Lewis: Ch 31, 32, 33, 35 NCLEX questions

A pt's electrocardiogram strip shows atrial & ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, & the QRS complex measures 0.08 second. The nurse interprets this rhythm is: 1. Normal sinus rhythm 2. Sinus bradycardia 3. Sinus tachycardia 4. Sinus dysrhythmia

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Which of the following nursing diagnoses would be appropriate for a pt with heart failure? Select all that apply. 1. Ineffective tissue perfusion R/T decreased peripheral blood flow secondary to decreased CI 2. Activity intolerance R/T increased cardiac output. 3. Decreased cardiac output R/T structural & functional changes. 4. Impaired gas exchange R/T decreased sympathetic nervous system activity.

1 & 3. HF is a result of structural & functional abnormalities of the heart tissue muscle. The heart muscle becomes weak & does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle & backs up into the left atrium, & eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition, this pooling leads to thrombus formation & ineffective tissue perfusion because of the decrease in blood flow to the other organs & tissues of the body. Typically, these pts have an ejection fraction of less than 50% & poorly tolerate activity. Activity intolerance is related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity.

Furosemide is administered intravenously to a pt with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? 1. 5 to 10 min 2. 30 to 60 min 3. 2 to 4 hours 4. 6 to 8 hours

1. After IV injection of furosemide, diuresis normally begins in about 5 minutes & reaches its peak w/in about 30 minutes. Med effects last 2 - 4 hours.

Which of the following terms describes the force against which the ventricle must expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload

1. Afterload refers to the resistance normally maintained by the aortic & pulmonic valves, the condition & tone of the aorta, & the resistance offered by the systemic & pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

Which of the following types of cardiomyopathy can be associated with childbirth? 1. Dilated 2. Hypertrophic 3. Myocarditis 4. Restrictive

1. Although the cause isn't entirely known, cardiac dilation & heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't specifically associated w/ childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis the underlying cause is usually myocardial.

Which of the following recurring conditions most commonly occurs in pts with cardiomyopathy? 1. Heart failure 2. Diabetes 3. MI 4. Pericardial effusion

1. Because the structure & function of the heart muscle is affected, heart failure most commonly occurs in pts w/ cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in pts w/ pericarditis.

Which of the following classes of meds protects the ischemic myocardium by blocking catecholamines & sympathetic nerve stimulation? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Narcotics 4. Nitrates

1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines & sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand promote vasodilation, & decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) & systemic vascular resistance (afterload).

Which of the following heart muscle diseases is unrelated to other cardiovascular disease? 1. Cardiomyopathy 2. Coronary artery disease 3. Myocardial infarction 4. Pericardial effusion

1. Cardiomyopathy isn't usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. CAD & MI are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated w/ Pericarditis & advanced heart failure.

Which of the following symptoms is most commonly associated with left-sided heart failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension

1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated w/ both right- & left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

An 18-year-old pt who recently had an URI is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis? 1. Erythema marginatum, subcutaneous nodules, & fever 2. Tachycardia, finger clubbing, & a load S3 3. Dyspnea, cough, & palpitations 4. Dyspnea, fatigue, & synocope

1. Diagnosis of rheumatic fever requires that the pt have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham's chorea, subcutaneous nodules, & erythema maginatum (transient, nonprurtic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, & a prolonged PR-interval on ECG.

The physician orders continuous intravenous nitroglycerin infusion for the pt with MI. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the med 2. Monitoring BP q4h 3. Monitoring urine output hourly 4. Obtaining serum potassium levels daily

1. IV nitro infusion requires an infusion pump for precise control of the med. BP monitoring would be done w/ a continuous system, & more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated w/ nitroglycerin infusion.

A pt admitted with angina compains of severe chest pain & suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? 1. Activate the resuscitation team 2. Open the pt's airway 3. Check for breathing 4. Check for signs of circulation

1. Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver & check for breathing (looking, listening, & feeling for no more than 10-seconds). If the pt isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse.

An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: 1. Left ventricular atrophy 2. Irregular heartbeats 3. peripheral vascular occlusion 4. Pacemaker placement

1. In older adults who are less active & do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased dem&s on the myocardial muscle.

Toxicity from which of the following meds may cause a pt to see a green-yellow halo around lights? 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec)

1. One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other meds aren't associated w/ such an effect.

Which of the following actions is the appropriate initial response to a pt coughing up pink, frothy sputum? 1. Call for help 2. Call the physician 3. Start an I.V. line 4. Suction the pt

1. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the pt is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions would immediately follow.

Which of the following complications is indicated by a third heart sound (S3)? 1. Ventricular dilation 2. Systemic hypertension 3. Aortic valve malfunction 4. Increased atrial contractions

1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur.

Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress & anxiety 4. Reduction of associated risk factors

1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption & increasing oxygen supply. An infarction is permanent & can't be reversed.

A pt comes into the E.R. with acute shortness of breath & a cough that produces pink, frothy sputum. Admission assessment reveals crackles & wheezes, a BP of 85/46, a HR of 122 BPM, & a respiratory rate of 38 breaths/minute. The pt's medical history included DM, HTN, & heart failure. Which of the following disorders should the nurse suspect? 1. Pulmonary edema 2. Pneumothorax 3. Cardiac tamponade 4. Pulmonary embolus

1. SOB, tachypnea, low BP, tachycardia, crackles, & a cough producing pink, frothy sputum are late signs of pulmonary edema.

Which of the following interventions should be the first priority when treating a pt experiencing chest pain while walking? 1. Sit the pt down 2. Get the pt back to bed 3. Obtain an ECG 4. Administer sublingual nitroglycerin

1. The initial priority is to decrease the oxygen consumption

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricupsid valve malfunction

1. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial & alveolar spaces in the lungs & causes crackles. Pulmonic & tricuspid valve malfunction causes right sided heart failure.

Which of the following is the most common symptom of myocardial infarction (MI)? 1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations

1. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

When developing a teaching plan for a pt with endocarditis, which of the following points is most essential for the nurse to include? 1. "Report fever, anorexia, & night sweats to the physician." 2. "Take prophylactic antibiotics after dental work & invasive procedures." 3. "Include potassium rich foods in your diet." 4. "Monitor your pulse regularly."

1. The most essential teaching point is to report signs of relapse, such as fever, anorexia, & night sweats, to the physician. To prevent further endocarditis episodes, prophylactic antibiotics are taken before & sometimes after dental work, childbirth, or GU, GI, or gynecologic procedures. A potassium-rich diet & daily pulse monitoring aren't necessary for a pt w/ endocarditis.

The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects: 1. Left atrial enlargement 2. Left ventricular enlargement 3. Right atrial enlargement 4. Right ventricular enlargement

2. A normal apical impulse is found under over the apex of the heart & is typically located & auscultated in the left fifth intercostal space in the midclavicular line. An apical impulse located or auscultated below the fifth intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement.

What is the first intervention for a pt experiencing MI? 1. Administer morphine 2. Administer oxygen 3. Administer sublingual nitroglycerin 4. Obtain an ECG

2. Administering supplemental oxygen to the pt is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation & prevent further damage. Morphine & nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

Aspirin is administered to the pt experiencing an MI because of its: 1. Antipyrectic action 2. Antithrombotic action 3. Antiplatelet action 4. Analgesic action

2. Aspirin does have antipyretic, antiplatelet, & analgesic actions, but the primary reason ASA is administered to the pt experiencing an MI is its antithrombotic action.

Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? 1. Antihypertensives 2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Nitrates

2. Beta-adrenergic blockers By decreasing the heart rate & contractility, beta-blockers improve myocardial filling & cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in pts who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers however, they aren't as effective as beta-blockers & cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.

Which of the following foods should the nurse teach a pt with heart failure to avoid or limit when following a 2-gram sodium diet? 1. Apples 2. Tomato juice 3. Whole wheat bread 4. Beef tenderloin

2. Canned foods & juices, such as tomato juice, are typically high in sodium & should be avoided in a sodium-restricted diet. BRING ON THE STEAK!

In which of the following types of cardiomyopathy does cardiac output remain normal? 1. Dilated 2. Hypertrophic 3. Obliterative 4. Restrictive

2. Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. All of the rest decrease cardiac output.

A nurse is preparing for the admission of a pt with heart failure who is being sent directly to the hospital from the physician's office. The nurse would plan on having which of the following meds readily available for use? 1. Diltiazem (Cardizem) 2. Digoxin (Lanoxin) 3. Propranolol (Inderal) 4. Metoprolol (Lopressor)

2. Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the med of choice to treat heart failure. Diltiazem (calcium channel blocker) & propranolol & metoprolol (beta blockers) have a negative inotropic effect & would worsen the failing heart.

With which of the following disorders is jugular vein distention most prominent? 1. Abdominal aortic aneurysm 2. Heart failure 3. MI 4. Pneumothorax

2. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. JVD isn't a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure, however, in & of itself, an MI doesn't cause JVD.

cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management

2. MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this pt is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute pain, & ineffective therapeutic regimen management are appropriate but don't take priority.

Which of the following reflects the principle on which a pt's diet will most likely be based during the acute phase of MI? 1. Liquids as ordered 2. Small, easily digested meals 3. Three regular meals per day 4. NPO

2. Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are better tolerated. Fluids are given according to the pt's needs, & sodium restrictions may be prescribed, especially for pts w/ manifestations of heart failure. Cholesterol restrictions may be ordered as well. Pts are not prescribed a diet of liquids only or NPO unless their condition is very unstable.

Stimulation of the sympathetic nervous system produces which of the following responses? 1. Bradycardia 2. Tachycardia 3. Hypotension 4. Decreased myocardial contractility

2. Stimulation of the sympathetic nervous system causes tachycardia & increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.

A home care nurse is making a routine visit to a pt receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the pt for: 1. Thrombocytopenia & weight gain 2. Anorexia, nausea, & visual disturbances 3. Diarrhea & hypotension 4. Fatigue & muscle twitching

2. The first signs & symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, & other dysrhythmias.

A nurse is preparing to ambulate a pt on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the pt to best tolerate the ambulation? 1. Encourage the pt to cough & deep breathe 2. Premedicate the pt with an analgesic 3. Provide the pt with a walker 4. Remove telemetry equipment because it weighs down the hospital gown.

2. The nurse should encourage regular use of pain med for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, & allow better participation in activities such as coughing, deep breathing, & ambulation. Options 1 & 3 will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed.

Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina

2. The pain of stable angina is predictable in nature, builds gradually, & quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, & lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress.

Which of the following symptoms is the most likely origin of pain the pt described as knifelike chest pain that increases in intensity with inspiration? 1. Cardiac 2. Gastrointestinal 3. Musculoskeletal 4. Pulmonary

4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases w/ movement. Cardiac & GI pains don't change w/ respiration.

Which of the following positions would best aid breathing for a pt with acute pulmonary edema? 1. Lying flat in bed 2. Left side-lying 3. In high Fowler's position 4. In semi-Fowler's position

3. A high Fowler's position promotes ventilation & facilitates breathing by reducing venous return. Lying flat & side-lying positions worsen the breathing & increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as the Fowler's position will.

Captopril may be administered to a pt with HF because it acts as a: 1. Vasopressor 2. Volume expander 3. Vasodilator 4. Potassium-sparing diuretic

3. ACE inhibitors have become the vasodilators of choice in the pt w/ mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt heart failure.

Which of the following would be a priority nursing diagnosis for the pt with heart failure & pulmonary edema? 1. Risk for infection related to stasis of alveolar secretions 2. Impaired skin integrity related to pressure 3. Activity intolerance related to pump failure 4. Constipation related to immobility

3. Activity intolerance is a primary problem for pts w/ heart failure & pulmonary edema. The decreased cardiac output associated w/ heart failure leads to reduced oxygen & fatigue. Pts frequently complain of dyspnea & fatigue. The pt could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the pt w/ HF & pulmonary edema, nor is constipation related to immobility.

What is the most common complication of an MI? 1. Cardiogenic shock 2. Heart failure 3. arrhythmias 4. Pericarditis

3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of pts w/ MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.

Which of the following conditions is most commonly responsible for myocardial infarction? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis 4. Renal failure

3. Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel & doesn't cause an MI. Renal failure can be associated w/ MI but isn't a direct cause. Heart failure is usually a result from an MI.

A nurse is conducting a health history with a pt with a primary diagnosis of heart failure. Which of the following disorders reported by the pt is unlikely to play a role in exacerbating the heart failure? 1. Recent URI 2. Nutritional anemia 3. Peptic ulcer disease 4. A-Fib

3. Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, & hypervolemia.

If medical treatments fail, which of the following invasive procedures is necessary for treating cariomyopathy? 1. Cardiac catherization 2. Coronary artery bypass graft (CABG) 3. Heart transplantation 4. Intra-aortic balloon pump (IABP)

3. Heart transplant The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible.

Septal involvement occurs in which type of cardiomyopathy? 1. Congestive 2. Dilated 3. Hypertrophic 4. Restrictive

3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy.

Which of the following symptoms might a pt with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia

3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria.

Myocardial oxygen consumption increases as which of the following parameters increase? 1. Preload, afterload, & cerebral blood flow 2. Preload, afterload, & renal blood flow 3. Preload, afterload, contractility, & heart rate. 4. Preload, afterload, cerebral blood flow, & heart rate.

3. Myocardial oxygen consumption increases as preload, afterload, renal contractility, & heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption.

Medical treatment of coronary artery disease includes which of the following procedures? 1. Cardiac catherization 2. Coronary artery bypass surgery 3. Oral med therapy 4. Percutaneous transluminal coronary angioplasty

3. Oral med administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery & percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

A pt with angina complains that the angina pain is prolonged & severe & occurs at the same time each day, most often in the morning, On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as: 1. Stable angina 2. Unstable angina 3. Variant angina 4. Nonanginal pain

3. Stable angina is induced by exercise & is relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower & lower levels of activity & rest, is less predictable, & is often a precursor of myocardial infarction. Variant angina, or Prinzmetal's angina, is prolonged & severe & occurs at the same time each day, most often in the morning.

Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle

3. The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is damaged, the output decreases & fluid accumulates in the interstitial & alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium & right ventricle were damaged, right-sided heart failure would result.

A pt with pulmonary edema has been on diuretic therapy. The pt has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the pt also will be started on Digoxin (Lanoxin), a nurse checks the pt's most recent: 1. Digoxin level 2. Sodium level 3. Potassium level 4. Creatinine level

3. The serum potassium level is measured in the pt receiving digoxin & furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the pt w/ hypokalemia. Hypokalemia also predisposes the pt to ventricular dysrhythmias.

Which of the following blood tests is most indicative of cardiac damage? 1. Lactate dehydrogenase 2. Complete blood count (CBC) 3. Troponin I 4. Creatine kinase (CK)

3. Troponin I levels rise rapidly & are detectable w/in 1 hour of myocardial injury. Troponin I levels aren't detectable in people w/out cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues & not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, & a complete chemistry is obtained to review electrolytes. Because CK levels may rise w/ skeletal muscle injury, CK isoenzymes are required to detect cardiac injury

Which of the following cardiac conditions does a fourth heart sound (S4) indicate? 1. Dilated aorta 2. Normally functioning heart 3. Decreased myocardial contractility 4. Failure of the ventricle to eject all of the blood during systole

4. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart.

Which of the following is an expected outcome for a pt on the second day of hospitalization after an MI? 1. Has severe chest pain 2. Can identify risks factors for MI 3. Agrees to participate in a cardiac rehabilitation walking program 4. Can perform personal self-care activities without pain

4. By day 2 of hospitalization after an MI, pts are expected to be able to perform personal care w/out chest pain. Day 2 hospitalization may be too soon for pts to be able to identify risk factors for MI or begin a walking program

Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia

4. In an attempt to compensate for increased work of breathing due to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the condition persists, CO2 retention occurs & hypercapnia results.

Which of the following conditions is the predominant cause of angina? 1. Increased preload 2. Decreased afterload 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium

4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina.

Which of the following classes of meds maximizes cardiac performance in pts with heart failure by increasing ventricular contractibility? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Diuretics 4. Inotropic agents

4. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility & ultimately increasing cardiac output.

What is the primary reason for administering morphine to a pt with an MI? 1. To sedate the pt 2. To decrease the pt's pain 3. To decrease the pt's anxiety 4. To decrease oxygen demand on the pt's heart

4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain & anxiety while causing sedation, but it isn't primarily given for those reasons.

A nurse caring for a pt in one room is told by another nurse that a second pt has developed severe pulmonary edema. On entering the 2nd pt's room, the nurse would expect the pt to be: 1. Slightly anxious 2. Mildly anxious 3. Moderately anxious 4. Extremely anxious

4. Pulmonary edema causes the pt to be extremely agitated & anxious. The pt may complain of a sense of drowning, suffocation, or smothering.

Which of the following tests is used most often to diagnose angina? 1. Chest x-ray 2. Echocardiogram 3. Cardiac catherization 4. 12-lead electrocardiogram (ECG)

4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, w/ variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina.

Which of the following is a compensatory response to decreased cardiac output? 1. Decreased BP 2. Alteration in LOC 3. Decreased BP & diuresis 4. Increased BP & fluid retention

4. The body compensates for a decrease in cardiac output w/ a rise in BP, due to the stimulation of the sympathetic NS & an increase in blood volume as the kidneys retain sodium & water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.

In which of the following disorders would the nurse expect to assess sacral edema in a bedridden pt? 1. Diabetes 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure

4. The most accurate area on the body to assess dependent edema in a bed-ridden pt is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.

The nurse coming on duty receives the report from the nurse going off duty. Which of the following pts should the on-duty nurse assess first? 1. The 58-year-old pt who was admitted 2 days ago with heart failure, BP of 126/76, & a RR 21 bpm 2. The 88-year-old pt with end-stage right-sided heart failure, BP of 78/50, & a DNR order. 3. The 62-year-old pt who was admitted one day ago with thrombophlebitis & receiving IV heparin. 4. A 76-year-old pt who was admitted 1 hour ago with new-onset atrial fibrillation & is receiving IV diltiazem (Cardizem).

4. The pt w/ A-fib has the greatest potential to become unstable & is on IV med that requires close monitoring. After assessing this pt, the nurse should assess the pt w/ thrombophlebitis who is receiving a heparin infusion, & then go to the 58-year-old pt admitted 2-days ago w/ heart failure (her s/s are resolving & don't require immediate attention). The lowest priority is the 89-year-old w/ end stage right-sided heart failure, who requires time consuming supportive measures.

A pt who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The pt received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL & the serum creatinine is 2.2 mg/dL. A nurse interprets the pt is at risk for: 1. Hypovolemia 2. UTI 3. Glomerulonephritis 4. Acute renal failure

4. The pt who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor med therapy. Renal insult is signaled by decreased urine output, & increased BUN & creatinine levels. The pt may need meds such as dopamine (Intropin) to increase renal perfusion & possibly could need peritoneal dialysis or hemodialysis.

Dyspnea, cough, expectoration, weakness, & edema are classic signs & symptoms of which of the following conditions? 1. Pericarditis 2. Hypertension 3. MI 4. Heart failure

4. These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest & auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, & a flushed face. MI causes heart failure but isn't related to these symptoms.

Which of the following types of angina is most closely related with an impending MI? 1. Angina decubitus 2. Chronic stable angina 3. Noctural angina 4. Unstable angina

4. Unstable angina progressively increases in frequency, intensity, & duration & is related to an increased risk of MI w/in 3 to 18 months.

A pt has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: 1. It is uncomfortable for the pt, giving a sense of impending doom. 2. It produces a high cardiac output that quickly leads to cerebral & myocardial ischemia. 3. It is almost impossible to convert to a normal sinus rhythm. 4. It can develop into ventricular fibrillation at any time.

4. Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral & myocardial ischemia. Pt's frequently experience a feeling of impending death. Ventricular tachycardia is treated w/ antidysrhythmic meds or magnesium sulfate, cardioversion (pt awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.

Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output? 1. Angina pectoris 2. Cardiomyopathy 3. Left-sided heart failure 4. Right-sided heart failure

4. Weight gain, nausea, & a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output.

A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a. iron. b. folic acid. c. cobalamin (vitamin B12). d. ascorbic acid (vitamin C).

ANS: B Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.

ANS: A Hypercalcemia may lead to complications such as dysrhythmias or seizures, and should be addressed quickly. The other patient findings will also be discussed with the health care provider, but are not life threatening

Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation.

A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used

A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?

ANS: 21 To infuse 250 mL over 2 hours, the calculated drip rate is 20.8 drops/minute or 21 drops/minute

When caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Give the scheduled aspirin and lipid-lowering medication. b. Perform the initial assessment of the catheter insertion site. c. Teach the patient about the usual postprocedure plan of care. d. Titrate the heparin infusion according to the agency protocol.

ANS: A Administration of oral medications is within the scope of practice for LPNs/LVNs. The initial assessment of the patient, patient teaching, and titration of IV anticoagulant medications should be done by the registered nurse (RN). DIF: Cognitive Level: Apply (application)

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? a. Attach the heart monitor. c. Assess the peripheral pulses. b. Obtain the blood pressure. d. Auscultate the breath sounds.

ANS: A Because dysrhythmias are the most common complication of myocardial infarction (MI), the first action should be to place the patient on a heart monitor. The other actions are also important and should be accomplished as quickly as possible. DIF: Cognitive Level: Analyze (analysis)

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.

ANS: A Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching for this patient would include a. when cardiac rehabilitation will begin. b. the typical emotional responses to AMI. c. information regarding discharge medications. d. the pathophysiology of coronary artery disease.

ANS: A Early after an AMI, the patient will want to know when resumption of usual activities can be expected. At this time, the patient's anxiety level or denial will interfere with good understanding of complex information such as the pathophysiology of coronary artery disease. Teaching about discharge medications should be done closer to discharge. The nurse should support the patient by decreasing anxiety rather than discussing the typical emotional responses to myocardial infarction. DIF: Cognitive Level: Apply (application)

Which menu choice indicates that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice

ANS: A Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. "I will call my health care provider if my stools turn black." b. "I will take a stool softener if I feel constipated occasionally." c. "I should take the iron with orange juice about an hour before eating." d. "I should increase my fluid and fiber intake while I am taking iron tablets."

ANS: A It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the doctor about this. The other patient statements are correct

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness with rapid position changes c. Nausea when taking the drugs before meals d. Flushing and pruritus after taking the drugs

ANS: A Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and although the nurse should follow-up with the health care provider, they do not indicate that a change in medication is needed. DIF: Cognitive Level: Analyze (analysis)

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains

ANS: A Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process

A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. The platelet count is 42,000/mL. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.

ANS: A Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/mL unless the patient is actively bleeding. Therefore the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate

The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will a. immobilize the joint. b. apply heat to the knee. c. assist the patient with light weight bearing. d. perform passive range of motion to the knee.

ANS: A The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started

A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? a. "What do you think caused your chest pain?" b. "Where are you planning to go for your vacation?" c. "Sometimes plans need to change after a heart attack." d. "Recovery from a heart attack takes at least a few weeks."

ANS: A When the patient is experiencing denial, the nurse should assist the patient in testing reality until the patient has progressed beyond this step of the emotional adjustment to MI. Asking the patient about vacation plans reinforces the patient's plan, which is not appropriate in the immediate post-MI period. Reminding the patient in denial about the MI is likely to make the patient angry and lead to distrust of the nursing staff. DIF: Cognitive Level: Apply (application)

After an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse evaluates the patient's response to the activity, which data would indicate that the exercise level should be decreased? a. O2 saturation drops from 99% to 95%. b. Heart rate increases from 66 to 98 beats/min. c. Respiratory rate goes from 14 to 20 breaths/min. d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

ANS: B A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in O2 saturation, are normal responses to exercise. DIF: Cognitive Level: Apply (application)

Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours d. The patient with thrombocytopenia who has oozing after having a tooth extracted

ANS: B A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. 56-year-old with frequent explosive diarrhea b. 33-year-old with a fever of 100.8° F (38.2° C) c. 66-year-old who has white pharyngeal lesions d. 23-year old who is complaining of severe fatigue

ANS: B Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems

When developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease (CAD), the nurse should focus primarily on the a. family history of coronary artery disease. b. elevated low-density lipoprotein (LDL) level. c. increased risk associated with the patient's gender. d. increased risk of cardiovascular disease as people age.

ANS: B Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient's LDL level. Decreases in LDL will help reduce the patient's risk for developing CAD. DIF: Cognitive Level: Apply (application)

To improve the physical activity level for a mildly obese 71-yr-old patient, which action should the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity.

ANS: B Because patients are more likely to continue physical activities that they already enjoy, the nurse will plan to ask the patient about preferred activities. The goal for older adults is 30 minutes of moderate activity on most days. Older adults should plan for a longer warm-up period. Benefits of exercises, such as improved activity tolerance, should be emphasized rather than aiming for significant weight loss in older mildly obese adults. DIF: Cognitive Level: Apply (application)

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema

ANS: B Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema

A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about a. blood transfusion b. bone marrow biopsy. c. filgrastim (Neupogen) administration. d. erythropoietin (Epogen) administration.

ANS: B Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.

The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms.

ANS: B Chest pain that lasts for 20 minutes or more is characteristic of AMI. Changes in pain that occur with raising the arms or with deep breathing are more typical of musculoskeletal pain or pericarditis. Stable angina is usually relieved when the patient takes nitroglycerin. DIF: Cognitive Level: Apply (application)

When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that a. sudden cardiac death events rarely reoccur. b. additional diagnostic testing will be required. c. long-term anticoagulation therapy will be needed. d. limiting physical activity will prevent future SCD events.

ANS: B Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac catheterization) is used to determine the possible cause of the SCD and treatment options. SCD is likely to recur. Anticoagulation therapy will not have any effect on the incidence of SCD, and SCD can occur even when the patient is resting. DIF: Cognitive Level: Apply (application)

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/µL. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.

ANS: B Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening and requires immediate action. The other information should be documented and reported but would not be unusual in a patient with thrombocytopenia

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a soft toothbrush for oral care. d. Restrict activity to passive and active range of motion.

ANS: B IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room

The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the a. Schilling test. b. bilirubin level. c. stool occult blood test. d. gastric analysis testing.

ANS: B Jaundice is caused by the elevation of bilirubin level associated with red blood cell (RBC) hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes? a. Inform the patient about a diet containing no saturated fat and minimal salt. b. Help the patient modify favorite high-fat recipes by using monounsaturated oils. c. Emphasize the increased risk for heart problems unless the patient makes the dietary changes. d. Give the patient a list of low-sodium, low-cholesterol foods that should be included in the diet.

ANS: B Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences. The highest percentage of calories from fat should come from monounsaturated or polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the patient with a list alone is not likely to be successful in making dietary changes. Completely removing saturated fat from the diet is not a realistic expectation. Up to 7% of calories in the therapeutic lifestyle changes diet can come from saturated fat. Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful. DIF: Cognitive Level: Analyze (analysis)

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician? a. Leg bruises b. Tarry stools c. Skin abrasions d. Bleeding gums

ANS: B Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as checking hemoglobin and hematocrit and administration of coagulation factors. The other problems indicate a need for patient teaching about how to avoid injury, but are not indicators of possible serious blood loss

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to a. provide a diet high in vitamin K. b. alternate periods of rest and activity. c. teach the patient how to avoid injury. d. place the patient on protective isolation.

ANS: B Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia

It is important for the nurse providing care for a patient with sickle cell crisis to a. limit the patient's intake of oral and IV fluids. b. evaluate the effectiveness of opioid analgesics. c. encourage the patient to ambulate as much as tolerated. d. teach the patient about high-protein, high-calorie foods.

ANS: B Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized

The nurse suspects that the patient with stable angina is experiencing a side effect of the prescribed drug metoprolol (Lopressor) if the a. patient is restless and agitated. b. blood pressure is 90/54 mm Hg. c. patient complains about feeling anxious. d. heart monitor shows normal sinus rhythm.

ANS: B Patients taking -adrenergic blockers should be monitored for hypotension and bradycardia. Because this class of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, and anxiety will not be side effects. Normal sinus rhythm is a normal and expected heart rhythm. DIF: Cognitive Level: Apply (application)

After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. "Carvedilol will help my heart muscle work harder." b. "It is important not to suddenly stop taking the carvedilol." c. "I can expect to feel short of breath when taking carvedilol." d. "Carvedilol will increase the blood flow to my heart muscle."

ANS: B Patients who have been taking -adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases myocardial contractility. Shortness of breath that occurs when taking -adrenergic blockers for angina may be due to bronchospasm and should be reported to the health care provider. Carvedilol works by decreasing myocardial O2 demand, not by increasing blood flow to the coronary arteries. DIF: Cognitive Level: Apply (application)

After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? a. Hyperglycemia c. Q waves on ECG b. Bilateral crackles d. Elevated troponin

ANS: B Pulmonary congestion suggests that the patient may be developing heart failure, a complication of myocardial infarction (MI). Hyperglycemia is common after MI because of the inflammatory process that occurs with tissue necrosis. Troponin levels will be elevated for several days after MI. Q waves often develop with ST-segment-elevation MI. DIF: Cognitive Level: Analyze (analysis)

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse when sexual intercourse can be resumed. Which response by the nurse is best? a. "Most patients are able to enjoy intercourse without any complications." b. "Sexual activity uses about as much energy as climbing two flights of stairs." c. "The doctor will provide sexual guidelines when your heart is strong enough." d. "Holding and cuddling are good ways to maintain intimacy after a heart attack."

ANS: B Sexual activity places about as much physical stress on the cardiovascular system as most moderate-energy activities such as climbing two flights of stairs. The other responses do not directly address the patient's question or may not be accurate for this patient. DIF: Cognitive Level: Apply (application)

A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient? a. Infuse the PRBCs slowly over 4 hours. b. Transfuse only leukocyte-reduced PRBCs. c. Administer the scheduled diuretic before the transfusion. d. Give the PRN dose of antihistamine before the transfusion.

ANS: B TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory problems caused by circulatory overload or by allergic reactions, but they will not prevent TRALI

A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the a. platelet count. b. bleeding time. c. thrombin time. d. prothrombin time.

ANS: B The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision

ANS: B The changes in the right hand indicate compromised blood flow, which requires immediate evaluation and actions such as prescribed calcium channel blockers or surgery. The other changes are expected or require nursing interventions. DIF: Cognitive Level: Analyze (analysis)

Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.

ANS: B The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a "no visitors" policy is not needed

When titrating IV nitroglycerin for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the drug? a. Monitor heart rate. c. Check blood pressure. b. Ask about chest pain. d. Observe for dysrhythmias.

ANS: B The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. The nurse will also monitor heart rate and blood pressure and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective. DIF: Cognitive Level: Apply (application)

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

ANS: B The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are stable. DIF: Cognitive Level: Analyze (analysis)

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? a. captopril c. furosemide (Lasix) b. sildenafil (Viagra) d. warfarin (Coumadin)

ANS: B The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation. The other home medications should also be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment. DIF: Cognitive Level: Analyze (analysis)

Three days after experiencing a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with hygiene activities, saying, "I am too nervous about my heart to be alone while I get washed up." Based on this information, which nursing diagnosis is appropriate? a. Activity intolerance related to weakness b. Anxiety related to change in health status c. Denial related to lack of acceptance of the MI d. Altered body image related to cardiac disease

ANS: B The patient data indicate anxiety about the impact of the MI is a concern. The other nursing diagnoses may be appropriate for some patients after an MI, but the data for this patient do not support denial, activity intolerance, or altered body image. DIF: Cognitive Level: Apply (application)

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.

ANS: B The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 500/µL), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment

Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 44-year-old with sickle cell anemia who says "my eyes always look sort of yellow" b. 23-year-old with no previous health problems who has a nontender lump in the axilla c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement

ANS: B The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently

A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Avoid venipunctures. b. Notify the patient's physician. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.

ANS: B The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions also are appropriate, but the most important action should be to notify the physician so that DIC treatment can be initiated rapidly

A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly."

ANS: B This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Verify the patient identification (ID) according to hospital policy. b. Obtain the temperature, blood pressure, and pulse before the transfusion. c. Double-check the product numbers on the PRBCs with the patient ID band. d. Monitor the patient for shortness of breath or chest pain during the transfusion.

ANS: B UAP education includes measurement of vital signs. UAP would report the vital signs to the registered nurse (RN). The other actions require more education and a larger scope of practice and should be done by licensed nursing staff members

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following? a. "They will circulate my blood with a machine during surgery." b. "I will have incisions in my leg where they will remove the vein." c. "They will use an artery near my heart to go around the area that is blocked." d. "I will need to take an aspirin every day after the surgery to keep the graft open."

ANS: B When the internal mammary artery is used there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective. DIF: Cognitive Level: Apply (application)

Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Administering subcutaneous filgrastim (Neupogen) injection d. Developing a discharge teaching plan for the patient and family

ANS: C Administration of subcutaneous medications is included in LPN/LVN education and scope of practice. Patient education, assessment, and developing the plan of care require RN level education and scope of practice

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care? a. Discourage deep breathing to reduce risk for splenic rupture. b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain. c. Schedule immunization with the pneumococcal vaccine (Pneumovax). d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.

ANS: C Asplenic patients are at high risk for infection with Pneumococcus and immunization reduces this risk. There is no need to avoid acetaminophen use before surgery, but nonsteroidal antiinflammatory drugs (NSAIDs) may increase bleeding risk and should be avoided. The enlarged spleen may decrease respiratory depth and the patient should be encouraged to take deep breaths

A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I a. need to start eating more red meat and liver." b. will stop having a glass of wine with dinner." c. could choose nasal spray rather than injections of vitamin B12." d. will need to take a proton pump inhibitor like omeprazole (Prilosec)."

ANS: C Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin

Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? a. An increase in troponin levels from baseline b. A large bruise at the patient's IV insertion site c. No change in the patient's reported level of chest pain d. A decrease in ST-segment elevation on the electrocardiogram

ANS: C Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention may be needed. Bruising is a possible side effect of thrombolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac biomarkers into the circulation as the blocked vessel is opened. DIF: Cognitive Level: Analyze (analysis)

Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis? a. Take a daily multivitamin with iron. b. Limit fluids to 2 to 3 quarts per day. c. Avoid exposure to crowds when possible. d. Drink only two caffeinated beverages daily.

ANS: C Exposure to crowds increases the patient's risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? a. Heparin enhances platelet aggregation at the plaque site. b. Heparin decreases the size of the coronary artery plaque. c. Heparin prevents the development of new clots in the coronary arteries. d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.

ANS: C Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation. DIF: Cognitive Level: Understand (comprehension)

A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.

ANS: C Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will a. reduce heart palpitations. b. prevent coronary artery plaque. c. decrease coronary artery spasms. d. increase contractile force of the heart.

ANS: C Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., diltiazem, amlodipine [Norvasc]) are a first-line therapy for this type of angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and -adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations). Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing O2 demand. DIF: Cognitive Level: Apply (application)

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication? a. Administer the medication at the patient's usual bedtime. b. Have the patient take the colesevelam 1 hour before breakfast. c. Give the patient's other medications 2 hours after colesevelam. d. Have the patient take the dose at the same time as the prescribed aspirin.

ANS: C The bile acid sequestrants interfere with the absorption of many other drugs and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. For maximum effect, colesevelam should be administered with meals. DIF: Cognitive Level: Apply (application)

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider? a. Hematocrit 55% b. Presence of plethora c. Calf swelling and pain d. Platelet count 450,000/mL

ANS: C The calf swelling and pain suggest that the patient may have developed a deep vein thrombosis, which will require diagnosis and treatment to avoid complications such as pulmonary embolus. The other findings will also be reported to the health care provider but are expected in a patient with this diagnosis

During the administration of the thrombolytic agent to a patient with an acute myocardial infarction, the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. increase in blood pressure. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

ANS: C The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding, a possible complication of thrombolytic therapy. Some bleeding of the gums is an expected side effect of the therapy but not an indication to stop infusion of the thrombolytic medication. A decrease in blood pressure could indicate internal bleeding. A nonsustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective. DIF: Cognitive Level: Apply (application)

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies having a heart attack. c. Bilateral crackles in the mid-lower lobes. d. Occasional premature atrial contractions (PACs).

ANS: C The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme inhibitors for the patient. Elevation in troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI. DIF: Cognitive Level: Analyze (analysis)

Which action will the nurse include in the plan of care for a patient who has thalassemia major? a. Teach the patient to use iron supplements. b. Avoid the use of intramuscular injections. c. Administer iron chelation therapy as needed. d. Notify health care provider of hemoglobin 11g/dL.

ANS: C The frequent transfusions used to treat thalassemia major lead to iron toxicity in patients unless iron chelation therapy is consistently used. Iron supplementation is avoided in patients with thalassemia. There is no need to avoid intramuscular injections. The goal for patients with thalassemia major is to maintain a hemoglobin of 10 g/dL or greater

After reviewing information shown in the accompanying figure from the medical records of a 43-yr-old patient, which risk factor modification for coronary artery disease should the nurse include in patient teaching? a. Importance of daily physical activity b. Effect of weight loss on blood pressure c. Dietary changes to improve lipid levels d. Cardiac risk associated with previous tobacco use

ANS: C The patient has an elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol, which will increase the risk of coronary artery disease. Although the blood pressure is in the prehypertensive range, the patient's waist circumference and body mass index indicate an appropriate body weight. The risk for coronary artery disease a year after quitting smoking is the same as a nonsmoker. The patient's occupation indicates that daily activity is at the levels suggested by national guidelines. DIF: Cognitive Level: Analyze (analysis)

Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain? a. Inverted P wave c. ST-segment elevation b. Sinus tachycardia d. First-degree atrioventricular block

ANS: C The patient is likely to be experiencing an ST-segment-elevation myocardial infarction. Immediate therapy with percutaneous coronary intervention or thrombolytic medication is indicated to minimize myocardial damage. The other ECG changes may also suggest a need for therapy but not as rapidly. DIF: Cognitive Level: Analyze (analysis)

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? a. "I will check my pulse rate before I take any nitroglycerin tablets." b. "I will put the nitroglycerin patch on as soon as I get any chest pain." c. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue." d. "I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin."

ANS: C The patient should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin. Although the nurse should check blood pressure before giving nitroglycerin, patients do not need to check the pulse rate before taking nitrates. DIF: Cognitive Level: Apply (application)

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies.

ANS: C The patient's blood pressure indicates hypovolemia caused by blood loss and should be addressed immediately to improve perfusion to vital organs. The other actions also are appropriate and should be rapidly implemented, but improving perfusion is the priority for this patient

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse? a. Heart rate 102 beats/min c. Report of severe chest pain b. Pedal pulses 1+ bilaterally d. Blood pressure 103/54 mm Hg

ANS: C The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse. DIF: Cognitive Level: Analyze (analysis)

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Give the PRN diphenhydramine (Benadryl).

ANS: C The patient's clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine (Benadryl) is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching

A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom? a. Assess the feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias.

ANS: C The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms. DIF: Cognitive Level: Apply (application)

A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first? a. Chest x-ray c. Electrocardiogram (ECG) b. Troponin level d. Insertion of a peripheral IV

ANS: C The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that the appropriate therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion, and an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours. Data from the chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction. Peripheral access will be needed but not before the ECG. DIF: Cognitive Level: Analyze (analysis)

A patient with diabetes mellitus and chronic stable angina has a new order for captopril . The nurse should teach the patient that the primary purpose of captopril is to a. decrease the heart rate. c. prevent changes in heart muscle. b. control blood glucose levels. d. reduce the frequency of chest pain.

ANS: C The purpose for angiotensin-converting enzyme (ACE) inhibitors in patients with chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling. ACE inhibitors do not directly impact angina frequency, blood glucose, or heart rate. DIF: Cognitive Level: Apply (application)

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction. Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. "Do you have any allergies?" b. "Do you take aspirin on a daily basis?" c. "What time did your chest pain begin?" d. "Can you rate your chest pain using a 0 to 10 scale?"

ANS: C Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction, so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information is not a factor in the decision about thrombolytic therapy. DIF: Cognitive Level: Apply (application)

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? a. A 39-yr-old patient with pericarditis who is complaining of sharp, stabbing chest pain b. A 56-yr-old patient with variant angina who is scheduled to receive nifedipine (Procardia) c. A 65-yr-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

ANS: D After PCI, the patient is at risk for hemorrhage from the arterial access site. The nurse should assess the patient's blood pressure, pulses, and the access site immediately. The other patients should also be assessed as quickly as possible, but assessment of this patient has the highest priority. DIF: Cognitive Level: Analyze (analysis)

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? a. Use low-molecular-weight heparin (LMWH) only. b. Administer the warfarin (Coumadin) at the scheduled time. c. Teach the patient about the purpose of platelet transfusions. d. Discontinue heparin and flush intermittent IV lines using normal saline.

ANS: D All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/µL. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which nursing diagnosis is a priority for the patient? a. Acute pain related to myocardial infarction b. Anxiety related to perceived threat of death c. Stress overload related to acute change in health d. Decreased cardiac output related to cardiogenic shock

ANS: D All the nursing diagnoses may be appropriate for this patient, but the hypotension and tachycardia indicate decreased cardiac output and shock from the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g., brain, kidney, heart) and is a priority. DIF: Cognitive Level: Analyze (analysis)

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? a. "I will switch from whole milk to 1% milk." b. "I like salmon and I will plan to eat it more often." c. "I can have a glass of wine with dinner if I want one." d. "I will miss being able to eat peanut butter sandwiches."

ANS: D Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monounsaturated fats such as are found in nuts, olive oil, and canola oil. The patient can include peanut butter sandwiches as part of the TLC diet. The other patient comments indicate a good understanding of the TLC diet. DIF: Cognitive Level: Apply (application)

Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis? a. "Home oxygen therapy is frequently used to decrease sickling." b. "There are no effective medications that can help prevent sickling." c. "Routine continuous dosage narcotics are prescribed to prevent a crisis." d. "Risk for a crisis is decreased by having an annual influenza vaccination."

ANS: D Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises

Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a. Skin color b. Hematocrit c. Liver function d. Serum iron level

ANS: D Because iron chelating agents are used to lower serum iron levels, the most useful information will be the patient's iron level. The other parameters will also be monitored, but are not the most important to monitor when determining the effectiveness of deferoxamine

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and heart rate. b. fewer complaints of having cold hands and feet. c. improvement in the strength of the distal pulses. d. participation in daily activities without chest pain.

ANS: D Because the drug is ordered to improve the patient's angina, effectiveness is indicated if the patient is able to accomplish daily activities without chest pain. Blood pressure and heart rate may decrease, but these data do not indicate that the goal of decreased angina has been met. The noncardioselective -adrenergic blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in distal pulse quality or skin temperature. DIF: Cognitive Level: Apply (application)

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? a. "The pain wakes me up at night." b. "The pain is level 3 to 5 (0 to 10 scale)." c. "The pain has gotten worse over the last week." d. "The pain goes away after a nitroglycerin tablet."

ANS: D Chronic stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina. DIF: Cognitive Level: Understand (comprehension)

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count

ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Evaluation of the patient's response to walking in the hallway b. Completion of the referral form for a home health nurse follow-up c. Education of the patient about the pathophysiology of heart disease d. Reinforcement of teaching about the purpose of prescribed medications

ANS: D LPN/LVN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient's response to exercise after a NSTEMI requires more education and should be done by the RN. Teaching and discharge planning and referral are skills that require RN education and scope of practice. DIF: Cognitive Level: Apply (application)

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia b. Vomiting c. Oral ulcers d. Lip swelling

ANS: D Lip swelling in angioedema may indicate a hypersensitivity reaction to the rituximab. The nurse should stop the infusion and further assess for anaphylaxis. The other findings may occur with chemotherapy, but are not immediately life threatening

A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output.

ANS: D Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time

ANS: D Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT

Following successful treatment of Hodgkin's lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy

ANS: D The chemotherapy used in treating Hodgkin's lymphoma results in a high incidence of secondary malignancies

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. "I can expect nausea as a side effect of nitroglycerin." b. "I should only take nitroglycerin when I have chest pain." c. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart." d. "I will call an ambulance if I still have pain after taking three nitroglycerin 5 minutes apart."

ANS: D The emergency response system (ERS) should be activated when chest pain or other symptoms are not completely relieved after three sublingual nitroglycerin tablets taken 5 minutes apart. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis. DIF: Cognitive Level: Apply (application)

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to include a. a hematocrit (Hct) of 38%. b. an RBC count of 4,500,000/mL. c. normal red blood cell (RBC) indices. d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

ANS: D The patient's clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.

ANS: D The patient's symptoms indicate a possible acute hemolytic reaction caused by the transfusion. The first action should be to disconnect the transfusion and infuse normal saline. The other actions also are needed but are not the highest priority

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to best determine whether the patient has had an AMI? a. Myoglobin c. C-reactive protein b. Homocysteine d. Cardiac-specific troponin

ANS: D Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI) and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but it lacks specificity and its use is limited. The other laboratory data are useful in determining the patient's risk for developing coronary artery disease but are not helpful in determining whether an acute MI is in progress. DIF: Cognitive Level: Understand (comprehension)