Targeted Medical Surgical Cardiovascular Online Practice 2019

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

"I can't get rid of these hiccups." Rationale: Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.

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

"I smoked a cigarette this morning to calm my nerves about having this procedure."

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

"You may no longer be able to feel chest pain."

A nurse in the emergency department is caring for a client who had an anterior MI. The client's history reveals she is 1 week post-op open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated?

Assisting with thrombolytic therapy

A nurse is assessing a client in the emergency room who has a bradydysrhythmia. Which of the following findings should the nurse expect?

Confusion Rationale: Bradydysrhythmia can decrease systemic perfusion and can lead to confusion.

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

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

A nurse is caring for a client who has a history of DVT and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy? a. hemoglobin 14 b. minimal bruising of extremities. c. Decreased blood pressure d. INR 2.0

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

A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.

Left fifth intercostal space in the mid clavicular line. *Apex left ventricular area

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

Lightheadedness

A nurse is planning a presentation about hypertension for a community women's group. Which of the following lifestyle modifications should the nurse include? a. Limited alcohol intake b. Regular exercise program c. Tobacco cessation d. Decreased magnesium intake e. Reduced potassium intake

Limited alcohol intake Regular exercise program Tobacco cessation

A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Identify the area of the strip the nurse should examine to observe for atrial depolarization

P wave

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

Place the patch on an area of skin away from skin folds and joints.

A nurse is preparing a client for coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure?

Previous allergic reaction to shellfish

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

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

A nurse is reviewing the laboratory results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which laboratory values?

The expected reference range of cholesterol is less than 200 mg/dL, HDL above 45 mg/dL for men and above 55 mg/dL for women, and LDL less than 130 mg/dL.

A nurse is caring for a client in the first hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider?

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

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

Valvular disease Rationale: Damage occurs as a results of inflammation or infection of the endocardium.

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

a. Slurred speech Rationale: Client is at risk for an embolus caused by pooling of blood that can occur with AFib. Dependent edema is an expected finding for a client with HF.

P wave

atrial depolarization

A nurse is reviewing the medical record of a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse anticipate taking if the client's aPTT is 96 seconds? a. Increase heparin flow rate by 2 mL/hr b. Continue to monitor the heparin infusion as prescribed. c. Request a prothrombin time (PT) d. Stop the heparin infusion.

d. Stop the heparin infusion Rationale: the aPTT is above the critical value and client is displaying manifestations of bleeding, so the heparin should be discontinued.

Point of maximal impulse (PMI)

the point where the apex of the heart touches the anterior chest wall and heart movements are most easily observed and palpated

A nurse is assessing a client who has pulmonary edema related to hear failure. Which of the following findings indicates effective treatment of the client's condition? a. Absence of adventitious breath sounds b. Presence of a nonproductive cough c. Decrease in respiratory rate at rest d. SaO2 86% on room air

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

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

Creatine kinase- MB Rationale: Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury.Myoglobin is elevated following an MI, and with skeletal muscle injury. However, it is not specific to the cardiac muscle. C-reactive protein increases soon after the beginning of an inflammatory process, such as rheumatoid arthritis, and is not specific to cardiac muscle. Homocysteine is always present in the blood. An increased level might indicate a risk factor for the development of cardiovascular disease.

A nurse is providing discharge teaching for a client who has HF. The nurse should instruct the client to report which of the following findings immediately to the provider? a. Weight gain of 0.9 kg (2 lb) in 24 hr b. Increase of 10 mm Hg in systolic blood pressure c. Dyspnea with exertion d. Dizziness when rising quickly

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

A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? a. A client who has hypothyroidism. b. A client who has diabetes mellitus. c. A client whose daily caloric intake consists of 25% fat. d. A client who consume two 12-oz bottles of beer a day.

b. A client who has diabetes mellitus. Rationale: risk for microvascular damage and progressive PAD.

A nurse is teaching a client who has a new prescription for an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify the provider if they experience which of the following adverse effects of this medication? a. Tendon pain b. Persistent cough c. Frequent urination d. Constipation

b. Persistent cough

A nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. Which of the following client findings should the nurse report to the provider? a. Mediastinal drainage 100 mL/hr b. BP 160/80 mm Hg c. Temp 37.1 C (98.8 F) d. Potassium 4.0 mEq/L

b. Report an elevated blood pressure. Rationale: because increased vascular pressure can cause bleeding at the incision sites.

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

b. Vagal stimulation Rationale: might temporarily convert the client's HR to normal sinus rhythm, and have defibrillator and resuscitation equipment at bedside in cause vagal stimulation causes bradydysrhythmias, ventricular dysrhmythmias, or asystole.

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

b. Weak peripheral pulses.

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

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

A nurse is caring for a client who presents to the ER with a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? a. Initiate seizure precautions b. Tell the client to report vision changes c. Elevate the head of the client's bed. d. Start a peripheral IV

c. Elevate the head of the client's bed. Rationale: the greatest risk to this client is organ injury due to severe hypertension. Elevating the bed reduces BP and promotes oxygenation.

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

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