CARDIAC EXAM - practice questions

a nurse is reviewing an ECG strip of a client on telemetry. which of the areas should the nurse examine to observe for atrial depolarization? a. p wave b. QRS complex c. t wave

a

a patient arrives at an urgent care after experiencing unrelenting substernal and epigastric pain and pressure for about 12 hours. the nurse reviews labs with the understanding that at this point in time, an MI would be indicated by peak levels of: a. troponin T b. homocysteine c. creatinine kinase-MB d. type b natriuretic peptide (BNP)

a

which patient is most at risk for developing coronary artery disease? a. a patient with HTN who smokes b. an overweight patient who uses smokeless tobacco c. a patient with diabetes who uses methamphetamines d. a sedentary patient with elevated homocysteine levels

a

while performing BP screening at a health fair, the nurse counsels which person as having the greatest risk for developing HTN? a. a 56 y/o man whose father died at age 62 from a stroke b. a 30 y/o female advertising agent who is unmarried and lives alone c. a 68 y/o man who uses herbals to treat his enlarged prostate gland d. a 43 y/o man who travels extensively with his job and exercises only on weekends

a

a nurse is assessing a client who has pulmonary edema related to heart failure. which of the following findings indicates effective treatment of client's condition? a. absence of adventitious breath sounds b. presence of nonproductive cough c. decrease in respiratory rate at rest d. SaO2 86% on RA

a - adventitious breath sounds occur when there is fluid in the lungs, the absence of these indicates that the pulmonary edema is resolving

the nurse determines that the patient has stage 2 hypertension when the patient's average blood pressure is (SATA) a. 150/96 mmHg b. 155/88 mmHg c. 172/92 mmHg d. 160/110 mmHg e. 182/106 mmHg

a, b, c, d, e

a nurse is planning a presentation for a group of clients who have HTN. which of the following lifestyle modifications should the nurse include? SATA a. limited alcohol intake b. regular exercise program c. decreased magnesium intake d. reduced potassium intake e. tobacco cessation

a, b, e

a nurse is providing health teaching to a group of clients. which of the following clients is at risk for developing PAD? a. a client who has hypothyroidism b. a client who has diabetes c. a client whose daily caloric intake consists of 25% fat d. a client who consumes 2 12oz bottles of beer a day

b - DM places a client at risk for microvascular damage and progressive PAD

a nurse is caring for a client who is 8 hr post-op following a coronary artery bypass graft. which of the following should the nurse report? a. mediastinal drainage 100mL/hr b. BP 160/80 mmHg c. temperature 37.1 d. potassium 4.0

b - an elevated BP following a CABG causes increased vascular pressure which can cause bleeding at the incision site

a nurse is caring for a client who is being treated for HF and has a prescription for furosemide. the nurse should plan to monitor for the following adverse effects of the medication? a. SOB b. lightheadedness c. dry cough d. metallic taste

b - furosemide can cause a substantial drop in BP, resulting in lightheadedness or dizziness

a nurse is caring for a client who was admitted for tx of left sided HF and is receiving IV loop diuretics and digitalis therapy. the client is experiencing weakness and an irregular HR. which of the following actions should the nurse take first? a. obtain the client's current weight b. review serum electrolyte values c. determine the time of the last digoxin dose d. check the client's urine output

b - weakness and irregular HR indicate the client is at greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. the first action would be to review labs specifically potassium because the client is at risk for dysrhythmias from hypokalemia

a patient is receiving a drug that decreases afterload. to evaluate the patient's response to this drug, what is most important for the nurse to assess? a. heart rate b. lung sounds c. BP d. jugular venous distention

c

the nurse is caring for a patient who survived a sudden cardiac death. what should the nurse include in discharge teaching? a. the most common way to prevent another arrest is to take your prescribed meds. b. because you responded well to CPR, you will not need an implanted defibrillator. c. your family should learn how to perform CPR and practice these skills regularly. d. since there was no evidence of a heart attack, you don't need to worry about another one.

c

a nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hrs. which of the following client statements indicates a need for further clarification by the nurse? a. my arthritis is really bothering me because I haven't taken my aspirin in a week b. my BP shouldn't be high because I took my BP medication this morning c. i took my warfarin last night according to my usual schedule d. i will check my blood sugar because i took a reduced dose of insulin this morning

c - clients who are scheduled for a CABG should not take anticoagulants (warfarin) for several days prior to the surgery to prevent any excess bleeding

a nurse in the ED is caring for a client has a BP of 254/139 mmHg. the nurse recognizes that the client is in hypertensive crisis. which of the following actions should the nurse take first? a. initiate seizure precautions b. tell the client to report vision changes c. elevate the HOB d. start a peripheral IV

c - greatest risk for client is organ injury d/t severe hypertension. therefore, the nurses first action should be to elevate the HOB to reduce BP and promote oxygenation

a nurse is admitting a client who has a leg ulcer and a history of DM. which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer? a. explore the client's family hx of PVD b. note the presence or absence of pain at the ulcer site c. inquire about the presence or absence of claudication d. ask if the client has had a recent infection

c - knowing if the client is experiencing claudication helps differentiate venous vs arterial ulcers. clients who have arterial ulcers experience claudication but those who have venous ulcers do not

a nurse is reviewing labs of several male clients who have PAD. the nurse should plan to provide dietary teaching for the client who has which of the following lab values? a. cholesterol 180, HDL 70 LDL 90 b. cholesterol 185, HDL 50, LDL 120 c. cholesterol 190, HDL 25, LDL 160 d. cholesterol 195, HDL 55, LDL 125

c - these labs for HDL and LDL are outside of expected range. expected reference range for cholesterol is less than 200, for HDL above 45 (males and above 55 (females), and LDL less than 130

a nurse is caring for a client who had an onset of chest pain 24 hrs ago. the nurse should identify that an increase in which of the following values is diagnostic of an MI? a. myoglobin b. c-reactive protein c. creatine-kinase MB d. homocysteine

c - this is an isoenzyme specific to the myocardium. an elevated creatine kinase-MB indicates myocardial muscle injury

a nurse is caring for a client who is 1 hr post-op following an aortic aneurysm repair. which of the following findings can indicate shock and should be reported to the provider? a. serosanguineous drainage on the dressing b. severe pain with coughing c. urine output of 20mL/hr d. increase in temp from 36.8 to 37.5

c - urine output less than 30mL/hr is an manifestation of shock. urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture

where would a nurse inspect when evaluating the point of maximal impulse?

the left fifth intercostal space in the midclavicular line

a patient's BP has not responded to the prescribed drugs for HTN. which of the following should the nurse assess first? a. potential for drug interactions b. progressive target organ damage c. possible use of recreational drugs d. patient's adherence to drug therapy

d

a nurse is preparing a client for a coronary angiography. which of the following findings should the nurse report to the provider prior to the procedure? a. hemoglobin 14.4 b. history of PAD c. urine output 200 mL/4 hr d. previous allergic reaction to iodine

d - contrast medium used for coronary angiography is iodine-based. clients who have a hx of allergic reaction to iodine might need a steroid or antihistamine prior to procedure

a nurse in the ED is caring for a client who had an anterior MI. the client's history reveals they are 1 week post-op following an open cholecystectomy. the nurse should identify which of the following interventions as contraindicated? a. administering IV morphine sulfate b. administering O2 at 2L via nasal cannula c. helping the client to the bedside commode d. assisting with thrombolytic therapy

d - major surgery within previous 3 weeks is a contraindication for thrombolytic therapy

a nurse is caring for a 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? a. i'm still hungry after the bowl of cereal I ate at 7am b. i didn't take my heart pills this morning because the doctor told me not to c. i have had chest pain a couple times since i saw my doctor in the office last week d. i smoked a cigarette this morning to calm my nerves after having this procedure

d - smoking prior to this test can change the outcome and places the client at additional risk. this procedure should be rescheduled if the client has smoked before taking this test

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? a. increase the heparin infusion by 2mL/hr b. continue to monitor heparin infusion as prescribed c. request a prothrombin time (PT) d. stop the heparin infusion

d - the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury

a nurse is assessing a client who has a history of DVT and is receiving warfarin. which of the following findings should indicate to the nurse that the medication is effective? a. hemoglobin 14 g/dL b. minimal bruising of extremities c. decreased BP d. INR 2.0

d - the nurse should identify that an INR of 2.0 within reference range of 2.0-3.0 for a client who has DVT and is receiving warfarin to reduce the risk of a new clot formation and stroke

a nurse is caring for a client who has endocarditis. which of the following findings should the nurse recognize as a potential complication? a. ventricular depolarization b. guillan-barre syndrome c. myelodysplastic syndrome d. valvular disease

d - this disease or damage often occurs as a result of inflammation or infection of the endocardium

a nurse is providing teaching to a client who is 2 days post-op following a heart transplant. which of the following statements should the nurse include in the teaching? a. you might no longer be able to feel chest pain b. your level of activity intolerance will not change c. after 6 months, you will no longer need to restrict your sodium intake d. you will be able to stop take immunosuppressants after 12 months

a - heart transplant clients usually are no longer able to feel chest pain d/t denervation of the heart

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? a. i can't get ride of these hiccups b. i feel dizzy when i stand c. my incision site stings d. i have a headache

a - hiccups can indicate the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation

a nurse is providing discharge teaching to a client who has HF. the nurse should instruct the client to report which of the following findings immediately to the provider? a. weight gain of 0.9kg in 24 hours b. increase of 10 mmHg in systolic BP c. dyspnea on exertion d. dizziness when rising quickly

a - priority finding is a weight gain of 0.5-0.9 kg in 1 day. this weight gain is an indication of fluid retention resulting from worsening HF

a nurse is assessing a client who has dilated cardiomyopathy. which of the following findings should the nurse expect? a. dyspnea on exertion b. tracheal deviation c. pericardial rub d. weight loss

a - this is an expected finding of dilated cardiomyopathy. dyspnea is due to ventricular compromise and reduced cardiac output

a nurse in the ED is assessing a client who has a bradydysrhythmia. which of the following findings should the nurse monitor for? a. confusion b. friction rub c. hypertension d. dry skin

a - bradydysrhythmia can cause decreased systemic perfusion which can lead to confusion. the nurse should monitor the client's mental status

a nurse is caring for a client who has HF and is experiencing a fib. which of the following findings should the nurse plan to monitor for and report to the provider immediately? a. slurred speech b. irregular pulse c. dependent edema d. persistent fatigue

a - greatest risk for this client is injury from an embolus caused by pooling of blood that can occur with a fib. slurred speech can indicate inadequate circulation to the brain because of an embolus

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? a. apply the new patch to the same site as the previous patch b. place the patch on an area away from skin folds and joints c. keep the patch on 24 hrs per day d. replace the patch at the onset of angina

b - the nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly

a nurse is teaching a client who has a new prescription for an ACE inhibitor to treat hypertension. the nurse should instruct the client to notify their provider if they experience which of the following adverse effects of this medication? a. tendon pain b. persistent cough c. frequent urination d. constipation

b - this is an adverse effect of ACE inhibitors, the nurse should report this to the provider and discontinue the medication

a nurse is monitoring a client's ECG and notes the client's rhythm has changed from NSR to supraventricular tachycardia. the nurse should prepare to assist which of the following interventions? a. initiate chest compressions b. vagal stimulation c. administration of atropine IV d. defibrillation

b - vagal stimulation might temporarily convert the client's HR to NSR. the nurse should have a defibrillator and resuscitation equipment at bedside

a nurse is assessing a client who has left sided HF. which of the following manifestations would the nurse expect to find? a. increased abdominal girth b. weak peripheral pulses c. jugular venous neck distention d. dependent edema

b - weak peripheral pulses are related to decreased CO related to left sided HF