Medical surgical (cardiovascular and hematologic)

A nurse is assisting with the care of a client who is in hypovolemic shock. While waiting for a unit of blood, the nurse should plan to administer which of the following IV solutions?

D. 0.9% sodium chloride

A nurse is assisting with a client who is 85 years old. Which of the following findings should the nurse identify as a manifestion of a myocardial infarction?

D. Acute confusion

A nurse is checking laboratory values for an adult client who has sickle cell anemia and is in crisis. For which of the following complications should the nurse monitor?

D. Elevate bilirubin

A nurse is caring for a client with peripheral vascular disease (PVD) and ulcers on the toes. Which of the following findings of PVD is a risk factor for ulceration of the extremities?

D. Impaired circulation

A nurse is collecting data on a client who has a manifestation of aplastic anemia. Which of the following finding should the nurse expect?

D. Petechaie and ecchymosis

A nurse is caring for a client who has thrombocytopenia and develops epistaxis. Which of the following actions should the nurse take?

D. Pinch the soft portion of the clients nose for 10 minutes.

A nurse is caring for a client who has pernicious anemia. Which of the following factors is associated with this condition?

D. Vitamin B12 deficiency

A nurse is caring for a client who is undergoing treatment for hypertension. Which of the following statement should the nurse identify as an indication that the client is adhering to the treatment plan?

A. "I would never have believed I could get used to enjoying my food without salt".

A nurse is contributing to the place of care for a client who has thrombophlebitis. Which of the following actions should the nurse recommend for the plan of care?

A. Place compression stockings on the lower extremities.

A nurse is caring for a client who is undergoing conservative treatment for deep vein thrombosis. The client asks the nurse what will happen to the clot. Which of the following responses should the nurse make?

A. "Your body has a process called fibronolysis that will eventually dissolve the clot.

A nurse is assisting with data collection from a client who has a history of unstable angina. Which of the following findings should the nurse expect?

A. A client reports chest pain when at rest.

A nurse is reviewing the medical record of a client who has heart failure. Which of the following findings should the nurse expect?

A. BNP of 200 pg/mL

A nurse is reinforcing teaching with a client who has iron deficiency anemia. The nurse should encourage the client to increase her consumption of which of the following foods?

A. Beef liver

A nurse is assisting with a client who is scheduled to receive a transfusion of packed red blood cells (RBC's). Which of the following actions should the nurse take? Select all that apply.

A. Check and document the clients vital signs. C. Make sure the blood type and RH of the packed RBCs are checked by 2 nurses. E. Provide the RN with IV that has a filter.

A nurse participating in a community health fair is providing information on a client who has a reading of 150/90 mm/Hg during a blood pressure screening. Which of the following actions should the nurse take?

A. Give the client a written record of his BP to bring to his provider.

A nurse is preparing a client for cardiac catheterization. Which of the following pieces of information should the nurse reinforce with the client before the procedure? Select all that apply.

A."You'll have to lie flat for several hours after the procedure. B. "You'll receive medication to relax you before the procedure". D. " You'll have to keep your legs straight after the procedure.

A nurse is collecting data from a client who has fluid overload resulting from a cardiovascular disorder. Which of the following manifestions should the nurse expect? Select all that apply.

A.jugular vein distention B. Moist crackles D. Increased heart rate

A nurse is examining the ECG of a client who is having an acute myocardial infarction. The nurse should identify that the elevated ST segments on the ECG indicate which of the following alterations?

A.necrosis

A nurse is caring for a client who has a platelet count of 50,000/mm^3. After discontinuing the clients peripheral IV site. Which of the following actions should the nurse take?

B. Apply pressure to the catheter removal site for 10 minutes.

A nurse is caring for a client who had a myocardial infarction 5days ago. The client has a sudden onset of shortness of breath and begins coughing frothy, pink sputum. The nurse auscultates loud, bubbly sounds on aspiration. Which of following adventitious breath sounds should the nurse document?

B. Coarse crackles

A nurse is collecting data from a client who has left sided heart failure. Which of the following findings should the nurse expect?

B. Crackles in the lung bases

A nurse is caring for a client who has a severely elevated blood pressure. Which of the following findings should the nurse identify as a manifestation of hypertension?

B. Epstaxis

A nurse is collecting data from a client. Which of the following findings should the nurse identify as a risk factor for coronary artery disease? Select all that apply.

B. Hypertension C.diabetes mellitus D. Hyperlipidemia E. Tobacco smoking

A nurse is assisting with planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan of care?

B. Measure the clients abdominal girth daily.

A nurse is caring for a client who has hemophilia. The client report pain and swelling in a joint following an injury. Which of the following actions should the nurse take?

B. Prepare for replacement of the missing clotting factor.

A nurse is evaluating a clients repeat laboratory result 4hrs after administering fresh frozen plasma (FFP). Which of the following laboratory values should the nurse review?

B. Prothrombin time

A nurse is monitoring a client who is receiving a unit Of packed blood cells following surgery. The client reports itching and has hives 30 minutes after the infusion begins. Which of the following actions should the nurse take first?

B. Stop the infusion of blood.

A nurse is collecting data about the hematologic system of an older adult client. The nurse should report which of the following findings to the provider as a possible indication of a hematologic disorder?

C. Absence of hair on the legs

A nurse is reinforcing teaching with a client who has polycythemia Vera about self care measures. Which of the following interventions should the nurse include?

C. Elevate your legs when sitting.

A nurse is reinforcing discharge teaching with a client who has a newly inserted permanent pacemaker. Which of the following instructions should the nurse include in the teaching?

C. Use cellular phone on the opposite ear from the pacemaker.

A client who has just learned that he has variant (prinzmetals) angina asks the nurse how this condition compares to stable angina. Which of the following replies should the nurse make?

C. Variant angina can cause changes on your electrocardiogram.

A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the clients provider to prescribe which of the following medications for this client?

C. Vitamin B12

A nurse is reinforcing teaching with client who has anemia and a new prescription for exporting Alfa. Which of the following pieces of information should the nurse include in the teaching?

C.Hypertension is a common adverse effect for this medication.

A nurse is assisting with the preparation of an in service presentation about the management of myocardial infarction (MI). The nurse should identity that death following MI is most often result of which of the following complications?

B. Dysrythmias

A nurse is examining the ECG of a client who has frequent premature ventricular contractions (PVCs). Which of the following QRS changes should the nurse expect to see on the clients ECG?

B. Greater amplitude QRS complexes.

A nurse is caring for a client who has hemophilia. The client reports pain and swelling in a joint following injury. Which of the following actions should the nurse make?

B. Prepare for the replacement of the missing clotting factor.

A nurse is contributing to the plan of care for a client who has pernicious anemia. Which of the following interventions should the nurse recommend?

C. Initiate weekly injections of vitamin B12

A nurse is collecting data from a client who has pernicious anemia. Which of the following findings should the nurse expect?

C. Paresthesias in the hand and feet.

A client who has thrombocytopenia asks the nurse why platelets are so important. Which of the following responses should the nurse make?

C. Platelets plug breaks in blood vessels.

A nurse collecting data from a client who has abdominal aortic aneurysm (AAA). Which of the following findings indicate that AAA is expanding?

C. Report of sudden, severe back pain

A nurse is assisting with the preparation of an in service about the collecting data from a clients who are having acute myocardial infarction (MI). The nurse should identify that the most common finding of acute MI which of the following?

C. Substernal chest pain

A nurse is showing a client who has right sided heart failure an illustration of the heart. The nurse should identify the blood vessels that carry deoxygenated blood to the right atrium as which of the following?

D. Superior vena cava

A nurse is reinforcing teaching about a low-cholesterol diet with a client who had a myocardial infarction. Which of the following meal selections by the client indicates an understanding of the teaching?

A. Chicken breast and corn on the cob

A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition. Which of the following findings should the nurse expect?

A. Decreased albumin

A nurse is caring for a client who has femoral thrombophlebitis and a prescription for enoxaprin. Which of the following actions should the nurse take?

A. Elevate affected leg.

A nurse is examining the ECG of a client who has hyperkalemia. Which of the following ECG changes should the nurse expect?

A. Elevated ST segments

A nurse is reinforcing dietary teaching about a low-cholesterol diet with a client who has heart disease. Which of the following clients statements indicates the teaching was effective?

A. I should remove the skin from the poultry before eating it.

A nurse is collecting data from a client who has isotonic dehydration. Which of the following findings should the nurse expect?

A. Increased hematocrit

A nurse is monitoring a client for a reperfusion following thrombolytic therapy to treat acute myocardial infarction (MI). Which of the following indicators should the nurse identify to confirm reperfusion?

A. Ventricular dysrhythmias

A nurse is assisting with developing the plan of care for an older adult client who is to receive a unit of packed blood cells (RBCs). Which of the following actions should the nurse recommend?

A. Verify the information on the packed RBCs with another nurse.

A nurse is caring for a client who has late stage heart failure and is experiencing fluid volume overload. Which of the following findings should the nurse expect?

A. Weight gain 1 kg (2.2lb) in 1 day