Lipptioncott Cardiovascular
A community health nurse is involved in a teaching program to help prevent rheumatic fever in school-age children. Which is the most important intervention to decrease the incidence of the disease? a. teaching clients to seek medical treatment for streptococcal pharyngitis b. promoting hygienic measures to prevent the transmission of streptococcal infections c. providing prophylactic antibiotics to clients with a history of rheumatic heart disease d. educating clients on the importance of vaccinations for hepatitis B
a
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? a. "I sleep on three pillows each night." b. "My feet are bigger than normal." c. "My pants don't fit around my waist." d. "I don't have the same appetite I used to."
a
A client comes to the emergency department reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which should the nurse do first when the client is admitted to the coronary care unit? a. Begin telemetry monitoring. b. Obtain a health history. c. Auscultate heart sounds. d. Evaluate the client's pain.
a
A client has atrial fibrillation. The nurse should monitor the client for which condition? a. cardiac arrest b. cerebrovascular accident c. heart block d. ventricular fibrillation
b
Which statement indicates that the parents understand the need for their child to receive long-term antibiotic therapy after an episode of rheumatic fever? "It will prevent recurring acute rheumatic fever." "It will protect against further joint damage." "The inflammation will subside more quickly." "The inflammation will be reduced with future attacks."
"It will prevent recurring acute rheumatic fever."
An obese male client with history of heart failure is prescribed a beta blocker. Which of the following is important to teach regarding home drug therapy? Select all that apply. "Take your medication at the same time daily." "Contact the health care provider if you have difficulty getting or maintaining an erection." "Weigh yourself weekly with the same amount of clothes on each time." "Change positions between sitting and standing carefully." "Check your pulse for a full minute before administering your medication." "Monitor your blood glucose readings every morning."
"Take your medication at the same time daily." "Contact the health care provider if you have difficulty getting or maintaining an erection." "Change positions between sitting and standing carefully." "Check your pulse for a full minute before administering your medication."
A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60 mm Hg. What should the nurse do first? a. Prepare for transcutaneous pacing. b. Prepare to defibrillate the client at 200 J. c. Administer an intravenous lidocaine infusion. d. Schedule the operating room for the insertion of a permanent pacemaker.
a
A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for: a. Intermittent claudication. b. Dyspnea. c. Dependent edema. d. Crackles.
c
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as a. a first heart sound (S1). b. a third heart sound (S3). c. a fourth heart sound (S4). d. a murmur.
b
A client is admitted to the emergency department with severe abdominal pain. A radiograph reveals a large abdominal aortic aneurysm. What is the nurse's primary goal at this time? a. Maintain circulation. b. Manage pain. c. Prepare the client for emergency surgery. d. Teach postoperative breathing exercises.
c
A client displays signs associated with a possible ruptured aortic aneurysm. What is the priority nursing intervention? a. Administer prescribed antihypertensive medication b. Prepare the client for an aortogram c. Administer prescribed beta-adrenergic blocker medication d. Prepare the client for surgical intervention
d
A nurse is awaiting the arrival of a client from the emergency department with a diagnosis of anterior wall myocardial infarction. In caring for this client, the nurse would be alert for which signs and symptoms of left-sided heart failure? Select all that apply. jugular vein distention hepatomegaly dyspnea crackles tachycardia skin tenting
dyspnea crackles tachycardia
The nurse is assessing a client who has a history of peripheral artery disease. The nurse observes that the left great toe is black. The nurse determines that the black color is caused by which factor? atrophy contraction gangrene rubor
gangrene
A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply. ascites jugular vein distention orthopnea cough hepatomegaly crackles
orthopnea, cough, crackles
The nurse is caring for a client with peripheral artery disease (PAD) who has just returned from having a percutaneous transluminal balloon angioplasty. Which finding requires immediate action from the nurse? a. a change in the intensity of the pulse from the baseline b. pain "2 out of 10" at the catheterization site c. shiny skin and a hairless appearance on the affected leg d. the presence of an ulcer on the limb of the catheterization site
s=a
The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)? Select all that apply. serum bilirubin serum troponin serum myoglobin urinalysis electroencephalogram 24-hour creatinine clearance
serum troponin serum myoglobin
A client has mitral stenosis and will have a valve replacement. The nurse is instructing the client about health maintenance prior to surgery. Inability to follow which prescription would pose the greatest health hazard to this client at this time? a. medication therapy b. diet modification c. activity restrictions d. dental care
a
A client has sudden, severe pain in the back and chest, accompanied by shortness of breath. The client describes the pain as a "tearing" sensation. The health care provider suspects the client is experiencing a dissecting aortic aneurysm. The nurse should assess the client for which potential complication of a dissecting aneurysm? a. cardiac tamponade b. stroke c. pulmonary edema d. myocardial infarction
a
The emergency department protocol provides for administration of alteplase (tPA) for clients with confirmed acute coronary syndrome (ACS). The nurse contacts the healthcare provider to clarify the order for the client with which health history? a. atrial fibrillation and a mild stroke one month ago b. myocardial infarction one year ago with angioplasty c. hypertension, dyslipidemia, and peripheral artery disease d. no previous history of cardiovascular disease
a
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? a. Risk for infection b. Chronic pain c. Impaired gas exchange d. Impaired memory
a
Which client statement should the nurse evaluate as indicating the client's correct understanding of the causes of coronary artery disease (CAD)? a. "The leading cause of CAD is atherosclerosis." b. "There are many causes of CAD." c. "Cigarette smoking is the most common cause of CAD." d. "I will need to ask my healthcare provider about the causes of CAD."
a
The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel. The nurse should develop a teaching plan that includes which point(s)? Select all that apply. a. to report unexpected bleeding or bleeding that lasts a long time b. to take clopidogrel with food c. to understand that the client may bruise more easily and may experience bleeding gums. d. to know that clopidogrel works by preventing platelets from sticking together and forming a clot e. to drink a glass of water after taking clopidogrel
a, c, d
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? a. urine output of 15 ml/hour and 2+ hematuria b. blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute c. urine output of 150 ml/hour and heart rate of 45 beats/minute d. blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute
b
A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of a. right-sided heart failure. b. acute pulmonary edema. c. pneumonia. d. cardiogenic shock.
b
A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which is the priority intervention? a. Reduce the nausea and vomiting and stabilize the blood glucose. b. Control the pain and support breathing and oxygenation. c. Decrease the anxiety and reduce the workload on the heart. d. Monitor and manage potential complications.
b
During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client? a. Monitor the radial pulse. b. Assess the digoxin level. c. Measure the urine output. d. Evaluate the B-type natriuretic peptide level (BNP).
b
Prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which contradiction to administering the drug? a. age greater than 60 years b. history of cerebral hemorrhage c. history of heart failure d. cigarette smoking
b
The nurse is assigned to a client in the ICU. During the initial assessment, the nurse notes jugular vein distention and recognizes that the plan of care will follow which disorder? a. abdominal aortic aneurysm b. heart failure c. myocardial infarction (MI) d. pneumothorax
b
A client admitted to the emergency department with atrial fibrillation has a heart rate of 160 bpm. The nurse should implement which prescription first? a. Administer a heparin bolus. b. Administer a beta blocker. c. Administer oxygen via nasal cannula. d. Prepare client for an immediate cardioversion.
c
A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? a. prolonged PR interval b. absent Q wave c. elevated ST segment d. widened QRS complex
c
A client is admitted to the hospital through the emergency department with chest pain. Which intervention is the priority? a. monitoring the platelet count b. assessing B-type natriuretic peptide levels c. assessing troponin 1 levels d. monitoring the white blood cell count
c
A client is receiving cilostazol for peripheral artery disease causing intermittent claudication. Which statement by the client indicates to the nurse that this medication is effective? a. "I am having fewer aches and pains." b. "I do not have headaches anymore." c. "I am able to walk further without leg pain." d. "My toes are turning grayish-black in color."
c
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? a. "When I finish the rehabilitation program I'll never have to worry about heart trouble again." b. "I won't be able to jog again even with rehabilitation." c. "Rehabilitation will help me function as well as I physically can." d. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."
c
A physician admits a client to the healthcare facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind when formulating interventions? a. decreasing blood pressure and increasing mobility b. increasing blood pressure and reducing mobility c. stabilizing heart rate and blood pressure and easing anxiety d. increasing blood pressure and monitoring fluid intake and output
c
A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? a. Bleeding time b. Platelet count c. Prothrombin time (PT) d. Partial thromboplastin time (PTT)
c
The nurse is assessing a client admitted to the hospital for surgery to repair an abdominal aortic aneurysm. Before surgery, the nurse should assess the client for which factor that puts the client at risk for rupture? a. anemia b. dehydration c. high blood pressure d. hyperglycemia
c
The nurse is caring for a client in the coronary care unit when the cardiac monitor reveals ventricular fibrillation. The nurse should anticipate which intervention? a. an I.V. push of digoxin b. an I.V. line for emergency medications c. immediate defibrillation d. synchronized cardioversion
c
The nurse is teaching a client with a demand pacemaker. What should the nurse tell the client about how the device functions by providing stimuli to the heart muscle:? The pacemaker will provide a stimulus: a. when the heart begins to beat irregularly. b. constantly, resulting in a predetermined heart rate. c. when the heart rate falls below a specified level. d. whenever ventricular fibrillation occurs.
c
The nurse observes the cardiac rhythm (see ECG strip) for a client who is being admitted with a myocardial infarction. What should the nurse do first? a. Prepare for immediate cardioversion. b. Begin cardiopulmonary resuscitation (CPR). c. Check for a pulse. d. Prepare for immediate defibrillation.
c
an older adult is admitted to the hospital with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for: a. chronic renal failure. b. exacerbation of heart failure. c. digoxin toxicity. d. metabolic acidosis.
c
A client arrives in the emergency department reporting intense pain in the abdomen and tells the nurse that it feels like a heartbeat in the abdomen. Which nursing assessment would indicate potential rupture of an aortic aneurysm? a. The blood pressure and pulse are within normal limits, but the client's skin color is pale and slightly diaphoretic. b. The client reports feeling nauseated. c. The client has been taking an antihypertensive for the past 3 years but forgot to take it today. d. The client reports increasing severe back pain.
d
A client is to have a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the health care provider (HCP) before the stress test? a. cholesterol level b. erythrocyte sedimentation rate c. prothrombin time d. troponin level
d
A client with aortic stenosis tells the nurse, "I have been feeling so tired lately that I take a nap in my recliner every afternoon." On assessment, the nurse notes apical heart sounds 2 cm left of the midclavicular line, crackles in lower lung fields during respiration, blood pressure 110/90 mm Hg, and weight gain of 2.5 kg (5.5 lb) in 24 hours. Which assessment requires further action? a. apical heart sounds 2 cm to the left of midclavicular line b. crackles in lower lung fields during inspiration c. blood pressure 110/90 mm Hg d. weight gain of 2.5 kg (5.5 lb) in 24 hours
d
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? a. fourth heart sound (S4) b. increased PR interval c. orthostatic hypotension d. irregularly irregular heart rate
d
A physician admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has a. retrosternal pain that worsens during supine positioning. b. pulsus paradoxus. c. a scratchy pericardial friction rub. d. Osler's nodes and splinter hemorrhages.
d
The nurse is reviewing the electrocardiogram of a client who has elevated ST segments visible in leads II, III, and aVf. Which choice is the nurse's best action? a. Document the finding in the medical record. b. Determine whether the rhythm is irregular, coinciding with inspiration and expiration. c. Teach the client about risks for coronary artery disease. d. Notify the healthcare provider.
d
a client who has a history of bacterial endocarditis is scheduled to have oral surgery to remove a tooth. What should the nurse instruct the client to do? a. Gargle with a saline solution before the appointment. b. Rinse with mouthwash the night before and the day of the surgery. c. Contact the health provider (HCP) to request a sedative. d. Be sure the dentist prescribes a prophylactic antibiotic before the oral surgery.
d
A nurse is working in the intermediate care unit. After receiving change of shift report who should the nurse assess first? a. a client with aortic stenosis who has a blood pressure of 84/52 mm Hg b. a client with pericarditis who has sharp chest pain with a deep inspiration c. a client with infective endocarditis who has a murmur and a heart rate of 58 d. a client with heart failure who has bilateral crackles at the lung bases
a
After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize the client care assignment. The nurse has an ancillary staff member available to help care for the clients. Which of these clients should the registered nurse assess first? a. the client with heart failure who is having some difficulty breathing b. the anxious client who was diagnosed with an acute myocardial infarction (MI) 2 days ago, and was transferred from the coronary care unit today c. the coronary bypass client asking for pain medication for "11 of 10" pain in the donor site d. the client admitted during the previous shift with new-onset controlled atrial fibrillation, who has a call light on
a
A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis? a. race b. age c. history of diabetes mellitus d. history of aortic valve replacement
d
The client with peripheral artery disease reports both legs hurt when walking. What should the nurse instruct the client to do? a. Avoid walking when the pain occurs. b. Rest frequently with the legs elevated. c. Wear support stockings. d. Enroll in a supervised exercise training program.
d
The nurse is assessing an individual with peripheral artery disease. Which finding indicates complete arterial obstruction in the lower left leg? a.aching pain in the left calf b. burning pain in the left calf c. numbness and tingling in the left leg d. coldness of the left foot and ankle
d
