MED SURG**new**

The nurse is assessing a client newly diagnosed with mild hypertension. Which assessment finding should the nurse expect? 1.Asymptomatic 2.Shortness of breath 3.Visual disturbances 4.Frequent nosebleeds

1

The nurse is performing a cardiovascular assessment on a client. Which parameter would the nurse assess to gain the best information about the client's left-sided heart function? 1.Breath sounds 2.Peripheral edema 3.Hepatojugular reflux 4.Jugular vein distention

1

The health care provider (HCP) prescribes limited activity (bed rest and bathroom only) for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply 1.Encourage coughing with deep breathing. 2.Place in high Fowler's position for eating. 3.Encourage increased oral intake of water daily. 4.Place thigh-length elastic stockings on the client. 5.Place sequential compression boots on the client.

1,3,4

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? 1.Glipizide 2.Metformin 3.Repaglinide 4.11.Regular insulin

2

The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions? 1."I'll need to become a strict vegetarian." 2."I should use polyunsaturated oils in my diet." 3."I need to substitute eggs and whole milk for meat."

2

The nurse reading the operative record of a client who had cardiac surgery notes that the client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac output results leads the nurse to make which conclusion? 1.The cardiac output is above the normal range. 2.The cardiac output is below the normal range. 3.The cardiac output is in the low-normal range. 4.The cardiac output is in the high-normal range

2

The nurse employed in a cardiac unit determines that which client is the least likely to have an implanted cardioverter-defibrillator (ICD) inserted? 1.A client with syncopal episodes related to ventricular tachycardia 2.A client with ventricular dysrhythmias despite medication therapy 3.A client with an episode of cardiac arrest related to myocardial infarction 4.A client with 3 episodes of cardiac arrest unrelated to myocardial infarction

3

The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? 1.Flat neck veins 2.A pulse rate of 60 beats/minute 3.Muffled or distant heart sounds 4.Wheezing on auscultation of the lungs

3

The nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be avoided. The nurse instructs the client to avoid consuming which item? 1.Bananas 2.Broccoli 3.Antacids 4.Cantaloupe

3

The ambulatory care nurse is working with a client who has been diagnosed with Prinzmetal's (variant) angina. What should the nurse plan to teach the client about this type of angina? 1.It is most effectively managed by beta-blocking agents. 2.It has the same risk factors as stable and unstable angina. 3.It can be controlled with a low-sodium, high-potassium diet. 4.Generally it is treated with calcium channel-blocking agents

4

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? 1.Assessing pain 2.Administering vasodilators 3.Avoiding over-the-counter (OTC) medications 4.Moving slowly from a sitting to a standing position

4

A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem? 1.Ambulates 10 feet (3 meters) farther each day 2.Verbalizes the benefits of increasing activity 3.Chooses a healthy diet that meets caloric needs

1

A client is having a follow-up health care provider (HCP) office visit after vein ligation and stripping. The client describes a sensation of "pins and needles" in the affected leg. Which would be an appropriate action by the nurse based on evaluation of the client's comment? 1.Report the complaint to the HCP. 2.Instruct the client to apply warm packs. 3.Reassure the client that this is only temporary. 4.Advise the client to take acetaminophen until it is gone.

1

A client with rapid-rate atrial fibrillation asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective? 1."The vagus nerve slows the heart rate." 2."The diaphragmatic nerve slows the heart rate." 3.The diaphragmatic nerve overdrives the rhythm." 4."The vagus nerve increases the heart rate, overdriving the rhythm.

1

An ambulatory care nurse measures the blood pressure of a client and finds it to be 156/94 mm Hg. Which statement indicates that the client needs additional education? 1."It is important that I limit protein intake." 2."I need to maintain a regular exercise program." 3.I understand that I need to avoid adding salt to foods." 4."It is important that I begin reducing and then maintaining weight."

1

The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided? 1."I will eat enough daily fiber to prevent straining at stool." 2."I will try to exercise vigorously to strengthen my heart muscle." 3."I will drink 3000 to 3500 mL of fluid daily to promote good kidney function."

1

The new registered nurse (RN) is orienting on the cardiac unit. Which statement by the new RN indicates an understanding of an early indication of fluid volume deficit due to blood loss? 1."Pulse rate will increase." 2."Blood pressure will decrease." 3."Edema will be present in the legs." 4."Crackles in the lungs will be present."

1

The nurse assesses the sternotomy incision of a client on the third day after cardiac surgery. The incision shows some slight puffiness along the edges and is nonreddened, with no apparent drainage. The client's temperature is 99°F (37.2°C) orally. The white blood cell count is 7500 mm3 (7.5 × 109/L). How should the nurse interpret these findings? 1.Incision is slightly edematous but shows no active signs of infection. 2.Incision shows early signs of infection, although the temperature is nearly normal. 3.Incision shows no sign of infection, although the white blood cell count is elevated. 4.Incision shows early signs of infection, supported by an elevated white blood cell count.

1

The nurse determines that a client requires further teaching after permanent pacemaker insertion if which statement is made? 1."My pulse rate should be less than what my pacemaker is set at." 2."I'll need to call my health care provider if I feel tired or dizzy." 3.I'll have to avoid carrying the grocery bags into the house for the next 6 weeks." 4.It's safe to use my microwave as long it is properly grounded and well shielded."

1

The nurse has just completed education on myocardial infarction (MI) to a group of new nurses. Which statement made by one of the nurses indicates that the teaching has been effective? 1."Chest pain is caused by tissue hypoxia in the myocardium." 2."Chest pain is caused by tissue hypoxia in the vessels of the heart." 3."Chest pain is caused by tissue hypoxia in the parietal pericardium." 4."Chest pain is caused by tissue hypoxia in the visceral pericardium."

1

The nurse is caring for a client after an above-the-knee amputation. The nurse assesses the residual (remaining) limb and expects to note which finding? 1.Pink color to the skin flap 2.Hot feeling on palpation of the skin flap 3.Serous fluid leaking from the skin flap incision 4.Absent pulse at the proximal pulse point site closest to the skin flap

1

The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? 1.Listening to lung sounds 2.Palpating for organomegaly 3.Assessing for jugular vein distention 4.Assessing for peripheral and sacral edema

1

The nurse is providing postoperative care for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should be most concerned about monitoring for which potential complications 1.Bleeding and infection 2.Thrombosis and infection 3.Bleeding and wound dehiscence 4.Wound dehiscence and evisceration

1

The nurse monitors the client for which condition as a complication of polycythemia vera? 1.Thrombosis 2.Hypotension 3.Cardiomyopathy 4.Pulmonary edema

1

The nurse notes bilateral 2+ edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. Based on this observation, what should the nurse plan to do first? 1.Review intake and output records for the last 2 days. 2.Prescribe daily weights starting on the following morning. 3.Change the time of diuretic administration from morning to evening. 4.Request a sodium restriction of 1 g/day from the health care provider (HCP).

1

A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding? 1.Bilateral edema 2.Increased calf circumference 3.Diminished distal peripheral pulses 4.Coolness and pallor of the affected limb

2

A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation. Which finding indicates that further preparation is needed for the procedure? 1.The client's digoxin has been withheld for the last 48 hours. 2.The client is wearing a nasal cannula delivering oxygen at 2 L/min. 3.The defibrillator has the synchronizer turned on and is set at 120 joules (J). 4.The client has received an intravenous dose of a conscious sedation medication.

2

A client seeks treatment in a health care provider's office for unsightly varicose veins, and radiofrequency ablation (RFA) is recommended. Before leaving the examining room, the client says to the nurse, "Can you tell me again how this is done?" Which statement should the nurse make? 1."The varicosity is surgically removed." 2.A heating element is used to occlude the vein." 3."The vein is tied off at the upper end to prevent stasis from occurring." 4.The vein is tied off at the lower end to prevent stasis from occurring."

2

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? 1.Hypovolemia 2.Acute kidney injury 3.Glomerulonephritis 4.Urinary tract infection

2

After instruction on the application of antiembolism stockings, the nurse determines that the client requires further teaching if which of these actions is performed? 1.The client puts on the stockings before getting out of bed. 2.The client bunches up the stockings for easier application. 3.The client ensures that stockings are pulled up all the way. 4.The client ensures that the rough seams of the stockings are on the outside

2

The nurse has provided self-care activity instructions to a client after insertion of an implanted cardioverter-defibrillator (ICD). The nurse determines that further instruction is needed if the client makes which statement? 1.I need to avoid doing anything that could involve rough contact with the ICD insertion site." 2.I can perform activities such as swimming, driving, or operating heavy equipment as I need to." 3."I should try to avoid doing strenuous things that would make my heart rate go up to or above the rate cutoff on the ICD." 4."I should keep away from electromagnetic sources such as transformers, large electrical generators, and metal detectors, and I shouldn't lean over running motors."

2

The nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is unrelated to the aneurysm? 1.Pulsatile abdominal mass 2.Hyperactive bowel sounds in the area 3.Systolic bruit over the area of the mass 4.Subjective sensation of "heart beating" in the abdomen

2

The nurse is caring for a client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. Which activity will assist with preventing dislodgement of the pacing catheter? 1.Limiting both movement and abduction of the left arm 2.Limiting both movement and abduction of the right arm 3.Assisting the client to get out of bed and ambulate with a walker 4.Having the physical therapist do active range-of-motion exercises to the right arm

2

The nurse is concerned about the adequacy of peripheral tissue perfusion in the post-cardiac surgery client. Which action should the nurse include within the plan of care for this client? 1.Use the knee gatch on the bed. 2.Cover the legs lightly when sitting in a chair. 3.Encourage the client to cross the legs when sitting in a chair. 4.Provide pillows for the client to place under the knees as desired.

2

The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention? 1.Keep the legs aligned with the heart. 2.Elevate the legs higher than the heart. 3.Clean the skin with alcohol every hour. 4.Position the client onto the side during every shift.

2

The nurse is educating the client about variant angina. Which statement by the client indicates that the teaching has been effective? 1."Variant angina is induced by exercise." 2."Variant angina occurs at the same time each day." 3."Variant angina occurs at lower levels of activity." 4."Variant angina is less predictable and a precursor of myocardial infarction.

2

The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? 1.Blood pressure 2.Status of airway 3.Oxygen flow rate 4.Level of consciousness

2

The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. 1.Soak the feet in hot water daily. 2.Be careful not to injure the legs or feet. 3.Use a heating pad on the legs to aid vasodilation. 4.Walk each day to increase circulation to the legs. 5.Cut down on the amount of fats consumed in the diet.

2,4,5

A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action? 1.Check the blood pressure. 2.Call the health care provider (HCP). 3.Check the client and the chest leads. 4.Initiate cardiopulmonary resuscitation (CPR)

3

A client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure was performed, she has been experiencing a sensation as though the affected leg is falling asleep. The nurse should make which response to the client? 1.Apply warm packs to the leg." 2.Keep the leg elevated as much as possible." 3."Your health care provider needs to be contacted to report this problem." 4."This normally occurs after surgery and will subside when the edema goes down.

3

A client has been admitted with left-sided heart failure. When planning care for the client, interventions should be focused on reduction of which specific problem associated with this type of heart failure? 1.Ascites 2.Pedal edema 3.Bilateral lung crackles 4.Jugular vein distention

3

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment? 1.Flat neck veins 2.Nausea and vomiting 3.Hypotension and dizziness 4.Clubbed fingertips and headache

3

A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions? 1."I need to cut down on cigarette smoking." 2."I am so relieved that my heart is repaired." 3."I need to adhere to my dietary restrictions."

3

A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure? 1.Eat breakfast just before the procedure. 2.Wear firm, rigid shoes, such as work boots. 3.Wear loose clothing with a shirt that buttons in front. 4.Avoid cigarettes for 30 minutes before the procedure.

3

A client's total cholesterol level is 344 mg/dL (8.6 mmol/L), low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL (4.25 mmol/L), and high-density lipoprotein cholesterol (HDL-C) level is 30 mg/dL (1.2 mmol/L). Based on analysis of the data, how should the nurse direct client teaching? 1.The client should maintain the current dietary regimen but increase activity level. 2.Results are inconclusive unless the triglyceride level is also screened, so teaching is not indicated at this time. 3.The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught. 4.The client is at low risk for cardiovascular disease, so the client should be encouraged to continue to follow the current regimen

3

The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit (ICU). The nurse notes that a cardiac troponin T assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition? 1.Heart failure 2.Atrial fibrillation 3.Myocardial infarction 4.Ventricular tachycardia

3

The nurse is auscultating a 56-year-old adult client's apical heart rate before giving digoxin and notes that the heart rate is 48 beats/minute. Which action should the nurse take? 1.Withhold the digoxin, and re-evaluate the heart rate in 4 hours. 2.Administer half of the prescribed dose to avoid a further decrease in heart rate. 3.Withhold the digoxin, and assess for signs of decreased cardiac output and digoxin toxicity. 4.Administer the digoxin; the heart rate would be considered normal because of the client's age

3

The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client? 1.Use nail polish to protect the nail beds from injury. 2.Wear gloves for all activities involving the use of both hands. 3.Stop smoking because it causes cutaneous blood vessel spasm. 4.Always wear warm clothing, even in warm climates, to prevent vasoconstriction.

3

The nurse is preparing to ambulate a client on the third day after cardiac surgery. What should the nurse plan to do to enable the client to best tolerate the ambulation? 1.Remove telemetry equipment. 2.Provide the client with a walker. 3.Premedicate the client with an analgesic. 4.Encourage the client to cough and breathe deeply.

3

A client admitted to the hospital with coronary artery disease complains of dyspnea at rest. The nurse caring for the client uses which item as the best means to monitor respiratory status on an ongoing basis? 1.Apnea monitor 2.Oxygen flowmeter 3.Telemetry cardiac monitor 4.Oxygen saturation monitor

4

A client is scheduled for a cardiac catheterization using an iodineagent. Which assessment is most critical before the procedure? 1.Intake and output 2.Height and weight 3.Baseline peripheral pulse rates 4.Previous allergy to contrast agents

4

A client with pulmonary edema has been receiving diuretic therapy. The client has a prescription for additional furosemide in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin, which laboratory result should the nurse review as the priority? 1.Sodium level 2.Digoxin level 3.Creatinine level 4.Potassium level

4

A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? 1."I should notify my doctor if my feet or legs start to swell." 2.My doctor told me to call his office if my pulse rate decreases below 60." 3."Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." 4."My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

4

A new registered nurse (RN) is assigned to the care of a client hospitalized with a diagnosis of hypothermia. After consulting with an experienced RN, which statement by the new RN indicates understanding of likely assessment findings for this client? 1.Increased heart rate and increased blood pressure 2.Increased heart rate and decreased blood pressure 3.Decreased heart rate and increased blood pressure 4.Decreased heart rate and decreased blood pressure

4

A new registered nurse (RN) is assisting the RN in admitting a client who has a diagnosis of hypothermia. The RN provides education to the new RN on anticipated vital signs in the client with hypothermia. Which statement by the new RN indicates that the teaching has been effective? 1."The client will likely exhibit increased heart rate and increased blood pressure." 2."The client will likely exhibit increased heart rate and decreased blood pressure." 3."The client will likely exhibit decreased heart rate and increased blood pressure." 4."The client will likely exhibit decreased heart rate and decreased blood pressure.

4

The nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1.Serum chloride level of 98 mEq/L (98 mmol/L) 2.Serum sodium level of 145 mEq/L (145 mmol/L) 3.Serum calcium level of 10.5 mg/dL (2.75 mmol/L) 4.Serum potassium level of 2.8 mEq/L (2.8 mmol/L)

4

The nurse is caring for a postoperative client who has lost a significant amount of blood because of complications during a surgical procedure. Which assessment finding would be indicative of further fluid volume deficit? 1.4+ edema noted in lower extremities 2.Crackles auscultated from lung bases to apices 3.Blood pressure rises from 116/68 to 118/74 mm Hg 4.Pulse rate increases from 100 beats/min to 136 beats/min

4

Which is the priority assessment in the care of a client who is newly admitted to the hospital for acute arterial insufficiency of the left leg and moderate chronic arterial insufficiency of the right leg? 1.Monitor oxygen saturation with pulse oximetry. 2.Assess activity tolerance before and after exercise. 3.Observe the client's cardiac rhythm with telemetry. 4.Assess peripheral pulses with an ultrasonic Doppler device.

4

The nurse is listening to a lecture about angina. Which statement by the nurse indicates that the teaching has been effective? 1."Stable angina is chronic." 2."Variant angina is caused by emotional stress." 3."Unstable angina is not a life-threatening condition." 4."Intractable angina rarely limits the client's lifestyle."

1

The nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse should immediately ask the client which question? 1.Where is the pain located?" 2"Are you having any nausea?" 3.Are you allergic to any medications?"

1

The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider (HCP) will most likely prescribe which option? 1.Maintain activity level as prescribed. 2.Maintain the affected leg in a dependent position. 3.Administer an opioid analgesic every 4 hours around the clock. 4.Apply cool packs to the affected leg for 20 minutes every 4 hours.

1

A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? 1.Chest pain 2.Urge to cough 3.Warm, flushed feeling 4.Pressure at the insertion site

1

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge 1.Weigh self on a daily basis. 2.Sleep with the head of the bed flat. 3.Take a double dose of the diuretic if peripheral edema is noted. 4.Withhold prescribed digoxin if slight respiratory distress occurs.

1

A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse provides education to the client based on which physiological concept? 1.Vagus nerve stimulation causes a decrease in heart rate and cardiac contractility. 2.Vagus nerve stimulation causes an increase in heart rate and cardiac contractility. 3.Sympathetic nerve stimulation causes a decrease in heart rate and cardiac contractility. 4.Sympathetic nerve stimulation causes an increase in heart rate and cardiac contractility

1

A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as an indicator that the client is experiencing complications of this therapy? 1.Tarry stools 2.Nausea and vomiting 3.Orange-colored urine 4.Decreased urine output

1

The nurse is assessing a client's legs for the presence of edema. The nurse notes that the client has mild pitting with slight indentation and no perceptible swelling of the leg. How should the nurse define and document this finding? . 1. 1+ edema 2.2+ edema 3.3+ edema 4.4+ edema

1

The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription? 1.120 joules 2.200 joules 3.250 joules 4.350 joules

1

The registered nurse (RN) is educating a new nurse about aortic regurgitation. Which statement by the new nurse indicates that the teaching has been effective? 1.Failure of the aortic valve to close completely allows blood to flow retrograde through the aorta to the left ventricle." 2."Failure of the aortic valve to close completely allows blood to flow retrograde through the left ventricle to the left atrium." 3."Failure of the aortic valve to close completely allows blood to flow retrograde through the right ventricle to the right atrium." 4."Failure of the aortic valve to close completely allows blood to flow retrograde through the pulmonary artery to the right ventricle

1

The registered nurse (RN) is orienting a new RN assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. After educating the new RN about cardiac output, which statement made by the new RN indicates the need for further instruction? 1."A cardiac output of 2 L/min is normal." 2."A cardiac output of 4 L/min is normal." 3."A cardiac output of 6 L/min is normal." 4."A cardiac output of 7 L/min is normal."

1

A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? 1.Dietitian 2.Medical social worker 3.Pain management clinic 4.Smoking cessation program

4

A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if which finding is noted with regard to the PVCs? 1.They occur in pairs. 2.They appear to be multifocal. 3.They fall on the second half of the T wave. 4.They decrease to a frequency of less than 6 per minute

4

The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's (HCP's) prescriptions? Select all that apply. 1.Elevation of the right leg 2.Administration of acetaminophen 3.Application of moist heat to the right leg 4.Monitoring for signs of pulmonary embolism 5.Ambulation in around the nursing unit every hour

1,2,3,4

The nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? Select all that apply. 1.Emotional stress 2.Atrial fibrillation 3.Nutritional anemia 4.Peptic ulcer disease 5.Recent upper respiratory infection

1,2,3,5

A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? 1.Anterior chest pain 2.Pericardial friction rub 3.Weakness and irritability 4.Chest pain that worsens on inspiration

2

A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value comes back elevated? 1.Myoglobin 2.Troponinn 3.C-reactive protein 4.Creatine kinase (CK)

2

The nurse is instructing the post-cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse should include which item in the instructions? 1.Driving is permitted as long as the lap and shoulder seat belts are worn. 2.Lifting should be restricted to objects that do not weigh more than 25 pounds (11.3 kg). 3.Use the arms for balance, not weight support, when getting out of bed or a chair. 4.Activities that involve straining may be resumed as long as they do not cause pain

3

The nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? 1.Bundle of His 2.Purkinje fibers 3.Sinoatrial (SA) node 4.Atrioventricular (AV) node

3

The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge? 1."I need to start exercising more to improve my health." 2."I will be sure to keep my appointment with the cardiologist." 3."I don't have anyone to help me with doing heavy housework at home." 4."I think I have a good understanding of what all my medications are for."

3

The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding? 1.The client is not experiencing dyspnea. 2.The client is not experiencing nausea or vomiting. 3.The pain has not been relieved by rest and nitroglycerin tablets. 4.The client says the pain began while she was trying to open a stuck dresser drawer.

3

The registered nurse (RN) is educating a new RN about the use of oxygen for clients with angina pectoris. Which statement by the new nurse indicates that the teaching has been effective? 1."Oxygen has a calming effect." 2."Oxygen will prevent the development of any thrombus." 3."The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells." 4."Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle."

3

The registered nurse (RN) is listening to a lecture on pulmonary edema. Which statement by the RN indicates that the teaching has been effective? 1.The client may have mild anxiety." 2."The client will not experience anxiety." 3.The client will experience extreme anxiety." 4.The client will only experience anxiety in a stressful environment."

3

A client with no history of cardiovascular disease comes to the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which question should best help the nurse discriminate pain caused by a noncardiac problem? 1."Can you describe the pain to me?" 2."Have you ever had this pain before?" 3."Does the pain get worse when you breathe in?" 4."Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"

3

A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms? 1.Left atrium 2.Right atrium 3.Left ventricle 4.Right ventricle

3

The client who is beginning an exercise program asks the nurse why his heart "feels like it's pounding" when he is exercising vigorously. The nurse provides education to the client about increased cardiac response based on which physiological concept? 1.Pulse rate is not a reflection of cardiac response. 2.Cardiac index is the mechanism that allows blood to flow better. 3.Cardiac output is the body's attempt to meet metabolic demands. 4.Stroke volume is an artificial number used to determine the adequacy of cardiac output.

3

The home health nurse is visiting a client who has had a mechanical valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this surgery 1."I need to count my pulse every day." 2."I have to do deep-breathing exercises every 2 hours." 3.I need to throw away my straight razor and buy an electric razor." 4."I have to go to the bathroom frequently because of my medication."

3

Spironolactone is prescribed for a client with heart failure. In providing dietary instructions to the client, the nurse identifies the need to avoid foods that are high in which electrolyte? 1.Calcium 2.Potassium 3.Magnesium 4.Phosphorus

2

A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted? 1.Rhonchi 2.Wheezes 3.Crackles in the bases 4.Crackles throughout the lung fields

3

The nurse educator is teaching the new registered nurse (RN) how to care for clients with a decrease in blood pressure. Which statement by the new RN indicates the need for further instruction? 1."Decreased contractility occurs." 2."Decreased heart rate is not a side effect." 3."Decreased myocardial blood flow is not a concern." 4.Increased resistance to electrical stimulation often occurs.

3

A client is at risk for vasovagal attacks that cause bradydysrhythmias. The nurse would tell the client to avoid which actions to prevent this occurrence? Select all that apply. 1.Applying pressure on the eyes 2.Raising the arms above the head 3.Taking stool softeners on a daily basis 4.Bearing down during a bowel movement 5.Simulating a gag reflex when brushing the teeth

1,2,4,5

A nursing student who is researching a medication at the nurses' station asks the registered nurse (RN) what the function of an alpha-adrenergic receptor is, and where the receptors are primarily found. The RN educates the nursing student. Which statement by the nursing student indicates that teaching has been effective? 1."The peripheral arteries and veins; when stimulated they cause vasoconstriction." 2.Arterial and bronchial walls; when stimulated they cause vasodilation and bronchodilation." 3."The heart; when stimulated it causes an increase in heart rate, atrioventricular node conduction, and contractility." 4."Several tissues; when stimulated they cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation."

1

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? 1.The neurovascular status is normal because of increased blood flow through the leg. 2.The neurovascular status is moderately impaired, and the surgeon should be called. 3.The neurovascular status is slightly deteriorating and should be monitored for another hour. 4.The neurovascular status is adequate from an arterial approach, but venous complications are arising

1

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse should next assess the client for which finding? 1.Hypotension 2.Flat neck veins 3.Complaints of nausea 4.Complaints of headache

1

The nurse is developing a plan of care for a client recovering from pulmonary edema. The nurse establishes a goal to have the client participate in activities that reduce cardiac workload. The nurse should identify which client action as contributing to this goal? 1.Using a bedside commode 2.Sleeping in the supine position 3.Elevating the legs when in bed 4.Using seasonings to improve the taste of food

1

The nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin notes that the heart rate is 52 beats/min. The nurse should make which interpretation of this information? 1.Normal, because of the client's age 2.Abnormal, requiring further assessment 3.Normal, as a result of the effects of digoxin 4.Normal, because this is the reason the client is receiving digoxin

2

The post-myocardial infarction client is scheduled for a technetium-99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure? 1.A urinary catheter 2.Signed informed consent 3.A central venous pressure (CVP) line 4.Notation of allergies to iodine or shellfish

2

The registered nurse (RN) is educating a new nurse on mitral stenosis. Which statement by the new nurse indicates that the teaching has been effective? 1."Left ventricle to aorta narrowing will impede flow of blood." 2."Left atrium to left ventricle narrowing will impede flow of blood." 3."Right atrium to right ventricle narrowing will impede flow of blood." 4."Right ventricle to pulmonary artery narrowing will impede flow of blood

2

The nurse in the medical unit is assigned to provide discharge teaching to a client with a diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to minimize the effects of the disease process. The client continually changes the subject during the teaching session. The nurse interprets that this client's behavior is most likely related to which problem? 1.Anxiety related to the need to make lifestyle changes 2.Boredom resulting from having already learned the material 3.An attempt to ignore or deny the need to make lifestyle changes 4.Lack of understanding of the material provided at the teaching session and embarrassment about asking questions

3

Endovenous laser treatment (EVLT) is done on a client with varicose veins. Which interventions should the nurse include in the postprocedure plan of care? 1.Inform the client that the EVLT procedure ensures closure of the treated vein. 2.Assess color and temperature of the affected limb to determine vascular status. 3.Teach the client the importance of using graduated compression stockings (GCSs) during the day. 4.Inform the client that circulation impairment and nerve damage is expected to occur following the procedure.

2

The nurse educator is lecturing new registered nurses (RNs) about serum calcium levels. Which statement by one of the new RNs indicates that teaching has been effective? 1.Calcium has no effect on the risk for stroke." 2."Low calcium levels can lead to cardiac arrest." 3."Low calcium levels cause high blood pressure." 4.Calcium has no effect on urinary stone formation.

2

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? 1.Muffled heart sounds 2.A rise in blood pressure 3.Jugular venous distention 4.Client expressions of dyspnea

2

The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary to control disease progression. Which statement by the client indicates a need for further teaching? 1.I will avoid using table salt with meals." 2."It is best to exercise once a week for 1 hour." 3.I will take nitroglycerin whenever chest discomfort begins." 4."I will use muscle relaxation to cope with stressful situations.

2

The nurse is assessing the client's condition after cardioversion. Which observation should be of highest priority to the nurse? 1.Heart rate 2.Skin color 3.Status of airway 4.Peripheral pulse strength

3

A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer? 1.Ad lib activities as tolerated 2.Strict bed rest for 24 hours after transfer 3.Bathroom privileges and self-care activities 4.Unsupervised hallway ambulation for distances up to 200 feet (60 meters)

3

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? 1.Call a code. 2.Call the health care provider. 3.Check the client's status and lead placement. 4.Press the recorder button on the electrocardiogram console.

3

A client who has been exercising in a gymnasium stops to measure his pulse and places his fingers over both carotid arteries simultaneously. The nurse exercising nearby is correct when cautioning the client to check the pulse on only one side, primarily for which reason? 1.It is unnecessary to use both hands. 2.The client could occlude the trachea. 3.The heart rate and blood pressure could drop. 4.Feeling dual pulsations may lead to an incorrect measurement.

3

A client with a history of hypertension has been prescribed triamterene. The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit? 1.Pears 2.Apples 3.Bananas 4.Cranberries

3

A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise? 1.Oxygen saturation decreased from 96% to 91%. 2.Pulse rate increased from 80 to 104 beats per minute. 3.Blood pressure decreased from 140/86 to 112/72 mm Hg. 4.Respiratory rate increased from 16 to 19 breaths per minute.

4

The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease? 1.Checking for a rash on the digits 2.Observing for softening of the nails or nail beds 3.Palpating for a rapid or irregular peripheral pulse 4.Palpating for diminished or absent peripheral pulses

4

A home care nurse is visiting a client to provide follow-up evaluation and care of a leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is pale and deep and that the surrounding tissue is cool to the touch. The nurse should document that these findings identify which type of ulcer? 1.A stage 1 ulcer 2.A vascular ulcer 3.An arterial ulcer 4.A venous stasis ulcer

3``

A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client about the dietary restrictions required with HF. Which statement by the client indicates that further teaching is needed? 1."I'm not supposed to eat cold cuts." 2."I can have most fresh fruits and vegetables." 3."I'm going to weigh myself daily to be sure I don't gain too much fluid." 4."I'm going to have a ham and cheese sandwich and potato chips for lunch."

4

A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction? 1.Take acetaminophen if the chest pain worsens. 2.Take antibiotics until the chest pain is fully resolved. 3.Use a firm-bristle toothbrush and floss vigorously to prevent cavities. 4.Notify all health care providers (HCPs) of the history of infective endocarditis before any invasive procedures

4

A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions? 1."It will really hurt when the catheter is first put in." 2."I will receive general anesthesia for the procedure." 3"I will have to go to the operating room for this procedure." 4.I probably will feel tired after the test from lying on a hard x-ray table for a few hours."

4

A client who had coronary artery bypass surgery states to the home health nurse, "I get so frustrated. I can't even do my gardening." The nurse then assesses the client for activity level since the surgery. Which client statement indicates a need for further teaching? 1."I pace my activities throughout the day." 2."I plan regular rest periods during the day." 3."I avoid outdoor physical activity during the heat of the day." 4."I try to walk immediately after lunch, after I've finished my morning housecleaning.

4

A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and is receiving education about the procedure from the nurse. Which statement by the client indicates that the teaching has been effective? 1."It involves tying off the veins so that circulation is redirected in another area." 2."It involves surgically removing the varicosity, so anesthesia will be required." 3.It involves tying off the veins to prevent sluggishness of blood from occurring." 4.It involves injecting an agent into the vein to damage the vein wall and close it off."

4

A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. Which nursing action should be included in the client's plan of care? 1.Limiting oral and intravenous fluids 2.Measuring the client's pulse each shift 3.Providing the client with short, frequent walks 4.Eliminating sources of caffeine from meal trays

4

A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement? 1."The work of breathing is increased when the client is anemic." 2."Blood flows more slowly when the hemoglobin or hematocrit is low." 3."The body has to work harder to fight infection in the presence of anemia." 4.Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."

4

A client with myocardial infarction is experiencing new, multiform premature ventricular contractions and short runs of ventricular tachycardia. The nurse plans to have which medication available for immediate use to treat the ventricular tachycardia? 1.Digoxin 2.Verapamil 3.Acebutolol 4.Amiodarone

4

A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which response by the student indicates a need for further teaching on the anatomy and physiology of the heart? 1."The coronary arteries branch from the aorta." 2."The coronary arteries supply the heart muscle with blood." 3."The left coronary artery provides blood for the left atrium and the left ventricle." 4."The left coronary artery supplies the right atrium and right ventricle with blood."

4

The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction? 1."I need to be sure not to go barefoot around the house." 2."If I cut my toenails, I need to be sure that I cut them straight across." 3.It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." 4."I need to be sure that I elevate my leg above the level of my heart for at least an hour every day."

4

The home health nurse makes a home visit to a client who has an implanted cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary? 1."If I feel an internal defibrillator shock, I should sit down." 2."I won't be able to have a magnetic resonance imaging test (MRI)." 3."My wife knows how to call the emergency medical services (EMS) if I need it." 4."I can stop taking my antidysrhythmic medicine now because I have a pacemaker."

4

The home health nurse visits a client recovering after an episode of cardiogenic shock secondary to an anterior myocardial infarction (MI) and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? 1.I exercise every day after breakfast." 2."I've gained 8 pounds (3.6 kg) since discharge." 3."I take an antacid when I experience epigastric pain." 4.I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily."

4

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority? 1.Anxiety level of the client and family 2.Presence of a MedicAlert card for the client to carry 3.Knowledge of restrictions on post discharge physical activity 4.Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver

4

The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking? 1.None of the cardiovascular effects are reversible, but quitting might prevent lung cancer." 2.Because most of the damage has already been done, it will be all right to cut down a little at a time." 3.If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year." 4.If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years.

4

The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do? 1.Walk for as long as possible each day. 2.Cross the legs at the ankle only, not at the knee. 3.Sit in a chair 3 times a day for 3 hours at a time. 4.Lie down with the legs elevated and avoid sitting.

4

The nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The health care provider (HCP) tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse determines that the blockage is located in which area? 1.Circumflex coronary artery 2.Right coronary artery (RCA) 3.Posterior descending coronary artery (PDA) 4.Left anterior descending coronary artery (LAD)

4

The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL (4.9 mmol/L), and fasting blood glucose level of 184 mg/dL (10.2 mmol/L). The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)? 1.Age 2.Hypertension 3.Hyperlipidemia 4.Glucose intolerance

4