CHA 1 Exam 3 EAQ
A client who is suspected of having a silent MI has an ECG prescribed by the primary healthcare provider. While the nurse prepares the client for this procedure, the client asks, "Why was this test prescribed?" Which is the best reply by the nurse? a. This test will detect your heart sounds b. This test will reflect any heart damage c. This procedure helps us change your heart's rhythm d. The ECG will tell us how much stress your heart can tolerate
b. This test will reflect any heart damage
A client has surgery to replace a prolapsed mitral valve. What should the nurse teach the client? a. The signs and symptoms of pericarditis b. The signs and symptoms of heart failure c. That cardiac surgery will have to be done eventually for the other valves d. That cardiac surgery will have to be done every six months to replace the valve
b. The signs and symptoms of heart failure
A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication? a. Aspirin b. Midazolam c. Gabapentin d. Alprazolam
a. Aspirin
The client is on a cardiac monitor. The monitor begins to alarm showing ventricular tachycardia. What should the nurse do first? a. Check for a pulse b. Start cardiac compressions c. Prepare to defibrillate the client d. Administer oxygen via and ambu bag
a. Check for a pulse
An older adult client is diagnosed with left-sided congestive heart failure. Which assessments should the nurse expect to find? Select all that apply: a. Dyspnea b. Crackles c. Hacking cough d. Peripheral edema e. Jugular distention
a. Dyspnea b. Crackles c. Hacking cough
A nurse us caring for a client who just had coronary artery bypass graft surgery. For which complication should the nurse monitor the client in the immediate postoperative period? a. Dysrhythmias, especially atrial fibrillation b. Postpericardiotomy syndrome with fever and friction rub c. Mediastinitis with boggy sternum and increased WBC count d. Increased hemoglobin and hematocrit level with a risk for embolization
a. Dysrhythmias, especially atrial fibrillation
A nurse is caring for a client who is admitted to the hospital with a diagnosis of unstable angina. Sublingual nitroglycerin has been prescribed. What client response indicates that nitroglycerin is effective? a. Pain subsides as a result of arteriole and venous dilation b. Pulse rate increases because the cardiac output has been stimulated c. Sublingual area tingles because sensory nerves are being triggered d. Capacity for activity improves as a response to increased collateral circulation
a. Pain subsides as a result of arteriole and venous dilation
The nurse assessed a newborn and observes central cyanosis. What type of congenital heart defect usually results in central cyanosis? a. Shunting from the right to left b. Shunting from the left to right c. Obstruction of blood flow from the left side of the heart d. Obstruction of blood flow from the left and right sides of the heart
a. Shunting from the right to left
A nurse identifies premature ventricular complexes (PVCs) on a client's cardiac monitor. What does the nurse conclude that these complexes are a sign of? a. Atrial fibrillation b. Cardiac irritability c. Impending heart block d. Ventricular tachycardia
b. Cardiac irritability
What client response will the nurse monitor to determine the effectiveness of amiodarone? a. Absence of ischemic chest pain b. Decrease in cardiac dysrhythmias c. Improvement in fasting lipid profile d. Maintenance of blood pressure control
b. Decrease in cardiac dysrhythmias
A nurse is caring for a client with right-sided heart failure. Which assessment findings are key features of right-sided heart failure? Select all that apply: a. Collapsed neck veins b. Distended abdomen c. Dependent edema d. Urinating at night e. Cool extremities
b. Distended abdomen c. Dependent edema d. Urinating at night
A nurse is assessing a newborn with suspected retention of a fetal structure that will result in a congenital heart defect. Which fetal structures should undergo change after birth? Select all that apply: a. Mitral valve b. Foramen ovale c. Pulmonary veins d. Ductus arteriosus e. Pulmonary arteries
b. Foramen ovale d. Ductus arteriosus
A nurse is caring for a client after cardiac surgery. What signs will cause the nurse to suspect cardiac tamponade? Select all that apply: a. Hypertension b. Pulsus paradoxus c. Muffled heart sounds d. Jugular vein distention e. Increased urine output
b. Pulsus paradoxus c. Muffled heart sounds d. Jugular vein distention
The nurse is caring for client who is on a cardiac rhythm monitor. The nurse notes that the client's P waves are of normal configuration and that each P wave is followed by a QRS complex. All intervals are normal as well, but the client's heart rate is 112 beats per minute. How will the nurse interpret this rhythm? a. Sinus arrhythmia b. Sinus tachycardia c. Junctional tachycardia d. Ventricular tachycardia
b. Sinus tachycardia
The spouse of a client who had emergency coronary bypass surgery asks why there is a dressing on the client's left leg. How should the nurse explain the dressing? a. This is the access site for the heart-lung machine b. A filter is inserted in the leg to prevent embolization c. A vein in the leg was used to bypass the coronary artery d. The arteries in the extremities are examined during surgery
c. A vein in the leg was used to bypass the coronary artery
A client with a history of heart failure and hypertension is admitted with reports of syncope. Which prescribed medication should the nurse prepare to administer based on ECG- which shows sinus bradycardia? a. Digoxin b. Enalapril c. Atropine d. Metoprolol
c. Atropine
The nurse provides discharge teaching to a client with a history of angina. The nurse instructs the client to call for emergency services immediately if the client's pain exhibits which characteristic? a. Causes mild perspiration b. Occurs after moderate exercise c. Continues after rest and nitroglycerin d. Precipitates discomfort in the arms and jaw
c. Continues after rest and nitroglycerin
An ECG is prescribed for a client complaining of chest pain. The nurse recognizes which as an early finding of an infarcted area of the heart? a. Flattened T waves b. Absence of P waves c. Elevated ST segments d. Disappearance of Q waves
c. Elevated ST segments
What is the priority nursing action when admitting a patient to the emergency department during cardia arrest from ventricular fibrillation? a. Treating pain b. Assessing respirations c. Initiating defibrillation d. Monitoring blood pressure
c. Initiating defibrillation
When assessing a client, the nurse auscultates a murmur at the second left intercostal space along the sternal border. This reflects sound from which valve? a. Aortic b. Mitral c. Pulmonic d. Tricuspid
c. Pulmonic
While performing a physical assessment in a client, the RN notices reddish linear streaks in the nail bed. Which systemic condition can the RN suspect in the client based on these assessment findings? a. Syphilis b. Iron deficiency anemia c. Subacute bacterial endocarditis d. Chronic obstructive pulmonary disease
c. Subacute bacterial endocarditis
A man is being seen for a cholesterol screening and asks the nurse which risk factors can be modified as he is high risk for coronary artery disease. Select all that apply: a. Age b. Height c. Weight d. Smoking e. Family history
c. Weight d. Smoking
The client with heart disease has been reading on the internet about the anatomy and physiology of the heart and tells the nurse, "I'm so confused." The nurse reinforces the pattern of circulation in the body. Which client statement indicates correct understanding? a. Blood enters the heart through the ductus arteriosus, flows into the left side of the heart, and exits via the aorta into the systemic circulation b. Blood enters the heart from the inferior vena cava; it then flows through the left atrium into the left ventricle, then into the lungs, and back into the aorta c. Blood enters the heart from the aorta, flows into the right atrium and right ventricle, through the lungs, then into the left atrium and left ventricle, and finally exits through the superior vena cava d. Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta
d. Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta
A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The healthcare provider informs the parents that antibiotics are required before any dental work is performed. Later the parents ask the nurse why this is necessary. When responding, the nurse explains that this is done to prevent what type of infection? a. Gingivitis b. Pericarditis c. Myocarditis d. Endocarditis
d. Endocarditis
A client is returned to the surgical unit immediately after placement of a coronary artery stent that was accomplished via access through the femoral artery. What should the nurse consider the priority when assessing this client? a. Acute pain b. Impaired mobility c. Impaired swallowing d. Hematoma formation
d. Hematoma formation
The nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? a. My ankles are swollen b. I am tired at the end of the day c. When I eat a large meal, I feel bloated d. I have trouble breathing when I walk rapidly
d. I have trouble breathing when I walk rapidly
A client is admitted for a coronary artery bypass graft. The client states that the preoperative teaching materials contain information about pacemaker wires being inserted as a precautionary measure. The client asks, "What is the purpose of the pacemaker?" What is the best response by the nurse? a. These wires can be attached to a temporary pacemaker to shock the heart if it starts beating too fast b. This type of pacemaker will automatically defibrillate the heart if the heart forgets to beat c. The pacemaker will maintain a constant cardiac rhythm d. In case of too slow of a heart rate, the epicardial leads are attached to a pacemaker to maintain a normal rate
d. In case of too slow of a heart rate, the epicardial leads are attached to a pacemaker to maintain a normal rate
After a discussion with the PCP, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond? a. The diameter of the aorta is enlarged b. The wall between the right and left ventricles is open c. It is a narrowing of the entrance to the pulmonary artery d. It is a connection between the pulmonary artery and the aorta
d. It is a connection between the pulmonary artery and the aorta