practice questions med surg test 2
a client with hypertension has been given a prescription to treat the disorder. the nurse should explain that cough and loss of taste are side effects in which antihypertensive med? A. lisinopril B. propanolol C. diltiazam D. furosemide
lisinopril
You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?
"Have you had any episodes of dizziness or fainting?"
a client who is receiving digoxin daily has a serum potassium level of 3mEq/L and is complaining of anorexia. the health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. the nurse checks the results knowing that which value is the therapeutic serum level for digoxin A. 0.5-2 B. 1.2-2.8 C.3-5 D3.5-5.5
A
a nurse is admitting a client who has a suspected MI and a history of angina. which of the following findings will help the nurse to distinguish angina from an MI? A. angina can be relieved with rest and nitroglycerin B. the pain of an MI resolves in less than 15 minutes C. the type of activity that causes an MI can be identified D. angina can occur for longer than 30 minutes
A
a nurse is caring for a client who asks why her provider prescribed a daily aspirin. which of the following is an appropriate response by the nurse? A. aspirin reduces the formation of blood clots that could cause a heart attack B. aspirin relieves the pain due to myocardial ischemia C. aspirin dissolves clots that are forming in your coronary arteries D. aspirin relieves headaches that are caused by other medications
A
An ER nurse is reviewing the charts of several patients. Which of the following patients would the nurse interpret as having an angina? A. A 39-year-old female patient complaining of indigestion, discomfort, and states that she feels like she has to "catch her breath." B. A 51-year-old male patient who states "It hurts when I breathe!" C. A 42-year-old female patient complaining of pain traveling up and down her chest D. A 27-year old male patient complaining of a dull ache on his chest, palpitations, and numbness in his fingertips
A patient who is being hemodynamically monitored has an increased RA pressure. How does the nurse interpret this finding? A. Pulmonary rupture B. Hypovolemia C. Right ventricular failure D. Afterload reduction
the nurse in a medical unit is caring for a client with heart failure. the client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. the nurse immediately asks another nurse to contact the health care provider and prepares to implement which priority intervention (select all that apply) A. administering oxygen B. inserting a foley catheter C. administering furosemide D. administering morphine sulfate IV E. transporting the client to the coronary care unit F. placing the client in low fowlers side lying position
A, B, C, D
a nurse is completing the admission assessment of a client who has suspicious pulmonary edema. which of the following manifestations are expected findings?(select all that apply) A.tachycardia B.persistent cough C. increased urinary output D.thick yellow sputum E. orthopnea
A, B, E
a nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. which of the foods would you recommend A. slice of cheddar cheese B. hot dog C. salmon D. chicken E.bacon
A, C, D
a client is admitted to an emergency department with chest pain that is consistent with myocardial infarction based on elevated troponin levels. Heart sounds are normal and vital signs are noted on the clients chart. the nurse should alert the health care provider because the blood pressure begins to drop and it is consistent with which complication? A. cariogenic shock B. cardiac tamponade C. pulmonary embolism D. dissecting thoracic aortic aneurysm
A. cariogenic shock
the nurse is assessing the neuromuscular 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 and unchanged from admission. how should the nurse correctly interpret the clients neuromuscular status?
A. the neuromuscular status is normal because of increased blood flow through the leg
Which assessment finding by the nurse is the most significant finding suggestive of aortic aneurysm?
Abdomen bruit
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching?
Avoid heavy lifting for the next 24 hours
1.a nurse is completing discharge teaching with a client who has a surgical placement of a mechanical heart valve. which of the following statements by the client indicates understanding of the teaching? (should think mechanical are on anticoagulant) i will be glad to get back to my exercise routine right away i will have prothrombin time check on a regular basis i will stop using antibiotics during dental exam
B
a client has an order to begin an IV nitroglycerin drip. what considerations should the nurses make in preparing to administer that medication? A. cover the solution with a plastic bag B. maintain the solution in a glass bottle C. replace the solution every 4 hours
B
a client with angian pectoris received nitroglycerin tablets sublingually for chest pain. the client reports a severe headache shortly after the medication is administered. what should you do? A. this a common but unhealthy response to the medication B. this common response will diminish as tolerance to the medication develops C. this is a response caused by cerebral hypoa induced by the medication D. this is an andover reaction that should be reported
B
a client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. how would the nurse best describe this type of anginal pain? A. stable angina B. variant angina c. unstable angina D. nonanginal pain
B
a nurse i caring for a 72 year old client who is to undergo percutaneous balloon valvulplasty. the clients daughter asks the nurse to explain the expected outcome of the procedure. which of the following responses should the nurse give? A.this will improve blood flow in your mother coronary arteries B.this will permit your mother to resume her activities of daily living C.this is prologn mother life D.theis will reverse effects to damage area
B
intravenous heparin therapy is prescribed for a client. while implementing this prescription the nurse ensure that which medication is available on the nursing unit? A. vitamin K B. protamine sulfate C. potassium chloride E. aminocaproic acid
B
the nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. the client has an intravenous 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 creatinine level is 1.8 mg/dl measured this morning. which nursing actions is the priority? A. check the urine specific gravity B. call the health care provider C. check to see if the client had a sample for a serum albumin level drawn D. put the IV line on a pump so that the infusion rate is sure to stay stable
B
a client with hypertension monitor his blood pressure daily, and is ordered on verapamil 240 mh daily and hydrochlorthiazide 125 mg daily. the client states that if his systolic BP reading is response by the nurse? select all that apply A. if the systolic is lower than 140 it is okay to skip the dose B. you should not skip doses unless instructed by the ordering physician C. maybe you won't even need your BP medication in a few months D. your doctor may want to stop the HCTZ and have you take only the verapamil E. your lower systolic blood pressure is a response to the medication
B E
the home health nurse is concerned that a patient is experiencing digoxin toxicity after noting which manifestation during a routine exam? select all that apply A. palpitation elevated BP, SOB B. anorexia, nausea and reports yellow vision C. chest pain, fatigue and decrease BP D. taste alteration dry mouth and constipation E. visual disturbances vomiting and diarrhea
B and E also would see -bradycardia -confusion -visual disturbances -all GI distress issues
the nurse is monitoring a client who is taking digoxin for adverse effects. which findings are characteristic of digoxin toxicity? select all that apply A. tremor B. diarrhea C. irritability D. blurred vision E. nausea and vomiting
B, D, E
A patient who is being hemodynamically monitored has an increased RA pressure. How does the nurse interpret this finding? A. Pulmonary rupture B. Hypovolemia C. Right ventricular failure D. Afterload reduction
C. Right ventricular failure
a nurse is caring for a client who has heart failure and reports increased shortness of breath. the nurse increases the clients oxygen per protocol. which of the following action should the nurse take first? A.obtain the clients weight B.assist the client into high-fowlers position C. auscultation lung sounds D.check oxygen saturation with pulse oximeter
B. assist the client into high fowlers position due to the SOB
a client with myocardial infarction suddenly becomes tachycardia, shows sings of air hunger, and begins coughing frothy, pink tinged sputum. which finding would the nurse anticipate when auscultating the clients breath sounds? A. stridor B. crackles C. scattered rhonchi D. diminished breath sounds
B. crackles
the nurse is monitoring a client who is taking propranolol. which assessment data indicates a potential serious complication associated with this medication? A. the development of complaints of insomnia B. the development of audible expiratory wheezes C. a baseline blood pressure of 150/80 followed by a blood pressure of 138/72 after two doses of the medication D. a baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication
B. the development of audible expiratory wheezes
a client with myocardial infarction is developing cariogenic shock. be cause of the risk of myocardial ischemia, what conditions should the nurse carefully assess the client for? A. bradycardia B. ventricular dysrhythmia C. rising diastolic blood pressure D. falling central venous pressure
B. ventricular dysrhythmias
a client is diagnosed with an ST segment elevation of myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase. which action is a priority nursing intervention? A. monitor kidney failure B. monitor psychosocial status C. monitor for signs of bleeding D. have heparin sodium available
C
a client receiving thromboltyic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and complains of itching. the nurse hears stridor and notes generalized urticaria and hypotension. which nursing action is the priority? A. administer oxygen an protamine sulfate B. cute the infusion rate in half and sit the client up in bed C. stop the infusion and call the health care provider D. administer diphenhydramine and continue the infusion
C
a nurse is presenting a community education program on recommended lifestyle changes to prevent angina and MI. which of the following changes should the nurse recommend be made first? A. diet modification B.relaxation exercises C. smoking cessation D. taking omega-3 capsules
C
a nurse on a cardiac unit is reviewing the lab findings of a client who has diagnosis of MI and reports that his dyspnea began two weeks ago. which of the following cardiac enzymes would confirm the MI occurred 14 days ago? A. CK-MB B. troponin I C. troponin T D. myoglobin
C
a nurses i complete the admission physical assessment of a client who has a history of mitral valve regurgitation. which os the finding should the nurse expect? pericardial friction rub petechiae crackles in the lung base angina
C
the nurse is planning to administer hydrochloridethiazide to a client. the nurse understands that which is a concern related to the administration of this medication? A. hypouricemia, hyperkalemia B. increased risk of osteoporosis C. hypokalemia, hyperglycemia, sulfa allergy D. hyperkalemia, hypoglycemia, penicillin allergy
C
the nurse should report which assessment finding to the health care provider before initiating thrombolytic theory in a client with pulmonary embolism? A. adventitious breath sounds B. temperature of 99.4 F orally C. blood pressure of 198/110 D. respiratory rate of 28 breaths/minute
C
diltiazem (calcium channel blockers) is prescribed for a client with chronic stable angina. which statement by the client indicates to the clients nurse that the client needs additional medication information A. i will call the physician if shortness of breath occurs B. i will rise slowly when getting out of bed C. i will take the medication after meals D. i may notice changes in mental alertness until my dose is regulated
C.
A patient arrives at the emergency department complaining of mid-sternal chest pain. Which of the following nursing action should take priority? A. A complete history with emphasis on preceding events. B. An electrocardiogram. C. Careful assessment of vital signs. D. Chest exam with auscultation.
C`
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?
Clopidogrel (Plavix)
a client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. which statement by the client indicates an understanding of the instructions? A. it is not necessary to avoid the use of alcohol B. the medication should be taken with meals to decrease flushing C. clay-colored stools are a common side effect and should not be of concern D. ibuprofen taken 30 minutes before the nicotinic acid should decrease flushing
D
a nurse is teaching a client who has angina about a new prescription for metoprolol. which of the following statements by the client indicates understanding of teaching? A.i should place the tablet under my tongue B. i should have my clotting time checked weekly C. i will report any ringing in my ears D. i will call my doctor if my pulse rate is less than 60
D
the home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dl. the client is taking questran. which statement by the client indicates the need for further education? A. constipation and bloating might be a problem B. ill continue to watch my diet and reduce my fats C. walking a mile each day will help the whole process D. ill continue my nicotinic acid form the food store
D
the nurse provides discharge instructions to a client who is taking warfarin. which statement by the client reflects the need for further teaching? A. i will avoid alcohol consumption B i will take my pulls every day at the same time C. i have already called my family to pick up a medic-alert bracelet D. i will take ecotrin (enteric coated aspirin) for my headaches because it is coated
D
the physician prescribes losartan for a client with hypertension. the nurse caring out the order explains to the client that this medication promotes vasodilation by which action? A. preventing calcium from going into the cells B. promoting epinephrine and C. promoting release of aldosterone E. inhibiting conversion of a substance that would cause vasoconstriction
D
the nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. which observation would indicate that the procedure was unsuccessful? A. rising blood pressure B. clearly audible heart sounds C. client expressions of relief D. rising central venous pressure
D.
A patient is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the patient for which diagnostic test used to confirm the patient's diagnosis?
Echocardiogram NOT CHEST XRAY
A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when
Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.
In presenting a workshop on parameters of cardiac function, which conditions should a nurse list as those most likely to lead to a decrease in preload?
Hemorrhage, sepsis, and anaphylaxis
A patient has been recently placed on nitroglycerin. Which of the following should be included in the patient teaching plan?
Instruct the patient on side effects of flushing, throbbing headache, and tachycardia.
In an assessment for intermittent claudication, the cardiac/vascular nurse assesses for leg pain and cramping with exertion, then asks the patient: "Does shortness of breath accompany the leg pain?" "Does this same type of pain occur without activity?" "Is the leg pain relieved by rest?" "Is the leg pain relieved with elevation?"
Is the leg pain relieved by rest?"
For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations?
Left ventricular dysfunction
Aortic dissection may be mistaken for which of the following disease processes?
MI
A physician has scheduled a client with mitral stenosis for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?
Pulmonary hypertension
Which is the primary consideration when preparing to administer thrombolytic therapy to a patient who is experiencing an acute myocardial infarction (MI)? History of heart disease. Sensitivity to aspirin. Size and location of the MI. Time since onset of symptoms.
Time since onset of symptoms.
A patient with cardiogenic shock receives a nursing diagnosis of decreased cardiac output. With the appropriate interventions, the anticipated outcome is for the patient to achieve: baseline activity level. baseline cardiac function. decreased afterload. reduced anxiety.
baseline cardiac function.
A patient who is recovering from a myocardial infarction may benefit from meditation, because this technique: decreases sympathetic nervous system activity. decreases vasodilation. increases sympathetic nervous system activity. increases the release of catecholamines.
decreases sympathetic nervous system activity.
Excessive alcohol use while on warfarin (Coumadin) therapy leads to: decreased anticoagulation effect. decreased international normalized ratio. increased anticoagulation effect. increased vitamin K absorption.
increased anticoagulation effect.
Examination of a patient in a supine position reveals distended jugular veins from the base of the neck to the angle of the jaw. This finding indicates: decreased venous return. increased central venous pressure. increased pulmonary artery capillary pressure. left-sided heart failure.
increased central venous pressure.
A patient who underwent a percutaneous, transluminal coronary angioplasty four weeks ago has a subsequent ejection fraction of 30%. The patient returns for a follow-up visit. Examination reveals lungs that are clear to auscultation and slight pedal edema. The patient's medications are digoxin (Lanoxin), furosemide (Lasix), enalapril maleate (Vasotec), and aspirin. The patient reports a 5-lb (2.27-kg) weight gain over the past two days. The cardiac/vascular nurse's initial action is to: document the weight and reassess the patient at the next session. inquire about the patient's medication compliance. notify the patient's physician. review the patient's most recent nuclear scan.
inquire about the patient's medication compliance.
A patient comes to the emergency department with reports of a swollen and painful leg but denies sustaining any injury. Physical examination reveals a tense calf muscle, decreased sensation to the foot and leg, and absent pedal pulses. The cardiac/vascular nurse asks the patient when the symptoms began, because: a compartment syndrome develops days after an arterial occlusion. an arterial thrombosis is sudden and emergent, and an embolism develops gradually. irreversible anoxic injury to muscles and nerves can occur in as few as four hours. metabolic alkalosis from muscle swelling is cardiotoxic.
irreversible anoxic injury to muscles and nerves can occur in as few as four hours.
A patient with negative troponins and stress test results reports recurring chest pain that is similar to the patient's pain on admission. According to the American Nurses Association's cardiovascular nursing scope and standards of practice, the cardiac/vascular nurse's next action is to: activate the cardiac catheterization team. administer analgesics. obtain a 12-lead electrocardiogram. promote relaxation and monitor the response.
obtain a 12-lead electrocardiogram.
patient recently had a cardiac catheterization via right-radial approach. The patient has a compression device in place. The patient complains of numbness and pain in the right hand. The cardiac/vascular nurse notes a diminished pulse, with a cool and cyanotic hand. The nurse: calls the physician. performs an Allen's test. reduces the pressure on the puncture site. uses the Doppler to assess for pulse signals.
reduces the pressure on the puncture site.
A patient has been receiving heparin IV for the last three days. The patient's most current platelet count is 65,000 X 103/uL; the platelet count on admission was 350,000 X 103/uL. The cardiac/vascular nurse contacts the physician to: report that the medication level is subtherapeutic. report that the patient is exhibiting signs of an adverse reaction. request an increase in the medication infusion rate. request an order for platelet transfusion.
report that the patient is exhibiting signs of an adverse reaction.
A 55-year-old patient who is diagnosed with an evolving myocardial infarction (MI) insists on going home. The cardiac/vascular nurse encourages the patient to be admitted, because the greatest risk within the first 24 hours of sustaining an MI is: heart failure. pulmonary embolism. ventricular aneurysm. ventricular fibrillation.
ventricular fibrillation.`
When caring for a patient who has intermittent claudication, a cardiac/vascular nurse advises the patient to: apply graduated compression stockings before getting out of bed. elevate the legs when sitting. refrain from exercise. walk as tolerated.
walk as tolerated.
