ATI - car. Circulation and Perfusion 2

· A nurse is preparing to administer Dabigatran to a client who has A Fib. The nurse should explain that the purpose of this medication is which of the following?

To red. the risk of stroke in clients who have A Fib

· A nurse in the emergency dept. is caring for a client who reports chest pressure and SOB. Which of the following lab tests should the nurse anticipate the provider to order?

Troponin I

· A nurse is caring for a client who has a prescription for Digoxin 0.25mg PO daily. The amount available is 0.125mg tab. The current vitals: BP- 144/96 HR- 54 RR- 18 Temp- 98.6. Which action should the nurse take?

Withhold dose due to dec. HR

· A nurse on a med-surg unit is caring for a client who reports pain in the jaw, back, and shoulder; shortness of breath and nausea. Which of the following actions should the nurse take?

obtain an ekg

· A nurse is providing teaching to a client who has a family hx or hypertension. The nurse should inform the client that his BP of 124/84 places him in which category?

pre-hypertension

• A client is to receive Enoxaparin 30mg Sub Q. Available is Enoxaparin 40mg/ml. How many mL should the nurse administer?

0.8mls

· A nurse is preparing to administer Digoxin 8mcg/kg/day PO to divide equally every 12hrs for a preschooler who weights 33lbs. Available is Digoxin elixir 0.05mg/ml. How many mL should the nurse administer per dose?

1.2mls

· A nurse is caring for a client who reports a new onset of chest pressure, severe epigastric distress. The physician prescribes monitoring of CK isoenzymes. When should the nurse anticipate the CK isoenzymes will begin to rise if the client has had a MI?

2-3hrs

· Nurse is preparing to administer Hydrochlorothiazide 25mg PO daily to a client. Available is 50mg/5ml. How many milliliters should the nurse administer?

2.5mls

· A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

Apply pressure to needlesticks for 10mins

· A nurse is admitting a client who has a serum calcium level of 12.3mg and initiates cardiac monitoring. Which of the following findings should the nurse expect during the initial assessment? [9-11]

Lethargy

· A nurse in an outpatient clinic is assessing a middle adult client as part of a routine physical examination. The client's BP is 142/88. BMI is 31. Current smoker. The nurse should identify that this client has multiple risk factors for which disorder?

Cardiovascular disease

· A nurse is assessing a client's circulatory system. Which of the following pulse sites should the nurse avoid assessing bilaterally at the same time?

Carotid

· A nurse is assessing a client who has chronic venous insufficiency. Which of the following findings should the nurse expect?

Edema

· A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. Which of the following findings should the nurse expect?

Elevated CVP

· A nurse is providing discharge teaching to a client who has a new diagnosis of heart failure. Which of the following instructions should the nurse include in the teaching?

Exercise at least three times per week

· A nurse is providing teaching for a client who has a new diagnosis of Angina Pectoris. The nurse should give the client which of the following information about Anginal pain?

Exertion and anxiety can trigger angina

· A nurse is assessing a client who is postop and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect?

Fatigue

· A nurse is preparing an in-service about the various supplements clients might use. Which of the following herbal supplements should the nurse include as potentially increasing the anticoagulant effects of Aspirin and other oral anticoagulants?

Feverfew

· A nurse is assessing a client who is at risk for DVT. Which of the following findings is a manifestation of DVT?

Groin Tenderness

· A nurse is reviewing discharge instructions with a client who has Raynaud's disease. Which of the following client statements indicates an understanding of the teaching?

I am going to take a stress management class

· A nurse is providing discharge instructions for a client who has CHF. Which of the following client statements indicates to the nurse that the teaching was effective?

I plan to slow down if I am tired the day after exercising

· A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following statements by the client indicates an understanding of the teaching?

I should expect dark, tarry stools

· A nurse is providing teaching to a client who has a new prescription for Lisinopril. Which of the following statements by the nurse indicates an understanding of the teaching?

I should report a cough to my provider

· A nurse is performing an ECG on a client who is experiencing chest pain. Which of the following statements should the nurse make?

I will need to apply electrodes to your chest and extremeties

· A client tells the nurse that he is concerned because his provider told him he has a heart murmur. The nurse should explain to the client that a murmur...

Indicates turbulent blood flow through a valve

· A nurse at a provider's office receives a phone call from a client who reports nausea and unrelieved chest pain after taking a nitroglycerin tablet 5 minutes ago. Which of the following is an appropriate response by the nurse?

Instruct client to call 911

· A nurse is caring for a client who has PAD. Which of the following symptoms should the nurse expect to find in the early stage of the disease?

Intermittent claudication

· A nurse is preparing a client who is scheduled for an echocardiogram the following day. Which of the following instructions should the nurse include about the test?

It requires lying quietly on one side

· A nurse is preparing a client for an MRI of the heart and great vessels. Which of the following instructions should the nurse include about this test?

It requires removing metal objects like jewelry

· A nurse is reviewing the laboratory results of a male adult client who is at risk for peripheral arterial disease from atherosclerosis. The nurse should identify that which of the following results places the client at risk?

LDL 172mg

· A nurse is collecting a medication hx from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury?

Metformin

· A nurse in an emergency dept. is planning care for a client who is having an acute MI. The nurse should plan to administer which of the following medications after the initial acute phase to manage the client's pain and anxiety?

Morphine

· A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

Oral mucuosa

· A nurse is reviewing lab results of a client who has A Fib and is taking Warfarin. For which of the following results should the nurse notify the provider?

PT 45seconds [11-12.5]

· A nurse is assessing a child who is in sickle cell crisis. Which of the following findings should the nurse expect?

Pain

· A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take?

Perform neurovascular checks with vital signs

· A nurse is caring for a female client who reports an increase in bruising. The nurse should expect which of the following lab values?

Platelets 110,000 [150,000-400,000]

· A nurse is reviewing the serum lab findings of a client who has hypertension and is prescribed Hydrochlorothiazide. Which of the following findings should the nurse report to the provider?

Potassium 2.3 [3.5-5]

· A nurse is teaching a client who has a new diagnosis of A Fib. The nurse should instruct the client to monitor which of the following complications?

Pulmonary embolism

· A nurse is assessing a client prior to the administration of Morphine. The nurse should recognize that which of the following assessments is the priority?

RR

A nurse is reviewing a client's lab results. Which of the following lab values should the nurse report to the provider?

Sodium 126 [135-145]

· A nurse is caring for a client who has hypertension and is afraid to take his BP medication. Which of the following nursing statements is an example of the therapeutic communication response of reflection?

You seem upset about taking your BP medication

· A nurse is teaching a client who has a new prescription for Simvastatin. Which of the following instructions should the nurse include?

You should avoid grapefruit juice

· A nurse is providing teaching about iron deficiency anemia to the parents of a toddler. Which of the following should the nurse recommend as a method of preventing iron deficiency anemia?

avoid a diet consisting primarily of milk

· A nurse enters a client's room and finds him unresponsive. After notifying the rapid response team, which of the following actions should the nurse take first?

check for a carotid pulse

· A nurse is caring for a client who has A Fib and receiving Heparin. Which of the following findings is the nurse's priority?

client experiences sudden weakness of one arm and leg

· A nurse is reviewing BP classifications with a group of nurses at an in-service meeting. Which of the following should the nurse include as a risk factor for the development of hypertension?

obstructive sleep apnea

· A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect?

frothy sputum

· A nurse is providing teaching about a heart healthy diet to a group of clients with hypertension. Which of the following statements by one of the clients indicates a need for further teaching?

lean meats should be limited to 5-6 ounces per day

· A nurse is assessing a client who has heart failure and is prescribed Furosemide. Which of the following findings is an adverse effect of this mediation?

leg cramps

· A nurse is assessing a client who had hypercholesterolemia and receiving Simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect? o Muscle weakness

muscle weakness

· A nurse is preparing a sterile field prior to inserting a Foley Cath. Identify the sequence of steps the nurse should plan to follow.

o Hand hygiene o Place package on work surface o Open outermost flap away from self o Open side flap, pulling to the side o Open innermost flap to self o Use inner surface of package as sterile field

· A nurse is reinforcing teaching with a client regarding reduction of risk factors for coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply.

o I must stop smoking o I need to monitor my weight o I am limiting my intake of fast foods

· A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the client indicates the need for further teaching?

o I should leave the patch in place until it is time for the next dose

· A nurse is caring for a client who has a new prescription for Ferrous Sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take ferrous sulfate between meals. Which of the following responses should the nurse make?

o Taking the mx between meals will help you absorb the mx more efficiently

· A nurse is providing discharge instructions to a client following a cardiac cath. Which of the following information should the nurse include?

o You will notice a small hematoma at the incision site

· A nurse is caring for a client who is receiving Heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose?

protamine

· A nurse is teaching with a group of nurses about the administration of Nitroglycerin. Which of the following routes of administration provides the most rapid onset for the client?

sublingual

· A nurse is teaching a client who has a new diagnosis of venous insufficiency. Which of the following instructions should the nurse include?

use elastic stockings