Lippincott's cardiac questions for MedSurg

44. When the nurse informs the client about the use of the PCA pump, which instruction is most important to include? [ ] 1. "Press the control button whenever you feel you need pain medication." [ ] 2. "Call the nurse each time you need to use the PCA pump." [ ] 3. "Use the PCA pump only when the pain is severe." [ ] 4. "Do not use the PCA pump too frequently, because it can cause addiction."

1

47. Which assessment fi nding is most closely correlated with an evolving MI? [ ] 1. Profuse sweating [ ] 2. Facial fl ushing [ ] 3. Severe headache [ ] 4. Coughing up pink-tinged mucus

1

165. Which of the following outcomes is most appropriate for a nursing diagnosis of Ineffective tis- sue perfusion related to interruption of arterial flow? Select all that apply. ■ 1. Extremities warm to touch. ■ 2. Improved respiratory status. ■ 3. Decreased muscle pain with activity. ■ 4. Participation in self-care measures. ■ 5. Lungs clear to auscultation.

1, 2, 5

23. Which side effects are most closely associated with the use of nitroglycerin tablets? Select all that apply. [ ] 1. Headache [ ] 2. Backache [ ] 3. Diarrhea [ ] 4. Jaundice [ ] 5. Dizziness [ ] 6. Pallor

1, 5

5. When obtaining a health history from this client, which fi nding strongly suggests that the client is hypertensive? Select all that apply. [ ] 1. Unexplained nosebleeds [ ] 2. Diffi culty sleeping at night [ ] 3. Waking to urinate at night [ ] 4. Occasional heart palpitations [ ] 5. Dizziness [ ] 6. Pale skin color

1, 5

10. When preparing discharge instructions for this client, the nurse's instructions should include taking oral furosemide (Lasix) at what time of day? [ ] 1. Before bedtime [ ] 2. When arising in the morning [ ] 3. With the main meal [ ] 4. In the late afternoon

2

101. The nurse is assessing a client with irrevers- ible shock. The nurse should document which of the following? ■ 1. Increased alertness. ■ 2. Circulatory collapse. ■ 3. Hypertension. ■ 4. Diuresis.

2

37. When the client asks the nurse how propranolol helps to prevent angina, what is the best explanation? [ ] 1. Propranolol promotes excretion of body fl uid. [ ] 2. Propranolol reduces the rate of heart contraction. [ ] 3. Propranolol alters pain receptors in the heart. [ ] 4. Propranolol dilates the major coronary arteries.

2

17. When the client asks the nurse how cholesterol acts as a cardiac risk factor, what is the best explanation? [ ] 1. Excess fat in the blood expands the circulating blood volume. [ ] 2. Excess fat in the blood thickens the lining of the arteries. [ ] 3. Excess fat in the blood causes slower blood clotting. [ ] 4. Excess fat in the blood stimulates the heart to beat faster.

2.

109. The nurse is developing an education plan for clients with hypertension. Which of the following long-term goals is most appropriate for the nurse to emphasize? ■ 1. Develop a plan to limit stress. ■ 2. Participate in a weight reduction program. ■ 3. Commit to lifelong therapy. ■ 4. Monitor blood pressure regularly.

3

115. A client has been prescribed digoxin (Lan- oxin). Which of the following symptoms should the nurse tell the client to report as a potential indica- tion of digoxin toxicity? ■ 1. Urticaria. ■ 2. Shortness of breath. ■ 3. Visual disturbances. ■ 4. Hypertension.

3

149. A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for: ■ 1. Intermittent claudication. ■ 2. Dyspnea. ■ 3. Dependent edema. ■ 4. Crackles.

3

22. The nurse informs the client that the correct way to administer nitroglycerin is to place one tablet where? [ ] 1. Between the gum and cheek [ ] 2. At the back of the throat [ ] 3. Under the tongue [ ] 4. Between the teeth

3

85. The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm shown below. The nurse identifies that this rhythm is: ■ 1. Atrial fibrillation. ■ 2. Ventricular tachycardia. ■ 3. Premature ventricular contractions. ■ 4. Third-degree heart block.

3

9. Which observation by the nurse is the best indication that the furosemide (Lasix) has had a desired effect? [ ] 1. The client's pulse becomes slower. [ ] 2. The client's blood pressure stabilizes. [ ] 3. The client's urine output increases. [ ] 4. The client's anxiety is diminished.

3

18. When providing dietary instructions for this client, which healthful alternative should the nurse recommend? [ ] 1. Wheat toast for white bread [ ] 2. Margarine for butter [ ] 3. Cereal for eggs [ ] 4. Ham for sausage

3.

24. The nurse knows that the client understands how to determine when the nitroglycerin tablets need replacing when the client makes which statement? [ ] 1. "The tablets will smell like vinegar." [ ] 2. "The tablets will be discolored." [ ] 3. "They won't tingle in my mouth." [ ] 4. "They will disintegrate when I touch them."

3.

1. Which modifi cation used by the nurse is most appropriate when taking the blood pressure of a client who weighs 250 pounds? [ ] 1. The nurse takes the blood pressure on the client's thigh. [ ] 2. The nurse has the client lie down during the assessment. [ ] 3. The nurse pumps the manometer up to 250 mm Hg. [ ] 4. The nurse uses an extra-large blood pressure cuff

4

27. Which assessment fi nding should signal the nurse to withhold applying the client's nitroglycerin patch and notify the physician? [ ] 1. Temperature of 99.8°F (37.6°C) [ ] 2. Respiratory rate of 24 breaths/minute at rest [ ] 3. Apical heart rate of 90 beats/minute [ ] 4. Blood pressure of 94/62 mm Hg

4

31. Which statement by the client indicates an understanding of what will happen during the testing procedure? [ ] 1. "I will be able to hear my heart beating in my chest." [ ] 2. "I will feel a heavy sensation all over my body." [ ] 3. "I will be anesthetized and will not feel any discomfort." [ ] 4. "I will feel a warm sensation as the dye is instilled."

4

38. While the client takes propranolol (Inderal), what changes would the nurse expect to see in the client's pulse rate? [ ] 1. Faster than usual [ ] 2. Stronger than before [ ] 3. Temporarily irregular [ ] 4. Slower than in the past

4

40. When the client returns to the room after the percutaneous transluminal coronary angioplasty (PTCA) procedure, which assessment fi nding should be reported immediately to the physician? [ ] 1. Urine output of 100 mL/hour [ ] 2. Blood pressure of 108/68 mm Hg [ ] 3. Dry mouth [ ] 4. Chest pain

4

48. Which of the following electrocardiogram (ECG) changes supports the diagnosis that the client is experiencing a myocardial infarction (MI)? [ ] 1. Inverted P wave [ ] 2. Prolonged PR interval [ ] 3. Widened QRS complex [ ] 4. Elevated ST segment

4

49. When the nurse is obtaining this client's health history, which question about pain is least helpful? [ ] 1. "How long have you been in pain?" [ ] 2. "Where is your pain located?" [ ] 3. "What were you doing when your pain started?" [ ] 4. "What medications do you take for pain?"

4

50. If the client's severe chest pain is typical of other people who experience myocardial infarction (MI), the client is most likely to tell the nurse that the discomfort radiates to which area? [ ] 1. Flank [ ] 2. Groin [ ] 3. Abdomen [ ] 4. Shoulder

4

68. A nurse is planning care for a client who has heart failure. Which goal is appropriate for a client with excess fluid volume? 1. A weight reduction of 10% will occur. 2. Pain will be controlled effectively. 3. Arterial blood gas values will be within nor- mal limits. 4. serum osmolatity will be within normal limits

4

102. The nurse is caring for a client who has been diagnosed with deep vein thrombosis. When assess- ing the client's vital signs, the nurse notes an apical pulse of 150 bpm, a respiratory rate of 46 breaths/ minute, and blood pressure of 100/60 mm Hg. The client appears anxious and restless. What should be the nurse's first course of action? ■ 1. Notify the physician. ■ 2. Administer a sedative. ■ 3. Try to elicit a positive Homan's sign. ■ 4. Increase the flow rate of intravenous fluids.

1

11. When teaching the client about the side effects of furosemide (Lasix), the nurse's instructions should include the need to eat foods high in which mineral? [ ] 1. Potassium [ ] 2. Sodium [ ] 3. Calcium [ ] 4. Iron

1

12. The nurse instructs the client to monitor urine output while taking furosemide (Lasix) at home because use of the medication may lead to which condition? [ ] 1. Dehydration [ ] 2. Fluid overload [ ] 3. Hypernatremia [ ] 4. Hyperkalemia

1

20. When the client asks why the physician ordered the ECG, how does the nurse correctly explain its purpose? [ ] 1. It will show how the heart performs during exercise. [ ] 2. It will determine the client's potential target heart rate. [ ] 3. It will verify how much the client needs to improve fi tness. [ ] 4. It will help predict whether the client will have a heart attack soon.

1

36. The nurse knows that the client understands the physician's explanation of the PTCA procedure when the client makes which statement? [ ] 1. "A balloon-tipped catheter will be inserted into my coronary artery." [ ] 2. "A Tefl on graft will be used to replace an area of weakened heart muscle." [ ] 3. "A section of my leg vein will be grafted around a narrowed coronary artery." [ ] 4. "A battery-operated pacemaker will be implanted to maintain my heart rate."

1

41. The nurse checking the client's leg incision is aware that which is the most common blood vessel used in CABG surgery? [ ] 1. The saphenous vein [ ] 2. The femoral artery [ ] 3. The popliteal vein [ ] 4. The iliac artery

1

42. Which action by a newly hired nursing assistant indicates that the nurse needs to provide more instruction to the nursing assistant on how to accurately assess the client's pulse rate? [ ] 1. The nursing assistant places a thumb over the radial artery. [ ] 2. The nursing assistant counts the pulse rate for 1 full minute. [ ] 3. The nursing assistant rests the client's arm on the abdomen. [ ] 4. The nursing assistant presses the radial artery against the bone.

1

44. A loading dose of digoxin (Lanoxin) is given to a client newly diagnosed with atrial fibrillation. The nurse begins instructing the client about the medication and the importance of monitoring his heart rate. An expected outcome of the education program will be: 1.A return demonstration of palpating the radial pulse. 2. A return demonstration of how to take the medication. 3. Verbalization of why the client has atrial fibrillation. 4. Verbalization of the need for the medication.

1

7. The best evidence that the client understands the nurse's instructions regarding dietary restrictions is if the client states to avoid which food? [ ] 1. Soy sauce [ ] 2. Lemon juice [ ] 3. Maple syrup [ ] 4. Onion powder

1

80. A client is receiving digoxin (Lanoxin). His pulse range is normally 70 to 76 bpm. After assess- ing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should first: ■ 1. Call the physician for orders. ■ 2. Withhold the digoxin. ■ 3. Administer the digoxin. ■ 4. Notify the charge nurse.

2

93. A client has been prescribed hydrochloro- thiazide (HydroDIURIL) to treat heart failure. For which of the following symptoms should the nurse monitor the client? ■ 1. Urinary retention. ■ 2. Muscle weakness. ■ 3. Confusion. ■ 4. Diaphoresis.

2

171. Before discharge from the hospital after a myocardial infarction, a client is taught to exercise by gradually increasing the distance walked. Which vital sign should the nurse teach the client to moni- tor to determine whether to increase or decrease the exercise level? ■ 1. Pulse rate. ■ 2. Blood pressure. ■ 3. Body temperature. ■ 4. Respiratory rate.

2

2. The nurse obtains adult blood pressure readings on four separate clients. Which client should have a follow-up blood pressure check within 2 months? [ ] 1. The client whose blood pressure is 138/88 mm Hg [ ] 2. The client whose blood pressure is 132/98 mm Hg [ ] 3. The client whose blood pressure is 120/80 mm Hg [ ] 4. The client whose blood pressure is 118/78 mm Hg

2

21. If the client is typical of others who have angina pectoris, the nurse would expect the client to report that chest pain is best relieved by which nonpharmacological measure? [ ] 1. Taking a deep breath [ ] 2. Resting in a chair [ ] 3. Applying heat to the chest [ ] 4. Rubbing the chest

2

39. What is the best explanation for the drug therapy in this situation? [ ] 1. Aspirin tends to relieve chest pain. [ ] 2. Aspirin tends to prevent blood clots. [ ] 3. Aspirin tends to lower the blood pressure. [ ] 4. Aspirin tends to dilate the coronary arteries.

2

46. After the coronary artery bypass graft (CABG) surgery, which assessment fi nding provides the best evidence that collateral circulation at the donor graft site is adequate? [ ] 1. The client is free from chest pain. [ ] 2. The client's toes are warm and nonedematous. [ ] 3. The client moves the operative leg easily. [ ] 4. The client's heart rate remains regular.

2

28. The best evidence that the client is complying with the diet therapy is the report of using which type of fat for cooking? [ ] 1. Melted margarine [ ] 2. Clarifi ed butter [ ] 3. Cooking spray [ ] 4. Liquid corn oil

3

32. Before the cardiac catheterization and coronary arteriogram, it is essential for the nurse to ask the client about any allergy to iodine or which other substance? [ ] 1. Penicillin [ ] 2. Morphine [ ] 3. Shellfi sh [ ] 4. Eggs

3

33. A client with angina shows the nurse her nitroglycerin (Nitrostat) that she carries in a plastic bag in her pocket. The nurse instructs the client that nitroglycerin should be kept in: ■ 1. The refrigerator. ■ 2. A cool, moist place. ■ 3. A dark container to shield from light. ■ 4. A plastic bag where it is readily available.

3

39. A client whose condition remains stable after a myocardial infarction gradually increases his activity. Which the following conditions should the nurse assess to determine whether the activity is appropriate for the client? ■ 1. Edema. ■ 2. Cyanosis. ■ 3. Dyspnea. ■ 4. Weight loss.

3

92. Which of the following findings should the nurse note in the client who is in the compensatory stage of shock? ■ 1. Decreased urinary output. ■ 2. Significant hypotension. ■ 3. Tachycardia. ■ 4. Mental confusion.

3

153. The nurse monitors the serum electrolyte levels of a client who is taking digoxin (Lanoxin). Which of the following electrolyte imbalances is a common cause of digoxin toxicity? ■ 1. Hyponatremia. ■ 2. Hypomagnesemia. ■ 3. Hypocalcemia. ■ 4. Hypokalemia.

4

157. The physician has prescribed amiodarone (Cordarone) for a client with cardiomyopathy. The nurse should monitor the client's rhythm to determine the effectiveness of the medication in controlling: ■ 1. Sinus node dysfunction. ■ 2. Heart block. ■ 3. Severe bradycardia. ■ 4. Life-threatening ventricular dysrhythmias.

4

16. Which of the following client risk factors is most signifi cant for developing CAD? [ ] 1. Drinking a nightly cocktail [ ] 2. History of mitral valve repair [ ] 3. Rheumatic fever during childhood [ ] 4. Weighing 25 pounds (11.3 kg) above norm

4

The antidote for heparin is: 1. Vitamin K. 2. Warfarin (Coumadin). 3Thrombin. 4. Protamine sulfate.

4

8. If the client with hypertension is willing to implement lifestyle changes to reduce blood pressure, which changes, encouraged by the nurse, would be most benefi cial? Select all that apply. [ ] 1. Eating a diet higher in fi ber [ ] 2. Balancing rest with exercise [ ] 3. Taking time for more leisure activities [ ] 4. Giving up smoking cigarettes [ ] 5. Pursuing measures for losing weight [ ] 6. Assessing blood pressure in the morning and evening

4, 5

25. If the chest pain is not relieved after taking one nitroglycerin tablet, the nurse should teach the client to take what action? [ ] 1. Take another tablet in 5 minutes. [ ] 2. Drive to the emergency department. [ ] 3. Call the physician immediately. [ ] 4. Swallow two additional tablets.

1

26. Which nursing action is most appropriate when applying a new transdermal patch? [ ] 1. Rotate the application site. [ ] 2. Clean the skin with alcohol. [ ] 3. Tape the patch to the client's chest. [ ] 4. Take the blood pressure afterward.

1

33. After the coronary arteriogram, the nurse must keep the client fl at in bed with the affected leg in which position? [ ] 1. Extended [ ] 2. Flexed [ ] 3. Abducted [ ] 4. Adducted

1

34. After the femoral artery has been cannulated and the client is returned to the room, what should the nurse plan to do fi rst? [ ] 1. Palpate the client's distal peripheral pulses. [ ] 2. Auscultate the client's heart and breath sounds. [ ] 3. Percuss all four quadrants of the client's abdomen. [ ] 4. Inspect the skin integrity in the client's groin.

1

52. An expected physiologic response to a low potassium level is: ■ 1. Cardiac dysrhythmias. ■ 2. Hyperglycemia. ■ 3. Hypertension. ■ 4. Increased energy.

1

14. When caring for the client who is prescribed the combination of a loop diuretic and beta blocker to control hypertension, which nursing considerations are essential? Select all that apply. [ ] 1. Assist the client to a standing position. [ ] 2. Maintain an intake and output record. [ ] 3. Maintain bed rest until blood pressure is normal. [ ] 4. Encourage keeping up with work as a diversional activity. [ ] 5. Monitor blood sugar readings. [ ] 6. Discuss sexual implications.

1, 2, 5, 6.

35. The nurse provides discharge instructions for a client who has recovered after a cardiac catheterization. Which instructions should be included? Select all that apply. [ ] 1. Take a shower rather than a tub bath until the puncture site heals. [ ] 2. Perform leg exercises every 2 hours while awake. [ ] 3. Drink a generous amount of fl uids for the next 24 hours. [ ] 4. Report worsening of pain in the leg that was catheterized. [ ] 5. Flush the toilet twice after eliminating urine and stool in the next 24 hours. [ ] 6. Change the dressing over the puncture site daily until it heals

1, 3, 4, 6

3. According to the nurse, when is the correct time to note the diastolic blood pressure reading? [ ] 1. When the loud knocking sounds become muffl ed [ ] 2. When the last loud knocking sound is heard [ ] 3. When the swishing sound becomes loud [ ] 4. When the swishing sound becomes faint

2

30. Which nursing action can best help reduce the client's anxiety in this situation? [ ] 1. Teach the client how coronary artery disease (CAD) is usually treated. [ ] 2. Listen to the client's feelings about this condition. [ ] 3. Explain that the procedure has been very helpful for other clients. [ ] 4. Avoid discussing the heart catheterization until the client has relaxed.

2

4. Which response by the nurse is most accurate? [ ] 1. Sustained hypertension decreases the life span of many blood cells. [ ] 2. Sustained hypertension leads to the formation of venous blood clots. [ ] 3. Sustained hypertension compromises blood fl ow to many vital organs. [ ] 4. Sustained hypertension predisposes to narrowing of the cardiac valves.

3

45. What information about the client's use of a patientcontrolled analgesia (PCA) pump is most important to communicate to the staff on the next shift? [ ] 1. Name of the client's physician [ ] 2. Purpose for using the pump [ ] 3. Number of doses administered [ ] 4. The client's need for further teaching

3

6. When the nurse at the physician's offi ce reviews the client's medical record, which fi nding is the best indication that the client's heart has been affected by sustained high blood pressure? [ ] 1. The client has a strong S1 heart sound. [ ] 2. The client's heart rate is 100 beats/minute when active. [ ] 3. The client's heart is moderately enlarged. [ ] 4. The client has an irregular heart rhythm.

3