Exam 2 MED SURG practice questions

The client is scheduled for a right femoral cardiac cath. What is the priority nursing intervention? - Perform passive range of motion exercises - assess the client's neurovascular status - Keep the client in high fowler position - Asses the gag reflex prior to feeding

- Assess the client's neurovascular status

a 74 year old female presents to the ER with dyspnea, persistent cough and unable to sleep at night with difficulty breathing. Which of the following labs confirms suspicions of HF a) K+ 5.6 b) BNP 820 c) BUN 9 d) troponin <0.02

- BNP 820

a client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items? a) BP and peripheral perfusion b) sensation of palpitations c) causative factors such as caffeine d) precipitating factors such as infection

- Blood pressure and peripheral perfusion

What should the nurse teach women about CAD? a) estrogen replacement in postmenopausal women decreases risk of CAD b) cholesterol levels are not as significant a risk factor for women as men c) CAD is the leading cause of death in women d) women typically have substernal crushing chest pain

- CAD is the leading cause of death in women

1) Which potential complication should the nurse assess for in the client with infective endocarditis who has embolization of vegetative lesions from the mitral valve a. Pulmonary embolus b. CVA accident c. Hemoptysis d. Deep vein thrombosis

- CVA accident (blood flowing not correctly could lead to a clot to the brain)

Along with persistent crushing chest pain, which clinical assessment finding would make the nurse suspect that the client is experiencing a myocardial infarction - Pain that worsens with an intake of breath - diaphoresis and cool, clammy skin - Intermittent claudication and pallor - Juglar vein distention and dependent edema

- Diaphoresis and cool, clammy skin

a client with chest pain is admitted to the ED and all of the following items are ordered. which one should be completed first a) chest xray b) troponin level c) ECG d) insertion of the peripheral IV

- ECG

The client diagnosed with rule out MI is experiencing chest pain while walking to the bathroom which action should the nurse implement first - Administer sublingual nitroglycerin - Obtain a STAT ECG - Have the client sit down immediately - Assess the clients' vital signs

- Have the client sit down immediately

The nurse is discussing angina with a client who is diagnosed with CAD. Which action should the client take first when experiencing angina - Put a nitroglycerin tablet under the tongue - stop the activity immediately and rest - Document when and what activity caused the angina - Notify their physician immediately

- Stop the activity immediately and rest

1) The client is exhibiting v tachy on the tele monitor which intervention should the nurse implement first a. Administer antidysrhythmic b. Prepare the defib c. Assess apical pulse and BP d. Start CPR

- assess the apical pulse and BP

1) The client is POD 1 from an aortic valve replacement and is exhibiting sinus tachycardia with a heart rate of 122. What is the appropriate intervention a. Asses the apical for one full minute b. Notify the client's cardiac surgeon c. Notify the crash cart to the beside d. Determine if the client is having pain

- determine if the client is having pain

what are manifestations of acute coronary syndrome? select all that apply A) dysrhythmias B) stable angina c) unstable angina d) st segment elevation MI e) non st segment elevation MI

- dysrhythmias - unstable angina - ST segment elevation - Non ST elevation

1) A client has developed A fib. With a ventricular rate of 150 bpm a nurse assesses the client for. a. Hypotension and dizzy b. Nausea and vomiting c. Hypertension and headache d. Flat and neck veins

- hypotension and dizzy (look for signs of cardiac output)

1) The nurse enter counters the client's room and notes an unconscious client with no pulse or blood pressure. Which action should the nurse implement first? a. Notify the HCP b. Call the rapid response team c. Determine the tele monitor reading d. Initiate a code

- initiate a code

what is the most common finding in people at risk for sudden cardiac death A) mitral valve stenosis B) left ventricular dysfunction c) atheroslcerotic heart diseasse d) aortic valve disease

- left ventricular dysfunction

1) The client diagnosed with HF is complaining of leg cramps at night a. Check the client for peripheral edema b. Monitor the client's potassium level and assess the client intake of bananas c. Determine if the client has gained weight and instruct the client to keep legs elevated d. Instruct the client to ambulate frequently and preform calf stretches

- monitor the clients potassium level and assess the client intake of bananas

in the patient with SVT, which assessment indicates decreased cardiac output A) dyspnea and hypertension b) palpitations and chest pain c) tachypnea and abdominal distention d) bounding pulses and a systolic murmur

- palpitations and chest pain

A nurse is caring for a client receiving IV lasix and morphine for decompensated HF with orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a) weight loss of 2 lb in 24 hours b) hourly output of urine of 50mL C) client denies chest pain or pressure d) reduced dyspnea with the head of bed at 30 degrees

- reduced dyspnea with the head of the bed at 30 degrees

In the patient with chest pain which results distinguish unstable angina from an MI? a) serum troponin levels increased 4-6 hours after onset of pain b) a chest x ray showing left ventricular hypertrophy c) CK - MB elevations that peak 6 hours after the infarct d) ECG changes present at the onset of pain

- serum troponin levels increased 4-6 hours after onset of pain

1) The patient with chronic HF is being discharged from the hospital. What info should the nurse emphasize in the patient discharge teaching to prevent progressing of disease ADFH ? a. Take medications as prescribed b. Use oxygen when feeling short of breath c. Direct questions only to the health care provider d. Encourage most activity in the morning when rested

- take the medications as prescribed

1) The nurse received shift report. Which client should the nurse see first? a. The client diagnosed with CAD complaining of severe indigestion - could be related to cardiac chest pain (MI) b. The client with HF has 3+ pitting edema c. The client diagnosed with A fib whose apical rate is 100 and irregular d. The client is diagnosed with sinus bradycardia and complaining of constipation

- the client diagnosed with CAD complaining of severe indigestion

1) The client with a mechanical valve replacement asks the nurse, why do I have to take antibiotics before getting my teeth cleaned? Which response by the nurse is the most appropriate? a. You are at risk of developing an infection in your heart b. Your teeth will not bleed as much if you have antibiotics c. This procedure may cause your valve to malfunction d. Antibiotics will prevent vegetation growth on your valves

- you are at risk of developing an infection in your heart

1) The nurse is preparing to administer dig to a patient with HF, lab results are reviewed with the following findings sodium 139, potassium 5.6 chloride 103, and glucose 106 what is the priority action? a. Withhold the daily dose until the following day b. Withhold the dose and report the potassium level c. Give the dig with a salty snack such as crackers d. Give the dig with extra fluids to dilute the sodium level

B) withhold the dose and report the potassium level

When teaching a client about metoprolol the nurse should base the information on the knowledge that metoprolol a)- Blocks beta adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction b) increases norepi secretion and thus decreases blood pressure and heart rate c) is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers BP d) is an angiotensin converting enzyme inhibitor that reduces BP by blocking the conversion of angiotensin I to angiotensin II

Blocks beta adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction

A client with no history of cardiovascular disease comes into the ambulatory clinic with flu like symptoms. the client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? a) have you ever had this pain before b) can you describe the pain to me c) does the pain get worse when you breathe in d) can you rate the pain on a scale of 1-10 with 10 being the worst

C) does the pain get worse when you breathe in

after an MI which of the following problems is indicated by auscultation of crackles in the lungs? a) left sided heart failure b) pulmonic valve malfunction c) right sided heart failure d) tricuspid valve malfunction

a) left sided heart failure b)

a client comes into the ER with acute SOB< and a cough that has pink frothy sputum. Admission assessment reveals crackles and wheezes, a BP 85/46 a HR of 122 bpm, and a RR of 28. a) pulmonary edema b) pneumothorax c) cardiac tamponade d) pulmonary embolism

a) pulmonary edema b) c) d)

A nurse on a cardiac unit is caring for several clients. Which of the following clients is at risk for the development of a dysrhythmia?• a. A client with metabolic alkalosis• b. A client with a potassium level of 4.3• c. A client with an O2 sat of 95%• d. A client with COPD• e. A client who underwent PCI with stent placement

a. A client with metabolic alkalosis• d. A client with COPD• e. A client who underwent PCI with stent placement

1) The client is admitted to the telemetry unit diagnosed with acute exacerbation of HF which assessment finding would the nurse expect? a. Apical pulse 110 and 4+ pitting edema b. Bilateral inspiratory and expiratory wheeze c. The client sleeping without a pillow d. Radial pulse of 90 and CRT <3 seconds

a. apical pulse 110 and 4+ pitting edema

Which signs indicate a Patient is "unstable" in their cardiac rhythm? Select all that apply.• a. blood pressure 82/47• b. c/o dizziness • c. flushed face • d. HR 108 • e. breathlessness

a. blood pressure 82/47 b. c/o dizziness d. breathlessness

WHICH ASSESSMENT FINDING WOULD THE NURSE EXPECT TOBE PRESENT EARLY IN A PATIENT WITH ACUTE LEFT-SIDED HF? a. DYSPNEA, CRACKLES AND TACHYCARDIA b. HEPATOSPLENOMEGALY AND TACHYPNEA c. PERIPHERAL EDEMA AND COOL, DIAPHORETIC SKIN d. FROTHY, BLOOD TINGED SPUTUM AND DISTENDED JUGULAR VEINS

a. dyspnea, crackles and tachycardia

When teaching a patient with angina about taking SL nitroglycerin tablets, what should the nurse teach the patient? a. Lie or sit and place 1 tablet under the tongue when chest pain occurs. b. Take the tablets with a large amount of water so that it will dissolve right away. c. If 1 tablet does not relieve the pain in 15 min., the patient should goto the hospital. d. If the tablet causes dizziness and a headache, stop the medication and call the doctor or go to the hospital.

a. lie or sit and place 1 tablet under the tongue when chest pain occurs

What early manifestation(s) is the patient with primary hypertension likely to report? a. No symptoms b. Cardiac palpitations c. Dyspnea on exertion d. Dizziness and vertigo

a. no symptoms

When planning care for the patient with hypertrophic CMP, what should the nurse include? a. Ventricular pacing b. Administration of vasodilators c. Teach the patient to avoid strenuous activity and dehydration d. Surgery for cardiac transplantation will have to be done soon

a. ventricular pacing c. teach the patient to avoid strenuous activity and dehydration

a client is scheduled for a cardiac catheterization. Which of the following assessments is most critical before the procedure? a) intake and output b) baseline peripheral pulse amplitude and extremity sensation c) height and weight d) gag reflex

b) baseline peripheral pulse amplitude and extremity sensation

which of the following actions is the first priority of care for a client exhibiting signs and symptoms of CAD? a) decrease anxiety b) enhance myocardial oxygenation c) administer sublingual nitro d) educate the client about symptoms

b) enhance myocardial oxygenation

which of the following are NOT typical signs and symptoms of right sided heart failure ? select all that apply a) JVD b) persistent cough c) weight gain d) crackles e) hepatomegaly f) orthopnea

b) persistent cough d) crackles f) orthopnea

your patient reports having substernal chest pain two times this week after carrying laundry up the stairs. After sitting down and resting the pain went away. How would the nurse best classify this ? a) anxiety b) stable angina c) unstable angina d) variant angina

b) stable angina

A Pt is receiving Warfarin therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply) • a. Teach proper subcutaneous administration • b. administers oral dose at the same time every day • c. assesses carefully for excessive bruising or bleeding • d. monitor lab results for a target INR of 2 to 3 • e. monitor lab results for a therapeutic PTT value of 1.5 to 2.5 times the control value

b. administers oral dose at the same time every day c. assess carefully for excessive bruising or bleeding d. monitor lab results for a target INR of 2 to 3

Which drugs would the nurse expect to be prescribed for patients with a mechanical valve replacement? a. Oral nitrates b. Anticoagulants c. Atrial antidysrhythmic d. Beta-adrenergic blocking agents

b. anticoagulants

An EKG is a test used to detect :• a. ventricular hypertrophy • b. cardiac strain • c. coronary artery blockage • d. mitral valve regurgitation

b. cardiac strain

A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to a. Perform defibrillation .b. Initiate cardiopulmonary resuscitation. c. Prepare for synchronized cardioversion. d. Administer IV antidysrhythmic drugs per protocol.

b. initiate CPR

As an initial step in treating a client with angina, the physician prescribes nitro tablets, 0.3mg given sublingually. This drug principal effects are produced by? A) antispasmodic effect on the pericardium b) causing an increases myocardial oxygen demand c) vasodilation of peripheral vasculature d) improved conductivity in the myocardium

c) - Vasodilation of peripheral vasculature

Which diagnostic test will be most useful to the nurse in differentiating dyspnea related to pulmonary edema from HF or a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c) BNP levels

to evaluate a client's condition following cardiac catheterization, it is most important for the nurse to palpate the pulse a) in all extremities b) at the insertion site c) distal to the cath insertion d) above the cath insertion

c) distal to the cath insertion

one hour after administering IV furosemide to a client with HF a short burst of ventricular tachy appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? A) hypocalcemia b) hypermagnesemia c) hypokalemia d) hypernatremia

c) hypokalemia

which of the following positions would best aid breathing for a client with acute pulmonary edema? a) lying flat in bed b) left side lying c) in high fowler's position d) in semi fowler position

c) in high fowler position

which of the following blood tests is most indicative of cardiac damage? a) alkaline phosphatase b) BMP c) troponin I d) creatine kinase (CK)

c) troponin I

In which patient would a mechanical prosthetic valve be preferred over a biologic valve for valve replacement? a. 41-year-old man with peptic ulcer disease b. 22-year-old woman who wants to have children c. 35-year-old man with a history of seasonal asthma d. 62-year-old woman with early Alzheimer's disease

c. 35-year-old man with a history of seasonal asthma

A patient has a diagnosis of acute myocardial infarction, and his cardiac rhythm is sinus bradycardia with 6 to 8 premature ventricular contractions (PVCs) per minute. The pattern that the nurse recognizes as the most characteristic of PVCs is a. An irregular rhythm. b. An inverted T wave. c. A wide, distorted QRS complex. d. An increasingly long PR interval.

c. A wide distorted QRS complex

A 52-year-old man is admitted to the emergency department with severe chest pain. On what basis would the nurse suspect an MI? A. He has pale, cool, clammy skin B. He reports nausea and vomiting once at home C. He says he is anxious and has a feeling of impending doom D. He reports he has had no relief of pain with rest or position change

c. he says he is anxious and has a feeling of impending doom

what causes the pain that occurs with myocardial ischemia? a) death of myocardial tissue b) dysrhythmias caused by cellular irritability c) lactic acid accumulation anaerobic metabolism d) increased pressure in the arteries and pulmonary vessels

c. lactic acid accumulation during anaerobic metabolism

a client with angina complains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness which of the following actions should the nurse take first? a) activate the resuscitation team b) open the client' airway c) check for breathing d) check for signs of circulation

d) check for signs of circulation

which of the following conditions is the predominant cause of angina a) increased preload b) decreased afterload c) coronary artery spasm d) inadequate oxygen supply to the myocardium

d) inadequate oxygen to the myocardium

a client has frequent bursts of ventricular tachy on the cardiac monitor. A nurse is most concerned with the dysrhythmias because a) it is uncomfortable for the client giving a sense of impending doom b) is produces a high cardiac output that quickly leads to the cerebral and myocardial ischemia c) it is almost impossible to convert to a normal sinus rhythm d) it can develop into v fib

d) it can develop into v fib

the nurse assessing the blood pressure of a client diagnosed with primary HTN. The nurse ensures accurate measurement by avoiding which of the following a) seating the client with arm bared, supported, and at heart level b) measuring the blood pressure after the client has been seated quietly for 5 minutes c) using a cuff with a rubber band the encircles at least 80% of the limb d) taking a blood pressure within 15 minutes after nicotine or caffeine ingestion

d) taking a blood pressure within 15 minutes after nicotine or caffeine ingestion

What should the nurse emphasize when teaching women about the risks and incidence of CAD? a. Smoking is not as significant a risk factor for CAD in women as it is men. b. Women seek treatment sooner than do men when they have symptoms of CAD. c. Estrogen replacement therapy in postmenopausal women decreases the risk for CAD. d. CAD is the leading cause of death in women, with a higher mortality rate after MI than in men.

d. CAD is the leading cause of death in women, with a higher mortality rate after MI than in men

What does the nursing responsibility in the management of the patient with hypertensive urgency include? a. Monitoring hourly urine output for drug effectiveness b. Titrating IV drug dosage based on BP and HR measurements every 2-3min. c. Providing continuous electrocardiographic (ECG)monitoring to detect side effects of the drugs d. Instructing the patient to follow up with a health care provider within 24 hours after outpatient treatment

d. instructing the patient to follow up with a health care provider within 24 hours after outpatient treatment

A patient has a blood pressure of 222/148 and confusion, nausea, and vomiting. Which goal should the nurse try to achieve by titrating medications? a. Decrease the mean arterial pressure (MAP) to 129 mm Hgb. Lower the BP to the patient's normal within the second to third hour c. Decrease the SBP to 160 mm Hg and the DBP to 100 mm Hg as quickly as possible d. Reduce the SBP to 158 mm Hg and the DBP to 90 mm Hg within the first two hours

d. reduce the SBP to 158 mm Hg and the DBP to 90 mm Hg within the first 2 hours

A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit a. Palpitations. b. Hypertension. c. Warm, flushed skin. d. Shortness of breath

d. shortness of breath

What is included in the correct technique for BP measurement? a. Always take the blood pressure in both arms b. Position the patient supine for all readings c. Place the cuff loosely around the upper arm d. Take readings at least 2 times at least 1 min. apart

d. take the readings at least 2 times at least 1 min apart

1) The home health nurse is assigned a client with HF, which of following should the nurse implement? a. Request a dietary consult for a sodium restricted diet b. Instruct the client to elevate feet during the day c. Teach the client to weight every morning wearing the same type of clothes d. Assess for edema in the dependent areas of the body e. Encourage the client to drink at least 2,500 mL per day f. Have the client repeat back instructions to the nurse

A) request a dietary consult for a sodium restricted diet B) instruct the client to elevate feet during the day C) teach the client to weight every morning wearing the same type of clothes D) Assess for edema in the dependent areas of the body F) have the client back instructions to the nurse