Patho test 2
The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.
The client who is postop total knee replacement and receiving client-controlled analgesia
A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment?
The goal is to depolarize the entire heart during the passage of current.
Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?
The man's α- and β-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.
All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?
Epinephrine (Adrenalin)
Which of the following health problems can contribute to diastolic dysfunction heart failure?
Myocardial hypertrophy
A patient who will be undergoing a Holter monitor examination would be given which of the following instructions?
"Keep a diary of your activities and symptoms throughout the examination."
COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?
PO2 level of 50 mm Hg
When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle?
Parasympathetic nervous system stimulation resulting in airway constriction
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which of the following lab results would the provider expect to see?
Increased blood glucose
A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia?
Increased heart rate
A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles?
"The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen."
A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him about his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching?
"The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently."
The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening?
"There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast."
Ventilation is driven by which alteration in arterial blood?
Increased PCO2
A client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation?
dull pain in mid-chest that is worse when coughing
Bronchiectasis is considered a secondary COPD, and, with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?
Chickenpox
An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?
"Do you tend to have a cough even when you don't feel sick?"
A client with advanced chronic obstructive pulmonary disease (COPD) has been taught methods to maintain maximum functioning. What client statement indicates accurate understanding of the instructions?
"I will skip church during flu season and wear a scarf when out in the cold."
A client with heart failure asks, "Why am I taking a 'water pill9 when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which of the following explanations is most appropriate to share?
"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."
A young nurse working on a cardiac floor who is working with a nursing student informs the student that there are numerous ways to evaluate coronary blood flow. Which does she identify as the most frequently used cardiovascular diagnostic procedure?
12 lead ECG
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:
20 mL/hour
Completion of a client's pulmonary function study has yielded the following data: tidal volume, 500 mL; inspiratory reserve, 3100 mL; expiratory reserve, 1200 mL; residual volume, 1200 mL; functional residual capacity, 2400 mL. What is this client's inspiratory capacity?
3600 mL
A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2?
380 mm Hg.
What is the normal tidal volume for a person at rest?
500 mL
A number of patients in an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?
A 69-year-old woman who has entered ventricular fibrillation
Which client most likely faces the highest risk of developing secondary pulmonary hypertension?
A client with COPD and a 35 pack-year smoking
A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be:
A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.
Which of the following clients is at risk for developing acute respiratory failure?
A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation
The nurse determines that the client has clubbing of the fingertips. Which is the best intervention?
Check the patient's O2 saturation level.
Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?
A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"
An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure?
AV node pacemaking activity and vagal nerve suppression
Cardiac reserve refers to which of the following events?
Ability to increase cardiac output during physical exercise
A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring?
Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording.
Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?
Airway inflammation
A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work?
BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology.
A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?
Barrel chest
A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?
Barrell chest
Which of the following antidysrhythmic medications works by blunting the effect of sympathetic nervous system stimulation on the heart?
Beta blockers, such as metoprolol
A patient, who is experiencing some angina associated with atrial tachycardia, has been placed on verapamil (Calan), a calcium channel blocker. Knowing that this medication blocks the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2 action potential, the nurse should assess this patient for which of the following adverse reactions?
Bradycardia
The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?
Bradycardia with rate of 20-40
The nurse is caring for a patient who has been admitted to the hospital with a diagnosis of unstable angina and the client wants to know why daily ECGs are necessary. The nurse explains that the ECGs can pick up early indications of cardiac ischemia and the nurse knows that according to the American Heart Association practice standards, the client falls into which of the following ECG monitoring categories?
Class I
Which of the following classes of cardiac antiarrhythmic drugs extends the action potential and refractoriness of the heart's contraction?
Class III
Bronchial circulation differs from the pulmonary circulation by providing blood for the:
Conducting airways
A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:
Constriction of the pulmonary vessels in response to hypoxemia
During the admission interview the client, who is admitted with bacterial pneumonia, reveals a 20 pack per year smoking history. The nurse relates the possible cause of this pneumonia to the decreased defense of the pulmonary system caused by cigarette smoking. Smoking affects the pulmonary defense system by which of these?
Damage or destruction of cilia
The nurse caring for the client with respiratory alkalosis and renal compensation determines which of these diagnostic findings is consistent with this disorder?
Decreased PCO2 and HCO3, and increased pH
The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:
Decreased cardiac output
A respiratory therapist has asked a client to breathe in as deeply as possible during a pulmonary function test. Inspiration is normally the result of which of the following phenomena?
Decreased intrathoracic pressure
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?
Dyspnea and crackles in bilateral lung bases
A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?
Dyspnea, cough
In the ICU setting, clients who develop shock need thorough head-to-toe assessments. Which of the following clinical manifestations would alert the health care provider that the client may be developing ischemia associated with gastrointestinal redistribution of blood flow?
Gastric bleeding
A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically?
His ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue.
Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?
Histamine release causes massive vasodilation.
Which factors increase the risk that a client will develop chronic obstructive pulmonary disease (COPD)? Select all that apply.
History of tobacco use • History of asthma
A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion?
Holter monitoring
Which of the following manifestations typically accompanies an asthmatic attack?
Hyperinflation of the lungs
While rock climbing, a 22-year-old male has endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition?
Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?
Hypovolemic
A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
Infusion of normal saline or Ringer lactate to maintain the vascular space
Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?
Inherent spontaneous action-potential
A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:
Insertion of a large-bore needle or chest tube
A 28-year-old client is admitted to the hospital for severe dehydration following a marathon, with fatigue the only complaint. Admission vital signs include a heart rate of 38, blood pressure 98/60, RR 16. Cardiac monitor reveals regular QRS complexes preceded by normal P waves. Which of the following does the nurse determine is the most likely cause for the bradycardia?
Large stroke volume
Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis?
Laryngeal edema
A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?
Myocardial infarction
A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?
Obstructive shock
Following surgery, a client had a chest x-ray that reported some opacities in the lung bases likely due to atelectasis. Which of the following pathophysiologic processes will result from this condition?
Perfusion without ventilation
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema weight gain
A client with a history of emphysema from long-term cigarette smoking has loss of many alveoli. When comparing the type I alveolar cell physiologic function with the primary role of type II alveoli, the nurse would be aware that the type II alveoli are responsible for:
Production of surfactant
Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis?
Pseudomonas aeruginosa and Staphylococcus aureus
A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis?
Septic shock
Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders?
Smaller airways create a susceptibility to changes in airway resistance and airflow.
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?
Sympathetic nervous system
A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax.
The priority intervention would be: Insertion of a large-bore needle or chest tube
Which of the following heart block results in decreased cardiac output and fainting?
Third degree
Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes pulmonary:
Vasoconstriction
A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?
Ventricular repolarization
A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary disease (COPD) is undergoing lung function tests to gauge the progression of his disease. Which of the following aspects of the lung volumes will the respiratory therapist be most justified in using to guide interpretation of the test results?
Vital capacity will equal the patient's combined inspiratory reserve, expiratory reserve, and tidal volume.
A client with new onset atrial fibrillation (AF) is being admitted to the hospital for possible cardioversion. The initial vital signs include a heart rate of 160 and blood pressure of 90/60. The admission nurse anticipates the presence of a pulse deficit. To verify this finding which of the following would the nurse do?
With another nurse assess the apical and radial pulses simultaneously for one minute.
A patient is admitted with pneumoconiosis. His history most likely reveals which of the following?
Work in a coal mine for 20 years
The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?
You have a 25% chance that your next child will have CF.
A patient has developed left heart failure. Which of the following symptoms might have precipitated this
condition? Myocardial infarction
The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:
decreased afterload
A group of nursing students is discussing ventricular arrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:
decreased ventricular filling time.
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client
has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?
pH of 7.50 and HCO3 of 45 mEq/L
A patient with a new automatic implantable cardioverter-defibrillator (AICD) asks the nurse what happens if he goes into that deadly heart rhythm again. The nurse will base her response knowing that the AICD will
respond to ventricular tachyarrhythmia by delivering a shock within 10 to 20 seconds of its onset.
An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because:
stimulation of irritant receptors causes bronchoconstriction.
Two months following a myocardial infarction (MI) a client visits the physician because of severe fatigue and shortness of breath. During the evaluation the client reports frequent episodes of palpitations over the past couple of weeks that cause the shortness of breath to increase. A 12-lead ECG reveals that the client has atrial fibrillation with a heart rate of 120. The practitioner should consider which of the following medications? Select all that apply.
• Antiarrhythmics • Anticoagulants
An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?
"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"
A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?
:Barrel chest
Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?
:Chronic obstructive bronchitis and emphysema
A COPD patient asks the nurse what medications are prescribed to help his breathing. The nurse, looking at the list of medications, will educate the patient about which of the following medications to help his COPD in the long term? Select all that apply.
A) Salmeterol (Serevent), a bronchodilator B) Tiotropium (Spiriva), anticholinergic
Respiratory movement of air that does not participate in alveolar gas exchange is known as alveolar dead space. Dead space increases when alveolar/alveoli:
Air supply exceeds blood flow.
Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?
An 81-year-old male who has a productive cough and recurrent respiratory infections
A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?
Anaphylactic
A client presents with sinus bradycardia. What is the nurse's best action?
Assess the client's history
A nurse is caring for a patient with persistent atrial fibrillation. Which of the following interventions is the priority?
Assessing for shortness of breath or changes in level of consciousness
Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma?
Chemical mediators are released from presensitized mast cells.
A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?
Continuous cardiac monitoring
For which of the following types of shock might intravenous antibiotic therapy be indicated?
Distributive shock
A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display?
Dry and warm skin
The sensation of chest tightness due to an impending asthmatic attack appears to be related to which of the following physiological causes?
Input from lung receptors that monitor bronchial constriction
Pleuritic chest pain associated with respiratory movements is usually described as:
Localized
A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?
Low blood pressure
The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is:
Pleural effusion.
A young adult is brought to the urgent care by a parent. The client states that he just does not feel good. Upon further assessment, the health care provider notes the following: • Unilateral chest pain when the client is asked to cough or move • Rapid respiratory rate • Splinting of the chest • Decreased tidal volume The provider would interpret these manifestations as:
Pleuritis
A short, nonsmoking 44 year old male presents to the emergency room with left-sided chest pain and a cough. He states the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, no cyanosis. Which condition is most likely causing his symptoms?
Pleuritis related to infection
A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states that the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, and no cyanosis. Which condition is most likely causing his symptoms?
Pleuritis related to infection
Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem?
Right-sided heart failure
Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?
Severe asthma attack
An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?
Severity and duration of shock
A patient is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 sec preceding each QRS complex. Which of the following does the nurse determine the rhythm to be?
Sinus tachycardia
Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response
Systemic corticosteroids
Torsade de pointes is a specific type of polymorphic ventricular tachycardia in which the polarity of the QRS complex swings between positive and negative, often on a beat-to-beat basis. It is the result of the long QT syndrome and can cause sudden cardiac death. Which medication is not linked to torsade de pointes as a causative agent?
Tetracycline
When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:
The bronchioles near the trachea
The nurse is caring for a client who has experienced hypovolemic shock secondary to penetrating multiple trauma. When caring for the client postoperatively, which of these factors does the nurse recognize places the client at risk for poor wound healing?
Tissue hypoxia
Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?
Transcutaneous
Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal instead of low lung volumes, which result in
Trapping of large amounts of air that cannot participate in gas exchange
Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?
Ventricular fibrillation
A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:
"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infant's care?
Supplementary oxygen therapy
When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?
Isolates and destroys arrhythmogenic cardiac tissue
A 68-year-old male complains to his family physician that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also had occasionally light-headedness and a recent syncopal episode. What is this client's most likely diagnosis and the phenomenon underlying it?
Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias
A client has experienced a bout of coughing after aspirating some of his secretions. The client's coughing was triggered by which of the following?
Signals from receptors in the tracheobronchial wall
The nurse is reviewing the near-drowning client's pulmonary function tests and is concerned that the forced vital capacity (FVC) is decreased. Which of the following accurately describes FVC?
The volume of air exhaled vigorously and quickly after maximum inspiration
In which of the following atrioventricular (AV) conduction disorders does the link between the atria and ventricles get lost, resulting in atrial and ventricular depolarization being controlled by separate pacemakers?
Third-degree AV block
The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable?
"Research has shown that viruses may actually be a factor in many children's asthma."
A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate?
Anticoagulants and beta-blockers to control rate
Which of the following individuals is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray?
A 30-year-old African American man who has been diagnosed with sarcoidosis
An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client's most recent health problem
A) Thoracentesis
A client has been diagnosed with atrial flutter. What assessment finding does the nurse expect?
An atrial heart rate above 240 beats per minute
Which of the following cardiac drug classifications decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?
Beta-adrenergic blockers
A moderate hemothorax diagnosis would be confirmed by the presence of which of the following?
Blood filling approximately one third of the pleural space
A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?
Chest pain and dyspnea
Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?
Chronic obstructive bronchitis and emphysema
What intervention is appropriate for a client with sarcoidosis?
Corticosteroids
Which manifestation of left-sided heart failure can be diagnosed by examination of the lips and mucous
Cyanosis
Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?
During sleep or rest
The pulmonary rehabilitation specialist is educating medical students on a respiratory disease process that causes a severe compromise in exhalation due to air trapping. Air trapping is caused by the loss of elastic recoil, especially in the alveoli, which occurs after overstretching in which of the following diseases?
Emphysema
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?
Hypertrophy
A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:
Hypovolemic shock due to acute intravascular volume loss
A patient diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?
Hypoxemia
People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which of the following to help air leave the lungs more effectively?
Intercostal and abdominal muscles
Respiratory sinus arrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus arrhythmia, what is the variation in cardiac cycles related to?
Intrathoracic pressure changes that occur with respiration
The nurse is performing an assessment for a patient that is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which of these problems?
Isotonic fluid volume excess
A patient is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which of the following actions is important for the nurse to tell the patient to ensure accuracy in correlating dysrhythmias with symptoms?
It is important to keep a diary of activities and symptoms.
Increased secretion of renin in heart failure is caused by which of the following events?
Low cardiac output
A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice?
Measurement of urine output and mental status assessment
A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart?
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
A patient recently had surgery for a hip fracture. Which of the following nursing interventions would be most effective for preventing pulmonary emboli in this patient?
Prevention of the development of a deep vein thrombosis
As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to
Pulmonary hypertension
The nurse is assisting with a synchronized cardioversion for a patient with atrial fibrillation (AF). Which of the following waveforms does the nurse understand the discharge of electrical energy should be synchronized with?
R wave
A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. Upon assessment of the lungs, what clinical manifestations should the nurse expect?
Short, shallow breaths.
Which description of symptoms would the nurse expect to obtain from a client with exacerbation of sarcoidosis?
Shortness of breath, non-productive cough, and chest pain
A patient with supraventricular tachycardia has received a dose of verapamil to slow the heart rate. Which of the following describes the effect of this drug on the heart?
Slows the sinoatrial (SA) node pacemaker and inhibit conduction in the atrioventricular (AV) node
An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG?
The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.
Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)?
The client who is sitting in bed resting elbows on overbed table, expiratory wheezes noted.
A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive β-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers?
They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.
A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following?
Valvular regurgitation
In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?
Vasoconstrictive drugs
Anaphylactic shock is directly associated with:
type I hypersensitivity response.
Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:
ventilation-perfusion mismatch.
A 10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:
β-adrenergic agonist
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?
Administer epinephrine (adrenaline).
The nurse caring for a client with bilateral rib fractures explains to the client that the pain causes him to take more shallow respirations which will contribute to feeling SOB due to a
Decreased tidal volume.
A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler?
Enlargement of the liver
A client has these arterial blood gas values: anion gap 20 mEq/L, pH 7.29, pCO2 37mm Hg, HCO3- 11 mEq/L, base excess -6 mEq/L. With what condition do these values correspond?
Lactic acidosis
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following drugs will the nurse anticipate administering first?
Short-acting beta 2-adrenergic agonists such as albuterol (SABA)
An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?
Staphylococcus aureus
Following electrophysiological testing that included ablation therapy, the nurse should be assessing the patient for which complication that may occur postprocedure?
Sudden onset of dysonea, tachypnea, and chest pain of a "pleuritic" nature (worsened by breathing)
Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?
They have the same compensatory mechanisms.
An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client's most recent health problem?
Thoracentesis
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis
Ventricular dilation and wall tension are significantly lower than normal.
A nurse educator is teaching a group of nurses at a long-term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct?
"The contraction of the ventricles and the atria can range from 400 to 600 beats/minute."
What is the underlying cause of respiratory failure in a child with bronchiolitis?
Impaired gas exchange
Which of the following patients should the nurse be assessing for long QT syndrome?
A 32-year-old male admitted for cocaine overdose with long history of illicit drug abuse
Assuming that they have not responded to drug therapy, which of the following clients is likely to be the best candidate for surgical cardiac ablation?
A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long QT syndrome and episodes of frequent ventricular arrhythmias
A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to
Apply a Vaseline gauze (airtight) dressing over the insertion site
A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:
Apply a Vaseline gauze (airtight) dressing over the insertion site
The elderly client, with a history of congestive heart failure, is upset following the death of her husband yesterday. The practitioner observes the client for which of the following?
Arrhythmias
A client has sudden severe dyspnea, fear, asymmetrical chest movement and decreased lung sounds on the right side. Which intervention is most appropriate?
Assist to high-Fowler's position and prepare for chest tube insertion.
The purpose of a cardioversion device is the treatment of which of the following cardiac disorders?
Atrial fibrillation
For a client with which of the following is the use of oxygen at a rate above 2 L/minute inappropriate?
Chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%
A client with primary lung disease has developed right heart failure. The health care provider would document this as:
Cor pulmonale
A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems?
Fluid volume excess.
A patient diagnosed with asthma is scheduled for a pulmonary function test. During the test, the technician instructs the patient to forcefully exhale air for 1 second to evaluate:
Forced expiratory volume
A diagnosis of exudative pleural effusion would be based on which of the following?
Pleural fluid protein/serum protein ratio >0.5
Select the primary function of bronchial circulation.
Supplies the blood supply for the conducting airways and supporting structures
A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter, and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother?
The child is experiencing a reentry rhythm in his right atrium.
With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:
The stiffening of the lung, making it more difficult to inflate
The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?
The sweat test measures the concentration of salt in the infant's sweat.
A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure.
This means your lungs collapsed and expelled its air when you lose negative pressure."
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasodilation
A nurse is conducting a class on healthy living with COPD and presents potential complications with the disease. Many clients with COPD have bronchospasms, airway inflammation, and excess mucus production which contribute to obstruction to the alveoli. Which of the following physiologic conditions could result from the obstruction?
Ventilation perfusion mismatch
A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could
be a result of catecholamines released from SNS that could increase the myocardial oxygen demand.
Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to
call for emergency assistance utilizing hospital protocol.
An acutely ill patient is developing multiple organ dysfunction syndrome (MODS). The nurse knows that which statements regarding multiple organ dysfunction syndrome are true?
• Organs affected include kidneys, lungs, liver, brain, and heart. • Homeostasis is disrupted. • Risk factors for development of MODS include severe trauma, hepatic dysfunction, and prolonged hypotension. • Treatment is primarily supportive of the affected organs.
Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.
Diffusion of gases in the lung is decreased, as in pulmonary edema or pneumonia, by causing an increase in alveolar
Capillary membrane thickness
When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis?
Forced expiratory volume (FEV) is decreased.
The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced
Fractured or dislocated ribs
The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced:
Fractured or dislocated ribs
A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?
Hyperkalemia
A community health nurse who is attending a marathon recognizes which of the following types of hypotonic hyponatremia is likely when a patient reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?
Hypovolemic
The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen in the arterial blood and a decreased in the partial pressure of oxygen. The nurse would interpret this as:
Hypoxemia
Which alteration in acid-base balance could be expected as a compensatory response for a client with severe chronic respiratory impairment?
Increased arterial blood bicarbonate
Unilateral chest pain associated with respiratory movements is usually described as which of the following?
Pleuritic
A 40-year-old male presents to the emergency department reporting chest pain and shortness of breath. The health care provider suspects a pulmonary embolism and orders several diagnostic tests. Select the test that would require further follow-up.
Positive D-dimer
Which of the following consequences of cardiogenic shock will the nurse monitor? Select all that apply.
• Decreased stroke volume • Decreased cardiac output • Increased afterloading
Which factors increase the risk that a client will develop chronic obstructive pulmonary disease (COPD)? Select all that apply.
• History of tobacco use • History of asthma
The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply.
• Severe burns • Fifteen percent blood volume loss • Severe dehydration
A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?
"Avoid bearing down while having a bowel movement."
A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?
"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?
"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."
A nurse is observing a patient's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating which of the following??
"The patient is experiencing premature atrial contractions (PACs)."
A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse is most appropriate?
"You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."
In the early morning, an African American woman brings her 5-year-old son to the emergency room. The boy is wheezing, is short of breath, and has a dry cough. The mother states that he has always been very healthy. He went to bed with only a slight cold and a runny nose but woke her with his coughing shortly after 4 AM. His symptoms worsened so dramatically that she brought him to the hospital. The care team would most likely suspect that he has
Asthma
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
Improving quality of life by relieving symptoms
Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?
It documents only current cardiac function
A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?
Monitor the patient and document the findings.
The pathogenesis of multiorgan dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is not a major risk factor in MODS?
Respiratory dysfunction
A nurse is providing care for a patient who has been admitted with a newly diagnosed bilateral pleural effusion. Which of the following findings from the nurse's initial assessment of the patient is incongruent with the patient's diagnosis and would require further investigation?
The client complains of sharp pain exacerbated by deep inspiration.
A client with a 2-week history of hyperthyroidism due to a virus is admitted for non-emergent cardioversion. The client states that she has been experiencing intermittent episodes of palpitations over the past week along with shortness of breath and fatigue. The nurse attaches the client to a cardiac monitor and notes that the client is in normal sinus rhythm with frequent episodes of atrial fibrillation. The nurse anticipates which of the following to be ordered prior to the cardioversion to avoid a possible stroke?
Transesophageal echocardiography
A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering
a corticosteroid.
Which client will the nurse prioritize to assess first?
he client with sinus arrest
An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it.
An intensive care unit nurse is caring for a client who suffered a myocardial infarction involving the anterior wall, and notes a change in the cardiac rhythm. The rhythm has a PR interval that does not change, but there are twice as many P waves as there are R waves. The nurse prepares for a temporary pacemaker insertion because the client has developed:
second-degree, type 2 AV block.
A college student is in pre-op area prior to knee surgery. The nurse attaches the cardiac monitor and notes a gradual lengthening and shortening between the R waves. The nurse realizes that this rhythm is most often found in people with healthy hearts. This rhythm is a respiratory:
sinus arrhythmia.
The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply.
• Accumulation of fluid in the alveoli and airways • Lung stiffness • Impaired gas exchange
A client presents with sinus tachycardia. What is an appropriate nursing action? Select all that apply.
• Assess the client's temperature • Assess the client's pain level • Assess the client's vital signs
Atrial fibrillation is the most common chronic arrhythmia whose incidence increases with age. Atrial fibrillation may present as asymptomatic to severe symptomatology. What is the treatment of atrial fibrillation dependent on? (Select all that apply.)
• Etiology • Recency of onset • Persistence of arrhythmia
A client with a past medical history of idiopathic cardiomyopathy is admitted to the hospital for the placement of an automatic implantable cardioverter defibrillator (AICD) due to frequent episodes of non-sustained ventricular fibrillation (V-tach). When the admitting nurse attaches the cardiac monitor the presenting rhythm is V-tach. The nurse identifies which of the following in the rhythm? Select all that apply.
• Heart rate of 80 • Monomorphic QRS complexes • QRS complexes > 0.12 seconds
In circulatory shock, the adrenergic (or sympathetic) nervous system is activated. The nurse knows that stimulation of beta-2 adrenergic receptors will result in which responses? Select all that apply.
• Vasodilation of the skeletal muscle vascular bed • Dilation of the bronchioles
A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?
A symptomatic bradyarrhythmia
A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest x-ray indicates diffuse bilateral infiltrates of his lung tissue, and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis?
Acute lung injury
A client admitted with septic shock has a BP of 70/46 mm Hg, pulse 125, respirations 30, temperature 103° F, and blood glucose 266 mg/dL. Which intervention ordered by the health care provider should the nurse implement first?
Administer a fluid bolus of normal saline IV at 500 mL/hr.
A nurse is caring for four patients. Which of the following patients is most at risk for atrial fibrillation (AF)?
An elderly male who is 2 days postcoronary artery bypass surgery
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.
Anaphylatic shock
The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?
Cardiogenic
A client with a past medical history of congestive heart failure is admitted to the hospital with severe palpitations and a heart rate of 170, blood pressure 88/60. Home medications include Digoxin, a loop diuretic, and a baby aspirin. The physician has diagnosed the client with focal atrial tachycardia and is discussing the treatment options with the client. Which of the following actions would most likely be ordered first?
Correction of the underlying cause
Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)?
Decreased tidal volume
A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?
Defibrillate the patient
The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?
Immediate defibrillation
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Most ECG-detected ischemic events are clinically silent.
A client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?
Myocardial infarction
A patient's electrocardiogram rhythm shows normal sinus rhythm followed by a complex of six premature ventricular contractions with a return to normal sinus rhythm. Which of the following is the nurse's interpretation of this finding?
Nonsustained ventricular tachycardia
Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?
P wave
The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?
P wave above the baseline
A nurse is monitoring the electrocardiogram (ECG) of a patient with a recent right ventricular infarction. The ECG reveals a first-degree arterioventricular (AV) block, which is characterized by which of the following?
PR interval >0.20 seconds
A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?
Paroxysmal
A 35-year-old client arrives for an appointment with his primary care physician because he has been experiencing "this funny fluttering in my chest" and is concerned that there is something seriously wrong. The physician evaluates the client and discovers that the client has many stressors along with suspected alcohol and tobacco abuse. The physician notes on the cardiac monitor that the client has a heart rate of 90 with a slightly irregular rhythm with P waves before the QRS although not all the P waves are the same shape. Which of the following rhythms fits this description?
Premature atrial contractions
A patient experiencing a sinus arrest would demonstrate which of the following symptoms or findings?
Prolonged periods of asystole demonstrated on an electrocardiogram
A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?
Raising the head of the bed to a high Fowler's position
A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience:
Relaxation of the bronchioles
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this patient most likely is experiencing which of the following types of shock?
Septic
A nurse witnesses an elderly woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?
Severe anxiety
A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which of the following common dysrhythmias is the nurse aware this patient most likely has related to maintaining a large stroke volume?
Sinus bradycardia
In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply.
• Increased heart rate • Vasoconstriction • Activitation of the renin angiotensin system (RAAS)
A child brought to the emergency department is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are true? Select all that apply. .
• Inotropic agents such as digoxin may be used in children. • Congenital defects are a risk factor. • Symptoms include tachypnea and tachycardia
A 70-year-old client with a past medical history of diabetes type II and myocardial infarction (MI) is admitted to the hospital with sudden shortness of breath and palpitations. As the nurse is doing the admission assessment she notices that the apical pulse is very irregular with no pattern, vital signs include a heart rate of 130 and blood pressure of 100/60. The nurse suspects atrial fibrillation (AF) for which of the following reasons? Select all that apply.
• Irregular-irregular rhythm • Palpitations • Tachycardia
The nurse should suggest which of the following medications for a patient in cardiogenic shock? Select all that apply.
• Nitroprusside (Nitropress) • Nitroglycerin • Dobutamine (Dobutrex) • Milrinone (Primacor)
