Med-Surg: Cardiovascular Review Questions

The nurse is admitting a 32-year-old woman to the presurgical unit. The nurse learns during the admission assessment that the patient takes oral contraceptives. Consequently, the nurse's postoperative plan of care should include what intervention? A) Early ambulation and leg exercises B) Cessation of the oral contraceptives until 3 weeks postoperative C) Doppler ultrasound of peripheral circulation twice daily D) Dependent positioning of the patient's extremities when at rest

Ans: A Feedback: Oral contraceptive use increases blood coagulability; with bed rest, the patient may be at increased risk of developing deep vein thrombosis. Leg exercises and early ambulation are among the interventions that address this risk. Assessment of peripheral circulation is important, but Doppler ultrasound may not be necessary to obtain these data. Dependent positioning increases the risk of venous thromboembolism (VTE). Contraceptives are not normally discontinued to address the risk of VTE in the short term.

While assessing a patient the nurse notes that the patient's ankle-brachial index (ABI) of the right leg is 0.40. How should the nurse best respond to this assessment finding? A) Assess the patient's use of over-the-counter dietary supplements. B) Implement interventions relevant to arterial narrowing. C) Encourage the patient to increase intake of foods high in vitamin K. D) Adjust the patient's activity level to accommodate decreased coronary output.

Ans: B Feedback: ABI is used to assess the degree of stenosis of peripheral arteries. An ABI of less than 1.0 indicates possible claudication of the peripheral arteries. It does not indicate inadequate coronary output. There is no direct indication for changes in vitamin K intake and OTC medications are not likely causative.

The nurse is providing care for a patient who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? A) Numbness and tingling in the distal extremities B) Unequal peripheral pulses between extremities C) Visible clubbing of the fingers and toes D) Reddened extremities with muscle atrophy

Ans: B Feedback: PAD assessment may manifest as unequal pulses between extremities, with the affected leg cooler and paler than the unaffected leg. Intermittent claudication is far more common than sensations of numbness and tingling. Clubbing and muscle atrophy are not associated with PAD.

86. Which parameter is elevated in right-sided heart failure? 1. CVP 2. Left-ventricular end-diastolic pressure 3. PAWP 4. Cardiac output

Answer: 1 Rational: CVP is elevated in right-sided heart failure

71. A patient is suspected of having a decreased cardiac output due to dysrhythmias. Which of the following assessments would be included in a decreased cardiac output? Select all that apply 1. Elevated jugular venous distention 2. Polyuria 3. Full and bounding pulses 4. Diaphoresis 5. Constricted pupils 6. Crackles and gurgles 7. Muffled heart sounds

Answer: 1, 3, 4 and 6 Rationale: A, C, D and F are associated with fluid buildup in the body from a lack of pumping (cardiac) action. Patients have oliguria due to poor kidney perfusion, dilated pupils due to sympathetic activation, and do not usually have muffled heart sounds, which is associated with cardiac tamponade.

1. A client complains of crushing chest pain that radiates to his left arm. He should be presented with the following treatment: 1. Aspirin, oxygen, nitroglycerin, and morphine 2. Aspirin, oxygen, nitroglycerin, and codeine 3. Oxygen, nitroglycerin, meperidine, and thrombolytics 4. Aspirin, oxygen, nitroprusside, and morphine

Answer: 1. Aspirin, oxygen, nitroglycerin, and morphine

84. Which sign is characteristic of cardiac tamponade? 1. Shortness of breath 2. Beck's triad 3. Holosystolic murmur 4. Bounding peripheral pulse

Answer: 2 Rational: Beck's triad comprises the three classic signs of cardiac tamponade: elevated CVP with jugular vein distention, muffled heart sounds, and a drop in systolic blood pressure.

16. A client is prescribed diltiazem (Cardizem) to manage his hypertension. The nurse should tell the client the diltiazem will: 1. lower his blood pressure only. 2. Lower his heart rate and blood pressure. 3. Lower his blood pressure and increase his urine output 4. lower his heart rate and blood pressure and increase his urine output.

Answer: 2. Lower his heart rate and blood pressure. Rationale: Diltiazem, a calcium channel blocker, will reduce both the heart rate and blood pressure. It doesn't directly affect urine output.

25. A child returns to his room after a cardiac catheterization. Which nursing intervention is most appropriate? 1. Maintain the child on bed rest with no further activity restrictions. 2. Maintain the child on bed rest with the affected extremity immobilized. 3. Allow the child to get out of bed to go to the bathroom, if necessary. 4. Allow the child to sit in a chair with the affected extremity immobilized.

Answer: 2. Maintain the child on bed rest with the affected extremity immobilized. Rationale: The child should be maintained on bed rest with the affected extremity immobilized after cardiac catheterization to prevent hemorrhage. Allowing the child to move the affected extremity while on bed rest, allowing the child bathroom privileges, or allowing the child to sit in a chair with the affected extremity immobilized places the child at risk for hemorrhage.

59. A toddler requires supplemental oxygen therapy for a cyanotic heart defect. In planning for home care, the nurse would discuss which of the following with the parents? 1. The need to maintain the child on bedrest. 2. Means of promoting mobility while meeting the need for supplemental oxygen. 3. Symptoms of oxygen toxicity. 4. How to draw blood for blood gases.

Answer: 2. Means of promoting mobility while meeting the need for supplemental oxygen. Rationale: Allowing mobility is helpful to promote growth and development in the toddler. Strategies should be discussed to promote mobility while maintaining the supplemental oxygen. Option 1 and 4 are unnecessary. Signs of oxygen toxicity are not the priority based on the information in the question. Strategy: The core issue of the question is home care needs of a toddler receiving oxygen therapy. Use principles of needs related to normal growth and development to help select the correct option.

31. A nurse is caring for an infant with tetralogy of Fallot. Which drug should the nurse anticipate administering during a tet spell? 1. Propranolol (Inderal) 2. Morphine 3. Meperidine (Demerol) 4. Furosemide (Lasix)

Answer: 2. Morphine Rationale: The nurse should anticipate administering morphine during a tet spell to decrease the associated infundibular spasm. Propranolol may be administered as a preventive measure in an infant with tetralogy of Fallot but isn't administered during a tet spell. Furosemide and meperidine aren't appropriate agents for an infant experiencing a tet spell.

76. A patient has multiple saw-toothed P waves at a rate of 300 beats per minute. This patient's rhythm is most likely 1. Paroxysmal atrial tachycardia (PAT) 2. Premature atrial contractions (PACs) 3. Atrial flutter 4. Atrial fibrillation

Answer: 3 Rationale: Atrial flutter is detected by its multiple, saw-toothed-patterned P waves that are fast, countable, and regular. PAT is fast but has only one P wave/one QRS. PACs can fall on any underlying rhythm, but they are limited to one or two beats with premature P waves. Atrial fibrillation has uncountable P waves.

63. A newly admitted patient, diagnosed with a myocardial infarction and left ventricular heart failure might exhibit which of the following physical symptoms? Choose all that apply. 1. Jugular vein distention 2. Hepatomegaly 3. Dyspnea 4. Crackles 5. Tachycardia 6. Right-upper-quadrant pain

Answer: 3, 4 and 5 are some of the signs and symptoms of left-sided hear failure, which backs up into the lungs. A, B and F are indicators of right-sided heart failure, which is cause by systemic congestion.

21. Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? 1. A drop in central venous pressure 2. An increase in the cardiac index 3. A rise in pulmonary artery diastolic pressure 4. A decline in mean pulmonary artery pressure

Answer: 3. A rise in pulmonary artery diastolic pressure Rationale: A rise in pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous pressure would rise in heart failure. The cardiac index would decline in heart failure. The mean pulmonary artery pressure would increase in heart failure.

40. The nurse is discharging a client to home with a new diagnosis of atrial fibrillation.. The nurse explains that which of the following is the most important symptoms to report to the physician? 1. Irregular pulse 2. Fever 3. Fatigue 4. Hemoptysis

Answer: 4. Hemoptysis Rationale: A serious complication of atrial fibrillation is pulmonary embolism. Chest pain and hemoptysis are common symptoms of pulmonary embolism. Irregular pulse is expected with atrial fibrillation. Fatigue may accompany atrial fibrillation in some individuals. Fever is not associated with atrial fibrillation and is not necessarily included in discharge teaching. However, it could be a sign of illness that could increase the workload of the heart, and therefore it would be the second-most important item to report if it occurred. Strategy: The core issue of the question is knowledge of signs and symptoms of complications to report to the physician in the presence of atrial fibrillation. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

A nurse is assessing a new patient who is diagnosed with PAD. The nurse cannot feel the pulse in the patient's left foot. How should the nurse proceed with assessment? A) Have the primary care provider order a CT. B) Apply a tourniquet for 3 to 5 minutes and then reassess. C) Elevate the extremity and attempt to palpate the pulses. D) Use Doppler ultrasound to identify the pulses.

Ans: D Feedback: When pulses cannot be reliably palpated, a hand-held continuous wave (CW) Doppler ultrasound device may be used to hear (insonate) the blood flow in vessels. CT is not normally warranted and the application of a tourniquet poses health risks and will not aid assessment. Elevating the extremity would make palpation more difficult.

The critical care nurse is caring for a patient who is in cardiogenic shock. What assessments must the nurse perform on this patient? Select all that apply. A) Platelet level B) Fluid status C) Cardiac rhythm D) Action of medications E) Sputum volume

Ans: B) Fluid status, C) Cardiac rhythm, D) Action of medications Feedback: The critical care nurse must carefully assess the patient in cardiogenic shock, observe the cardiac rhythm, monitor hemodynamic parameters, monitor fluid status, and adjust medications and therapies based on the assessment data. Platelet levels and sputum production are not major assessment parameters in a patient who is experiencing cardiogenic shock.

2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? A) Retinal blood vessel damage B) Glaucoma C) Cranial nerve damage D) Hypertensive emergency

Ans: A Feedback: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.

27. During an adult patient's last two office visits, the nurse obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively. How would this patient's BP be categorized? A) Normal B) Prehypertensive C) Stage 1 hypertensive D) Stage 2 hypertensive

Ans: B Feedback: Prehypertension is defined systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg.

13. If a nurse knows a client's heart rate, what other value and formula does she need to know to calculate CO?

Answer: Stroke Volume Rationale: Cardiac output equals stroke volume (the amount of blood ejected with each beat) times heart rate. [CO = SV X HR]

34. ****************************************************************When planning the care of a patient with an implanted pacemaker, what assessment should the nurse prioritize? A) Core body temperature B) Heart rate and rhythm C) Blood pressure D) Oxygen saturation level

B Feedback: For patients with pacemakers, close monitoring of the heart rate and rhythm is a priority, even though each of the other listed vital signs must be assessed.

A nursing student is assigned to the medical intensive care unit for the first time. The nurse preceptor asks the student to listen to a water-hammer pulse. The nursing student knows that the sound will resemble which of the following? a) Quick, sharp strokes that suddenly collapse b) Low-pitched diastolic murmur at the apex c) High-pitched blowing sound at the apex d) Mitral click

a) Quick, sharp strokes that suddenly collapse With the water-hammer (Corrigan's) pulse, the pulse strikes the palpating finger with a quick, sharp stroke and then suddenly collapses.

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? a) Renal failure b) Enteric fistula c) Graft occlusion d) Hemorrhage and shock

a) Renal failure Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: a) dependent pallor. b) elevational rubor. c) a 30-second filling time for the veins. d) no rubor for 10 seconds after the maneuver.

a) dependent pallor. Explanation: If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

A patient with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. The nurse expects that collaborative management of the patient will include a) surgical valve replacement b) administration of anticoagulants c) higher than usual antibiotic dosages d) embolectomy

a) surgical valve replacement Aortic or mitral valve debridement, excision, or replacement is required in patients with more than one serious systemic embolic episode.

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Total CK b) Myoglobin c) Troponin d) CK-MB

b) Troponin Explanation: Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days

In a patient with a bypass graft, the distal outflow vessel must be at least what percentage patent for the graft to remain patent? a) 40 b) 30 c) 50 d) 20

c) 50 Explanation: The distal outflow vessel must be at least 50% patent for the graft to remain patent.

After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have? a) Increased cardiac output and increased systolic and diastolic blood pressure b) Decreased blood pressure with reflex tachycardia c) Decreased cardiac output and decreased systolic and diastolic blood pressure d) Decreased peripheral vascular resistance

c) Decreased cardiac output and decreased systolic and diastolic blood pressure As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.

A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? a) Potassium and calcium b) Potassium and sodium c) Magnesium and potassium d) Calcium and magnesium

c) Magnesium and potassium Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.

The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following? a) Decreased O2 saturation levels b) Oliguria c) Pitting edema d) S3 ventricular gallop sign

c) Pitting edema The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response.

Part of the continued management of a patient with infective endocarditis is assessment for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? a) Patterns of petechiae on the chest b) Splinter hemorrhages seen under the fingernails c) Red or purple macules found on the palms of the hands d) Erythematosus modules on the pads of the fingers

c) Red or purple macules found on the palms of the hands Janeway lesions are painless, red or purple macules found on the palms and soles.

Idioventricular rhythm occurs when the impulse starts in the conduction system below the AV node. The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? a) Not measurable b) 100 to 250 c) 220 to 350 d) 20 to 40

d) 20 to 40 The rate is 20 to 40. If the rate exceeds 40, the rhythm is known as accelerated idioventricular rhythm (AIVR). The rate is not measurable in asystole. Ventricular tachycardia has a rate of 100 to 250 per minute. Atrial flutter has a rate of 220 to 350.

An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms? a) Bundle branch block b) Heart block c) Atrial flutter d) Atrial fibrillation

d) Atrial fibrillation In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits.

The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? a) Thallium b) Ativan c) Diazepam d) Dobutamine

d) Dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.

You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a) Nausea b) Hypotension c) Fever d) Fluttering

d) Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Variant b) Refractory c) Intractable d) Unstable

d) Unstable Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

3. A client's cardiac monitor alarm sounds, indicating ventricular tachycardia. The nurse should: 1. perform immediate defibrillation. 2. Assess the client. 3. Call the physician. 4. Administer a precordial thump.

Answer: 2. Assess the client.

61. Which isoenzyme most quickly reflects that a patient has suffered an acute and recent myocardial infarction? 1. LDH 2. CK-MM 3. SGOT 4. Troponin

Answer: 4 Rationale: this enzyme is found in cardiac tissue and will rapidly increase with the onset of a myocardial infarction

The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock? a) Hyperactive bowel sounds b) High blood pressure c) Restlessness and confusion d) Increased urinary output

c) Restlessness and confusion Cardiogenic shock occurs when decreased cardiac output leads to inadequate tissue perfusion and initiation of the shock syndrome. Inadequate tissue perfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).

What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis? a) Offer cold applications to promote comfort and to enhance circulation. b) Teach the patient how to apply a graduated compression stocking. c) Avoid elevating the area. d) Inform the physician if the temperature remains low.

Teach the patient how to apply a graduated compression stocking. Explanation: In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the patient how to apply a graduated compression stocking. The nurse informs the physician if the temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: a) 2.5 to 3.0 times the baseline control. b) 1.5 to 2.5 times the baseline control. c) 4.5 times the baseline control. d) 3.5 times the baseline control.

b) 1.5 to 2.5 times the baseline control. A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.

Which of the following is the treatment of choice for ventricular fibrillation? a) Implanted defibrillator b) Pacemaker c) Immediate bystander CPR d) Atropine

c) Immediate bystander CPR The treatment of choice for v-fib is immediate bystander cardiopulmonary resuscitation (CPR), defibrillation as soon as possible, and activation of emergency services.

29. The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding? A) Decreased ejection fraction B) Decreased heart rate C) Ventricular hypertrophy D) Mitral valve regurgitation

A Feedback: DCM is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in patients with DCM.

26. A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty? A) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory. B) Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well. C) Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay. D) It's prudent to get a second opinion before deciding to have valvuloplasty.

A Feedback: Some valvuloplasty procedures do not require general anesthesia or cardiopulmonary bypass and can be performed in a cardiac catheterization laboratory or hybrid room. Open heart surgery is not required and the procedure does not carry exceptional risks that would designate it as being dangerous. Normally there is no need for the nurse to advocate for a second opinion.

38. Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse? Select all that apply. A) Anxiety B) Fatigue C) Shoulder pain D) Tachypnea E) Palpitations

A, B, E Feedback: Most people who have mitral valve prolapse never have symptoms. A few have symptoms of fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, and anxiety. Hyperpnea and shoulder pain are not characteristic symptoms of mitral valve prolapse.

Which aneurysm occurs as a result of infection at arterial suture or graft sites? a) Saccular b) Anastomotic c) False d) Dissecting

Anastomotic Explanation: An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma.

The nurse is evaluating a patient's diagnosis of arterial insufficiency with reference to the adequacy of the patient's blood flow. On what physiological variables does adequate blood flow depend? Select all that apply. A) Efficiency of heart as a pump B) Adequacy of circulating blood volume C) Ratio of platelets to red blood cells D) Size of red blood cells E) Patency and responsiveness of the blood vessels

Ans: A, B, E Feedback: Adequate blood flow depends on the efficiency of the heart as a pump, the patency and responsiveness of the blood vessels, and the adequacy of circulating blood volume. Adequacy of blood flow does not primarily depend on the size of red cells or their ratio to the number of platelets.

The nurse has performed a thorough nursing assessment of the care of a patient with chronic leg ulcers. The nurse's assessment should include which of the following components? Select all that apply. A) Location and type of pain B) Apical heart rate C) Bilateral comparison of peripheral pulses D) Comparison of temperature in the patient's legs E) Identification of mobility limitations

Ans: A, C, D, E Feedback: A careful nursing history and assessment are important. The extent and type of pain are carefully assessed, as are the appearance and temperature of the skin of both legs. The quality of all peripheral pulses is assessed, and the pulses in both legs are compared. Any limitation of mobility and activity that results from vascular insufficiency is identified. Not likely is there any direct indication for assessment of apical heart rate, although peripheral pulses must be assessed.

A postsurgical patient has illuminated her call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the patient's left leg is visibly swollen and reddened. What is the nurse's most appropriate action? A) Administer a PRN dose of subcutaneous heparin. B) Inform the physician that the patient has signs and symptoms of VTE. C) Mobilize the patient promptly to dislodge any thrombi in the patient's lower leg. D) Massage the patient's lower leg to temporarily restore venous return.

Ans: B Feedback: VTE requires prompt medical follow-up. Heparin will not dissolve an established clot. Massaging the patient's leg and mobilizing the patient would be contraindicated because they would dislodge the clot, possibly resulting in a pulmonary embolism.

Graduated compression stockings have been prescribed to treat a patient's venous insufficiency. What education should the nurse prioritize when introducing this intervention to the patient? A) The need to take anticoagulants concurrent with using compression stockings B) The need to wear the stockings on a "one day on, one day off" schedule C) The importance of wearing the stockings around the clock to ensure maximum benefit D) The importance of ensuring the stockings are applied evenly with no pressure points

Ans: D Feedback: Any type of stocking can inadvertently become a tourniquet if applied incorrectly (i.e., rolled tightly at the top). In such instances, the stockings produce rather than prevent stasis. For ambulatory patients, graduated compression stockings are removed at night and reapplied before the legs are lowered from the bed to the floor in the morning. They are used daily, not on alternating days. Anticoagulants are not always indicated in patients who are using compression stockings.

20. The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include? A) Patient will reduce Na+ intake to no more than 2.4 g daily. B) Patient will have a stable BUN and serum creatinine levels. C) Patient will abstain from fat intake and reduce calorie intake. D) Patient will maintain a normal body weight.

Ans: A Feedback: Dietary sodium intake of no more than 2.4 g sodium is recommended as a dietary lifestyle modification to prevent and manage hypertension. Giving a specific amount of allowable sodium intake makes this a measurable goal. None of the other listed goals is quantifiable and measurable.

11. The nurse is planning the care of a patient who has been diagnosed with hypertension, but who otherwise enjoys good health. When assessing the response to an antihypertensive drug regimen, what blood pressure would be the goal of treatment? A) 156/96 mm Hg or lower B) 140/90 mm Hg or lower C) Average of 2 BP readings of 150/80 mm Hg D) 120/80 mm Hg or lower

Ans: B Feedback: The goal of antihypertensive drug therapy is a BP of 140/90 mm Hg or lower. A pressure of 130/80 mm Hg is the goal for patients with diabetes or chronic kidney disease.

The nurse is assessing a patient who is known to have right-sided HF. What assessment finding is most consistent with this patient's diagnosis? A) Pulmonary edema B) Distended neck veins C) Dry cough D) Orthopnea

Ans: B) Distended neck veins Feedback: Right-sided HF may manifest by distended neck veins, dependent edema, hepatomegaly, weight gain, ascites, anorexia, nausea, nocturia, and weakness. The other answers do not apply.

36. The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. A) Increased venous return B) Decreased peripheral resistance C) Decreased blood volume D) Decreased strength and rate of myocardial contractions E) Decreased blood viscosity

Ans: B, C, D Feedback: The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.

30. The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal? A) Less than 140/90 mm Hg B) Less than 130/90 mm Hg C) Less than 129/89 mm Hg D) Less than 120/80 mm Hg

Ans: D Feedback: JNC 7 defines a blood pressure of less than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension.

An older adult patient with HF is being discharged home on an ACE inhibitor and a loop diuretic. The patient's most recent vital signs prior to discharge include oxygen saturation of 93% on room air, heart rate of 81 beats per minute, and blood pressure of 94/59 mm Hg. When planning this patient's subsequent care, what nursing diagnosis should be identified? A) Risk for ineffective tissue perfusion related to dysrhythmia B) Risk for fluid volume excess related to medication regimen C) Risk for ineffective breathing pattern related to hypoxia D) Risk for falls related to hypotension

Ans: D) Risk for falls related to hypotension Feedback: The combination of low BP, diuretic use, and ACE inhibitor use constitute a risk for falls. There is no evidence, or heightened risk, of dysrhythmia. The patient's medications create a risk for fluid deficit, not fluid excess. Hypoxia is a risk for all patients with HF, but this is not in evidence for this patient at this time.

The nurse is assessing an older adult patient with numerous health problems. What assessment datum indicates an increase in the patient's risk for heart failure (HF)? A) The patient takes Lasix (furosemide) 20 mg/day. B) The patient's potassium level is 4.7 mEq/L. C) The patient is an African American man. D) The patient's age is greater than 65.

Ans: D) The patient's age is greater than 65. Feedback: HF is the most common reason for hospitalization of people older than 65 years of age and is the second most common reason for visits to a physician's office. A potassium level of 4.7 mEq/L is within reference range and does not indicate an increased risk for HF. The fact that the patient takes Lasix 20 mg/day does not indicate an increased risk for HF, although this drug is often used in the treatment of HF. The patient being an African American man does not indicate an increased risk for HF.

11. A client has developed acute pulmonary edema. Which test result should the nurse expect? 1. Interstitial edema by chest X-ray 2. Metabolic alkalosis by ABG analysis 3. Bradycardia by ECG 4. Decreased PAWP by hemodynamic monitoring

Answer: 1. Interstitial edema by chest X-ray Rationale: The chest X-ray of a client with acute pulmonary edema shows interstitial edema as a result of the heart's failure to pump adequately. Metabolic alkalosis is incorrect because the ABG analysis of a client in acute pulmonary edema shows respiratory alkalosis or acidosis. Bradycardia is incorrect because the ECG would most likely indicate tachycardia. Decreased PAWP is incorrect because PAWP rises in the client with acute pulmonary edema.

7. A nurse administers heparin to a client with deep vein thrombophlebitis. Which laboratory value should the nurse monitor to determine the effectiveness of heparin? 1. PTT 2. HCT 3. CBC 4. PT

Answer: 1. PTT Rationale: The therapeutic effectiveness of heparin is determined by monitoring the patient's PTT, PT, HCT, and CBC don't monitor the therapeutic effectiveness of heparin. Monitoring the PT determines warfarin's effectiveness.

12. A nurse is performing discharge teaching for a client with PVD. The nurse should teach the client to: 1. inspect his feet weekly 2. begin a daily walking program 3. wear constrictive clothing 4. stand rather than sit when possible

Answer: 2. begin a daily walking program Rationale: The nurse should encourage the client with PVD to follow a program of walking and other leg exercises. Inspecting the feet weekly is incorrect because the nurse should teach the client to inspect his feet daily. Wearing constrictive clothing is incorrect because the client should wear loose clothing that doesn't restrict circulation. Standing when possible—rather than sitting—is incorrect because the client should avoid standing for long periods.

24. A client comes to the emergency department with a dissecting aortic aneurysm. The client is at greatest risk for: 1. septic shock 2. anaphylactic shock 3. cardiogenic shock 4. hypovolemic shock

Answer: 4. hypovolemic shock Rationale: A dissecting aortic aneurysm is a precursor to aortic rupture, which leads to hemorrhage and hypovolemic shock. Septic shock occurs with overwhelming infection. Anaphlactic shock is an allergic response. Cardiogenic shock is the result of ineffective cardiac function

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: a) providing warmth to the extremity. b) forcing blood into the deep venous system. c) encouraging ambulation to prevent pooling of blood. d) elevating the extremity to prevent pooling of blood.

Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? a) Urine output of 150 ml/hour and heart rate of 45 beats/minute b) Urine output of 15 ml/hour and 2+ hematuria c) Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute d) Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute

Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from aneurysm repair or recurring dissection.

30. A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy? A) Dilated cardiomyopathy (DCM). B) Arrhythmogenic right ventricular cardiomyopathy (ARVC) C) Hypertrophic cardiomyopathy (HCM) D) Restrictive or constrictive cardiomyopathy (RCM)

C Feedback: With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? a) Numbness, warm skin temperature, and redness b) Redness, cool skin temperature, and swelling c) Swelling, warm skin temperature, and drainage d) Numbness, cool skin temperature, and pallor

Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include normal sensation and warm skin with normal return of skin color after blanching.

A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching? a) Avoid heavy lifting for the next 24 hours. b) Take a tub bath, rather than a shower. c) Bend only at the waist. d) New bruising at the puncture site is normal.

a) Avoid heavy lifting for the next 24 hours. For the next 24 hours, the patient should not bend at the waist, strain, or life heavy objects. The patient should avoid tub baths, but shower as desired. The patient should call her the health care provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit or more.

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Bibasilar crackles b) Dependent edema c) Jugular vein distention d) Right upper quadrant pain

a) Bibasilar crackles Bibasilar crackles are a sign of alveolar fluid, a sequelae of left ventricular fluid, or pressure overload and indicate left-sided heart failure. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.

Which of the following is a key diagnostic indicator of heart failure (HF)? a) Brain natriuretic peptide (BNP) b) Creatinine c) Complete blood count (CBC) d) Blood urea nitrogen (BUN)

a) Brain natriuretic peptide (BNP) The BNP is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of HF. A BUN, creatinine, and CBC are included in the initial workup.

The nurse accompanies a client to an exercise stress test. The client can achieve the "target heart rate," but the ECG leads show an ST-segment elevation. The nurse recognizes this as a "positive" stress test, and will begin to prepare the client for which of the following procedures? a) Cardiac catheterization b) Transesophageal echocardiogram c) Pharmacologic stress test d) Telemetry monitoring

a) Cardiac catheterization An elevated ST-segment means an evolving myocardial infarction. A cardiac catheterization would be the logical next step.

Which of the following is the hallmark of systolic heart failure? a) Low ejection fraction (EF) b) Basilar crackles c) Limitation of activities of daily living (ADLs) d) Pulmonary congestion

a) Low ejection fraction (EF) A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the patient's symptoms.

While receiving a heparin infusion to treat deep vein thrombosis, a client reports that his gums bleed when he brushes his teeth. What should the nurse do first? a) Notify the physician. b) Administer a coumarin derivative, as ordered, to counteract heparin. c) Reassure the client that bleeding gums are a normal effect of heparin. d) Stop the heparin infusion immediately.

a) Notify the physician. Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the physician, who will evaluate the client's condition. The physician should order laboratory tests such as partial thromboplastin time before concluding that the client's bleeding is significant. The ordered heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion unless the physician orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: a) forcing blood into the deep venous system. b) providing warmth to the extremity. c) encouraging ambulation to prevent pooling of blood. d) elevating the extremity to prevent pooling of blood.

a) forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.

A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac: a) troponin. b) lactate dehydrogenase. c) myoglobin. d) creatine kinase.

a) troponin. This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase and myoglobin tests can show evidence of muscle injury, but they're less specific indicators of myocardial damage than troponin.

Which of the following would be a factor that may decrease myocardial contractility? a) Administration of digoxin (Lanoxin) b) Acidosis c) Sympathetic activity d) Alkalosis

b) Acidosis Contractility is depressed by hypoxemia, acidosis, and certain medications, such as beta-adrenergic blocking medications. Contractility is enhanced by sympathetic neuronal activity, and certain medications, such as Lanoxin.

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Dyspnea b) Constant chest pain c) Uncontrolled restlessness d) Fatigue lasting more than 1 month

b) Constant chest pain The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. Pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Elevation of the legs above the heart b) Keeping the legs in a neutral or dependent position c) Application of ace wraps from the toe to below the knees d) Use of antiembolytic stockings

b) Keeping the legs in a neutral or dependent position Explanation: Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? a) Right atrial function b) Left ventricular function c) Left atrial function d) Right ventricular function

b) Left ventricular function The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction.

The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage? a) Rash b) Orthostatic hypotension c) Dry mouth d) Nausea

b) Orthostatic hypotension A common side effect of Nitrostat, especially at higher dosages, is orthostatic hypotension. The action of the medication is to dilate the blood vessels to improve circulation to the heart. The side effect of the medication is orthostatic hypotension. A rash, nausea, and dry mouth are not common side effects.

Undersensing occurs as a pacemaker malfunctions as a result of which of the following events? a) Total absence of the pacing spike b) Pacing spike occurs at the preset level despite the patient's intrinsic rhythm c) Loss of pacing artifact d) The complex does not follow the pacing spike

b) Pacing spike occurs at the preset level despite the patient's intrinsic rhythm Undersensing means that the pacing spike occurs at preset interval despite the patient's intrinsic rhythm. Loss of capture occurs when a complex does not follow a pacing spike. Loss of pacing is total absence of the pacing spike. Oversensing occurs when there is a loss of pacing artifact.

Following a coronary artery bypass graft, a client begins having chest "fullness" and anxiety. The nurse suspects cardiac tamponade and prints a lead II electrocardiogram (ECG) strip for interpretation. In looking at the strip, the change in the QRS complex that would most support her suspicion is: a) narrowing complex. b) amplitude decrease. c) widening complex. d) amplitude increase.

b) amplitude decrease. An amplitude decrease would support the nurse's suspicion because fluid surrounding the heart, such as in cardiac tamponade, suppresses the amplitude of the QRS complexes on an ECG. Narrowing and widening complexes as well as an amplitude increase aren't expected findings on the ECG of an individual with cardiac tamponade.

A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? a) Intubation of the airway b) Insertion of a central venous catheter c) BP and pulse measurements every 15 to 30 minutes d) Hourly administration of a fluid bolus

c) BP and pulse measurements every 15 to 30 minutes Bedside ECG monitoring is standard, as are continuous pulse oximetry, automatic BP, and pulse measurements approximately every 15 to 30 minutes.

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? a) Elective electrical defibrillation b) Chemical cardioversion c) Elective electrical cardioversion d) Mace procedure

c) Elective electrical cardioversion Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure.

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? a) Ventricular tachycardia b) Ventricular bigeminy c) Premature ventricular contraction (PVC) d) Ventricular fibrillation

c) Premature ventricular contraction (PVC) A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.

A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: a) postural hypotension. b) skin rash. c) peripheral edema. d) dry cough.

c) peripheral edema. Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. The nurse should tell the client that: a) his cholesterol is within the recommended guidelines and he doesn't need to lower it. b) he should begin a running program, working up to 2 miles per day. c) she'll ask the dietitian to talk with him about modifying his diet. d) he should take his statin medication and not worry about his cholesterol.

c) she'll ask the dietitian to talk with him about modifying his diet. A dietitian can help the client decrease the fat in his diet and make other beneficial dietary modifications. This client's total cholesterol isn't within the recommended guidelines; it should be less than 200 mg/dl. LDL should be less than 79 mg/dl, and HDL should be greater than 40 mg/dl. Although this client should take his statin medication, he should still be concerned about his cholesterol level and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase his activity level, but he doesn't need to run 2 miles per day.

A client with peripheral arterial disease asks the nurse about using a heating pad to warm the feet. The nurse's best response is which of the following? a) "It is better to soak your feet in hot water as long as the water temperature is below 110 degrees F." b) "A heating pad to your feet is a good idea because it increases the metabolic rate." c) "A heating pad to your feet is fine as long as the temperature stays below 105 degrees F." d) "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet."

d) "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet." It is safer to apply a heating pad to the abdomen, causing a reflex vasodilation in the extremities. Heat may be applied directly to ischemic extremities; however, the temperature of the heating source must not exceed body temperature. Excess heat may increase the metabolic rate of the extremities and increase the need for oxygen beyond that provided by the reduced arterial flow through the diseased artery.

Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)? a) Hypotension b) Change in level of consciousness c) Weight gain d) Fatigue

d) Fatigue Fatigue is an early warning symptom of ACS, heart failure, and valvular disease. Other signs and symptoms of cardiovascular disease are hypotension, change in level of consciousness, and weight gain.

Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a: a) PR interval of 0.18 seconds. b) P-to-QRS ratio of 1:1. c) QT interval of 0.37 seconds. d) Heart rate of 42 beats per minute (bpm).

d) Heart rate of 42 beats per minute (bpm). All answers refer to a normal sinus rhythm (NSR) except for the heart rate. A rate of 42 bpm is slow but normal when it occurs in athletes without symptoms.

Aortic dissection may be mistaken for which of the following disease processes? a) Stroke b) Angina c) Pneumothorax d) Myocardial infarction (MI)

d) Myocardial infarction (MI) Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.

The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is: a) Hormonal secretion. b) Independent arterial wall activity. c) The influence of circulating chemicals. d) The sympathetic nervous system.

d) The sympathetic nervous system. Stimulation of the sympathetic nervous system causes vasoconstriction thus regulating blood flow. Norepinephrine is the responsible neurotransmitter.

Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? a) Lymphoscintigraphy b) Air plethysmography c) Contrast phlebography d) Lymphangiography

Contrast phlebography Explanation: When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system. (

15. The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication? A) Epinephrine 1 mg IV push B) Lidocaine 100 mg IV push C) Amiodarone 300 mg IV push D) Sodium bicarbonate 1 amp IV

A Feedback: Epinephrine should be administered as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and licocaine are given if ventricular dysrhythmia persists.

27. The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should know that complications following this procedure include what? Select all that apply. A) Emboli B) Mitral valve damage C) Ventricular dysrhythmia D) Atrial-septal defect E) Plaque formation

A, B, C Feedback: Possible complications include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, and bleeding from the catheter insertion sites. Atrial-septal defect and plaque formation are not complications of a balloon valvuloplasty.

28. The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patient's diagnosis? A) Mitral valve regurgitation B) Aortic stenosis C) Aortic regurgitation D) Mitral valve stenosis

D Feedback: Because no valve protects the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails. None of the other listed valvular disorders has this pathophysiological effect.

A 79-year-old man is admitted to the medical unit with digital gangrene. The man states that his problems first began when he stubbed his toe going to the bathroom in the dark. In addition to this trauma, the nurse should suspect that the patient has a history of what health problem? A) Raynaud's phenomenon B) CAD C) Arterial insufficiency D) Varicose veins

Ans: C Feedback: Arterial insufficiency may result in gangrene of the toe (digital gangrene), which usually is caused by trauma. The toe is stubbed and then turns black. Raynaud's, CAD and varicose veins are not the usual causes of digital gangrene in the elderly.

The nurse is caring for an acutely ill patient who is on anticoagulant therapy. The patient has a comorbidity of renal insufficiency. How will this patient's renal status affect heparin therapy? A) Heparin is contraindicated in the treatment of this patient. B) Heparin may be administered subcutaneously, but not IV. C) Lower doses of heparin are required for this patient. D) Coumadin will be substituted for heparin.

Ans: C Feedback: If renal insufficiency exists, lower doses of heparin are required. Coumadin cannot be safely and effectively used as a substitute and there is no contraindication for IV administration.

An older adult patient has been treated for a venous ulcer and a plan is in place to prevent the occurrence of future ulcers. What should the nurse include in this plan? A) Use of supplementary oxygen to aid tissue oxygenation B) Daily use of normal saline compresses on the lower limbs C) Daily administration of prophylactic antibiotics D) A high-protein diet that is rich in vitamins

Ans: D Feedback: A diet that is high in protein, vitamins C and A, iron, and zinc is encouraged to promote healing and prevent future ulcers. Prophylactic antibiotics and saline compresses are not used to prevent ulcers. Oxygen supplementation does not prevent ulcer formation.

66. A nurse is monitoring a patient newly admitted with acute heart failure (HF). Which of the following laboratory/diagnostic results would indicate the presence of significant HF? 1. BNP of 1000 pg/mL 2. Sodium of 150 3. Potassium of 5.7 mEq/L 4. pH of 7.30

Answer: 1 Rationale: The BNP is a significant diagnostic and monitoring tool for HF. Any value greater than 400 pg/mL indicates significant HF. Although all of the additional laboratory values may be elevated (sodium and potassium) or decreased (pH) in HF, BNP is the most accurate predictor.

78. A patient is being taught how to care for his pacemaker site by the critical care nurse. Which of the following indicates that this patient understands safe care of the device? 1. "I will not handle the pacemaker leads at the same time as the toaster." 2. "I will obtain a medic alert tag as soon as I can." 3. "Since it was implanted in the OR I do not have to worry about infection." 4. "I must not be around a home microwave."

Answer: 2 The patient needs to get a medical alert tag as health care providers need to avoid the generator box site during defibrillation. There are no external wires, so electrical safety is not an issue. All surgical sites need to be monitored for infection, and home microwaves do not interfere with newer permanent pacers.

30. A nurse is caring for a child with a cyanotic heart defect. Which signs should the nurse expect to observe? 1. Cyanosis, hypertension, clubbing, and lethargy. 2. Cyanosis, hypotension, crouching, and lethargy. 3. Cyanosis, irritability, clubbing, and crouching. 4. Cyanosis, confusiion, clonus, and crouching.

Answer: 3. Cyanosis, irritability, clubbing, and crouching. Rationale: The child with a cyanotic heart defect has cyanosis along with crabiness (irritability), clubbing of the digits, and crouching or squatting. The child with cyanotic heart defect doesn't typically have hypertension, lethargy, confusion, or clonus.

85. Which drug is effective in managing mild to moderate hypotension? 1. Phenylephrine (Neo-Synephrine) 2. Amiodraone (Cordarone) 3. Ibutilide (Covert) 4. Milrione

Answer: 1 Rational: Phenylephrine is indicated for mild to moderate hypotension

22. A client with dilated cardiomyopathy, pulmonary edema, and severe dyspnea is placed on dobutamine. Which assessment finding indicates that the drug is effective? 1. Increased activity tolerance 2. Absence of arrhythmias 3. Negative Homans' sign 4. Blood pressure of 160/90 mm Hg

Answer: 1. Increased activity tolerance Rationale: Dobutamine should improve the client's symptoms and the client should experience an increase tolerance for activity. The absence of arrhythmias doesn't indicate effectiveness of dobutamine. A negative Homans' sign indicates absence of blood clots, which isn't a therapeutic effect of dobutamine.

19. A client with unstable angina receives routine applications of nitroglycerin ointment. The nurse should delay the next dose if the client has: 1. atrial fibrillation. 2. A systolic blood pressure below 90 mm Hg. 3. A headache. 4. Skin redness at the current site.

Answer: 2. A systolic blood pressure below 90 mm Hg. Rationale: Nitroglycerin is a vasodilator and can lower arterial blood pressure. As a rule, when the client's systolic blood pressure is below 90 mm Hg, the nurse should delay the dose and notify the physician. Nitroglycerin isn't contraindicated in a client with atrial fibrillation. Headache, a common occurrence with nitroglycerin isn't a cause for withholding a dose. Application sites should be changed with each dose, especially if skin irritation occurs.

67. A patient is admitted with severe uncompensated pulmonary edema secondary to chronic heart failure. After diagnostic testing, it is found that the left coronary artery is blocked, which has led to his pulmonary edema. Which of the following signs and symptoms is consistent with this diagnosis? 1. Elevated central venous pressure 2. Elevated blood pressure 3. Elevated pulmonary artery wedge pressure (PAWP) or PAOP 4. Increased oxygen saturation

Answer: 3 Rationale: An increased PAWP (PAOP) is consistent with fluid buildup in the lungs and inability of the left side of the heart to pump to the body. A would be correct if this patient had a right ventricular infarction causing right sided heart failure. The BP and oxygen saturation are usually lower in left-sided HF.

64. A patient is admitted to your telemetry unit with chest pain that has been increasing in intensity and duration. The critical care nurse can identify that this type of angina is called 1. Stable 2. Variant 3. Predictable 4. Unstable

Answer: 4 Rationale: Unstable angina increases in intensity and occurs more frequently with longer events. Stable angina is predictable; the patient can tell you when it is going to occur. Variant or Prinzmetal's angina is atypical and occurs at rest.

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a) Acute limb ischemia b) Vertigo c) Dizziness d) Intermittent claudication

The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? a) Avoid foods with iodine. b) Elevate the legs periodically for at least 15 to 20 minutes. c) Refrain from sexual activity for a week. d) Elevate the legs periodically for at least an hour.

The nurse should advise the client to periodically elevate the legs for at least 15 to 20 minutes. Avoiding foods with iodine or refraining from sexual activity for a week does not relate to venous insufficiency

The nurse suspects a diagnosis of mitral valve regurgitation when what type of murmur is heard on auscultation? a) High-pitched blowing sound at the apex b) Diastolic murmur at the left sternal border c) Mitral click d) Low-pitched diastolic murmur at the apex

a) High-pitched blowing sound at the apex Mitral valve regurgitation is associated with a systolic murmur, which is a high-pitched, blowing sound at the apex.

62. A 75-year-old individual is admitted with a diagnosis of left-sided heart failure and is administered Lasix 80 mg by slow IV push. Which nursing assessment indicates that the Lasix (furosemide) is NOT having the desired effect? 1. Oliguria 2. Decrease in blood pressure 3. Absence of crackles 4. Polydipsia

Answer: 1 Rationale: Furosemide (Lasix) is a loop diuretic, which should increase urinary output. Oliguria is scant or severely decreased urinary output

79. Which of the following pacemakers is usually used in an emergency and attached by the critical care nurse to the patient? 1. Transcutaneous pacer 2. Epicardial pacer 3. Transvenous pacer 4. Permanent pacer

Answer: 1 Rationale: Transcutaneous pacers are placed on the anterior and posterior chest via electrodes by the critical care nurse. All other pacers are inserted by the physician.

For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? a) Edema b) Left ventricular dysfunction c) Angina d) Dyspnea

b) Left ventricular dysfunction Digoxin may be used to treat left ventricular dysfunction, and diuretics may be used for dyspnea. Nitrates may be prescribed for the treatment of angina, but must be used with caution due to the risk of orthostatic hypotension and syncope.

Myocarditis is most commonly caused by which of the following? a) Bacterial infection b) Viral infection c) Toxic agents d) Immune-mediated mechanisms

b) Viral infection Myocarditis is an inflammation of the heart muscle, commonly resulting from viral infection. It may also be caused by bacterial infections, immune-mediated mechanisms, and toxic agents.

20. A client experiences acute myocardial ischemia. The nurse administers oxygen and sublingual nitroglycerin. When assessing an electrocardiogram (ECG) for evidence that blood flow to the myocardium has improved, the nurse should focus on the: 1. widening of the QRS complex. 2. Frequency of ectopic beats. 3. Return of the ST segment to baseline. 4. Presence of a significant Q wave.

Answer: 3. Return of the ST segment to baseline. Rationale: During episodes of myocardial ischemia, an ECG may show ST-segmant elevation or depression. With successful treatment, the ST segment should return to baseline. Widening QRS complex, presence of a Q wave, and frequent ectopic beats aren't directly indicative of myocardial ischemia.

Which of the following medications is considered a thrombolytic? a) Heparin b) Lovenox c) Coumadin d) Alteplase

d) Alteplase Explanation: Alteplase is considered a thrombolytic, which lyses and dissolves thrombi. Thrombolytic therapy is most effective when given within the first 3 days after acute thrombosis. Heparin, Coumadin, and Lovenox do not lyse clots.

Which condition most commonly results in coronary artery disease (CAD)? a) Renal failure b) Myocardial infarction c) Diabetes mellitus d) Atherosclerosis

d) Atherosclerosis Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.

How should the nurse best position a patient who has leg ulcers that are venous in origin? A) Keep the patient's legs flat and straight. B) Keep the patient's knees bent to 45-degree angle and supported with pillows. C) Elevate the patient's lower extremities. D) Dangle the patient's legs over the side of the bed.

Ans: C Feedback: Positioning of the legs depends on whether the ulcer is of arterial or venous origin. With venous insufficiency, dependent edema can be avoided by elevating the lower extremities. Dangling the patient's legs and applying pillows may further compromise venous return.

18. A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following? A) Tried to rest quietly for 5 minutes before the reading is taken B) Refrained from smoking for at least 8 hours C) Drunk adequate fluids during the day prior D) Avoided drinking coffee for 12 hours before the visit

Ans: A Feedback: Prior to the nurse assessing the patient's BP, the patient should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.

19. The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem? A) Migraines B) Atrial-septal defect C) Atherosclerosis D) Thrombocytopenia

Ans: C Feedback: Hypertension is both a sign and a risk factor for atherosclerotic heart disease. It is not associated with structural cardiac defects, low platelet levels, or migraines.

73. Good conduction of electricity from the patient's heart to the monitor requires that the critical care nurse 1. Periodically change electrode pads for good conduct 2. Place electrodes over the ribs as they are excellent conductors 3. Place electrodes with contacts on their anterior and posterior surfaces 4. Place electrodes further apart if they pick up respiratory movement

Answer: 1 Rationale: Electrodes dry out rather quickly, so replace them periodically, especially if the patient is febrile. They are placed anteriorly over intercostal spaces with all surfaces making good contact. To avoid respiratory movement, place the electrodes closer together.

69. The nurse is assessing the laboratory values for a patient with chronic heart failure before administering furosemide. Which of the following values would cause the nurse to withhold this drug and notify the primary care provider? 1. Potassium level of 3.5 mEq/L 2. Digoxin level of 0.7 ng/mL 3. Calcium level of 5 mg/dL 4. Magnesium level of 1 mg/dL

Answer: 1 Rationale: Even though this potassium level is on the low side and it will go even lower without potassium supplementation. The other values are within normal limits.

Which of the following is the most effective intervention for preventing progression of vascular disease? a) Risk factor modification b) Use neutral soaps c) Avoid trauma d) Wear sturdy shoes

Risk factor modification is the most effective intervention for preventing progression of vascular disease. Measures to prevent tissue loss and amputation are a high priority. Patients are taught to avoid trauma; wear sturdy, well-fitting shoes or slippers; and use pH neutral soaps and body lotions.

Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment? a) 5 b) 2 c) 3 d) 4

a) 5 Explanation: Beginning warfarin concomitantly with heparin can provide a stable INR by day 5 of heparin treatment, at which time the heparin maybe discontinued.

A patient is admitted with aortic regurgitation. Which of the following medication classifications are contraindicated since they can cause bradycardia and decrease ventricular contractility? a) Calcium channel blockers b) Beta blockers c) Ace inhibitors d) Nitrates

a) Calcium channel blockers The calcium channel blockers diltiazem (Cardizem) and verapamil (Calan, Isoptin) are contraindicated for patients with aortic regurgitation as they decrease ventricular contractility and may cause bradycardia.

Identify which of the following as an age-related change associated with conduction system of the heart? a) Heart block b) Murmur c) Thrills d) Tachycardia

a) Heart block Age-related changes to the conduction system may include bradycardia and heart block. Age-related changes to the heart valves include the presence of a murmur or thrill.

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? a) Homans' b) Rinne c) Romberg's d) Phalen's

a) Homans' Explanation: A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.

A nurse completed a physical exam for an insurance company. The nurse noted a cluster of abnormalities that she knew was considered a major risk factor for coronary artery disease. Choose that condition. a) Metabolic syndrome b) Diabetes mellitus c) Hypolipidemia d) Congestive heart failure

a) Metabolic syndrome Metabolic syndrome includes three of six conditions that are recognized as a major risk factor for CAD. Insulin resistance is part of the syndrome but the patient may not yet have diabetes.

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) a) Sharp pain that may be relieved by the elevation of the extremity b) Full superficial veins c) Initial absence of edema d) Cool and cyanotic skin e) Brisk capillary refill of the toes

a) Sharp pain that may be relieved by the elevation of the extremity b) Full superficial veins d) Cool and cyanotic skin Postthrombotic syndrome is characterized by chronic venous stasis, resulting in edema, altered pigmentation, pain, and stasis dermatitis. The patient may notice the symptoms less in the morning and more in the evening. Obstruction or poor calf muscle pumping in addition to valvular reflux must be present for the development of severe postthrombotic syndrome and stasis ulcers. Superficial veins may be dilated.

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change? a) Purplish stools b) Bluish urine c) Redness of the upper part of the feet d) Coldness of the soles

b) Bluish urine Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? a) Hypertension b) Cardiac tamponade c) Elevated central venous pressure d) Hypothermia

b) Cardiac tamponade Preload alterations occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.

Patient with myocarditis are sensitive to which of the following medications? a) Corticosteroids b) Digoxin c) Lasix d) Penicillin

b) Digoxin The nurse must closely monitor these patients for digoxin toxicity, which is evidenced by arrhythmia,, anorexia, nausea, vomiting, headache, and malaise. If the cause of the myocarditis is haemolytic streptococci, penicillin will be given. The use of corticosteroids remains controversial.

Which of the following is an action of the intra-aortic balloon pump (IABP)? a) Reduction of right ventricular afterload b) Reduction of left ventricular afterload c) Reduction of right ventricular preload d) Reduction of left ventricular preload

b) Reduction of left ventricular afterload The IABP decreases the workload of the heart by reducing left ventricular afterload. Additionally, it improves coronary artery blood flow by increasing coronary artery perfusion pressure. It does not reduce left or right ventricular preload.

You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Raynaud's disease b) Coronary thrombosis c) Atherosclerosis d) Arteriosclerosis

c) Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. The disease correlates with the aging process. The other choices may occur at any age.

The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)? a) First-degree atrioventricular block b) Ventricular tachycardia c) Atrial fibrillation d) Sinus dysrhythmia

c) Atrial fibrillation In mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by strain on the atrium).

The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? a) Sympathetic nerve fibers b) Vagus nerve c) Baroreceptors d) Chemoreceptors

c) Baroreceptors Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate.

A nurse working in a cardiac step-down unit understands that the following drugs can affect the contractility of the heart. The nurse recognizes that contractility is depressed by which of the following drugs? a) Lanoxin b) Dobutrex c) Lopressor d) Intropin

c) Lopressor Contractility is depressed by beta-adrenergic blocking medications. The other choices all enhance contractility.

Which of the following mitral valve conditions generally produces no symptoms? a) Regurgitation b) Infection c) Prolapse d) Stenosis

c) Prolapse Mitral valve prolapse is a deformity that usually produces no symptoms and has been diagnosed more frequently in recent years, probably as a result of improved diagnostic methods. Mitral valve stenosis usually causes progressive fatigue. Mitral valve regurgitation, in its acute stage, usually presents as severe heart failure. Mitral valve infection, when acute, will produce symptoms typical of infective endocarditis.

Which of the following is the most common site for a dissecting aneurysm? a) Cervical area b) Sacral area c) Thoracic area d) Lumbar area

c) Thoracic area Explanation: The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" The nurse's appropriate response is which of the following? a) Bok choy, cooked leeks, alfalfa sprouts b) Cranberries, apples, popcorn c) Asparagus, blueberries, green beans d) Apricots, dried peas and beans, dates

d) Apricots, dried peas and beans, dates Apricots, dried peas and beans, dates, and kiwi contain high amounts of potassium. The other foods listed contain minimal amounts.

58. A toddler with Kawasaki's disease is going home on salicylate (aspirin) therapy. Which is the priority teaching at the time of discharge? 1. Monitor the child for gastrointestinal bleeding. 2. Avoid contact with other children. 3. Report complaints of tingling extremities. 4. Maintain a low-calorie diet.

Answer: 1. Monitor the child for gastrointestinal bleeding. Rationale: Salicylates prevent platelet agglutination. Gastrointestinal bleeding is often a side effect of aspirin therapy. It is not necessary to avoid other children. Tingling of extremities is not a concern, although ringing in the ears could be a sign of salicylate toxicity. A low-calorie diet is not indicated. Strategy: The core issue of the question is knowledge of adverse drug effects of salicylate therapy for the child with Kawasaki's disease. Use this knowledge and the precess of elimination to make a selection.

Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Diltiazem (Cardizem) b) Felodipine (Plendil) c) Amlodipine (Norvasc) d) Clopidogrel (Plavix)

d) Clopidogrel (Plavix) Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.

28. ************The nurse is caring for a patient on telemetry. The patient's ECG shows a shortened PR interval, slurring of the initial QRS deflection, and prolonged QRS duration. What does this ECG show? A) Sinus bradycardia B) Myocardial infarction C) Lupus-like syndrome D) Wolf-Parkinson-White (WPW) syndrome

-D Feedback- In WPW syndrome there is a shortened PR interval, slurring (called a delta wave) of the initial QRS deflection, and prolonged QRS duration. These characteristics are not typical of the other listed cardiac anomalies-

13. A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention? A) Defibrillation B) ECG monitoring C) Implantation of a cardioverter defibrillator D) Angioplasty

A Feedback: Any type of VT in a patient who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: Immediate defibrillation is the action of choice. ECG monitoring is appropriate, but this is an assessment, not an intervention, and will not resolve the problem. An ICD and angioplasty do not address the dysrhythmia.

17. ******************************************************************A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? A) Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. B) Administer atropine as a continuous infusion until symptoms resolve. C) Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. D) Administer atropine 1.0 mg sublingually.

A Feedback: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.

12. A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this? A) To prevent bacterial endocarditis B) To prevent hospital-acquired pneumonia C) To minimize the need for antibiotic use during the procedure D) To decrease the need for surgical asepsis

A Feedback: Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to decrease the need for surgical asepsis.

A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of HF and peripheral arterial disease (PAD). At present the patient is unable to stand or ambulate. The nurse should implement measures to prevent what complication? A) Aoritis B) Deep vein thrombosis C) Thoracic aortic aneurysm D) Raynaud's disease

Ans: B Feedback: Although the exact cause of venous thrombosis remains unclear, three factors, known as Virchow's triad, are believed to play a significant role in its development: stasis of blood (venous stasis), vessel wall injury, and altered blood coagulation. In this woman's case, she has venous stasis from immobility, vessel wall injury from PAD, and altered blood coagulation from HF. The cause of aoritis is unknown, but it has no direct connection to HF, PAD, or mobility issues. The greatest risk factors for thoracic aortic aneurysm are atherosclerosis and hypertension; there is no direct connection to HF, PAD, or mobility issues. Raynaud's disease is a disorder that involves spasms of blood vessels and, again, no direct connection to HF, PAD, or mobility issues.

A nurse has written a plan of care for a man diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. What is the most appropriate intervention for this diagnosis? A) Elevate his legs and arms above his heart when resting. B) Encourage the patient to engage in a moderate amount of exercise. C) Encourage extended periods of sitting or standing. D) Discourage walking in order to limit pain.

Ans: B Feedback: The nursing diagnosis of altered peripheral tissue perfusion related to compromised circulation requires interventions that focus on improving circulation. Encouraging the patient to engage in a moderate amount of exercise serves to improve circulation. Elevating his legs and arms above his heart when resting would be passive and fails to promote circulation. Encouraging long periods of sitting or standing would further compromise circulation. The nurse should encourage, not discourage, walking to increase circulation and decrease pain.

The prevention of VTE is an important part of the nursing care of high-risk patients. When providing patient teaching for these high-risk patients, the nurse should advise lifestyle changes, including which of the following? Select all that apply. A) High-protein diet B) Weight loss C) Regular exercise D) Smoking cessation E) Calcium and vitamin D supplementation

Ans: B, C, D Feedback: Patients at risk for VTE should be advised to make lifestyle changes, as appropriate, which may include weight loss, smoking cessation, and regular exercise. Increased protein intake and supplementation with vitamin D and calcium do not address the main risk factors for VTE.

A nurse is closely monitoring a patient who has recently been diagnosed with an abdominal aortic aneurysm. What assessment finding would signal an impending rupture of the patient's aneurysm? A) Sudden increase in blood pressure and a decrease in heart rate B) Cessation of pulsating in an aneurysm that has previously been pulsating visibly C) Sudden onset of severe back or abdominal pain D) New onset of hemoptysis

Ans: C Feedback: Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Impending rupture is not typically signaled by increased blood pressure, bradycardia, cessation of pulsing, or hemoptysis.

A nurse working in a long-term care facility is performing the admission assessment of a newly admitted, 85-year-old resident. During inspection of the resident's feet, the nurse notes that she appears to have early evidence of gangrene on one of her great toes. The nurse knows that gangrene in the elderly is often the first sign of what? A) Chronic venous insufficiency B) Raynaud's phenomenon C) VTE D) PAD

Ans: D Feedback: In elderly people, symptoms of PAD may be more pronounced than in younger people. In elderly patients who are inactive, gangrene may be the first sign of disease. Venous insufficiency does not normally manifest with gangrene. Similarly, VTE and Raynaud's phenomenon do not cause the ischemia that underlies gangrene.

7. A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patient's care, what desired outcome should the nurse identify? A) Patient takes medication as prescribed and reports any adverse effects. B) Patient's BP remains consistently below 140/90 mm Hg. C) Patient denies signs and symptoms of hypertensive urgency. D) Patient is able to describe modifiable risk factors for hypertension.

Ans: A Feedback: The most appropriate expected outcome for a patient who is given the nursing diagnosis of risk for ineffective health maintenance is that he or she takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the patient's role in his or her treatment regimen.

9. A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged, uncontrolled hypertension is at risk for developing what health problem? A) Renal failure B) Right ventricular hypertrophy C) Glaucoma D) Anemia

Ans: A Feedback: When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.

The nurse is reviewing the medication administration record of a patient diagnosed with systolic HF. What medication should the nurse anticipate administering to this patient? A) A beta-adrenergic blocker B) An antiplatelet aggregator C) A calcium channel blocker D) A nonsteroidal anti-inflammatory drug (NSAID)

Ans: A) A beta-adrenergic blocker Feedback: Several medications are routinely prescribed for systolic HF, including ACE inhibitors, beta-blockers, diuretics, and digitalis. Calcium channel blockers, antiplatelet aggregators, and NSAIDs are not commonly prescribed.

A patient who is at high risk for developing intracardiac thrombi has been placed on long-term anticoagulation. What aspect of the patient's health history creates a heightened risk of intracardiac thrombi? A) Atrial fibrillation B) Infective endocarditis C) Recurrent pneumonia D) Recent surgery

Ans: A) Atrial fibrillation Feedback: Intracardiac thrombi are especially common in patients with atrial fibrillation, because the atria do not contract forcefully and blood flows slowly and turbulently, increasing the likelihood of thrombus formation. Endocarditis, pneumonia, and recent surgery do not normally cause an increased risk for intracardiac thrombi formation.

The nurse is performing an initial assessment of a client diagnosed with HF. The nurse also assesses the patient's sensorium and LOC. Why is the assessment of the patient's sensorium and LOC important in patients with HF? A) HF ultimately affects oxygen transportation to the brain. B) Patients with HF are susceptible to overstimulation of the sympathetic nervous system. C) Decreased LOC causes an exacerbation of the signs and symptoms of HF. D) The most significant adverse effect of medications used for HF treatment is altered LOC.

Ans: A) HF ultimately affects oxygen transportation to the brain. Feedback: As the volume of blood ejected by the heart decreases, so does the amount of oxygen transported to the brain. Sympathetic stimulation is not a primary concern in patients with HF, although it is a possibility. HF affects LOC but the reverse is not usually true. Medications used to treat HF carry many adverse effects, but the most common and significant effects are cardiovascular.

The nurse is providing patient education prior to a patient's discharge home after treatment for HF. The nurse gives the patient a home care checklist as part of the discharge teaching. What should be included on this checklist? A) Know how to recognize and prevent orthostatic hypotension. B) Weigh yourself weekly at a consistent time of day. C) Measure everything you eat and drink until otherwise instructed. D) Limit physical activity to only those tasks that are absolutely necessary.

Ans: A) Know how to recognize and prevent orthostatic hypotension. Feedback: Patients with HF should be aware of the risks of orthostatic hypotension. Weight should be measured daily; detailed documentation of all forms of intake is not usually required. Activity should be gradually increased within the parameters of safety and comfort.

A cardiovascular patient with a previous history of pulmonary embolism (PE) is experiencing a sudden onset of dyspnea, rapid breathing, and chest pain. The nurse recognizes the characteristic signs and symptoms of a PE. What is the nurse's best action? A) Rapidly assess the patient's cardiopulmonary status. B) Arrange for an ECG. C) Increase the height of the patient's bed. D) Manage the patient's anxiety.

Ans: A) Rapidly assess the patient's cardiopulmonary status. Feedback: Patient management in the event of a PE begins with cardiopulmonary assessment and intervention. This is a priority over ECG monitoring, management of anxiety, or repositioning of the patient, even though each of these actions may be appropriate and necessary.

13. The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to avoid which of the following actions? A) Measuring the BP after the patient has been seated quietly for more than 5 minutes B) Taking the BP at least 10 minutes after nicotine or coffee ingestion C) Using a cuff with a bladder that encircles at least 80% of the limb D) Using a bare forearm supported at heart level on a firm surface

Ans: B Feedback: Blood pressures should be taken with the patient seated with arm bare, supported, and at heart level. The patient should not have smoked tobacco or taken caffeine in the 30 minutes preceding the measurement. The patient should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured and have a width of at least 40% of limb circumference. Using a cuff that is too large results in a lower BP and a cuff that is too small will give a higher BP measurement.

22. The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem? A) Deficient knowledge regarding the lifestyle modifications for management of hypertension B) Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C) Deficient knowledge regarding BP monitoring D) Noncompliance with treatment regimen related to medication costs

Ans: B Feedback: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. For many patients, this is related to adverse effects of medications. Medication cost is relevant for many patients, but adverse effects are thought to be a more significant barrier. Many patients are aware of necessary lifestyle modification, but do not adhere to them. Most patients are aware of the need to monitor their BP.

39. A patient's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? A) Drowsiness or lethargy B) Increased urine output C) Decreased heart rate D) Mild agitation

Ans: B Feedback: Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.

29. A patient has been diagnosed as being prehypertensive. What should the nurse encourage this patient to do to aid in preventing a progression to a hypertensive state? A) Avoid excessive potassium intake. B) Exercise on a regular basis. C) Eat less protein and more vegetables. D) Limit morning activity.

Ans: B Feedback: To prevent or delay progression to hypertension and reduce risk, JNC 7 urged health care providers to encourage people with blood pressures in the prehypertension category to begin lifestyle modifications, such as nutritional changes and exercise. There is no need for patients to limit their activity in the morning or to avoid potassium and protein intake.

A patient with HF is placed on a low-sodium diet. Which statement by the patient indicates that the nurse's nutritional teaching plan has been effective? A) "I will have a ham and cheese sandwich for lunch." B) "I will have a baked potato with broiled chicken for dinner." C) "I will have a tossed salad with cheese and croutons for lunch." D) "I will have chicken noodle soup with crackers and an apple for lunch."

Ans: B) "I will have a baked potato with broiled chicken for dinner." Feedback: The patient's choice of a baked potato with broiled chicken indicates that the teaching plan has been effective. Potatoes and chicken are relatively low in sodium. Ham, cheese, and soup are often high in sodium.

A patient presents to the ED complaining of increasing shortness of breath. The nurse assessing the patient notes a history of left-sided HF. The patient is agitated and occasionally coughing up pink-tinged, foamy sputum. The nurse should recognize the signs and symptoms of what health problem? A) Right-sided heart failure B) Acute pulmonary edema C) Pneumonia D) Cardiogenic shock

Ans: B) Acute pulmonary edema Feedback: Because of decreased contractility and increased fluid volume and pressure in patients with HF, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema and signs and symptoms described. In right-sided heart failure, the patient exhibits hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the patient would have a temperature spike, and sputum that varies in color. Cardiogenic shock would show signs of hypotension and tachycardia.

Which assessment would be most appropriate for a patient who is receiving a loop diuretic for HF? A) Monitor liver function studies B) Monitor for hypotension C) Assess the patient's vitamin D intake D) Assess the patient for hyperkalemia

Ans: B) Monitor for hypotension Feedback: Diuretic therapy increases urine output and decreases blood volume, which places the patient at risk of hypotension. Patients are at risk of losing potassium with loop diuretic therapy and need to continue with potassium in their diet; hypokalemia is a consequent risk. Liver function is rarely compromised by diuretic therapy and vitamin D intake is not relevant.

The nurse is caring for a 68-year-old patient the nurse suspects has digoxin toxicity. In addition to physical assessment, the nurse should collect what assessment datum? A) Skin turgor B) Potassium level C) White blood cell count D) Peripheral pulses

Ans: B) Potassium level Feedback: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. Skin turgor, white cell levels, and peripheral pulses are not normally affected in cases of digitalis toxicity.

The nurse's comprehensive assessment of a patient who has HF includes evaluation of the patient's hepatojugular reflux. What action should the nurse perform during this assessment? A) Elevate the patient's head to 90 degrees. B) Press the right upper abdomen. C) Press above the patient's symphysis pubis. D) Lay the patient flat in bed.

Ans: B) Press the right upper abdomen. Feedback: Hepatojugular reflux, a sign of right-sided heart failure, is assessed with the head of the bed at a 45-degree angle. As the right upper abdomen (the area over the liver) is compressed for 30 to 40 seconds, the nurse observes the internal jugular vein. If the internal jugular vein becomes distended, a patient has positive hepatojugular reflux.

24. The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following? A) Reduced intake of protein and carbohydrates B) Increased intake of calcium and vitamin D C) Reduced intake of fat and sodium D) Increased intake of potassium, vitamin B12 and vitamin D

Ans: C Feedback: Lifestyle modifications usually include restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. There is no need to increase calcium, potassium, and vitamin intake. Calorie restriction may be required for some patients, but a specific reduction in protein and carbohydrates is not normally indicated.

72. A nurse is analyzing a patient's rhythm and counts a heart rate of 46. There are no "P" waves at all in this rhythm and the other components are normal. This rhythm is most likely 1. A normal sinus rhythm 2. A junctional rhythm 3. Atrial fibrillation 4. A ventricular rhythm

Answer: 2 Rationale: a junctional rhythm is known by a rate of between 60 and 40. Junctional rythms are started in the AV junction, so they are not caused by atrial depolarization, hence no "P" waves. Everything else about them is normal. Atrial fibrillation is very fast and the P waves cannot be counted. A ventricular rhythm is known by a ventricular rate around 30.

18. A client with a myocardial infarction and cardiogenic shock is placed on an intra-aortic ballon pump (IAPB). If the device is functioning properly, the balloon inflates when the: 1. tricuspid valve is closed. 2. Pulmonic valve is open. 3. Aortic valve is closed. 4. Mitral valve is closed.

Answer: 3. Aortic valve is closed. Rationale: An intra-aortic ballon pump (IAPB) inflates during diastole when the tricuspid and mitral valves are open and the aortic and pulmonic valves are closed.

40. The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis? A) Wheezes B) Friction rub C) Fine crackles D) Coarse crackles

B Feedback: A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these occurs with pericarditis.

16. The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following? A) Use of patient-controlled analgesia B) Long-term anticoagulant therapy C) Steroid therapy D) Use of IV diuretics

B Feedback: Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and patient-controlled analgesia may or may be not be used in the immediate postoperative period.

2. The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patient's heart? A) P wave B) T wave C) U wave D) QRS complex

B Feedback: The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.

34. The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications? A) The nurse keeps the patient isolated to prevent nosocomial infections. B) The nurse encourages coughing and deep breathing. C) The nurse helps the patient with activities until the pain and fever subside. D) The nurse encourages increased fluid intake until the infection resolves.

C Feedback: To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patient's condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated. Due to pain, coughing and deep breathing are not normally encouraged. An increase in fluid intake is not always necessary.

31. The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient? A) To eat a small meal before taking nitroglycerin B) To drink a glass of milk before taking nitroglycerin C) To engage in 15 minutes of light exercise before taking nitroglycerin D) To rest and relax before taking nitroglycerin

D Feedback: The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.

A patient asks the nurse how long he will have to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? a) 3 minutes b) 15 minutes c) 60 minutes d) 30 minutes

a) 3 minutes Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch) and ideally alleviates the pain of ischemia within 3 minutes.

A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which of the following risk factors will the nurse include? Choose all that apply. a) African-American descent b) Family history of coronary heart disease c) Elevated C-reactive protein d) Body mass index (BMI) of 23 e) Age greater than 45 years for men

a) African-American descent b) Family history of coronary heart disease c) Elevated C-reactive protein e) Age greater than 45 years for men Risk factors for coronary heart disease (CHD) include family history of CHD, age older than 45 years for men and 65 years for women, African-American race, BMI of 25 or greater, and elevated C-reactive protein.

The client teaching instructions for a 57-year-old male client with thrombophlebitis who is being discharged should include which of the following? Select all that apply. a) Ambulate as tolerated. b) Avoid elevating affected extremity. c) Take anticoagulant therapy when symptoms occur. d) Avoid sitting for too long. e) Perform leg exercises each hour.

a) Ambulate as tolerated. d) Avoid sitting for too long. e) Perform leg exercises each hour. Nurses instruct clients with thrombophlebitis to prevent recurrences by being active, avoiding knee bending or leg crossing, elevating legs periodically, and taking long-term anticoagulant therapy exactly as prescribed. Clients should also watch for and report signs that indicate impaired clotting: nosebleeds, bleeding gums, rectal bleeding, easy bruising, and prolonged oozing from minor cuts.

The nurse is performing a neurovascular assessment of a client's injured extremity. Which of the following would the nurse report? a) Dusky or mottled skin color b) Positive distal pulses c) Skin warm to touch d) Capillary refill of 3 seconds

a) Dusky or mottled skin color Normally, skin color would be similar to the color in other body areas. Pale or dusky skin color indicates an abnormality that needs to be reported. Presence of pulses, capillary refill of 3 seconds, and warm skin are normal findings.

The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? a) More P waves than QRS complexes b) Atrial rate of 60 bpm or below c) Extended PR interval d) Shortened QRS duration.

a) More P waves than QRS complexes There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: a) left calf circumference 1" (2.5 cm) larger than the right. b) a decrease in the left pedal pulse. c) loss of hair on the lower portion of the left leg. d) pallor and coolness of the left foot.

a) left calf circumference 1" (2.5 cm) larger than the right. Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

The most common site of aneurysm formation is in the: a) abdominal aorta, just below the renal arteries. b) aortic arch, around the ascending and descending aorta. c) ascending aorta, around the aortic arch. d) descending aorta, beyond the subclavian arteries.

abdominal aorta, just below the renal arteries. Explanation: About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? a) "I should increase my fluid intake." b) "I can still drink coffee and tea." c) "I should eat foods rich in protein." d) "I'll enroll in an aerobic exercise program."

b) "I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.

Which of the following is a characteristic of an arterial ulcer? a) Brawny edema b) Border regular and well demarcated c) Ankle-brachial index (ABI) > 0.90 d) Edema may be severe

b) Border regular and well demarcated Characteristics of an arterial ulcer include a border that is regular and demarcated. Brawny edema, ABI > 0.90, and edema that may be severe are characteristics of a venous ulcer.

Jack Johnson is a 58-year-old who's been living with an internal, fixed-rate pacemaker. You're checking his readings on a cardiac monitor and notice an absence of spikes. What should you do? a) Suggest the need for a new beta-blocker to the doctor. b) Double-check the monitoring equipment. c) Nothing, there's no cause for alarm. d) Take Jack's blood pressure.

b) Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. It's important to be careful. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Focus on the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Check the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: a) loss of hair on the lower portion of the left leg. b) left calf circumference 1" (2.5 cm) larger than the right. c) pallor and coolness of the left foot. d) a decrease in the left pedal pulse.

b) left calf circumference 1" (2.5 cm) larger than the right. Explanation: Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a patient with a cardiac dysrhythmia? a) Administer every five minutes during cardiac resuscitation b) Document heart rate before and after administration c) Monitor vital signs and cardiac rhythm d) Keep the patient flat for one hour after administration

c) Monitor vital signs and cardiac rhythm The nurse should monitor the patient's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill patient. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a patient flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.

A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? a) Blood pressure every 2 hours b) Ankle-arm indices every 12 hours c) Peripheral pulses every 15 minutes following surgery d) Color of the leg every 4 hours

c) Peripheral pulses every 15 minutes following surgery The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable.

The nurse is caring for a client with manifestations of dilated cardiomyopathy. When planning care, which consideration would the nurse make? a) Assist client to bathroom every 2 hours. b) Assess abdominal girth daily. c) Place bed in a high or semi-high Fowler's position as needed. d) Instruct client to avoid strenuous activity.

c) Place bed in a high or semi-high Fowler's position as needed. Dilated cardiomyopathy has clinical manifestations of dyspnea on exertion and when lying down. Depending on level of dyspnea, placing the client in an upright Fowler's position is helpful. Clients with hypertrophic cardiomyopathy have syncopal episodes and can collapse following strenuous activity. Assistance with ambulation to avoid falls is helpful. Restrictive cardiomyopathy includes manifestations of ascites and assessment of abdominal girth.

The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? a) Aspirin b) Digoxin c) Warfarin d) Furosemide

c) Warfarin To reduce the risk of thrombosis in patients with porcine or bovine tissue valves, warfarin is required for 6 to 12 weeks, followed by aspirin therapy. Furosemide would not be given for 6 to 12 weeks following this type of surgery. Digoxin may be used for the treatment of arrhythmias, but not just for 6 to 12 weeks.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: a) a 30-second filling time for the veins. b) no rubor for 10 seconds after the maneuver. c) dependent pallor. d) elevational rubor.

c) dependent pallor. If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) elevate the affected leg as high as possible. b) place a heating pad around the affected calf. c) keep the affected leg level or slightly dependent. d) shave the affected leg in anticipation of surgery.

c) keep the affected leg level or slightly dependent. Explanation: While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

Which drug is most commonly used to treat cardiogenic shock? a) Metoprolol (Lopressor) b) Furosemide (Lasix) c) Enalapril (Vasotec) d) Dopamine (Intropin)

d) Dopamine (Intropin) Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.

A patient is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the patient for which diagnostic test used to confirm the patient's diagnosis? a) Chest x-ray b) Cardiac cauterization c) CT scan d) Echocardiogram

d) Echocardiogram Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.

Cardiogenic shock is pump failure that primarily occurs because of which of the following? a) Coronary artery stenosis b) Right atrial flutter c) Myocardial ischemia d) Inadequate tissue perfusion

d) Inadequate tissue perfusion The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage. Reduced cardiac output and stroke volume reduces arterial blood pressure and tissue perfusion.

A patient's heart rate is observed to be 140 bpm on the monitor. The nurse knows that the patient is at risk for what complication? a) A stroke b) Right-sided heart failure c) A pulmonary embolism d) Myocardial ischemia

d) Myocardial ischemia As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, patients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially patients with coronary artery disease.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) place a heating pad around the affected calf. b) elevate the affected leg as high as possible. c) shave the affected leg in anticipation of surgery. d) keep the affected leg level or slightly dependent.

d) keep the affected leg level or slightly dependent. Explanation: While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurse's admission interview, the patient states that she takes over-the-counter water pills on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics? A) Encourage the patient to drink at least 2 liters of fluid daily. B) Increase the patient's oral sodium intake. C) Inform the care provider because diuretics are contraindicated. D) Ensure that the patient's fluid balance is monitored vigilantly.

C Feedback: Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware. Adjusting the patient's sodium or fluid intake or fluid monitoring does not address this important contraindication.

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a) Worsening angina b) Internal bleeding c) Thrombocytopenia d) Formation of blood clots

a) Worsening angina Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or thrombocytopenia.

Which of the following is a true statement regarding the role of baroreceptors? a) Increases in heart rate b) Initiates the parasympathetic response c) Initiates the sympathetic response d) Increases blood pressure

b) Initiates the parasympathetic response During elevations of blood pressure, the baroreceptors increase their rate of discharge. This initiates parasympathetic activity and inhibits sympathetic response, lowering the heart rate and blood pressure.

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: a) skeletal muscle damage due to a recent fall. b) I.M. injection. c) myocardial necrosis. d) cerebral bleeding.

c) myocardial necrosis. An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.

The most common site of aneurysm formation is in the: a) aortic arch, around the ascending and descending aorta. b) descending aorta, beyond the subclavian arteries. c) ascending aorta, around the aortic arch. d) abdominal aorta, just below the renal arteries.

d) abdominal aorta, just below the renal arteries. About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

53. In coordinating care for a client with venous stasis ulcers, the nurse explains to unlicensed assistive personnel that which of the following is the most important intervention in ulcer healing? 1. Surgical debridement 2. Meticulous cleaning of the ulcers to prevent infection. 3. Performance of leg exercises to increase collateral circulation. 4. Elevation of the extremities to increase venous return.

Answer: 4. Elevation of the extremities to increase venous return. Rationale: The client with venous ulcers must keep the legs elevated above the level of the heart as much as possible. Elevation of the extremities enhances venous return and improves circulation, providing oxygen and nutrients to the lower extremities. The client with a leg ulcer should avoid exercise to prevent further damage to tissues at risk. Option1 may or may not be indicated. Asepsis is important, but no ulcer will heal unless the edema and stagnant tissue metabolites can be reduced through leg elevation. Strategy: The critical words in the stem of the question are most important intervention, indicating that more than one option, or all options, may be correct, but one is better than the others. Look at the question carefully and note that the nurse is talking to an ancillary caregiver. Consider that the correct option is one that is within the scope of practice of that caregiver in making a selection.

80. A nurse is preparing drugs for a cardiac arrest victim. Which of the following drug is used in almost all cardiac arrest scenarios? 1. Atropine 2. Epinephrine 3. Adenosine 4. Sodium bicarbonate

Answer: 2 Rationale: "Epi" or epinephrine is used in almost all cardiac arrest scenarios. Atropine is reserved for asystole. Adenosine might be given for fast tachydysrhyhmias. Sodium bicarbonate is reserved for after a set of arterial blood gasses are obtained if the patient is in acidosis.

When assessing venous disease in a patient's lower extremities, the nurse knows that what test will most likely be ordered? A) Duplex ultrasonography B) Echocardiography C) Positron emission tomography (PET) D) Radiography

Ans: A Feedback: Duplex ultrasound may be used to determine the level and extent of venous disease as well as its chronicity. Radiographs (x-rays), PET scanning, and echocardiography are never used for this purpose as they do not allow visualization of blood flow.

A nurse is creating an education plan for a patient with venous insufficiency. What measure should the nurse include in the plan? A) Avoiding tight-fitting socks. B) Limit activity whenever possible. C) Sleep with legs in a dependent position. D) Avoid the use of pressure stockings.

Ans: A Feedback: Measures taken to prevent complications include avoiding tight-fitting socks and panty girdles; maintaining activities, such as walking, sleeping with legs elevated, and using pressure stockings. Not included in the teaching plan for venous insufficiency would be reducing activity, sleeping with legs dependent, and avoiding pressure stockings. Each of these actions exacerbates venous insufficiency.

You are caring for a patient who is diagnosed with Raynaud's phenomenon. The nurse should plan interventions to address what nursing diagnosis? A) Chronic pain B) Ineffective tissue perfusion C) Impaired skin integrity D) Risk for injury

Ans: B Feedback: Raynaud's phenomenon is a form of intermittent arteriolar vasoconstriction resulting in inadequate tissue perfusion. This results in coldness, pain, and pallor of the fingertips or toes. Pain is typically intermittent and acute, not chronic, and skin integrity is rarely at risk. In most cases, the patient is not at a high risk for injury.

The nurse is planning the care of a patient with HF. The nurse should identify what overall goals of this patient's care? Select all that applies A) Improve functional status B) Prevent endocarditis. C) Extend survival. D) Limit physical activity. E) Relieve patient symptoms.

Ans: A) Improve functional status, C) Extend survival, E) Relieve patient symptoms Feedback: The overall goals of management of HF are to relieve the patient's symptoms, to improve functional status and quality of life, and to extend survival. Activity limitations should be accommodated, but reducing activity is not a goal. Endocarditis is not a common complication of HF and preventing it is not a major goal of care.

14. A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension? A) Obesity and high intake of sodium and saturated fat B) Diabetes and use of oral contraceptives C) Metabolic syndrome and smoking D) Renal disease and coarctation of the aorta

Ans: A Feedback: Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.

The nurse is addressing exercise and physical activity during discharge education with a patient diagnosed with HF. What should the nurse teach this patient about exercise? A) "Do not exercise unsupervised." B) "Eventually aim to work up to 30 minutes of exercise each day." C) "Slow down if you get dizzy or short of breath." D) "Start your exercise program with high-impact activities."

Ans: B) "Eventually aim to work up to 30 minutes of exercise each day." Feedback: Eventually, a total of 30 minutes of physical activity every day should be encouraged. Supervision is not necessarily required and the emergence of symptoms should prompt the patient to stop exercising, not simply to slow the pace. Low-impact activities should be prioritized.

The nurse is caring for a patient who has developed obvious signs of pulmonary edema. What is the priority nursing action? A) Lay the patient flat. B) Notify the family of the patient's critical state. C) Stay with the patient. D) Update the physician.

Ans: C) Stay with the patient. Feedback: Because the patient has an unstable condition, the nurse must remain with the patient. The physician must be updated promptly, but the patient should not be left alone in order for this to happen. Supine positioning is unlikely to relieve dyspnea. The family should be informed, but this is not the priority action.

The nurse has entered a patient's room and found the patient unresponsive and not breathing. What is the nurse's next appropriate action? A) Palpate the patient's carotid pulse. B) Illuminate the patient's call light. C) Begin performing chest compressions. D) Activate the Emergency Response System (ERS).

Ans: D) Activate the Emergency Response System (ERS). Feedback: After checking for responsiveness and breathing, the nurse should activate the ERS. Assessment of carotid pulse should follow and chest compressions may be indicated. Illuminating the call light is an insufficient response.

The nurse is reviewing a newly admitted patient's electronic health record, which notes a history of orthopnea? What nursing action is most clearly indicated? A) Teach the patient deep breathing and coughing exercises. B) Administer supplemental oxygen at all times. C) Limit the patient's activity level. D) Avoid positioning the patient supine.

Ans: D) Avoid positioning the patient supine. Feedback: Orthopnea is defined as difficulty breathing while lying flat. This is a possible complication of HF and, consequently, the nurse should avoid positioning the patient supine. Oxygen supplementation may or may not be necessary and activity does not always need to be curtailed. Deep breathing and coughing exercises do not directly address this symptom.

1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm? A) Ventricular fibrillation (VF) B) Ventricular tachycardia (VT) C) Atrial fibrillation D) Sinus bradycardia

C Feedback: In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.

27. A patient has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this patient's care, what nursing diagnosis is most appropriate? A) Acute pain B) Risk for unilateral neglect C) Risk for activity intolerance D) Risk for fluid volume excess

C Feedback: Sinus bradycardia causes decreased cardiac output that is likely to cause activity intolerance. It does not typically cause pain, fluid imbalances, or neglect of a unilateral nature.

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: a) aids in weight reduction. b) decreases venous congestion. c) reduces stress. d) increases high-density lipoprotein (HDL) level.

Regular walking is the best way to decrease venous congestion because using the leg muscles as a pump helps return blood to the heart. Regular exercise also aids in stress reduction and weight reduction and increases the formation of HDLs — which are all beneficial to a client with peripheral vascular disease. However, these changes don't have as significant an effect on the client's condition as decreasing venous congestion.

Age-related changes associated with the cardiac system include which of the following? Select all that apply. a) Increased size of the left atrium b) Myocardial thinning c) Endocardial fibrosis d) Increase in the number of SA node cells

a) Increased size of the left atrium c) Endocardial fibrosis Age-related changes associated with the cardiac system include endocardial fibrosis, increased size of the left atrium, decreased number of SA node cells, and myocardial thickening.

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? a) Lead wire dislodgement b) Faulty generator c) Sensitivity is too low d) Fracture of the lead wire

a) Lead wire dislodgement Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Morphine IV b) Angiotensin-converting enzyme (ACE) inhibitor c) Aspirin d) Statin

a) Morphine IV Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine.

Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? a) Valium b) Vasotec c) Atropine d) Lanoxin

a) Valium Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as Valium.

A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? a) 15 minutes b) 10 minutes c) 20 minutes d) 25 minutes

b) 10 minutes The survival rate decreases for every minute that defibrillation is delayed. If the patient has not been defibrillated within 10 minutes, the chance of survival is close to zero. The other options are too long of a time frame.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a) Slow heart rate and high blood pressure b) Constant, intense back pain and falling blood pressure c) Constant, intense headache and falling blood pressure d) Higher than normal blood pressure and falling hematocrit

b) Constant, intense back pain and falling blood pressure Explanation: Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) a) Jugular vein distention b) Cough c) Pulmonary crackles d) Ascites e) Dyspnea

b) Cough c) Pulmonary crackles e) Dyspnea The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention.

A nurse is completing a head to toe assessment on a patient diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined? a) Legs, Toes b) Fingers, hands c) Under the sacrum d) Lips, earlobes

b) Fingers, hands When right-sided heart failure occurs, blood accumulates in the vessels and backs up in peripheral veins, and the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. Other prominent areas prone to edema are the fingers, hands, and over the sacrum. Cyanosis can be detected by noting color changes in the lips and earlobes.

A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm? a) Saccular b) False c) Anastomotic d) Dissecting

c) Anastomotic An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma.

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine (Duramorph), oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order? a) Nitroprusside (Nipride) b) Furosemide (Lasix) c) Carvedilol (Coreg) d) Digoxin (Lanoxin)

c) Carvedilol (Coreg) A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.

A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider. a) 3.0 b) 2.6 c) 3.4 d) 3.8

d) 3.8 Coumadin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.

A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? a) It never needs batteries. b) It's designed for extremely active patients. c) It's specifically designed for long-term use. d) An LVAD only supports a failing left ventricle.

d) An LVAD only supports a failing left ventricle. A TAH is considered an extension of LVADs, which only support a failing left ventricle. TAHs are targeted for clients who are unlikely to live more than a month without further interventions.

The nurse is caring for a patient with a large venous leg ulcer. What intervention should the nurse implement to promote healing and prevent infection? A) Provide a high-calorie, high-protein diet. B) Apply a clean occlusive dressing once daily and whenever soiled. C) Irrigate the wound with hydrogen peroxide once daily. D) Apply an antibiotic ointment on the surrounding skin with each dressing change.

Ans: A Feedback: Wound healing is highly dependent on adequate nutrition. The diet should be sufficiently high in calories and protein. Antibiotic ointments are not normally used on the skin surrounding a leg ulcer and occlusive dressings can exacerbate impaired blood flow. Hydrogen peroxide is not normally used because it can damage granulation tissue.

A nurse on a medical unit is caring for a patient who has been diagnosed with lymphangitis. When reviewing this patient's medication administration record, the nurse should anticipate which of the following? A) Coumadin (warfarin) B) Lasix (furosemide) C) An antibiotic D) An antiplatelet aggregator

Ans: C Feedback: Lymphangitis is an acute inflammation of the lymphatic channels caused by an infectious process. Antibiotics are always a component of treatment. Diuretics are of nominal use. Anticoagulants and antiplatelet aggregators are not indicated in this form of infection.

8. The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patient's adherence to the prescribed therapeutic regimen? A) Screen the patient for visual disturbances regularly. B) Have the patient participate in monitoring his or her own BP. C) Emphasize the dire health outcomes associated with inadequate BP control. D) Encourage the patient to lose weight and exercise regularly.

Ans: B Feedback: Adherence to the therapeutic regimen increases when patients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some patients, but for many patients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.

15. The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this client's hypertension? A) Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption. B) Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. C) Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient. D) Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

Ans: B Feedback: Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.

6. A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient? A) Quitting smoking will cause the patient's hypertension to resolve. B) Tobacco use increases the patient's concurrent risk of heart disease. C) Tobacco use is associated with a sedentary lifestyle. D) Tobacco use causes ventricular hypertrophy.

Ans: B Feedback: Smoking increases the risk for heart disease, for which a patient with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurse's advice; the association with heart disease is more salient.

Diagnostic imaging reveals that the quantity of fluid in a client's pericardial sac is dangerously increased. The nurse should collaborate with the other members of the care team to prevent the development of what complication? A) Pulmonary edema B) Pericardiocentesis C) Cardiac tamponade D) Pericarditis

Ans: C) Cardiac tamponade Feedback: An increase in pericardial fluid raises the pressure within the pericardial sac and compresses the heart, eventually causing cardiac tamponade. Pericardiocentesis is the treatment for this complication. Pericarditis and pulmonary edema do not result from this pathophysiological process.

32. A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? A) Pacific Islanders B) African Americans C) Asian-Americans D) Hispanics

Ans: D Feedback: The prevalence of uncontrolled hypertension varies by ethnicity, with Hispanics and African Americans having the highest prevalence at approximately 63% and 57%, respectively.

17. A client reports substernal chest pain. Test results show electrocardiographic changes and an elevated cardiac troponin level. What should be the focus of nursing care? 1. Improving myocardial oxygenation and reducing cardiac workload. 2. Confirming a suspected diagnosis and preventing complications. 3. Reducing anxiety and relieving pain. 4. Eliminating stressors and providing a nondemanding environment.

Answer: 1. Improving myocardial oxygenation and reducing cardiac workload. Rationale: The client is exhibiting clinical signs and symptoms of a myocardial infarction (MI); therefore, nursing care should focus on improving myocardial oxygenation and reducing cardiac workload. Confirming the diagnosis of MI and preventing complications, reducing anxiety and relieving pain, and providing a nondemanding environment are secondary to improving myocardial oxygenation and reducing workload. Stressors can't be eliminated, only reduced.

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change? a) Purplish stools b) Coldness of the soles c) Redness of the upper part of the feet d) Bluish urine

Bluish urine Explanation: Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

25. A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient? A) Patients generally stay in the hospital for 6 to 8 days. B) Patients are kept in the hospital until they are independent with all aspects of their care. C) Patients need to stay in the hospital until they regain normal heart function for their age. D) Patients usually remain at the hospital for 24 to 48 hours.

D Feedback: After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.

5. A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs? A) Enoxaparin (Lovenox) B) Metoprolol (Lopressor) C) Azathioprine (Imuran) D) Amoxicillin (Amoxil)

D Feedback: Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.

A patient is receiving enoxaparin (Lovenox) and warfarin (Coumadin) therapy for a venous thromboembolism (VTE). Which lab value indicates that anticoagulation is adequate and enoxaparin (Lovenox) can be discontinued? a) The patient's international normalized ratio (INR) is 2.5. b) The patient's activated partial thromboplastin time (aPPT) is half of the control value. c) The patient's K+ level is 3.5. d) The patient's prothrombin time (PT) is 0.5 times normal.

The patient's international normalized ratio (INR) is 2.5. Explanation: Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to: a) A lack of oxygen in the heart muscle that causes the death of cells. b) Complete closure of an artery. c) Incomplete blockage of a major coronary artery. d) A destroyed part of the heart muscle.

a) A lack of oxygen in the heart muscle that causes the death of cells. Impeded blood flow, due to blockage in a coronary artery, deprives the cardiac muscle cells of oxygen thus leading to a condition known as ischemia.

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a) Neither venous nor arterial insufficiency b) Venous insufficiency c) Arterial insufficiency d) Trauma

b) Venous insufficiency Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.

A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements? a) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." b) "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease." c) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." d) "The older I get the higher my risk for peripheral arterial disease gets."

c) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.

A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range? a) 4.0 mg/mL b) 0.25 mg/mL c) 2.0 mg/mL d) 3.2 mg/mL

c) 2.0 mg/mL For many years, digitalis (digoxin) was considered an essential agent for the treatment of HF, but with the advent of new medications, it is not prescribed as often. Digoxin increases the force of myocardial contraction and slows conduction through the atrioventricular node. It improves contractility, increasing left ventricular output.

When teaching a client with peripheral vascular disease about foot care, a nurse should include which instruction? a) Avoid using cornstarch on the feet. b) Avoid using a nail clipper to cut toenails. c) Avoid wearing canvas shoes. d) Avoid wearing cotton socks.

c) Avoid wearing canvas shoes. Explanation: The client should be instructed to avoid wearing canvas shoes. Canvas shoes cause the feet to perspire, and perspiration can cause skin irritation and breakdown. Cotton and cornstarch absorb perspiration. The client should be instructed to cut toenails straight across with nail clippers.

Which of the following are characteristics of arterial insufficiency? a) Aching, cramping pain b) Superficial ulcer c) Diminished or absent pulses d) Pulses are present, may be difficult to palpate

c) Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.

On his return to the cardiac step-down unit after his diagnostic procedure, a client awaits the report from his cardiologist. As the client's nurse, you review the process of measuring ejection fraction and explain to the client that it measures the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? a) 45% b) 50% c) 40% d) 55%

d) 55% Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.

Which medication should a nurse have on hand when removing a sheath after cardiac catheterization? a) Heparin b) Adenosine (Adenocard) c) Protamine sulfate d) Atropine

d) Atropine Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. The nurse should have atropine on hand to increase the client's heart rate if this occurs. Heparin thins the blood; clients should stop taking it before the sheath removal. Protamine sulfate is an antidote to heparin, but the nurse shouldn't administer it during sheath removal. Adenosine treats tachyarrhythmias.

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? a) An active daily walking program b) A history of diabetes mellitus c) History of increased aspirin use d) Recent pelvic surgery

d) Recent pelvic surgery Explanation: The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? a) Air plethysmography b) Contrast phlebography c) Lymphoscintigraphy d) Lymphangiography

Contrast phlebography Explanation: When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

19. An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patient's echocardiogram? A) Blood to flow back from the aorta to the left ventricle B) Obstruction of blood flow from the left ventricle C) Blood to flow back from the left atrium to the left ventricle D) Obstruction of blood from the left atrium to left ventricle

A Feedback: Aortic regurgitation occurs when the aortic valve does not completely close, and blood flows back to the left ventricle from the aorta during diastole. Aortic regurgitation does not cause obstruction of blood flow from the left ventricle, blood to flow back from the left atrium to the left ventricle, or obstruction of blood from the left atrium to left ventricle.

39. A cardiac surgery patient's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? A) Prepare to assist with pericardiocentesis. B) Reposition the patient into a prone position. C) Administer a dose of metoprolol. D) Administer a bolus of normal saline.

A Feedback: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.

11. A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease? A) Recognizing and promptly treating streptococcal infections B) Prophylactic use of calcium channel blockers in high-risk populations C) Adhering closely to the recommended child immunization schedule D) Smoking cessation

A Feedback: Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.

36. The nurse on the hospital's infection control committee is looking into two cases of hospital-acquired infective endocarditis among a specific classification of patients. What classification of patients would be at greatest risk for hospital-acquired endocarditis? A) Hemodialysis patients B) Patients on immunoglobulins C) Patients who undergo intermittent urinary catheterization D) Children under the age of 12

A Feedback: Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis. Patients on immunoglobulins, those who need in and out catheterization, and children are not at increased risk for nosocomial infective endocarditis.

14. The nurse is preparing a patient for cardiac surgery. During the procedure, the patient's heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo? A) Orthotopic transplant B) Xenograft C) Heterotropic transplant D) Homograft

A Feedback: Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipient's heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipient's heart, leaving a portion of the recipient's atria (with the vena cava and pulmonary veins) in place. Homografts, or allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not terms used to describe heart transplantation.

20. A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following? A) The need for regularly scheduled testing of the patient's International Normalized Ratio (INR) B) The need to learn to sleep in a semi-Fowler's position for the first 6 to 8 weeks to prevent emboli C) The need to avoid foods that contain vitamin K D) The need to take enteric-coated ASA on a daily basis

A Feedback: Patients who take warfarin (Coumadin) after valve replacement have individualized target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement. Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping upright is unnecessary.

23. A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patient's most recent laboratory results, the nurse should prioritize assessment of which of the following? A) Sodium B) AST, ALT, and bilirubin C) White blood cell differential D) BUN

A Feedback: Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels. Consequently, sodium levels are followed more closely than other important laboratory values, including BUN, leukocytes, and liver function tests.

9.A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? A) "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" B) "To detect and treat bradycardia, which is an excessively slow heart rate" C) "To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently" D) "To shock your heart if you have a heart attack at home"

A Feedback: The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.

32. A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment? A) Heart transplantation B) Balloon valvuloplasty C) Cardiac catheterization D) Stent placement

A Feedback: When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Valvuloplasty, stent placement, and cardiac catheterization will not address the pathophysiology of cardiomyopathy.

4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond? A) Azathioprine decreases the risk of thrombus formation. B) Azathioprine ensures adequate cardiac output. C) Azathioprine increases the number of white blood cells. D) Azathioprine minimizes rejection of the transplant.

D Feedback: After heart transplant, patients are constantly balancing the risk of rejection with the risk of infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf), azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.

21. A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge? A) The need for long-term antibiotics B) The need for 7 to 10 days of bed rest C) Strategies for preventing atherosclerosis D) Strategies for infection prevention

D Feedback: Patients with a mechanical valve prosthesis (including annuloplasty rings and other prosthetic materials used in valvuloplasty) require education to prevent infective endocarditis. Despite these infections risks, antibiotics are not used long term. Activity management is important, but extended bed rest is unnecessary. Valve replacement does not create a heightened risk for atherosclerosis.

24. A cardiac care nurse is aware of factors that result in positive chronotropy. These factors would affect a patient's cardiac function in what way? A) Exacerbating an existing dysrhythmia B) Initiating a new dysrhythmia C) Resolving ventricular tachycardia D) Increasing the heart rate

D Feedback: Stimulation of the sympathetic system increases heart rate. This phenomenon is known as positive chronotropy. It does not influence dysrhythmias.

35. A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurse's assessment findings is most consistent with myocarditis? A) Sudden changes in level of consciousness (LOC) B) Peripheral edema and pulmonary edema C) Pleuritic chest pain D) Flulike symptoms

D Feedback: The most common symptoms of myocarditis are flulike. Chest pain, edema, and changes in LOC are not characteristic of myocarditis.

A patient with advanced venous insufficiency is confined following orthopedic surgery. How can the nurse best prevent skin breakdown in the patient's lower extremities? A) Ensure that the patient's heels are protected and supported. B) Closely monitor the patient's serum albumin and prealbumin levels. C) Perform gentle massage of the patient's lower legs, as tolerated. D) Perform passive range-of-motion exercises once per shift.

Ans: A Feedback: If the patient is on bed rest, it is important to relieve pressure on the heels to prevent pressure ulcerations, since the heels are among the most vulnerable body regions. Monitoring blood work does not directly prevent skin breakdown, even though albumin is related to wound healing. Massage is not normally indicated and may exacerbate skin breakdown. Passive range- of-motion exercises do not directly reduce the risk of skin breakdown.

The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walks several blocks. The patient has type 1 diabetes and has smoked a pack of cigarettes every day for the past 40 years. The physician diagnoses intermittent claudication. The nurse should provide what instruction about long-term care to the client? A) "Be sure to practice meticulous foot care." B) "Consider cutting down on your smoking." C) "Reduce your activity level to accommodate your limitations." D) "Try to make sure you eat enough protein."

Ans: A Feedback: The patient with peripheral vascular disease or diabetes should receive education or reinforcement about skin and foot care. Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing; therefore, meticulous foot care is essential. The patient should stop smoking—not just cut down—because nicotine is a vasoconstrictor. Daily walking benefits the patient with intermittent claudication. Increased protein intake will not alleviate the patient's symptoms.

A patient who has undergone a femoral to popliteal bypass graft surgery returns to the surgical unit. Which assessments should the nurse perform during the first postoperative day? A) Assess pulse of affected extremity every 15 minutes at first. B) Palpate the affected leg for pain during every assessment. C) Assess the patient for signs and symptoms of compartment syndrome every 2 hours. D) Perform Doppler evaluation once daily.

Ans: A Feedback: The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable. Doppler evaluations should be performed every 2 hours. Pain is regularly assessed, but palpation is not the preferred method of performing this assessment. Compartment syndrome results from the placement of a cast, not from vascular surgery.

The nurse is taking a health history of a new patient. The patient reports experiencing pain in his left lower leg and foot when walking. This pain is relieved with rest. The nurse notes that the left lower leg is slightly edematous and is hairless. When planning this patient's subsequent care, the nurse should most likely address what health problem? A) Coronary artery disease (CAD) B) Intermittent claudication C) Arterial embolus D) Raynaud's disease

Ans: B Feedback: A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise. The nurse would not suspect the patient has CAD, arterial embolus, or Raynaud's disease; none of these health problems produce this cluster of signs and symptoms.

An occupational health nurse is providing an educational event and has been asked by an administrative worker about the risk of varicose veins. What should the nurse suggest as a proactive preventative measure for varicose veins? A) Sit with crossed legs for a few minutes each hour to promote relaxation. B) Walk for several minutes every hour to promote circulation. C) Elevate the legs when tired. D) Wear snug-fitting ankle socks to decrease edema.

Ans: B Feedback: A proactive approach to preventing varicose veins would be to walk for several minutes every hour to promote circulation. Sitting with crossed legs may promote relaxation, but it is contraindicated for patients with, or at risk for, varicose veins. Elevating the legs only helps blood passively return to the heart and does not help maintain the competency of the valves in the veins. Wearing tight ankle socks is contraindicated for patients with, or at risk for, varicose veins; socks that are below the muscles of the calf do not promote venous return, the socks simply capture the blood and promote venous stasis.

The nurse is caring for a 72-year-old patient who is in cardiac rehabilitation following heart surgery. The patient has been walking on a regular basis for about a week and walks for 15 minutes 3 times a day. The patient states that he is having a cramp-like pain in the legs every time he walks and that the pain gets "better when I rest." The patient's care plan should address what problem? A) Decreased mobility related to VTE B) Acute pain related to intermittent claudication C) Decreased mobility related to venous insufficiency D) Acute pain related to vasculitis

Ans: B Feedback: Intermittent claudication presents as a muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest. Patients with peripheral arterial insufficiency often complain of intermittent claudication due to a lack of oxygen to muscle tissue. Venous insufficiency presents as a disorder of venous blood reflux and does not present with cramp-type pain with exercise. Vasculitis is an inflammation of the blood vessels and presents with weakness, fever, and fatigue, but does not present with cramp-type pain with exercise. The pain associated with VTE does not have this clinical presentation.

The nurse is caring for a patient who is admitted to the medical unit for the treatment of a venous ulcer in the area of her lateral malleolus that has been unresponsive to treatment. What is the nurse most likely to find during an assessment of this patient's wound? A) Hemorrhage B) Heavy exudate C) Deep wound bed D) Pale-colored wound bed

Ans: B Feedback: Venous ulcerations in the area of the medial or lateral malleolus (gaiter area) are typically large, superficial, and highly exudative. Venous hypertension causes extravasation of blood, which discolors the area of the wound bed. Bleeding is not normally present.

The triage nurse in the ED is assessing a patient who has presented with complaint of pain and swelling in her right lower leg. The patient's pain became much worse last night and appeared along with fever, chills, and sweating. The patient states, "I hit my leg on the car door 4 or 5 days ago and it has been sore ever since." The patient has a history of chronic venous insufficiency. What intervention should the nurse anticipate for this patient? A) Platelet transfusion to treat thrombocytopenia B) Warfarin to treat arterial insufficiency C) Antibiotics to treat cellulitis D) Heparin IV to treat VTE

Ans: C Feedback: Cellulitis is the most common infectious cause of limb swelling. The signs and symptoms include acute onset of swelling, localized redness, and pain; it is frequently associated with systemic signs of fever, chills, and sweating. The patient may be able to identify a trauma that accounts for the source of infection. Thrombocytopenia is a loss or decrease in platelets and increases a patient's risk of bleeding; this problem would not cause these symptoms. Arterial insufficiency would present with ongoing pain related to activity. This patient does not have signs and symptoms of VTE.

A medical nurse has admitted four patients over the course of a 12-hour shift. For which patient would assessment of ankle-brachial index (ABI) be most clearly warranted? A) A patient who has peripheral edema secondary to chronic heart failure B) An older adult patient who has a diagnosis of unstable angina C) A patient with poorly controlled type 1 diabetes who is a smoker D) A patient who has community-acquired pneumonia and a history of COPD

Ans: C Feedback: Nurses should perform a baseline ABI on any patient with decreased pulses or any patient 50 years of age or older with a history of diabetes or smoking. The other answers do not apply.

The nurse is preparing to administer warfarin (Coumadin) to a client with deep vein thrombophlebitis (DVT). Which laboratory value would most clearly indicate that the patient's warfarin is at therapeutic levels? A) Partial thromboplastin time (PTT) within normal reference range B) Prothrombin time (PT) eight to ten times the control C) International normalized ratio (INR) between 2 and 3 D) Hematocrit of 32%

Ans: C Feedback: The INR is most often used to determine if warfarin is at a therapeutic level; an INR of 2 to 3 is considered therapeutic. Warfarin is also considered to be at therapeutic levels when the client's PT is 1.5 to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage, whereas lower values indicate increased risk of blood clot formation. Heparin, not warfarin, prolongs PTT. Hematocrit does not provide information on the effectiveness of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of hemorrhage.

A patient presents to the clinic complaining of the inability to grasp objects with her right hand. The patient's right arm is cool and has a difference in blood pressure of more than 20 mm Hg compared with her left arm. The nurse should expect that the primary care provider may diagnose the woman with what health problem? A) Lymphedema B) Raynaud's phenomenon C) Upper extremity arterial occlusive disease D) Upper extremity VTE

Ans: C Feedback: The patient with upper extremity arterial occlusive disease typically complains of arm fatigue and pain with exercise (forearm claudication) and inability to hold or grasp objects (e.g., combing hair, placing objects on shelves above the head) and, occasionally, difficulty driving. Assessment findings include coolness and pallor of the affected extremity, decreased capillary refill, and a difference in arm blood pressures of more than 20 mm Hg. These symptoms are not closely associated with Raynaud's or lymphedema. The upper extremities are rare sites for VTE.

A nurse is admitting a 45-year-old man to the medical unit who has a history of PAD. While providing his health history, the patient reveals that he smokes about two packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. What would be the priority health education for this patient? A) The lack of exercise, which is the main cause of PAD. B) The likelihood that heavy alcohol intake is a significant risk factor for PAD. C) Cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate PAD. D) Alcohol suppresses the immune system, creates high glucose levels, and may cause PAD.

Ans: C Feedback: Tobacco is powerful vasoconstrictor; its use with PAD is highly detrimental, and patients are strongly advised to stop using tobacco. Sedentary lifestyle is also a risk factor, but smoking is likely a more significant risk factor that the nurse should address. Alcohol use is less likely to cause PAD, although it carries numerous health risks.

A patient comes to the walk-in clinic with complaints of pain in his foot following stepping on a roofing nail 4 days ago. The patient has a visible red streak running up his foot and ankle. What health problem should the nurse suspect? A) Cellulitis B) Local inflammation C) Elephantiasis D) Lymphangitis

Ans: D Feedback: Lymphangitis is an acute inflammation of the lymphatic channels. It arises most commonly from a focus of infection in an extremity. Usually, the infectious organism is hemolytic streptococcus. The characteristic red streaks that extend up the arm or the leg from an infected wound outline the course of the lymphatic vessels as they drain. Cellulitis is caused by bacteria, which cause a generalized edema in the subcutaneous tissues surrounding the affected area. Local inflammation would not present with red streaks in the lymphatic channels. Elephantiasis is transmitted by mosquitoes that carry parasitic worm larvae; the parasites obstruct the lymphatic channels and results in gross enlargement of the limbs.

The nurse caring for a patient with a leg ulcer has finished assessing the patient and is developing a problem list prior to writing a plan of care. What major nursing diagnosis might the care plan include? A) Risk for disuse syndrome B) Ineffective health maintenance C) Sedentary lifestyle D) Imbalanced nutrition: less than body requirements

Ans: D Feedback: Major nursing diagnoses for the patient with leg ulcers may include imbalanced nutrition: less than body requirements, related to increased need for nutrients that promote wound healing. Risk for disuse syndrome is a state in which an individual is at risk for deterioration of body systems owing to prescribed or unavoidable musculoskeletal inactivity. A leg ulcer will affect activity, but rarely to this degree. Leg ulcers are not necessarily a consequence of ineffective health maintenance or sedentary lifestyle.

The nurse is assessing a woman who is pregnant at 27 weeks' gestation. The patient is concerned about the recent emergence of varicose veins on the backs of her calves. What is the nurse's best response? A) Facilitate a referral to a vascular surgeon. B) Assess the patient's ankle-brachial index (ABI) and perform Doppler ultrasound testing. C) Encourage the patient to increase her activity level. D) Teach the patient that circulatory changes during pregnancy frequently cause varicose veins.

Ans: D Feedback: Pregnancy may cause varicosities because of hormonal effects related to decreased venous outflow, increased pressure by the gravid uterus, and increased blood volume. In most cases, no intervention or referral is necessary. This finding is not an indication for ABI assessment and increased activity will not likely resolve the problem.

A nurse is reviewing the physiological factors that affect a patient's cardiovascular health and tissue oxygenation. What is the systemic arteriovenous oxygen difference? A) The average amount of oxygen removed by each organ in the body B) The amount of oxygen removed from the blood by the heart C) The amount of oxygen returning to the lungs via the pulmonary artery D) The amount of oxygen in aortic blood minus the amount of oxygen in the vena caval blood

Ans: D Feedback: The average amount of oxygen removed collectively by all of the body tissues is about 25%. This means that the blood in the vena cava contains about 25% less oxygen than aortic blood. This is known as the systemic arteriovenous oxygen difference. The other answers do not apply.

A nurse in the rehabilitation unit is caring for an older adult patient who is in cardiac rehabilitation following an MI. The nurse's plan of care calls for the patient to walk for 10 minutes 3 times a day. The patient questions the relationship between walking and heart function. How should the nurse best reply? A) "The arteries in your legs constrict when you walk and allow the blood to move faster and with more pressure on the tissue." B) Walking increases your heart rate and blood pressure. Therefore your heart is under less stress." C) "Walking helps your heart adjust to your new arteries and helps build your self-esteem." D) "When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart."

Ans: D Feedback: Veins, unlike arteries, are equipped with valves that allow blood to move against the force of gravity. The legs have one-way bicuspid valves that prevent blood from seeping backward as it moves forward by the muscles in our legs pressing on the veins as we walk and increasing venous return. Leg arteries do constrict when walking, which allows the blood to move faster and with more pressure on the tissue, but the greater concern is increasing the flow of venous blood to the heart. Walking increases, not decreases, the heart' pumping ability, which increases heart rate and blood pressure and the hearts ability to manage stress. Walking does help the heart adjust to new arteries and may enhance self-esteem, but the patient had an MI—there are no "new arteries."

10. A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker and the nurse assesses characteristic signs and symptoms of postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the nurse emphasize? A) Rising slowly from a lying or sitting position B) Increasing fluids to maintain BP C) Stopping medication if dizziness persists D) Taking medication first thing in the morning

Ans: A Feedback: Patients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these patients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Patient should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurse's scope of practice.

16. A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary hypertension and secondary hypertension is which of the following? A) Secondary hypertension has a specific cause. B) Secondary hypertension has a more gradual onset than primary hypertension. C) Secondary hypertension does not cause target organ damage. D) Secondary hypertension does not normally respond to antihypertensive drug therapy.

Ans: A Feedback: Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.

A cardiac patient's resistance to left ventricular filling has caused blood to back up into the patient's circulatory system. What health problem is likely to result? A) Acute pulmonary edema B) Right-sided HF C) Right ventricular hypertrophy D) Left-sided HF

Ans: A) Acute pulmonary edema Feedback: With increased resistance to left ventricular filling, blood backs up into the pulmonary circulation. The patient quickly develops pulmonary edema from the blood volume overload in the lungs. When the blood backs up into the pulmonary circulation, right-sided HF, left-sided HF, and right ventricular hypertrophy do not directly occur.

The nurse is performing a physical assessment on a patient suspected of having HF. The presence of what sound would signal the possibility of impending HF? A) An S3 heart sound B) Pleural friction rub C) Faint breath sounds D) A heart murmur

Ans: A) An S3 heart sound Feedback: The heart is auscultated for an S3 heart sound, a sign that the heart is beginning to fail and that increased blood volume fills the ventricle with each beat. HF does not normally cause a pleural friction rub or murmurs. Changes in breath sounds occur, such as the emergence of crackles or wheezes, but faint breath sounds are less characteristic of HF.

A patient with HF has met with his primary care provider and begun treatment with an angiotensin-converting enzyme (ACE) inhibitor. When the patient begins treatment, the nurse should prioritize what assessment? A) Blood pressure B) Level of consciousness (LOC) C) Assessment for nausea D) Oxygen saturation

Ans: A) Blood pressure Feedback: Patients receiving ACE inhibitors are monitored for hypotension, hyperkalemia (increased potassium in the blood), and alterations in renal function. ACE inhibitors do not typically cause alterations in LOC. Oxygen saturation must be monitored in patients with HF, but this is not particular to ACE inhibitor therapy. ACE inhibitors do not normally cause nausea.

The nurse is caring for an adult patient with HF who is prescribed digoxin. When assessing the patient for adverse effects, the nurse should assess for which of the following signs and symptoms? A) Confusion and bradycardia B) Uncontrolled diuresis and tachycardia C) Numbness and tingling in the extremities D) Chest pain and shortness of breath

Ans: A) Confusion and bradycardia Feedback: A key concern associated with digitalis therapy is digitalis toxicity. Symptoms include anorexia, nausea, visual disturbances, confusion, and bradycardia. The other listed signs and symptoms are not characteristic of digitalis toxicity.

A patient with a diagnosis of HF is started on a beta-blocker. What is the nurse's priority role during gradual increases in the patient's dose? A) Educating the patient that symptom relief may not occur for several weeks B) Stressing that symptom relief may take up to 4 months to occur C) Making adjustments to each day's dose based on the blood pressure trends D) Educating the patient about the potential changes in LOC that may result from the drug

Ans: A) Educating the patient that symptom relief may not occur for several weeks Feedback: An important nursing role during titration is educating the patient about the potential worsening of symptoms during the early phase of treatment and stressing that improvement may take several weeks. Relief does not take 4 months, however. The nurse monitors blood pressure, but changes are not made based on short-term assessment results. Beta-blockers rarely affect LOC.

The nurse is creating a care plan for a patient diagnosed with HF. When addressing the problem of anxiety, what interventions should the nurse include in the care plan? Select all that apply. A) Facilitate the presence of friends and family whenever possible. B) Teach the patient about the harmful effects of anxiety on cardiac function. C) Provide supplemental oxygen, as needed. D) Provide validation of the patient's expressions of anxiety. E) Administer benzodiazepines two to three times daily.

Ans: A) Facilitate the presence of friends and family whenever possible C) Provide supplemental oxygen, as needed D) Provide validation of the patient's expressions of anxiety Feedback: The nurse should empathically validate the patient's sensations of anxiety. The presence of friends and family are frequently beneficial and oxygen supplementation promotes comfort. Antianxiety medications may be necessary for some patients, but alternative methods of relief should be prioritized. As well, medications are administered on a PRN basis. Teaching the patient about the potential harms of anxiety is likely to exacerbate, not relieve, the problem.

A patient admitted to the medical unit with HF is exhibiting signs and symptoms of pulmonary edema. The nurse is aware that positioning will promote circulation. How should the nurse best position the patient? A) In a high Fowler's position B) On the left side-lying position C) In a flat, supine position D) In the Trendelenburg position

Ans: A) In a high Fowler's position Feedback: Proper positioning can help reduce venous return to the heart. The patient is positioned upright. If the patient is unable to sit with the lower extremities dependent, the patient may be placed in an upright position in bed. The supine position and Trendelenburg positions will not reduce venous return, lower the output of the right ventricle, or decrease lung congestion. Similarly, side-lying does not promote circulation.

The nurse is caring for a patient with severe left ventricular dysfunction who has been identified as being at risk for sudden cardiac death. What medical intervention can be performed that may extend the survival of the patient? A) Insertion of an implantable cardioverter defibrillator B) Insertion of an implantable pacemaker C) Administration of a calcium channel blocker D) Administration of a beta-blocker

Ans: A) Insertion of an implantable cardioverter defibrillator Feedback: In patients with severe left ventricular dysfunction and the possibility of life-threatening dysrhythmias, placement of an implantable cardioverter defibrillator (ICD) can prevent sudden cardiac death and extend survival. A pacemaker, a calcium channel blocker, and a beta-blocker are not medical interventions that may extend the survival of the patient with left ventricular dysfunction.

Cardiopulmonary resuscitation has been initiated on a patient who was found unresponsive. When performing chest compressions, the nurse should do which of the following? A) Perform at least 100 chest compressions per minute. B) Pause to allow a colleague to provide a breath every 10 compressions. C) Pause chest compressions to allow for vital signs monitoring every 4 to 5 minutes. D) Perform high-quality chest compressions as rapidly as possible.

Ans: A) Perform at least 100 chest compressions per minute. Feedback: During CPR, the chest is compressed 2 inches at a rate of at least 100 compressions per minute. This rate is the resuscitator's goal; the aim is not to give compressions as rapidly as possible. Compressions are not stopped after 10 compressions to allow for a breath or for full vital signs monitoring.

A nurse in the CCU is caring for a patient with HF who has developed an intracardiac thrombus. This creates a high risk for what sequela? A) Stroke B) Myocardial infarction (MI) C) Hemorrhage D) Peripheral edema

Ans: A) Stroke Feedback: Intracardiac thrombi can become lodged in the cerebral vasculature, causing stroke. There is no direct risk of MI, hemorrhage, or peripheral edema.

23. The nurse is teaching a patient about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply. A) Transient ischemic attacks B) Cerebrovascular accident C) Retinal hemorrhage D) Venous insufficiency E) Right ventricular hypertrophy

Ans: A, B, C Feedback: Potential complications of hypertension include the following: left ventricular hypertrophy; MI; heart failure; transient ischemic attacks (TIAs); cerebrovascular accident; renal insufficiency and failure; and retinal hemorrhage. Venous insufficiency and right ventricular hypertrophy are not potential complications of uncontrolled hypertension.

The nurse is educating an 80-year-old patient diagnosed with HF about his medication regimen. What should the nurse to teach this patient about the use of oral diuretics? A) Avoid drinking fluids for 2 hours after taking the diuretic. B) Take the diuretic in the morning to avoid interfering with sleep. C) Avoid taking the medication within 2 hours consuming dairy products. D) Take the diuretic only on days when experiencing shortness of breath.

Ans: B) Take the diuretic in the morning to avoid interfering with sleep. Feedback: Oral diuretics should be administered early in the morning so that diuresis does not interfere with the patient's nighttime rest. Discussing the timing of medication administration is especially important for elderly patients who may have urinary urgency or incontinence. The nurse would not teach the patient about the timing of fluid intake. Fluid intake does not need to be adjusted and dairy products are not contraindicated.

The nurse overseeing care in the ICU reviews the shift report on four patients. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock? A) The patient admitted with acute renal failure B) The patient admitted following an MI C) The patient admitted with malignant hypertension D) The patient admitted following a stroke

Ans: B) The patient admitted following an MI Feedback: Cardiogenic shock may occur following an MI when a large area of the myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. While patients with acute renal failure are at risk for dysrhythmias and patients experiencing a stroke are at risk for thrombus formation, the patient admitted following an MI is at the greatest risk for development of cardiogenic shock when compared with the other listed diagnoses.

17. The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? A) Progressive target organ damage B) Possibility of medication interactions C) Lack of adherence to prescribed drug therapy D) Possible heavy alcohol use or use of recreational drugs

Ans: C Feedback: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of patients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.

1. An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurse's health education should include which of the following? A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C) Use of strategies to prevent falls stemming from postural hypotension D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Ans: C Feedback: Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension. The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk and activity should not normally be limited.

5. A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses by the nursing instructor would be best? A) "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." B) "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." C) "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." D) "You have no need to worry. Your pressure is probably elevated because you are being tested."

Ans: C Feedback: Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.

12. A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what? A) Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. B) Decrease the BP to a normal level based on the patient's age. C) Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. D) Reduce the BP to 120/75 mm Hg as quickly as possible.

Ans: C Feedback: Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a patient whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning.

34. A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student? A) "Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up." B) "Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly." C) "Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure." D) "The neurologic system of older adults is less efficient at monitoring and regulating blood pressure."

Ans: C Feedback: Structural and functional changes in the heart and blood vessels contribute to increases in BP that occur with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.

25. The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication? A) Warfarin (Coumadin) B) Furosemide (Lasix) C) Sodium nitroprusside (Nitropress) D) Ramipril (Altace)

Ans: C Feedback: The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside (Nitropress), nicardipine hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate (Corlopam), enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is administered orally and would not meet the patient's immediate need for BP management. Diuretics, such as Lasix, are not used as initial treatments and there is no indication for anticoagulants such as Coumadin.

37. A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient? A) "Eat a banana every day because Diuril causes moderate hyperkalemia." B) "Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium." C) "Diuril can cause low blood pressure and dizziness, especially when you get up suddenly." D) "Diuril increases sodium levels in your blood, so cut down on your salt."

Ans: C Feedback: Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Diuril does not cause either moderate hyperkalemia or severe hypokalemia and it does not result in hypernatremia.

3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? A) Hyperlipidemia B) Excessive alcohol intake C) A family history of hypertension D) Closer adherence to medical regimen

Ans: C Feedback: Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.

The triage nurse in the ED is assessing a patient with chronic HF who has presented with worsening symptoms. In reviewing the patient's medical history, what is a potential primary cause of the patient's heart failure? A) Endocarditis B) Pleural effusion C) Atherosclerosis D) Atrial-septal defect

Ans: C) Atherosclerosis Feedback: Atherosclerosis of the coronary arteries is the primary cause of HF. Pleural effusion, endocarditis, and an atrial-septal defect are not health problems that contribute to the etiology of HF.

The nurse is caring for an 84-year-old man who has just returned from the OR after inguinal hernia repair. The OR report indicates that the patient received large volumes of IV fluids during surgery and the nurse recognizes that the patient is at risk for left-sided heart failure. What signs and symptoms would indicate left-sided heart failure? A) Jugular vein distention B) Right upper quadrant pain C) Bibasilar fine crackles D) Dependent edema

Ans: C) Bibasilar fine crackles Feedback: Bibasilar fine crackles are a sign of alveolar fluid, a sequela of left ventricular fluid, or pressure overload. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.

The nurse is caring for a patient with systolic HF whose previous adverse reactions preclude the safe use of ACE inhibitors. The nurse should anticipate that the prescriber may choose what combination of drugs? A) Loop diuretic and antiplatelet aggregator B) Loop diuretic and calcium channel blocker C) Combination of hydralazine and isosorbide dinitrate D) Combination of digoxin and normal saline

Ans: C) Combination of hydralazine and isosorbide dinitrate Feedback: A combination of hydralazine and isosorbide dinitrate may be an alternative for patients who cannot take ACE inhibitors. Antiplatelet aggregators, calcium channel blockers, and normal saline are not typically prescribed.

The nurse is providing discharge education to a patient diagnosed with HF. What should the nurse teach this patient to do to assess her fluid balance in the home setting? A) Monitor her blood pressure daily B) Assess her radial pulses daily C) Monitor her weight daily D) Monitor her bowel movements

Ans: C) Monitor her weight daily Feedback: To assess fluid balance at home, the patient should monitor daily weights at the same time every day. Assessing radial pulses and monitoring the blood pressure may be done, but these measurements do not provide information about fluid balance. Bowel function is not indicative of fluid balance.

The nurse notes that a patient has developed a cough productive for mucoid sputum, is short of breath, has cyanotic hands, and has noisy, moist-sounding, rapid breathing. These symptoms and signs are suggestive of what health problem? A) Pericarditis B) Cardiomyopathy C) Pulmonary edema D) Right ventricular hypertrophy

Ans: C) Pulmonary edema Feedback: As a result of decreased cerebral oxygenation, the patient with pulmonary edema becomes increasingly restless and anxious. Along with a sudden onset of breathlessness and a sense of suffocation, the patient's hands become cold and moist, the nail beds become cyanotic (bluish), and the skin turns ashen (gray). The pulse is weak and rapid, and the neck veins are distended. Incessant coughing may occur, producing increasing quantities of foamy sputum. Pericarditis, ventricular hypertrophy, and cardiomyopathy do not involve wet breath sounds or mucus production.

31. A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? A) Heart rate B) Sodium levels C) Potassium levels D) Blood lipid levels

Ans: D Feedback: Hypertension often accompanies other risk factors for atherosclerotic heart disease, such as dyslipidemia (abnormal blood fat levels), obesity, diabetes, metabolic syndrome, and a sedentary lifestyle. Individuals with hypertension need to monitor their sodium intake, but hypernatremia is not a risk factor for hypertension. In many patients, heart rate does not correlate closely with BP. Potassium levels do not normally relate to BP.

35. A 55-year-old patient comes to the clinic for a routine check-up. The patient's BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurse's best response? A) "Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs." B) "Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group." C) "Hypertension is the leading cause of death in people your age." D) "Hypertension greatly increases your risk of stroke and heart disease."

Ans: D Feedback: Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.

4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? A) The BP is always higher in a hypertensive emergency. B) Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP. D) Hypertensive emergencies are associated with evidence of target organ damage.

Ans: D Feedback: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patient's BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.

26. A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action? A) Add sodium to the patient's IV fluid, as ordered. B) Administer a vasoconstrictor, as ordered. C) Promptly cease antihypertensive therapy. D) Administer normal saline IV, as ordered.

Ans: D Feedback: If there is volume depletion secondary to natriuresis caused by the elevated BP, then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are administered. Sodium administration, cessation of antihypertensive therapy, and administration of vasoconstrictors are not normally indicated.

38. A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency? A) Normalizing BP within 2 hours B) Obtaining a BP of less than 110/70 mm Hg within 36 hours C) Obtaining a BP of less than 120/80 mm Hg within 36 hours D) Normalizing BP within 24 to 48 hours

Ans: D Feedback: In cases of hypertensive urgency, oral agents can be administered with the goal of normalizing BP within 24 to 48 hours. For patients with this health problem, a BP of 120/80 mm Hg may be unrealistic.

28. A patient comes to the walk-in clinic complaining of frequent headaches. While assessing the patient's vital signs, the nurse notes the BP is 161/101 mm Hg. According to JNC 7, how would this patient's BP be defined if a similar reading were obtained at a subsequent office visit? A) High normal B) Normal C) Stage 1 hypertensive D) Stage 2 hypertensive

Ans: D Feedback: JNC 7 defines stage 2 hypertension as a reading 160/100 mm Hg.

40. A patient's recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following? A) The client's oxygen saturation level B) The patient's red blood cells, hematocrit, and hemoglobin C) The patient's level of consciousness D) The patient's potassium level

Ans: D Feedback: Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.

33. The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? A) "Are you eating less salt in your diet?" B) "How is your energy level these days?" C) "Do you ever get chest pain when you exercise?" D) "Do you ever see spots in front of your eyes?"

Ans: D Feedback: To identify complications or worsening hypertension, the patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed, but angina pain and decreased energy are not normally suggestive of worsening hypertension. Sodium limitation is a beneficial lifestyle modification, but nonadherence to this is not necessarily a sign of worsening symptoms.

21. A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurse's best response? A) "We do this so you don't suffer a stroke." B) "We do this to determine how your blood pressure changes throughout the day." C) "We do this to see how often you should change your medication dose." D) "We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

Ans: D Feedback: When hypertension is initially detected, nursing assessment involves carefully monitoring the BP at frequent intervals and then at routinely scheduled intervals. The reference to stroke is frightening and does not capture the overall rationale for the monitoring regimen. Changes throughout the day are not a clinical priority for most patients. The patient must not change his or her medication doses unilaterally.

When assessing the patient with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by what assessment finding? A) A diastolic blood pressure that is lower during exhalation B) A diastolic blood pressure that is higher during inhalation C) A systolic blood pressure that is higher during exhalation D) A systolic blood pressure that is lower during inhalation

Ans: D) A systolic blood pressure that is lower during inhalation Feedback: Systolic blood pressure that is markedly lower during inhalation is called pulsus paradoxus. The difference in systolic pressure between the point that is heard during exhalation and the point that is heard during inhalation is measured. Pulsus paradoxus exceeding 10 mm Hg is abnormal.

The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. The nurse's rapid assessment suggests cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm? A) Pulseless electrical activity (PEA) B) Ventricular fibrillation C) Ventricular tachycardia D) Asystole

Ans: D) Asystole Feedback: Cardiac arrest occurs when the heart ceases to produce an effective pulse and circulate blood. It may be caused by a cardiac electrical event such as ventricular fibrillation, ventricular tachycardia, profound bradycardia, or when there is no heart rhythm at all (asystole). Cardiac arrest may also occur when electrical activity is present, but there is ineffective cardiac contraction or circulating volume, which is PEA. Asystole is the only condition that involves the absolute absence of a heart rhythm.

The triage nurse in the ED is performing a rapid assessment of a man with complaints of severe chest pain and shortness of breath. The patient is diaphoretic, pale, and weak. When the patient collapses, what should the nurse do first? A) Check for a carotid pulse. B) Apply supplemental oxygen. C) Give two full breaths. D) Gently shake and shout, "Are you OK?"

Ans: D) Gently shake and shout, "Are you OK?" Feedback: Assessing responsiveness is the first step in basic life support. Opening the airway and checking for respirations should occur next. If breathing is absent, two breaths should be given, usually accompanied by supplementary oxygen. Circulation is checked by palpating the carotid artery.

8. A client has just returned from cardiac catheterization. Which nursing intervention would be most appropriate? 1. Help the client ambulate to the bathroom. 2. Restrict fluids. 3. Monitor peripheral pulses. 4. Insert an indwelling urinary catheter.

Answer. 3. Monitor peripheral pulses. Rationale: After cardiac catheterization, monitor peripheral pulses to assess peripheral perfusion. Helping the client ambulate to the bathroom is incorrect because the client should be on bed rest for 4 to 8 hours after the procedure to reduce the risk of bleeding at the insertion site. Restricting fluids is incorrect because the client should be encouraged to drink fluids after the procedure, unless contraindicated. Adequate hydration reduces the risk of nephrotoxicity that can occur with the use of contrast dye. Although urine output is monitored following cardiac catheterization, the insertion of a urinary catherter isn't necessary.

15. A cardiologist prescribes digoxin (Lanoxin)125 mcg by mouth every morning for a client diagnosed with heart failure. The pharmacy dispenses tablets that contain 0.25 mg each. How many tablets should the nurse administer in each dose? Record your answer using one decimal place.

Answer: 0.5 tablet(s) Rationale: 0.5 tablets. The nurse should begin by converting 125 mcg to milligrams. 125 mcg / 1,000 = 0.125 mg. The following formula is used to calculate drug dosages: dose on hand / quality on hand = dose desired./ X. The nurse should use the following equations: 0.25 mg / 1 tablet = 0.125 mg / X. The equation then becomes 0.25(x) = 0.125. Which is 0.125 / 0.25 = X = 0.5 tablet

83. If a hypertensive client with asthma takes the maximal dose of his diuretic and his blood pressure still isn't controlled, the nurse understands the next step in controlling his hypertension would be to: 1. Add enalapril, an ACE inhibitor 2. Change him to Metoprolol, a beta blocker 3. Add another diuretic 4. Increase the drug dosage above recommended dosing levels

Answer: 1 Rational: if the maximal dosage of an antihypertensive fails to control a client's hypertension, the client should be switched to a new drug in the same class or a new drug from a different class should be added to his regimen. Metoprolol is contraindicated in asthma secondary to bronchoconstriction. Another diuretic shouldn't be added because any drug added should be from a different class than the drug the client already takes. Never increase a drug dosage able the established guidelines.

60. The nurse would assess for which of the following manifestations in a client with suspected arterial embolism to the left hand? Select all that apply. 1. Pain 2. Pale skin 3. Bounding radial pulse 4. Parasthesias 5. Pitting edema

Answer: 1, 2,4 Rationale: The client would exhibit pain, pallor of the affected skin, diminished or absent radial pulse, parasthesias (altered local sensation), paralysis (weakness or inability to move extremity), and poikilothermia (cooler temperature). The client would not have a bounding radial pulse(opposite finding is true) or pitting edema, indicating a fluid volume excess or heart failure. Strategy: The core issue of the question is knowledge of assessment findings in arterial embolism. Visualize a clot in the local circulation and use that image to determine the effect of the blockage on circulation to the affected area.

82. Right-sided heart failure may develop as a result of pulmonary embolus. What is a hallmark sign of right-sided heart failure? 1. P pulmonale 2. A physiologic second heart sound (S2) split 3. Pericardial friction rub 4. Expiratory wheezing

Answer: 1. Rationale: The elevated pulmonary pressures present with pulmonary embolus can lead to right-sided heart failure, leading to an increase in right atrial volume. The increase atrial volume will appear as an altered P wave (known as P pulmonale) on the electrocardiogram. The P wave will be taller and morepeaked than a normal P wave. A physiologic S2 split is normal. When pulmonary pressures become severly elevated, the split becomes pathologic. Lung sounds are generally clear in a client with pulmonary emboli. In extreme cases, there may be crackles in the bases. A pleural friction rub may be heard in clients with pulmonary emboli and must be differentiated from pericardial friction rub.

43. The nurse is caring for a client with a dignosis of aortic stenosis. The client reports episodes of angina and passing out recently at home. The client has surgery scheduled in 2 weeks. Which of the following would be the nurse's best explanation about activity at this time? 1. "It is best to avoid strenuous exercise, stairs, and lifting before your surgery." 2. "Take short walks three times daily to prepare for postoperative rehabilitation." 3. "There are no activity restrictions unless the angina reoccurs; then please call the office." 4. "Gradually increase activity before surgery to build stamina for the postoperative period."

Answer: 1. "It is best to avoid strenuous exercise, stairs, and lifting before your surgery." Rationale: Symptomatic aortic stenosis has a poor prognosis without surgery. Restricting activity limits myocardial oxygen consumption. Since the incidence of sudden death is high in this population, it is prudent to decrease the strain on the heart while awaiting surgery. Strategy: The core issue of the question is the level of activity that will minimize the client's risk of complications or sudden death until surgery. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

37. The registered nurse has finished reviewing the 7:00 a.m shift report on a telemetry unit. Which of the following clients would be the best for the RN to assign to the licensed practical nurse? 1. A 7-day postoperative CABG client with an infection in the sternal surgical incision, requiring dressings and irrigation. 2. A client who has just arrived on the unit from the emergency room for observation to rule out a myocardial infarction. 3. A client who has had successful valve replacement therapy and will be discharged this morning. 4. A client who is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) at 10:00 a.m.

Answer: 1. A 7-day postoperative CABG client with an infection in the sternal surgical incision, requiring dressings and irrigation. Rationale: A stable client with complex dressing is an appropriate assignment for a LPN because the task is appropriate for an LPN. Initial assessment (new admission from the Ed), the assessment of a client before and after a complex procedure (PTCA), and discharge teaching are all responsibilities of the professional registered nurse and may not be delegated to the LPN. Strategy: Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

51. Which of the following suggestions should the nurse include when conducting health teaching for clients with arterial insufficiency? 1. Avoid long periods of sitting and standing. 2. Keep the legs and feet in a raised position. 3. Decrease ambulation to decrease pain. 4. Apply moist heat twice a day.

Answer: 1. Avoid long periods of sitting and standing. Rationale: The client should avoid long periods of standing or sitting to promote adequate blood flow. The legs and feet should be below heart level to increase peripheral circulation. Regular exercise enhances development of collateral circulation, increases vascular return, and is recommended for clients with either arterial or venous insufficiency. Moist heat is helpful for venous problems. Strategy: A critical word in the stem of the question is arterial, which tells you that the correct answer is an option that is beneficial to the client with impaired circulation toe the legs. Choose option 1 over the others because it is a generally helpful measure to increase circulation, while option 2 and 4 are helpful with venous problems. Option 3 does not help either arterial or venous circulatory problems.

45. A client undergoes ligation of varicose veins. The nurse includes in the plan of care which of the following important interventions for the nursing diagnosis of ineffective tissue perfusion? 1. Teach client to remove compression stockings for at least 1 hour per day. 2. Teach client to flex lower extremities four times a day. 3. Teach client that numbness is common after vein ligation. 4. Encourage client to briskly scrub lower extremities to improve circulation.

Answer: 1. Teach client to remove compression stockings for at least 1 hour per day. Rationale: Compression stockings exert pressure on the veins of the lower extremities, promoting venous return back to the heart. Stockings are removed for at least an hour per day to allow for inspection and ensure blood flow through small, superficial vessels. Flexing the extremities does not aid tissue perfusion, although it maintains joint range of motion. However, after this surgery clients are taught to either stand or lie down and avoid flexing at the hip and knee. Numbness is a temporary or rarely permanent complication of surgery. Briskly scrubbing the extremities will not aid tissue perfusion. Strategy: The core issue of the question is a measure that will improve tissue perfusion for a client following vein ligation. Using principles of blood flow, choose the option that will aid circulation. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

46. A client's angiogram demonstrates the final stage of atherosclerosis. The nurse concludes that this client's pathophysiology includes which of the following elements? 1. The presence of atheromas. 2. Fatty deposits in the intima 3. Lipoprotein accumulation in the intima 4. Inflammation of the arterial wall

Answer: 1. The presence of atheromas. Rationale: The final stage of the atherosclerotic process is the development of atheromas, which are complex lesions consisting of lipids, fibrous tissue, collagen, calcium, cellular waste, and capillaries. The calcified lesions may rupture or ulcerate, stimulating thrombosis. The other options are not consistent with the ultimate or final changes in the atherosclerotic process. Strategy: Note the critical words final stage. Evaluate each option carefully, and use knowledge of pathophysiology and the process of elimination to make a selection.

33. An infant age 2 months has a tentative diagnosis of congenital heart defect. During physical assessment, the nurse notes that the infant has a pulse rate of 168 beats/minute and a respiratory rate of 72 breaths/minute. In which position should the nurse place the infant? 1. Upright in an infant seat 2. Lying on the back 3. Lying on the abdomen 4. Sitting in high Fowler's position

Answer: 1. Upright in an infant seat Rationale: Because these signs suggest development of respiratory distress, the nurse should position the infant with the head elevated at a 45-degree angle to promote maximum chest expansion. This can be accomplished by placing the infant in an infant seat. Placing an infant flat on the back or abdomen or in high Fowler's position could increase respiratory distress by preventing maximum chest expansion.

57. A 6-year-old child has been diagnosed with coarctation of the aorta. Lately, he has been complaining when he comes in from recess. The health nurse should question the child about which of the following? 1. Weakness and pain in legs. 2. Blurred vision. 3. Increased respiratory rate. 4. Bruises on shins.

Answer: 1. Weakness and pain in legs. Rationale: Decreased circulation to lower extremities would contribute to muscle fatigue and pain in the legs. Many of the children returning from recess will have increased respiratory rate secondary to play activities. Blurred vision and bruises are not related to coarctation. Strategy: The core issue of the question is knowledge of signs of exercise intolerance in a 6-year-old client with a cyanotic heart defect. Use principles of gas exchange and knowledge of normal and abnormal findings after exercise to make a selection.

28. A nurse checks an infant's apical pulse before digoxin (Lanoxin) administration and finds that the pulse rate is 90 beats/minute. Which action is most appropriate for the nurse? 1. Withhold the digoxin and notify the physician. 2. Administer the digoxin and notify the physician. 3. Administer the digoxin and document the infant's pulse rate. 4. Withhold the digoxin and document the infant's pulse rate.

Answer: 1. Withhold the digoxin and notify the physician. Rationale: The nurse should withhold the digoxin and notify the physician because an apical pulse below 100 beats/minute in an infant is considered bradycardic. The nurse should also document her findings and interventions in the medical record. Administering the drug to a bradycardic infant could further decrease his heart rate and compromise his status. Withholding the drug and not notifying the physician could compromise the existing treatment plan.

68. A patient is admitted with and ST segment myocardial infarction. The patient's wife overhears the physician talking about this and asks you, the nurse, what the physician means by this type of heart attack. The nurse's BEST response would include 1. "Your husband has permanent changes that will stay on his ECG and the practitioner will always be able to tell that he has an MI." 2. "Your husband has had a smaller MI that goes through only part of the wall of the heart and therefore causes small areas to stay elevated." 3. "Your husband has had a rather large heart attack that has caused the death of the heart muscle through all of its three layers." 4. "Your husband is lucky; his cardiac markers are not elevated but he has had a severe heart attack that we can take care of with medication."

Answer: 2 Rationale: An ST segment MI is one that is usually referred to as a smaller, less severe type where the enzymes are elevated but the depth of tissue death has not penetrated all three muscular coats. The ECG changes are not permanent; therefore, a trained practitioner would not see a "Q" wave that is permanent on the ECG.

65. A patient is admitted in acute distress with unrelieved back pain that radiates to his groin. This patient has a history of abdominal aortic aneurysm (AAA). What additional signs and symptoms might the patient state? 1. Midsternal chest pressure relieved with nitroglycerin paste 2. Bruit to left of the midline in the abdominal area 3. Extreme headache 4. Numbness and tingling in the hands and arms

Answer: 2 Rationale: Bruits are associated with turbulence of blood flow and are ausculated in 50% of patients with an AAA. Otherwise the patient is asymptomatic. A is more associated with angina, and C is associated with stroke. Numbness and tingling in the lower extremities is usually due to a decreased blood supply to the lower extremities from hemorrhage into the peritoneal cavity.

29. A child has been diagnosed with rheumatic fever. Which statement by the mother indicates an understanding of rheumatic fever? 1. "I should avoid giving my child aspirin for the arthritic pain." 2. "It's very upsetting that my child must take penicillin until he's 20 years old." 3. "I need to wear a gown, gloves, and mask to stay in my child's room." 4. "I don't know how I'll be able to keep my child away from his sister when he gets home."

Answer: 2. "It's very upsetting that my child must take penicillin until he's 20 years old." Rationale: Rheumatic fever is an acquired autoimmune-complex disorder that occurs 1 to 3 weeks after an infection of group A beta-hemolytic streptococci, in many cases as a result of strep throat that hasn't been treated with antibiotics. To prevent additional heart damage from future attacks, the child must take penicillin or another antibiotic until the age of 20 or for 5 years after the attack, whichever is longer. Children shouldn't be given aspirin because it may result in Reye's syndrome. Rheumatic fever isn't contagious, so isolation precautions aren't necessary.

38. The nurse is caring for a client with a history of hypertension. The client is being treated with metoprolol (Lopressor), hydrochlorothiazide (Hydrodiuril), and captopril (Capoten). The client has a blood pressure of 120/80 mmHg and a pulse rate of 48. Which of the following is the best action by the nurse? 1. Administer the metoprolol (Lopressor) and the hydrochlorothiazide (HydroDiuril), hold the captopril (Copoten), and notify the physician. 2. Administer the captopril (Capoten) and the hydrochlorothiazide (HydroDiuril), hold the metoprolol (Lepressor), and notify the physican. 3. Administer all the medications and notify the physician. 4. Withhold all the medications and notify the physician.

Answer: 2. Administer the captopril (Capoten) and the hydrochlorothiazide (HydroDiuril), hold the metoprolol (Lepressor), and notify the physican. Rationale: The client's heart rate is bradycardic, and metoprolol, a beta-blocker, decreases the heart rate. Neither the captopril nor the hydrochlorothiazide lower the heart rate, and either may be safely administered to maintain control of he hypertension. When a dose of medication is withheld, it is the responsibility of the nurse to notify the physician of the action and rational. Strategy: The core issue of the question is determining which medication is responsible for the adverse effects on client status and acting accordingly. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

56. During the acute phase of rheumatic fever, which of the following is a priority action of the nurse? 1. Encourage ambulation at least four times per day. 2. Assess for early signs of endocarditis. 3. Maintain hydration by encouraging sips of water. 4. Manage pain with strong narcotic analgesics.

Answer: 2. Assess for early signs of endocarditis. Rationale: The main complication of rheumatic fever is carditis. The nurse must assess for early signs of bacterial endocarditis. The client should be encouraged to rest during the acute phase, and hydration needs may not be sufficiently met with sips of water. Narcotic analgesics may not be necessary, although NSAIDs are likely to be ordered. Strategy: The core issue of the question is the ability to set priorities for a client with rheumatic fever. Omit option 1 because of the words at least, knowing that rest is encouraged. Likewise, eliminate option 3 because of the word sips. Choose option 2 over 4 knowing that NSAIDs are likely to be effective in managing pain and inflammation from rheumatic fever.

50. An important outcome of care for a female client with hypertension has been met when the client is able to do which of the following? 1. Return to her usual activities of daily living 2. Identify actions to counteract two of her modifiable risk factors 3. Lower her blood pressure by 10% 4. Discontinue lifestyle modifications

Answer: 2. Identify actions to counteract two of her modifiable risk factors Rationale: An important outcome in care of the hypertensive client is the ability to identify and counteract personal risk factors that the client has the ability to change. Modifiable risk factors for hypertension include smoking, hypercholesterolemia, diabetes mellitus, sedentary lifestyle, obesity, stress, and alcohol use. Option 1 is not likely to be an issue. Option 3 may or may not be sufficient. Option 4 is contraindicated. Strategy: The core issue of the question is the ability to identify an indicator that is a positive effect of care for the hypertensive client. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

23. A nurse administers warfarin (Coumadin) to a client with deep vein thrombophlebitis. Which laboratory valve indicates that the client has a therapeutic level of warfarin? 1. Partial thromboplastin time (PTT) 1 ½ to 2 times the control 2. Prothrombin time (PT) 1 ½ to 2 times the control 3. International Normalized Ratio (INR) of 3 to 4 4. Hematocrit (HCT) of 32%

Answer: 2. Prothrombin time (PT) 1 ½ to 2 times the control Rationale: Warfarin is at a therapeutic level when the PT is 1 ½ to 2 times the control. Values greater than this increase the risk of bleeding and hemorrhage; lower values increase the risk of blood clot formation. Heparin, not warfarin, prolongs PTT. The INR may also be used to determine whether warfarin is at a therapeutic level; however, an INR of 2 to 3, not 3 to 4, is considered therapeutic. HCT doesn't provide information on the effectiveness of warfarin. However, a falling HCT in a client taking warfarin may be a sign of hemmorrhage.

6. While auscultating the heart sounds of a client with mitral insufficiency, the nurse hears an extra heart sound immediately after the S2. The nurse should document this extra heart sound as a: 1. S1. 2. S3. 3. S4. 4. mitral murmur.

Answer: 2. S3. Rationale: An S3, is heard following an S2. This indicates that the client is experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before S1 and is caused by resistance to ventricular filling. A murmur of mitral insufficiency occurs during systole and is heard when there's turbulent blood flow across the valve.

52. A client with endocarditis develops sudden leg pain with pallor, tingling, and loss of peripheral pulses. The nurse's initial action should be to: 1. Elevate the leg above the level of the heart. 2. Wrap the leg in a loose blanket. 3. Notify the physician about the findings. 4. Perform passive ROM exercises to stimulate circulation.

Answer: 2. Wrap the leg in a loose blanket. Rationale: The client is exhibiting symptoms of acute arterial occlusion. Without immediate intervention, ischemia and necrosis will result within hours. The nurse should first wrap the leg to maintain warmth and protect it from further injury, and should then quickly notify the physician. The leg should not be elevated above heart level because doing so would worsen the tissue ischemia, and passive range of motion will also increase ischemia by increasing tissue demand for oxygen. Strategy: The core issue of the question is recognizing the complication of acute arterial occlusion and then determining which action should be taken first. Choose an option that is client-focused rather than physician-notification focused, if one is available. In this case, the nurse can protect the client from further injury with option 2.

70. A patient is admitted to your acute coronary care unit with the diagnosis of ACS. The nurse has seen ECG changes that are indicative of an anterior wall infarction and is observing the patient for signs/symptoms of complications. The nurse has noted the following vital sign trends: 1100-HR 92, RR 24, BP 140/88, Cardiac rhythm NSR 1115-HR 96, RR 26, BP 128/82, Cardiac rhythm NSR 1130-HR 104, RR 28, BP 102/68, Cardiac rhythm ST 1145-HR 120, RR 32, BP 80/52, Cardiac rhythm ST with frequent PVC's The nurse should be alert for which of the following complications? Choose all that apply. 1. Syncope 2. Pericarditis 3. Cardiogenic shock 4. Cardiac tamponade 5. Ventricular aneurysm 6. Acute respiratory failure

Answer: 3, 4and 5 Rationale: Because there is a progressive downward spiral in the BP and a dramatic increase in the HR and RR with rhythm disturbances, this patient could be experiencing cardiogenic shock and tamponade. In shock, the hear fails to keep the BP elevated to nourish the tissues, so the HR elevates causing tacycardias and tachydysrhythmias. The same sequela can occur when the heart is compressed and no blood can enter or exit as in a cardiac tamponade as well as an aneurysem, where the hear pumping can be compromised by lack of pumping in the ballooned out or weakened areas. Pericarditis is noted by a friction rub and elevated temperature with constant, dull chest pain. Syncope could look like the above but it is associated with activity, which this patient is not doing in an acute situation. Acute respiratory failure would look like the above if the BP were elevated.

26. A child is scheduled for echocardiography. The nurse is providing teaching to the child's mother. Which statement by the mother about echocardiography indicates the need for further teaching? 1. "I'm glad my child won't have an I.V catheter inserted for this procedure." 2. "I'm glad my child won't need to have dye injected into him before the procedure." 3. "How am I going to explain to my son that he can't have anything to eat before the test?" 4. "I know my child may need to lie on his left side and breathe in and out slowly during the procedure."

Answer: 3. "How am I going to explain to my son that he can't have anything to eat before the test?" Rationale: Echocardiography is a noninvasive procedure used to evaluate the size, shape, and motion of various cardiac structures. Therefore, it isn't necessary for the client to have an I.V catheter inserted, dye injected, or nothing by mouth, as would be the case with a cardiac catheterization. The child may need to lie on his left side and inhale and exhale slowly during the procedure.

44. The nurse is caring for a client who has just undergone cardiac angiography. The catheter insertion site is free from bleeding or signs of hematoma. The vital signs and distal pulses remain in the client's normal range. The intravenous fluids were discontinued. The client is not hungry or thirsty and refuses any food or fluids, asking to be left alone to rest. Which of the following is the nurse's best response? 1. "You are recovering well from the procedure and resting is a good idea." 2. "It is important for you to walk, so I will be back in 1 hour to walk with you." 3. "It is important to drink fluids after this procedure, to protect your kidney function. I will bring you a pitcher of water, and I encourage you to drink." 4. "You will need to do the leg exercises that you practiced before the procedure to keep good circulation to your legs. After your exercises, you can rest."

Answer: 3. "It is important to drink fluids after this procedure, to protect your kidney function. I will bring you a pitcher of water, and I encourage you to drink." Rationale: The dye used in angiography is nephrotoxic, and a client should have adequate fluids after the procedure to eliminate the dye. The client should lie with the affected leg extended for 6 to 8 hours. Leg exercises are not recommended because exercise could disrupt the clot that formed at the insertion site. Option 1 is incorrect because it gives false reassurance to a client who could be at risk if fluids are not taken in. Strategy: The core issue of the question is knowledge of the correlation between lack of fluid intake and risk of kidney complications following angiography. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

54. Which of the following clients is most at risk for developing a deep-vein thrombosis? 1. A 30-year-old client who is 1 week postpartum. 2. A 63-year-old client post-CVA on anticoagulant therapy. 3. A 40-year-old woman who smokes and uses oral contraceptives. 4. A 41-year-old female who underwent laparoscopic cholecystectomy.

Answer: 3. A 40-year-old woman who smokes and uses oral contraceptives. Rationale: A major risk factor for formation of thrombophlebitis is oral contraceptive use in woman who smoke. Being 1-week postpartum does not place a client at risk since mobility is usually restored. Anticoagulant therapy is used to prevent development of thrombi. Laparoscopic surgical procedures are associated with more rapid recovery times with reduced immobility, keeping this client at lower risk than the client in option 3. Strategy: The critical words in the stem of the question are most at risk, telling you that the correct option is the one that contains the most severe or greatest number of risk factors for thrombophlebitis. With this in mind, evaluate each option and use the process of elimination to make a selection.

39. The nurse has finished reviewing the shift report on a cardiac unit. The nurse should plan to see which of the following assigned clients first? 1. A client with hypertrophic cardiomyopathy who is reporting dyspnea. 2. A client who had a cardiac caterterization and will be ambulating for the first time. 3. A client receiving antibiotics for bacterial endocarditis who is reporting anxiety and chest pain. 4. A client who is recovering from coronary artery bypass grafting (CABG) surgery with a temperature of 101 F.

Answer: 3. A client receiving antibiotics for bacterial endocarditis who is reporting anxiety and chest pain. Rationale: A client with endocarditis is at risk for thrombus formation, and chest pain and anxiety are signs of pulmonary embolism (PE), which is a life-threatening complication requiring immediate attention. Dyspnea is a chronic symptom with hypertrophic cardiomyopathy, which requires assessment; a temperature of 101 F requires additional assessment, and a client who is ambulating for the first time will be assessed by the nurse. However, the client who needs to be assessed for PE is the most emergent. Strategy: The key to determining the answer to priority-setting questions is to evaluate which client is the most unstable or has the greatest risk for developing a complication. Evaluate each option carefully using these methods, and use nursing knowledge and the process of elimination to make a selection.

14. A client comes to the clinic and states he has a history of hypertension. Which type of medication might the nurse expect the client to be taking to control his blood pressure? 1. Antilipemics 2. Antibiotics 3. ACE inhibitors 4. Antidiabetics

Answer: 3. ACE inhibitors Rationale: ACE inhibitors may be prescribed to help control high blood pressure. Other types of medications that may be prescribed include diuretics, calcium channel blockers, angiotensin II receptor blockers, and beta-adrenergic blockers. Antilipemics help lower serum cholesterol levels. Antibiotics are used to fight infection, and antidiabetics help control serum glucose levels.

41. The nurse is caring for a client with a history of renal failure and a new myocardial infarction. The nurse who is reviewing laboratory findings would call the doctor to report which of the following results? 1. Potassium level of 5.0 mEq/L 2. Sodium level of 145 mEq/L 3. Calcium level of 7.0 mg/dL 4. Digoxin/digitalis level of 0.8 ng/mL

Answer: 3. Calcium level of 7.0 mg/dL Rationale: Renal failure is a common cause of hypocalcemia, and a value of 7.0 mg/dL is below the normal range of serum calcium. Options 1 and 2 are within the upper limits for potassium and sodium, and option 4 is within the therapeutic range of digoxin. Strategy: The core issue of the question is knowledge of normal and abnormal values that are important to report in a client with an acute cardiac problem and a history of renal failure. The best strategy in question such as these is to pick the value with the most abnormal number and/or one that relates to the underlying disorder(s).

47. When assessing a client with peripheral arterial disease, the nurse assesses the client for which of the following signs and symptoms that would be consistent with tissue ischemia? 1. Peripheral edema 2. Widened pulse pressure 3. Leg pain while walking 4. Brownish discoloration to the skin on the leg

Answer: 3. Leg pain while walking Rationale: Leg pain (also called intermittent claudication) is a primary manifestation of peripheral arterial disease. Intermittent claudication is muscle pain caused by interruption in arterial flow, resulting in tissue hypoxia. Peripheral edema and brownish discoloration to the skin on the leg would be consistent with venous disease, not arterial disease. Widened pulse pressure would be an unrelated finding. Strategy: The critical words in the question are peripheral arterial disease, which direct you to look for manifestations that are abnormal and that are consistent with arterial but not venous disease. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

9. A client is in the first postoperative day after left femoropopliteal revascularization. Which position would be most appropriate for this client? 1. On his left-sided 2. In high Fowler's position 3. On his right side 4. In a left lateral decubitus position

Answer: 3. On his right side Rationale: Following revascularization, avoid positioning the client on the surgical side. Because this client had left femoropoliteal revascularization, he may be positioned on the right side. Placing the client on the left side is incorrect because this would position the client on the operative side. Positioning the client in high Fowler's position is incorrect because the client should avoid flexion at the surgical site. Placing the client in a left lateral decubitus position is incorrect because this would place the client on the surgical side and cause flexion at the site.

74. A nurse is describing one of the waveforms to a novice critical care nurse. S/he describes this wave as being upright rounded and symmetrical and occurring after the QRS. The nurse is describing the 1. P wave 2. QRS 3. ST segment 4. T wave

Answer: 4 Rationale: the T wave is after the ST segment and is upright, rounded, and symmetrical. The P wave is upright, rounded, and symmetrical but it is after the T wave and is smaller. The QRS is after the P wave and can have three phases. The St segment is after the QRS and before the T wave

27. An infant with a ventricular septal defect is receiving digoxin (Lanoxin). Which intervention by the nurse is most appropriate before digoxin administration? 1. Take the infant's blood pressure. 2. Check the infant's respiratory rate for 1 minute. 3. Check the infant's radial pulse for 1 minute. 4. Check the infant's apical pulse for 1 minute.

Answer: 4. Check the infant's apical pulse for 1 minute. Rationale: Before administering digoxin, the nurse should check the infant's apical pulse for 1 minute. Checking the radial pulse may be inaccurate. Checking the blood pressure and respiratory rate isn't necessary before digoxin administration because the medication doesn't affect these parameters.

48. In providing community education on prevention of peripheral arterial disease, the nurse is careful to include which of the following as a major risk factor? 1. Dysrhythmias 2. Low-protein intake 3. Exposure to cool weather 4. Cigarette smoking

Answer: 4. Cigarette smoking Rationale: Nicotine in cigarettes promotes vasoconstriction. The three most significant risk factors for development of peripheral arterial disease are smoking, hyperlipidemia, and hypertension. The presence of dysrhythmias, low-protein intake, and exposure to cool weather are not risk factors for the disease, although cool weather could worsen the symptoms when disease is already present. Strategy: Note the critical word prevention to focus on the option that contains information that will affect the likelihood of whether the client will develop peripheral arterial disease. Evaluate each option carefully, using nursing knowledge and the process of elimination to make a selection.

42. The nurse is caring for a client who had a permanent pacemaker inserted because of a complete heart block. The nurse determines that which of the following client outcomes indicates a successful procedure? 1. Client ambulating in the hall within 4 hours of the procedure without dyspnea or chest pain. 2. Client's ECG monitor demonstrates normal sinus rhythm. 3. Heart rate of 80 beats per minute, blood pressure 120 systolic, and 80 diastolic. 4. Client's ECG monitor shows paced beats at the rate of 68 per minute.

Answer: 4. Client's ECG monitor shows paced beats at the rate of 68 per minute. Rationale: The client is not allowed to ambulate for 24 hours to prevent dislodging of the electrodes. Normal sinus rhythm, heart rate of 80, and a BP of 120 over 80 do not reflect pacemaker function. Paced beats indicate that the pacemaker is functioning. Strategy: Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

36. The nurse is preparing to discharge a client after CABG surgery. The client is taking several new medications, including digoxin (Lanoxin), metoprolol (Lopressor), and furosemide (Lasix). The client complains of nausea and anorexia. The nurse is preparing to report this finding to the physician before discharging the client. Which laboratory result will the nurse check before calling the physician? 1. Potassium level 2. Sodium level 3. PT / INR 4. Digoxin level

Answer: 4. Digoxin level Rationale: Nausea and anorexia are signs of digitalis toxicity. The other laboratory values would not explain the client's symptoms and therefore are not priorities to assess before telephoning the physician. Strategy: The core issue of the question is the ability to correlate early signs of digoxin toxicity with a need to check digoxin level in a client with cardiac disease. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

49. When teaching a client with an aneurysm what signs and symptoms may indicate impending rupture, the nurse considers which of the following? 1. Medication therapy the client is receiving 2. Client's usual blood pressure 3. Age and gender of the client 4. Size and location of the aneurysm

Answer: 4. Size and location of the aneurysm Rationale: Aneurysms vary by size and location. Signs of rupture depend on the location of the aneurysm. Dissection can occur anywhere but most often occurs in the ascending aorta where pressure is the highest. The medication the client is receiving is vague and is not directly related. The blood pressure relates to whether the aneurysm may rupture, not to the associated signs and symptoms. The age and gender of the client are unrelated to the size and symptoms of aneurysm rupture. Strategy: With the critical words signs and symptoms in mind, choose the option that most directly relates to the core issue of the question. Evaluate each option carefully, and choose option 4 as the only one that could affect the specific list of signs and symptoms that the nurse would teach related to aneurysm rupture.

17. The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what? A) Cardiac tamponade B) Left ventricular hypertrophy C) Right-sided heart failure D) Ventricular insufficiency

B Feedback: Aortic regurgitation eventually causes left ventricular hypertrophy. In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood. Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.

6. A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient? A) Chest pain B) Bleeding at the implantation site C) Malignant hyperthermia D) Bradycardia

B Feedback: Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.

9. The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM? A) Dilated ventricles with atrophy of the ventricles B) Dilated ventricles without hypertrophy of the ventricles C) Dilation and hypertrophy of all four heart chambers D) Dilation of the atria and hypertrophy of the ventricles

B Feedback: DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.

30. The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient? A) Implanted pacemaker B) Trancutaneous pacemaker C) ICD D) Asynchronous defibrillator

B Feedback: If a patient suddenly develops a bradycardia, is symptomatic but has a pulse, and is unresponsive to atropine, emergency pacing may be started with transcutaneous pacing, which most defibrillators are now equipped to perform. An implanted pacemaker is not a time-appropriate option. An asynchronous defibrillator or ICD would not provide relief.

33. A patient has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus. In light of this patient's medication regimen, what nursing diagnosis should be prioritized? A) Risk for injury B) Risk for infection C) Risk for peripheral neurovascular dysfunction D) Risk for unstable blood glucose

B Feedback: Immunosuppressants decrease the body's ability to resist infections, and a satisfactory balance must be achieved between suppressing rejection and avoiding infection. These drugs do not create a heightened risk of injury, neurovascular dysfunction, or unstable blood glucose levels.

8. The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite? A) The procedure can be performed on an outpatient basis in a physician's office. B) Repaired valves tend to function longer than replaced valves. C) The procedure is not associated with a risk for infection. D) Lower doses of antirejection drugs are required than with valve replacement.

B Feedback: In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation. Valvuloplasty carries a risk of infection, like all surgical procedures, and it is not performed in a physician's office. Antirejection drugs are unnecessary because foreign tissue is not introduced.

38. During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response? A) "Cardioversion is done on a beating heart; defibrillation is not." B) "The difference is the timing of the delivery of the electric current." C) "Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not." D) "Cardioversion is always attempted before defibrillation because it has fewer risks."

B Feedback: One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the patient's electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized. Both can be done on beating heart (i.e., in a dysrhythmia). Cardioversion is not necessarily attempted first.

22. A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patient's symptoms, the nurse should teach the patient to do which of the following? A) Eat a high-protein, low-carbohydrate diet. B) Avoid activities that cause an increased heart rate. C) Avoid large crowds and public events. D) Perform deep breathing and coughing exercises.

B Feedback: Patients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.

23. New nurses on the telemetry unit have been paired with preceptors. One new nurse asks her preceptor to explain depolarization. What would be the best answer by the preceptor? A) "Depolarization is the mechanical contraction of the heart muscles." B) "Depolarization is the electrical stimulation of the heart muscles." C) "Depolarization is the electrical relaxation of the heart muscles." D) "Depolarization is the mechanical relaxation of the heart muscles."

B Feedback: The electrical stimulation of the heart is called depolarization, and the mechanical contraction is called systole. Electrical relaxation is called repolarization, and mechanical relaxation is called diastole.

7. A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient? A) Aortic regurgitation B) Mitral stenosis C) Mitral valve prolapse D) Aortic stenosis

B Feedback: The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.

25. The nurse is caring for a patient with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the patient's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best respond to this finding? A) Recognize that the procedure was unsuccessful. B) Recognize this as a therapeutic goal of the procedure. C) Liaise with the care team in preparation for repeating the maze procedure. D) Prepare the patient for pacemaker implantation.

B Feedback: The maze procedure is an open heart surgical procedure for refractory atrial fibrillation. Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the electrical impulse. Consequently, scar formation would constitute a successful procedure. There is no indication for repeating the procedure or implanting a pacemaker.

6. A patient with pericarditis has just been admitted to the CCU. The nurse planning the patient's care should prioritize what nursing diagnosis? A) Anxiety related to pericarditis B) Acute pain related to pericarditis C) Ineffective tissue perfusion related to pericarditis D) Ineffective breathing pattern related to pericarditis

B Feedback: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Anxiety is highly plausible and should be addressed, but chest pain is a nearly certain accompaniment to the disease. Breathing and tissue perfusion are likely to be at risk, but pain is certain, especially in the early stages of treatment.

10. A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physician's choice of antibiotics would be primarily based on what diagnostic test? A) Echocardiography B) Blood cultures C) Cardiac aspiration D) Complete blood count

B Feedback: To help determine the causative organisms and the most effective antibiotic treatment for the patient, blood cultures are taken. A CBC can help establish the degree and stage of infection, but not the causative microorganism. Echocardiography cannot indicate the microorganisms causing the infection. Cardiac aspiration is not a diagnostic test.

14. A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what? A) Decrease SA node conduction B) Control ventricular heart rate C) Improve oxygenation D) Maintain anticoagulation

B Feedback: Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. This is a priority because it directly affects cardiac output. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice, followed by anticoagulation with heparin and then Coumadin.

11. ******************************************************** The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment? A) Assessing the patient's activity level B) Facilitating transthoracic echocardiography C) Vigilant monitoring of the patient's ECG D) Close monitoring of the patient's peripheral perfusion

C Feedback: After a permanent electronic device (pacemaker or ICD) is inserted, the patient's heart rate and rhythm are monitored by ECG. This is a priority over peripheral circulation and activity. Echocardiography is not indicated.

2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following? A) Exposure to immunocompromised individuals B) Future hospital admissions C) Dental procedures D) Live vaccinations

C Feedback: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.

5. ******************************************************** The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient? A) Maintain a resting heart rate below 70 bpm. B) Maintain adequate control of chest pain. C) Maintain adequate cardiac output. D) Maintain normal cardiac structure.

C Feedback: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.

4. *****************************************************************An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? A) PP interval and RR interval are irregular. B) PP interval is equal to RR interval. C) Fewer QRS complexes than P waves D) PR interval is constant.

C Feedback: In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.

24. A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse? A) Arrange for an alternative bed. B) Measure the degree of the curvature. C) Notify the surgeon immediately. D) Note the scoliosis on the intake assessment.

C Feedback: Most often used for mitral and aortic valve stenosis, balloon valvuloplasty is contraindicated for patients with left atrial or ventricular thrombus, severe aortic root dilation, significant mitral valve regurgitation, thoracolumbar scoliosis, rotation of the great vessels, and other cardiac conditions that require open heart surgery. Therefore notifying the physician would be the priority over further physical assessment. An alternative bed would be unnecessary and documentation is not a sufficient response.

13. The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patient's ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy? A) Cardiac catheterization B) Arterial blood gases C) Echocardiogram D) Exercise stress test

C Feedback: The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. The ECG is also important, and can demonstrate dysrhythmias and changes consistent with left ventricular hypertrophy. Cardiac catheterization specifically addresses coronary artery function and arterial blood gases evaluate gas exchange and acid balance. Stress testing is not normally used to differentiate cardiomyopathy from other cardiac pathologies.

15. A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurse's interview is most suggestive of this valvular disorder? A) I get chest pain from time to time, but it usually resolves when I rest. B) Sometimes when I'm resting, I can feel my heart skip a beat. C) Whenever I do any form of exercise I get terribly short of breath. D) My feet and ankles have gotten terribly puffy the last few weeks.

C Feedback: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some patients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.

37. The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what? A) A decrease in gamma globulins B) An insect bite C) Rheumatic heart disease and its sequelae D) Sepsis and its sequelae

C Feedback: The most common cause of mitral valve regurgitation in developing countries is rheumatic heart disease and its sequelae.

18. The nurse is creating a plan of care for a patient with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this patient? A) Absence of complications B) Adherence to the self-care program C) Improved cardiac output D) Increased activity tolerance

C Feedback: The priority nursing diagnosis of a patient with cardiomyopathy would include improved or maintained cardiac output. Regardless of the category and cause, cardiomyopathy may lead to severe heart failure, lethal dysrhythmias, and death. The pathophysiology of all cardiomyopathies is a series of progressive events that culminate in impaired cardiac output. Absence of complications, adherence to the self-care program, and increased activity tolerance should be included in the care plan, but they do not have the priority of improved cardiac output.

Vasodilation or vasoconstriction produced by an external cause will interfere with a nurse's accurate assessment of a client with peripheral vascular disease (PVD). Therefore, the nurse should: a) match the room temperature to the client's body temperature. b) maintain room temperature at 78° F (25.6° C). c) keep the client warm. d) keep the client uncovered.

C) keep the client warm. Explanation: The nurse should keep the client covered and expose only the portion of the client's body that she's assessing. The nurse should also keep the client warm by maintaining his room temperature between 68° F and 74° F (20° and 23.3° C). Extreme temperatures aren't good for clients with PVD. The valves in their arteries and veins are already insufficient, and exposing them to vast changes in temperature could affect assessment findings. Keeping the client uncovered would cause him to become chilled. Matching the room temperature to the client's body temperature is inappropriate.

What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis? a) Teach the patient how to apply a graduated compression stocking. b) Avoid elevating the area. c) Offer cold applications to promote comfort and to enhance circulation. d) Inform the physician if the temperature remains low.

Teach the patient how to apply a graduated compression stocking. Explanation: In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the patient how to apply a graduated compression stocking. The nurse informs the physician if the temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

A patient with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which of the following is the most likely cause? a) The patient is experiencing inflammation of the aneurysm. b) The aneurysm has become obstructed. c) The aneurysm may be preparing to rupture. d) The patient is experiencing normal sensations associated with this condition.

The aneurysm may be preparing to rupture. Explanation: Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is rapidly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

Which of the following is the most common site for a dissecting aneurysm? a) Lumbar area b) Sacral area c) Cervical area d) Thoracic area

The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine if the students understand the pathophysiology of the disease, the instructor asks, "What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?" a) 30 b) 20 c) 50 d) 40

Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced

What are the symptoms a nurse should assess for in a patient with lymphedema as a result of impaired nutrition to the tissue? a) Evident scaring b) Ulcers and infection in the edematous area c) Loose and wrinkled skin d) Cyanosis

Ulcers and infection in the edematous area Explanation: In a patient with lymphedema, the tissue nutrition is impaired from the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored. Scaring does not occur in patients with lymphedema, and cyanosis is a bluish discoloration of the skin and mucous membranes.

A nurse is teaching a client who is having a valuloplasty tomorrow. The client asks what the advantage is for having a tissue valve replacement instead of a mechanical valve. The correct answer by the nurse is which of the following? a) "A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required." b) "A tissue valve does not become infected as easily as mechanical valves." c) "A tissue valve is thought to be more durable and so requires replacement less often." d) "A tissue valve does not deteriorate as easily as mechanical valves."

a) "A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required." Tissue valves are less likely to generate thromoemboli, so long-term anticoagulation is not required. Mechanical valves do not deteriorate or become infected as easily as tissue valves. They are thought to be more durable than tissue valves and so require replacement less often.

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a) "Client will verbalize the intention to stop smoking." b) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." c) "Client will verbalize the intention to avoid exercise." d) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."

a) "Client will verbalize the intention to stop smoking." A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).

Your client is being prepared for echocardiography when he asks you why he needs to have this test. What would be your best response? a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." b) "This test can tell us a lot about your heart." c) "This test will find any congenital heart defects." d) "Echocardiography will tell your doctor if you have cancer of the heart."

a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." Echocardiography uses ultrasound waves to determine the functioning of the left ventricle and to detect cardiac tumors, congenital defects, and changes in the tissue layers of the heart. All answers are correct. Option C is the best answer because it addresses the client's question without making him anxious or minimizing the question.

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? a) "I have my wife look at the soles of my feet each day." b) "I like to soak my feet in the hot tub every day." c) "I stopped smoking and use only chewing tobacco." d) "I walk only to the mailbox in my bare feet."

a) "I have my wife look at the soles of my feet each day." Explanation: A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.

The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following? a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." b) "The medications will prevent your husband from having an erection." c) "It is usually better to just give up sex after a heart attack." d) "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it."

a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? a) "Walk to the point of pain, rest until the pain subsides, then resume ambulation." b) "If you feel pain during the walk, keep walking until the end of the hallway is reached." c) "As soon as you feel pain, we will go back and elevate your legs." d) "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

a) "Walk to the point of pain, rest until the pain subsides, then resume ambulation." The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.

Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal? a) 2 to 2.5 b) .5 to 1 c) 2.5 to 3 d) .25 to .75

a) 2 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to any alteration of dosage. The patient's aPTT value would have to be greater than .5 to 1 times normal to be considered therapeutic. An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic. The patient's aPTT value would have to be greater than .25 to .75 times normal to be considered therapeutic.

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a) A client with atrial dysrhythmias b) A client with poor kidney perfusion c) A new myocardial infarction client d) A client with third-degree heart block

a) A client with atrial dysrhythmias The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker.

A 65-year-old male client complains of pain and cramping in his thigh when climbing the stairs and numbness in his legs after exertion. The nurse anticipates the physician will perform which of the following diagnostic tests right in the office to determine PAD? a) Ankle-brachial index b) Exercise electrocardiography c) Photoplethysmography d) Electron beam computed tomography

a) Ankle-brachial index The client's symptoms indicate he may have peripheral artery disease (PAD). The ankle-brachial index is a simple, noninvasive test used for its diagnosis. An exercise electrocardiography may be ordered for a client with possible CAD. An EBCT is a radiologic test that produces x-rays of the coronary arteries using an electron beam. It is used to diagnose for CAD. Clients with suspected venous insufficiency will undergo photoplethysmography, a diagnostic test that measures light that is not absorbed by hemoglobin and consequently is reflected back to the machine.

A patient is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in patient teaching prior to discharge? a) Application of graduated compression stockings b) Methods of keeping the wound area dry c) Adequate carbohydrate intake d) Prophylactic antibiotic therapy

a) Application of graduated compression stockings Graduated compression stockings usually are prescribed for patients with venous insufficiency. The amount of pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose.

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a) Assess the client's level of pain and administer prescribed analgesics. b) Ensure that the client's family is kept informed of his status. c) Prepare the client for pulmonary artery catheterization. d) Assess the client's level of anxiety and provide emotional support.

a) Assess the client's level of pain and administer prescribed analgesics. Explanation: The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and his family should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

A 23-year-old female client has been diagnosed with Raynaud's disease. The nurse teaches the client which of the following self-care strategies to minimize risks associated with this disease? Select all that apply. a) Avoid over-the-counter decongestants and cold remedies. b) Wear gloves to protect hands from injury when performing tasks. c) Refrain from going outdoors in cold weather. d) Limit activities that place stress on the ulnar nerve. e) Do not smoke or stop smoking.

a) Avoid over-the-counter decongestants and cold remedies. b) Wear gloves to protect hands from injury when performing tasks. e) Do not smoke or stop smoking. The nurse instructs clients with Raynaud's disease to quit smoking, avoid over-the-counter decongestants, cold remedies, and drugs for symptomatic relief of hay fever because of their vasoconstrictive qualities, protect hands and feet from injury, and wear warm socks and mittens when going outdoors in the cold weather.

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.) a) Call for emergency assistance if feeling dizzy. b) The patient may have a throbbing pain that is normal c) The patient will have to schedule monthly chest x-rays to make sure the device is patent. d) Avoid magnetic fields such as metal detection booths. e) Record events that trigger a shock sensation.

a) Call for emergency assistance if feeling dizzy. d) Avoid magnetic fields such as metal detection booths. e) Record events that trigger a shock sensation. The nurse should instruct the patient to avoid large magnetic fields such as those created by magnetic resonance imaging, large motors, arc welding, electrical substations, and so forth. Magnetic fields may deactivate the device, negating its effect on a dysrhythmia. The patient should call 911 for emergency assistance if a feeling of dizziness occurs. The patient should maintain a log that records discharges of an implantable cardioverter defibrillator (ICD). Record events that precipitate the sensation of shock. This provides important data for the physician to use in readjusting the medical regimen. Throbbing pain is not normal and should be reported immediately. An initial x-ray is indicated prior to discharge, but monthly x-rays are unnecessary.

A 78-year-old client has been diagnosed with right-sided heart failure from her symptomology. Her cardiologist will confirm his suspicions through diagnostics. Which of the following diagnostics are used to reveal right ventricular enlargement? Select all that apply. a) Chest radiograph b) Echocardiography c) Pulmonary arteriography d) Electrocardiogram

a) Chest radiograph b) Echocardiography d) Electrocardiogram An echocardiogram is usually performed to confirm the diagnosis of HF, identify the underlying cause, and determine the EF, which helps identify the type and severity of HF. This information may also be obtained noninvasively by radionuclide ventriculography or invasively by ventriculography as part of a cardiac catheterization procedure. A chest x-ray and an electrocardiogram (ECG) are obtained to assist in the diagnosis. Pulmonary arteriography is the one diagnostic tool here that does not apply.

A 62-year-old female who is 2 weeks CABG returns to her cardiologist due to new symptoms, including heaviness in her chest and pain between her breasts. She reports that leaning forward decreases the pain. The cardiologist admits her to the hospital to rule out pericarditis. Which of the following is a contributing cause to pericarditis? Select all that apply. a) Chest trauma b) Cardiac surgery c) Tuberculosis d) Myocarditis e) Pneumonia

a) Chest trauma b) Cardiac surgery c) Tuberculosis d) Myocarditis Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack) or develops after cardiac surgery.

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following? a) Computed tomography angiography (CTA) b) Magnetic resonance angiography (MRA) c) Doppler ultrasound d) Angiography

a) Computed tomography angiography (CTA) A CTA is used to visualize arteries and veins and help assess for stenosis and occlusion.

The nurse is caring for a patient who was admitted to the telemetry unit with a diagnosis of rule/out acute MI. The patient's chest pain began 3 hours ago. Which of the following laboratory tests would be most helpful in confirming the diagnosis of a current MI? a) Creatinine kinase-myoglobin (CK-MB) level b) Troponin C level c) Myoglobin level d) CK-MM

a) Creatinine kinase-myoglobin (CK-MB) level Elevated CK-MB assessment by mass assay is an indicator of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (due to thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. There are three isomers of troponin: C, I, and T. Troponin I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. An increase in myoglobin is not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI.

A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which of the following indicates that cardiac tamponade has been relieved? a) Decrease in central venous pressure (CVP) b) Decrease in blood pressure c) Increase in CVP d) Absence of cough

a) Decrease in central venous pressure (CVP) A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.

The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics? a) Diminished or absent pulses b) Aching, cramping pain c) Pulses are present, may be difficult to palpate d) Superficial ulcer

a) Diminished or absent pulses Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.

The nurse is assessing the client newly prescribed Lasix 20mg daily for 3+ pitting edema. To evaluate the effectiveness of diuretic therapy, which of the following would be documented? a) Edema b) Blood pressure c) Urine output d) Weight

a) Edema The best method to evaluate the effectiveness of diuretic therapy is to note a decrease in edema. Weight, blood pressure, and urine output all are affected by diuretic therapy, but the therapeutic goal is to decrease the edema.

The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, "Where did I pick up these bacteria?"The nurse is most safe to speculate which of the following? a) From a break in the skin b) From ingestion of a food c) From droplets from a cough d) From the fecal-oral route

a) From a break in the skin The microorganisms that cause infective endocarditis include bacteria and fungi. Streptococci and staphylococci are the bacteria most frequently responsible for this disorder. Both bacteria are abundantly found on the skin. These organisms are not found in the other locations.

The nurse is interviewing a client who is complaining of chest pain. Which of the following questions related to the client's history are most important to ask? Select all that apply. a) How would you describe your symptoms? b) Do you have any children? c) How did your mother die? d) Are you allergic to any medications or foods?

a) How would you describe your symptoms? c) How did your mother die? d) Are you allergic to any medications or foods? During initial assessment, the nurse should obtain important information about the client's history that focuses on a description of the symptoms before and during admission, family medical history, prescription and nonprescription drug use, and drug and food allergies.

Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? a) Hypertension b) Hyperlipidemia c) Obesity d) Glucose intolerance

a) Hypertension Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.

The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following? a) Hypervolemia b) Excessive blood loss c) Overdiuresis d) Left-sided heart failure (HF)

a) Hypervolemia The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a) Increased abdominal and back pain b) Elevated blood pressure and rapid respirations c) Decreased pulse rate and blood pressure d) Retrosternal back pain radiating to the left arm

a) Increased abdominal and back pain Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

The nurse is caring for a client on the cardiac unit. Which change of condition may indicate potential increasing of right-side heart failure? Select all that apply. a) Increased weakness on ambulation b) Jugular vein distention c) Edema changed from a 3+ to a 1+ d) One-pound weight loss e) Increased palpitations f) Increased dyspnea

a) Increased weakness on ambulation b) Jugular vein distention e) Increased palpitations f) Increased dyspnea A change in assessment finding may indicate an increase in heart failure. Right-sided heart failure symptoms include jugular vein distention, increased dyspnea, increased palpitations, and an increased weakness on ambulation. Edema is a common sign of right-sided heart failure, but changing from a 3+ to 1+ is improvement in condition. Weight loss is also improvement in condition.

A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? a) Irregularly irregular heart rate b) Increased PR interval c) Fourth heart sound (S4) d) Orthostatic hypotension

a) Irregularly irregular heart rate An irregularly irregular heart rate indicates atrial fibrillation and should be investigated further. It's normal for an elderly client to have a prolonged systole, which causes an S4 heart sound. It's also normal for an elderly client to have slowed conduction, causing an increased PR interval. As a person ages, it's normal for baroreceptors in the body to decrease their response to changes in body position, which can cause orthostatic hypotension.

A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement? a) Keep the patient's affected leg straight. b) Monitor the patient's chest drainage. c) Evaluate the patient's endotracheal lip line. d) Assess the patient's chest tube output.

a) Keep the patient's affected leg straight. Balloon valvuloplasty is performed in the cardiac catheterization laboratory. A catheter is inserted into the femoral artery. The patient must keep the affected leg straight to prevent hemorrhage at the insertion site. It is not an open heart surgery requiring chest tubes nor a chest dressing. ET tubes are placed when someone has general anesthesia, and this procedure is performed using light or moderate sedation.

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Keeping the legs in a neutral or dependent position b) Use of antiembolytic stockings c) Elevation of the legs above the heart d) Application of ace wraps from the toe to below the knees

a) Keeping the legs in a neutral or dependent position Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor? a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection b) Intake and output, nutrition level, respirations, and characteristics of pain c) Cultural needs, characteristics of pain, and signs of hemorrhage or dissection d) BP, pulse, respirations, and signs of hemorrhage or dissection

a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection Explanation: The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard? a) Low-pitched, rumbling diastolic murmur at the apex of the heart b) High-pitched blowing sound at the apex c) Mitral valve click d) Diastolic murmur at the left sternal border of the heart

a) Low-pitched, rumbling diastolic murmur at the apex of the heart The murmur is caused by turbulent blood flow through the abnormally tight valve opening. A low-pitched, rumbling, diastolic murmur (heard on S2) is heard best at the apex. A loud S1, due to abrupt closure of the mitral valve, and an early diastolic opening snap can be heard. The snap is the premature opening of the stenotic mitral valve.

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Maintain the patient on bed rest. b) Elevate the patient's head. c) Administer a prescribed antipyretic. d) Administer supplemental oxygen.

a) Maintain the patient on bed rest. The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. Bed rest also helps decrease myocardial damage and the complications of myocarditis. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures such as minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient's head to promote maximal breathing potential.

The nurse is evaluating the expected outcomes following thrombolytic therapy for a right leg deep vein thrombosis. Which of the following findings confirms a positive outcome?(Select all that apply.) a) No bleeding or bruising noted b) Right extremity pink c) Right extremity comparable in size to left d) Client denies pain e) Homan's sign positive f) Pedal pulse thready

a) No bleeding or bruising noted b) Right extremity pink c) Right extremity comparable in size to left d) Client denies pain Evaluation of the expected outcome of thrombolytic therapy includes restoring blood flow to the extremity. Findings include no pain from impaired circulation, a pink extremity of comparable size, and no bleeding from complications of the thrombolytic medication. A thready pulse would indicate impaired circulation, and a positive Homan's sign would indicate a continuing thrombus.

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities? a) Participate in a regular walking program. b) Massage the calf muscles if pain occurs. c) Use a heating pad to promote warmth. d) Keep the extremities elevated slightly.

a) Participate in a regular walking program. Explanation: Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education? a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR b) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR) c) Obtaining the supine measurements prior to the sitting and standing measurements d) Taking the patient's BP with the patient sitting on the edge of the bed with feet dangling

a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR The following steps are recommended when assessing patients for postural hypotension: Position the patient supine for 10 minutes before taking the initial BP and HR measurements; reposition the patient to a sitting position with legs in the dependent position, wait 2 minutes then reassess both BP and HR measurements; if the patient is symptom free or has no significant decreases in systolic or diastolic BP, assist the patient into a standing position, obtain measurements immediately and recheck in 2 minutes; continue measurements every 2 minutes for a total of 10 minutes to rule out postural hypotension. Return the patient to supine position if postural hypotension is detected or if the patient becomes symptomatic. Document HR and BP measured in each position (e.g., supine, sitting, and standing) and any signs or symptoms that accompany the postural changes.

Which of the following is accurate regarding the effects of nicotine and tobacco smoke on the body? Select all that apply. a) Reduces circulation to the extremities b) Impairs transport and cellular use of oxygen c) Causes vasospasm d) Increases blood viscosity e) Decreases blood viscosity

a) Reduces circulation to the extremities b) Impairs transport and cellular use of oxygen c) Causes vasospasm d) Increases blood viscosity Explanation: Nicotine from tobacco products causes vasospasm and can dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity.

The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart. Which of the following actions should the nurse complete prior to the patient undergoing the procedure? Select all that apply. a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. d) Sedate the patient prior to the procedure. e) Position the patient on his/her stomach for the procedure.

a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm, Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to prevent burning of the skin. A patient who is claustrophobic may need to receive a mild sedative before undergoing an MRA. During an MRA, the patient is positioned supine on a table that is placed into an enclosed imager or tube containing the magnetic field. Patients are instructed to remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or thumping that can be annoying is generated by the magnetic coils, so the patient may be offered a headset to listen to music.

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? a) Renal failure b) Graft occlusion c) Hemorrhage and shock d) Enteric fistula

a) Renal failure Explanation: Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.) a) Sleep with the foot of the bed elevated about 6 inches. b) Sit as much as possible to rest the valves in the legs. c) Avoid constricting garments. d) Sit on the side of the bed and dangle the feet. e) Elevate the legs above the heart level for 30 minutes every 2 hours.

a) Sleep with the foot of the bed elevated about 6 inches. c) Avoid constricting garments. e) Elevate the legs above the heart level for 30 minutes every 2 hours. Elevating the legs decreases edema, promotes venous return, and provides symptomatic relief. The legs should be elevated frequently throughout the day (at least 15 to 20 minutes four times daily). At night, the patient should sleep with the foot of the bed elevated about 15 cm (6 inches). Prolonged sitting or standing in one position is detrimental; walking should be encouraged. When sitting, the patient should avoid placing pressure on the popliteal spaces, as occurs when crossing the legs or sitting with the legs dangling over the side of the bed. Constricting garments, especially socks that are too tight at the top or that leave marks on the skin, should be avoided.

A 26-year-old male patient, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is being treated in the emergency department. The patient is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the patient becomes lightheaded but does not lose consciousness. Which of the following maneuvers may be used to interrupt the patient's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. a) Stimulating the patient's gag reflex b) Performing carotid massage c) Instructing the patient to breathe deeply d) Placing the patient's face in cold water e) Instructing the patient to vigorously exercise

a) Stimulating the patient's gag reflex b) Performing carotid massage c) Instructing the patient to breathe deeply The following vagal maneuvers can be used to interrupt AVNRT: stimulating the patient's gag reflex, having the patient hold his breath, cough, bear down, placing his face in cold water, or performing carotid massage. These measures elicit a vagal response which will slow AV conduction time and help restore a regular rhythm. Because of the risk of a cerebral embolic event, carotid massage is contraindicated in patients with carotid bruits. If the vagal maneuvers are ineffective, the patient may receive a bolus of adenosine to correct the rhythm; this is nearly 100% effective in terminating AVNRT. Overexertion and deep inspirations are measures that could precipitate SVT.

A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? a) The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. b) The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. c) The balloon keeps the vessels open so that blood will adequately deliver to the myocardium. d) The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium.

a) The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The IABP uses internal counterpulsation through the regular inflation and deflation of the balloon to augment the pumping action of the heart. It inflates during diastole, increasing the pressure in the aorta during diastole and therefore increasing blood flow through the coronary and peripheral arteries. It deflates just before systole, lessening the pressure within the aorta before left ventricular contraction, decreasing the amount of resistance the heart has to overcome to eject blood and therefore decreasing left ventricular workload.

A patient was admitted to the hospital with a diagnosis of aortic regurgitation. On assessment, the nurse notes the following positive indicators for the disease process. Select all that apply. a) The pulse has a rapid upstroke, then collapses b) Systolic pressure in the lower extremities is lower than in the upper extremities c) Visible neck vein pulsations d) The presence of a diastolic murmur e) Shortened pulse pressure

a) The pulse has a rapid upstroke, then collapses c) Visible neck vein pulsations d) The presence of a diastolic murmur Pulse pressure widens and systolic blood pressure in the lower extremities is higher than in the upper extremities as a result of progressive left ventricular failure.

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? a) Withhold anticoagulant therapy. b) Remove hair from skin insertion sites. c) Inform client of diagnostic tests. d) Assess distal pulses.

a) Withhold anticoagulant therapy. The nurse knows to withhold the anticoagulant therapy to decrease chance of hemorrhage during the procedure. The nurse does inform the client of diagnostic test, will assess pulses, and prep the skin prior to the angioplasty, but this is not the most important action to be taken.

The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include? a) Your family and friends may want to take a CPR class. b) If you miss a dose of your antiarrhythmia medication, double up on the next dose. c) It is not necessary to learn how to take your own pulse. d) Do not be concerned if you experience symptoms of lightheadedness and dizziness.

a) Your family and friends may want to take a CPR class. Having friends and family learn to take a pulse and perform CPR will help patients to manage their condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness are symptoms which should be reported to the provider.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: a) anticonvulsant. b) antihypertensive. c) anticoagulant. d) antibiotic.

a) anticoagulant. Explanation: During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses don't routinely give antibiotics during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor? a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection b) BP, pulse, respirations, and signs of hemorrhage or dissection c) Cultural needs, characteristics of pain, and signs of hemorrhage or dissection d) Intake and output, nutrition level, respirations, and characteristics of pain

a)Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection Explanation: The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

A patient with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The graduate nurse discusses this development with the nurse preceptor. The preceptor is assured when the graduate nurse states: a) "I instructed the patient to do coughing and deep breathing and I will reassess in 30 minutes." b) "I anticipated this complication and I will call the doctor right now." c) "I placed the patient in a semi-Fowler's position and made him NPO." d) "I told the patient that this is a normal complication and to take deep breaths."

b) "I anticipated this complication and I will call the doctor right now." With right-sided heart endocarditis, the nurse assesses for signs and symptoms of organ damage such as stroke, meningitis, heart failure, myocardial infarction, glomerulonephritis, and splenomegaly. This requires further assessment and collaborative interventions to prevent further deterioration. The other actions are not appropriate at this time.

A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? a) "I should expect bruising at the catheter site for up to 3 weeks." b) "I should expect a low-grade fever and swelling at the site for the next week." c) "I should avoid taking a tub bath until my catheter site heals." d) "I should avoid prolonged sitting."

b) "I should expect a low-grade fever and swelling at the site for the next week." Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "See the physician if complications occur." b) "Practice meticulous foot care." c) "Consider cutting down on your smoking." d) "Reduce your level of exercise."

b) "Practice meticulous foot care." Explanation: Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? a) "Contact dermatitis and skin irritations are common when the patch remains on all day." b) "Removing the patch at night prevents drug tolerance while keeping the benefits." c) "Nitroglycerine causes headaches, but removing the patch decreases the incidence." d) "You do not need the effects of nitroglycerine while you sleep."

b) "Removing the patch at night prevents drug tolerance while keeping the benefits." Tolerance to antiangina effects of nitrates can occur when taking these drugs for long periods of time. Therefore, to prevent tolerance and maintain benefits, it is a common regime to remove transdermal patches at night. Common adverse effects of nitroglycerine are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while you rest, there is less demand on the heart but not the primary reason for removing the patch.

The nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following? a) "This test will show the specific area causing the atrial fibrillation and what can be done to stop it." b) "This test will show any blood clots in the heart and if it is safe to do a cardioversion." c) "This test will let the doctor know if the client is at risk for hypotension." d) "This test will show if the client needs a cardiac catheterzation."

b) "This test will show any blood clots in the heart and if it is safe to do a cardioversion." When contemplating cardioversion for the client with atrial fibrillation, the absence of a thrombus in the atria can be confirmed by transesophageal echocardiogram.

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." b) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." c) "You should avoid tennis; basketball or football would be a good substitute." d) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity."

b) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey).

The nurse is aware that age-related changes in the heart muscle put the elderly at risk for dyspnea, angina, and syncope. Which of the following is an age-related change in the cardiovascular system that affects the sympathetic nervous system? a) An increased contractility response to exercise b) A decreased response to beta-blockers c) Decreased time for the heart rate to return to baseline d) Tachycardia

b) A decreased response to beta-blockers The sympathetic nervous system exhibits structural and functional changes that are age-related. Heart rate will decrease, and it will take longer for the heart rate to return to baseline. Refer to Table 12-1 in the text.

You are overseeing a 62-year-old who has started to exhibit dangerous PVCs in the cardiac postoperative unit. He's been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should you be ready to do? a) Prepare for defibrillation. b) Adjust the IV infusion. c) Administer additional lidocaine. d) Call for the doctor and just wait.

b) Adjust the IV infusion. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Do not do anything else. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Stay focused on the IV. Call for the physician and while waiting, adjust the IV infusion to the slowest possible rate until the physician can examine the patient.

Which of the following diagnostic tests are used to quantify venous reflux and calf muscle pump ejection? a) Lymphangiography b) Air plethysmography c) Lymphoscintigraphy d) Contrast phlebography

b) Air plethysmography Explanation: Air plethysmography is used to quantify venous reflux and calf muscle pump action. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at present intervals. Lymphoangiography provides a way of detecting lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse? a) Minimal oozing of blood from the IV site b) Altered level of consciousness c) Chest pain: 2 of 10 (1-to-10 pain scale) d) Presence of reperfusion dysrhythmias

b) Altered level of consciousness A patient receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low, and indicates the patient's chest pain is subsiding, an expected outcome of this therapy.

Which of the following methods to induce hemostasis after sheath removal post percutaneous transluminal coronary angioplasty (PTCA) is the least effective? a) Application of a vascular closure device, such as Angioseal, VasoSeal, Duett, or Syvek patch b) Application of a sandbag to the area c) Direct manual pressure d) Application of a pneumatic compression device (eg, Fem-Stop)

b) Application of a sandbag to the area Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding. Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site has been demonstrated to be effective and was the first method used to induce hemostasis post PTCA. Application of a pneumatic compression device post PTCA has been demonstrated to be effective.

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? a) Neither venous nor arterial b) Arterial insufficiency c) Trauma d) Venous insufficiency

b) Arterial insufficiency Explanation: Characteristics of arterial insuffiency ulcers include location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases. Ulcers caused by venous insufficiency will be irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterier tibial area.

Which of the following is a characteristic of an arterial ulcer? a) Brawny edema b) Border regular and well demarcated c) Ankle-brachial index (ABI) > 0.90 d) Edema may be severe

b) Border regular and well demarcated Explanation: Characteristics of an arterial ulcer include a border that is regular and demarcated. Brawny edema, ABI > 0.90, and edema that may be severe are characteristics of a venous ulcer.

Ronald is a 46-year-old who has developed congestive heart failure. He has to learn to adapt his diet and you are his initial counselor. Which of the following should you tell him to avoid? a) Angel food cake b) Canned peas c) Dried peas d) Ready-to-eat cereals

b) Canned peas There are a wide variety of foods that Ronald can still eat. The key is they have to have low-salt content. Canned vegetables are usually very high in salt or sodium, unless they have labels such as low-salt or sodium free or salt free. The key is to read the food labels and look for foods that contain <300 mg sodium/serving.

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a) Left ventricular hypertrophy b) Cardiac tamponade c) Decreased venous pressure d) Hypertension

b) Cardiac tamponade The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade (see Chapter 29).

A 73-year-old male client is diagnosed with dilated cardiomyopathy. The nurse is aware that which of the following is the most likely cause of his condition? a) Scleroderma b) Chronic alcohol abuse c) Previous myocardial infarction d) Heredity

b) Chronic alcohol abuse Chronic alcohol ingestion is one of the main causes of dilated cardiomyopathy. Other causes include history of viral myocarditis, an autoimmune response, and exposure to other chemicals in addition to alcohol. Heredity is considered the main cause of hypertrophic cardiomyopathy. This a connective tissue disorder is thought to cause restrictive cardiomyopathy. Scar tissue that forms after a myocardial infarction is thought to be a cause of restrictive cardiomyopathy.

A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have? a) Class IV (Severe) b) Class I (Mild) c) Class II (Mild) d) Class III (Moderate)

b) Class I (Mild) Class I is when ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.

Which of the following is a term used to describe the splitting or separating of fused cardiac valve leaflets? a) Chordoplasty b) Commissurotomy c) Valvuloplasty d) Annuloplasty

b) Commissurotomy Commissurotomy is the splitting or separating of fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve's outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.

The nurse practitioner inspects the patient's skin during a physical examination. She is looking for any abnormalities, especially skin findings associated with cardiovascular disease. The nurse notes a bluish tinge in the buccal mucosa and the tongue. She knows this is probably due to: a) Intermittent arteriolar vasoconstriction. b) Congenital heart disease. c) Peripheral vasoconstriction. d) Blood leaking outside the blood vessels.

b) Congenital heart disease. Cyanosis is due to serious cardiac disorders. A bluish tinge in the tongue and buccal mucosa are signs of central cyanosis caused by venous blood passing through the pulmonary circulation without being oxygenated. In the absence of pulmonary edema and cardiogenic shock, this sign is indicative of congenital heart disease. Refer to Table 12-3 in the text.

A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? a) Call the physician and obtain an order for a fluid bolus. b) Continue to monitor the client as ordered. c) Call the physician and obtain an order for a diuretic. d) Rezero the equipment and take another reading.

b) Continue to monitor the client as ordered. Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to rezero the equipment. Calling a physician and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg. Administering a diuretic would be appropriate if the client had excess fluid, as demonstrated by a CVP greater than 7 mm Hg.

The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient's ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse's most appropriate action? a) Instruct the patient to bear down as if having a bowel movement. b) Document the findings and continue to monitor the patient. c) Notify the patient's primary care provider of the findings. d) Apply oxygen via nasal cannula and obtain a 12-lead ECG.

b) Document the findings and continue to monitor the patient. The patient's ECG tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the patient.

The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include? a) The procedure takes less time than a cardiac catheterization. b) During the procedure, the arrhythmia will be reproduced under controlled conditions. c) After the procedure, the arrhythmia will not recur. d) The procedure will occur in the operating room under general anesthesia.

b) During the procedure, the arrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the arrhythmia. EP studies do not always include ablation of the arrhythmia.

A patient with congestive heart failure is admitted to the hospital with complaints of shortness of breath. How should the nurse position the patient in order to decrease preload? a) Head of the bed elevated at 30 degrees and legs elevated on pillows b) Head of the bed elevated at 45 degrees and lower arms supported by pillows c) Prone with legs elevated on pillows d) Supine with arms elevated on pillows above the level of the heart

b) Head of the bed elevated at 45 degrees and lower arms supported by pillows Preload is the amount of blood presented to the ventricle just before systole. The patient is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the patient may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the patient's weight on the shoulder muscles.

A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis? a) Race b) History of aortic valve replacement c) History of diabetes mellitus d) Age

b) History of aortic valve replacement A heart valve prosthesis such as an aortic valve replacement is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, I.V. drug abuse, and immunosuppression. Although race, age, and a history of diabetes mellitus may predispose a person to cardiovascular disease, they aren't major risk factors for infective endocarditis.

A patient diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes an overall goal of rehabilitation for a patient who has had an MI includes which of the following? a) Returning the patient to work and a preillness lifestyle b) Improvement of the quality of life c) Prevention of another cardiac event d) Limiting the effects and progression of atherosclerosis

b) Improvement of the quality of life Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following? a) Chordoplasty b) Left ventricular assist device c) Annuloplasty d) Open commissurotomy

b) Left ventricular assist device When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Because of the limited number of organ donors, many clients die waiting. In some cases, a left ventricular assist device is implanted to support the failing heart until a suitable donor becomes available. The other three choices have to do with failing valves and valve repairs.

A nurse is assessing a client with suspected cardiac tamponade. How should the nurse assess the client for pulsus paradoxus? a) Measure the blood pressure in right arm as the client inhales slowly, then measure the blood pressure in the left arm as the client exhales slowly. b) Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. c) Measure blood pressure in the right arm, then in the left arm as the client slows the pace of his inhalations and exhalations. d) Measure blood pressure in either arm with the client holding his breath, then with the client breathing normally.

b) Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. To determine pulsus paradoxus, the nurse should measure blood pressure in either arm as the client slowly exhales and then as the client breathes normally. Unless the client has cardiac tamponade, the two measurements are usually less than 10 points apart.

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? a) Decreased white blood cell (WBC) count b) Pericardial friction rub c) Decreased erythrocyte sedimentation rate (ESR) d) Hypothermia

b) Pericardial friction rub Explanation: The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.

The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Increased appetite b) Persistent cough c) Weight loss d) Ability to sleep through the night

b) Persistent cough Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? a) Monitor the partial thromboplastin time (PTT). b) Prepare to administer protamine sulfate. c) Decrease the heparin infusion rate. d) Start an I.V. infusion of dextrose 5% in water (D5W).

b) Prepare to administer protamine sulfate. Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate? a) The client and family understands the need for medication. b) The client and family understands the discharge instructions. c) The client and family understands the need to restrict activity for 72 hours. d) The client and family understands the client's CV diagnosis.

b) The client and family understands the discharge instructions. The client is relaxed and feels secure. The test is performed uneventfully or the client is stabilized when complications are managed successfully. The client and family have an accurate understanding of the diagnostic testing process and discharge instructions. The scenario does not indicate that the client has a CV diagnosis, a need for medication, or a need to restrict their activity for 72 hours.

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? a) The registered nurse stating to administer all medications accept those which are cardiotonics b) The registered nurse administering atropine sulfate intravenously c) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute d) The registered nurse stating to administer Lanoxin (digoxin)

b) The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.

A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate? a) Sclerotherapy is used to cure varicose veins. b) The severity of discomfort isn't related to the size of varicosities. c) Primary varicose veins are caused by deep vein thrombosis (DVT) and inflammation. d) Varicose veins are more common in men than in women.

b) The severity of discomfort isn't related to the size of varicosities. Clients with varicose veins commonly complain of aching, heaviness, itching, moderate swelling, and unsightly appearance of the legs. However, the severity of discomfort is hard to assess and seems unrelated to the size of varicosities. Varicose veins are more common in women than in men. Primary varicose veins typically result from a congenital or familial predisposition that makes the vein wall less elastic; secondary varicosities occur when trauma, obstruction, DVT, or inflammation damages valves. Sclerotherapy, in which a sclerosing agent is injected into a vein, is used to treat varicose veins; it doesn't cure them.

A 24-year-old obese woman describes her symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm his suspected diagnosis. What diagnostic would you expect him to prescribe? a) Radionuclide angiography b) Transesophageal echocardiography c) Electrocardiography d) Chest radiograph

b) Transesophageal echocardiography TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle.

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a) Within 5 to 7 days b) Within 6 hours c) Within 12 hours d) Within 24 to 48 hours

b) Within 6 hours For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Physicians initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.

A client with stage IV heart failure has a living will indicating that he doesn't want to be placed on a ventilator. A nurse is caring for this client when he begins experiencing severe dyspnea. The nurse should: a) ask the client's family to consent to ventilator placement. b) administer oxygen, morphine, and a bronchodilator for client comfort. c) administer oxygen and hope the client will change his mind. d) call for respiratory therapy to intubate the client.

b) administer oxygen, morphine, and a bronchodilator for client comfort. A living will is a statement of a client's wishes in the event that a life-threatening illness or injury occurs. The client's comfort should be paramount and the nurse should respect his wishes. Morphine, oxygen, and bronchodilators can relieve dyspnea and make the client more comfortable, which will enable him to breathe more easily. The nurse shouldn't arrange for intubation without the client's consent or ask his family for permission to initiate mechanical ventilation.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) place a heating pad around the affected calf. b) keep the affected leg level or slightly dependent. c) shave the affected leg in anticipation of surgery. d) elevate the affected leg as high as possible.

b) keep the affected leg level or slightly dependent. While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

A client with heart failure must be monitored closely after starting diuretic therapy. The best indicator for the nurse to monitor is: a) urine specific gravity. b) weight. c) vital signs. d) fluid intake and output.

b) weight. Heart failure typically causes fluid overload, resulting in weight gain. Therefore, weight is the best indicator of this client's status. One pound gained or lost is equivalent to 500 ml. Fluid intake and output and vital signs are less accurate indicators than weight. Urine specific gravity reflects urine concentration, indicating overhydration or dehydration. Numerous factors can influence urine specific gravity, so it isn't the most accurate indicator of the client's status.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "Reduce your level of exercise." b) "See the physician if complications occur." c) "Practice meticulous foot care." d) "Consider cutting down on your smoking."

c) "Practice meticulous foot care." Explanation: Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve? a) "The valve is from a tissue donor, and I will not need to take any blood thinning drugs with I am discharged." b) "The valve is mechanical, and it will not deteriorate or need replacing." c) "The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." d) "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged."

c) "The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." Autografts (i.e., autologous valves) are obtained by excising the patient's own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the patient's own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.

The nurse is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. The best response by the nurse is which of the following? a) "This is the association of heart dysrhythmias, especially atrial fibrillation, with extramarital sex." b) "This is the association of heart dysrhythmias, especially atrial fibrillation, with very heavy meals." c) "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." d) "This is the association of heart dysrhythmias, especially atrial fibrillation, with physical activity. the client is not used to"

c) "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." Atrial fibrillation may be found in people with acute moderate to heavy ingestion of alcohol.

The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education. a) "I will call the doctor if my incision becomes swollen and red." b) "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." c) "We will be getting rid of our microwave oven so it will not affect my pacemaker." d) "I will avoid any large magnets that may affect my pacemaker."

c) "We will be getting rid of our microwave oven so it will not affect my pacemaker." Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances.

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication? a) 250-275 mg/dL b) 210-240 mg/dL c) 160-190 mg/dL d) 280-300 mg/dL

c) 160-190 mg/dL Simvastatin (Zocor) is a statin frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.

Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a) 125 seconds or less. b) 100 seconds or less. c) 50 seconds or less. d) 75 seconds or less.

c) 50 seconds or less. Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.

Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? a) Decreased cardiac output b) Risk for imbalanced body temperature c) Acute pain d) Anxiety

c) Acute pain The nursing diagnosis of Acute pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. This makes Risk for imbalanced body temperature an incorrect answer. The client's blood pressure and heart rate don't suggest a nursing diagnosis of Decreased cardiac output. Anxiety could be an appropriate nursing diagnosis, but addressing Acute pain (the priority concern) may alleviate the client's anxiety.

The nurse is aware that statistics show an increase in the prevalence of infective endocarditis among older adults. Which of the following factors places older adults at risk for developing infective endocarditis? a) Higher rate of tuberculosis b) A greater incidence of a history of repaired congenital heart defects c) An increased use in the number of prosthetic valve replacements d) An increase in IV drug use

c) An increased use in the number of prosthetic valve replacements The prevalence of infective endocarditis among older adults has increased, due in part to the increased number of prosthetic valve replacements, including replacements for older adults, and an increase in hospital-acquired bacteremia. While history of a repaired congenital heart defect does place a client at greater risk for developing infective endocarditis in the future, it has not been shown as a contributing factor in the prevalence of infective endocarditis among older adults. IV drug use and IV drug abuse places individuals at greater risk for infective endocarditis. However, this risk has not been attributed to an increase in its prevalence among older adults. Tuberculosis is known to contribute to pericarditis among the general population and not specific to the older adult client.

A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be? a) Sinus tachycardia b) Ventricular flutter c) Atrial flutter d) Nonparoxysmal junctional tachycardia

c) Atrial flutter Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Ventricular rhythm may be irregular, and P waves may be absent. Ventricular rate usually ranges between 75 and 150 bpm.

After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker? a) Stay at least 2' away from microwave ovens. b) Never engage in activities that require vigorous arm and shoulder movement. c) Avoid undergoing magnetic resonance imaging (MRI). d) Avoid going through airport metal detectors.

c) Avoid undergoing magnetic resonance imaging (MRI). A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens; nonetheless, the client should stay at least 5' away from microwaves, not 2'. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector.

Which of the following observations regarding ulcer formation on the patient's lower extremity indicates that the ulcer is a result of venous insufficiency? a) Is deep, involving the joint space b) Base is pale to black c) Border of the ulcer is irregular d) Is very painful to the patient, even though superficial

c) Border of the ulcer is irregular The border of an ulcer caused by arterial insufficiency is circular. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color. Venous insufficiency ulcers are usually superficial.

A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously? a) Memory lapses b) Ankle edema c) Depression d) Dizziness

c) Depression For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate physician notification.

A patient who has had a recent myocardial infarction develops pericarditis and complains of level 6 (on a scale of 0-10) chest pain with deep breathing. Which of these ordered pro re nata (PRN) medications will be the most appropriate for the nurse to administer? a) Morphine sulfate 6 mg IVP every 2-4 hours b) Acetaminophen (Tylenol) 650 mg per os (po) every 4 hours c) Ibuprofen (Motrin) 800 mg po every 8 hours d) Fentanyl 2 mg intravenous pyelogram (IVP) every 2-4 hours

c) Ibuprofen (Motrin) 800 mg po every 8 hours Pain associated with pericarditis is caused by inflammation, thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? a) Within 12 hours b) Within the first 24 hours c) In 3 to 5 days d) In 2 days

c) In 3 to 5 days Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a) Elevated blood pressure and rapid respirations b) Decreased pulse rate and blood pressure c) Increased abdominal and back pain d) Retrosternal back pain radiating to the left arm

c) Increased abdominal and back pain Explanation: Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is: a) Quiet but readily heard. b) Easily heard with no palpable thrill. c) Loud and may be associated with a thrill sound similar to (a purring cat). d) Very loud; can be heard with the stethoscope half-way off the chest.

c) Loud and may be associated with a thrill sound similar to (a purring cat). Heart murmurs are characterized by location, timing, and intensity. A grading system is used to describe the intensity or loudness of a murmur. A grade 1 is very faint and difficult to describe, whereas a grade 6 is extremely loud. Refer to Box 12-3 in the text for a description of grades 1 to 6.

A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a) Serum electrolytes b) Ativan 1 mg orally c) Nitroglycerin SL d) Chest x-ray

c) Nitroglycerin SL Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient's chest pain.

A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? a) Bleeding time b) Platelet count c) Prothrombin time (PT) d) Partial thromboplastin time (PTT)

c) Prothrombin time (PT) Explanation: PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose appoximately 99% of bleeding disorders on the basis of PT and PTT values.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a) Increasing blood pressure and monitoring fluid intake and output b) Decreasing blood pressure and increasing mobility c) Stabilizing heart rate and blood pressure and easing anxiety d) Increasing blood pressure and reducing mobility

c) Stabilizing heart rate and blood pressure and easing anxiety Explanation: For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

Which of the following teaching interventions should the nurse include in the plan of care for a patient with valvular heart disease who is experiencing pulmonary congestion? a) Teaching patients to take nitroglycerin if shortness of breath develops b) Teaching patients to drink at least 2 L of fluid daily and monitor urine output c) Teaching patients to rest and sleep in a chair or sit in bed with head elevated d) Teaching patients to report a weight gain of 3 pounds in 1 week

c) Teaching patients to rest and sleep in a chair or sit in bed with head elevated Patients who experience symptoms of pulmonary congestion are advised to rest and sleep sitting in a chair or bed with the head elevated. In addition, the nurse educates the patient to take a daily weight and report gains of 3 pounds in 1 day or 5 pounds in 1 week to the primary provider. The nurse may assist the patient with planning activity and rest periods to achieve an acceptable lifestyle.

A patient with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which of the following is the most likely cause? a) The patient is experiencing normal sensations associated with this condition. b) The aneurysm has become obstructed. c) The aneurysm may be preparing to rupture. d) The patient is experiencing inflammation of the aneurysm.

c) The aneurysm may be preparing to rupture. Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is rapidly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

A patient with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which of the following assessment data obtained by the nurse should be immediately communicated to the health care provider? a) The patient has a palpable thrill felt over the left anterior chest. b) The patient has 4+ peripheral edema in both legs. c) The patient has crackles audible throughout the lungs. d) The patient has a loud systolic murmur all across the precordium.

c) The patient has crackles audible throughout the lungs. Acute mitral regurgitation, resulting from a myocardial infarction, usually manifests as severe congestive heart failure. Dyspnea, fatigue and weakness are the most common symptoms. Palpitations, shortness of breath on exertion and cough from pulmonary congestion also occur. Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and need immediate interventions, such as diuretics.

When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block? a) First degree b) Second degree, type II c) Third degree d) Second degree, type I

c) Third degree In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.

A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? a) A pulse deficit b) Weak pulse c) Thready pulse d) Bounding pulse

c) Thready pulse The nurse is most correct to anticipate a thready (barely palpable) pulse quality. A bounding pulse indicates a strong cardiac output. A weak pulse indicates a lower pulse quality. A pulse deficit occurs when the pulses between the apex of the heart differs from the radial pulse.

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? a) To decrease homocysteine levels b) To dilate coronary arteries c) To decrease workload of the heart d) To prevent angiotensin II conversion

c) To decrease workload of the heart Beta-adrenergic blockers are used in the treatment of CAD to decrease the myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and Bvitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.

The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred? a) CK-MB b) Brain natriuretic peptide (BNP) c) Troponin T and I d) Myoglobin

c) Troponin T and I After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.

A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? a) Implanted cardioverter-defibrillator (ICD) b) Pacemaker c) Ventricularassistdevice (VAD) d) Intra-aortic balloon pump (IABP)

c) Ventricularassistdevice (VAD) VADs may be used for one of three purposes:(1) a bridge to recovery, (2) a bridge to transport, or (2) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days.

The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? a) "The first test I am getting is an echocardiography. I am glad that it is not painful." b) "I had an ECG already. It provided information on my heart rhythm. c) "I am able to have a nuclide study because I do not have any allergies." d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."

d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker." A magnetic resonance imaging (MRI) test is prohibited on clients with various metal devices within their body. External metal objects must be removed. All other options are correct statements not needing clarification.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "Reduce your level of exercise." b) "Consider cutting down on your smoking." c) "See the physician if complications occur." d) "Practice meticulous foot care."

d) "Practice meticulous foot care." Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

A nurse is providing education about maintaining tissue integrity to a client with peripheral arterial disease. Which of the following statements by the client indicates a need for clarification? a) "It is important to apply sunscreen to the top of my feet when wearing sandals." b) "I can use lamb's wool between my toes if necessary." c) "I should apply powder daily because my feet perspire." d) "Shoes made of synthetic material are best for my feet."

d) "Shoes made of synthetic material are best for my feet." The client should wear leather shoes with an extra-depth toebox. Synthetic shoes do not allow air to circulate.

You are caring for a client with left-sided heart failure. When you go in to do your shift assessment, you find your client is wheezing, restless, tachycardic, and has severe apprehension. You know that these are symptoms of what? a) Progressive heart failure b) Cardiogenic shock c) Pulmonary hypertension d) Acute pulmonary edema

d) Acute pulmonary edema Clients with acute pulmonary edema exhibit sudden dyspnea, wheezing, orthopnea, restlessness, cough (often productive of pink, frothy sputum), cyanosis, tachycardia, and severe apprehension. These symptoms do not indicate progressive heart failure, pulmonary hypertension, or cardiogenic shock.

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. b) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. c) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

d) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the physician before completing the initial assessment is premature.

A 73-year-old client has returned to the postanesthesia care unit where you practice nursing. The client had a pacemaker implanted and it is your responsibility to begin client education upon his becoming alert. Which of the following postimplantation instructions must you provide to the client now that he has a permanent pacemaker? a) Delay for at least 3 weeks activities such as swimming and bowling. b) Keep the arm on the side of the pacemaker higher than the head. c) Keep moving the arm on the side where the pacemaker is inserted. d) Avoid sources of electrical interference.

d) Avoid sources of electrical interference. The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc. The main warning to a client with a pacemaker is to avoid sources of electrical interference.

The nurse hears the alarm sound on the telemetry monitor and observes a flat line. The patient is found unresponsive, without a pulse, and no respiratory effort. What is the first action by the nurse? a) Administer epinephrine 1:10,000 10 mL IV push. b) Deliver breaths with a bag-valve mask. c) Defibrillate the patient with 360 joules. d) Call for help and begin chest compressions.

d) Call for help and begin chest compressions. Following the recognition of unresponsiveness, a protocol for basic life support is initiated. This includes activation of the emergency response team for help and performance of high-quality cardiopulmonary resuscitation (CPR), which includes beginning chest compressions.

A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? a) Insertion of an ICD b) Maze procedure c) Insertion of a permanent pacemaker d) Catheter ablation therapy

d) Catheter ablation therapy Catheter ablation destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It is performed with or after an electrophysiology study. Usual indications for ablation are atrioventricular nodal reentry tachycardia, a recurrent atrial dysrhythmia (especially atrial fibrillation), or ventricular tachycardia unresponsive to previous therapy (or for which the therapy produced significant side effects).

A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next? a) Summon the nurse-manager. b) Administer potassium. c) Call the physician. d) Check the client's potassium level.

d) Check the client's potassium level. The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the physician. Because the client is taking furosemide (Lasix), a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the physician with a more complete database. The physician will need to be notified after the nurse checks the latest potassium level. Calling the nurse-manager is not indicated at this time. Administering potassium requires a physician's order.

The nurse is aware that a client who has been diagnosed with Prinzmetal's angina will present with which of the following symptoms? a) Radiating chest pain that lasts 15 minutes or less b) Chest pain of increased frequency, severity, and duration c) Prolonged chest pain that accompanies exercise d) Chest pain that occurs at rest and usually in the middle of the night

d) Chest pain that occurs at rest and usually in the middle of the night A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8 AM, is sporadic over 3-6 months, and diminishes over time. Client with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Client with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a) Higher than normal blood pressure and falling hematocrit b) Constant, intense headache and falling blood pressure c) Slow heart rate and high blood pressure d) Constant, intense back pain and falling blood pressure

d) Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

The health care provider documents that the patient's pulse quality is a +1 on a scale of 0 to 4. The nurse knows that this describes a pulse that is: a) Full, easy to palpate, and cannot be obliterated. b) Diminished, but cannot be obliterated. c) Strong and bounding and may be abnormal. d) Difficult to palpate and is obliterated with pressure.

d) Difficult to palpate and is obliterated with pressure. The quality of pulses is reported using descriptors and a scale of 0 to 4. The lower the number, the weaker the pulse and the easier it is to obliterate it. A +1 pulse is weak and thready and easily obliterated with pressure.

In providing nursing management to a client post-varicose vein surgery, the nurse would include which of the following teaching measures? Select all that apply. a) Cool compresses b) Take warm showers in the morning. c) Stand rather than sit. d) Elastic stockings e) Exercise f) Lower the extremities.

d) Elastic stockings e) Exercise Movement/exercise and use of elastic stocking aid in venous return. Cool compresses can cause vasoconstriction, which can diminish arterial blood flow. Elevation of legs can be helpful in aiding venous return. Standing or sitting for prolonged periods of time should be avoided. Showers in the morning can dilate blood vessels and contribute to venous congestion and edema.

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? a) Cimetidine (Tagamet) b) Metoprolol (Lopressor) c) Hydrocortisone (Solu-Cortef) d) Epinephrine

d) Epinephrine Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.

A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? a) Hyperuricemia b) Hyperglycemia c) Gastrointestinal distress d) Increased liver enzymes

d) Increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statins, HMG-CoA reductase inhibitors that are used to affect lipoprotein metabolism.

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a) Vertigo b) Dizziness c) Acute limb ischemia d) Intermittent claudication

d) Intermittent claudication Explanation: The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.

A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? a) No arterial insufficiency b) Very mild arterial insufficiency c) Tissue loss to that foot d) Moderate to severe arterial insufficiency

d) Moderate to severe arterial insufficiency Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? a) WBC (white blood cell) count b) Troponin I c) C-reactive protein d) Myoglobin

d) Myoglobin Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels due not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.

The nurse is caring for clients on a busy cardiac unit. Following morning assessment, the nurse would notify the physician with which of the following symptoms? a) A noted irregular pulse rate prior to Lanoxin (digoxin) administration b) Cyanosis with a pulse oximetry level of 92% c) Dyspnea when ambulating from the bathroom d) Pulsus paradoxus on vital sign assessment

d) Pulsus paradoxus on vital sign assessment Pulsus paradoxus is a difference of 10mm Hg or more between the first Korotkoff sound noting systolic blood pressure heard during expiration and the first that is heard during inspiration. Pulsus paradoxus can signal a deteriorating condition including diminished stroke volume, compromised cardiac output, and death. This would be of high priority to notify the physician.

The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? a) ST segment that is isoelectric in appearance b) PR interval that is 0.18 seconds long c) QRS complex that is 0.10 seconds long d) QT interval that is 0. 46 seconds long

d) QT interval that is 0. 46 seconds long The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following? a) SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches b) SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers c) AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers d) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

d) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers.

Which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? a) Second-degree heart block b) Asystole c) First-degree AV block d) Third-degree atrioventricular (AV) heart block

d) Third-degree atrioventricular (AV) heart block In third-degree AV heart block there is no relationship or synchrony between the atrial and ventricular contraction. Each is beating at its own inherent rate and is independent of each other, thus the cardiac output is affected. Second-degree AV block occurs when only some of the atrial impulses are conducted through the AV node into the ventricles. First-degree AV block occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval. During asystole, there is no electrical activity.

Which of the following tests used to diagnose heart disease is least invasive? a) Cardiac catheterization b) Magnetic resonance imaging c) Coronary arteriography d) Transthoracic echocardiography

d) Transthoracic echocardiography Transthoracic echocardiography uses high-frequency sound waves that pass through the chest wall (transthoracic) and are displayed on an oscilloscope. MRI uses magnetism to identify disorders that affect many different structures in the body without performing surgery. While an MRI does not expose clients to radiation, it does require intravenous infusion to instill medication and contrast medium. Cardiac catheterization requires the insertion of a long, flexible catheter from a peripheral blood vessel in the groin, arm, or neck into one of the great vessels and then into the heart. This procedure requires the instillation of a contrast medium into each coronary artery.

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a) Trauma b) Arterial insufficiency c) Neither venous nor arterial insufficiency d) Venous insufficiency

d) Venous insufficiency Explanation: Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.

The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to: a) educate the client about his symptoms. b) decrease anxiety. c) administer sublingual nitroglycerin. d) enhance myocardial oxygenation.

d) enhance myocardial oxygenation. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are import in care delivery, neither is a priority when a client is compromised.

Vasodilation or vasoconstriction produced by an external cause will interfere with a nurse's accurate assessment of a client with peripheral vascular disease (PVD). Therefore, the nurse should: a) match the room temperature to the client's body temperature. b) maintain room temperature at 78° F (25.6° C). c) keep the client uncovered. d) keep the client warm.

d) keep the client warm. The nurse should keep the client covered and expose only the portion of the client's body that she's assessing. The nurse should also keep the client warm by maintaining his room temperature between 68° F and 74° F (20° and 23.3° C). Extreme temperatures aren't good for clients with PVD. The valves in their arteries and veins are already insufficient, and exposing them to vast changes in temperature could affect assessment findings. Keeping the client uncovered would cause him to become chilled. Matching the room temperature to the client's body temperature is inappropriate.

The nurse is caring for a patient who returned from the tropics a few weeks ago and who sought care with signs and symptoms of lymphedema. The nurse's plan of care should prioritize what nursing diagnosis? A) Risk for infection related to lymphedema B) Disturbed body image related to lymphedema C) Ineffective health maintenance related to lymphedema D) Risk for deficient fluid volume related to lymphedema

Ans: A Feedback: Lymphedema, which is caused by accumulation of lymph in the tissues, constitutes a significant risk for infection. The patient's body image is likely to be disturbed, and the nurse should address this, but infection is a more significant threat to the patient's physiological well-being. Lymphedema is unrelated to ineffective health maintenance and deficient fluid volume is not a significant risk.

81. A nurse is assessing a client who may be in the early stages of dehydration. Early manifestations of dehydration include: 1. Sunken eyeballs and poor skin turgor 2. Thirst or confusion 3. Increase heart rate with hypotension 4. Coma or seizures

Answer: 2 Rationale: Early signs and symptoms of dehydration include thirst, irritability, confusion, dizziness, coma, seizures, sunken eyeballs, poor skin turgor, and increase heart rate with hypotension are all later signs.

5. A key diagnostic test for heart failure is: 1. serum potassium. 2. B-type natriuretic peptide. 3. Troponin I 4. cardiac enzymes.

Answer: 2. B-type natriuretic peptide.

10. A nurse is evaluating a client with left-sided heart failure. Which finding should the nurse expect to assess? 1. Ascites 2. Dyspnea 3. Hepatomegaly 4. Jugular vein distention

Answer: 2. Dyspnea Rationale: Dyspnea may occur in a client with left-sided heart failure. Ascites, hepatomegaly, and jugular vein distention are assessment findings in right-sided heart failure.

75. A nurse is measuring a waveform of the ECG strip and determines it is normally around 0.06 to 0.1 the waveform s/he is measuring is the 1. P wave 2. PRI 3. QRS 4. QT interval

Answer: 3 Rationale: The QRS is around 0.06 to 0.1 seconds. The P wave is not usually measured but we look to see that it is upright, rounded, and symmetrical. The PRI is from 0.12 to 0.2 seconds, and the QT is rate related but is around 0.36 to 0.42 seconds.

87. ACE inhibitors correct heart failure by: 1. Increasing preload 2. Causing vasoconstriction 3. Increasing afterload. 4. Reducing afterload

Answer: 4 Rational: ACE inhibitors reduce afterload through vasodilation, thereby reducing heart failure.

34. An infant with a congenital cyanotic heart defect has a complete blood count drawn, revealing an elevated red blood cell (RBC) count. Which condition do these findings indicate? 1. Anemia 2. Dehydration 3. Jaundice 4. Hypoxia compensation

Answer: 4. Hypoxia compensation Rationale: A congenital cyanotic heart defect alters blood flow through the heart and lungs, which produces hypoxia. To compensate for this, the body increases the oxygen-carring capacity by increasing RBC production, which causes the hemoglobin level and hematocrit to increase. The hemoglobin level and hematocrit are typically decreased in anemia. Altered electrolyte levels and other laboratory values provide better evidence of dehydration. An elevated hemoglobin level and hematocrit aren't associated with jaundice.

77. A patient has a VVIR mode pacemaker. The nurse knows that this pacemaker is characterized by which of the following? a. atrial (pacing), atrial (sensing), triggered (response to sensing), and none (rate modulation) b. atrial (pacing), ventricular (sensing), inhibited (response to sensing), and rate modulated (rate modulation) c. ventricular (pacing), atrial (sensing), triggered (response to sensing), and rate modulated (rate modulation) d. ventricular (pacing), ventricular (sensing), inhibited (response to sensing), rate modulated (rate modulation)

Answer: D Rationale: This is the most common mode for permanent ventricular pacing. V= Ventricular, I= inhibited, and R= rate modulated.

35. The nurse has admitted a client to the emergency room with complaints of chest pain over the previous 2 hours. There are no clear changes on the 12-lead. The nurse would expect which laboratory test to provide confirmation of a myocardial infarction (MI)? 1. Potassium of 5.2 mEq/L 2. Creatinine kinase (CK) of 545 with MB of 4% 3. CK of 320 with MB of 12% 4. WBC of 11,400 / mm3

Answer:3. CK of 320 with MB of 12% Rationale: A CK level above 150 with over 5% MB isoenzyme indicates myocardial damage from acute myocardial infarction. Elevated potassium is not indicative of myocardial infarction. Elevated WBC is an indicator of many conditions, including MI. Strategy: The core issue of the question is the ability to correlate indicators of myocardial damage with a client situation. Evaluate each option carefully, and use nursing knowledge and the process of elimination to make a selection.

55. The nurse is caring for a 2-month-old child with transposition of the great vessels. Which of these interventions has highest priority? 1. Providing comfort for parents. 2. Maintaining proper caloric intake. 3. Reducing stressors for infant. 4. Documenting vital signs.

Answers: 3. Reducing stressors for infant. Rationale: The open ductus arteriosus will allow a small amount of mixing of oxygenated and unoxygenated blood. Stress will increase the cardiac workload and therefore is a priority for the nurse to avoid. Maintaining caloric intake and comfort are the next priorities using Maslow's hierarchy. Documenting vital signs is a routine activity and not a priority when compared to actual care activities. Strategy: Using Maslow's hierarchy of needs to review each option and choose the one that most closely relates to the ABC's and thus cardiac workload. Use this knowledge and the process of elimination to make a selection.

4. A complication of peripheral vascular disease may be: 1. stasis ulcer. 2. Pressure ulcer. 3. Gastric ulcer. 4. Duodenal ulcer.

Answer: 1. stasis ulcer.

2. Which lifestyle changes should a client diagnosed with coronary artery disease consider? 1. Smoking cessation 2. Establishing a regular exercise routine 3. Weight reduction 4. All of the Above

Answer: 4. All of the Above

32. An infant is diagnosed with patent ductus arteriosus. Which drug should the nurse anticipate administering to attempt to close the defect? 1. Digoxin (Lanoxin) 2. Predinisone. 3. Furosemide (Lasix) 4. Indomethacin (Indocin)

Answer: 4. Indomethacin (Indocin) Rationale: Indomethacin is administered to an infant with patent ductus arteriosus in the hope of closing the defect. Digoxin and furosemide may be used to treat the symptoms associated with patent ductus arteriosus, but they don't achieve closure. Prednisone isn't used to treat the condition.