Cardiac Practice Questions

29. The nurse is discussing the pathophysiology of atherosclerosis with a client who has a normal high-density lipoprotein (HDL) level. Which information should the nurse discuss with the client concerning HDLs? 1. A normal HDL is good because it has a protective action in the body. 2. The HDL level measures the free fatty acids and glycerol in the blood. 3. HDLs are the primary transporters of cholesterol into the cell. 4. The client needs to decrease the amount of cholesterol and fat in the diet.

1. A normal HDL level is good because HDL transports cholesterol away from the tissues and cells of the arterial wall to the liver for excretion. This helps d ecrease the development of atherosclerosis. TEST-TAKING HINT: If the test taker has no idea what the correct answer is, the test taker should look at the specific words in the answer options. Normal laboratory data would probably be good for the client; therefore, option "1" would be a probable correct answer.

55. Which assessment data would warrant immediate intervention by the nurse? 1. The client diagnosed with DVT who complains of pain on inspiration. 2. The immobile client who has refused to turn for the last three (3) hours. 3. The client who had an open cholecystectomy who refuses to breathe deeply. 4. The client who has had an inguinal hernia repair who must void before discharge.

1. A potentially life-threatening complication of DVT is a pulmonary embolus, which causes chest pain. The nurse should determine if the client has "thrown" a pulmonary embolus. Test taking hint: the test taker should determine which option contains information that indicates a potentially life-threatening situation. This is the priority client.

10. The client diagnosed with essential hypertension asks the nurse, "I don't know why the doctor is worried about my blood pressure. I feel just great." Which statement by the nurse would be the most appropriate response? 1. "Damage can be occurring to your heart and kidneys even if you feel great." 2. "Unless you have a headache, your blood pressure is probably within normal limits." 3. "When is the last time you saw your doctor? Does he know you are feeling great?" 4. "Your blood pressure reflects how well your heart is working."

1. Even if the client feels great, the blood pressure can be elevated, causing damage to the heart, kidney, and blood vessels. TEST-TAKING HINT: The test taker should select the option that provides the client with correct information in a nonthreatening, nonjudgmental approach.

82. The client diagnosed with a pulmonary embolus is being discharged. Which intervention should the nurse discuss with the client? 1. Increase fluid intake to two (2) to three (3) L/day. 2. Eat a low-cholesterol, low-fat diet. 3. Avoid being around large crowds. 4. Receive pneumonia and flu vaccines.

1. Increasing fluids will help increase fluid volume, which will, in turn, help prevent the development of deep vein thrombosis, the most common cause of PE. TEST-TAKING HINT: The test taker must know deep vein thrombosis is the most common cause of pulmonary embolus and preventing dehydration is an important intervention. The test taker can attempt to eliminate answers by trying to determine which disease process is appropriate for the intervention.

77. The nurse is caring for a client diagnosed with coronary artery disease (CAD). Which should the nurse teach the client prior to discharge? 1. Carry your nitroglycerin tablets in a brown bottle. 2. Swallow a nitroglycerin tablet at the first sign of angina. 3. If one nitroglycerin tablet does not work in 10 minutes, take another. 4. Nitroglycerin tablets have a fruity odor if they are potent.

1. Nitroglycerin tablets are dispensed in small brown bottles to preserve the potency. The client should not change the tablets to another container. TEST-TAKING HINT: The test taker should be knowledgeable of common medications and what to teach the client.

76. The nurse is caring for a client diagnosed with deep vein thrombosis. Which information reported to the nurse by the unlicensed assistive personnel (UAP) requires immediate intervention? 1. The UAP informed the nurse the client is complaining of chest pain. 2. The UAP notified the nurse the client's blood pressure is 100/66. 3. The UAP reported the client is requesting to be able to take a shower. 4. The UAP tells the nurse the client is asking for medication for a headache.

1. The UAP has informed the nurse that a client is having chest pain. A DVT can break loose and become an embolism, which can cause life-threatening problems for the client. TEST-TAKING HINT: The test taker should ask himself/herself which could be the most serious of the situations listed for the client. This is the one that requires immediate intervention.

62. Which assessment data would support that the client has a venous stasis ulcer? 1. A superficial pink open area on the medial part of the ankle. 2. A deep pale open area over the top side of the foot. 3. A reddened blistered area on the heel of the foot. 4. A necrotic gangrenous area on the dorsal side of the foot.

1. The medial part of the ankle usually ulcerates because of edema that leads to stasis, which, in turn, causes the skin to break down. TEST-TAKING HINT: There are some questions that require the test taker to be knowledgeable of the disease process.

56. The client diagnosed with a DVT is on a heparin drip at 1,400 units per hour, and Coumadin (warfarin sodium, also an anticoagulant) 5 mg daily. Which intervention should the nurse implement first? 1. Check the PTT and PT/INR. 2. Check with the HCP to see which drug should be discontinued. 3. Administer both medications. 4. Discontinue the heparin because the client is receiving Coumadin.

1. The nurse should check the laboratory values pertaining to the medications before administering the medications TEST-TAKING HINT: Knowing the actions of each medication, as well as the laboratory tests that monitor the safe range of dosing, is important. Remember, assessment is first. Assess blood levels and then administer the medication.

74. The client is suspected of having a pulmonary embolus. Which diagnostic test suggests the presence of a pulmonary embolus and requires further investigation? 1. Plasma D-dimer test. 2. Arterial blood gases. 3. Chest x-ray (CXR). 4. Magnetic resonance imaging (MRI).

1. The plasma D-dimer test is highly specific for the presence of a thrombus; an elevated D-dimer indicates a thrombus formation and lysis. This result would require a CT or V/Q scan to then confirm the diagnosis. TEST-TAKING HINT: The key to answering this question is "confirms the diagnosis." The test taker should eliminate options "2" and "3" based on the fact these are diagnostic tests used for many disease processes and conditions.

26. The client with coronary artery disease asks the nurse, "Why do I get chest pain?" Which statement would be the most appropriate response by the nurse? 1. "Chest pain is caused by decreased oxygen to the heart muscle." 2. "There is ischemia to the myocardium as a result of hypoxemia." 3. "The heart muscle is unable to pump effectively to perfuse the body." 4. "Chest pain occurs when the lungs cannot adequately oxygenate the blood."

1. This is a correct statement presented in layman's terms. When the coronary arteries cannot supply adequate oxygen to the heart muscle, there is chest pain. TEST-TAKING HINT: The nurse must select the option that best explains the facts in terms a client who does not have medical training can understand.

28. The nurse is preparing to administer a beta blocker to the client diagnosed with coronary artery disease. Which assessment data would cause the nurse to question administering the medication? 1. The client has a BP of 110/70. 2. The client has an apical pulse of 56. 3. The client is complaining of a headache. 4. The client's potassium level is 4.5 mEq/L.

2. A beta blocker decreases sympathetic stimulation to the heart, thereby decreasing the heart rate. An apical rate less than 60 indicates a lower-than-normal heart rate and should make the nurse question administering this medication because it will further decrease the heart rate. TEST-TAKING HINT: If the test taker does not know when to question the use of a certain medication, the test taker should evaluate the options to determine if any options include abnormal data based on normal parameters. This would make the test taker select option "2" because the normal apical pulse in an adult is 60 to 100.

81. Which complication of anticoagulant therapy should the nurse teach the client to report to the health-care provider? 1. Gastric upset. 2. Bleeding from any site. 3. Constipation. 4. Myocardial infarction.

2. Anticoagulant therapy reduces the client's ability to form clots; bleeding is the most important issue to discuss with the client. TEST-TAKING HINT: When answering questions about medications, the nurse must be aware of common instructions. In the case of any medication that involves changing the body's ability to form a clot, bleeding must always be an issue.

57. Which actions should the surgical scrub nurse take to prevent personally developing a DVT? 1. Keep the legs in a dependent position and stand as still as possible. 2. Flex the leg muscles and change the leg positions frequently. 3. Wear white socks and shoes that have an elevated heel. 4. Ask the surgeon to allow the nurse to take a break midway through each surgery.

2. Flexing the leg muscles and changing positions assist the blood to return to the heart and move out of the peripheral vessels. TEST-TAKING HINT: The test taker can eliminate option "4" by imagining the reaction of the HCP if this were done. Thewords "dependent" and "still" make option "1" wrong.

29. Which intervention should the nurse implement when administering a loop diuretic to a client diagnosed with coronary artery disease? 1. Assess the client's radial pulse. 2. Assess the client's serum potassium level. 3. Assess the client's glucometer reading. 4. Assess the client's pulse oximeter reading.

2. Loop diuretics cause potassium to be lost in the urine output. Therefore, the nurse should assess the client's potassium level, and if the client is hypokalemic, the nurse should question administering this medication. TEST-TAKING HINT: Knowing that diuretics increase urine output would lead the test taker to eliminate glucose level and oxygenation (options "3" and "4"). In very few instances does the nurse assess the radial pulse; the apical pulse is assessed.

82. The nurse is teaching a class to clients diagnosed with hypertension. Which should the nurse teach the clients? 1. The blood pressure target range should be 120/80. 2. Take the medication even when feeling well. 3. Get up quickly when rising from a recumbent position. 4. Consume a 3,000-mg sodium diet.

2. Many clients decide that because they do not feel ill, medication is not needed. Hypertension is called the silent killer because damage to the body can occur without the client realizing it. TEST-TAKING HINT: The test taker should be aware of commonly administered medications and which instructions apply. This will allow the test taker to make decisions as to the appropriate nursing actions to implement.

84. The client is getting out of bed and becomes very anxious and has a feeling of impending doom. The nurse thinks the client may be experiencing a pulmonary embolism. Which action should the nurse implement first? 1. Administer oxygen 10 L via nasal cannula. 2. Place the client in high Fowler's position. 3. Obtain a STAT pulse oximeter reading. 4. Auscultate the client's lung sounds.

2. Placing the client in this position facilitates maximal lung expansion and reduces venous return to the right side of the heart, thus lowering pressures in the pulmonary vascular system. TEST-TAKING HINT: The test taker must select the option that will directly help the client breathe easier. Therefore, assessment is not the first intervention and option "4" can be eliminated as the correct answer. When the client is in distress, do not assess.

9. The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse? 1. The telemetry reads normal sinus rhythm. 2. The client has a weight gain of 2 kg within 1 to 2 days. 3. The client's blood pressure is 148/92. 4. The client's serum potassium level is 4.5 mEq.

2. Rapid weight gain—for example, 2 kg in one (1) to two (2) days—indicates that the loop diuretic is not working effectively; 2 kg equals 4.4 lb; 1 L of fluid weighs l kg. TEST-TAKING HINT: The phrase "requires immediate intervention" should make the test taker think that the correct answer will be abnormal assessment data that require medical intervention or indicate conditions that are life threatening.

33. The nurse is discussing angina with a client who is diagnosed with coronary artery disease. Which action should the client take first when experiencing angina? 1. Put a nitroglycerin tablet under the tongue. 2. Stop the activity immediately and rest. 3. Document when and what activity caused angina. 4. Notify the health-care provider immediately.

2. Stopping the activity decreases the heart's need for oxygen and may help decrease the angina (chest pain). TEST-TAKING HINT: The question is asking which action the client should take first. This implies that more than one of the answer options could be appropriate for the chest pain, but that only one is done first. The test taker should select the answer that will help the client directly and quickly—and that is stopping the activity.

35. Which statement by the client diagnosed with coronary artery disease indicates that the client understands the discharge teaching concerning diet? 1. "I will not eat more than six (6) eggs a week." 2. "I should bake or grill any meats I eat." 3. "I will drink eight (8) ounces of whole milk a day." 4. "I should not eat any type of pork products."

2. The American Heart Association recommends a low-fat, low-cholesterol diet for a client with coronary artery disease. The client should avoid any fried foods, especially meats, and bake, broil, or grill any meat. TEST-TAKING HINT: The test taker must be knowledgeable of prescribed diets for s pecific disease processes. This is mainly memorizing facts. There is no test-taking hint to help eliminate any of the options.

36. The nurse is caring for clients on a telemetry floor. Which nursing task would be most appropriate to delegate to an unlicensed assistive personnel (UAP)? 1. Teach the client how to perform a glucometer check. 2. Assist feeding the client diagnosed with congestive heart failure. 3. Check the cholesterol level for the client diagnosed with atherosclerosis. 4. Assist the nurse to check the unit of blood at the client's bedside.

2. The UAP can feed a client. TEST-TAKING HINT: Many states have rules concerning what tasks can be delegated to unlicensed assistive personnel, but even those states that don't have delegation rules agree that teaching and assessing an unstable client cannot be delegated to unlicensed a ssistive personnel.

6. The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease who has a BP of 170/100. 2. The client diagnosed with DVT who is complaining of chest pain. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis who has non-bloody diarrhea.

2. The chest pain could be a pulmonary embolus secondary to deep vein thrombosis and requires immediate intervention by the nurse. TEST-TAKING HINT: The nurse should assess the client who has abnormal assessment data or a life-threatening condition first when determining which client is priority.

28. The client tells the nurse that his cholesterol level is 240 mg/dL. Which action should the nurse implement? 1. Praise the client for having a normal cholesterol level. 2. Explain that the client needs to lower the cholesterol level. 3. Discuss dietary changes that could help increase the level. 4. Allow the client to ventilate feelings about the blood test result.

2. The client needs to be taught ways to lower the cholesterol level. TEST-TAKING HINT: The nurse needs to know normal laboratory test findings. If the test taker is not aware of normal cholesterol levels, he or she could only guess the answer to the question.

1. The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first? 1. Recommend that the client have his blood pressure checked in one (1) month. 2. Instruct the client to see his health-care provider as soon as possible. 3. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. 4. Explain that this BP is within the normal range for an elderly person.

2. The diastolic blood pressure should be less than 85 mm Hg according to the American Heart Association; therefore, this client should see the health-care provider. TEST-TAKING HINT: Remember, the question asks which action should be implemented first. Therefore, more than one answer is appropriate but the first to be implemented should be the one that directly affects the client.

75. Which nursing assessment data support that the client has experienced a pulmonary embolism? 1. Calf pain with dorsiflexion of the foot. 2. Sudden onset of chest pain and dyspnea. 3. Left-sided chest pain and diaphoresis. 4. Bilateral crackles and low-grade fever.

2. The most common signs of a pulmonary embolism are sudden onset of chest pain when taking a deep breath and shortness of breath. TEST-TAKING HINT: The key to selecting option "2" as the correct answer is sudden onset. The test taker would need to note "left-sided" in option "3" to eliminate this as a possible correct answer, and option "4" is nonspecific for a pulmonary embolism.

4. The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement? 1. Notify the health-care provider if the potassium level is 3.8 mEq. 2. Question administering the medication if the BP is less than 90/60 mm Hg. 3. Do not administer the medication if the client's radial pulse is greater than 100. 4. Monitor the client's BP while he or she is lying, standing, and sitting.

2. The nurse should question administering the beta blocker if the BP is low because this medication will cause the blood pressure to drop even lower, leading to hypotension. TEST-TAKING HINT: Be sure to read the entire question and all the answer options and note the specific numbers that are identified. The test taker must know normal laboratory data and assessment findings.

79. The nurse identified the client problem "decreased cardiac output" for the client diagnosed with a pulmonary embolus. Which intervention should be included in the plan of care? 1. Monitor the client's arterial blood gases 2. Assess skin color and temperature. 3. Check the client for signs of bleeding. 4. Keep the client in the Trendelenburg position.

2. These assessment data monitor tissue perfusion, which evaluates for decreased cardiac output. TEST-TAKING HINT: The test taker must think about which answer option addresses the problem of the heart's inability to pump blood. Decreased blood to the extremities results in cyanosis and cold extremities.

74. The 45-year-old male client diagnosed with essential hypertension has decided not to take his medications. The client's BP is 178/94, indicating a perfusion issue. Which question should the nurse ask the client first? 1. "Do you have the money to buy your medication?" 2. "Does the medication give unwanted side effects?" 3. "Did you quit taking the medications because you don't feel bad?" 4. "Can you tell me why you stopped taking the medication?"

2. This is a mild way of introducing the subject of side effects to a client not wishing to admit the medication causes unwanted effects. It opens the door to more probing assessment questions. The nurse should bring up the subject in order to allow the client to be forthcoming with the issues of why he is not taking his medication. TEST-TAKING HINT: To answer this question the test taker must remember that all medications have potential side effects. Antihypertensive medications can cause erectile dysfunction in males, frequently resulting in noncompliance with the medication regimen. The issue is a psychological as well as a physiological one.

25. The nurse is teaching a class on coronary artery disease. Which modifiable risk factor should the nurse discuss when teaching about atherosclerosis? 1. Stress. 2. Age. 3. Gender. 4. Family history.

25. 1. A modifiable risk factor is a risk factor that can possibly be altered by modifying or changing behavior, such as developing new ways to deal with stress. TEST-TAKING HINT: The test taker needs to key in on adjectives when reading the stem of a question. The word "modifiable" should cause the test taker to select "stress" because it is the only answer option referring to something that can be changed or modified.

74. The nurse identifies the concept of clotting for a client diagnosed with a deep vein thrombosis. Which clinical manifestations support the diagnosis? 1. Brown-purple discoloration on the calf. 2. Bright red skin on the lower legs. 3. Swelling in the calf, warmth, and tenderness. 4. Pain after walking for short distances that resolve with rest.

3. A clot disrupts the blood flow; swelling and warmth, along with pain, indicate a potential blood clot. TEST-TAKING HINT: The test taker should apply pathophysiology knowledge to answer this question. Venous blood is returning to the heart to pick up oxygen from the lungs and be redistributed to the body, making it a bright red color; oxygen in the blood makes the blood bright red. This could eliminate both options "1" and "2."

83. The nurse is preparing to administer medications to the following clients. Which medication should the nurse question administering? 1. The oral coagulant warfarin (Coumadin) to the client with an INR of 1.9. 2. Regular insulin to a client with a blood glucose level of 218 mg/dL. 3. Hang the heparin bag on a client with a PT/PTT of 12.9/98. 4. A calcium channel blocker to the client with a BP of 112/82.

3. A normal PTT is 39 seconds, and for heparin to be therapeutic, it should be 1.5 to 2 times the normal value, or 58 to 78. A PTT of 98 indicates the client is not clotting and the medication should be held. TEST-TAKING HINT: This question is asking the test taker to select a distracter with assessment data that are unsafe for administering the medication. The test taker must know normal laboratory values to administer medication safely.

78. The nurse is preparing to administer the oral anticoagulant warfarin (Coumadin) to a client who has a PT/PTT of 22/39 and an INR of 2.8. What action should the nurse implement? 1. Assess the client for abnormal bleeding. 2. Prepare to administer vitamin K (AquaMephyton). 3. Administer the medication as ordered. 4. Notify the HCP to obtain an order to increase the dose.

3. A therapeutic INR is 2 to 3; therefore, the nurse should administer the medication. test taking hint: the test taker must know normal laboratory values; this is the only way the test taker will be able to answer this question. The test taker should make a list of laboratory values that must be memorized for successful test taking.

3. The health-care provider prescribes an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication? 1. ACE inhibitors prevent beta receptor stimulation in the heart. 2. This medication blocks the alpha receptors in the vascular smooth muscle. 3. ACE inhibitors prevent vasoconstriction and sodium and water retention. 4. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.

3. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II and this, in turn, prevents vasoconstriction and sodium and water retention. TEST-TAKING HINT: The test taker needs to understand how the major classifications of medications work to answer this question.

49. The nurse is discharging a client diagnosed with DVT from the hospital. Which discharge instructions should be provided to the client? 1. Have the PTT levels checked weekly until therapeutic range is achieved. 2. Staying at home is best, but if traveling, airplanes are better than automobiles. 3. Avoid green, leafy vegetables and notify the HCP of red or brown urine. 4. Wear knee stockings with an elastic band around the top.

3. Green, leafy vegetables contain vitamin K, which is the antidote for warfarin. These foods will interfere with the action of warfarin. Red or brown urine may indicate bleeding. TEST-TAKING HINT: The test taker must know laboratory data for specific medications. The INR and PT are monitored for oral anticoagulants. Remember: "PT boats go to war" ( warfarin). PTT monitors heparin ("tt" is like an H for heparin).

30. Which assessment data would cause the nurse to suspect the client has atherosclerosis? 1. Change in bowel movements. 2. Complaints of a headache. 3. Intermittent claudication. 4. Venous stasis ulcers.

3. Intermittent claudication is a sign of generalized atherosclerosis and is a marker of atherosclerosis. TEST-TAKING HINT: Knowledge of medical terminology—in this case, knowing that " atherosclerosis" refers to arteries—would allow the test taker to rule out all of the answer options except option "3," even if the test taker does not know what "intermittent claudication" means.

60. The client is being admitted with Coumadin (warfarin, an anticoagulant) toxicity. Which laboratory data should the nurse monitor? 1. Blood urea nitrogen (BUN) levels. 2. Bilirubin levels. 3. International normalized ratio (INR). 4. Partial thromboplastin time (PTT).

3. PT/INR is a test to monitor warfarin (Coumadin) action in the body. TEST-TAKING HINT: The test taker should devise some sort of memory-jogging mnemonic or aid to remember which laboratory test monitors for which condition. Try "PT boats go to war," to recall that PT monitors warfarin.

76. The client diagnosed with a pulmonary embolus is in the intensive care department. Which assessment data warrant immediate intervention from the nurse? 1. The client's ABGs are pH 7.36, Pao2 95, Paco2 38, Hco3 24. 2. The client's telemetry exhibits occasional premature ventricular contractions (PVCs). 3. The client's pulse oximeter reading is 90%. 4. The client's urinary output for the 12-hour shift is 800 mL.

3. The normal pulse oximeter reading is 93% to 100%. A reading of 90% indicates the client has an arterial oxygen level of around 60. TEST-TAKING HINT: This question is asking the test taker to select abnormal, unexpected, or life-threatening assessment data in relationship to the client's disease process. A pulse oximeter reading of less than 93% indicates severe hypoxia and requires immediate intervention.

7. The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate? 1. "You probably have some type of kidney disease that causes the high BP." 2. "More than likely you have had a diet high in salt, fat, and cholesterol." 3. "There is no specific cause for hypertension, but there are many known risk factors." 4. "You are concerned that you have high blood pressure. Let's sit down and talk."

3. There is no known cause for essential hypertension, but many factors—both modifiable (obesity, smoking, diet) and nonmodifiable (family history, age, gender)—are risk factors for essential hypertension. TEST-TAKING HINT: When clients request information, the exchange should not address emotions. Just facts should be given. Therefore, option "4" can be eliminated as a correct answer.

58. The client receiving low molecular weight heparin (LMWH) subcutaneously to prevent DVT following hip replacement surgery complains to the nurse that there are small purple hemorrhagic areas on the upper abdomen. Which action should the nurse implement? 1. Notify the HCP immediately. 2. Check the client's PTT level. 3. Explain this results from the medication. 4. Assess the client's vital signs.

3. This is not hemorrhaging, and the client should be reassured that this is a side effect of the medication. TEST-TAKING HINT: Before selecting "Notify the HCP," the test taker should ask, "What will the HCP do with this information? What can the HCP order or do to help the purple hemorrhaged areas?" This would cause the test taker to eliminate option "1" as a possible answer.

31. The nurse is teaching a class on atherosclerosis. Which statement describes the scientific rationale as to why diabetes is a risk factor for developing atherosclerosis? 1. Glucose combines with carbon monoxide, instead of with oxygen, and this leads to oxygen deprivation of tissues. 2. Diabetes stimulates the sympathetic nervous system, resulting in peripheral constriction that increases the development of atherosclerosis. 3. Diabetes speeds the atherosclerotic process by thickening the basement membrane of both large and small vessels. 4. The increased glucose combines with the hemoglobin, which causes deposits of plaque in the lining of the vessels.

3. This is the scientific rationale for why diabetes mellitus is a modifiable risk factor for atherosclerosis. TEST-TAKING HINT: The nurse must understand the reason "why," or the scientific rationale, for teaching in addition to nursing interventions. This is critical thinking.

61. The nurse is teaching a class on venous insufficiency. The nurse would identify which condition as the most serious complication of chronic venous insufficiency? 1. Arterial thrombosis. 2. Deep vein thrombosis. 3. Venous ulcerations. 4. Varicose veins.

3. Venous ulcerations are the most serious complication of chronic venous insufficiency. It is very difficult for these ulcerations to heal, and often clients must be seen in wound care clinics for treatment. TEST-TAKING HINT: The test taker must use knowledge of anatomy, which would eliminate option "1" because "venous" and " arterial" refer to different parts of the vascular system. The test taker must key in on the most serious complication to select the correct answer.

59. The home health nurse is admitting a client diagnosed with a DVT. Which action by the client warrants immediate intervention by the nurse? 1. The client takes a stool softener every day at dinnertime. 2. The client is wearing a Medic Alert bracelet. 3. The client takes vitamin E over-the-counter medication. 4. The client has purchased a new recliner that will elevate the legs.

3. Vitamin E can affect the action of warfarin. The nurse should explain to the client that these and other medications could potentiate the action of warfarin. TEST-TAKING HINT: The test taker can eliminate option "1" by realizing that a stool softener would not cause a problem and could help with an unrelated problem. Medic Alert bracelets are frequently recommended for many clients with certain diseases and conditions.

77. The client is admitted to the medical unit diagnosed with a pulmonary embolus. Which intervention should the nurse implement? 1. Administer oral anticoagulants. 2. Assess the client's bowel sounds. 3. Prepare the client for a thoracentesis. 4. Institute and maintain bedrest.

4. Bedrest reduces the risk of another clot becoming an embolus leading to a pulmonary embolus. Bedrest reduces metabolic demands and tissue needs for oxygen in the lungs. TEST-TAKING HINT: The test taker must be aware of adjectives such as "oral" in option "1," which makes this option incorrect. The test taker should apply the body system of the disease process to eliminate option "2" as a correct answer.

78. The client prescribed rivaroxaban (Xarelto), an anticoagulant, is complaining of dark, tarry stool. Which should the nurse implement first? 1. Notify the health-care provider (HCP). 2. Ask the client to provide a stool sample. 3. Ask the client when the rivaroxaban was last taken. 4. Assess the client for ecchymotic areas and bleeding.

4. Ecchymotic areas (bruising) indicate bleeding; the nurse should determine the extent of the client's bleeding before notifying the HCP. TEST-TAKING HINT: When answering a question and the test taker wishes to choose "notify the health-care provider (HCP)," the test taker should read all the options carefully; if any option has needed information to report to the HCP, then that option comes before notifying the HCP.

77. The client presents to the outpatient clinic complaining of calf pain. The client reports returning from an airplane trip the previous day. Which should the nurse assess first? 1. The nurse should auscultate the lung fields and heart sounds. 2. The nurse should determine the length of the airplane trip. 3. The nurse should determine if the client has had chest pain. 4. The nurse should measure the calf and palpate the calf for warmth.

4. Measuring the client's calf and assessing for warmth are part of a focused assessment for deep vein thrombosis, which the client's flight placed him/her at risk for DVT. TEST-TAKING HINT: The test taker should apply decision-making questions when determining which to do first. One such question is: Which option will give the nurse the most needed information the fastest? The nurse 137 138 Med-Surg SucceSS should acquire information which will eliminate or support the suspected diagnosis.

5. The male client diagnosed with essential hypertension has been prescribed an alpha-adrenergic blocker. Which intervention should the nurse discuss with the client? 1. Eat at least one (1) banana a day to help increase the potassium level. 2. Explain that impotence is an expected side effect of the medication. 3. Take the medication on an empty stomach to increase absorption. 4. Change position slowly when going from a lying to sitting position.

4. Orthostatic hypotension may occur when the blood pressure is decreasing and may lead to dizziness and light-headedness, so the client should change position slowly. TEST-TAKING HINT: The test taker should understand the side effects of medications. The test taker who does not know the answer may realize that hypertension is being treated and that hypotension is the opposite of hypertension and might be a complication of treating hypertension. Only option "4" refers to hypotension, providing advice on how to avoid orthostatic hypotension.

83. The nurse is admitting a client diagnosed with coronary artery disease (CAD) and angina. Which concept is priority? 1. Sleep, rest, activity. 2. Comfort. 3. Oxygenation. 4. Perfusion.

4. The cardiac muscle is not perfused when there is a narrowing of the arteries caused by CAD or when an embolus or a thrombus occludes the artery. Adequate perfusion will supply oxygen to the cardiac muscle, allow for increased activity, and decrease pain. TEST-TAKING HINT: The test taker should remember basic pathophysiology to answer this priority question. The other three interrelated concepts are based on the issue of tissue perfusion.

75. The client diagnosed with a deep vein thrombosis is prescribed heparin via continuous infusion. The client's laboratory data are: PT 12.2 aPTT 48 Control 1.4 Control 32 INR 1 Based on the laboratory results, which intervention should the nurse implement? 1. Request a change of medication to a subcutaneous anticoagulant. 2. Administer AquaMephyton (vitamin K) IM. 3. Have the dietary department remove all green, leafy vegetables from the trays. 4. Administer the IV as ordered.

4. The client is in therapeutic range for intravenous heparin; the nurse should administer the heparin as ordered. TEST-TAKING HINT: The test taker should be aware of therapeutic levels as they apply to commonly administered medications. This will allow the test taker to make decisions as to the appropriate nursing actions to implement.

25. The male client is diagnosed with coronary artery disease (CAD) and is prescribed sublingual nitroglycerin. Which statement indicates the client needs more teaching? 1. "I should keep the tablets in the dark-colored bottle they came in." 2. "If the tablets do not burn under my tongue, they are not effective." 3. "I should keep the bottle with me in my pocket at all times." 4. "If my chest pain is not gone with one tablet, I will go to the ER."

4. The client should take one tablet every five (5) minutes and, if no relief occurs after the third tablet, have someone drive him to the emergency department or call 911. TEST-TAKING HINT: This question is an " except" question, requiring the test taker to identify which statement indicates the client doesn't understand the teaching. Sometimes the test taker could restate the question and think which statement indicates the client understands the teaching.

81. Which statement by the client diagnosed with a pulmonary embolus indicates the discharge teaching is effective? 1. "I am going to use a regular-bristle toothbrush." 2. "I will take antibiotics prior to having my teeth cleaned." 3. "I can take enteric-coated aspirin for my headache." 4. "I will wear a Medic Alert band at all times."

4. The client should wear a Medic Alert band at all times so that, if any accident or situation occurs, the health-care providers will know the client is receiving anticoagulant therapy. The client understands the teaching. TEST-TAKING HINT: This is a higher level question in which the test taker must know clients with a pulmonary embolus are prescribed anticoagulant therapy on discharge from the hospital. If the test taker had no idea of the answer, the option stating "wear a Medic Alert band" is a good choice because many disease processes require the client to take long-term medication and a health-care provider should be aware of this.

26. The client asks the nurse, "My doctor just told me that atherosclerosis is why my legs hurt when I walk. What does that mean?" Which response by the nurse would be the best response? 1. "The muscle fibers and endothelial lining of your arteries have become thickened." 2. "The next time you see your HCP, ask what atherosclerosis means." 3. "The valves in the veins of your legs are incompetent so your legs hurt." 4. "You have a hardening of your arteries that decreases the oxygen to your legs."

4. This response explains in plain terms why the client's legs hurt from atherosclerosis. TEST-TAKING HINT: If the test taker knows medical terminology, option "3" could be eliminated because athero- means "arteries," not veins. The test taker should be very cautious when choosing an option that asks the health-care provider to answer questions that nurses should be able to answer.