cardio exam practice questions

3. A patient is admitted with myocarditis. While performing the initial assessment, the nurse may find which clinical signs and symptoms (select all that apply)? a. Angina b. Pleuritic chest pain c. Splinter hemorrhages d. Pericardial friction rub e. Presence of Osler's nodes

3. Correct answers: a, b, d Rationale: Clinical manifestations of myocarditis may include early systemic manifestations (i.e., fever, fatigue, malaise, myalgias, pharyngitis, dyspnea, lymphadenopathy, and nausea and vomiting), early cardiac manifestations (e.g., pleuritic chest pain with a pericardial friction rub and effusion), and late cardiac signs (e.g., S3 heart sound, crackles, jugular venous distention [JVD], syncope, peripheral edema, and angina).

3. You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (select all that apply) a. increases SVR. b. produces diuresis. c. improves contractility. d. dilates renal blood vessels. e. works on the β1-receptors in the heart.

3. Correct answers: c, e Rationale: Dobutamine (Dobutrex) has a positive chronotropic effect and increases heart rate and improves contractility. It is a selective β-adrenergic agonist and works primarily on the β1-adrenergic receptors in the heart. It is frequently used in the short-term management of acute decompensated heart failure (ADHF).

4. A priority consideration in the management of the older adult with hypertension is to a. prevent primary hypertension from converting to secondary hypertension. b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult. c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

4. Correct answer: d Rationale: Careful technique is important in assessing BP in older adults. In some older people, there is a wide gap between the first Korotkoff sound and subsequent beats; such a wide interval is called an auscultatory gap. Failure to inflate the cuff high enough may result in a serious underestimate of systolic BP.

4. Priority nursing management for a patient with myocarditis includes interventions related to a. meticulous skin care. b. antibiotic prophylaxis. c. tight glycemic control. d. oxygenation and ventilation.

4. Correct answer: d Rationale: General supportive measures for management of myocarditis include interventions to improve ventilation and oxygenation (oxygen therapy, bed rest, and restricted activity).

10. The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy. Which intervention would be a priority? a. Encourage caregivers to learn CPR. b. Consider a consultation with hospice for palliative care. c. Monitor the patient's response to prescribed medications. d. Arrange for the patient to enter a cardiac rehabilitation program.

10. Correct answer: c Rationale: Observing for signs and symptoms of worsening heart failure, dysrhythmias, and embolus formation in patients with dilated cardiomyopathy is essential, as is monitoring drug responsiveness. The goal of therapy is to keep the patient at an optimal level of functioning and out of the hospital. The priority intervention is to manage the acute symptoms with medications. The caregivers should learn cardiopulmonary resuscitation (CPR) before hospital discharge, and the patient may be referred to cardiac rehabilitation. Patients with dilated cardiomyopathy with progression to class IV stage D heart failure are candidates for palliative care.

12. In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is a. discussing activity guidelines. b. using moist environment dressings. c. taking horse chestnut seed extract daily. d. applying graduated compression stockings.

12. Correct answer: d Rationale: Compression is essential for treating chronic venous insufficiency (CVI), healing venous ulcers, and preventing ulcer recurrence. Use of custom-fitted graduated compression stockings is one option for compression therapy.

2. The nurse is caring for a patient with chronic constrictive pericarditis. Which assessment finding reflects a more serious complication of this condition? a. Fatigue b. Peripheral edema c. Jugular venous distention d. Thickened pericardium on echocardiography

2. Correct answer: c Rationale: Cardiac tamponade is a serious complication of pericarditis. As the compression of the heart increases, decreased left atrial filling results in decreased cardiac output. Neck veins usually are markedly distended as a result of jugular venous pressure elevation related to compression of the right side of the heart. Heart sounds become muffled secondary to sound distortion by the fluid causing compression of the heart.

2. Rest pain is a manifestation of PAD that occurs due to a chronic a. vasospasm of small cutaneous arteries in the feet. b. increase in retrograde venous blood flow in the legs. c. decrease in arterial blood flow to the nerves of the feet. d. constriction in arterial blood flow to the leg muscles during exercise.

2. Correct answer: c Rationale: Rest pain most often occurs in the forefoot or toes and is aggravated by limb elevation. Rest pain occurs when blood flow is insufficient to meet basic metabolic requirements of the distal tissues. Rest pain occurs more often at night because cardiac output tends to drop during sleep and the limbs are at the level of the heart. Patients often try to achieve partial pain relief by dangling the leg over the side of the bed or sleeping in a chair to allow gravity to maximize blood flow.

A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern? (Select all that apply.) A.Trace of bloody drainage on dressing B.Capillary refill of affected limb of 6 seconds C.Mottled appearance of the limb D.Throbbing pain of affected limb that is decreased following IV bolus analgesic E.Pulse of 2+ in the affected limb

B.Capillary refill of affected limb of 6 seconds C.Mottled appearance of the limb

A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse suspect? A.Retroperitoneal bleeding B.Cardiac tamponade C.Bleeding from the incisional site D.Heart failure

C.Bleeding from the incisional site

A nurse is completing the admission physical assessment of client who has a history of mitral valve insufficiency. Which of the following findings should the nurse expect? A.S4 heart sound B.Petechiae C.Crackles in lung bases D.Splenomegaly

C.Crackles in lung bases

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? A.Diet modification B.Relaxation exercises C.Smoking cessation D.Taking omega‑3 capsules

C.Smoking cessation

7. Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation? a. Reduction in peripheral edema and weight b. Carotid venous distention and new-onset atrial fibrillation c. Significant pulsus paradoxus and diminished peripheral pulses d. Shortness of breath on minimal exertion and a diastolic murmur

7. Correct answer: d Rationale: Clinical manifestations of aortic regurgitation (AR) that indicate decreased cardiac output include severe dyspnea, chest pain, and hypotension. Other manifestations of chronic AR include water-hammer pulse (i.e., a strong, quick beat that collapses immediately), soft or absent S1, presence of S3 or S4, and soft, high-pitched diastolic murmur. A low-pitched diastolic murmur may be heard in severe AR. Early manifestations may include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? A. "I can't get rid of these hiccups." b. "I feel dizzy when I stand." c. "My incision site stings." d. "I have a headache."

A. "I can't get rid of these hiccups." Rationale:

A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition? A. Absence of adventitious breath sounds B. Presence of a nonproductive cough C. Decrease in respiratory rate at rest D. Sao2 86% on room air

A. Absence of adventitious breath sounds Rationale: Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving.

A nurse is caring for a client who asks why her provider prescribed a daily aspirin. Which of the following is an appropriate response by the nurse? A."Aspirin reduces the formation of blood clots that could cause a heart attack." B."Aspirin relieves the pain due to myocardial ischemia." C."Aspirin dissolves clots that are forming in your coronary arteries." D."Aspirin relieves headaches that are caused by other medications."

A."Aspirin reduces the formation of blood clots that could cause a heart attack."

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? A. Ventricular depolarization B. Guillain-Barre syndrome C. Myelodysplastic syndrome D. Valvular disease

D. Valvular disease Rationale: Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.

A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? A. A client who has hypothyroidism b. A client who has diabetes mellitus c. A client whose daily caloric intake consists of 25% fat d. A client who consumes two bottles of beer a day

b. A client who has diabetes mellitus Rationale: Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease.

A nurse is assessing a client who has left-sided HF. Which of the following manifestations should the nurse expect to find? A. Inc abdominal girth b. Weak peripheral pulses c. Jugular vein distention d. Dependent edema

b. Weak peripheral pulses Rationale: Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure.

2. While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. a low-calcium diet. b. excessive alcohol intake. c. a family history of hypertension. d. consumption of a high-protein diet.

2. Correct answer: b Rationale: Alcohol intake is a modifiable risk factor for hypertension. Excessive alcohol intake is strongly associated with hypertension. Males with hypertension should limit their daily intake of alcohol to 2 drinks per day, and 1 drink per day for females with hypertension.

A nurse is providing teaching for a client who is 2 days post-op following a heart transplant. Which of the following statements should the nurse include in the teaching? A. "you may no longer be able to feel chest pain." b. "your level of activity tolerance will not change." c. "after 6 months, you will no longer need to restrict your sodium intake." d. "you will be able to stop taking immunosuppressants after 12 months."

A. "you may no longer be able to feel chest pain." Rationale: Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.

2. A nurse is caring for four clients. Which of the following clients should the nurse identify as being at risk of acquiring rheumatic endocarditis? A. Older adult who has chronic obstructive pulmonary disease B. Child who has streptococcal pharyngitis C. Middle-age adult who has lupus erythematosus D. Young adult who recently received a body tattoo

A. An older adult who has chronic obstructive pulmonary disease is not at risk for rheumatic endocarditis unless he develops rheumatic fever. B. CORRECT: A child who has streptococcal pharyngitis is at risk for developing rheumatic fever which could result in rheumatic endocarditis. C. A middle-age adult who has lupus erythematosus is not at risk for rheumatic endocarditis unless he develops rheumatic fever. D. A young adult who receives a body tattoo is at increased risk for infective endocarditis but is not at risk for rheumatic endocarditis unless he develops rheumatic fever.

4. A nurse is assessing a client who has splinter hemorrhages in her nail beds and reports a fever. The nurse should identify these findings as manifestations of which of the following disorders? A. Infective endocarditis B. Pericarditis C. Myocarditis D. Rheumatic endocarditis

A. CORRECT: Splinter hemorrhages in nail beds and a report of fever are findings associated with infective endocarditis. B. A client who has pericarditis would report chest pain. C. A client who has myocarditis would report a rapid heart rate. D. A client who has rheumatic endocarditis would report joint pain.

A nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. Which of the following foods should the nurse recommend for the client? (Select all that apply.) A.1 slice cheddar cheese B.1 medium beef hot dog C.3 oz Atlantic salmon D.3 oz roasted chicken breast E.2 oz lean baked ham

A.1 slice cheddar cheese C.3 oz Atlantic salmon D.3 oz roasted chicken breast

A nurse educator is reviewing expected findings in a client who has right‑sided valvular heart disease with a group of nurses. Which of the following findings should the nurse include in the discussion? (Select all that apply.) A.Dyspnea B.Client report of fatigue C.Bradycardia D.Pleural friction rub E.Peripheral edema

A.Dyspnea B.Client report of fatigue E.Peripheral edema

A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching? A. Apply the new patch to the same site as the previous patch. B. Place the patch on an area of skin away from skin folds and joints. C. Keep the patch on 24 hr per day. D. Replace the patch at the onset of angina.

B. Place the patch on an area of skin away from skin folds and joints. Rationale: The nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly.

A nurse is caring for a client who was admitted for a treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? A. Obtain clients current weight B. Review serum electrolyte values C. Determine the time of the last digoxin dose D. Check the clients urine output)

B. Review serum electrolyte values Rationale: Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.

A nurse is completing discharge teaching with a client who has heart failure and is encouraged to increase potassium in his diet. Which of the following food selections should the nurse include as having the highest source of potassium? A.1 medium apple B.1 medium baked potato C.1 slice toast with 1 tbsp peanut butter D.1 large scrambled egg

B.1 medium baked potato

A nurse is caring for a client who presents to the ER with a BP of 254/138 mmhg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? A. Initiate seizure precautions. B. Tell the client to report vision changes C. Elevate the head of the clients bed D. Start a peripheral IV

C. Elevate the head of the clients bed Rationale: The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.

A nurse is admitting a client who has a leg ulcer and a history of DM. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer? A. Explore the clients family history of peripheral vascular disease B. Note the presence or absence of pain at the ulcer site C. Inquire about the presence or absence of claudication D. Ask if the client has had a recent infection

C. Inquire about the presence or absence of claudication Rationale: Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.

A nurse is caring for a client in the first hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? A. Serosanguinous drainage on dressing B. Severe pain with coughing C. Urine output of 20 ml/hr D. Increase in temp from 36.C (98.2F)- 37.5C (99.5F)

C. Urine output of 20 ml/hr Rationale: Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.

A nurse working on a cardiac unit is admitting a client who is to undergo a cardioversion and is reviewing the health record. Which of the following data requires that the nurse notify the provider to cancel the procedure? (Review the data below for additional client information.) MAR Ferrous Sulfate 200 mg PO 0800 & 2000 Diazepam 2 mg PO 0800 & 2000 Isosorbide 2.5 mg PO 4 times a day AC and HS VITAL SIGNS HISTORY & PHYSICAL A.Respiratory history B.Vital signs C.Medication history D.Medications to be administered

C.Medication history

A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse. (You will find "Hot Spots" to select in the artwork below. Select only the hotspot that corresponds to your answer.)

D Rationale: Inspection of this location allows the nurse to assess for pulsations of the apex area of the heart, which is considered the apical pulse or point of maximal impulse. The point of maximal impulse is located at the left fifth intercostal space in the midclavicular line.

A nurse in the emergency department is caring for a client who had an anterior MI. The client's history reveals she is 1 week post-op open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated? A. Administering IV morphine sulfate B. Administering oxygen at 2:/min via nasal cannula C. Helping the client to the bedside commode D. Assisting with thrombolytic therapy

D. Assisting with thrombolytic therapy Rationale: The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.

A nurse is teaching a client who is scheduled for an angiography. Which of the following statements should the nurse include in the teaching? A."you should have nothing to eat or drink for 4 hours prior to the procedure." B."you will be given general anesthesia during the procedure." C."you should not have this procedure done if you are allergic to eggs." D."you will need to keep your affected leg straight following the procedure."

D." you will need to keep your affected leg straight following the procedure." Rationale: instruct the client of the need to remain on bed rest in the supine position with the affected leg straight for a prescribed amount of time this positioning decreases the clients risk for bleeding and hematoma formation of the catheter insertion site

A nurse is completing the admission assessment of a client who will undergo peripheral bypass graft surgery on the left leg. Which of the following findings should the nurse expect? A.Rubor of the affected leg when elevated B.3+ dorsal pedal pulse in left foot C.Thin, peeling toenails of left foot D.Report of intermittent claudication in the affected leg

D.Report of intermittent claudication in the affected leg

A nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. Which of the following client findings should the nurse report to the provider? A. Mediastinal drainage 100 ml/hr b. Blood pressure 160/80 mm Hg C. Temperature 37.1° C (98.8° F) D. Potassium 4.0 meq/L

b. Blood pressure 160/80 mm Hg Rationale: The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.

A nurse is caring for a client who is being treated for HF and has prescriptions for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication? A. SOB b. Lightheadedness c. Dry cough d. Metallic taste

b. Lightheadedness Rationale: Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness.

A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following? A. Tendon pain b. Persistent cough c. Frequent urination d. Constipation

b. Persistent cough Rationale: A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication.

A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The client is conscious with a HR of 200-210 bpm and has a faint radial pulse. The nurse should anticipate assisting with which of the following interventions? A. Initiate chest compressions b. Vagal stimulation c. Administration of atropine IV d. Defibrillation

b. Vagal stimulation Rationale: The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.

A nurse is reviewing the laboratory results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which laboratory values? A. Cholesterol 180 mg/dl, HDL 70 mg/dl, LDL 90 mg/dl b. Cholesterol 185 mg/dl, HDL 50 mg/dl, LDL 120 mg/dl c. Cholesterol 190 mg/dl, HDL 25 mg/dl, LDL 160 mg/dl d. Cholesterol 195 mg/dl, HDL 55 mg/dl, LDL 125 mg/dl

c. Cholesterol 190 mg/dl, HDL 25 mg/dl, LDL 160 mg/dl Rationale: These laboratory values for HDL and LDL are outside of the expected reference range and indicate that the nurse should provide dietary teaching to the client. The expected reference range for cholesterol is less than 200 mg/dL; for HDL is above 45 mg/dL for males and above 55 mg/dL for females; and for LDL is less than 130 mg/dL.

A nurse is caring for a client who has a history of angina and is schedules for a stress test at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? A. "I'm still hungry after the bowl of cereal I ate at 7am." b. "I didn't take my heart pills this morning because the doctor told me not to." c. "I have had chest pain a couple of times since I saw my doctor in the office last week." d. "I smoked a cigarette this morning to calm my nerves about having this procedure."

d. "I smoked a cigarette this morning to calm my nerves about having this procedure." Rationale: Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test.

5. A nurse is admitting a client who has suspected rheumatic endocarditis. The nurse should anticipate a prescription from the provider for which of the following laboratory tests to assist in confirmation of this diagnosis? A. Arterial blood gases B. Serum albumin C. Liver enzymes D. Throat culture

A. Arterial blood gases are used to monitor the respiratory status of a client who has suspected rheumatic endocarditis, but they do not confirm the diagnosis. B. Serum albumin monitors the nutrition status of a client who has a suspected inflammatory disorder, but it does not confirm the diagnosis. C. Liver enzymes monitor a client's response to antibiotic therapy, which is used to treat rheumatic endocarditis, but they do not confirm the diagnosis. D. CORRECT: A throat culture can reveal the presence of streptococcus, which is the leading cause of rheumatic endocarditis.

3. A nurse in a clinic is caring for a client who has been on long-term NSAID therapy to treat myocarditis. Which of the following laboratory findings should the nurse report to the provider? A. Platelets 100,000/mm3 B. Serum glucose 110 mg/dL C. Serum creatinine 0.7 mg/dL D. Amino alanine transferase (ALT) 30 IU/L

A. CORRECT: Long-term NSAID therapy can lower platelets. This finding is outside the expected reference range and should be reported to the provider. B. Serum glucose is not affected by long-term NSAID therapy. This finding is within the expected reference range. C. Kidney function, which is monitored by serum creatinine level, is affected by long-term NSAID therapy. This finding is within the expected reference range. D. Liver function, which is monitored by the ALT level, is affected by long-term NSAID therapy. This finding is within the expected reference range.

A nurse is assessing a client in the emergency room who has a bradydysrhythmia. Which of the following findings should the nurse expect? A. Confusion B. Friction Rub C. Hypertension D. Dry Skin

A. Confusion Rationale: Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.

A nurse is caring for a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? A. Dyspnea on exertion B. Tracheal deviation C. Pericardial rub D. Weight loss

A. Dyspnea on exertion Rationale: The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output.

1. A nurse is caring for a client who has pericarditis. Which of the following findings should the nurse expect? A. Petechiae B. Murmur C. Rash D. Friction rub

A. Petechiae are an expected finding in a client who has endocarditis. B. A murmur is an expected finding in a client who has myocarditis and endocarditis. C. Rash is an expected finding in a client who has rheumatic endocarditis. D. CORRECT: A friction rub can be heard during auscultation of a client who has pericarditis.

A nurse is admitting a client to the coronary care unit following placement of a temporary pacemaker. Which of the following nursing actions should the nurse use to promote client safety? (Select all that apply.) A.Wear gloves when handling pacemaker leads. B.Ensure electronic equipment has three‑pronged grounding plugs. C.Minimize the client's shoulder movements. D.Hold the lead wires taut when turning the client. E.Keep extra pacemaker batteries at least 300 ft away from the client.

A.Wear gloves when handling pacemaker leads. C.Minimize the client's shoulder movements.

A nurse is caring for a client who has heart failure and reports increased shortness of breath. The nurse increases the client's oxygen per protocol. Which of the following actions should the nurse take first? A.Obtain the client's weight. B.Assist the client into high‑Fowler's position. C.Auscultate lungs sounds. D.Check oxygen saturation with pulse oximeter.

B.Assist the client into high‑Fowler's position.

A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? A.CK‑MB B.Troponin I C.Troponin T D.Myoglobin

C.Troponin T

A nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? A. "My arthritis is really bothering me because I haven't taken my aspiring in a week." b. "My blood pressure shouldn't be high because I took my BP medication this morning." c. "I took my warfarin last night according to my usually schedule." d. "I will check my BP because I took a reduced dose of insulin this morning."

C: "I took my warfarin last night according to my usually schedule." Rationale: Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding.

7. The first priority of interprofessional care of a patient with a suspected acute aortic dissection is to a. reduce anxiety. b. monitor for chest pain. c. control blood pressure. d. increase myocardial contractility.

7. Correct answer: c Rationale: The initial goals of therapy for acute aortic dissection without complications are blood pressure (BP) control and pain management. BP control reduces stress on the aortic wall by reducing systolic BP and myocardial contractility.

A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Identify the area of the strip the nurse should examine to observe for atrial depolarization. (You will find "Hot Spots" to select in the artwork below. Select only the hotspot that corresponds to your answer.)

A: P wave Rationale: you observe the p wave for atrial depolarization.......so thats A.

A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statements by the client indicates understanding of the teaching? A."I will be glad to get back to my exercise routine right away." B."I will have my prothrombin time checked on a regular basis." C."I will talk to my dentist about no longer needing antibiotics before dental exams." D."I will continue to limit my intake of foods containing potassium."

B."I will have my prothrombin time checked on a regular basis."

A nurse is caring for a client who is 4 hr postoperative following coronary artery bypass grafting (CABG) surgery. He is able to inspire 200 mL with the incentive spirometer, then refuses to cough because he is tired and it hurts too much. Which of the following actions should the nurse take? A.Allow the client to rest, and return in 1 hr. B.Administer IV bolus analgesic, and return in 15 min. C.Document the 200 mL as an appropriate inspired volume. D.Tell the client that he must try to cough if he does not want to get pneumonia.

B.Administer IV bolus analgesic, and return in 15 min.

A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client? A.Defibrillation B.Pacemaker insertion C.Synchronized cardioversion D.Administration of IV lidocaine

B.Pacemaker insertion

A nurse is caring for a client who has a history of DVT and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy? A. Hemoglobin 14 g/dl B. Minimal bruising of extremities C. Decreased Blood pressure D. INR 2.0

D. INR 2.0 Rationale: The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.

A nurse is preparing a client for coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure? A. Hemoglobin 14.4 g/dl b. History of peripheral arterial disease. c. Urine output 200 ml/4 hr. D. Previous allergic reaction to shellfish

D. Previous allergic reaction to shellfish Rationale: The contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine prior to the procedure.

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which one of the following actions should the nurse take if the clients aPTT is 96 seconds? A. Increase the heparin infusion flow rate by 2 ml/hr B. Continue to monitor the heparin infusion as prescribed C. Request a prothrombin time D. Stop the heparin infusion

D. Stop the heparin infusion Rationale: The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.

A nurse is admitting a client who has complete heart block as demonstrated by ECG. The client's heart rate is 34/min and blood pressure is 83/48 mm Hg. The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first? A.Transport the client to the cardiovascular laboratory. B.Prepare the client for insertion of a permanent pacemaker. C.Obtain a signed informed consent form for a pacemaker. D.Apply transcutaneous pacemaker pads.

D.Apply transcutaneous pacemaker pads.

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in which of the following is diagnostic of a MI? A. Myoglobin b. C-reactive protein c. Creatine kinase- MB d. Homocysteine

c. Creatine kinase- MB Rationale: Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury.

3. In teaching a patient with hypertension about controlling the illness, the nurse recognizes that a. all patients with elevated BP require medication. b. obese persons must achieve a normal weight to lower BP. c. it is not necessary to limit salt in the diet if taking a diuretic. d. lifestyle modifications are indicated for all persons with elevated BP.

3. Correct answer: d Rationale: Lifestyle modifications are indicated for all patients with prehypertension and hypertension.

9. Which diagnostic study best differentiates the various types of cardiomyopathy? a. Echocardiography b. Arterial blood gases c. Heart catheterization d. Endomyocardial biopsy

9. Correct answer: a Rationale: Echocardiography is the primary diagnostic tool used to differentiate between the different types of cardiomyopathies and other structural heart abnormalities.

A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? (Select all that apply.) A.Follow‑up ECG B.Energy settings used C.IV fluid intake D.Urinary output E.Skin condition under electrodes

A.Follow‑up ECG B.Energy settings used E.Skin condition under electrodes

A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following manifestation are expected findings? (Select all that apply.) A.Tachypnea B.Persistent cough C.Increased urinary output D.Thick, yellow sputum E.Orthopnea

A.Tachypnea B.Persistent cough E.Orthopnea

1. The nurse recognizes that primary manifestations of systolic failure include a. ↓ EF and ↑ PAWP. b. ↓ PAWP and ↑ EF. c. ↓ pulmonary hypertension associated with normal EF. d. ↓ afterload and ↓ left ventricular end-diastolic pressure.

1. Correct answer: a Rationale: Systolic heart failure results in systolic failure in the left ventricle (LV). The LV loses its ability to generate enough pressure to eject blood forward through the aorta. This results in increased pulmonary artery wedge pressure (PAWP). The hallmark of systolic failure is a decrease in the left ventricular ejection fraction (EF).

1. A 50-year-old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease (PAD) that must be modified are a. weight and diet. b. activity level and salt intake. c. tobacco use and high blood pressure. d. sedentary lifestyle and exercise training.

1. Correct answer: c Rationale: Significant risk factors for peripheral artery disease include tobacco use, hyperlipidemia, elevated levels of high-sensitivity C-reactive protein, diabetes mellitus, and uncontrolled hypertension; the most important is tobacco use. Other risk factors include family history, hypertriglyceridemia, hyperuricemia, increasing age, obesity, sedentary lifestyle, and stress.

1. Assessment of an IV cocaine user with infective endocarditis should focus on which signs and symptoms (select all that apply)? a. Retinal hemorrhages b. Splinter hemorrhages c. Presence of Osler's nodes d. Painless nodules over bony prominences e. Painless erythematous macules on the palms and soles

1. Correct answers: a, b, c, e Rationale: Clinical manifestations of infective endocarditis may include hemorrhagic retinal lesions (Roth's spots), splinter hemorrhages (black, longitudinal streaks) that may occur in the nail beds, Osler's nodes (painful, tender, red or purple, pea-size lesions) on the fingertips or toes, and Janeway's lesions (flat, painless, small, red spots) seen on the fingertips, palms, soles of feet, and toes.

1. Which BP-regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

1. Correct answers: a, c, e Rationale: Norepinephrine (NE) is released from the sympathetic nervous system nerve endings and activates receptors located in the vascular smooth muscle. When the α-adrenergic receptors in smooth muscle of the blood vessels are stimulated by NE, vasoconstriction results. Increased sympathetic nervous system stimulation produces increased vasoconstriction and increased renin release. Increased renin levels activate the renin-angiotensin-aldosterone system, leading to elevation in BP.

10. The recommended treatment for an initial VTE in an otherwise healthy person with no significant co-morbidities would include a. IV argatroban (Acova) as an inpatient. b. IV unfractionated heparin as an inpatient. c. subcutaneous unfractionated heparin as an outpatient. d. subcutaneous low-molecular-weight heparin as an outpatient.

10. Correct answer: d Rationale: Patients with confirmed VTE should receive initial treatment with low-molecular-weight heparin (LMWH), unfractionated heparin (UH), fondaparinux, or rivaroxaban, followed by warfarin for 3 months to maintain the international normalized ratio (INR) between 2.0 and 3.0 for 24 hours. Patients with multiple comorbid conditions, complex medical issues, or a very large VTE usually are hospitalized for treatment and typically receive intravenous UH. LMWH only for 3 months is another option for patients with acute VTE. Depending on the clinical presentation, patients often can be managed safely and effectively as outpatients.

11. A key aspect of teaching for the patient on anticoagulant therapy includes which instructions? a. Monitor for and report any signs of bleeding. b. Do not take acetaminophen (Tylenol) for a headache. c. Decrease your dietary intake of foods containing vitamin K. d. Arrange to have blood drawn twice a week to check drug effects.

11. Correct answer: a Rationale: Patients taking anticoagulants should be taught to monitor and report any signs of bleeding, which can be a serious complication. Other important patient teaching includes maintenance of a consistent intake of foods containing vitamin K and avoidance of supplements that contain vitamin K. If a patient is taking warfarin, routine coagulation laboratory studies are necessary, although frequency is patient dependent, not necessarily twice a week

2. A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is a. ventricular dilation. b. ventricular hypertrophy. c. neurohormonal response. d. sympathetic nervous system activation.

2. Correct answer: c Rationale: The following mechanisms in heart failure lead to inappropriate fluid retention and additional workload of the heart: activation of the renin-angiotensin-aldosterone system (RAAS) cascade and release of antidiuretic hormone from the posterior pituitary gland in response to low cerebral perfusion pressure that results from low cardiac output.

3. A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to a. elevate the leg to promote venous return. b. start anticoagulant therapy with IV heparin. c. notify the HCP of the change in peripheral perfusion. d. place the bed in reverse Trendelenburg to promote perfusion.

3. Correct answer: c Rationale: The patient has potentially developed acute arterial ischemia (sudden interruption in the arterial blood supply to the extremity), caused by an embolism from a cardiac thrombus that occurred as a complication of infective endocarditis. Clinical manifestations of acute arterial ischemia include any or all of the six Ps : pain, pallor, paralysis, pulselessness, paresthesia, and poikilothermia. Without immediate intervention, ischemia may progress quickly to tissue necrosis and gangrene within a few hours. If the nurse detects these signs, the HCP should be notified immediately.

4. A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do (select all that apply)? a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate. c. Keep an accurate measure of intake and output. d. Teach the patient about dietary restriction of potassium. e. Withhold digitalis and notify health care provider if pulse is irregular.

4. Correct answers: a, b Rationale: Hypokalemia, which can be caused by the use of potassium-depleting diuretics (e.g., thiazides, loop diuretics), is one of the most common causes of digitalis toxicity. Low serum levels of potassium enhance the action of digitalis, causing a therapeutic dose to achieve toxic levels. Hypokalemia can also precipitate dysrhythmias. Monitoring the serum potassium levels of patients receiving digitalis preparations and potassium-depleting diuretics is essential. Patients taking digitalis preparations should be taught how to measure their pulse rate because bradycardia and atrioventricular blocks are late signs of digitalis toxicity. In addition, patients should know what pulse rate would require a call to the HCP. Patients should not independently decide to skip a dose of digitalis.

4. Which clinical manifestations are seen in patients with either Buerger's disease or Raynaud's phenomenon (select all that apply)? a. Intermittent fevers b. Sensitivity to cold temperatures c. Gangrenous ulcers on fingertips d. Color changes of fingers and toes e. Episodes of superficial vein thrombosis

4. Correct answers: b, c, d Rationale: Both Buerger's disease and Raynaud's phenomenon have the following clinical manifestations in common: cold sensitivity, ischemic and gangrenous ulcers on fingertips, and color changes of the distal extremity (fingers or toes).

5. When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of a. valvular heart disease. b. pulmonary hypertension. c. superior vena cava syndrome. d. hypertrophy of the right ventricle.

5. Correct answer: a Rationale: Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.

5. A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not at goal. b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension. c. Lifestyle changes are less important, since they were not effective, and medications will be started. d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications.

5. Correct answer: a Rationale: The patient has hypertension, stage 1. Lifestyle modifications will continue, but drug initiation of therapy is a priority. Reduction of BP can help to prevent serious complications related to hypertension.

5. A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which signs and symptoms would suggest that his aneurysm has ruptured? a. Rapid onset of shortness of breath and hemoptysis b. Sudden, severe low back pain and bruising along his flank c. Gradually increasing substernal chest pain and diaphoresis d. Sudden, patchy blue mottling on feet and toes and rest pain

5. Correct answer: b Rationale: The clinical manifestations of a ruptured abdominal aortic aneurysm include severe back pain, back or flank ecchymosis (Grey Turner's sign), and hypovolemic shock (tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness).

5. Patients with a heart transplantation are at risk for which complications in the first year after transplantation (select all that apply)? a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden cardiac death

5. Correct answers: b, c, e Rationale: A variety of complications can occur after heart transplantation. In the first year after transplantation, the major causes of death are acute rejection and infection. Heart transplant recipients also are at risk for sudden cardiac death. Later, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are major causes of death.

6. Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever? a. Administration of antibiotics as ordered b. Management of pain with opioid analgesics c. Encouragement of fluid intake for hydration d. Performance of frequent active range-of-motion exercises

6. Correct answer: a Rationale: The primary goal of managing a patient with acute rheumatic fever is to control and eradicate the infecting organism. The nurse should administer antibiotics as ordered to treat the streptococcal infection and teach the patient that completion of the full course of antibiotic therapy is essential for successful treatment.

6. What are the priority nursing interventions after an abdominal aortic aneurysm repair? a. Assessment of cranial nerves and mental status b. Administration of IV heparin and monitoring of PT c. Administration of IV fluids and monitoring of kidney function d. Elevation of the legs and application of graduated compression stockings

6. Correct answer: c Rationale: Postoperative priorities include administration of IV fluids and maintenance of renal perfusion. An adequate blood pressure is important for maintaining graft patency, and administration of IV fluids and blood components (as indicated) is essential for adequate blood flow. The nurse should evaluate renal function by measuring hourly urine output and monitoring daily blood urea nitrogen (BUN) and serum creatinine levels. Irreversible renal failure may occur after aortic surgery, particularly in individuals at high risk.

6. A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be most appropriate for this patient (select all that apply)? a. Measuring hourly urine output b. Decreasing the MAP by 50% within the first hour c. Continuous BP monitoring with an arterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

6. Correct answers: a, c, e Rationale: Measure urine output hourly to assess renal perfusion. Patients treated with IV sodium nitroprusside should have continuous intraarterial BP monitoring. Hypertensive crisis can cause encephalopathy, intracranial or subarachnoid hemorrhage, acute left ventricular failure, myocardial infarction, renal failure, dissecting aortic aneurysm, and retinopathy. The initial treatment goal is to decrease the mean atrial pressure (MAP) by no more than 25% within minutes to 1 hour. Patients receiving IV antihypertensive drugs may be restricted to bed rest. Getting up (e.g., to use the toilet/commode) may cause severe cerebral ischemia and fainting.

8. 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.

8. Correct answer: b Rationale: Three important factors (called Virchow's triad) in the etiology of venous thrombosis are (1) venous stasis, (2) damage of the endothelium (inner lining of the vein), and (3) hypercoagulability of the blood. Patients at risk for venous thrombosis usually have predisposing conditions for these three disorders (see Table 37-8). The 32-year-old woman has the highest risk: long trips without adequate exercise (venous stasis), tobacco use, and use of oral contraceptives. Note: The likelihood of hypercoagulability of blood is increased in women older than 35 years who use tobacco.

8. A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to unlicensed assistive personnel (UAP) (select all that apply)? a. Obtain and record daily weight. b. Determine apical-radial pulse rate. c. Observe for overt signs of bleeding. d. Obtain and record vital signs, including pulse oximetry. e. Teach the patient how to purchase a Medic Alert device.

8. Correct answers: a, c, d Rationale: The nurse may delegate routine procedures such as measuring weights and vital signs. The nurse may give specific directions to the unlicensed assistive personnel (UAP) to observe and report obvious signs of bleeding. The nurse cannot delegate teaching, assessment, or activities that require clinical judgment. Obtaining an apical-radial pulse rate is an assessment.

9. Which are clinical findings in a person with an acute lower extremity VTE (select all that apply)? a. Pallor and coolness of foot and calf b. Mild to moderate calf pain and tenderness c. Grossly diminished or absent pedal pulses d. Unilateral edema and induration of the thigh e. Palpable cord along a superficial varicose vein

9. Correct answers: b, d Rationale: The patient with lower extremity venous thromboembolism (VTE) may or may not have unilateral leg edema, extremity pain, a sense of fullness in the thigh or calf, paresthesias, warm skin, erythema, or a systemic temperature greater than 100.4 F (38 C). If the calf is involved, it may be tender to palpation.

A nurse is planning a presentation about hypertension for a community women's group. Which of the following lifestyle modifications should the nurse include? (Select all that apply.) A. Limited alcohol intake B. Regular exercise program C. Decreased magnesium intake D. Reduced potassium intake E. Smoking cessation

A / B / E Rationale: Limited alcohol intake is correct. Clients who have hypertension should limit alcohol intake. Regular exercise program is correct. Clients who have hypertension should develop a regular exercise program to help reduce blood pressure. Decreased magnesium intake is incorrect. Low magnesium intake is associated with hypertension and is not a lifestyle modification the nurse should include. Reduced potassium intake is incorrect. Low potassium intake is associated with hypertension and is not a lifestyle modification the nurse should include. Tobacco cessation is correct. Clients who have hypertension should have a goal of tobacco cessation because tobacco use exacerbates hypertension.

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately? A. Slurred speech B. Irregular pulse C. Dependent edema D. Persistent fatigue

A. Slurred speech Rationale: The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately.

A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A. Weight gain of 2 lb. in 24 hr b. Increase of 10 mmhg in systolic BP c. Dyspnea with exertion d. Dizziness when rising quickly

A. Weight gain of 2 lb. in 24 hr Rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching? A."I will notify the airport screeners about my pacemaker." B."I will expect to have occasional hiccups." C."I will have to disconnect my garage door opener." D."I will take my pulse every 2 to 3 days."

A."I will notify the airport screeners about my pacemaker."

A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. The client asks the nurse how to determine the appropriate amount of fluids he is allowed. Which of the following statements is an appropriate response by the nurse? A."Pour the amount of fluid you drink into an empty 2‑liter bottle to keep track of how much you drink." B."Each glass contains 8 ounces. There are 30 milliliters per ounce, so you can have a total of 8 glasses or cups of fluid each day." C."This is the same as 2 quarts, or about the same as two pots of coffee." D."Take sips of water or ice chips so you will not take in too much fluid."

A."Pour the amount of fluid you drink into an empty 2‑liter bottle to keep track of how much you drink."

A nurse educator is reviewing the use of cardiopulmonary bypass during surgery for coronary artery bypass grafting with a group of nurses. Which of the following statements should the nurse include in the discussion? (Select all that apply.) A."The client's demand for oxygen is lowered." B."Motion of the heart ceases." C."Rewarming of the client takes place." D."The client's metabolic rate is increased." E."Blood flow to the heart is stopped."

A."The client's demand for oxygen is lowered." B."Motion of the heart ceases." C."Rewarming of the client takes place."

A cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. Which of the following statements by a newly hired nurse indicates understanding of the review? A."This means the pacemaker fires in an asynchronous pattern." B."This means the pacemaker fires only when the heart rate is below a certain rate." C."The pacemaker can automatically adjust to a client's increased activity level." D."The pacemaker activity is triggered by heart muscle activity."

A."This means the pacemaker fires in an asynchronous pattern."

A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? (Select all that apply.) A.A client who has metabolic alkalosis B.A client who has a serum potassium level of 4.3 mEq/L C.A client who has an SaO2 of 96% D.A client who has COPD E.A client who underwent stent placement in a coronary artery

A.A client who has metabolic alkalosis D.A client who has COPD E.A client who underwent stent placement in a coronary artery

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A.Angina can be relieved with rest and nitroglycerin. B.The pain of an MI resolves in less than 15 min. C.The type of activity that causes an MI can be identified. D.Angina can occur for longer than 30 min.

A.Angina can be relieved with rest and nitroglycerin.

A nurse at a provider's office is reviewing the laboratory test results for a group of clients. The nurse should identify that which of the following results indicates the client is at risk for heart disease? (Select all that apply.) A.Cholesterol (total) 245 mg/dL B.HDL 90 mg/dL C.LDL 140 mg/dL D.Triglycerides 125 mg/dL E.Troponin I 0.02 ng/mL

A.Cholesterol (total) 245 mg/dL C.LDL 140 mg/dL Rationale: A client who has a total cholesterol level greater than 200 mg/dL is at increased risk for heart disease A client who has an LDL level greater than 130 mg/dL is at an increased risk for heart disease

A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? (Select all that apply.) A.Cool and clammy foot with capillary refill of 5 seconds B.Observed pacing spike followed by a QRS complex C.Persistent hiccups D.Heart rate 84/min E.Blood pressure 104/62 mm Hg

A.Cool and clammy foot with capillary refill of 5 seconds C.Persistent hiccups

A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? (Select all that apply.) A.Surgical repair of an atrial septal defect at age 2 B.Measles infection during childhood C.Hypertension for 5 years D.Weight gain of 10 lb in past year E.Diastolic murmur present

A.Surgical repair of an atrial septal defect at age 2 C.Hypertension for 5 years E.Diastolic murmur present

A nurse planning care for a client who has a PICC line in the right arm. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A.Use a 10 mL syringe to flush the PICC line. B.Apply gentle force if resistance is met during injection. C.Cleanse ports with alcohol for 15 seconds prior to use. D.Maintain a transparent dressing over the insertion site. E.Flush with 10 mL heparin before and after medication administration.

A.Use a 10 mL syringe to flush the PICC line. C.Cleanse ports with alcohol for 15 seconds prior to use. D.Maintain a transparent dressing over the insertion site. Rationale: - Use a 10 mL syringe to flush the pick line to avoid excess pressure that could cause catheter fracture or rupture - Cleanse insertion ports with alcohol for 15 seconds and allowed to air dry prior to use this action decreases the risk of bacterial contamination - maintain a transparent dressing over the insertion site to decrease the risk for infection and allow for visualization plan to change the dressing at least every seven days and when wet, loose, or soiled

A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching? A."I should place the tablet under my tongue." B."I should have my clotting time checked weekly." C."I will report any ringing in my ears." D."I will call my doctor if my pulse rate is less than 60."

D."I will call my doctor if my pulse rate is less than 60."

A nurse is caring for a 72‑year‑old client who is to undergo a percutaneous balloon valvuloplasty. The client's daughter asks the nurse to explain the expected outcome of this procedure. Which of the following responses should the nurse give? A."This will improve blood flow in your mother's coronary arteries." B."This will permit your mother to resume her activities of daily living." C."This will prolong your mother's life." D."This will reverse the effects to the damaged area."

B."This will permit your mother to resume her activities of daily living."

A nurse is assessing a client who is undergoing hemodynamic monitoring. The client has a CVP of 7 mm Hg and a PAWP of 17 mm Hg. Which of the following findings should the nurse expect? (Select all that apply.) A.Poor skin turgor B.Bilateral crackles in the lungs C.Jugular vein distension D.Dry mucous membranes E.Hepatomegaly

B.Bilateral crackles in the lungs C.Jugular vein distension E.Hepatomegaly Rationale: expect the client to have bilateral crackles in the lungs, jugular vein distension, and hepatomegaly for an increased CVP and PAWP

A student nurse is observing a cardioversion procedure and hears the team leader call out, "Stand clear." The student should recognize the purpose of this action is to alert personnel that A.the cardioverter is being charged to the appropriate setting. B.they should initiate CPR due to pulseless electrical activity. C.they cannot be in contact with equipment connected to the client. D.a time‑out is being called to verify correct protocols

C.they cannot be in contact with equipment connected to the client.

A nurse is orienting a newly licensed nurse on the care of a client who is to have a line placed for hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates effectiveness of the teaching? A."Air should be instilled into the monitoring system prior to the procedure." B."The client should be positioned on the left side during the procedure." C."The transducer should be level with the second intercostal space after the line is placed." D."A chest x‑ray is needed to verify placement after the procedure."

D."A chest x‑ray is needed to verify placement after the procedure." rationale: ensure that a chest x-ray is obtained to confirm the proper placement of the line following placement