Cancer
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?
Potassium
The nurse is preparing to administer furosemide to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to check before administering this medication?
Potassium level
A client is due for a dose of bumetanide. The nurse would temporarily withhold the dose and notify the primary health care provider (PHCP) if which laboratory test result is noted?
Potassium level of 2.9 mEq/L (2.9 mmol/L)4
The nurse is preparing to ambulate a client on the third day after cardiac surgery. What would the nurse plan to do to enable the client to best tolerate the ambulation?
Premedicate the client with an analgesic.4
A client is scheduled for a cardiac catheterization using an iodine agent. Which assessment is most critical before the procedure?
Previous allergy to contrast agents
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?
"It involves injecting an agent into the vein to damage the vein wall and close it off." Submit
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?
"Low calcium levels can lead to cardiac arrest."
The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement would the nurse make to try to motivate the client to quit smoking?
"If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."
A client with iron-deficiency anemia complains of feeling fatigued almost all of the time. The nurse would respond with which statement?
"Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism." Submit
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?
"Chest pain is caused by tissue hypoxia in the myocardium."
The nurse educator is teaching the new registered nurse (RN) about clients with a structural heart disorder experiencing a decrease in blood pressure. Which statement by the new RN indicates the need for further instruction?
"Decreased myocardial blood flow is not a concern."4
A child with rheumatic fever will be arriving at the nursing unit for admission. On admission assessment, the nurse would ask the parents which question to elicit assessment information specific to the development of rheumatic fever?
"Did the child have a sore throat or fever within the last 2 months?"
A client with no history of cardiovascular disease comes to the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which question would best help the nurse discriminate pain caused by a noncardiac problem?
"Does the pain get worse when you breathe in?"
A home health nurse instructs a client about the use of a nitrate patch. The nurse would make which statement to the client to prevent client tolerance to nitrates?
"Have a 12-hour 'no-nitrate' time."
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?
"I can perform activities such as swimming, driving, or operating heavy equipment as I need to."
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?
"I can stop taking my antidysrhythmic medicine now because I have a pacemaker." Submit
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?
"I don't have anyone to help me with doing heavy housework at home."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?
"I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily."
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?
"I need to throw away my straight razor and buy an electric razor."
A client with coronary artery disease 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?
"I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
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?
"I try to walk immediately after lunch, after I've finished my morning housecleaning."
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?
"I'm going to have a ham and cheese sandwich and potato chips for lunch."
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction?
"If my child vomits after medication administration, I will repeat the dose."
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?
"My spouse told me that since I have this problem, we are going to stop walking in the mall every morning." Submit
The nurse has completed an educational course about first-degree heart block. Which statement by the nurse indicates that teaching has been effective?
"Prolonged, equal PR intervals indicate first-degree heart block." Submit
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?
"Pulse rate will increase."
The nurse is listening to a lecture on Advanced Cardiac Life Support (ACLS). The instructor is discussing electrocardiographic (ECG) changes caused by myocardial ischemia. Which statement by the nurse indicates that teaching has been effective?
"ST segment elevation or depression can indicate ischemia."
Following a lecture on coronary artery disease, 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?
"The left coronary artery supplies the right atrium and right ventricle with blood." Submit
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?
"The peripheral arteries and veins; when stimulated they cause vasoconstriction."
A client with rapid-rate atrial fibrillation asks the nurse why the cardiologist is going to perform carotid sinus massage. The nurse educates the client about the vagus and diaphragmatic nerves and about the treatment. Which statement by the client indicates that the teaching has been effective?
"The vagus nerve slows the heart rate."
The nurse is educating the client about variant angina. Which statement by the client indicates that the teaching has been effective?
"Variant angina occurs at the same time each day."4
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction?
"We can apply lotion or powder to the incision if it is itchy."3
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 would immediately ask the client which question?
"Where is the pain located?"
A client calls the nurse at the clinic and reports experiencing a sensation as though the affected leg is falling asleep ever since the vein ligation and stripping procedure was performed. The nurse would make which response to the client?
"Your primary health care provider needs to be contacted to report this problem."
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 2Raising the arms above the head 4Bearing down during a bowel movement 5Simulating a gag reflex when brushing the teeth
The nurse is caring for a postoperative client weighing 68 kilograms (kg) who began to show signs of altered mental status, decreased mean arterial pressure (MAP), hypotension, fever, and tachycardia. The nurse suspects sepsis and notifies the primary health care provider (PHCP). The nurse would anticipate which of the following interventions? Select all that apply.
1 Obtain blood cultures 2Draw serum lactate levels 3Administer broad-spectrum antibiotics 5Administer 2 liters (L) of IV 0.9% normal saline solution over 1 hour
The nurse is caring for a client with no significant medical history who is receiving intravenous antibiotics for cellulitis of the right lower extremity. The nurse is reviewing the client's laboratory results and would determine that which of the following results are indicative of developing sepsis? Select all that apply.
1 Plasma glucose of 162 mg/dL (9 mmol/L) 2 Platelet count of 90,000 mm3 (90 × 109/L) 5 White blood cell (WBC) count of 3,000 mm3 (3 × 109/L)
The nurse is caring for a client in septic shock with hyperlactatemia. The nurse notes the first serum lactate level was drawn at 1200. When would the nurse expect the next lactate level to be drawn?
1800
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.
1Emotional stress 2Atrial fibrillation 3Nutritional anemia 5Recent upper respiratory infection
Which of the clients under the nurse's care is at an increased risk for sepsis or septic shock? Select all that apply.
2 A 40-year-old client receiving chemotherapy for breast cancer 3A 45-year-old client with a CD4 count of 180 cells/mm3 (0.18 × 109/L) 4A 52-year-old client with a glycosylated hemoglobin (HbA1c) of 9.2% (77 mmol/mol) 5A 63-year-old client with chronic kidney disease managed with dialysis 3 times per week
The nurse is preparing to administer furosemide 40 mg by intravenous (IV) injection (IV push) to a client. The nurse would administer the medication over which time period?
2 minutes
The nurse is caring for a client with hypertension who is receiving torsemide orally daily. Which laboratory test result would indicate to the nurse that the client may be experiencing a side or adverse effect related to the medication?
A potassium level of 3.1 mEq/L (3.1 mmol/L)4
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. Which assessment is the nursing priority?
Activation status and settings of the device
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse would assess which item based on priority?
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver
A client with severe coronary artery disease 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?
Acute kidney injury
The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority?
Airway patency
Hydrochlorothiazide has been prescribed for a client with hypertension. The nurse contacts the primary health care provider (PHCP) to verify the prescription if which condition is noted in the assessment data?
Allergy to sulfonamides
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 would document that these findings identify which type of ulcer?
An arterial ulcer4
Endovenous laser treatment (EVLT) is done on a client with varicose veins. Which interventions would the nurse include in the postprocedure plan of care?
Assess color and temperature of the affected limb to determine vascular status.
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?
Assess peripheral pulses with an ultrasonic Doppler device.
The nurse is assessing a client newly diagnosed with mild hypertension. Which assessment finding would the nurse expect?
Asymptomatic2
A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level would the nurse encourage for the client immediately after transfer?
Bathroom privileges and self-care activities4
A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point?
Before each QRS complex
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 would be most concerned about monitoring for which potential complications?
Bleeding and infection2
The nurse is performing a cardiovascular assessment on a client with heart failure. Which parameter would the nurse assess to gain the best information about the client's left-sided heart function?
Breath sounds2
A client returning to the nursing unit after a cardiac catheterization procedure has a stat prescription to receive a dose of intravenous procainamide. Which piece of equipment would be most appropriate for the nurse to use in determining the client's response to this medication?
Cardiac monitor
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?
Pulse rate increases from 100 beats/min to 136 beats/min
An emergency room nurse is performing a cardiovascular assessment on a client. During auscultation of the heart sounds, the nurse hears these abnormal sounds. The nurse suspects that the client has which condition? Refer to audio.
Ventricular hypertrophy
A client is attached to a cardiac monitor, and the nurse notes the presence of this cardiac rhythm on the monitor. The nurse quickly assesses the client, knowing that this rhythm is indicative of which of the following? Refer to figure.
Ventricular tachycardia (VT)4
A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction would the nurse plan to provide to the client about this procedure?
Wear loose clothing with a shirt that buttons in front.4
A client recovering from pulmonary edema is preparing for discharge. What would the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge?
Weigh self on a daily basis.2
A client with heart failure is scheduled to be discharged to home with digoxin and furosemide as daily prescribed medications. The nurse tells the client to report which finding as an indication that the medications are not having the intended effect?
Weight gain of 2 to 3 lb in a few days
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?
Crackles in the bases4
A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. Which nursing action would be included in the client's plan of care?
Eliminating sources of caffeine from meal trays
An antihypertensive medication has been prescribed for a client with hypertension. The client tells the clinic nurse about wanting to take an herbal substance to help lower the blood pressure. The nurse would take which action?
Encourage the client to discuss the use of an herbal substance with the primary health care provider (PHCP).4
The nurse is caring for a client who is on strict bed rest and creates a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing?
Encouraging active range-of-motion exercises4
The nurse is planning to administer hydrochlorothiazide to a client diagnosed with hypertension. The nurse would monitor for which adverse effects related to the administration of this medication?
Hypokalemia, hyperglycemia, sulfa allergy4
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 would next assess the client for which finding?
Hypotension
A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation would the nurse observe for when performing the client's focused assessment?
Hypotension and dizziness4
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 non-reddened, 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 would the nurse interpret these findings?
Incision is slightly edematous but shows no active signs of infection.2
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?
Left ventricle4
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?
Lie down with the legs elevated and avoid sitting.
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?
Listening to lung sounds
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?
Metformin
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats per minute. Which action would the nurse take?
Monitor for any rhythm change.
The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication?
Muffled or distant heart sounds4
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?
Myocardial infarction
The nurse is preparing to administer intravenous fluids to a client in hypovolemic shock with significant interstitial edema. The nurse would anticipate administering which of the following solutions?
Normal serum human albumin
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?
Oxygen saturation monitor
The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How would the nurse assess for this disease?
Palpating for diminished or absent peripheral pulses
Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? Refer to figure (the circled area) to determine the condition.
Patent ductus arteriosus4
A client is admitted to the hospital with a diagnosis of pericarditis. The nurse would assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems?
Pericardial friction rub
A client is having a follow-up primary health care provider (PHCP) 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?
Report the complaint to the PHCP.
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 would the nurse plan to do first?
Review intake and output records for the last 2 days.
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?
Serum potassium level of 2.8 mEq/L (2.8 mmol/L) Submit
A client is scheduled to receive a daily morning dose of furosemide. Which client laboratory result warrants a call to the primary health care provider (PHCP) prior to the medication administration?
Serum potassium of 2.8 mEq/L (2.8 mmol/L)
A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/minute. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How would the nurse report this rhythm?
Sinus dysrhythmia
The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse would plan to provide which instruction to the client?
Stop smoking because it causes cutaneous blood vessel spasm.
The nurse has a prescription to give a first dose of hydrochlorothiazide to an assigned client. The nurse would question the prescription if the client has a history of allergy to which item?
Sulfa medications
The nurse is preparing to care for a client arriving at the emergency department who is in suspected hypovolemic shock. How would the nurse plan to position the client?
Supine position with lower extremities elevated
A client is taking amiloride 10 mg orally daily for hypertension. What medication instruction would the nurse provide to the client?
Take the dose in the morning.
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?
The cardiac output is below the normal range.3
The nurse is reviewing the procedure for performance of an electrocardiogram (ECG). Which action by the nurse indicates understanding of the correct position for the V1 lead when performing a 12-lead electrocardiogram?
The lead is placed on the fourth intercostal space right sternal border.3
The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving intravenous doses of furosemide. The client is attached to cardiac telemetry, and the nurse is monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has changed to this pattern. The nurse determines that the most likely cause of this cardiac rhythm in the client is which problem? Refer to figure.
The presence of hypokalemia
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?
They decrease to a frequency of less than 6 per minute.
The nurse monitors the client for which condition as a complication of polycythemia vera?
Thrombosis
A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse would suspect myocardial injury or infarction if which laboratory value comes back elevated?
Troponin
A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates that the medication has achieved the expected effect?
Urine output increases from 10 mL/hour to greater than 50 mL hourly.3
The nurse is preparing to instruct the post-cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse would include which item in the instructions?
Use the arms for balance, not weight support, when getting out of bed or a chair.
A client who is experiencing an inferior wall myocardial infarction has had a drop in heart rate into the 50 to 56 beats/minute range. The client is also complaining of nausea. Which cranial nerve damage would the nurse expect that the client is experiencing?
Vagus (CN X)2
