ATI Targeted CV 2019
A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure?
"I can't get rid of these hiccups."
A nurse is caring for client who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling?
"I smoked a cigarette this morning to calm my nerves about having the procedure"
A nurse is providing teaching to a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching?
"You might no longer be able to feel chest pain."
A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease?
A client who has diabetes mellitus
A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Which of the following areas of the strip should the nurse examine to observe atrial depolarization? (You will find "Hot Spots" to select in the artwork below. Select only the hot spot that corresponds to your answer.)
A- the p wave. the left most box
A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition?
Absence of adventitious breath sounds
A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals they are 1 week postoperative following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated?
Assisting with thrombolytic therapy
A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft (CABG). Which of the following should the nurse report?
Blood pressure 160/80 mm Hg
A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values?
Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL
A nurse in an emergency department is assessing a client who has a bradydysrhythmia. Which of the following findings should the nurse monitor for?
Confusion
A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should identify that an increase in which of the following values is diagnostic of a myocardial infarction (MI)?
Creatine kinase- MB
A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse. (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
D - the apical point of the heart
A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect?
Dyspnea on exertion
A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. The nurse recognize that the client is in a hypertensive crisis. Which of the following actions should the nurse take first?
Elevate the head of the client's bed
A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse?
I took my warfarin last night according to my usual schedule
A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. Which of the following findings should indicate to the nurse that the medication is effective?
INR 2.0
A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. Which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer?
Inquire about the presence or absence of claudication
A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following adverse effects of the medication?
Lightheadedness
A nurse is planning a presentation for a group of clients who have hypertension. Which of the following lifestyle modifications should the nurse include? (Select all that apply.)
Limited alcohol intake Regular exercise program Tobacco cessation
A nurse is teaching a client who has a new prescription for an ACE inhibitor to treat hypertension. The nurse should instruct the client o notify their provider if they experience which of the following adverse effects of this medication?
Persistent cough
A nurse is providing discharge teaching to a client who has a prescription for transdermal nitroglycerin patches. Which of the following instructions should the nurse include in the teaching?
Place the patch on an area of skin away from skin folds and joints
A nurse is preparing a client for coronary angiography. Which of the following findings should the nurse report to the provider prior to the procedure?
Previous allergic reaction to shellfish
A nurse is caring for a client who was admitted for treatment of left-sided heart failure and is receiving intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first?
Review serum electrolyte values
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which of the following findings should the nurse plan to monitor for and report to the provider immediately?
Slurred speech
A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds?
Stop the heparin infusion
A nurse is caring for a client who is 1 hr postoperative following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider?
Urine output of 20 mL/hr
A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions?
Vagal stimulation
A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication?
Valvular disease
A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find?
Weak peripheral pulses
A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider?
Weight gain of 0.9 kg (2 lb) in 24 hr