cardiovascular problems questions exam 1
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? a. "I sleep on three pillows each night." b. "My feet are bigger than normal." c. "My pants don't fit around my waist." d. "I don't have the same appetite I used to."
a
The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel. The nurse should develop a teaching plan that includes which point(s)? Select all that apply. a. to report unexpected bleeding or bleeding that lasts a long time b. to take clopidogrel with food c. to understand that the client may bruise more easily and may experience bleeding gums. d. to know that clopidogrel works by preventing platelets from sticking together and forming a clot e. to drink a glass of water after taking clopidogrel
a,c,d
A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of a. right-sided heart failure. b. acute pulmonary edema. c. pneumonia. d. cardiogenic shock.
b
A client is admitted to the hospital through the emergency department with chest pain. Which intervention is the priority? a. monitoring the platelet count b. assessing B-type natriuretic peptide levels c. assessing troponin 1 levels d. monitoring the white blood cell count
c
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? a. fourth heart sound (S4) b. increased PR interval c. orthostatic hypotension d. irregularly irregular heart rate
d
A physician admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has a. retrosternal pain that worsens during supine positioning. b. pulsus paradoxus. c. a scratchy pericardial friction rub. d. Osler's nodes and splinter hemorrhages.
d
which factor is significant barrier to hospitce referals for pts with stage D HF? a. family member refusal b. scarcity of hospice care c. history of pacemaker placement d. difficulty in estimating prognosis
d
A client arrives in the emergency department reporting intense pain in the abdomen and tells the nurse that it feels like a heartbeat in the abdomen. Which nursing assessment would indicate potential rupture of an aortic aneurysm? a. The blood pressure and pulse are within normal limits, but the client's skin color is pale and slightly diaphoretic. b. The client reports feeling nauseated. c. The client has been taking an antihypertensive for the past 3 years but forgot to take it today. d. The client reports increasing severe back pain.
d Increased severe back pain and increased irritation to nerves are indicative of a potential rupture of an aneurysm. The client would be hypertensive and present with tachycardia, so the other choices are not correct. Nausea, although possible, or a missed dose of medication, do not indicate potential rupture.
After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize the client care assignment. The nurse has an ancillary staff member available to help care for the clients. Which of these clients should the registered nurse assess first? a. the client with heart failure who is having some difficulty breathing b. the anxious client who was diagnosed with an acute myocardial infarction (MI) 2 days ago, and was transferred from the coronary care unit today c. the coronary bypass client asking for pain medication for "11 of 10" pain in the donor site d. the client admitted during the previous shift with new-onset controlled atrial fibrillation, who has a call light on
a
The emergency department protocol provides for administration of alteplase (tPA) for clients with confirmed acute coronary syndrome (ACS). The nurse contacts the healthcare provider to clarify the order for the client with which health history? a. atrial fibrillation and a mild stroke one month ago b. myocardial infarction one year ago with angioplasty c. hypertension, dyslipidemia, and peripheral artery disease d. no previous history of cardiovascular disease
a
The nurse is caring for a client with peripheral artery disease (PAD) who has just returned from having a percutaneous transluminal balloon angioplasty. Which finding requires immediate action from the nurse? a. a change in the intensity of the pulse from the baseline b. pain "2 out of 10" at the catheterization site c. shiny skin and a hairless appearance on the affected leg d. the presence of an ulcer on the limb of the catheterization site
a
Which client statement should the nurse evaluate as indicating the client's correct understanding of the causes of coronary artery disease (CAD)? a. "The leading cause of CAD is atherosclerosis." b. "There are many causes of CAD." c. "Cigarette smoking is the most common cause of CAD." d. "I will need to ask my healthcare provider about the causes of CAD."
a
Which statement indicates that the parents understand the need for their child to receive long-term antibiotic therapy after an episode of rheumatic fever? a. "It will prevent recurring acute rheumatic fever." b. "It will protect against further joint damage." c. "The inflammation will subside more quickly." d. "The inflammation will be reduced with future attacks."
a
A client has sudden, severe pain in the back and chest, accompanied by shortness of breath. The client describes the pain as a "tearing" sensation. The health care provider suspects the client is experiencing a dissecting aortic aneurysm. The nurse should assess the client for which potential complication of a dissecting aneurysm? a. cardiac tamponade b. stroke c. pulmonary edema d. myocardial infarction
a Cardiac tamponade is a life-threatening complication of a dissecting thoracic aneurysm. The sudden, painful "tearing" sensation is typically associated with the sudden release of blood, and the client may experience cardiac arrest. Stroke, pulmonary edema, and myocardial infarction are not common complications of a dissecting aneurysm.
A nurse is working in the intermediate care unit. After receiving change of shift report who should the nurse assess first? a. a client with aortic stenosis who has a blood pressure of 84/52 mm Hg b. a client with pericarditis who has sharp chest pain with a deep inspiration c. a client with infective endocarditis who has a murmur and a heart rate of 58 d. a client with heart failure who has bilateral crackles at the lung bases
a Hypotension in a client with aortic valve problems can indicate cardiogenic shock. The nurse should assess this client for other symptoms such as dyspnea or chest pain. The other clients are experiencing expected symptoms of their medical diagnosis and are in no acute distress.
An obese male client with history of heart failure is prescribed a beta blocker. Which of the following is important to teach regarding home drug therapy? Select all that apply. a. "Take your medication at the same time daily." b. "Contact the health care provider if you have difficulty getting or maintaining an erection." c. "Weigh yourself weekly with the same amount of clothes on each time." d. "Change positions between sitting and standing carefully." e. "Check your pulse for a full minute before administering your medication." f. "Monitor your blood glucose readings every morning."
a,b,d,e
A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which is the priority intervention? a. Reduce the nausea and vomiting and stabilize the blood glucose. b. Control the pain and support breathing and oxygenation. c. Decrease the anxiety and reduce the workload on the heart. d. Monitor and manage potential complications.
b
After teaching a pt about ways to decrease risk factors for CAD which pt statement indicates to the nurse tht further instruction is needed? a. i can keep my blood pressure normal with meds b. i would like to ass weightlifting to my exercise program c. i can change my diet to decrease my intake of saturated fats d. i will change my lifestyle to reduce activities that increase my stress
b
During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client? a. Monitor the radial pulse. b. Assess the digoxin level. c. Measure the urine output. d. Evaluate the B-type natriuretic peptide level (BNP).
b
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? a. urine output of 15 ml/hour and 2+ hematuria b. blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute c. urine output of 150 ml/hour and heart rate of 45 beats/minute d. blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute
b Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from aneurysm repair or recurring dissection.
Which pt teaching points would the nurse include when providing discharge instructions to a pt with a new permananet pacement? select all tht apply a. avoid or limit air travel b. take and record a daily pulse rate c. obtain and wear a medic alert id device at all times d. avoid lifting arm on the side of the pacemaker above the shoulder e. do not use a microwave oven because it interferes with pacemaker function
b,c,d
which information would the nurse include in teaching a pt about CAD? select all tht apply a. diffuse involvement of plaque formation in coronary veins b. abnormal levels of cholesterol especialy ldl c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to decreased blood supply to the heart muscle e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm
b,c,d
the hemodynamic changes the nurse expects to find after successful initation of intraaortic balloon pump therapy include? select all tht apply a. decreased SV b. decreased SVR c. decreased PAWP d. increased diastolic BP e, decreased myocardial O2 consumption
b,c,d,e
A client admitted to the emergency department with atrial fibrillation has a heart rate of 160 bpm. The nurse should implement which prescription first? a. Administer a heparin bolus. b. Administer a beta blocker. c. Administer oxygen via nasal cannula. d. Prepare client for an immediate cardioversion.
c
A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? a. prolonged PR interval b. absent Q wave c. elevated ST segment d. widened QRS complex
c
A client is admitted to the emergency department with severe abdominal pain. A radiograph reveals a large abdominal aortic aneurysm. What is the nurse's primary goal at this time? a. Maintain circulation. b. Manage pain. c. Prepare the client for emergency surgery. d. Teach postoperative breathing exercises.
c
A client is receiving cilostazol for peripheral artery disease causing intermittent claudication. Which statement by the client indicates to the nurse that this medication is effective? a. "I am having fewer aches and pains." b. "I do not have headaches anymore." c. "I am able to walk further without leg pain." d. "My toes are turning grayish-black in color."
c
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? a. "When I finish the rehabilitation program I'll never have to worry about heart trouble again." b."I won't be able to jog again even with rehabilitation." c."Rehabilitation will help me function as well as I physically can." d. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."
c
A pt with syncope has continous ECG monitoring the rhythm strop shows. Atrial rate 74 beats and regular ventricular rate of 62 beats and irregular p waves normal shape, PR interval lengthens progressively until a p wave is not conducted, QRS normal shape. which intervention would the nurse prioritize? a. administer epi 1 mg IV push b. prepare the pt for synchronized cardioversion c. observe for s/s of hypotension and angina d. apply transcutaneous pacemaker pads on the pt
c
An older adult is admitted to the hospital with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for: a. chronic renal failure. b. exacerbation of heart failure. c. digoxin toxicity. d. metabolic acidosis.
c
The nurse is assessing a client admitted to the hospital for surgery to repair an abdominal aortic aneurysm. Before surgery, the nurse should assess the client for which factor that puts the client at risk for rupture? a. anemia b. dehydration c. high blood pressure d. hyperglycemia
c
The nurse is caring for a client in the coronary care unit when the cardiac monitor reveals ventricular fibrillation. The nurse should anticipate which intervention? a. an I.V. push of digoxin b. an I.V. line for emergency medications c. immediate defibrillation d. synchronized cardioversion
c
The nurse is teaching a client with a demand pacemaker. What should the nurse tell the client about how the device functions by providing stimuli to the heart muscle:? The pacemaker will provide a stimulus: a. when the heart begins to beat irregularly. b. constantly, resulting in a predetermined heart rate. c. when the heart rate falls below a specified level. d. whenever ventricular fibrillation occurs.
c
which information would the nurse teach the pt scheduled for a radiofrequency catheter ablation procedure? a. ventricular bradycardia may be induced and treated during the procedure b. a catheter will be placed in both femoral arteries to allow double catheter intervention c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms d. general anesthetic will be given to prevent the awareness of any sudden cardiac death experiences
c
A physician admits a client to the healthcare facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind when formulating interventions? a. decreasing blood pressure and increasing mobility b. increasing blood pressure and reducing mobility c. stabilizing heart rate and blood pressure and easing anxiety d. increasing blood pressure and monitoring fluid intake and output
c For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.
A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? a. Bleeding time b. Platelet count c. Prothrombin time (PT) d. Partial thromboplastin time (PTT)
c PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose approximately 99% of bleeding disorders on the basis of PT and PTT values.
the nurse is caring for a pt with acute decompensated HF who is receiving IV dobutamine. which drug action is expected? select all tht apply a. rasies the HR b. dilated renal blood vessels c. increased heart contractility d. acts as a selective B agonist e. increases systemic vascular resistance
c,d
A nurse is awaiting the arrival of a client from the emergency department with a diagnosis of anterior wall myocardial infarction. In caring for this client, the nurse would be alert for which signs and symptoms of left-sided heart failure? Select all that apply. a. jugular vein distention b. hepatomegaly c. dyspnea d. crackles e. tachycardia f. skin tenting
c,d,e
A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply. a. ascites b. jugular vein distention c. orthopnea d. cough e. hepatomegaly f. crackles
c,d,f
A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis? a. race b. age c. history of diabetes mellitus d. history of aortic valve replacement
d
The ecg monitor of a pt in the cardiac care unit after an MI shows ventricular bigeminy with a rate of 50 beats/min. which action would the nurse take? a. perform defib b. administer IV amiodarone c. prepare for pacemaker insertion d. assess the pts response
d
The nurse is assessing an individual with peripheral artery disease. Which finding indicates complete arterial obstruction in the lower left leg? a. aching pain in the left calf b. burning pain in the left calf c. numbness and tingling in the left leg d. coldness of the left foot and ankle
d
the nurse prepares a pt for elective synchronized cardioversion. which information would the nurse consider in planning for the procedure? a. defib delivers a lower dose of electrical energy b. cardioversion is a tx for atrial bradydysrhythmias c. defib delivers shock during the QRS wave d. cardioversion is painful for an awake pt
d
which compensatory mechanism involved in both chronic HF and acute decompensated HF leads to fluid retention and edema? a. ventricular dilation b. ventricular hypertrophy c. increased systemic blood pressure d. renin-angiotensin aldosterone activation
d
which information would the nurse apply to a teaching plan for a pt with hypertension a, all pts with elevated BP need drug therapy b. obese persons must achieve a normal weight to lower BP c. it is not necessary to limit salt in the diet if taking a diuretic d. lifestyle modifications are needed for persons with elevated BP
d
A client with aortic stenosis tells the nurse, "I have been feeling so tired lately that I take a nap in my recliner every afternoon." On assessment, the nurse notes apical heart sounds 2 cm left of the midclavicular line, crackles in lower lung fields during respiration, blood pressure 110/90 mm Hg, and weight gain of 2.5 kg (5.5 lb) in 24 hours. Which assessment requires further action? a. apical heart sounds 2 cm to the left of midclavicular line b. crackles in lower lung fields during inspiration c. blood pressure 110/90 mm Hg d. weight gain of 2.5 kg (5.5 lb) in 24 hours
d Aortic stenosis leads to left ventricular enlargement and eventually to heart failure. Signs of heart failure include rapid weight gain, a shift of the apical pulse to the left of the midclavicular line, narrowed pulse pressure, and adventitious lung sounds. The nurse must intervene for rapid weight gain of more than 1 kg in 24 hours, which indicates fluid retention from worsening heart failure.
A client displays signs associated with a possible ruptured aortic aneurysm. What is the priority nursing intervention? a. Administer prescribed antihypertensive medication b. Prepare the client for an aortogram c. Administer prescribed beta-adrenergic blocker medication d. Prepare the client for surgical intervention
d When the vessel ruptures, prompt surgery is required for it's repair. Antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.
1
A client is admitted to the ED with chest pain tht is consistent with MI based on elevated troponin levels. Heart sounds are normal. The nurse should alert the HCP because the vital sign changes and clisent assessment are most consistent with which complication? refer to chart (I dont have chart) 1. cardiogenic shocks 2. cardiac tamponade 3. pulmonary embolism 4. dissecting thoracic aortic aneurysm
1
An 89- year old female client is admitted to a telemetry unit with a diagnosis of HF exacerbation. she reports a medical history of osteroarthritis, chronic renal insufficiency, and coronary artery disease including a MI and coronary artery bypass surgery 22 years ago. The client is scheduled to be discharged today and will move in with her daighter until she feels well enough to go home alone. which of the following discharge instructions will the nurse provide to the client and her daughter? select all tht apply 1. weigh yourself each day at the same time on the scale to monitor for fluid retention 2. contact your HCP if you experience cold s/s lasting more than 3 days 3. exertion can cause another episode of HF, so help your mother by performing daily activities for her 4. notify HCP if you experience shortness of breath or chest pain while resting 5. do not use table salt, avoid salty foods, and read labels on all foods items to ensure your diet is low in sodium 6. do not take meotprolol if your HR is less than 60 beats per min 7. HF is chronic condition so you dont need to be alarmed when you experience heart palpitations
1,2,4,5
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? 1.Call a code. 2.Call the health care provider. 3.Check the client's status and lead placement. 4.Press the recorder button on the electrocardiogram console.
2
A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1. causative factors, such as caffeine 2. sensation of fluttering or palpations 3. BP and O2 saturation 4. precipitating factors, such as infection
3
The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? 1. muffled heart sounds 2. client reports dyspnea 3. a rise in BP 4. JVD
3
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds and QRS complexes measure 0.06 seconds. The overall hear rate is 64 beats per min. Which action should the nurse take? 1. check vital signs 2. check lab results 3. monitor for any rhythm change 4. notify the HCP
3
The nurse is watching the cardiac monitor and notices that a clients rhythm suddenly changes. There are no P waves, the QRS complexes are wide and the ventricular rate is regular but more than 140 beats per min. The nurse determines that the client is experiencing which dysrythmia? 1. sinus tachycardia 2. ventricular fibrilattion 3. ventricular tachycardia 4. PVC
3
The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The clients rhythm suddenly changes to one with no P waves, no definable QRS complexes and coarse wavy lines of varying amplitude. How should the nurse interpret this rhythm? 1. asystole 2. A fib 3. V fib 4. V tach
3
A client in sinus bradycardia with a HR of 45 beats per min and bp of 82/60 mm Hg, reports dizziness. Which intervention should the nurse anticipate will be prescribed 1. administer digoxin 2. defib the client 3. continure to monitor the client 4. prepare for transcutaneous pacing
4
A client in ventricular fibrillation is about to be defibrillated. To convert this rhythm effectively, the monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery? 1. 50 J 2. 120 J 3. 200 J 4. 360 J
4
The nurse is assisting to defib a client in ventricular fib. After placing the pads on the clients chest and before discharging the device, which intervention is a priority? 1. ensure that the client has been intubated 2. set the defib to the synchronize mode 3. administer an amiodarone bolus IV 4. confirm that the rhythm is V fib
4
A client comes to the emergency department reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which should the nurse do first when the client is admitted to the coronary care unit? a. Begin telemetry monitoring. b. Obtain a health history. c. Auscultate heart sounds. d. Evaluate the client's pain.
a
A client has atrial fibrillation. The nurse should monitor the client for which condition? a. cardiac arrest b. cerebrovascular accident c. heart block d. ventricular fibrillation
b
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable. How should the nurse interpret the clients neurovascular status? 1. its normal because of icnreased blood flow through the leg 2. moderately impaired, and the surgeon should be called 3. slightly deteriorating and should be monitored for another hour 4. shows adequate arterial flow, but venous complications are arising.
1
The nurse should evaluate that defib of a client was most successful if which observation was made? 1. arousable, sinus rhythm, BP 116/72 2. nonarousable, sinus rhythm, BP of 88/60 3. arousable, marked bradycardia, BP of 86/54 4. nonarousable, SVT, BP of 122/60
1
The client has developed atrial fib, with a ventricular rate of 150 beats. The nurse should assess the client for which associated signs and or symptoms? select all that apply. 1. syncope 2. dizziness 3. palpatations 4. hypertension 5. flat neck veins
1,2,3
The nurse in a medical unit is caring for a client with HF. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. the nurse immediately asks another nurse to contact the HCP and prepares to implement which priority interventions? select all that apply 1. administering O2 2. inserting a foley catheter 3. administer furosemide 4. administering morphine sulfate IV 5. transporting the client to the coronary care unit 6. placing the client in a low fowlers side lying position
1,2,3,4
A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for: a. Intermittent claudication. b. Dyspnea. c. Dependent edema. d. Crackles.
c
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? 1.Sinus dysrhythmia 2.Sinus tachycardia 3.Sinus bradycardia 4.Normal sinus rhythm
1
A nurse is watching the cardiac monitor and a clients rhythm suddenly changes. There are no P waves instead there are fibrillatory waves before each QRS complex. How should the nurse interpret the clients HR? 1. A fib 2. sinus tachycardia 3. V fib 4. V tach
1
An 89- year old female client is admitted to a telemetry unit with a diagnosis of HF exacerbation. she reports a medical history of osteroarthritis, chronic renal insufficiency, and coronary artery disease including a MI and coronary artery bypass surgery 22 years ago. The client was disharged two weeks ago and is with her daighter for her follow up HCP visit. For each assessment finding label if it was effective, ineffective, or unrelated. 1. states she has had o shortness of breath since hospital discharge 2. has 2+ edema in both ankles and feet 3. BP 134/76 4. has had no chest pain since hospital discharge 5. reports feeling like she has more energy now when compared with before her hospital stay 6. has new onset fungal skin infection
1. effective 2. ineffective 3. effective 4. effective 5. effective 6. unrelated
The nurse is caring for a client who has a resection of an abdominal aortic aneurysm yesterday. The client has an iv infusion at a rate of 150 mL/hr, unchanged for the last 10 hours. The clients urine output for the last 3 hours has been 90, 50, and 28 mL. The clients blood urea nitrogen level is 35 mg/dL and the serum creatine level is 1.8 mg/DL, measured this morning. Which nursing action is the priority? 1. check the serum albumin level 2. check the urine specific gravity 3. continue monitoring urine output 4. call the HCP
4
A client with MI is developing cardiogenic shock. What condition should the nurse carefully assess the client for? 1. pulsus paradoxus 2. ventricular dysrhythmias 3. rising diastolic BP 4. falling central venous pressure
2
A client with a history of type 2 diabetes is admitted to the hospital with chest pain. The client is scheduled for cardiac catherization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? 1. glizipide 2. metformin 3. repaglidine 4. regular insulin
2
The nurse is evaluating a clients response to cardiovasion. which assessment would be the priority? 1. BP 2. airway patency 3. O2 4. level of consciousness
2
A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? 1. "I should notify my doctor if my feet or legs start to swell." 2. "My doctor told me to call his office if my pulse rate decreases below 60." 3. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." 4. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."
4
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as a. a first heart sound (S1). b. a third heart sound (S3). c. a fourth heart sound (S4). d. a murmur.
b
a hospitalized pt with a history of chronic stable angina tells the nurse they are having chest pain. which information about ischemia would the nurse use as a basis for planning care? a. it will always progress to MI b. it can be relieved by rest, nitroglycerin, or both c. it is often associated with vomiting and extreme fatigue d. it indicates that irreversible myocardial damage is occuring
b
A client has mitral stenosis and will have a valve replacement. The nurse is instructing the client about health maintenance prior to surgery. Inability to follow which prescription would pose the greatest health hazard to this client at this time? a. medication therapy b. diet modification c. activity restrictions d. dental care
a
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? a. Risk for infection b. Chronic pain c. Impaired gas exchange d. Impaired memory
a
Which statement accurately describe HF with perserved EJ select all tht apply. a. uncontrolled hypertension is a primary cause b. left ventricular ejection fraction may be within normal limits c. the patho involves ventricular relaxation and filling d. multiple evidence based therapies have been shown to decrease mortality e. therapies focus on symptoms control and tx of underlying conditions
a,b,c,e
The nurse is assessing a client who has a history of peripheral artery disease. The nurse observes that the left great toe is black. The nurse determines that the black color is caused by which factor? a. atrophy b. contraction c. gangrene d. rubor
c
The nurse is reviewing the electrocardiogram of a client who has elevated ST segements visible in leads II, III, and aVf. which choice is the nruses best action? a. document the finding in the medical record b. determine whether the rhythm is irregular, coinciding with inspiration and expiration c. teach the client about risks for coronary artery disease d. notify the HCP
d
A client who has cardiac surgery 24 hours ago has had a urine output averaging around 20 mL/hr for 2 hours. The client recieved a single bolus of 500mL of IV fluid. Urine output for the subsequent hour was 25mL. daily lab results indicate that the blood urea nitrogen level is 45mh/dl and the serum creatinine level is 2.2mg/dL. On the basis of these findings the nurse would anticipate that the client is at risk for which problem? 1. hypovolemia 2. acute kidney injury 3. glomerulonephritis 4. UTI
2
a defect in which BP regulating mechanisms can result in the development of hypertension? select all tht apply a. release of nonrepinephrine b. secretion of prostaglandins c. stimulation of the parasympathetic nervous system d. activation of the renin angiotensin aldosterone system
a,c,e
The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)? Select all that apply. a. serum bilirubin b. serum troponin c. serum myoglobin d. urinalysis e. electroencephalogram f. 24-hour creatinine clearance
b,c
An 89- year old female client is admitted to a telemetry unit with a diagnosis of HF exacerbation. she reports a medical history of osteroarthritis, chronic renal insufficiency, and coronary artery disease including a MI and coronary artery bypass surgery 22 years ago. she is alert and her daughter is at her bedside. Indicate which nursing action listed is appropriate for each potential HF complication. Note that not all actions will be used. 1. reduce sodium intake to 1 g daily 2. administer O2 therapy 3. weigh the client each morning on the same scale 4. administer furosemide 20 mg IV push 5. encourage the client to drink at least 3 L of fluid daily 6. administer potassium supplements 7. monitor ecg, O2, and serum electrolyte levels 8. resposition every 2 hours while in bed 9. consult a cardiac rehabilitation specialist WHICH OF THE FOLLOWING WILL BE USED FOR EACH POTENTIAL HF COMPLICATION a. acute pulmonary edema b. fatigue c. hypokalemia d. cardiac dysrhtyhmias e. hypoxemia
a: 4 b:9 c: 6 d: 7 e: 2
An 89- year old female client is admitted to a telemetry unit with a diagnosis of HF exacerbation. she reports a medical history of osteroarthritis, chronic lymphocytic leukemia, and coronary artery disease including a MI and coronary artery bypass surgery 22 years ago. she is alert and her daughter is at her bedside. the nurses intitial client assessment findings include: 1.orientated to person only 2.clear speech 3.follow simple commands 4.has sinus tachy 5.respirations 26 6.O@ 90% room air 7.breathing labored with use of accessory muscles 8.has productive cough with pink frothy sputum 9.crepitus boney nodes on hands 10.hemoglobin 12.4 11.hematocrit 39% 12.WBC 12,000 WHICH ASSESSMENT FINDINGS REQUIRE FOLLOW UPS BY THE NURSE?
1,4,5,6,7,8
In the pt with SVT, which assessment indicates decreased cardiac output? a. hypertension and dyspnea b. chest pain and palpitations c. abdominal distention and tachypnea d. bounding pulses and a systolic murmur
b
The nurse is carding for a client who has just had implantation of an automatic internal cardioverterdefibrillator. The nurse should assess which item based on priority? 1. anxiety level of the client and family 2. activation status and settings of the device 3. presence of a medicalert card for the client to carry 4. knowledge of restrictions on postdischarge physical activity
2
client with MI suddenly becomes tachycardic, shows signs of air hunger, and begins coughing pink frothy sputum. what adventitious sound would the nurse anticipate hearing 1. stridor 2. crackles 3. scattered rhonchi 4. diminished breath sounds
2
Prior to administering TPA the nurse should assess the client for which contradiction to administering the drug? a. age greater than 60 b. history of cerebral hemorrhage c. history of HF d. cigarette smoking
b
The nurse is assigned to a client in the ICU. During the initial assessment, the nurse notes jugular vein distention and recognizes that the plan of care will follow which disorder? a. abdominal aortic aneurysm b. heart failure c. myocardial infarction (MI) d. pneumothorax
b
which item in a pt history would the nurse recognize as a modifiable risk factor for the development of hypertension? a. low calcium diet b. excess alcohol use c. family history of hypertension d. consumption of a high protein diet
b
The nurse observes the cardiac rhythm (see ECG strip) for a client who is being admitted with a myocardial infarction. What should the nurse do first? a. Prepare for immediate cardioversion. b. Begin cardiopulmonary resuscitation (CPR). c. Check for a pulse. d. Prepare for immediate defibrillation.
c
A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60 mm Hg. What should the nurse do first? a. Prepare for transcutaneous pacing. b. Prepare to defibrillate the client at 200 J. c. Administer an intravenous lidocaine infusion. d. Schedule the operating room for the insertion of a permanent pacemaker.
a
A community health nurse is involved in a teaching program to help prevent rheumatic fever in school-age children. Which is the most important intervention to decrease the incidence of the disease? a. teaching clients to seek medical treatment for streptococcal pharyngitis b. promoting hygienic measures to prevent the transmission of streptococcal infections c. providing prophylactic antibiotics to clients with a history of rheumatic heart disease d. educating clients on the importance of vaccinations for hepatitis B
a
a pt with chronic HF and atrial fib is treated with low dose digitalis and a loop diuretic. which actions would the nurse take to prevent complications of this drug combination? select all tht apply a. monitor serum potassium levels b. teach the pt how to take a pulse rate c. keep an accurate measure of I&Os d. withhold digitalis if the pulse rhythm is irregular e. teach the pt about diet potassium restriction
a,b
Which are the greatest risk for pts in the first year after heart transplantation? select all tht apply a. cancer b. infection c. rejection d. vasculopathy e. sudden cardiac death
b,c,e
The client with peripheral artery disease reports both legs hurt when walking. What should the nurse instruct the client to do? a. Avoid walking when the pain occurs. b. Rest frequently with the legs elevated. c. Wear support stockings. d. Enroll in a supervised exercise training program.
d
A client is to have a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the health care provider (HCP) before the stress test? a. cholesterol level b. erythrocyte sedimentation rate c. prothrombin time d. troponin level
d
A client who has a history of bacterial endocarditis is scheduled to have oral surgery to remove a tooth. What should the nurse instruct the client to do? a. Gargle with a saline solution before the appointment. b. Rinse with mouthwash the night before and the day of the surgery. c. Contact the health provider (HCP) to request a sedative. d. Be sure the dentist prescribes a prophylactic antibiotic before the oral surgery.
d
