Cardiac & IV Therapy Test Questions
Nurse Russell is preparing to give a total parenteral nutrition using a central line. Place the following steps for administration in the correct order? 1. Connect the tubing to the central line. 2. Regulate the electric infusion pump at the ordered rate. 3. Maintain aseptic technique when handling the injection cap. 4. Check the solution for cloudiness, particles, or a change in color. 5. Prime the IV tubing through an infusion pump. 6. Select and flush the correct tubing and filter.
4, 6, 5, 3, 1, and 2.
A nurse observes the client receiving fat emulsions is having hives. A nurse reviews the client's history and note in which of the following may cause about by the complaint of the client? A Allergy to an egg. B Allergy to peanut. C Allergy to shellfish. D Allergy to corn
A --Fat emulsions (lipids) contain egg yolk phospholipids and should not be given to clients with egg allergies.
A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions? A Take another bottle of solution. B Runs the bottle solution under a warm water. C Rolls the bottle solution gently. D Shake the bottle solution vigorously
A --Fat emulsions are used as dietary supplements for patients who are unable to get enough fat in their diet, usually because of certain illnesses or recent surgery. The nurse should examine the bottle of fat emulsion for separation of emulsion into layers or fat globules or the accumulation of froth. The nurse should not hang a fat emulsion if any of these observed and should return the solution to the pharmacy.
A nurse is making initial rounds at the beginning of the shift and notice that the parenteral nutrition (PN) bag of an assigned client is empty. Which of the following solutions readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit? A 10% dextrose in water. B 5% dextrose in water. C 5% dextrose in normal saline. D 5% dextrose in lactated Ringer solution.
A --The client is at risk of hypoglycemia. Hence the nurse will hang a solution that has the highest amount of glucose until the new parenteral nutrition solution becomes readily available.
A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order? A Decrease the PN rate to 60ml/hr. B Start 0.9% normal saline at 30 ml/hr. C Maintain the present infusion rate. D Discontinue the PN
A --When a client begins eating a regular diet after a period of receiving PN, the PN is decreased slowly. PN that is terminated abruptly will cause hypoglycemia. Gradually decreasing the infusion rate allows the client to remain sufficiently nourished during the transition to a normal diet and prevents an episode of hypoglycemia.
A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials? A Send them to the laboratory for culture. B Save them for a return to the manufacturer. C Return them to the hospital pharmacy. D Discard them in the unit trash
A --When the client who is receiving PN has a high temperature, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for an infectious organism.
A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? A Review the intake and output records for the last 2 days B Change the time of diuretic administration from morning to evening C Request a sodium restriction of 1 g/day from the physician D Order daily weights starting the following morning
A--Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
Which is the MOST appropriate action for the nurse to take before administering digoxin? A Monitor potassium level B Assess blood pressure C Evaluate urinary output D Avoid giving with thiazide diuretic
A--Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.
When administering an antiarrhythmic agent, which of the following assessment parameters is the most important for the nurse to evaluate? A ECG B Pulse rate C Respiratory rate D Blood pressure
A--The ECG is the most important parameter to assess. B, C, and D need to be monitored, but the ECG is the most important.
Jason James is taking ß blockers, all of the following should be included in his assessment except: A Pulmonary function tests B Baseline ECG C Glucose level D Blood pressure
A--Unless the client has a history of pulmonary disease and pulmonary function tests are indicated, there is no need to include this in the routine assessment of the client taking ß blockers
Conduction defects will most likely be an adverse associated with the use of: A verapamil B nifedipine C diltiazem D felodipine
A--Verapamil (Calan) has the strongest chronotropic effect and will cause a delay in conduction at the SA and AV nodes.
ß blockers should be avoided in which of the following conditions? A Bronchoconstriction B Hypertension C Angina D Myocardial infarction
A--ß blockers should be avoided in bronchoconstrictive disease. B, C, and D are indications for the use of ß blockers.
Which of the following types of cardiomyopathy can be associated with childbirth? A Dilated B Hypertrophic C Myocarditis D Restrictive
A: Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Option B: Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Option C: Myocarditis isn't specifically associated with childbirth. Option D: Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial
Which of the following parameters should be checked before administering digoxin? A Apical pulse B Blood pressure C Radial pulse D Respiratory rate
A: An apical pulse is essential for accurately assessing the client's heart rate before administering digoxin. The apical pulse is the most accurate point in the body. Option B: Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. Option C: The radial pulse can be affected by cardiac and vascular disease and therefore, won't always accurately depict the heart rate. Option D: Digoxin has no effect on respiratory function.
Which of the following conditions most commonly results in CAD? A Atherosclerosis B DM C MI D Renal failure
A: Atherosclerosis, or plaque formation, is the leading cause of CAD. Option B: DM is a risk factor for CAD but isn't the most common cause. Option D: Renal failure doesn't cause CAD, but the two conditions are related. Option C: Myocardial infarction is commonly a result of CAD.
Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy? A Heart failure B DM C MI D Pericardial effusion
A: Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. Option C: Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Option D: Pericardial effusion is most predominant in clients with pericarditis. Diabetes mellitus is unrelated to cardiomyopathy
Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A Beta-adrenergic blockers B Calcium channel blockers C Narcotics D Nitrates
A: Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Option B: Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Option C: Narcotics reduce myocardial oxygen demand, promote vasodilation, and decreased anxiety. Option D: Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).
What is the term used to describe an enlargement of the heart muscle? A Cardiomegaly B Cardiomyopathy C Myocarditis D Pericarditis
A: Cardiomegaly denotes an enlarged heart muscle. Option B: Cardiomyopathy is a heart muscle disease of unknown origin. Option C: Myocarditis refers to inflammation of heart muscle. Option D: Pericarditis is an inflammation of the pericardium, the sac surrounding the heart.
Which of the following symptoms is most commonly associated with left-sided heart failure? A Crackles B Arrhythmias C Hepatic engorgement D Hypotens
A: Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Option B: Arrhythmias can be associated with both right and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.
Toxicity from which of the following medications may cause a client to see a green halo around lights? A Digoxin B Furosemide C Metoprolol D Enalapril
A: One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. Options B, C, and D: The other medications aren't associated with such an effect.
An anxious client is rushed to your unit. The vital signs measurements include a respiratory rate of 39 breaths/min. Which acid-base imbalance should the nurse suspect? A Respiratory alkalosis B Respiratory acidosis C Metabolic alkalosis D Metabolic acidosis
A: Prioritization, supervision. The client is blowing off carbon dioxide and is most likely hyperventilating. A sudden drop of carbon dioxide will result in an increase in pH and cause respiratory alkalosis.
The client with a diagnosis of Fluid Volume Deficit is assessed by the physician. The assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time? A Administer furosemide (Lasix) 40 mg IV push B Maintain accurate intake and output record C Limit fluids to 1500 mL/day D Weigh the client every morning
A: Prioritization. Bilateral moist crackles signify fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. Options B, C, and D: The other orders are important but are not urgent.
Which of the following complications is indicated by a third heart sound (S3)? A Ventricular dilation B Systemic hypertension C Aortic valve malfunction D Increased atrial contractions
A: Rapid filling of the ventricles causes vasodilation that is auscultated as S3. Option B and D: Increased atrial contraction or systemic hypertension can result is a fourth heart sound. Option C: Aortic valve malfunction is heard as a murmur.
After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? A Left-sided heart failure B Pulmonic valve malfunction C Right-sided heart failure D Tricuspid valve malfunction
A: The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Options B, C, and D: Pulmonic and tricuspid valve malfunction cause right-sided heart failure.
Which of the following is the most common symptom of myocardial infarction? A Chest pain B Dyspnea C Edema D Palpitations
A: The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Option C: Edema is a later sign of heart failure, often seen after an MI. Option D: Palpitations may result from reduced cardiac output, producing arrhythmias.
What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying? A "Tell me about your feeling right now." B "When the doctor arrives, everything will be fine." C "This is a bad situation, but you'll feel better soon." D "Please be assured we're doing everything we can to make you feel better
A: Validation of the client's feelings is the most appropriate response. It gives the client a feeling of comfort and safety. Options B, C, and D: The other three responses give the client false hope. No one can determine if a client experiencing MI will feel or get better and therefore, these responses are inappropriate.
A client with chronic obstructive pulmonary disease is receiving O2 at 2L/min. per nasal cannula. He is anxious and short of breath, and his mental status is clouded. The nurse should: 1. Increase the O2 to 3L/min. 2. Monitor for signs of impending respiratory failure. 3. Maintain the O2 at 2L/min but increase the humidity. 4. Change the oxygen delivery system from cannula to a mask.
Answer: 2 RATIONALE: Shortness of breath, anxiety, and cloudy mentation are associated with impending respiratory failure. Answer 1 might worsen the client's condition by robbing him of his CO2 drive to breathe. Answer 3 is incorrect because increased humidity might increase the work of breathing. Answer 4 is incorrect because oxygen masks require oxygen settings greater than those tolerated by the client with COPD.
When do coronary arteries primarily receive blood flow? A During inspiration B During diastole C During expiration D During systole
B -- Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Option A: Breathing patterns are irrelevant to blood flow.
A client receiving parenteral nutrition (PN) complains of a headache. A nurse notes that the client has an increased blood pressure, bounding pulse, jugular distension, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy? A Air embolism. B Hypervolemia. C Hyperglycemia. D Sepsis
B --Clients with cardiac, renal, or hepatic dysfunction are also at risk. The client's symptoms presented in the question are consistent with hypervolemia. The increased intravascular volume increases the blood pressure whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles.
A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse next assesses the client to identify the presence of which of the following? A Hypotension. B Crackles upon auscultation of the lungs. C Thirst. D Polyuria
B --Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight gain of 5 pounds over a week indicates a client is experiencing fluid retention that can result to hypervolemia. Signs of hypervolemia includes weight gain more than desired, headache, jugular vein distention, bounding pulse, and crackles on lung auscultation. Option A: Hypertension, not hypotension is expected. Options C and D are associated with hyperglycemia.
Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of the following actions? A Increased speed of conduction and gluconeogenesis B Bronchodilation and increased heart rate, contractility, and conduction C Increased vasodilation and enhanced myocardial contractility D Bronchoconstriction and increased heart rate
B--Bronchodilation results from stimulated beta receptors, and cardiac effects result from the stimulation of ß1 receptors. Choice A does not address respiratory effects of medication. Choice C is incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not bronchoconstriction, results from ß2 activity.
Class IA antiarrhythmic agents have little effect on: A AV node B SA node C Purkinje fibers D Bundle of His
B--Class IA antiarrhythmics have little effect on the SA node.
Blurred vision or halos are signs of: A Blurred vision or halos are signs of: B Digoxin toxicity C Nothing related to digoxin D Corneal side effects of digoxin
B--Halos is a hallmark sign of digoxin toxicity. A, C and D are incorrect because subtherapeutic digoxin levels have no such effects.
Which of the following calcium channel blockers has the most potent peripheral smooth muscle dilator effect? A diltiazem B nifedipine C nimodipine D verapami
B--Nifedipine has the strongest peripheral smooth muscle dilator effect of all the calcium channel blockers. Other choices have less of a vasodilator effect.
Which of the following effects of calcium channel blockers causes a reduction in blood pressure? A Increased cardiac output B Decreased peripheral vascular resistance C Decreased renal blood flow D Calcium influx into cardiac muscles
B--One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers
A nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse ask the client to take which essential action during the tube change? A Turn the head to the right. B Inhale deeply, hold it, and bear down. C Breathe normally. D Exhale slowly and evenly.
B--The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tube changes. The nurse asks the client to take a deep breath, hold it, and bear down. Option A is incorrect because if the intravenous line is on the right, the client turns his or head to the left. This position increases intrathoracic pressure. Options C and D can cause the potential for an air embolism during the tube change.
Routine laboratory monitoring in clients taking ß blockers should include: A sodium B Glucose C Thyrotropin D Creatine phosphokinase
B--ß blockers influence glucose metabolism. Although A, C, and D are nice to have, there is no indication that routine assessment of thyrotropin, sodium, or creatine phosphokinase is needed.
What is the first intervention for a client experiencing myocardial infarction? A Administer morphine B Administer oxygen C Administer sublingual nitroglycerin D Obtain an electrocardiogram
B: Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Options A and C: Morphine and sublingual nitroglycerin are also used to treat MI, but they're more commonly administered after the oxygen. Option D: An ECG is the most common diagnostic tool used to evaluate MI.
Atherosclerosis impedes coronary blood flow by which of the following mechanisms? A plaques obstruct the vein B Plaques obstruct the artery C Blood clots form outside the vessel wall D Hardened vessels dilate to allow the blood to flow through
B: Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Option A: Atherosclerosis is a direct result of plaque formation in the artery. Option D: Hardened vessels can't dilate properly and, therefore, constrict blood flow.
Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? A Antihypertensive B Beta-adrenergic blockers C Calcium channel blockers D Nitrates
B: By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Option A: Antihypertensives aren't usually indicated because they would decrease cardiac output in clients who are often already hypotensive. Option C: Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren't as effective as beta-adrenergic blockers and cause increase hypotension. Option D: Nitrates aren't' used because of their dilating effects, which would further compromise the myocardium
Which of the following types of cardiomyopathy does not affect cardiac output? A Dilated B Hypertrophic C Restrictive D Obliterative
B: Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Options A and C: Dilated cardiomyopathy and restrictive cardiomyopathy all decrease cardiac output.
Which of the following illnesses is the leading cause of death in the US? A Cancer B Coronary artery disease C Liver failure D Renal failure
B: Coronary artery disease accounts for over 50% of all deaths in the US. Option A: Cancer accounts for approximately 20%. Options C and D: Liver failure and renal failure account for less than 10% of all deaths in the US.
The nurse is caring for a client diagnosed with diabetic ketoacidosis. Which action should you delegate to the nursing assistant? (Select all that apply.) 1. Assess for indicators of fluid imbalance 2. Review fingerstick glucose results every hour 3. Measure vital signs every 15 minutes 4. Document intake and output every hour A 1 and 2 B 3 and 4 C 1 and 3 D 2 and 4
B: Delegation, supervision. A well-trained and educated nursing assistant is knowledgeable in measuring vital signs and recording intake and output. Option A: Performing fingerstick glucose checks and assessing clients demands further education and skill, as possessed by licensed nurses
The clinical instructor directed the student nurse to care for a client whose potassium is 6.7 mEq/L. Which intervention is delegated correctly to the student nurse? A Give potassium 10 mEq orally B Give sodium polystyrene sulfonate (Kayexelate) 15 g orally C Give spironolactone (Aldactone) 25 mg orally D Assess electrocardiogram (ECG) strip for tall T waves
B: Delegation, supervision. The normal range for potassium is 3.5 to 5 mEq/L. The client's potassium level is high. Kayexalate eliminates potassium from the body through the gastrointestinal system. Option C: Spironolactone is a potassium-sparing diuretic that may cause the client's potassium level to go even higher. Option D: The beginning nursing student does not have the skill to assess ECG strips
With which of the following disorders is jugular vein distention most prominent? A Abdominal aortic aneurysm B Heart failure C Myocardial infarction D Pneumothorax
B: Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Options A and D: Jugular vein distention isn't a symptom of abdominal aortic aneurysm or pneumothorax. Option C: An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn't cause jugular vein distention.
Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease? A Decrease anxiety B Enhance myocardial oxygenation C Administer sublingual nitroglycerin D Educate the client about his symptoms
B: Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Option C: Sublingual nitroglycerin is administered to treat acute angina, but its administration isn't the first priority. Options A and D: Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.
A client is admitted to the unit with the nursing diagnosis of Decreased Cardiac Output related to decreased plasma volume. Which assessment finding supports this nursing diagnosis? A Shallow respirations with crackles on auscultation B Flattened neck veins when the client is in the supine position C Full and bounding pedal and posttibial pulses D Pitting edema located in the feet, ankles, and calves
B: Prioritization. Neck veins are usually distended when the client is in the supine position. These veins flatten as the client moves to sitting position. Options A, C, and D: These responses are characteristic of the nursing diagnosis of Excess Fluid Volume.
For a client taking HCTZ, which blood test result would the nurse monitor? A Sodium level B Potassium level C Calcium level D Chloride level
B: Prioritization. Potassium level should be monitored regularly because potassium depletion is expected when a client is taking HCTZ.
The monitor watcher from the telemetry units informs the assigned nurse that the client developed prominent U waves. Which laboratory value should the nurse monitor? A Sodium level B Potassium level C Calcium level D Magnesium level
B: Prioritization. The nurse should immediately check the client's potassium level for hypokalemia. Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Heart block may also transpire to clients with hypokalemia.
Stimulation of the sympathetic nervous system produces which of the following responses? A Bradycardia B Tachycardia C Hypotension D Decreased myocardial contractility
B: Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. Options A, C, and D: The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.
Which of the following landmarks is the correct one for obtaining an apical pulse? A Left intercostal space, midaxillary line B Left fifth intercostal space, midclavicular line C Left second intercostal space, midclavicular line D Left seventh intercostal space, midclavicular line
B: The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. Option C: The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. Option A and D: Normally, heart sounds aren't heard in the midaxillary line or the seventh intercostal space in the midclavicular line.
A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse next assesses which of the following items? A Time of last dressing change. B Tightness of the tuning connections. C Client's temperature. D Expiration date on the bag
C --Redness at the catheter insertion site is a possible sign of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess.
A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be the least likely candidate for parenteral nutrition? A A 55-year-old with persistent nausea and vomiting from chemotherapy. B A 44-year old client with ulcerative colitis. C A 59-year old client who had an appendectomy. D A 25-year old client with a Hirschprung's Disease.
C --The client with an appendectomy is not a candidate because this client would resume a regular diet within a few days following the surgery. Options A, B, and D are incorrect because parenteral nutrition is indicated in these clients since their gastrointestinal tracts are not functional or who cannot take in a diet enterally for extended periods.
Which of the following arteries primarily feeds the anterior wall of the heart? A Circumflex artery B internal mammary artery C Left anterior descending artery D Right coronary artery
C --The left anterior descending artery is the primary source of blood for the anterior wall of the heart. Options A, B, and D: The circumflex artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.
Nurse Spencer is caring for an anorexic client who is having total parenteral nutrition solution for the first time. Which of the following assessments requires the most immediate attention? A Dry sticky mouth. B Temperature of 100° Fahrenheit. C Blood glucose of 210 mg/dl. D Fasting blood sugar of 98 mg/dl.
C --Total parenteral nutrition formula contains dextrose range from 5% to 70%. A blood glucose level of 210mg/dl is considered high.
A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? A "Have you ever had this pain before?" B "Can you describe the pain to me?" C "Does the pain get worse when you breathe in?" D "Can you rate the pain on a scale of 1-10, with 10 being the worst?"
C--Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.
The action of medication is inotropic when it: A Decreased afterload B Increases heart rate C Increases the force of contraction D Is used to treat CHF
C--Inotropic drugs increase the force of contraction. Preload, not afterload, is decreased. Chronotropic drugs increase heart rate. Treatment of CHF is an indication for use not an action of inotropic drug.
Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the blood to prevent arrhythmias? A Serum chemistries B Complete blood counts C Drug levels D None of the above
C--Knowing drug levels (peak and trough) is the only way to ensure there is enough drug in the body to work. Other choices do not demonstrate drug effect.
A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities? A Strict bed rest for 24 hours after transfer B Bathroom privileges and self-care activities C Unsupervised hallway ambulation with distances under 200 feet D Ad lib activities because the client is monitored
C--On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).
Which of the following is a contraindication for digoxin administration? A Blood pressure of 140/90 B Heart rate above 80 C Heart rate below 60 D Respiratory rate above 20
C--The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.
The most toxic antiarrhythmic agent is: A digoxin (Lanoxin) B lidocaine (Xylocaine) C amiodarone (Cordarone) D quinidine (Cardioquin)
C--This is the most toxic drug and should be used only if other less toxic agents have been tried. Digoxin, on the other hand, is cardiotonic, not antiarrhythmic agent. B and D are not known for their toxicity.
The nurse just received the client's morning laboratory results. Which of these results is of most concern? A Serum sodium level of 134 mEq/L B Serum potassium level of 5.2 mEq/L C Serum magnesium level of 0.8 mEq/L D Serum calcium level of 10.6 mg/dL
C. Serum magnesium level of 0.8 mEq/L Option C: Prioritization. With a magnesium level this low, the client is at risk for ECG changes and life-threatening ventricular dysrhythmias. Options A, B, and D: All of these values are also outside of the normal range, but the magnesium level is furthest from the normal values.
A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this? A Aortic B Mitral C Pulmonic D Tricuspid
C: Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Option D: Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border
What is the most common complication of a myocardial infarction? A Cardiogenic shock B Heart failure C Arrhythmias D Pericarditis
C: Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Option A: Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Option B: Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Option D: Pericarditis most commonly results from a bacterial or viral infection but may occur after MI
Which of the following risk factors for coronary artery disease cannot be corrected? A Cigarette smoking B DM C Heredity D HPN
C: Because "heredity" refers to our genetic makeup, it can't be changed. Option A: Cigarette smoking cessation is a lifestyle change that involves behavior modification. Option B: Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Option D: Altering one's diet, exercise, and medication can correct hypertension.
Which of the following conditions is most commonly responsible for myocardial infarction? A Aneurysm B Heart failure C Coronary artery thrombosis D Renal failure
C: Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. Option A: An aneurysm is an outpouching of a vessel and doesn't cause an MI. Option D: Renal failure can be associated with MI but isn't a direct cause. Option B: Heart failure is usually the result of an MI.
A client is admitted to the unit with the diagnosis of Deficient Fluid Volume related to excessive fluid loss. Which action related to fluid management should be charged to a nursing assistant? A Administer intravenous (IV) fluids as prescribed by the physician B Develop a plan for added fluid intake over 24 hours C Provide straws and offer fluids between meals D Educate family members to assist the client with fluid intake
C: Delegation, supervision. Additional fluid intake can be reinforced by the nursing assistance once it is part of the care plan. Options A, B, and D: Administering IV fluids, developing plans, and educating families demand further education and skills that are within the field of practice of an RN
Septal involvement occurs in which type of cardiomyopathy? A Congestive B Dilated C Hypertrophic D Restrictive
C: In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum - not the ventricle chambers - is apparent. Options A, B, and D: This abnormality isn't seen in other types of cardiomyopathy.
Which of the following symptoms might a client with right-sided heart failure exhibit? A Adequate urine output B Polyuria C Oliguria D Polydipsia
C: Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Options A, B, and D: Adequate urine output, polyuria, and polydipsia aren't associated with right-sided heart failure.
What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention? A High-Fowler's B Raised 10 degrees C Raised 30 degrees D Supine position
C: Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Options B and D: Inclined pressure can't be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). Option A: In high-Fowler's position, the veins would be barely discernible above the clavicle
Medical treatment of coronary artery disease includes which of the following procedures? A Cardiac catheterization B Coronary artery bypass surgery C Oral medication administration D Percutaneous transluminal coronary angioplasty
C: Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Option A: Cardiac catheterization isn't a treatment but a diagnostic tool. Options B and D: Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.
The assigned LPN of the unit reports to you that a client's blood pressure and heart rate have decreased, and when her face is assessed, one side twitches. What is the most appropriate thing to do as a nurse? A Assess client's pupillary reaction to light B Obtain a neurologic exam request for client C Review the client's morning calcium level D Retake the client's blood pressure and heart rate
C: Prioritization. Facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear is a positive Chvostek sign. It is a neurologic manifestation of hypocalcemia. Option D: The LPN is experienced and holds the skills to carefully and accurately measure vital signs.
What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)? A Chloride B Digoxin C Potassium D Sodium
C: Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Options A and D: Chloride and sodium aren't lost during diuresis. Option B: Digoxin acts to increase contractility but isn't given routinely with furosemide.
Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? A Anterior B Apical C Inferior D Lateral
C: The right coronary artery supplies the right ventricle or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. Options A, B, and D: The right coronary artery doesn't supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
Which of the following blood tests is most indicative of cardiac damage? A Lactate dehydrogenase B Complete blood count C Troponin I D Creatine kinase
C: Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Option A: Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. Option B: CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Option D: Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.
A nurse is caring a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation? A On the right side, with head higher than feet B On the right side, with head lower than feet. C On the left side, with head higher than feet. D On the left side, with head lower than feet.
D --Air embolism happens when air enters the catheter system when the IV tubing disconnects. If it is suspected, the client should be placed in a left-side-lying position. The head should be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart.
A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse determines that the client is experiencing which complication of PN therapy? A Air embolism. B Hypervolemia. C Hyperglycemia. D Pneumothorax
D --Pneumothorax might happen during a parenteral therapy due to inexact catheter placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the catheter to ensure proper catheter placement.
A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the therapy and assesses the client for which of the following signs of hyperglycemia? A High-grade fever, chills, and decreased urination. B Fatigue, increased sweating, and heat intolerance. C Coarse dry hair, weakness, and fatigue. D Thirst, blurred vision, and diuresis.
D --Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision, confusion, weakness, Kussmaul's respirations, diuresis, and coma when hyperglycemia is severe. Option A are signs of infection. Option B are signs of hyperthyroidism. Option C are signs of hypothyroidism.
A nurse is caring for a combative client who is ordered to have a nutritional therapy using parenteral nutrition (PN). The nurse should plan which of the following measures to prevent the client from injury? A Monitor blood glucose twice a day. B Instruct the relative to stay with the nurse. C Measure 24-hour intake and output. D Secure all connections in the parenteral system.
D --The nurse should plan to secure all connections in the tubing. This will prevent the client from pulling the connections apart.
Which of the following adverse reactions is found more often in volume-depleted elderly clients? A Bradycardia B Conduction defects C Ankle edema D Hypotension
D--Hypotension is more likely to occur in the elderly. Choices A, B, and C may occur but are not necessarily increased in frequency in elderly clients.
The therapeutic drug level for digoxin is: A 0.1-2.0 ng/mg B 1.0-2.0 ng/mg C 0.1-0.5 ng/mg D 0.5-2.0 ng/mg
D--Is the correct therapeutic range for digoxin. Every nurse should know this information.
A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure? A Intake and output B Baseline peripheral pulse rates C Height and weight D Allergy to iodine or shellfish
D--This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.
Which of the following cardiac conditions does a fourth heart sound (S4) indicate? A Dilated aorta B Normally functioning heart C Decreased myocardial contractility D Failure of the ventricle to eject all the blood during systole
D: An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decrease compliance of the ventricle. Option A: A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Option C: Decreased myocardial contractility is heard as a third heart sound. Option B: An s4 isn't heard in a normally functioning heart.
The newly hired nurse is assigned by the charge nurse to care for a client with acute renal failure and hypernatremia. Which action can the nurse assign to the nursing assistant? (Select all that apply.) A Administer 0.45% saline by IV line B Assess daily weights for trends C Check for indications of dehydration D Render oral care every 3 to 4 hour
D: Assignment, delegation, supervision. The nursing assistant can provide oral care to the client. This is within the scope of practice of nursing assistants. Options A, B, and D: Administering IV fluids as well as assessing and monitoring clients demand the additional education and skills of the RN.
After myocardial infarction, serum glucose levels and free fatty acids are both increased. What type of physiologic changes are these? A Electrophysiologic B Hematologic C Mechanical D Metabolic
D: Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Options A and C: Mechanical changes are those that affect the pumping action of the heart, and electrophysiologic changes affect conduction. Option B: Hematologic changes would affect the blood.
Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease? A 100 mg/dl B 150 mg/dl C 175 mg/dl D 200 mg/dl
D: Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD.
Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility? A Beta-adrenergic blockers B Calcium channel blockers C Diuretics D Inotropic agents
D: Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Options A and B: Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Option C: Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart
What is the primary reason for administering morphine to a client with myocardial infarction? A To sedate the client B To decrease the client's pain C To decrease the client's anxiety D To decrease oxygen demand on the client's heart
D: Morphine is administered because it decreases myocardial oxygen demand. Options A, B, and C: Morphine will also decrease pain and anxiety while causing sedation, but isn't primarily given for those reasons.
A client going through intense chemotherapy treatment is admitted to the unit. Which of these would the nurse instruct the nursing assistant to report to prevent an acid-base imbalance? A Hair loss during the morning bath B Complaints of pain associated with exertion C Failure to eat all the food on the breakfast tray. D Prolonged episodes of nausea and vomiting
D: Prioritization, supervision. Repeated nausea and vomiting can lead to an acid deficit and metabolic alkalosis. Options A, B, and C: The other options are vital and still need to be assessed, but are not related to acid-base problems.
A 56-year-old male is newly admitted to the medical unit. Which factor alerts the nurse that this client has a risk for acid-base imbalances? A The client takes antacids for occasional indigestion. B The client gets short of breath with extreme exertion. C The client has a history of myocardial infarction 1 year ago. D The client has chronic renal insufficiency
D: Prioritization. Chronic renal disease and pulmonary disease are risk factors for acid-base imbalances in the older adult. Option A: Although antacid abuse is a risk factor for metabolic alkalosis, occasional antacid use will not cause imbalances
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte irregularity will the nurse be certain to monitor? A Hyperkalemia B Hypokalemia C Hypernatremia D Hyponatremia
D: Prioritization. Due to an excessive water retention, SIADH causes a relative sodium deficit.
The physician prescribed hydrochlorothiazide (HCTZ, Microzide) 10 mg orally for the client to take every day. What should you be sure to include in a teaching plan for this drug? (Select all that apply.) 1. "Take this prescription in the morning." 2. "You should anticipate your urine output to increase." 3. "Notify your prescriber if you notice weight gain or increased swelling." 4. "This medication should be taken in 2 divided doses when you get up and when you go to bed." 5. "Eat foods with extra sodium every day."
D: Prioritization. HCTZ is under thiazide diuretics. It should not be taken at night because it will cause the client to awaken and go to the toilet to urinate. Weight gain and increased edema should not transpire while the client is using this drug, so this should be reported to the prescriber. Option A: This type of diuretic causes potassium depletion, so the nurse should educate the client about eating foods rich in potassium
Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration? A Cardiac B Gastrointestinal C Musculoskeletal D Pulmonary
D: Pulmonary pain is generally described by these symptoms. Option C: Musculoskeletal pain only increases with movement. Options A and B: Cardiac and GI pains don't change with respiration.
A group of nursing students is assigned to care for a client with a nasogastric tube connected to a wall suction. One student asks why the client's respiratory rate has decreased. Choose the best response. A "Whenever a client develops a respiratory acid-base problem, decreasing the respiratory rate helps fix the problem." B "The client is hypoventilating because of anxiety, and we will have to stay observant for the development of respiratory acidosis." C "It's common for clients with uncomfortable equipment such as nasogastric tubes to have a lower rate of breathing." D "The client may have a metabolic alkalosis due to the nasogastric suctioning, and the decreased respiratory rate is a compensatory mechanism."
D: Supervision, prioritization. Nasogastric suctioning can result in a decrease in acid components and a metabolic alkalosis. The client's decrease in rate and depth of ventilation is an attempt to compensate by retaining carbon dioxide. Options A and B: These responses are incorrect. Option C: This response may be right, but it does not discuss all the components of the question
Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? A Cardiac catheterization B Cardiac enzymes C Echocardiogram D Electrocardiogram
D: The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Option B: Cardiac enzymes are used to diagnose MI but can't determine the location. Option C: An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Option A: Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately
In which of the following disorders would the nurse expect to assess sacral edema in bedridden client? A DM B Pulmonary emboli C Renal failure D Right-sided heart failure
D: The most accurate area of the body to assess dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Options A, B, and C: Diabetes mellitus, pulmonary emboli, and renal disease aren't directly linked to sacral edema.
Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions? A Pericarditis B Hypertension C Obliterative D Restrictive
D: These are the classic symptoms of heart failure. Option A: Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Option B: Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. Myocardial infarction causes heart failure but isn't related to these symptoms.
Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? A Angina pectoris B Cardiomyopathy C Left-sided heart failure D Right-sided heart failure
D: Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Option B: Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Option C: Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Option A: Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output
A patient receiving parenteral nutrition is administered via the following routes except: A Subclavian line. B Central Venous Catheter. C PICC (Peripherally inserted central catheter) line. D PEG tube
Percutaneous endoscopic gastrostomy (PEG tube) is inserted into a person's stomach through the abdominal wall that is used to provide a means of feeding when oral intake is not adequate. While Parenteral nutrition bypasses the digestive system by the administration to the bloodstream..
A nurse is conducting a follow-up home visit to a client who has been discharged with a parenteral nutrition(PN). Which of the following should the nurse most closely monitor in this kind of therapy? A blood pressure and temperature. B Blood pressure and pulse rate. C Height and weight. D Temperature and weight
The client's temperature is monitored to identify signs of infection which is one of the complications of this therapy. While the weight is monitored to detect hypervolemia and to determine the effectiveness of this nutritional therapy
A nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 2 hours delay. The nurse should do which of the following actions? A Adjust the infusion rate to catch up over the next hour. B Make sure the infusion rate is infusing at the ordered rate. C Increase the infusion rate to catch up over the next few hours. D Adjust the infusion rate to full blast until the solution is back on time
The nurse should maintain the prescribed rate of a fat emulsion even if the infusion's time consume is behind. Options A, C, and D are incorrect since increasing the rate will potentially cause a fluid overload.
A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensure the availability of which medical equipment before hanging the solution? A Glucometer. B Dressing tray. C Nebulizer. D Infusion pump
The nurse should prepare an infusion pump prior hanging a parenteral solution. The use of an infusion pump is important to make sure that the solution does not infuse too quickly or delayed since the parenteral nutrition has a high glucose content. Option A: A glucometer is also needed since the client's glucose level is monitored every 4 to 6 hours, but it is not an essential item needed. Options B and C are not used before hanging a PN solution.