Congenital Heart Defects, HF and Valvular Heart disease

73. A client with aortic stenosis has increasing dyspnea and dizziness. Identify the area where the nurse would place the stethoscope to assess a murmur from aortic stenosis. Aortic Pulmonic Erb's point Tricuspid Mitral

second intercostal space right of sternum (1) to assess the aortic area

59. The major goal of nursing care for a client with heart failure and pulmonary edema is to: 1. Increase cardiac output. 2. Improve respiratory status. 3. Decrease peripheral edema. 4. Enhance comfort.

1

61. Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect? 1. 5 to 10 minutes. 2. 30 to 60 minutes. 3. 2 to 4 hours. 4. 6 to 8 hours.

1

68. The nurse is admitting an older adult to the hospital. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first? 1. Assess respiratory status. 2. Draw blood for laboratory studies. 3. Insert a Foley catheter. 4. Weigh the client.

1

78. A client has mitral stenosis and will have a valve replacement. The nurse is instructing the client about health maintenance prior to surgery. Inability to follow which of the following regimens would pose the greatest health hazard to this client at this time? 1. Medication therapy. 2. Diet modification. 3. Activity restrictions. 4. Dental care.

1

81. The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to: 1. Observe careful handwashing procedures. 2. Clean the incisional area with an antiseptic. 3. Use prepackaged sterile dressings to cover the incision. 4. Place soiled dressings in a waterproof bag before disposing of them.

1

82. For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery, which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion? 1. Ensure a liberal fluid intake. 2. Provide an alkaline-ash diet. 3. Prevent constipation. 4. Enrich the client's diet with dairy products.

1

66. A client receiving a loop diuretic should be encouraged to eat which of the following foods? Select all that apply. 1. Angel food cake. 2. Banana. 3. Dried fruit. 4. Orange juice. 5. Peppers

2, 3, 4.

62. The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to help: 1. Prevent electrolyte imbalances. 2. Retard rapid drug absorption. 3. Excrete excessive fluids accumulated during the night. 4. Prevent sleep disturbances during the night.

4

83. The nurse should teach the client who is receiving warfarin sodium that: 1. Partial thromboplastin time values determine the dosage of warfarin sodium. 2. Protamine sulfate is used to reverse the effects of warfarin sodium. 3. International Normalized Ratio (INR) is used to assess effectiveness. 4. Warfarin sodium will facilitate clotting of the blood.

3

14. As part of the preoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: 1. Be placed on a reduced sodium diet. 2. Have an activity restriction for several days. 3. Be assigned to an isolation room. 4. Have visits limited to a select few.

1.

69. The nurse's discharge teaching plan for the client with heart failure should emphasize the importance of doing which of the following? 1. Maintaining a high-fiber diet. 2. Walking 2 miles (3.2 km) every day. 3. Obtaining daily weights at the same time each day. 4. Remaining sedentary for most of the day

3

52. A client has a history of heart failure and has been furosemide (Lasix), digoxin (Lanoxin), and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of which of the following? 1. Hyperkalemia. 2. Digoxin toxicity. 3. Fluid deficit. 4. Pulmonary edema.

2.

6. An 18-month-old with a congenital heart defect is to receive digoxin (Lanoxin) twice a day. The nurse should instruct the parents about which of the following? 1. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. 2. Signs of toxicity include loss of appetite, vomiting, increased pulse, and visual disturbances. 3. Digoxin is absorbed better if taken with meals. 4. If the child vomits within 15 minutes of administration, the dosage should be repeated.

1.

16. The mother of a child hospitalized with tetralogy of Fallot tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than a usual amount of genital curiosity since this child's hospitalization. The nurse should tell the mother: 1. "This behavior is very typical for a 3-year-old." 2. "This may be how your child expresses feeling a need for attention." 3. "This may be an indication that your child may have been sexually abused." 4. "This may be a sign of depression in your child."

2.

13. A child has had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to: 1. Notify all health care providers before invasive procedures for the next 6 months. 2. Maintain adequate hydration of at least 10 glasses of water a day. 3. Provide for frequent rest periods and naps during the first 4 weeks. 4. Restrict the ingestion of bananas and citrus fruit.

1.

55. An older adult with a history of heart failure is admitted to the emergency department with pulmonary edema. On admission which of the following should the nurse assess first? 1. Blood pressure. 2. Skin breakdown. 3. Serum potassium level. 4. Urine output.

1.

86. Three days after mitral valve replacement surgery, the client tells the nurse there is a "clicking" noise coming from the chest incision and the incision seems to becoming larger. The nurse's response should reflect the understanding that the client may be experiencing which of the following? 1. Anxiety related to altered body image. 2. Anxiety related to altered health status. 3. Altered tissue perfusion. 4. Lack of knowledge regarding the postoperative course.

1

56. The nurse is assessing a client with chronic heart failure who is demonstrating neurohormonal compensatory mechanisms. Which of the following are expected findings on assessment? Select all that apply. 1. Decreased cardiac output. 2. Increased heart rate. 3. Vasoconstriction in skin, GI tract, and kidneys. 4. Decreased pulmonary perfusion. 5. Fluid overload. Lasix (furosemide) 40 mg intravenous push (IVP) is prescribed. Lasix 10 mg/mL is available. The nurse should administer _________________________ mL.

1, 2, 3, 5.

70. When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply. 1. Becoming increasingly short of breath at rest. 2. Weight gain of 2 lb (0.9 kg) or more in 1 day. 3. High intake of sodium for breakfast. 4. Having to sleep sitting up in a reclining chair. 5. Weight loss of 2 lb (0.9 kg) in 1 day.

1, 2, 4.

15. After surgery to correct a tetralogy of Fallot, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse recommends: 1. Introducing a new skill. 2. Play therapy. 3. Encouraging the behavior. 4. Having the volunteer hold the child

2.

60. A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following? 1. Dilated coronary arteries. 2. Increased myocardial contractility. 3. Decreased cardiac arrhythmias. 4. Decreased electrical conductivity in the heart.

2

65. Which of the following foods should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? 1. Apples. 2. Tomato juice. 3. Whole wheat bread. 4. Beef tenderloin.

2

67. When assessing an older adult, the nurse finds the apical impulse below the fifth intercostal space. The nurse should further assess the client for: 1. Left atrial enlargement. 2. Left ventricular enlargement. 3. Right atrial enlargement. 4. Right ventricular enlargement.

2

72. An elderly client with diabetes who has been maintained on metformin (Glucophage) has been scheduled for a cardiac catheterization. The nurse should verify that the physician has written a prescription to: 1. Limit the amount of protein in the diet prior to the cardiac cath. 2. Withhold the Glucophage prior to the cardiac catheterization. 3. Administer the Glucophage with only a sip of water prior to the cardiac catheterization. 4. Give the Glucophage before breakfast.

2

76. A client experiences initial indications of excitation after having an IV infusion of lidocaine hydrochloride started. The nurse should further assess the client when the client reports having: 1. Palpitations. 2. Tinnitus. 3. Urinary frequency. 4. Lethargy.

2

63. The nurse should teach the client that signs of digoxin toxicity include which of the following? 1. Rash over the chest and back. 2. Increased appetite. 3. Visual disturbances such as seeing yellow spots. 4. Elevated blood pressure.

3

71. A client has returned from the cardiac catheterization laboratory after a balloon valvuloplasty for mitral stenosis. Which of the following requires immediate nursing action? 1. A low, grade 1 intensity mitral regurgitation murmur. 2. SpO2 is 94% on 2 L of oxygen via nasal cannula. 3. The client has become more somnolent. 4. Urine output has decreased from 60 mL/h to 40 mL over the last hour.

3

75. Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization? 1. Monitor the laboratory values. 2. Observe neurologic function every 15 minutes. 3. Observe the puncture site for swelling and bleeding. 4. Monitor skin warmth and turgor.

3

51. A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to: 1. Decrease circulatory overload. 2. Improve the myocardial workload. 3. Prevent thrombus formation. 4. Regulate cardiac rhythm.

3.

58. In which of the following positions should the nurse place a client with heart failure who has orthopnea? 1. Semisitting (low Fowler's position) with legs elevated on pillows. 2. Lying on the right side (Sims' position) with a pillow between the legs. 3. Sitting upright (high Fowler's position) with legs resting on the mattress. 4. Lying on the back with the head lowered (Trendelenburg's position) and legs elevated.

3.

9. When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which of the following teaching and learning principles should the nurse address first? 1. Organizing information to be taught in a logical sequence. 2. Arranging to use actual equipment for demonstrations. 3. Building the teaching on the child's current level of knowledge. 4. Presenting the information in order from simplest to most complex.

3.

64. The nurse should assess the client for digoxin toxicity if serum levels indicate that the client has a: 1. Low sodium level. 2. High glucose level. 3. High calcium level. 4. Low potassium level.

4

79. In preparing the client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, the nurse should explain that: 1. The client will remain in the ICU for 5 days. 2. The client will sleep most of the time while in the ICU. 3. Noise and activity within the ICU are minimal. 4. The client will receive medication to relieve pain.

4

54. Which of the following sets of conditions is an indication that a client with a history of left-sided heart failure is developing pulmonary edema? Select all that apply. 1. Distended jugular veins. 2. Dependent edema. 3. Anorexia. 4. Coarse crackles. 5. Tachycardia.

4, 5.

11. Which of the following is the greatest priority for the therapeutic management of a child with congestive heart failure (CHF) caused by pulmonary stenosis? 1. Educating the family about the signs and symptoms of infection. 2. Administering enoxaparin (Lovenox) to improve left ventricular contractility. 3. Assessing heart rate and blood pressure every 2 hours. 4. Administrating furosemide (Lasix) to decrease systemic venous congestion

4.

7. Twelve hours after cardiac surgery, the nurse is assessing a 3-year-old who weighs 15 kg. The nurse should notify the surgeon about which of the following clinical findings? 1. A urine output of 60 mL in 4 hours. 2. Strong peripheral pulses in all four extremities. 3. Fluctuations of fluid in the collection chamber of the chest drainage system. 4. Alterations in levels of consciousness

4.

8. A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/min. Which of the following actions should the nurse do first? 1. Obtain a prescription for sedation for the child. 2. Assess for an irregular heart rate and rhythm. 3. Explain to the child that it will only hurt for a short time. 4. Place the child in a knee-to-chest position.

4.

12. An infant weighing 9 kg is in the pediatric intensive care unit following arterial switch surgery. In the past hour, the infant has had 16 mL of urine output. Which action should the nurse take? 1. Notify the primary health care provider immediately. 2. Record the urine output in the chart. 3. Administer a fluid bolus immediately. 4. Assess for other signs of hypervolemia.

2.

53. The nurse should assess the client with left-sided heart failure for which of the following? Select all that apply. 1. Dyspnea. 2. Jugular vein distention (JVD). 3. Crackles. 4. Right upper quadrant pain. 5. Oliguria. 6. Decreased oxygen saturation levels.

1, 3, 5, 6.

74. A client is scheduled for a cardiac catheterization. The nurse should do which of the following preprocedure tasks? Select all that apply. 1. Administer all prescribed oral medications. 2. Check for iodine sensitivity. 3. Verify that written consent has been obtained. 4. Withhold food and oral fluids before the procedure. 5. Insert a urinary drainage catheter.

2, 3, 4.

10. When assessing a child after heart surgery to correct tetralogy of Fallot, which of the following should alert the nurse to suspect a low cardiac output? 1. Bounding pulses and mottled skin. 2. Altered level of consciousness and thready pulse. 3. Capillary refill of 2 seconds and blood pressure of 96/67 mm Hg. 4. Extremities warm to the touch and pale skin

2.

84. Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include instructing the client to do which of the following? Select all that apply. 1. Brush the teeth at least twice a day. 2. Avoid use of an electric toothbrush. 3. Take an antibiotic prior to oral surgery. 4. Floss the teeth at least once a day. 5. Have regular dental checkups. 6. Rinse the mouth with an antibiotic mouthwash once a day.

1, 4, 5.

85. Before a client's discharge after mitral valve replacement surgery, the nurse should evaluate the client's understanding of postsurgery activity restrictions. Which of the following should the client not engage in until after the 1-month postdischarge appointment with the surgeon? 1. Showering. 2. Lifting anything heavier than 10 lb (4.5 kg). 3. A program of gradually progressive walking. 4. Light housework.

2

80. A client who has undergone a mitral valve replacement has persistent bleeding from the sternal incision during the early postoperative period. The nurse should do which of the following? Select all that apply. 1. Administer warfarin. 2. Check the postoperative CBC, INR, PTT, and platelet levels. 3. Confirm availability of blood products. 4. Monitor the mediastinal chest tube drainage. 5. Start a dopamine drip for a systolic BP less than 100.

2, 3, 4

5. Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin (Lanoxin) should include which of the following? Select all that apply. 1. Give the medication at regular intervals. 2. Mix the medication with a small volume of breast milk or formula. 3. Repeat the dose one time if the child vomits immediately after administration. 4. Notify the primary care provider of poor feeding or vomiting. 5. Make up any missed doses as soon as realized. 6. Notify the primary care provider if more than two consecutive doses are missed

1, 4, 6.

77. A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nurse administers furosemide (Lasix) to treat pulmonary congestion and begins a Nitroprusside (Nipride) drip per physician prescriptions. The nurse notices a sudden drop in the pulmonary artery diastolic pressure and pulmonary artery wedge pressure. The nurse should first assess: 1. 12-lead EKG. 2. Blood pressure. 3. Lung sounds. 4. Urine output.

2