Med surg exam 3

17. The elderly patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse's most helpful response would be:

"If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals,

44. Which patient teaching would help to prevent venous stasis? (Select all that apply.)

-Avoid crossing legs at the knee -Elevate legs when lying in bed or sitting -Wear elastic stockings when ambulating

48. Which of the following are signs of digoxin (Lanoxin) toxicity? (Select all that apply.)

-Bradycardia -Headache -Visual disturbance -Gastrointestinal complaints

46. The nurse outlines which of the following as conditions that would disqualify a candidate for a heart transplant? (Select all that apply.)

-Recent malignancy -Peptic ulcer disease -Severe obesity

15. A nurse cautions a patient with peripheral vascular disease (PVD) that continued smoking causes detrimental vasoconstriction for up to ____ after only one cigarette.

1 Hour

High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States?

1 in 3 adults

1. A nurse performs an apical-radial pulse evaluation, with the result of 100/88. What is the pulse deficit?

12

15. The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between:

2 and 3

54. The patient with congestive heart failure who is on a diuretic drug shows a weight loss of 6.6 lb. The nurse is aware that the patient has lost L of fluid.

3

26. The nurse reminds the patient that the National Heart, Lung, and Blood Institute recommends a lipid study every years.

5

OTHER 40. A nurse uses a picture to demonstrate the conduction pathway through the chambers of the heart. (Arrange the following options in the correct sequence. Separate letters by a comma and space as follows: A, B, C, D.)

E. The SA node fires. A. The atria contract. C. The AV node fires. B. Conduction occurs through the bundle branches. D. The Purkinje fibers conduct. F. The ventricles contract.

32. Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer?

Edematous, red scaly skin on medial surface of the leg

2. The endothelium lining of the heart chambers and valves is called the:

Endocardium

5. A patient asks what a transesophageal echocardiogram (TEE) is and what it is expected to do? What is the best explanation by the nurse?

Evaluates the efficiency of the valves

27. A patient with acute congestive heart failure has jugular vein distention, crackles bilaterally, and dyspnea. Which nursing diagnosis should have the highest priority?

Excess fluid volume

25. A medication, simvastatin (Zocor), is administered to lower a patient's cholesterol level. Follow-up lipid levels are reviewed by the nurse. Which level indicates the desired therapeutic range?

HDL, 42 mg/dL; LDL, 98 mg/dL

17. A stress test is scheduled for a 41-year-old patient. What action should the nurse implement to prepare the patient for the examination?

Have the patient sign a consent form.

30. A patient is receiving digoxin 0.25 mg/day. What should the nurse do prior to administering this medication?

Hold the dose if the apical rate is 57 beats/min.

28. A nurse is assessing the cardiac complex above. What pattern should the nurse recognize in this rhythm strip?

NSR

3. Which part of the electrocardiogram (EKG) represents the electrical impulse as it travels through the AV node?

QRS complex

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem?

Renal failure

21. A patient has returned from a vein ligation and stripping. What are the appropriate instructions for a nurse to provide?

Wear compression stockings to promote circulation.

25. A patient with Raynaud disease has a nursing diagnosis of "Ineffective tissue perfusion, related to vasoconstriction" and is being given discharge instructions. What should the nurse include when providing this information?

Wear gloves and warm socks when outdoors.

27. What patient teaching should be included for a patient with varicose veins?

Weight reduction

28. Why do older persons adapt more slowly to changes in the peripheral vascular system? (Select all that apply.)

a. Slowing heart rate b. Decreasing cardiac output d. Stiffening of blood vessels e. Thickening of aorta

2. The T wave in an ECG strip represents:

repolarization of ventricles

18. Discharge teaching for a client who has a pacemaker implanted would include which of the following?

wearing a medical alert tag to indicate presence of a pacemaker

16. A nurse is performing an intake examination on a patient with peripheral vascular disease (PVD). Which lifestyle information identified by the patient aggravates vascular disease?

Being employed as an air traffic controller

13. A patient inquires how something as simple as walking could help his venous vascular disorder. What is the best response by the nurse when explaining the benefits of walking?

Boosts venous circulation through leg muscle activity

17. Which pulse point is used to auscultate a client's blood pressure?

Brachial

4. A nurse records the assessment of stasis dermatitis on an intake assessment for a patient with peripheral vascular disease (PVD). What is the best way to describe this finding?

Brownish skin discoloration on the lower legs

28. The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask?

"Have you contacted your physician about your dental appointment?"

7. The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient says:

"I always take off the telemetry device when I shower."

6. At a preoperative cardiac surgery appointment, the nurse is educating a client and his wife about the heart's ability to pump blood and the cardiac output. The nurse explains that the normal cardiac output is:

4-6 L/minute

1. Over 50 million adults in the US have hypertension. Which of the following could be reduced if hypertension were controlled? (Select all that apply.) a. disseminated intravascular coagulation b. stroke c. deep vein thrombosis (DVT) d. myocardial infarction e. heart failure f. syncope

ANS: B stroke D myocardial infarction E. Heart failure

7. A client with an elevated BP when it is taken in a physician's office has what type of hypertension? a. medically related b. "white coat" c. false d. expected

ANS: "white coat"

5. Malignant hypertension is most common in which group? a. black males >60 years of age b. black males >40 years of age c. black males/females >40 years of age d. black males <40 years of age

ANS: Black males <40 yrs of age

19. Using a blood pressure cuff that doesn't fit the client properly can result in an incorrect BP reading. The BP cuff's bladder should encircle what percentage of the client's arm? a. 25% b. 50% c. 80% d. 100%

ANS: C The cuff bladder should encircle 80% of the arm to obtain an accurate blood pressure.

14. Client education for a client who has hypertension (HTN) would include avoiding which of the following foods? a. cold cuts b. bananas c. yogurt and milk d. oatmeal

ANS: Cold cuts

17. Which of the following is an excellent aerobic exercise for the client with hypertension? a. bowling b. walking c. golf d. tai kwan do

ANS: Walking

2. Ninety-five percent (95%) of clients with hypertension (HTN) have essential HTN, which means that the cause of the HTN is: a. atherosclerosis b. hypernatremia c. renal disease d. unknown

ANS: unknown

8. A 29-year-old patient is to receive cardioversion for a dysrhythmia. What should the nurse instruct the patient to expect?

Administration of a short-acting sedative

2. What is increased in hypertension that in turn causes an increase in the work of the heart?

Afterload

21. A patient is scheduled for a heart catheterization. What action should the nurse implement in preparation for this examination?

Ask the patient about allergies to seafood or iodine.

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.

Ask the patient to sit quietly while the BP is being measured. • The patient's arm should be positioned at the level of the heart. • Using a BP cuff that is too small will give a higher BP measurement.

The nurse is providing care for a client with a diagnosis of hypertension. The nurse should consequently assess the client for signs and symptoms of which other health problem?

Atherosclerosis

15. What is an important teaching point for a patient with mitral stenosis?

Balance activity with oxygen supply.

26. What assessment should a nurse perform on a patient after the repair of an abdominal aortic aneurysm?

Bowel sounds

22. A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage?

CK-MB

18. What action should a nurse expect to implement when a patient returns from a cardiac catheterization?

Check the puncture site.

24. Which postoperative sign should a nurse report immediately when caring for a patient with an endarterectomy with a synthetic graft?

Fever

18. Which instruction is most appropriate for a patient with arterial insufficiency?

Frequently allow the legs to dangle dependently.

39. The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times?

In the morning

6. A nurse performs Homans maneuver by flexing the knee and sharply dorsiflexing the foot. What response indicates a positive Homans sign?

Pain in the calf area

10. What is a characteristic of a venous stasis ulcer?

Painlessness

18. A positive Homan's sign is assessed by which movement of the client's foot?

Pointing toes

Which finding indicates that hypertension is progressing to target organ damage?

Retinal blood vessel damage

30. What is the difference between primary and secondary hypertension?

Secondary hypertension is caused by another disorder like renal disease.

A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the pat

Smoking increases the risk of heart disease.

The critical care nurse is caring for a client just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?

Sodium nitroprusside

22. A patient has had atropine sulfate that has been administered intravenously to treat a dysrhythmia. What should the nurse assess this patient for after administration?

Tachycardia

20. Which is TRUE about a client with a pacemaker?

The client should avoid contact sports.

22. What medication obtained in a patient's history will lessen the effects of warfarin (Coumadin)?

Yaz (drospirenone/estradiol) as an oral contraceptive

6. How is bradycardia usually treated?

administration of atropine

53. The nurse explains that the heart has the ability to contract in a rhythmic pattern that is called .

automaticity

57. Trace the impulse pattern of conduction in sequence through the heart. (Separate letters by a comma and space as follows: A, B, C, D)

b. Atrial-ventricular (AV) node a. Atrial wall d. Sinoatrial (SA) node f. Bundle of His e. Bundle branches c. Purkinje fibers

12. The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this arrhythmia as:

sinus tachycardia.

27. During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure?

"I have to sleep in my recliner and I have this hacking cough."

37. Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)?

"I try to eat more green leafy vegetables, especially broccoli, spinach, and kale."

20. Which statement made by a patient indicates to the nurse that a teaching plan for the use of warfarin was not effective?

"I'm drinking too much tea. My urine looks like tea."

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize?

"Sit quietly for 5 minutes prior to taking blood pressure."

9. A 68-year-old patient is scheduled for open heart surgery in the morning and is crying. What is the most appropriate response by the nurse?

"Tell me what concerns you the most."

8. The nurse assesses pitting edema that can be depressed approximately inch and refills in 15 seconds. The nurse would document this assessment as:

+2 edema.

35. Which factors affect stroke volume? (Select all that apply.)

-Contractility -Preload -Afterload

36. Which age-related changes in the heart should a nurse take into consideration? (Select all that apply.)

-Decrease in contractility -Thickened valves -Stiffened valves -Decreased SA node cells

43. What is the transesophageal echocardiogram (TEE) used for? (Select all that apply.)

-Detect thrombi before a cardioversion -Visualize vegetation on the heart valves -Visualize abscesses on the heart valves

45. The nurse points out which of the following as modifiable risks for coronary artery disease (CAD)? (Select all that apply.)

-Diabetes mellitus -Smoking -Hypertension -Hyperlipidemia

37. What actions should a nurse implement to decrease the workload of the heart in a patient with acute congestive failure? (Select all that apply.)

-Eliminate unnecessary activities. -Help the patient change positions every 2 hours. -Give a partial bed bath rather than full bed bath.

47. When assessing a patient with a possible MI, what should the nurse assess for? (Select all that apply.)

-Hypertension -Pallor -Diaphoresis -Erratic behavior -Cardiac rhythm changes

38. A nurse urges a 50-year-old overweight executive who had a myocardial infarction (MI) 3 months earlier to take up some conditioning exercises for 30 minutes a day. What rationale supports this suggestion? (Select all that apply.)

-Lose weight. -Improve function of the left ventricle. -Decrease arterial stiffening. -Decrease cholesterol levels.

42. Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply.)

-Take medication at the same time each day. -Report to physician cuts that do not stop bleeding with direct pressure.

41. The nurse would design teaching for a patient with Raynaud disease to include which of the following? (Select all that apply.)

-Using mittens in cold weather -Practicing stress-reducing techniques -Complete smoking cessation -Using caution when cleaning the refrigerator or freezer

50. Following an angiogram with the insertion site of the left groin, the nurse will include in the plan of care provisions for (select all that apply):

-checking pedal pulses. -checking color and warmth of left leg frequently. -sandbagging over insertion site.

49. The nurse encourages the patient who is recovering from a myocardial infarct (MI) to ask the health care provider to prescribe a cardiac rehabilitation series in order to learn to (select all that apply):

-improve stamina. -strengthen muscles. -reduce risk of further problems. -understand heart condition.

40. The nurse would assess closely for signs of right-sided heart failure which include (select all that apply):

-increasing abdominal girth. -edema of feet and ankles. -distended jugular veins.

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following?

130/80 or lower

2. Modifiable risk factors for hypertension include: (Select all that may apply.) a. stress b. diet high in sodium and fat c. alcohol intake d. gender e. smoking f. lack of exercise

ANS: a. stress b. diet high in sodium and fat c. alcohol intake e. smoking f. lack of exercise

3. Hypertension is defined as an elevated blood pressure with a systolic above: a. 80 mmHg b. 90 mmHg c. 140 mmHG d. 150 mmHg

ANS: 140 mmHG

10. Which of the following is a potassium sparing diuretic? a. Lasix b. Aldactone c. Inspra d. HCTZ

ANS: Aldactone

16. Which of the following would a nurse most likely say to a client who is taking Nifedipine (Procardia)? a. "You might feel really tired when first standing up in the morning." b. "Be sure to perform good oral hygiene because this medication may affect the health of your gums." c. "One side effect you may experience is swelling of the head and hands; report this to your physician." d. "You may experience a dry cough while taking this medication."

ANS: Be sure to perform good oral hygiene because this medication may affect the health of your gums."

15. Nursing interventions for the client with hypertension (HTN) would include all of the following. Which would increase client satisfaction and compliance with the prescribed treatment regimen? a. discussing possible sexual dysfunction in an open and candid manner b. encouraging the client to actively participate in the treatment c. reviewing records of the client's blood pressure readings and weight d. insisting on making referrals to a dietitian, a smoking cessation clinic, stress-management seminars, and fitness centers

ANS: Encouraging the client to actively participate in the treatment

11. An important nursing intervention for the nurse who is administering Inderal to a client is to: a. take apical pulse and withhold med if pulse is <60. b. take orthostatic hypotension precautions with this client. c. monitor lab values for liver function test elevations. d. monitor for bradycardia

ANS: Take apical pulse and withhold med if pulse is <60

12. A nurse is teaching a client who has hypertension (HTN) the stepped-care approach to keeping blood pressure within normal limits. Which of the following is part of the first step in this regimen? a. frequent rest periods during the day b. use of antihypertensive medications c. weight loss and dietary modifications d. having family members checked for HTN

ANS: Weight loss and dietary modifications

9. Spironolactone falls into which category of diuretics? a. loop diuretics b. aldosterone receptor blockers c. thiazides d. beta blockers

ANS: aldosterone receptor blockers

13. Which type of medication would be used FIRST in treating hypertension (HTN)? a. angiotensin-converting enzyme (ACE) inhibitors b. beta-adrenergic blocking agents c. diuretics d. vasodilators

ANS: diuretics

20. What is an appropriate nursing intervention for a client with hypertension who is noncompliant with medical treatment? a. Allow the client to have BP checked once a year. b. Insist that the client eat a low sodium diet. c. Frequently contact the client to make sure medication is being taken per physician's orders. d. Encourage client to become active participant in the treatment.

ANS: encourage client to become active participant in the treatment

8. The function of diuretics in the treatment of hypertension is to: a. block epinephrine receptor sites b. increase renal excretion of sodium/H2O c. inhibit the production of renin d. block calcium's movement into cell

ANS: increase renal excretion of sodium/H20

6. The main goal for the client with hypertension is to: a. limit dietary intake of sodium b. exercise regularly c. keep BP within normal limits d. maintain optimum weight

ANS: keep BP within normal limits

1. Risk factors for hypertension (HTN) include which of the following? a. Asian American heritage b. lack of exercise c. high socioeconomic status d. peripheral vascular disease

ANS: lack of exercise

18. It is recommended that a client with hypertension drink alcohol following which guideline? a. zero alcohol b. no more than 2 ounces at a time c. no more than 4 ounces at a time d. no more than 6 ounces at a time

ANS: no more than 2 ounces at a time

4. Which of the following is TRUE about African American clients and hypertension? a. They develop hypertension earlier in life b. Their HTN is defined as >110/70. c. It is the same as other ethnic groups. d. HTN is only diet related.

ANS: they develope hypertension earlier in life

4. The nurse identifies the "LUBB" sound of the "LUBB/DUBB" of the cardiac cycle as the sound of the:

AV valves closing.

19. A nurse assesses an inverted T wave on the ECG of a patient who had an acute MI two days earlier. How should the nurse interpret this finding?

Abnormal wave form

A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem?

Acute kidney injury

17. Vascular disease disorders often require the use of elastic stockings. Which action should the nurse implement when caring for a patient with elastic stockings?

Apply the stockings and roll down the cuff.

23. An obese postsurgical patient complains of sudden discomfort in her leg. The nurse assesses the leg and finds it cold and pale with no pedal or popliteal pulse. What should the nurse suspect?

Arterial occlusion

9. A nurse notes ulcerations on the surfaces of a patient's toes. What should this assessment most likely indicate?

Arterial stasis

8. Blood leaves the heart through which of these structures?

Arteries

24. A patient with atrial fibrillation is prescribed amiodarone for the dysrhythmia. Which potential adverse reaction should the nurse report?

Ataxia

17. Treatment of the client with ventricular fibrillation (VF) requires which of these measures?

CPR and immediate defibrillation

11. The nurse is providing counsel regarding diet to a client who has an atrial dysrhythmia. Which of these foods should the client be instructed to avoid?

Caffeine

3. A 69-year-old patient reports a burning, aching pain in the legs when walking to the mailbox. These symptoms are relieved with rest. What should the nurse suspect?

Claudication

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this client's care, what desired outcome should the nurse identify?

Client takes medication as prescribed and reports any adverse effects.

23. The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)?

Cocaine use

7. A nurse should anticipate that a patient taking Vasotec, an angiotensin-converting enzyme (ACE) inhibitor, should have which positive outcome to this drug?

Decrease Blood Pressure

A client in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the client will be treated with IV vasodilators, and that the primary goal of treatment is what?

Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment.

32. Which assessment should be immediately addressed in a patient on lidocaine?

Increase in temperature to 102° F

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect?

Increased urine output

12. A nurse is educating a patient regarding a stress test on a treadmill. Teaching includes that this test is a noninvasive procedure. What additional information is appropriate for the nurse to include?

Is monitored continuously by blood pressure and an electrocardiogram

19. A nurse is preparing to administer low-molecular-weight heparin (LMWH). What is a major advantage related to the administration of LMWH?

It is provided fixed doses.

20. If a positive Homans' sign is detected during assessment, the nurse should not perform this assessment again until a clot has been ruled out for which reason?

It may cause an embolus.

The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasize which of the following as part of the plan of care?

Limiting sodium intake in the diet

14. What is contraindicated for a patient performing Buerger-Allen exercises?

Lying on the stomach

31. The nurse is treating a patient who has had a pacemaker inserted for the correction of atrial fibrillation. Which diagnostic test is no longer available to the patient because of the implanted device?

MRI

16. A physician has ordered continuous pulse oximetry. What should the nurse explain to the patient about this procedure?

Measures the amount of oxygen in the blood

25. The nurse caring for a patient recovering from a myocardial infarction (MI) teaches which method to avoid the Valsalva maneuver during a bowel movement?

Mouth breathing

29. A diuretic medication, furosemide (Lasix), is being administered for congestive heart failure. Which assessment is not an anticipated consequence of the therapy?

Muscle weakness

31. A 46-year-old patient is receiving propranolol (Inderal), a nonselective beta-adrenergic blocker, for a heart condition. What patient teaching is most appropriate?

Never stop taking the drug abruptly.

11. A patient with an irregular sinoatrial (SA) node conduction has a permanent pacemaker with the code AAIOO and is now going home. The patient asks, "What happens when my real SA node fires on its own?" How should the nurse respond regarding what the pacemaker should do?

Not fire

7. Which technique should the nurse implement when performing the Allen test on a patient to evaluate the adequacy of circulation in the radial artery?

Observes whether the color is returning to the hand, which indicates perfusion

33. How should a nurse interpret the arrhythmia in the above strip?

PVC

34. The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg. What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot?

Pain, which would be a positive Homans sign

3. The double-walled sac that surrounds the heart is called the:

Pericardium

11. A nurse is caring for a patient who has had an angiogram. What should the nurse make a point of care to assess and document on this patient?

Peripheral pulses in the affected leg

13. All of the following are risk factors associated with cardiovascular disease. Which of these would be considered an alterable risk factor?

Physical Inactivity

24. The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention?

Place patient upright with legs in dependent position to reduce the symptoms of

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned?

Postural hypotension and resulting injury

A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together?

Potassium level

16. Cardioversion should be done during which part of the electrocardiogram (EKG) wave?

R Wave

A patient is being seen in the cardiology clinic for hypertension. He states that he is a 2 pack-a-day smoker. It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine

Raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

6. A nurse records the finding of a normal sinus rhythm (NSR) when the P, Q, R, S, and T are all present in the electrocardiographic complex. What additional information should the nurse document?

Rate of 82 seconds

2. What should a nurse ask a patient related to past history of deep-vein thrombosis (DVT) and other vascular problems?

Recurring chest pain

A client with primary hypertension comes to the clinic reporting a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?

Retinal blood vessel damage

19. What is the major cause of cardiac valve disease?

Rheumatic fever

16. The nurse notes a client's neck veins are distended when sitting upright. This finding is indicative of which of these conditions?

Right- Sided Heart Failure

10. Which of these normal heart sounds can BEST be heard on the left, fifth intercostal space close to the clavicle and occurs as the mitral and tricuspid valves close simultaneously?

S1

11. Which of these normally heard sounds is the simultaneous closing of the pulmonary and aortic valves and is heard on the right, second intercostal space?

S2

1. The electrical conduction of the heart begins with which of the following?

SA node

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what?

Secondary hypertension has a specific cause.

A client with severe hypertension states, "I feel fine; I'm not really sick at all." The nurse will teach the client that the system/organs particularly targeted for damage by severe hypertension include which of the following?

Sensory

23. A dopamine infusion is being administered to a patient with shock. For what should the nurse be alert?

Sharp spike in blood pressure

16. What should a person with unstable angina avoid?

Shoveling snow

4. A 49-year-old patient has multiple risk factors for coronary artery disease. Which risk factor is considered modifiable?

Smoking

6. The nurse assesses that the home health patient has no signs or symptoms of heart failure, but does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The nurse is aware that using the American College of Cardiology and the American Heart Association (ACC/AHA) staging, this patient would be a:

Stage A

1. What is a normal age-related change in older adults that makes them susceptible to cardiovascular disease?

Stiff peripheral vessels

35. How should the nurse advise a patient with an international normalized ratio (INR) of 5.8?

Stop taking the anticoagulant and notify health care provider

9. Which of these terms refers to the volume of blood pumped by the ventricle with each contraction?

Stroke Volume

13. A nurse explains that cardiac rehabilitation lasts from the end of acute care to the return to home and beyond. What does this service include?

Telemetry-monitored exercise

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension?

The incidence and prevalence of hypertension increase with age.

34. A nurse records a "1" for the pulse quality of the pedal pulse. What interpretation is correct regarding the pulse?

Thready

5. A nurse assesses a patient's capillary refill time as less than 3 seconds. What does this assessment indicate?

Tissue perfusion

9. What do dark or "cold" spots on a thallium scan indicate?

Tissue that has inadequate perfusion

8. A nurse records that a patient has a 3+ edema to the right foot. How deep did the nurse's thumb depress the edematous area?

To 1 inch

A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client?

Tobacco use increases the client's concurrent risk of heart disease.

10. What do fibrous plaques of atherosclerosis serve as when they are laid down in the vessels?

Trap to which other substances adhere

A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following?

Tried to rest quietly for 5 minutes before the reading is taken

A patient has come to the clinic for a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has:

Tried to rest quietly for 5 minutes before the reading is taken

20. Laboratory tests are performed to identify damage to the heart muscle. Which test is elevated the earliest with heart damage?

Troponin

12. A patient with angina pectoris complains of chest pain at rest and needs to take three nitroglycerin (NTG) pills to relieve the pain. Of what should the nurse assess this as a major symptom?

Unstable angina

14. On auscultation, a nurse detects a heart murmur. What should the nurse know that a heart murmur indicates?

Valves that do not close correctly

3. Which heart sound should the nurse record as normal?

Ventricular gallop in a 20-year-old patient

33. What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient?

Walk 2 miles in less than 60 minutes after 12 weeks.

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements.

Weight reduction

26. What information should a nurse include in a patient's discharge instruction after an acute myocardial infarction (MI)?

Written instructions on diet and follow-up appointments

19. A client with deep vein thrombosis (DVT) may be asymptomatic or may have which of the following?

a positive Homans' sign

19. A nurse is performing a routine ECG on a new client during an annual physical examination. On the ECG strip, which indicates that the client has a pacemaker?

a vertical line before each QRS

29. A nurse suspects a circulatory disorder in one leg. Which assessments should the nurse include when comparing both legs? (Select all that apply.)

a. Color b. Warmth d. Pulse quality e. Hair loss on extremity

1. The most common causes of dysrhythmias are: (Select all that apply.)

a. electrolyte imbalance b. myocardial infarction c. heart failure d. drug toxicity e. coronary artery disease (CAD)

1. What are the major risk factors associated with cardiovascular disease? (Select all that apply.)

a. gender b. age c. smoking d. dyslipidemia e. high blood pressure g. physical inactivity h. race

2. A client experiencing a dysrhythmia may experience which of the following symptoms? (Select all that apply.)

a. no symptoms b. fainting c. seizure d. fatigue e. chest pain f. palpitations g. decreased energy level

2. Which of the following factors will influence a client's stroke volume and cardiac output? (Select all that apply.)

a. the amount of pressure within the ventricles b. the strength of cardiac contraction c. resistance of blood ejection from the ventricles e. the number of beats per minute

52. The life support system that uses special techniques, ventilation equipment, and therapies for emergency situations is .

advanced cardiac life support (ACLS)

9. A rapid contraction of the atria yielding a heart rate of 250 to 350 beats per minute and displaying a sawtooth pattern on an ECG is called:

atrial flutter

5. Depolarization of which heart chamber pumps blood into the aorta and out to the entire body?

b. left ventricle

56. The process by which a heart is shocked from a persistent arrhythmia back into sinus rhythm is called a _.

cardioversion

36. The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for:

cessation of smoking.

18. The patient has been hospitalized for hypertensive episodes three times in the last months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse's immediate course of action would be to:

collect more information to identify his reasons for noncompliance.

14. What is the MOST common cause of premature ventricular contractions?

coronary artery disease

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress

decreases the production of neurotransmitters that constrict peripheral arterioles.

8. What is the usual treatment for tachycardia?

depends on the cause

58. Arrange in sequence the path of the blood through the coronary circulation. (Separate letters by a comma and space as follows: A, B, C, D)

e. Superior and inferior vena cava a. Right atrium c. Tricuspid valve d. Right ventricle b. Pulmonary artery j. Lungs f. Pulmonary vein g. Left atrium h. Mitral valve i. Left ventricle

A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension:

has a specific cause.

38. The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause:

heart failure.

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.)

heart rate heart rhythm character of apical and peripheral pulses

31. A nurse explains that when a patient history reveals a recent episode of vomiting and diarrhea, the nurse anticipates that this fluid loss will cause _____ and increased blood viscosity.

hemoconcentration

29. The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can:

increase the action of the Coumadin.

3. The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having:

indigestion.

13. After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of:

infective endocarditis.

55. The pain that a person with arterial insufficiency feels on exertion, which is relieved by rest, is .

intermittent claudication

30. A nurse explains that the lining of a vessel that allows for smooth blood flow and also reduced resistance in the vessel is the _____ of the vessel.

intima

A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?

kidneys

15. Which of these drugs is MOST commonly used to treat premature ventricular contractions?

lidocaine hydrochloride

10. The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of:

moderate heart failure.

5. A nurse is explaining to a client the causes of sinus bradycardia, which includes:

myocardial ischemia

1. The nurse is aware that the muscle layer of the heart, which is responsible for the heart's contraction, is the:

myocardium.

39. At rest, the cardiac cells in the myocardium are electrically polarized, with the inside of the cell being more _____ than the outside of the cell.

negative

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:

ophthalmic examination.

15. A client reports awakening suddenly, sweating profusely, and having difficulty breathing. Which of these terms should the nurse record in the client's health history?

paroxysmal nocturnal dyspnea

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as

prehypertension.

13. What are the MOST common ectopic heartbeats?

premature ventricular contractions

4. What prevents blood from flowing back into the ventricles from the pulmonary artery and aorta during repolarization?

pulmonic and aortic valves

20. The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low-density lipid (LDL) of 80. The nurse's reaction is one of:

satisfaction. This is good cholesterol control.

11. The nurse takes into consideration that age-related changes can affect the peripheral circulation because of:

sclerosed blood vessels.

5. A patient is admitted from the emergency department. The emergency department physician notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV. This indicates the patient's condition as:

severe heart failure.

2. The nurse clarifies that the master pacemaker of the heart is the:

sinoatrial (SA) node.

4. A heart rate of 60 bpm or less is called:

sinus bradycardia

7. What part of the heart is capable of conducting electrical impulses from one part of the heart to another?

specialized cardiac muscle cells

21. While assess a client's lower extremities, the nurse notices an inflammation of the skin around the ankle area. The nurse notes which of the following on the client's assessment form?

stasis dermatitis

10. Individuals with atrial fibrillation (AF) are five more times likely to have which condition than those who do not?

stroke

21. A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include:

substernal pain that radiates down the left arm.

7. A sinus rhythm with a heart rate ranging from 100 to 150 bpm is called:

tachycardia

12. Which of the following is a primary nursing goal when obtaining a health history from a client?

to identify present and potential health problems

12. During defibrillation, the paddle are lubricated and then placed on which anatomic landmarks?

to the right of the sternum below the clavicle and at the apex of the heart

51. The cardiac marker rises 3 hours after a myocardial infarct and measures myocardial contractile protein.

troponin I

14. Which of these factors, in combination with cigarette smoking, places a woman at greater risk for developing coronary artery disease?

use of oral contraceptives

1. In the peripheral vascular system, what carries deoxygenated blood back to the right side of the heart?

veins

14. The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into:

ventricular tachycardia and death.