NCLEX Book and Kaplan Test Questions for Perfusion Test
A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mmHg, reports dizziness. which intervention would the nurse anticipate will be prescribed?
prepare for transcutaneous pacing
Intravenous heparin therapy is prescribed for a client with a fib. While implementing this prescription, the nurse ensures that which medication is availible on the unit?
protamine sulfate
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortioilliac bypass graft. Leg is warm, and nurse notes redness and edema. Pedal pulse is palpable. How would the nurse interpret the status?
status is expected because of the increased blood flow through leg.
A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremity anxious and reports itching. the nurse hears stridor and notes generalized uritcaria and hypotension. Which interventions would the nurse take? Select all
stop the infusion, administer diphenhydramine, call for the rapid response team
A client has developed atrial fib with a ventricular rate of 150 beats per minutes. Which associated findings would the nurse anticipate in the assessment? Select all
syncope, dizziness, palpations
The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398. The client is taking cholestryamine and the nurse teaches the client about the medication. Which statement indicates the need for teaching?
i will continue my nicotnic acid for the health food store
Client's cardiac rhythm suddenly changes. No P waves, but there are fibrillatory waves before each QRS complex. What is it?
a fib
A client with a fib is receiving a continuous heparin infusion at 1000 units/ hr. Which result would indicate to the nurse that the client is receiving a therapeutic dose?
activated partial thrombolplastin time of 60 seconds
The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority?
airway patency
Client is having frequent premature ventricular contractions. the nurse would place priority on assessment of which information?
blood pressure and oxygen saturation
Nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this med?
development of expiratory wheezes
The nurse is monitoring a client with heart failure who is taking digoxin. which findings are characteristics of digoxin toxicity? Select all
diarrhea, blurred vision, nausea and vomiting
The nurse provides discharge instructions ot a client with atrial fibrillation who is taking warfarin sodium. Which statement by the client reflects the need for further teaching?
i will take coated aspirin for my headaches
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. Which factor is highest priority with regard to this dysrhythmia?
it can develop into ventricular fibrillation at any time.
A client with a history of type 2 diabetes is admitted to the hospital with chest pain and scheduled for a cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after?
metformin
Nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. the PR interval is 0.16 seconds and the QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats per minutes. What action should the nurse take?
monitor any rhythm changes
A client is diagnosed with an ST segment elevation myocardial infarction STEMI, and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?
monitor for signs of bleeding
A client with variant angina is scheduled to receive an oral calicum channel blocker twice daily. which statement by the cline indicates the need for further teaching?
"My spouse told me that since I have this problem, we are going to stop walking in the mall every morning."
The nurse would report which assessment finding to the primary health care provider before initiating thrombolytic therapy in a client with pulmonary embolism?
Blood pressure of 198/110
Client receiving digoxin daily has serum K+ level of 3 and reports anorexia. Cardiologist perscribes a serum digoxin level to be done. Which level would the nurse recognize as being outside of the therapeutic range?
2.2. digoxin should be 0.5 to 2.0
The nurse in a medical unit is caring for a client with heart failure. the client suddenly develops extreme dyspnea, tachycardia, and lung crackles. the nurse immediately asks another nurse to contact the primary health care provider and prepares to implement which priority interventions? Select all
Administering oxygen; inserting a foley catheter; administering furosemide; administering morphine sulfate intravenously
The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates that the meidcation has achieved the expected effect?
Urine output increases from 10 ml to 50 ml
Client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units and warfarin sodium 7.5 mg at 1600 daily. The morning lab results are as follows: activated partial thromboplastin time 32 seconds' international normalized ration 1.3. Which action would the nurse take based on client?
call PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed.
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds?
crackles
A client with myocardial infarction is developing cardiogenic shock. Which potential condition would the nurse anticipate and monitor the client for to detect cardiogenic shock?
ventricular dysrhythmias
the nurse is watching the cardiac monitor and notices that a client's rhythm suddenly changes. there are no P waves, the QRS complexes are wide and the ventricular rate is regular but more than 140 beats. the nurse determines that the client is experiencing which dysrhythmia?
ventricular tachycardia