heart failure?
- chest X ray -electrocardiogram - echocardiogram - pulmonary artery pressure
a student nurse is assessing the peripheral vascular system of an older adult. what action by the student would cause the faculty member to intervene?
- classifying capillary refil of 4 or more seconds as normal - auscultating the carotid arteries for any bruits - assessing blood pressure in both upper extremities - palpating both carotid arteries at the same time
A desired outcome for a patient with fluid volume deficit must meet criteria for being specific, correct and measurable . of the following outcomes, which one is the most appropriate for this nursing diagnosis?
- consume 2500 ml of fluid every 24 hours - not have a fluid volume deficit - drink enough fluids to equal urinary output - maintain strict intake and output records
while teaching the patient about dietary modifications for a AHA (cardiac) diet to reduce the risk of atherosclerosis, which instructions should the nurse include; select all that apply:
- consume low fat cheeses and dairy products - 40% of total dietary intake should be polyunsaturated and monounsaturated fats - eat lots of fresh fruits and vegetables - daily servings of red meat are encouraged as important source of protein and iron - consume egg yolks as they are a good source of vitamin A and protein
The patient with congestive heart failure became progressively worse and he experiences several expected symptoms. which one indicates an emergency involving pulmonary edema that requires immediate response?
- cough with some bubbly phlegm and a light pink appearance - heart rate that has risen from 90 to 110 and BP to 140/96 - must sleep on 3-4 pillows otherwise he says he cannot catch his breath - cough at night that keeps him from sleeping
The most common cause of peripheral arterial disease is?
- deep vein thrombosis - atherosclerosis - pregnancy - diabetes
The patient has a potassium level of 2.2 and the physician has ordered 40 mEq KCL IV push over 5 minutes STAT. the nurse should .....
- do not give as within normal range - call to clarify order - give as ordered - recheck K+ level prior to giving
The nurse notes that the patient who is on warfarin (coumadin) has a PT time that is nearly twice as long as the normal range. the nurse should:
- encourage foods higher in vitamin K - report the findings to the physician - hold warfarin until lab work can be repeated - do nothing as this is therapeutic
The patient with peripheral arterial disease asks," why should I exercise when my legs seem to cramp up after just a block or two of walking?" the nurse's best response would be:
- exercise is a noninvasive technique that is used to increase venous blood flow - continuing to walk while having cramping will allow you to eventually be nearly symptom free - exercise will improve strength of your legs and lymphatic system to help relieve pain - exercise improves blood flow rate and new blood vessels will develop to take over for ones that are blocked
dietary teaching for a patient with hypernatremia includes avoiding all of the following:
- fresh fruits - processed cheeses - lunch meats -fresh vegetables - canned vegetables
which of the following symptoms would indicate fluid volume deficit?
- heart rate of 115 bpm
The patient's potassium level is 2.5 mEq/L/ which clinical findings does the nurse expect to see when assessing this patient?
- hypertension, bounding pulses, and bradycardia - moist crackles, tachypnea, and increased deep tendon reflexes - generalized muscle weakness, lethargy, and shallow respirations - increased specific gravity and decreased urine output
which of the following conditions places the patient at risk for hypocalcemia, hyperkalemia, and hypernatremia?
- hypothyroidism - adrenal insufficiency - end stage renal failure - DM
the nurse is interviewing a patient with a history of cardiovascular problems. which statement by the patient causes the nurse to suspect the patient may have heart failure?
- i cannot wear my wedding ring; its just too tight now - i have been running a slight fever in the evening - I have been having more headaches and blurred vision - I have a fine red rash on my chest and its spreading down my arm
a patient has peripheral arterial disease (PAD). what statement by the patient indicates misunderstanding about self- management activities?
- i will go out and buy some warm, heavy socks to wear - I should not cross my legs when sitting or lying down - I can use a heating pad on my legs if it's set on low - Its going to be really hard but I will stop smoking
The nurse is performing an assessment on the patient brought in by emergency personnel. the nurse immediately observes that the patient has spontaneous respirations and the skin is cool, pale, and moist. what is the priority nursing diagnosis?
- impaired skin integrity - ineffective tissue perfusion - risk for peripheral neurovascular dysfunction - risk for imbalanced body temperature
the patient's cholesterol screening shows a high- density lipoprotein value of 46 and a total serum cholesterol level of 188. what does the nurse advise the patient to do in regards to diet and test results?
- increase foods in omega- 3 acids and most likely your physician will order a medication such as lipitor to reduce my cholesterol - continue with your diet and these tests will be repeated at your next routine exam - modify your diet to reduce saturated fats and increased insoluble fiber, then repeat tests in three months - decrease red meat consumption and repeat these tests in 6 to 12 weeks
The patient has a serum magnesium level of 0.9. which treatment does the nurse expect to be ordered for this patient?
- increase intake of citrus fruits and dark yellow vegetables - give diuretic therapy to reduce magnesium level - give oral supplements of magnesium sulfate -administer IV magnesium sulfate
The nurse is caring for a patient on the medical surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below. after calling for assistance and a defibrillator, what action would the nurse take next?
- initiating cardiopulmonary resuscitation - ask the patient's family about code status - perform a pericardial thump - start an 18 gauge intravenous line
A nurse teaches a patient who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolves spontaneously without treatment. which statement would the nurse include in this patient's teaching?
- lie on your side until the attack subsides - use your oxygen when you experience PACs - take amiodarone (cordarone) daily to prevent PACs - minimize or abstain from caffeine
The 32 year old patient with diabetes reports sudden onset of headaches, blurred vision and dyspnea. The patient's blood pressure is normally 132/84 mm hG but today is 206/152 mm Hg. what condition does the nurse suspect?
- malignant hypertension - sustained hypertension - primary hypertension - secondary hypertension
the nurse suspects that the patient may be developing fluid overload. what is the most important assessment that the nurse should immediately perform?
- measure blood pressure - check I&O - inspect extremities for pitting edema - auscultate lung sounds
a client has intra- arterial blood pressure monitoring after a myocardial infarction. The nurse notes the client's rate has increased from 88 to 110 beats/min and the blood pressure dropped from 120/82 to 100/60 mm Hg. what action by the nurse is most appropriate?
- medicate the client for pain - allow the client to rest quietly - assess the client for bleeding - document the findings in the chart
a nurse assesses a patient with tachycardia. which clinical manifestation requires immediate intervention by the nurse?
- midsternal chest pain - P wave touching the T wave - mild orthostatic hypotension - increased urine output
A telemetry nurse assesses a patient who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. which assessment would the nurse complete next?
- mobility and gait stability - level of consciousness - pulse strength and amplitude - pulmonary auscultation
a nurse is caring for four patients. which one would the nurse see first?
- patient who had a first dose of captopril (capoten) and needs to use the bathroom - patient who needs pain medication prior to a dressing change of a surgical wound - patient who needs a beta blocker, and has a blood pressure of 92/58 mm hg - hypertensive patient with a blood pressure of 188/92 mm HG
The nurse notes that the patient is on spironolactone for control of hypertension. the nurse would check lab values specifically for which electrolyte?
- potassium - calcium - magnesium - chloride
a nurse is assessing a patient with left- sided heart failure. for which clinical manifestations would the nurse assess? select all that apply
- pulmonary hypertension -confusion, restlessness - pulmonary crackles - dependent edema - cough that worsens at night
The nurse is aware that because the patient is taking hydrochlorothiazide he needs to have dietary instructions to prevent hypokalemia by eating which of the following foods?
- raisins, broccoli, oranges - pineapple, berries, bread - green beans, oatmeal, apples - carrots, eggs, cauliflower
the nurse reads in the patient's chart that a carotid bruit was heart during the last two annual checkups. Today on auscultation the bruit is not present. How does the nurse interpret this finding?
- simultaneous bilateral carotid palpation is needed - venous disease has developed as well - blockage of the vessel may have progressed - the restricted blood flow has resolved
a nurse evaluates prescriptions for a patient with chronic atrial fibrillation. which medication would the nurse expect to find on this patient's medication administration record to prevent a common complication of this condition?
- sotalol (betapace) - lidocaine (xylocaine) - warfarin (coumadin) - atropine (sal- tropine)
the nurse is assisting a patient with heart failure to ambulate to increase activity intolerance. the patient walked 200 feet yesterday and the goal today is 300 feet. at 250 feet the nurse evaluates the patient and calls for the nurse assistant to bring a wheelchair to assist the patient back to bed. which of the following factors would prompt the nurse to stop ambulating the patient?
- systolic blood pressure has risen by 25 mm Hg - heart rate increased from 88 to 110 - states that she does not like to walk - complains of chest pain - respiratory rate of 22
the nurse asks a patient who has experienced ventricular dysrhythmias about substance abuse. The patient asks," why do you want to know if I use cocaine?" What is the nurse's best response?
- the hospital requires that I ask you about cocaine use - substance abuse puts patients at risk for many health issues - patients who use cocaine are at risk for fatal dysrhythmias - we can provide services for cessation of substance abuse
which of the following lab tests is the nurse most concerned about if a myocardial infarction is suspected?
- troponin - triglycerides - creatine kinase -serum lipids
the nurse is caring for the patient with chronic venous insufficiency. which of the following instructions is the best for the nurse to include in this patient's continuing plan of care?
- wear compression stockings daily - cross your legs four to five times daily but not at the ankle - wear knee- high hose with narrow bands - do not elevate the legs above your heart
the discharge nurse is teaching self management for the patient with moderate to severe heart failure. which of the following would the nurse include in the teaching?
- weigh yourself periodically and record your findings - limit daily sodium intake to no more than 5 grams per day - take medication as prescribed and limit fluids to 2 liters per day - take NSAIDS such as motrin for minor discomfort or fever
The SA node fires at a rate of?
-40-60 - 60-100 - 80-90 - 60-80
The nurse shows a positive Chvostek's sign. the nurse anticipates that the physician will order which treatment?
-K- Dur, oral potassium supplement - IV potassium chloride - small amount of 3% sodium chloride - IV calcium chloride
True or false: depolarization of the heart muscle is when the muscle contracts and repolarization is when the heart muscle rests.
True
