HESI

Which electrical activity of the cardiac conduction system is reflected in the P wave? A. Atrial depolarization B. Atrial repolarization C. Ventricular depolarization D. Ventricular repolarization

A. Atrial depolarization Rationale: The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. Atrial repolarization also occurs simultaneously to ventricular depolarization, but because of the larger muscle mass of the ventricles, the QRS complex obscures visualization of atrial repolarization. The T wave represents ventricular repolarization.

How would anxiety affect outcomes for a client with heart failure? A. Increases the cardiac workload B. Interferes with usual respirations C. Produces an elevation in temperature D. Decreases the amount of oxygen used

A. Increases the cardiac workload Rationale: Anxiety increases sympathetic nervous system activity, leading to increases in heart rate, vasoconstriction, and increased metabolic rate, which increase cardiac workload and worsen outcomes in clients with heart failure. Anxiety does not directly interfere with respirations. Anxiety alone usually doe not elevate the body temperature. Anxiety can cause an increase in the amount of oxygen needed for body functions.

Which intervention would the nurse perform when caring for a client in the emergency department reporting chest pain? A. Providing oxygen B. Assessing vital signs C. Obtaining a 12-lead EKG D. Drawing blood for cardiac enzymes E. Auscultating heart sounds F. Administering nitroglycerin

A. Providing oxygen B. Assessing vital signs C. Obtaining a 12-lead EKG D. Drawing blood for cardiac enzymes E. Auscultating heart sounds F. Administering nitroglycerin Rationale: The nurse would provide oxygen to a client with chest pain, as the heart may be getting insufficient oxygen as a result of occluded coronary vessels. The nurse would also assess the client's vital signs, obtain a 12-lead EKG, and auscultate heart sounds to determine rhythm changes related to cardiac ischemia. The nurse would need to draw blood for evaluation of cardiac enzymes. Changes in the levels of these enzymes (including troponin, creatine kinase, and myoglobin) can indicate damage to heart tissue. Nitroglycerin is administered to promote coronary vasodilation.

Which object would the nurse teach the client with a newly implanted pacemaker to avoid? A. Strong magnet B. Microwave oven C. Mobile telephone D. Remote control device

A. Strong magnet Rationale: The client with a newly implanted pacemaker is taught to avoid strong magnets because they can change the settings and function of the pacemaker. Microwave oven use is not a concern for a client with a pacemaker. Remote control devices are not contraindicated for the client with a pacemaker. Mobile phones should be used in the ear opposite the pacemaker.

When teaching a client with atrial fibrillation about a new prescription for warfarin, the nurse will include information about which vitamin? A. Vitamin K B. Vitamin D C. Vitamin B1 D. Vitamin B12

A. Vitamin K Rationale: Warfarin causes inhibition of vitamin K-dependent clotting factors, and use of vitamin K would affect the therapeutic effect of warfarin. Vitamin D has no effect on warfarin. Vitamin B1 does not affect warfarin or clotting. Vitamin B12 does not affect warfarin effectiveness.

Which statement by an unlicensed assistive personnel (UAP) who is assisting the nurse in caring for a group of clients indicates a correct understanding of the UAP's role? A. "I will turn of the client's intravenous lines that have infiltrated." B. "I will take client's vital signs after their procedures are over." C. "I will use written materials to teach clients before surgery." D. "I will help by giving medications to clients who are slow in taking pills."

B. "I will take client's vital signs after their procedures are over." Rationale: Monitoring vital signs after procedures is within the scope of a UAP's role. Registered professional nurses or licensed practical nurses, not UAPs evaluate for intravenous fluid infiltration. Client teaching is performed by registered nurses or licensed practical nurses, not UAPs. Medication administration is performed by registered nurses or licensed practical nurses, not UAPs.

Which explanation will the nurse give when a client asks about what causes varicose veins? A. "Abnormal configurations of the veins." B. "Incompetent valves of superficial veins." C. "Decreased pressure within the deep veins." D. "Atherosclerotic plaque formation in the veins."

B. "Incompetent valves of superficial veins." Rationale: Incompetent valves result in retrograde venous flow and subsequent dilation of veins. Abnormal configurations of the veins are considered a result of, rather than a cause of, varicose veins. Pressure within the deep veins is increased, not decreased. Plaque formation is considered an arterial, rather than a venous, problem and is associated with atherosclerosis.

Which group of clients would the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? A. Children B. Older adults C. Young adults D. Middle-aged persons

B. Older adults Rationale: The incidence of non-Hodgkin lymphoma increases with age; the disease is more common in men and older adults. Younger individuals have a lower incidence of non-Hodgkin lymphoma.

When hypokalemia is suspected, which diagnostic test will the nurse use to confirm the diagnosis? A. Complete blood cell count B. Serum potassium level C. X-ray film of long bones D. Blood cultures x3

B. Serum potassium level Rationale: A serum potassium level less than 3.5 mEq/L (3.5 mmol/L) indicates hypokalemia. Complete blood cell count, x-ray film of long bones, and blood cultures x3 will have no significance in the diagnosis of a potassium deficit.

Which action will the nurse take to determine a client's pulse pressure? A. Multiply the heart rate by the stroke volume. B. Subtract the diastolic from the systolic reading C. Average the systolic and diastolic pressure readings. D. Calculate the difference between apical and radial pulse rates

B. Subtract the diastolic from the systolic reading Rationale: Pulse pressure is obtained by subtracting the diastolic from the systolic reading after the blood pressure has been recorded. Multiplying the heart rate by the stroke volume is the definition of cardiac output; it is not the pulse pressure. Determining the mean blood pressure by averaging the two is not pulse pressure. Calculating the difference between the apical and radial rate is the pulse deficit.

When arterial blood gases done on a client who is being resuscitated after cardiac arrest show a low pH, which factor is likely cause of the laboratory result? A. Ketoacidosis B. Irregular heartbeat C. Lactic acid production D. Sodium bicarbonate administration

C. Lactic acid production Rationale: Cardiac arrest causes decreased tissue perfusion, which results in anaerobic metabolism and lactic acid production. Fat-forming ketoacids occur in diabetes. An irregular heartbeat does not cause acidosis. Sodium bicarbonate causes alkalosis, not acidosis.

What is the purpose of encouraging active leg and foot exercises for a client who has had hip surgery? A. Maintain muscle strength B. Reduce leg discomfort C. Prevent clot formation D. Improve wound healing

C. Prevent clot formation Rationale: Active range-of-motion (ROM) exercises increase venous return in the unaffected leg, preventing complications of immobility, including thrombophlebitis. Although isotonic exercises do promote muscle strength, that is not the purpose of these exercises at this thime. These isotonic exercises are being performed on the unaffected extremity; there should be no discomfort. Active ROM exercises will not improve wound healing.

A client with type 1 diabetes asks what causes several brown spots on the skin. What would be the best response by the nurse? A. "The brown spots reflect the accumulation of blood fats in the skin; they should disappear" B. "Those spots indicate a high glucose content in the skin that may get infected if left untreated." C. They are the result of diseased small vessels in the shins and may spread if not treated soon." D. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."

D. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot." Rationale: "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot" is an accurate explanation for the client's concern; brown spots are caused by the deposit of hemosiderin in the tissue. Brown spots reflecting the accumulation of blood fats in the skin and disappearing is the definition of xanthoma. A high glucose content in the skin that has become infected is not the cause of brown spots on the skin; increased glucose in the skin is not observable by inspection. Brown spots result from the deposition of hemosiderin. Blood vessels may become diseased with diabetes, but this does not cause brown spots.

When performing cardiac compression on an adult client, how far would the nurse depress the lower sternum? A. 0.75 to 1 inch (2-2.5 cm) B. 0.5 to 0.75 inch (1.3-2 cm) C. 1 to 1.4 inches (2.5-3.6 cm) D. 2 to 2.4 inches (5-6 cm)

D. 2 to 2.4 inches (5-6 cm) Rationale: Current adult cardiopulmonary resuscitation (CPR) guidelines indicate that the sternum should be depressed at least 2 inches (5 cm) and not more than 2.4 inches (6 cm) to compress the heart adequately between the sternum and vertebrae. In infants, the recommendation is that the sternum be compressed by approximately one-third of the anteroposterior diameter of the chest, which is about 1.5 inches (3.8 cm). In children up to the age of puberty, compressions should be at least one-third of the anteroposterior diameter of the chest, which is about 2 inches (5 cm). In postpubertal adolescents, recommended compression depth is at the adult range of 2 to 2.4 inches (5-6 cm).

Which action would the nurse take to prevent venous thrombus formation after abdominal surgery? A. Keep the client in a gatch bed to elevate the knees. B. Have the client dangle the legs off the side of the bed. C. Help the client use and incentive spirometer every hour. D. Encourage the client to ambulate multiple times daily.

D. Encourage the client to ambulate multiple times daily. Rationale: Ambulation is essential to promote venous return and prevent thrombus formation. Keeping the client in a gatch bed to elevate the knees or having the client dangle the legs off the side of the bed cause increased popliteal pressure and impair venous return, which will increase risk for venous thrombosis in the legs. Having the client use an incentive spirometer every hour helps prevent atelectasis, not thrombi.

When a child is newly diagnosed with hemophilia A, the nurse will teach family members that hemophilia A is linked to a deficiency in which clotting factor? A. Factor II B. Factor XII C. Factor IX D. Factor VIII

D. Factor VIII Rationale: Hemophilia type A, the most common type of hemophilia, is from a deficiency of Factor VIII. Factors II and XII are part of the clotting cascade, but they are not associated with hemophilia. Factor IX is associated with hemophilia type B.

Which part of the electrocardiogram (ECG) represents depolarization of the ventricles? A. P wave B. T wave C. PR interval D. QRS interval

D. QRS interval Rationale: Atrial and ventricular depolarization and repolarization are represented on the ECG as a series of waves: the P wave followed by the QRS complex and the T wave. The QRS represents ventricular depolarization. The P wave occurs with depolarization of the atria. The T wave represent ventricular repolarization. The PR interval represents depolarization of the atria and of the atrioventricular node.

In what order does normal cardiac conduction occur through the heart?

The cardiac cycle begins with an impulse generated from a small concentrated area of pacemaker cells high in the right atria called the sinus or sinoatrial node. The impulse quickly reaches the AV node located in the area called the AV junction, between the atria and the ventricles. Here the impulse is slowed to allow time for ventricular filling before relaxation or ventricular diastole. The electrical impulse then is conducted rapidly through the bundle of His to the ventricles via the left and right bundle branches. The bundle branches divide into smaller and smaller branches, finally terminating in tiny fibers called Purkinje fibers that reach the myocardial muscle cells or myocytes,