DAVIS NUR 212 TEST 3

A nurse is to administer 40 mg of furosemide (Lasix®) to a client in heart failure. The prefilled syringe reads 100 mg/mL. In order to give the correct dose, the nurse should administer ____mL to the client.

0.4

A client admitted with unstable angina is started on intravenous heparin and nitroglycerin. The client's chest pain resolves, and the client is weaned from the nitroglycerin. Noting that the client had a synthetic valve replacement for aortic stenosis 2 years ago, a physician writes an order to restart the oral warfarin (Coumadin®) 5 mg at 1900 hours. Which is the nurse's best action? 1. Administer the warfarin as prescribed. 2. Call the physician to question the warfarin order. 3. Discontinue the heparin drip and then administer the warfarin. 4. Hold the dose of warfarin until the heparin has been discontinued.

1

A nurse is caring for a client following a coro- nary artery bypass graft. Which assessment finding in the immediate postoperative period should be most concerning to the nurse? 1. No chest tube output for 1 hour when previously it was copious 2. Client temperature of 99.1°F (37.2°C) 3. Arterial blood gas (ABG) results show pH 7.32; Pco2 48; HCO3 28; Po2 80 4. Urine output of 160 mL in the last 4 hours

1

At 0730 hours, a nurse receives a verbal order for a cardiac catheterization to be completed on a client at 1400 hours. Which action should the nurse initiate first? 1. Initiate NPO (nothing per mouth) status for the client. 2. Teach the client about the procedure. 3. Start an intravenous (IV) infusion of 0.9% NaCl. 4. Ask the client to sign a consent form.

1. Initiate NPO (nothing per mouth) status for the client.

A client is admitted with a diagnosis of acute infec- tive endocarditis (IE). Which findings during a nurs- ing assessment support this diagnosis? SELECT ALL THAT APPLY. 1. Skin petechiae 2. Crackles in lung bases 3. Peripheral edema 4. Murmur 5. Arthralgia 6. Decreased erythrocyte sedimentation rate (ESR)

1.2.3.4.5

A nurse should anticipate instructing a client scheduled for a coronary artery bypass graft to: SELECT ALL THAT APPLY. 1. discontinue taking aspirin prior to surgery. 2. perform postoperative cardiac rehabilitation exercises and stress management strategies. 3. wash with an antimicrobial soap the evening prior to surgery. 4. shave the chest and legs and then shower to remove the hair. 5. resume normal activities when discharged from the hospital. 6. expect close monitoring after surgery, several intravenous (IV) lines, a urinary catheter, endotracheal tube, and chest tubes.

1.2.3.6

A nurse evaluates that a client understands dis- charge teaching, following aortic valve replacement surgery with a synthetic valve, when the client states that he/she plans to: SELECT ALL THAT APPLY. 1. use a soft toothbrush for dental hygiene. 2. floss teeth daily to prevent plaque formation. 3. wear loose-fitting clothing to avoid friction on the sternal incision. 4. use an electric razor for shaving. 5. report black, tarry stools. 6. consume foods high in vitamin K, such as broccoli.

1.3.4.5

A nurse is planning care for a client admitted with a new diagnosis of persistent atrial fibrillation with rapid ventricular response. Although the client has had no previous cardiac problems, the client has been in atrial fibrillation for more than 2 days. The nurse should anticipate that the health-care provider is likely to initially order: SELECT ALL THAT APPLY. 1. oxygen. 2. immediate cardioversion. 3. administration of amiodarone (Cordarone®). 4. initiation of a IV heparin infusion. 5. immediate catheter-directed ablation of the AV node. 6. administration of a calcium channel antagonist such as diltiazem (Cardizem®).

1.3.4.6

A nurse receives a serum laboratory report for six different clients with admitting diagnoses of chest pain. After reviewing all of the lab reports, in which order should the nurse address each lab value? Priori- tize the order in which the nurse should address each of the clients' results. ______ Troponin T 42 ng/mL (0.0-0.4 ng/mL) ______ WBC 11,000 K/μL ______ Hgb 7.2 g/dL ______ SCr 2.2 mg/dL ______ K 2.2 mEq/L ______ Total cholesterol 430 mg/dL

1.6.3.4.2.5

A client admitted with a diagnosis of acute coronary syndrome calls for a nurse after experienc- ing sharp chest pains that radiate to the left shoulder. The nurse notes, prior to entering the client's room, that the client's rhythm is sinus tachycardia with a 10-beat run of premature ventricular contractions (PVCs). Admitting orders included all of the follow- ing interventions for treating chest pain. Which should the nurse implement first? 1. Obtain a stat 12-lead electrocardiogram (ECG). 2. Administer oxygen by nasal cannula. 3. Administer sublingual nitroglycerin. 4. Administer morphine sulfate intravenously.

2

A client experiences cardiac arrest at home and is successfully resuscitated. Following placement of an implantable cardioverter-defibrillator (ICD), a nurse is evaluating the effectiveness of teaching for the client. Which statement, if made by the client, indicates that further teaching is needed? 1. "The ICD will monitor my heart activity and provide a shock to my heart if my heart goes into ventricular fibrillation again." 2. "When I feel the first shock I should tell my family to start cardiopulmonary resuscitation (CPR) and call 911." 3. "I am fearful of my first shock since my friend stated his shock felt like a blow to the chest." 4. "I will need to ask my physician when I can resume driving because some states disallow driving until there is a 6-month discharge-free period."

2

A client is admitted to a coronary care unit following an anterior myocardial infarction (MI). A nurse, car- ing for the client, obtains the following assessment findings. Based on these findings, the nurse should immediately notify the physician and plan which intervention? 1. Administering an IV fluid bolus of 0.9% NaCl because the client is in right heart failure 2. Initiating an IV infusion of dopamine (Intropin®) because the client is in cardiogenic shock 3. Preparing the client for pericardiocentesis since cardiac tamponade is suspected 4. Calling for a stat chest x-ray to rule out pulmonary embolism (PE)

2

A nurse increases activity for a client with an admit- ting diagnosis of acute coronary syndrome. Which symptoms experienced by the client best support a nursing diagnosis of activity intolerance? 1. Pulse rate increased by 15 beats per minute during activity 2. Blood pressure (BP) 130/86 mm Hg before activity; BP 108/66 mm Hg during activity 3. Increased dyspnea and diaphoresis relieved when sitting in a chair 4. A mean arterial pressure (MAP) of 80 following activity

2

A nurse is caring for a client immediately following insertion of a permanent pacemaker via the right sub- clavian vein approach. The nurse best prevents pace- maker lead dislodgement by: 1. inspecting the incision site dressing for bleeding and the incision for approximation. 2. limiting the client's right arm activity and preventing the client reaching above shoulder level. 3. assisting the client with getting out of bed and ambulating with a walker. 4. ordering a stat chest x-ray following return from the implant procedure.

2

Following a normal chest x-ray for a client who had cardiac surgery, a nurse receives an order to re- move the chest tubes. Which intervention should the nurse plan to implement first? 1. Auscultate the client's lung sounds 2. Administer 4 mg morphine sulfate intravenously 3. Turn off the suction to the chest drainage system 4. Prepare the dressing supplies at the client's bedside

2

A nurse is evaluating the blood pressure (BP) results for multiple clients with cardiac problems on a telemetry unit. Which BP reading suggests to the nurse that the client's mean arterial pressure (MAP) is abnormal and warrants notifying the physician? 1. 94/60 mm Hg 2. 98/36 mm Hg 3. 110/50 mm Hg 4. 140/78 mm Hg

2. 98/36 mm Hg

Which nursing actions should a nurse plan when caring for a client experiencing dyspnea due to heart failure and chronic obstructive pulmonary disease (COPD)? SELECT ALL THAT APPLY. 1. Apply oxygen 6 liters per nasal cannula 2. Elevate the head of the bed 30 to 40 degrees 3. Weigh client daily in the morning 4. Teach client pursed-lip breathing techniques 5. Turn and reposition the client every 1 to 2 hours

2.3.4

A nurse is teaching a client newly diagnosed with chronic stable angina. Which instructions should the nurse incorporate in the teaching session on measures to prevent future angina? SELECT ALL THAT APPLY. 1. Increase isometric arm exercises to build endurance. 2. Wear a face mask when outdoors in cold weather. 3. Take nitroglycerin before a stressful situation even though pain is not present. 4. Perform most exertional activities in the morning. 5. Avoid straining at stool. 6. Eliminate tobacco use.

2.3.5.6

Because a step-down cardiac unit is unusually busy, a nurse fails to obtain vital signs at 0200 hours for a client 2 days postoperative for a mitral valve re- placement. The client was stable when assessed at 0600 hours, so the nurse documents the electrocar- diogram monitor's heart rate in the client's medical record for both the 0400 and 0600 vital signs. The charge nurse supervising the nurse determines that the nurse's behavior was: SELECT ALL THAT APPLY. 1. the correct action because neither complications nor harmful effects occurred. 2. a legal issue because the nurse has fraudulently falsified documentation. 3. demonstrating beneficence because the nurse decided what was best for the client. 4. an ethical issue of veracity because the nurse has been untruthful regarding the client's care. 5. an ethical legal issue of confidentiality because the nurse disclosed incorrect information. 6. demonstrating distributive justice because the nurse decided other clients' needs were priority.

2.4

A nurse is working with a certified nursing assistant (CNA) providing care for four clients on a busy telemetry unit. All four clients are in need of immedi- ate attention. The CNA is a senior nursing student who has been administering medications and per- forming procedures during clinical experiences as a student nurse. The charge nurse supervising care on the telemetry unit determines that care is appropriate when the registered nurse (RN) working with the CNA delegates: SELECT ALL THAT APPLY. 1. administering acetaminophen (Tylenol®) to the client with an elevated temperature. 2. taking vital signs on the client newly admitted with a diagnosis of heart failure. 3. finishing the discharge instructions so the client with a new pacemaker implant can go home. 4. changing a client's chest tube dressing because it got wet when the water pitcher overturned. 5. providing a sponge bath for the client with the elevated temperature. 6. checking the lung sounds of the client whose chest tube drainage system was tipped over and then righted

2.5

A client diagnosed with class II heart failure according to the New York Heart Association Func- tional Classification has been taught about the initial treatment plan for this disease. A nurse determines that the client needs additional teaching if the client states that the treatment plan includes: 1. diuretics. 2. a low-sodium diet. 3. home oxygen therapy. 4. angiotensin-converting enzyme (ACE) inhibitors.

3

A client is hospitalized for heart failure secondary to alcohol-induced cardiomyopathy. The client is started on milrinone (Primacor®) and placed on a transplant waiting list. The client has been curt and verbally aggressive in expressing dissatisfaction with the med- ication orders, overall care, and the need for energy conservation. A nurse should interpret that the client's behavior is likely related to the client's: 1. denial of the illness. 2. reaction to milrinone (Primacor®). 3. fear of the diagnosis. 4. response to cerebral anoxia.

3

A nurse is assessing a client diagnosed with an anterior-lateral myocardial infarction (MI). The nurse adds a nursing diagnosis to the client's plan of care of decreased cardiac output when which finding is noted on assessment? 1. One-sided weakness 2. Presence of an S4 heart sound 3. Crackles auscultated in bilateral lung bases 4. Vesicular breath sounds over lung lobes

3

After an inferior-septal wall myocardial infarction, which complication should a nurse suspect when not- ing jugular venous distention (JVD) and ascites? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Ruptured septum

3

A nurse admits a client to a telemetry unit and ob- tains the following electrocardiogram (ECG) strip of the client's heart rhythm. What should be the nurse's interpretation of this rhythm strip? 1. Atrial flutter 2. Atrial fibrillation 3. Sinus bradycardia 4. Sinus rhythm with premature atrial contractions (PACs)

3. Sinus bradycardia

A nurse who is beginning a shift on a cardiac step- down unit receives shift report for four clients. In which order should the nurse assess the clients? Prioritize the nurse's actions by placing each client in order from most urgent (1) to least urgent (4). ______ A 56-year-old client who was admitted 1 day ago with chest pain receiving intravenous (IV) heparin and has a partial thromboplastin time (PTT) due back in 30 minutes ______ A 62-year-old client with end-stage cardiomyopathy, blood pressure (BP) of 78/50 mm Hg, 20 mL/hr urine output, and a "Do Not Resuscitate" order and whose family has just arrived ______ A 72-year-old client who was transferred 2 hours ago from the intensive care unit (ICU) following a coronary artery bypass graft and has new onset atrial fibrillation with rapid ventricular response ______ A 38-year-old postoperative client who had an aortic valve replacement 2 days ago, BP 114/72 mm Hg, heart rate (HR) 100 beats/min, respiratory rate (RR) 28 breaths/min, and temperature 101.2°F (38.4°C)

3.4.1.2

A nurse is instructing a client diagnosed with coro- nary artery disease about care at home. The nurse determines that teaching is effective when the client states: SELECT ALL THAT APPLY. 1. "If I have chest pain, I should contact my physician immediately." 2. "I should carry my nitroglycerin in my front pants pocket so it is handy." 3. "If I have chest pain, I stop activity and place one nitroglycerin tablet under my tongue." 4. "I should always take three nitroglycerin tablets, 5 minutes apart." 5. "I plan to avoid being around people when they are smoking." 6. "I plan on walking on most days of the week for at least 30 minutes."

3.5.6

A client admitted to a telemetry unit with a diagnosis of Prinzmetal's angina, has the following medications ordered. Upon interpretation of the client's electro- cardiogram (ECG) rhythm, the nurse notes a prolonged PR interval of 0.32 second. Based on this information, which medication order should the nurse question administering to the client? 1. Isosorbide mononitrate (Imdur®) 20 mg oral daily upon awakening 2. Amlodipine (Norvasc®) 10 mg oral daily 3. Nitroglycerin (Nitrostat®) 0.4 mg sublingual prn for chest pain 4. Atenolol (Tenormin®) 50 mg oral daily.

4

A male client confides to a clinic nurse that he is no longer dyspneic after receiving his new St. Jude's heart valve. He wants to have a vasectomy so that he can enjoy sexual intercourse again without the fear of his wife becoming pregnant. What is the nurse's best response? 1. "That's probably a good idea. The life expectancy after heart valve replacement is 10 to 15 years." 2. "You seem relieved that the heart valve replacement was successful and that you can enjoy a normal life again." 3. "If you have cardiac symptoms such as dyspnea during sexual intercourse, you can take a nitroglycerin tablet before sexual activity to prevent symptoms." 4. "Be sure to inform the physician that you have an artificial heart valve so you are given antibiotics as a preventive measure before the procedure."

4

A nurse collects the following assessment data on a client who has no known health problems: blood pressure (BP) 135/89 mm Hg; body mass index (BMI) 23; waist circumference 34 inches; serum creatinine 0.9 mg/dL; serum K 4.0 mEq/L; low-density lipopro- tein (LDL) cholesterol 200 mg/dL; high-density lipoprotein (HDL) cholesterol 25 mg/dL; and triglyc- erides 180 mg/dL. Which order from the client's health-care provider should the nurse anticipate? 1. 1,500-calorie regular diet. 2. No added salt, low saturated fat, low-potassium diet. 3. Hydrochlorothiazide (HydroDIURIL®) 25 mg twice daily. 4. Atorvastatin (Lipitor®) 20 mg daily.

4

A nurse notes that a client, who experienced a myo- cardial infarction (MI) 3 days ago, seems unusually fatigued. Upon assessment, the nurse finds that the client is dyspneic with activity, has a heart rate (HR) of 110 beats per minute (bpm), and has generalized edema. Which action by the nurse is most appropriate? 1. Administer high-flow oxygen 2. Encourage the client to rest more 3. Continue to monitor the client's heart rhythm 4. Compare the client's admission weight with the client's current weight

4

A nurse, assessing a client hospitalized following a myocardial infarction (MI), obtains the following vital signs: blood pressure (BP) 78/38 mm Hg, heart rate (HR) 128, respiratory rate (RR) 32. For which life-threatening complication should the nurse care- fully monitor the client? 1. Pulonary embolism 2. Cardiac tamponade 3. Cardiomyopathy 4. Cardiogenic shock

4

A nurse assesses a client who has just returned to a telemetry unit after having a coronary angiogram us- ing the left femoral artery approach. The client's baseline blood pressure (BP) during the procedure was 130/72 mm Hg and the cardiac rhythm was a normal sinus throughout. Which assessment finding should indicate to the nurse that the client may be ex- periencing a complication? 1. BP 144/78 mm Hg 2. Pedal pulses palpable at +1 3. Left groin soft with 1 cm ecchymotic area 4. Apical pulse 132 beats per minute (bpm) with an irregular-irregular rhythm

4. Apical pulse 132 beats per minute (bpm) with an irregular-irregular rhythm

Blood for cardiac enzymes and serum laboratory tests are drawn on a diabetic client admitted to an emer- gency department (ED) 5 hours after beginning to ex- perience chest pressure. A nurse reviews the follow- ing laboratory results. Which serum laboratory findings should the nurse report to a primary health- care provider (HCP) immediately due to the possibil- ity that the client may be experiencing a myocardial infarction (MI)? SELECT ALL THAT APPLY. Laboratory Tests Client's Results BUN (10-20 mg/dL) 30 SCr (0.4-1.4 mg/dL) 1.8 Ca (8.5-10.5 mg/dL) 9.0 Cl (100-108 mEq/L) 105 CO2 (25-29 mEq/L) 24 Glucose (70-110 mg/dL) 160 Na (136-146 mEq/L) 135 K (3.8-5.3 mEq/L) 5.8 Mag (1.7-2.2 mg/dL) 1.6 CK (0-160 u/L) 320 CK-MB (0-16 u/L) 32 Troponin T (cTnT) 34 (0.0-0.4 NG/mL) WBC (3.9-11.9 K/μL) 14 RBC (4.08-5.79 m/μL) 5.0 Hgb (13.1-17.1%) 15 Hct (38.7-51 g/dL) 48 Platelets (PLT) (179-450 K/μL) 175 PT (9.2-11.9 sec)/INR (0.9-1.1 sec) 1. SCr 2. PT/INR 3. CK 4. CK-MB 5. Platelets 6. Troponin T

ANSWER: 3, 4, 6.