Med Surg II (Exam 2) questions
Which dysrhythmia causes the ventricles to quiver, resulting in the absence of cardiac output? a Ventricular tachycardia b Ventricular fibrillation c Asystole d Third degree heart block
b Ventricular fibrillation
On a telemetry monitor, the nurse observes that a patient's heart rhythm is sustained ventricular tachycardia (VT). Upon assessment, the patient is alert and oriented with no reports of chest pain but expresses feeling slightly short of breath. His blood pressure is 108/70. What is the nurse's first action? A. Synchronized cardioversion B. CPR and immediate defibrillation C. Administration of IV amiodarone (Cordarone) and dextrose D. Administration of oxygen and observation of the heart rhythm
D. Administration of oxygen and observation of the heart rhythm
The client comes into the emergency department saying, "I am having a heart attack" Which question is most pertinent when assessing the client? 1. "Can you describe the chest pain" 2. "What were you doing when the pain started" 3. "Did you have a high-fat meal today" 4. "Does the pain get worse when you lie down"
1. "Can you describe the chest pain" The chest pain for MI is usually described as an elephant sitting on the chest or a belt squeezing the substernal midchest, often radiating to the jaw or left arm.
The client has developed atrial fibrillation, with a ventricular rate of 150 beats per minute. Which associated findings would the nurse anticipate in the assessment? SATA 1. Syncope 2. Dizziness 3. Palpitations 4. Hypertension 5. Flat neck veins
1. Syncope 2. Dizziness 3. Palpitations rationale: the client with uncontrolled atrial fibrillation with a ventricular rate more than 100 bpm is at risk for low cardiac output because of loss of atrial kick. The nurse assess the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. Hypertension and flat neck veins are not associated with the loss of cardiac output
This medication is used to treat hyperparathyroidism in patients with chronic renal failure. It works by mimicking the role of calcium in the blood and tricks the parathyroid gland into stop secreting PTH (parathyroid hormone). Which of the following medications does this describe below? A. Calcitonin B. Fosamax C. Lasix D. Sensipar
D. Sensipar
A nurse working on a CVT unit receives report from day shift. After receiving report, which patient should the nurse see first? 1) A 23-year-old professional tennis player with a HR of 47 bpm. 2) A 69-year-old male with atrial fibrillation who has new onset confusion. 3) A 72-year-old female with atrial flutter who reports feeling unusually tired today and yesterday. 4) A 33-year-old female with sinus tachycardia who is asking for her at-home Metoprolol.
2) A 69-year-old male with atrial fibrillation who has new onset confusion. Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days than others.
The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? 1. Blood pressure 2. Airway patency 3. Oxygen flow rate 4. level of consciousness
2. Airway patency rationale: nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection
A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss
D: Hair loss
In Cushing's Disease and Syndrome there are:* A. Increased cortisol production B. Low potassium and glucose levels C. Increased production of aldosterone and cortisol D. Decreased production of cortisol and aldosterone
A. Increased cortisol production
Which patient is at highest risk for venous thromboembolism? A 50-year-old postoperative patient A 25-year-old patient with a central venous catheter in place to treat septicemia A 71-year-old otherwise healthy older adult A pregnant 30-year-old woman due in 2 weeks
A 25-year-old patient with a central venous catheter in place to treat septicemia Rationale: Some risk factors for venous thromboembolism include but are not limited to age older than 65 years, patients undergoing surgery, central venous catheter placement, septicemia, and pregnancy. The client in this question with two risk factors is the 25-year-old with a central venous catheter in place to treat septicemia. All other patients only have one risk factor
Which of the following patients are most likely to experience secondary hyperparathyroidism? A. A 58 year-old male with chronic renal failure. B. A 69 year-old female with an adenoma on the parathyroid gland. C. A 56 year-old male with a magnesium level of 0.5 mg/dL. D. A 7 year-old with diabetes type 1.
A. A 58 year-old male with chronic renal failure.
A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient's family is with the patient and reports that before the patient became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the patient has not been taking any medications. The patient was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient's blood pressure is 70/45. What disorder is this patient most likely experiencing?* A. Addisonian Crisis B. Cushing Syndrome C. Thyroid crisis D. Hashimoto thyroiditis
A. Addisonian Crisis
The nurse understands that patients with which dysrhythmia constitute the largest group of those hospitalized with dysrhythmias? A. Atrial fibrillation B. Sinus tachycardia C. Sinus bradycardia D. Ventricular fibrillation
A. Atrial fibrillation
A patient is recovering from a thyroidectomy. The patient starts to complain of tingling and numbness in the face, toes, and fingers. Which of the following findings below warrants attention?* A. Ca+ level: 6 mg/dL B. Na+ level: 145 mg/dL C. K+ level: 3.5 mg/dL D. Phosphate level: 4.3 mg/dL
A. Ca+ level: 6 mg/dL
A patient is diagnosed with hyperparathyroidism. Which of the following signs and symptoms would you NOT find in this patient? Select all that apply: A. Calcium level 6 mg/dL B. Bone fracture C. Positive Trousseau's Sign D. Tingling and numbness of lips and fingers E. Calcium level of 15 mg/dL F. Phosphate level 1.2 G. Renal calculi
A. Calcium level 6 mg/dL C. Positive Trousseau's Sign D. Tingling and numbness of lips and fingers
A nurse is reviewing manifestations of a thoracic aortic aneurysm with a newly hired nurse. Which of the following findings should the nurse include in the discussion (SATA) A. Cough B. Shortness of Breath C. Upper chest pain D. Diaphoresis E. Altered Mental Status
A. Cough B. Shortness of Breath C. Upper chest pain
A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the patient's discharge teaching after the procedure?* A. Glucocorticoid replacement therapy B. Avoiding avocadoes and pears C. Declomycin therapy D. Signs and symptoms of Grave's Disease
A. Glucocorticoid replacement therapy
Which of the following is not a typical sign and symptom of Cushing's Syndrome?* A. Hyperpigmentation of the skin B. Hirsutism C. Purplish striae D. Moon Face
A. Hyperpigmentation of the skin
In the scenario above, what medication do you expect the patient to be started on?* A. IV Solu-Cortef B. PO Prednisone C. PO Declomycin D. IV Insulin
A. IV Solu-Cortef
A physician orders Calcium Gluconate IV as treatment for a patient with hypoparathyroidism. The patient's calcium level is 5 mg/dL. Which of the following finding causes you to question this order? A. The patient is taking Digoxin. B. The patient complains of muscle cramping and numbness in the face. C. The patient is taking Aluminum carbonate. D. The patient's phosphate level is 7 mg/dL.
A. The patient is taking Digoxin.
A patient with Addison's Disease is being discharged home on Prednisone. Which of the following statements by the patient warrants you to re-educate the patient?* A. "I will notify the doctor if I become sick or experience extra stress." B. "I will take this medication as needed when symptoms present." C. "I will take this medication at the same time every day." D. "My daughter has bought me a Medic-Alert bracelet."
B. "I will take this medication as needed when symptoms present."
Which of the following patients are MOST at risk for hypoparathyroidism?* A. A 75 year-old female who is diabetic and takes Os-Cal daily. B. A 59 year-old male with a Mg+ level of 0.9 mg/dL. C. A 85 year-old female complaining of flank pain and constipation. D. A 19 year-old male with a Ca+ level of 8.9 mg/dL.
B. A 59 year-old male with a Mg+ level of 0.9 mg/dL.
Which of the following patients are at risk for developing Cushing's Syndrome?* A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted. B. A patient taking glucocorticoids for several weeks. C. A patient with a tuberculosis infection. D. A patient who is post-opt from an adrenalectomy.
B. A patient taking glucocorticoids for several weeks
A patient hospitalized with hypoparathyroidism is about to order lunch. Which food selection is best for this patient based on their dietary needs at this time?* A. Baked chicken, green beans, and boiled potatoes B. Broccoli salad, cottage cheese, and peaches C. Roast beef, carrots, and pinto beans D. Hamburger, fries, and sorbet
B. Broccoli salad, cottage cheese, and peaches
A patient is 6 hours post-opt from thyroid surgery. The patient's calcium level is 5 and phosphate level is 4.2. What physical signs and symptoms would NOT present with these findings? (Select-all-that-apply) A. Bronchospasm B. Constipation C. Numbness and tingling in the face D. Positive Chvostek's Sign E. Absent Trousseau's Sign F. Hypertension
B. Constipation E. Absent Trousseau's Sign F. Hypertension
The nurse is assessing a client who reports pain to the left lower extremity, especially while ambulating. The discomfort is relieved with rest. Assessment findings confirm left lower leg mottling and hairlessness. Which health problem will the nurse most likely include in the planning of the client's care? A. Coronary Artery Disease (CAD) B. Intermittent Claudication C. Arterial Embolism D. Raynaud's Disease
B. Intermittent Claudication This answer is correct because claudication occurs when blood flow is narrowed to peripheral circulation. It may occur during exercise or movement, depending on where the arterial narrowing is located. Signs include lower extremity mottling, hairlessness, and pain relieved by ceasing the activity (intermittent pain). Peripheral artery disease (PAD) is linked with intermittent claudication instead of CAD.
In Cushing's disease, the _______ is secreting too much ACTH (Adrenocorticotropic hormone) which is causing an increase in cortisol production.* A. Adrenal cortex B. Pituitary gland C. Thyroid gland D. Hypothalamus
B. Pituitary gland
The nurse is caring for a client with an open lower extremity leg ulcer. The wound margins are irregular, the wound bed is red, and is draining moderate amounts of thick exudate. The nurse documents which type of ulcer? A. Arterial Ulcer B. Venous Ulcer C. Edema Ulcer D. Would Ulcer
B. Venous Ulcer this answer is correct because venous insufficiency is when there is decreased blood flow in the venous system as blood is returned from the peripheral extremities, most often the legs and feet. Various symptoms are associated with this condition, including edema, darkening of the skin, scaly, discolored, thick skin on the legs, and irregularly shaped ulcers or wounds on the feet, ankles, or legs. In contrast, arterial insufficiency has symptoms including decreased pulse or pulselessness, pain, thin, shiny skin, thick toenails, hairlessness, and a round, punched-out wound ulcer.
You are providing discharge teaching to a patient who is prescribed calcium supplements with vitamin D for treatment of hypoparathyroidism. Which of the following statements by the patient warrants you to re-educate the patient on how they should take this medication?* A. "I will also make sure I eat foods rich in calcium, such as dairy and green leafy vegetables while I'm taking this medication." B. "A side effect of this medication is constipation. Therefore, I should drink plenty of fluids." C. "I will take my calcium supplements in the morning when I take my Synthroid." D. All the statements above are correctly stated by the patient.
C. "I will take my calcium supplements in the morning when I take my Synthroid."
A nurse in the emergency department is admitting a client who has a possible dissecting abdominal aortic aneurysm. Which of the following actions is the priority for the nurse to take? A. Administer pain medication as prescribed B. Provide a warm environment C. Administer IV fluids as prescribed D. Initiate a 12-lead ECG
C. Administer IV fluids as prescribed
Addison's Disease is:* A. Increased secretion of cortisol B. Increased secretion of aldosterone and cortisol C. Decreased secretion of cortisol D. Decreased secretion of aldosterone and cortisol
C. Decreased secretion of cortisol
A patient with Addison's Disease should consume which of the following diets?* A. High fat and fiber B. Low potassium and high protein C. High protein, carbs, and adequate sodium D. Low carbs, high protein, and increased sodium
C. High protein, carbs, and adequate sodium
. A patient is prescribed Fosamax (Alendronate). The patient is about to be discharged and you observe the patient taking the medication. Which of the following findings requires you to re-educate the patient on how to take this medication? A. The patient takes the medication on an empty stomach. B. The patient takes the medication with water. C. The patient sits up 10 minutes after taking the medication. D. The patient waits 30 minutes after taking Fosamax before taking the prescribed vitamins and antacids.
C. The patient sits up 10 minutes after taking the medication.
A patient is recovery from a parathyroidectomy. Which of the following findings causes concern and requires nursing intervention? A. The patient is in Semi-Fowler's position. B. The patient's calcium level is 8.9 mg/dL. C. The patient's voice is hoarse. D. The patient is drowsy but arouses to name.
C. The patient's voice is hoarse.
The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan? Elevate the lower extremities Exercise is discouraged Keep the lower extremities in a neutral or dependent position PAD should not cause pain
Keep the lower extremities in a neutral or dependent position Rationale: For patients with PAD, blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in a neutral or dependent position. In contrast, for patients with venous insufficiency, blood return to the heart needs to be enhanced, so the lower extremities are elevated. Exercise can be prescribed to aid in the development of collateral circulation. Some pain is associated with PAD
The nurse is caring for a client with heart failure who is receiving a prescribed angiotensin-converting enzyme inhibitor (ACE inhibitor). The client is asking how the drug works for heart failure. What will the nurse include in teaching the client about this medication? Select all that apply The ACE inhibitor reduces fluid volume The ACE inhibitor relaxes blood vessels and lowers blood pressure The ACE inhibitor reduces workload on the heart The ACE inhibitor decreases pulmonary venous pressure The ACE inhibitor prevents vasoconstriction and secretion of aldosterone
The ACE inhibitor relaxes blood vessels and lowers blood pressure The ACE inhibitor reduces workload on the heart
A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication do you suspect the patient will be started on? A. Propylthiouracil (PTU) B. Radioactive Iodine C. Tapazole D. Synthroid
The answer is A: Propylthiouracil (PTU) is the only anti-thyroid medication that can be used during the 1st trimester of pregnancy.
You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."
The answer is A: Synthroid is best taken in the MORNING on an empty stomach. All the other statements are correct about taking Synthroid.
A patient is being educated on how to take their anti-thyroid medication. Which of the following statements are INCORRECT? A. "I will continue taking aspirin daily." B. "I will take this medication at the same time every day." C. "It may take a while before I notice that the medication is helping my condition." D. "I will avoid foods containing high levels of iodine."
The answer is A: The patient needs to be instructed NOT to take aspirin because it increases thyroid hormones. All the other statements are correct.
Fill in the blank regarding the negative feedback loop for thyroid hormone production: The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______.* A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and
The answer is B: Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing?A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter
The answer is B: Myxedema Coma... The red flags in this question are the patient's signs/symptoms and the report from the family the patient hasn't been taking the prescribed Synthroid. The patient is showing signs and symptoms of extreme hypothyroidism known as Myxedema coma (which is life-threatening if not treated).
A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition? A. Tapazole B. PTU (Propylthiouracil) C. Synthroid D. Inderal
The answer is C: Synthroid is the only medication listed that treats hypothyroidism. All the other medications are used for hyperthyroidism.
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms? A. Thyroiditis B. Deficiency of iodine consumption C. Grave's Disease D. Hypothyroidism
The answer is C: Grave's Disease
A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism
The answer is D: Hypothyroidism... Iodine helps make T3 and T4....if a person does not consume enough iodine they are at risk for developing HYPOTHYROIDISM
Which of the following are treatment options for hyperthyroidism? Please select all that apply: A. Thyroidectomy B. Methimazole C. Liothyronine Sodium "Cytomel" D. Radioactive Iodine
The answers are A, B,and D. Liothyronine Sodium "Cytomel" is a treatment for hypothyroidism. All the other options are for hyperthyroidism.
The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Note: Select all that apply A. Storing calories B. Increasing the Heart Rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland
The answers are B, C, and E. T3 and T4 burn calories (not store them) and increases body temperature (not decrease).
A patient with atrial fibrillation is scheduled to have an electrical cardioversion. The nurse ensures that the patient has a prescription for a 4-6 supply of which type of medication? a Anticoagulants b Digitalis c Diuretics d Potassium supplements
a Anticoagulants
What does the P wave in an ECG represent? a Atrial depolarization b Atrial repolarization c Ventricular depolarization Ventricular repolarization
a Atrial depolarization
Traditionally, what medications will most likely be ordered for a patient with a fib? (Select all that apply) a Diltiazem ( Cardizem) b Furosemide ( Lasix) c Heparin d Enoxaparin ( Lovenox) e Warfarin ( Coumadin)
a Diltiazem ( Cardizem) c Heparin d Enoxaparin ( Lovenox) e Warfarin ( Coumadin)
A nurse is caring for a client who asks why the provider prescribed a daily aspirin. Which of the following responses should the nurse make? a) "Aspirin reduces the formation of blood clots that could cause a heart attack." b) "Aspirin relieves the pain due to myocardial ischemia." c) "Aspirin dissolves that clots that are forming in your coronary arteries." d) "Aspirin relieves the headaches that are caused by other medications."
a) "Aspirin reduces the formation of blood clots that could cause a heart attack."
1) A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 ml/day. The client asks the nurse how to determine the appropriate amount of fluids they are allowed. Which of the following statements is an appropriate response by the nurse? a) "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink." b) "Each glass contains 8 ounces. There are 30 milliliters per ounce, so you can have a total of 8 glasses or cups of fluid each day." c) "This is the same as 2 quarts, or about the same as 2 pots of coffee." d) "Take sips of water or ice chips so you will not take in too much fluid."
a) "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink."
Which of the following patients are MOST at risk for developing heart failure? Select all that apply. a) A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. b) A 55 year old female with a health history of asthma and hypoparathyroidism c) A 30 year old male with a history of endocarditis and has severe mitral stenosis d) A 45 year old female with a history of lung cancer; stage 2 e) A 58 year old female with uncontrolled hypertension and is being treated for influenza.
a) A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. c) A 30 year old male with a history of endocarditis and has severe mitral stenosis e) A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? Select all that apply. a) A client who has a metabolic alkalosis b) A client who has a blood potassium level of 4.3 meq/L c) A client who has an O2 sat of 96% d) A client who has COPD e) A client who underwent stent placement in a coronary artery
a) A client who has a metabolic alkalosis d) A client who has COPD e) A client who underwent stent placement in a coronary artery
1) A sedentary, obese middle aged client is recovering from surgery to remove an embolus in the right iliac artery. The nurse should develop a discharge plan with the client that will focus on participating in which activities? Select all that apply. a) Aerobic activity b) Strength training c) Weight control d) Stress management e) Wearing supportive athletic shoes
a) Aerobic activity c) Weight control Rationale: (Discharge teaching begins when the client enters the hospital. One of the risk factors for clot formation is a sedentary lifestyle, and the client should engage in daily aerobic activity, such as biking or swimming, (non-weight bearing). The client is also overweight and should plan to control the weight through dietary counseling or attending weight management programs in the community. Strength training is beneficial by increasing strength and lean body mass, but not helpful in preventing vascular disease. Stress management is not a focus based on the client's needs at this time. It is not necessary to wear special supportive shoes: comfortable shoes for walking are adequate.
1) What instructions should the nurse give the client experiencing signs and symptoms related to decreased arterial insufficiency? Select all that apply. a) Avoid smoking and exposure to cold. b) Take acetaminophen if experiencing pain at night. c) Take aspirin or clopidogrel as prescribed. d) Use additional bed clothes at night. e) Wear tight socks to keep feet warm.
a) Avoid smoking and exposure to cold. c) Take aspirin or clopidogrel as prescribed. d) Use additional bed clothes at night. Rationale: (Smoking and exposure to cold could cause vasoconstriction and should be avoided. Aspirin and clopidogrel should be taken as prescribed for the antiplatelet properties. Using extra bedclothes at night provides warmth, which increases vasodilatation. The presence of pain should be investigated as it could indicate increasing arterial insufficiency. Tight socks should be avoided as they could impair circulation.)
The nurse assess a 75 year old patient. Select the 3 assessments that will cause the nurse to suspect a myocardial infarction. a) Complaints of chest pain b) Weakness in the left leg c) Diaphoresis d) Complaints of left arm pain e) Difficulty urinating
a) Complaints of chest pain c) Diaphoresis d) Complaints of left arm pain
A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? Select all that apply. a) Follow up ECG. b) Energy settings used c) IV fluid intake d) Urinary output e) Skin condition under electrodes
a) Follow up ECG. b) Energy settings used e) Skin condition under electrodes
A client with acute chest pain is receiving IV morphine sulfate. Which is an expected effect of morphine? Select all that apply. a) Reduces myocardial oxygen consumption b) Promoted reduction in respiratory rate c) Prevents ventricular remodeling d) Reduces blood pressure and heart rate e) Reduces anxiety and fear
a) Reduces myocardial oxygen consumption d) Reduces blood pressure and heart rate e) Reduces anxiety and fear
1) A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish stable angina from an MI? a) Stable angina can be relieved with rest and nitroglycerin. b) The pain of an MI resolves in < 15 minutes c) The type of activity that causes an MI can be identified. d) Stable angina can occur for longer than 30 minutes
a) Stable angina can be relieved with rest and nitroglycerin.
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 points? Select all that apply. a) The client should report unexpected bleeding or bleeding that lasts a long time. b) The client should take clopidogrel with food. c) The client may bruise more easily and may experience bleeding gums. d) Clopidogrel works by preventing platelets from sticking together and forming a clot. e) The client should drink a glass of water after taking clopidogrel.
a) The client should report unexpected bleeding or bleeding that lasts a long time. c) The client may bruise more easily and may experience bleeding gums. d) Clopidogrel works by preventing platelets from sticking together and forming a clot.
1) A nurse is teaching a client who has heart failure and new prescriptions for furosemide and digoxin. Which of the following information should the nurse include? Select all that apply. a) Weigh daily, the first thing each morning b) Decrease intake of potassium c) Expect muscle weakness while taking digoxin. d) Hold digoxin if heart rate is less than 70/minute. e) Decrease sodium intake
a) Weigh daily, the first thing each morning e) Decrease sodium intake
A patient's ECG strip is irregular. Which method does the nurse use for an accurate assessment? a. 6 second strip b. memory method c. big block method d. commercial ECG rater ruler
a. 6 second strip
The nurse is assessing a patient's ECG rhythm strip and analyzing the P waves. Which questions does the nurse use to evaluate the P waves? ( select all that apply) a Are P waves present? b Are P waves occurring regularly? c Does one P wave follow each QRS complex? d Are the P waves greater than .20 seconds? e Do all P waves look similar? f Are the P waves smooth, round and upright in appearance?
a. Are P waves present? e. Do all P waves look similar? f. Are the P waves smooth, round and upright in appearance?
1) What is the ST segment in an ECG normally? a Isoelectric b Elevated c Depressed d biphasic
a. Isoelectric
The heart monitor of a patient shows a rhythm that appears as a wandering or fuzzy baseline. What is the priority action for the nurse? a Immediately obtain a 12 lead ECG to assess the actual rhythm. b Assess the patient to differentiate artifact from actual lethal rhythms. c Check to see if the patient has a do not resuscitate order. d Ask the patient care technician to take vital signs on the patient.
b Assess the patient to differentiate artifact from actual lethal rhythms.
Excessive vagal stimulation can result from which activities? ( Select all that apply) a Jogging b Carotid sinus massage c Suctioning d Voiding e Valsalva maneuver
b Carotid sinus massage c Suctioning e Valsalva maneuver
1) A client is scheduled for insertion of a coronary stent with right groin access. Which teaching points should the nurse include in this client's preoperative teaching plan? Select all that apply? a) "If you have a hearing aid, you will need to remove it prior to the procedure." b) "If you have chest pain during the procedure, please tell the staff when or if this should occur." c) "The stitches at your right groin will be able to be removed in 7 to 10 days following the procedure." d) " You will be given general anesthesia and you will be asleep throughout the procedure." e) " You will need to remain flat during the procedure and for 3 to 6 hours after the procedure." f) " You will need to keep your right leg in a flexed position for 1 to 2 hours following the procedure.
b) "If you have chest pain during the procedure, please tell the staff when or if this should occur." e) " You will need to remain flat during the procedure and for 3 to 6 hours after the procedure."
1) A nurse is caring for a client who has heart failure and reports increased shortness of breath. Which of the following actions should the nurse take first? a) Obtain the client's weight. b) Assist the client into the High Fowler's position c) Auscultate the lungs d) Check oxygen saturation with pulse oximeter.
b) Assist the client into the High Fowler's position
A 74 year old female presents to the ED with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25 bpm and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicion of heart failure? a) Potassium: 5.6 b) BNP : 820 c) BUN: 9 d) Troponin: < 0.02
b) BNP : 820
A client with chest pain is prescribed IV Nitroglycerin. Which finding is of greatest concern for the nurse initiating the Nitroglycerin drip? a) Serum potassium is 3.5 mEq/L b) Blood pressure is 88/46 mm Hg c) ST elevation is present on the EKG d) Heart rate is 61 bpm
b) Blood pressure is 88/46 mm Hg
A client returns from a left heart catheterization. The right groin was used for catheter access. In which location should the nurse palpate the distal pulse on this client? a) Anterior of the right tibia b) Dorsal surface of the right foot c) Posterior to the right knee d) Right midinguinal area
b) Dorsal surface of the right foot
1) A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0. The patient was recently started on a new medication for treatment of an MI and new heart failure. What medication can cause an increase in potassium level? a) Amlodipine b) Losartan c) Aspirin d) Diltiazem
b) Losartan
The nurse is assessing the lower extremities of the client with peripheral artery disease. Which findings are expected? Select all that apply. a) Hairy legs b) Mottled skin c) Pink skin d) Coolness e) Moist skin
b) Mottled skin d) Coolness
A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/minute and notifies the provider. Which of the following proscriptions might be appropriate for this client? a) Defibrillation b) Pacemaker insertion c) Synchronized cardioversion d) Administration of IV lidocaine
b) Pacemaker insertion
Which of the following are not typical signs and symptoms of right sided heart failure? Select all that apply. a) JVD b) Persistent cough c) Weight gain d) Crackles e) Nocturia f) Orthopnea
b) Persistent cough d) Crackles f) Orthopnea
A client is returned to the surgical care unit after having femoral popliteal bypass grafting. Indicate in which order from first to the last the nurse should conduct assessment of this client. a) Postoperative pain b) Peripheral pulses c) Urine output d) Incision site
b, d, c, a
The nurse is preparing a male patient to have a 12-lead ECG performed. When prepping the skin the nurse notices that the patient has abundant chest hair. What is the most appropriate nursing intervention to improve adhesion of the ECG leads? a. Use alcohol swabs to clean the skin before applying the leads b. Clip the chest hair with the patient's permission before applying the leads c. Apply the leads to the arms and legs only d. Reschedule the ECG
b. Clip the chest hair with the patient's permission before applying the leads Rationale: Alcohol should not be used to prep the skin because it increases the skin's electrical impedance, thereby hindering the detection of the cardiac electrical signal. Clipping the hair would provide access to the skin to assist with adhesion. The ECG would not be performed correctly if the leads were only placed on the extremities, and there is no need to reschedule the ECG at this time
Which dysrhythmia results in the asynchrony of atrial contraction and decreased cardiac output? a Sinus tachycardia b Atrial flutter c Atrial fibrillation d First degree AV block
c Atrial fibrillation
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) " I am able to walk further without leg pain."
The nurse is caring for a client with peripheral artery disease who has recently been prescribed clopidogrel. Which statement by the client indicates that the nurse should continue giving information to the client about this medication. a) "I should not be surprised if I bruise easier or if my gums bleed a little when brushing my teeth." b) "It does not really matter if I take this medicine with or without food, which ever works best for my stomach." c) "I should stop taking my medicine if it makes me feel weak and dizzy." d) " The doctor prescribed this medicine to make my platelets less likely to stick together and help prevent clots from forming."
c) "I should stop taking my medicine if it makes me feel weak and dizzy."
A nurse is talking with a client who has class I heart failure and asks about obtaining a ventricular assist device (VAD) Which of the following statements should the nurse make? a) "VADs are only implanted during heart transplantation." b) "A VAD helps to pace the heart." c) "VADs are used when heart failure is not responsive to medications." d) "A VAD is useful for clients who also have chronic lung disease."
c) "VADs are used when heart failure is not responsive to medications."
A patient with left sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? a) Encourage the patient to cough and deep breathe. b) Place the patient in Semi-Fowlers position c) Assist the patient into the High-Fowlers position d) Perform chest percussion therapy
c) Assist the patient into the High-Fowlers position
A patient with heart failure is taking Losartan and Spironolactone. The patient is having ECG changes that present with tall peaked T waves and flat P waves. Which of the following lab results confirms these findings? a) Sodium: 135 b) BNP: 560 c) Potassium: 8.0 d) Potassium: 1.5
c) Potassium: 8.0
A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? a) Diet modification b) Relaxation exercises c) Smoking cessation d) Taking omega-3 capsules.
c) Smoking cessation
The client who experiences angina has been told to follow a low cholesterol diet. Which meal would be the best? a) Hamburger, salad and mild shake b) Baked liver, green beans and coffee c) Spaghetti with tomato sauce, salad and coffee d) Fried chicken, green beans and skim milk
c) Spaghetti with tomato sauce, salad and coffee
One goal in caring for a client with arterial occlusive disease is to promote vasodilatation in the affected extremity. What priority measure should the nurse instruct the client to do to achieve this goal? a) Avoid eating low fat foods. b) Elevate the legs above the heart. c) Stop smoking. d) Jog daily.
c) Stop smoking.
A newly licensed nurse is observing a cardioversion procedure and hears the team leader call out "stand clear". This statement indicates which of the following events is occurring? a) The cardioverter is being charged to the appropriate setting. b) The team should initiate CPR due to pulseless electrical activity. c) Team members cannot be in contact with equipment connected to the client. d) A time out is being called to verify correct protocols.
c) Team members cannot be in contact with equipment connected to the client.
1) A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? a) CK-MB b) Troponin I c) Troponin T d) Myoglobin
c) Troponin T
The nurse is unable to palpate the client's left pedal pulses. What should the nurse do first? a) Auscultate the pulses with a stethoscope. b) Call the health care provider. c) Use a doppler ultrasound device. d) Inspect the lower left extremity.
c) Use a doppler ultrasound device.
The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse, and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? a) Obtain a history of which drugs the client has used recently b) Administer the prescribed dose of morphine c) Position the electrodes on the chest d) Take vital signs
c, d, b, a
A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching? a) "I should place the tablet under my tongue." b) "I should have my clotting time checked weekly." c) "I will report any ringing in my ears." d) "I will call my doctor if my pulse rate is less than 60."
d) "I will call my doctor if my pulse rate is less than 60."
These drugs are used a first line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to excrete. However, some patients develop a nagging cough with these types of drugs. These drugs are: a) Beta blockers b) Vasodilators c) Angiotensin II receptor blockers d) Angiotensin converting enzyme inhibitors
d) Angiotensin converting enzyme inhibitors
1) The nurse is assessing a 48 year old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which finding requires further evaluation? a) Heart rate 57 bpm b) SpO2 94% on room air c) Blood pressure 134/82 mm Hg d) Ankle-brachial index 0.65
d) Ankle-brachial index 0.65
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 legs elevated. c) Wear support stockings. d) Enroll in a supervised exercise training program.
d) Enroll in a supervised exercise training program.
The physician's order says to administer Lasix 40 mg IV twice a day. The patient has the following morning labs: Na: 148, BNP: 900, K:2.0, BUN: 10. Which of the following is a nursing priority? a) Administer the Lasix as ordered. b) Notify the MD of the BNP level c) Assess the patient for edema. d) Hold the dose and notify the physician about the potassium level.
d) Hold the dose and notify the physician about the potassium level.
Which type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. a) Left ventricular systolic dysfunction b) Left ventricular right sided dysfunction c) Right ventricular diastolic dysfunction d) Left ventricular diastolic dysfunction
d) Left ventricular diastolic dysfunction
A patient is diagnosed with left sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? a) Echocardiogram shows an ejection fraction of 38% b) Heart catheterization shows an ejection fraction of 65% c) Patient has frequent episodes of paroxysmal nocturnal dyspnea d) Options A and C are both expected findings with left sided systolic dysfunction heart failure.
d) Options A and C are both expected findings with left sided systolic dysfunction heart failure.
A client has chest pain rated at 8 on a 10 point visual analog scale. The 12 lead EKG reveals ST elevation in the inferior leads and the troponin levels are elevated. What should the nurse do first? a) Monitor daily weights and urine output b) Limit visitation by family and friends c) Provide client education on medications and diet d) Reduce pain and myocardial oxygen demand
d) Reduce pain and myocardial oxygen demand
A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? a) I've noticed I've gained 6 pounds in one week. b) While I sleep, I have to prop myself up with a pillow so I can breathe. c) I have not noticed any swelling in my hands or feet lately. d) Options B and C are correct. e) Options A and B are correct. f) Options A,B and C are all correct
e) Options A and B are correct.
The nurse is monitoring a client admitted with a myocardial infarction (MI) who is at risk for cardiogenic shock. The nurse should report which changes noted from the client's chart? a) BP at 1PM is 110/70, BP at 3PM is 100/65 b) T at 1PM is 98.7 (37.1), T at 3 PM is 99 (37.2) c) HR at 1PM is 70, HR at 3 PM is 75 d) RR at 1 PM is 20, RR at 3 PM is 26 e) UO at 1PM is 90 ml/hr, UO at 3PM is 20ml/hr
e) UO at 1PM is 90 ml/hr, UO at 3PM is 20ml/hr
