Cardiovascular and Hematology ATI
A nurse is caring for a client 5 days following a myocardial infarction (MI). the client has a sudden onset of shortness of breath. The nurse notes that the client appears air hungry and is coughing frothy, pink sputum. When auscultating the client's breath sounds, the nurse expects to hear which of the following bilateral sounds?
Crackles
A nurse in a clinic is assessing the lower extremities and ankles of a client who has a hx of PAD. Which of the following findings should the nurse expect?
Dry, pale skin with minimal body hair
A nurse is caring for a client with CHF whose EKG shows a flattening of the T wave. Which of the following laboratory results should the nurse anticipate with the EKG change?
Potassium 2.8
A nurse is caring for a client who has a demand pacemaker inserted with the rate set at 72/min. Which of the following findings should the nurse expect?
Telemetry monitoring shows QRS complexes occurring at a rate of 74/min with no pacing spikes
A nurse is caring for a client with hemophilia who has active bleed in a joint. The appropriate nursing intervention when providing care to this client is which of the following?
Prepare for replacement of the missing factor
A nurse administered a transfusion of fresh frozen plasma (FFP) to a client. Four hours later, the client has repeat laboratory work drawn. which value should the nurse analyze to evaluate the client's response to the transfusion?
Prothrombin time
A nurse realizes that a client whose blood type is B+ is being transfused with a unit of O- fresh frozen plasma (FFP). Which of the following is an appropriate nursing action to take?
Remove the unit of plasma immediately and start an IV infusion of normal saline solution
A nurse is caring for a client with a cardiac contusion. The nurse understands that blunt chest trauma commonly results in damage to which of the following?
Right ventricle
A nurse is caring for a client diagnosed with complete heart block who has a demand pacemaker inserted. The pacer is set for 72 beats/min. Which EKG pattern indicates to the nurse a FAILURE to capture?
Sharp spikes at 72/min; QRS complexes at 50 beats/min
A nurse is caring for a postoperative client who requires 1 unit of blood b/c of a hemorrhage that occurred during surgery. Within 30 min of hanging the unit of blood, the client develops itching and hives. Which of the following actions should the nurse take first?
Stop the infusion
A nurse is caring for a client following a vein ligation and stripping for varicose veins. Following this surgery, the nurse should know to place the client in which positions?
Supine with the legs elevated at a 15 degree angle
A nurse is providing teaching to a client who has anemia and a new prescription for epoetin alfa. Which of the following information should the nurse include in the teaching?
Hypertension is a common adverse effect of this medication
A nurse is providing teaching about lifestyle changes to a client who has a MI and has a new prescription for a beta blocker. Which of the following client statements indicates an understanding of the teaching?
"Before taking my medication, I will count my radial pulse rate."
A nurse is instructing a client after a myocardial infarction about lifestyle changes. A client returns for a follow up visit to the cardiac clinic after hospitalization for an acute myocardial infarction. Which statement made by the client indicates that additional teaching is needed?
"I Will exercise once a week for an hour at the health club."
A nurse is monitoring a client who has heart failure related to mitral stenosis. The client reports SOB on exertion. Which of the following conditions should the nurse expect?
Increased pulmonary congestion
A nurse is caring for a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are BP 160/98, HR 102/min, RR 22/min, and SpO2 95%. Which of the following actions should the nurse take?
Administer antihypertensive medication for BP
A nurse is caring for a client on telemetry who has an irregular radial pulse. The progress notes say that the client has had atrial flutter. Which EKG pattern does the nurse recognize as corresponding to atrial flutter?
Atrial rate of 300 with 80 QRS complex per min
A nurse is caring for a client whose abdominal aortic aneurysm is extending. The manifestations that the nurse should expect to observe include which of the following?
Back and abdominal pain
A nurse is caring for a client admitted with a suspected dissecting aortic aneurysm. The nurse should monitor the client for which of the following?
Back pain
A nurse is caring for an adult client with sickle cell disease who has a history of having received many transfusions. The nurse realizes that b/c of his history, the client is at risk for which of the following?
Iron toxicity
A nurse is assessing a client in the clinic with a history of arteriosclerosis obliterans. When assessing the client's lower extremities and ankles, the nurse will expect to observe which manifestation of this condition?
Thin, shiny skin with minimal body hair
A nurse is caring for a client experiencing an acute angina attack. The nurse should monitor the client for which of the following?
Transient abnormal PMI (point of maximal impulse)
A nurse is caring for a client who had a MI 24 hr ago. At this time, it is essential for the nurse to look for which of the following?
Ventricular dysrhythmias
A nurse is caring for a client with pernicious anemia. The nurse should know that to treat this condition, the client will require which of the following?
Weekly injections of vitamin B12
A nurse is assessing for cardiac tamponade on a client who had a coronary artery bypass grafts. Which of the following actions should the nurse take?
Auscultate BP for pulsus paradoxus
A nurse is completing an assessment for a client who has a history of unstable angina. Which of the following findings should the nurse expect?
Chest pain lasts longer than 15 min
A nurse is caring for a client diagnosed with angina pectoris and is scheduled to undergo a PTCA. the nurse explains to the client that PTCA is used to do which of the following?
Dilate an obstructed coronary artery
A nurse is caring for a client with pericarditis. Which of the following manifestations should the nurse expect to find on assessment?
Dyspnea with a rapid respiratory rate Hiccups
A nurse is preparing to transfuse a unit of blood to a client. the nurse must verify which factor?
Expiration time and date
A nurse is caring for a client with dyspnea who is diagnosed with having CHF related to mitral stenosis. The nurse is aware the cause of dyspnea is due to which of the following?
Fluid accumulation in the lungs
A nurse assess a client who has fluid volume excess. Which of the following manifestations indicate fluid volume excess?
Jugular vein distension Decreased hematocrit Increased heart rate Moist crackles
A nurse is planning care for a client who is having a PTCA with stent placement. Which of the following actions should the nurse anticipate in the postprocedure plan of care?
Monitor for bleeding
A client reports to a nurse that she is using several herbal and dietary supplements including fish oil. The nurse recognizes that the health benefit of this supplement is to provide increased dietary...
Omega-3 fatty acids
A nurse is caring for a client with aplastic anemia. The nurse expects the client to have which of the following symptoms?
Pancytopenia Fatigue Pale mucous membranes Petechiae Ecchymosis
A nurse is caring for a client with right sided congestive heart failure (CHF). The nurse knows that a manifestation of right sided CHF is which of the following?
Peripheral edema
A nurse is caring for a client with a history of congestive heart failure at risk for development of fluid volume excess. The nurse realizes that a LATE manifestation of fluid overload is which of the following?
Pitting Edema of +3
A nurse is caring for a client with suspected hypovolemic shock. Which solution is appropriate for the nurse to administer in this circumstance?
0.9% sodium chloride
A nurse is preparing to infuse a blood transfusion using packed cells (250 mL) to a client in a 4 hr. The blood set delivers 10 gtts per mL. What is the proper drip rate to use for the unit of packed cells?
10 gtt/min
A nurse is caring for a client who wants to know when the therapeutic results of epoetin alfa (Epogen, Procrit) will take effect. The nurse bases her response on the knowledge that epoetin alfa will improve hemoglobin and hematocrit levels in which of the following time frames?
2-4 weeks
A nurse is preparing to transfuse a unit of packed RBC's to a client who has anemia. Which of the following actions should the nurse take first?
Witness the informed consent
A nurse is assessing a client who has late-stage heart failure and is experiencing fluid volume overload. Which of the following findings should the nurse expect?
Weight gain 1 kg (2.2 lbs) in 1 day
