Cardiac

33 - Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation? A - Exertional dyspnea B - Confusion C - Elevated creatine phosphokinase concentration D - Chest pain

A

62 - A client has developed atrial fibrillation, which has a ventricular rate of 150 beats per minute. A nurse assesses the client for: A. Hypotension and dizziness B. Nausea and vomiting C. Hypertension and headache D. Flat neck veins

A

36 - What is the first intervention for a client experiencing MI? A - Administer morphine B - Administer oxygen C - Administer sublingual nitroglycerin D - Obtain an ECG

B

19 -An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take? A. No action is required; low blood pressure is normal for older adults. B. No action is required for postsurgical CABG clients. C. Assess pulmonary artery wedge pressure (PAWP). D. Give ordered loop diuretics.

C

50 - A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms? A. Left atrium B. Right atrium C. Left ventricle D. Right ventricle

C

18 - A client recently diagnosed with heart failure is being discharged on Lisinopril. Which client teaching related to the new medication is important to review? A - instruct client to report for monthly blood work to monitor drug levels. B - review foods high in potassium that client should include in diet. C - teach client to count own pulse for one minute, hold medication if pulse below 60 bpm D - teach client to rise slowly and sit on side of bed for several minutes before rising.

D

37 - What would be the treatment option of choice for an AAA that is 6 cm? A - Blood pressure medication B - Thrombolytic Agent C - Crestor D - Surgery

D

51 - The nurse expects that a client with mitral stenosis would demonstrate symptoms associated with congestion in the: A - Aorta B - Right atrium C - Superior vena cava D - Pulmonary circulation

D

69 - A client has atrial fibrillation and a heart rate of 165 bpm. In which order from first to last should the nurse implement these prescriptions? 1. Administer oxygen via nasal cannula 2. gather supplies for an IV insertion 3. place client on a cardiac monitor (ECG) 4. obtain vital signs including BP, P, R, T, and O2 saturation

1,4,3,2

70 - A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions are a priority? Select all that apply. 1. Stop the infusion. 2. Raise the head of the bed. 3. Administer protamine sulfate. 4. Administer diphenhydramine. 5. Call for the Rapid Response Team (RRT).

1,4,5

34 - The nurse is caring for a client diagnosed with and anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur at the apex. What should the nurse do first? A - Assess for changes in vital signs B - Draw an atrial blood gas C - Evaluate heart sounds with client leaning forward D - Obtain a 12-lead ECG

A

35 - A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation. Which finding indicates that further preparation is needed for the procedure? A - The client is wearing a nasal cannula delivering oxygen at 2 L/min B - The client's digoxin (Lanoxin) has been withheld for the last 48 hours C - The defibrillator has the synchronizer turned on and is set at 50 joules (J) D - The client has received an intravenous dose of a conscious sedation medication

A

38 - The nurse is planning care for a client who has just returned to the medical-surgical unit following repair of aortic aneurysm. What is a priority assessment for this client? A - Decreased urinary output B - Electrolyte imbalance C - Anxiety D - Wound infection

A

42 - The patient who has recently been experiencing runs of ventricular tachycardia suddenly loses consciousness. The patient is defibrillated, and the rate returns as the following. What should the nurse do first? A) Begin compressions B) Shock the client again immediately C) Prepare for intubation D) Administer adenosine

A

5 - A client admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurses notes an irregular heart rate and hears and extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. How should the nurse document these findings? A - Heart rate irregular with S3 B - Heart rate irregular with S4 C - Heart rate irregular with aortic regurgitation D - Heart rate irregular with mitral stenosis

A

61 - When preparing a client for discharge after surgery for a CABG, the nurse should teach the client that there will be: A. Some increase in edema in the leg used for the donor graft when activity increases B. A mild fever and extreme fatigue for several weeks after surgery C. No further drainage from the incisions after hospitalizations D. Little incisional pain and tenderness after 3 to 4 weeks after surgery

A

65 - Which person should the nurse identify as having the highest risk for abdominal aortic aneurysm? A - A 70-year-old male, with high cholesterol and hypertension B - A 40-year-old female with obesity and metabolic syndrome C - A 60-year-old male with renal insufficiency who is physically inactive D - A 65-year-old female with hyperhomocysteinemia and substance abuse

A

14 - Potassium chloride intravenously is prescribed for a client with hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. A - Obtain an intravenous infusion pump B - Monitor urine output during administration C - Monitor the iv site for signs of infiltration or phlebitis D - Ensure the medication is diluted in the appropriate volume of fluid E - Ensure that the bag is labeled so that it reads the volume of potassium in the solution

A,B,C,D,E

59 - Which of the following assessment data should be collected for a patient who has had a myocardial infarction? A - A full set of current vital signs B - Indications of heart failure C - Characteristic and location of discomfort D - Activities of daily living (ADL) assessments E - A follow up electrocardiogram

A,B,C,D,E

8 - Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? A - Chloride level of 98 mEq/L (98 mmol/L) B - Sodium level of 135 mEq/L (135 mmol/L) C - Potassium level of 6.8 mEq/L 6.8 mmol/L) D - Magnesium level of 1.6 mEq/L (0.8 mmol/L)

C

49 - A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? A Administer ordered morphine sulfate. B Position patient in a semi-Fowler's position. C Position patient on left side with head of bed flat. D Instruct patient on the use of relaxation techniques. E Use a calm, reassuring approach while talking to patient.

A,B,D,E

63 - A client who is in the progressive stage of hypovolemic shock has all of the following signs, symptoms, or changes. Which ones does the nurse attribute to ongoing compensatory mechanisms? A. Increasing pallor B. Increasing thirst C. Increasing confusion D. Increasing heart rate E. Increasing respiratory rate F. Decreasing systolic blood pressure G. Decreasing blood pH H. Decreasing urine output

A,B,D,E,H

68 - Which of the following medications are used to treat hypertension? Select all that apply. A. Losartan B. Lisinopril C. Atorvostatin D. Metformin E. Diltiazem

A,B,E

55 - An older adult is admitted to the emergency department at 2000 hours wth syncope, shortness of breath, and reported palpitations (see nurse's notes below). At 2015, the nurse places the client on the EKG monitor and identifies the following rhythm (see below). What should the nurse do? Select all that apply. A - Apply oxygen. B - Prepare to defibrillate the client C - Monitor vital signs. D - Have the client sign consent for cardioversion as prescribed. E - Teach the client about warfarin treatment and the need for frequent blood testing. F - Draw blood for a CBC count and thyroid function study.

A,C,D

60 - A client is brought to the emergency department complaining of substernal chest pain. To distinguish between angina and myocardial infarction, the nurse assesses for which characteristics of angina? Select all that apply. A. Chest pain that resolves with rest B. Chest pain requiring an opioid for relief C. Chest pain that is relieved by nitroglycerin D. Chest pain that lasts longer than 30 minutes E. Chest pain that is usually precipitated by exertion

A,C,E

64 - Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69-year-old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55-year-old female with a health history of asthma and hypoparathyroidism C. A 30-year-old male with a history of endocarditis and has severe mitral stenosis. D. A 45-year-old female with lung cancer stage 2. E. A 58-year-old female with uncontrolled hypertension and is being treated for influenza

A,C,E

13 - A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions are a priority? Select all that apply. A. Stop the infusion. B. Raise the head of the bed. C. Administer protamine sulfate. D. Administer diphenhydramine. E. Call for the Rapid Response Team (RRT).

A,D,E

52 - A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply: A - Pregnancy B - Being Female C - High Cholesterol D - Diabetes Mellitus E - Uncontrolled Hypertension F - Varicose Veins G - Smoking

C,D,E,G

11 -A client with chest pain is prescribed intravenous nitroglycerin. Which finding is of greatest concern for the nurse initiating the nitroglycerin drip? A. Serum potassium is 3.5 mEq/L (3.5 mmol/L) B. Blood pressure is 88/46 mmHg C. ST elevation is present on the electrocardiogram D. Heart rate is 61 bpm

B

2 .A patient is diagnosed with an abdominal aortic aneurysm (AAA). A patient with this diagnosis would describe the pain as: A - Sharp, intense, consistent pain affected by movement B - Steady with a gnawing quality, unaffected by movement C - Dull pain unaffected by movement D - Throbbing pain affected by movement

B

22 - Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to? A - Assess the surgical site for excessive drainage B - Assess and grade lower extremity pulses bilaterally C - Apply compression stockings D - Elevate the lower extremity above heart level

B

24 -The nurse is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention? a. Apply a pressure dressing to the insertion site. b. Ensure all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement. d. Restrain the affected extremity for 24 hours.

B

25 - The patient at highest risk for venous thromboembolism (VTE) is a. a 62-year-old man with spider veins who is having arthroscopic knee surgery. b. a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe. c. a 26-year-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor. d. an active 72-year-old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia.

B

28 - A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response. Based on this finding, the nurse anticipates assisting the physician with which treatment? a. Administer lidocaine, 75 mg intravenous push. b. Perform synchronized cardioversion. c. Defibrillate the client as soon as possible. d. Administer atropine, 0.4 mg intravenous push.

B

30 - The client diagnosed with congestive heart failure is complaining of leg cramps at night. Which nursing interventions should be implemented? A - Check the client for peripheral edema and make sure the client takes a diuretic early in the day. B - Monitor the client's potassium level and assess the client's intake of bananas and orange juice. C - Determine if the client has gained weight and instruct the client to keep the legs elevated. D - Instruct the client to ambulate frequently and perform calf-muscle stretching exercises daily.

B

4 - The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving intravenous doses of furosemide. The client is attached to cardiac telemetry, and the nurse is monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has changed to this pattern. The nurse determines that the most likely cause of this cardiac rhythm in the client is which problem? Refer to Figure A - Pacemaker dysfunction B - The presence of hypokalemia C - The effectiveness of the Furosemide D - An impeding myocardial infarction (MI)

B

41 - The nurse has just administered adenosine via IV push and sees the following rhythm on the monitor. What is the nurse's priority intervention? a) Apply conductive gel and defibrillate the patient b) Document the findings and continue to monitor c) Administer another mg of the medication d) Begin chest compressions

B

43 - A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The complication the nurse will constantly observe for is: A - Presence of a heart murmur B - Systemic emboli C - Fever D - Congestive heart failure

B

45 - The nurse in the outpatient clinic is reviewing phone messages. Which client should the nurse call back first? A - Client post kidney transplant who reports white spots in the oral cavity B - Client with a history of mitral valve regurgitation who reports fatigue C - Client with erythema and purulent drainage at the site of a spider bite D - Client with hypertension who reports a cold and nasal congestion

B

46 - The client is one day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first? A - Medicate the client with intravenous morphine B - Assess the client's chest dressing and vital signs C - Encourage the client to turn from side to side D - Check the client's telemetry monitor

B

48 - What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? A. Acute anxiety B. Hypotension and tachycardia C. Peripheral edema and weight gain D. Paroxysmal nocturnal dyspnea (PND)

B

56 - The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? A - Report of insomnia B - Development of expiratory wheezes C - A baseline blood pressure of 150/80 Hg followed by a blood pressure of 138/72 Hg after 2 doses of the medication. D - A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication

B

57 - The nurse has provided instructions to a client receiving enalapril maleate for hypertension. Which statement by the client indicates a need for further instruction? A - "I need to rise slowly from a lying to a sitting position." B - "I need to notify the primary health care provider if fatigue occurs." C - "I need to notify the primary health care provider if a sore throat occurs." D - "I know that several weeks of therapy may be required for the full therapeutic effect."

B

66 - A client is diagnosed with atrial fibrillation, and the primary health care provider prescribes medication therapy. Prior to initiating medication therapy, which cardiac rhythm would the nurse expect to note on the cardiac monitor?

B

9 - An older adult with peripheral vascular disease has stopped smoking, and the client's children want to make the home environment safe. What should the home healthcare nurse emphasize when providing instructions? A - Observe for evidence of blurred vision B - Use measures that can prevent thermal injuries C - Reduce fluid intake to prevent peripheral edema D - Limit activities to reduce the workload on the heart

B

54 - Cardiac telemetry shows that a client who is up to the bathroom has converted from normal sinus rhythm to atrial fibrillation with a ventricular response rate of 100 bpm. In what order from first to last should the nurse perform these interventions? All options must be used. A - Assess vital signs. B - Assist the client to the bed. C - Initiate intravenous access. D - Obtain a stat 12-lead electrocardiogram.

B,A,C,D

67 - There are five clients in the emergency unit. Which client conditions require immediate treatment? Select all that apply. A. Skin rash B. Unstable vital signs C. Severe abdominal pain D. Chest pain with diaphoresis E. Multiple complex soft tissue injuries

B,C,D

3 - Patients with rupturing AAA are at risk for hypovolemic shock. Select all that apply the signs and symptoms that may be present in the case of hypovolemic shock. A - Hypertension B - Diaphoresis C - Decreased LOC D - Polyuria E - Loss of pulse distal to rupture

B,C,E

39 - Which of the following are signs of a rupturing AAA? Select all that apply. A. Increased BP B. Decreased Hct C. Low back pain D. Decreased BP E. Intermittent abdominal pain

BCD

1. Which teaching point does the nurse include for a client with pad? A - "Elevate your legs above your heart to prevent swelling." B - "Inspect your legs daily for brownish discoloration around the ankles." C - Walk to the point of leg pain, then rest, resuming when pain stops." D - "Apply a heating pad to the legs if they feel cold."

C

12 - Captopril, furosemide, and metoprolol are prescribed for a client with systolic heart failure. The client's blood pressure is 136/82 mm Hg, and the heart rate is 65 bpm. Prior to medication administration at 0900, the nurse reviews the following lab tests (see chart). What should the nurse do first? Chart: Sodium ------- 140 mEq/L (140 mmol/L) Potassium ------ 6.8 mEq/L (6.8 mmol/L) BUN --- 18 mg/dL (6.4 mmol/L) Creatinine ------ 1.0 mg/dL (76.3 micromol/L) Hemoglobin ---- 12 g/dL (120 g/L) Hematocrit ----- 37% (0.37) A. Administer the medications B. Call the health care provider (HCP) C. Withhold the captopril D. Question the metoprolol dose

C

15 - The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. Pallor B. Hyperactivity C. Activity intolerance D. Gastrointestinal disturbances

C

26 - The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes the cardiac rhythm on the monitor. What should the nurse do first? A - Notify the health care provider B - Call the rapid response team C - Assess the client for changes in the rhythm D - Administer lidocaine as prescribed

C

27 - The nurse observes the cardiac rhythm for a client who is being admitted with a myocardial infarction. What should the nurse do first? A - Prepare for immediate cardioversion B - Begin cardiopulmonary resuscitation (CPR) C - Check for a pulse D - Prepare for immediate defibrillation

C

40 - The nurse is providing community health screening. Which of the following clients should be referred to a health care provider for further evaluation? A - 30-year-old athlete with a heart rate of 50/min B - 45-year-old client with a body mass index of 35 kg/m2 and fingerstick glucose of 150 mg/dL (8.3 mmol/L) C - 55-year-old client missing all the hair on the lower legs and failing the pinprick test D - 80-year-old client with a blood pressure 150/90 mmHg

C

44 - The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs? A - Mixed green salad with blue cheese dressing, crackers, and cold cuts B - Ham sandwich on rye bread and an orange C - Baked chicken, an apple, and a slice of white bread D - Hot dogs, baked beans, and celery and carrot sticks

C

47 - When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. shortness of breath on exertion. d. right upper quadrant tenderness.

C

58 - Which information should the nurse include when teaching a patient with newly diagnosed hypertension? A. Dietary sodium restriction will control BP for most patients. B. Most patients are able to control BP through lifestyle changes. C. Hypertension is usually asymptomatic until significant organ damage occurs. D. Annual BP checks are needed to monitor treatment effectiveness.

C

6 - A client is receiving furosemide to help treat heart failure. Which laboratory result will cause the nurse to notify the primary healthcare provider? a. Hematocrit 46% b. Hemoglobin 14.1 g/dL (141 mmol/L) c. Potassium 3.0 mEq/L (3.0 mmol/L) d. White blood cell 9200/mm3 (9.2 × 109/L)

C

10 - A client in shock develops a central venous pressure (CVP) of 2 mm Hg. Which prescribed intervention should the nurse implement first? A. Increase the rate of O2 flow B. Obtain arterial blood gas result C.Insert an indwelling urinary catheter D. Increase the rate of intravenous (IV) fluids

D

16 - The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

D

17 - A client diagnosed with stable angina is being discharged home on rovustatin. The nurse should teach the client to report which side effect to the hcp? A - abdominal discomfort B - insomnia C - morning headache D - muscles aches or weakness

D

20 - A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from? A - Cardiac dissection B - Ventricular septum rupture C - Mitral valve prolapse D - Pericarditis

D

21 - The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. "Do you have a history of a heart attack?" b. "Is there a family history of endocarditis?" c. "Have you had any recent immunizations?" d. "Have you had dental work done recently?"

D

23 - The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A - Blood pressure 110/90 mm Hg B - Flushing C - Headache D - Chest pain

D

29 - A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? A - "My ankles are swollen." B - "I am tired at the end of the day." C - "When I eat a large meal, I feel bloated." D - "I have trouble breathing when I walk rapidly."

D

31 - The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: A - Stroke volume B - Cardiac output C - Venous pressure D - Left ventricular functioning

D

32 - When preparing a client for discharge after surgery for a CABG, the nurse should teach the client that there will be: A - No further drainage from the incisions after hospitalizations B - A mild fever and extreme fatigue for several weeks after surgery C - Little incisional pain and tenderness after 3 to 4 weeks after surgery D - Some increase in edema in the leg used for the donor graft when activity increases

D

53 - A client had a repair of a thoracoabdominal aneurysm 2 days ago. Which findings should the nurse consider unexpected and report to the health care provider immediately? A - Abdominal pain at 5 on a scale of 0 to 10 for the last 2 days. B - Heart rate of 100 bpm after ambulating 200 feet (0.06 km). C - Urine output of 2,000 mL in 24 hours. D - Weakness and numbness in the lower extremities.

D

7 - A 21-year-old female is seen in the Emergency Department for vomiting and diarrhea for 3 days. Her BP is 94/64 and her EKG rhythm shows that she is sinus tachycardia. The best action for the nurse to take initially is to: a.) request pain medication for the patient. b.) cardiovert the patient immediately. c.) give Adenosine 6 mg IV push. d.) start IV and bolus normal saline per protocol.

D