Circulation Elsevier Question

Which landmark is correct for the RN to use when auscultating the mitral valve?

Left 5th intercostal space, midclavicular line

Prior to surgical removal of a client's pituitary tumor, which prescribed diagnostic test to determine the probability of an aneurysm would the nurse anticipate?

Angiogram Rationale: An angiogram is a diagnostic procedure used to visualize blood flow in the arteries.

In which instance can an adult give consent for a minor's medical treatment? (SATA)

As the guardian for a ward As the parent of an unemancipated minor As an adult for the treatment of their minor brother or sister (if an emergency and parents aren't present)

Which assessment finding will the nurse expect when caring for a client who has cardiogenic shock?

Cold, clammy skin Rationale: In cardiogenic shock, the action of the sympathetic nervous system causes vasoconstriction, which causes the skin to be cold and clammy.

Which anatomic area is palpated if the nurse suspects aortic (aorta) abnormalities?

D

Which action would the RN anticipate taking when a client develops third degree AV block with a heart rate of 30 BPM?

Obtain the transcutaneous pacemaker Rationale: Transcutaneous pacing is used for emergency treatment of bradycardia, because it's noninvasive and can be rapidly initiated.

While auscultating the heart, a HCP notices S3 sounds in four client. Which client has the highest risk for heart failure?

Older adult client

Place in the correct order the steps the RN would follow to detect paradoxical blood pressure (BP) in clients with pericarditis.

Palpate the BP and then inflate the cuff above the systolic. Then deflate the cuff gradually and note when sounds are first audible on expiration. It's also important to identify when sounds are audible on inspiration. Finally, subtract the inspiratory pressure from the expiratory pressure to determine the paradoxical BP.

Which findings would the RN expect when examining the laboratory report of a preschooler with rheumatic fever?

Positive antistreptolysin titer Rationale: A positive antistreptolysin titer is present with rheumatic fever because of a previous infection with streptococci.

Which client would benefit from the administration of prophylactic antibiotics? (SATA)

Preoperative hip replacement Congenital bicuspid aortic valve Current chemotherapy treatment

Which finding will cause the RN to suspect cardiac tamponade in a client who has had cardiac surgery? (SATA)

Pulsus paradoxus Muffled heart sounds JVD

When providing care to a client experiencing cardiogenic shock, which clinical manifestation would the RN anticipate? (SATA)

Rapid pulse Decreased urinary output

A child comes to the school RN reposting a sore throat, and the nurse verifies that the child has a fever and a red, inflamed throat. Which illness is of most concern if the sore throat is not treated?

Rheumatic fever

Which complication will the RN monitor for when caring for a client with an infection caused by group A beta-hemolytic streptococci?

Rheumatic fever Rationale: Antibodies produced against group A beta-hemolytic streptococci sometimes interact with antigens in the heart's valves, causing damage and symptoms of rheumatic heart disease; early recognition and treatment of streptococcal infections have limited the occurrence of rheumatic heart disease.

Which collaborative intervention will the RN anticipate to treat the dysrhythmia when a client has supraventricular tachycardia that has persisted despite treatment with vagal maneuvers and medications?

Synchronized cardioversion Rationale: Synchronized cardioversion is the application of a shock that's timed to land on the R wave to depolarize the myocardium and allow the normal cardiac pacemaker in the SA node to take over normal cardiac stimulation.

Which clinical finding is the RN most likely to identify when completing a history and physical assessment of a client with complete heart block?

Syncope Rationale: With complete AV Block, the ventricles take over the pacemaker function in the heart but at a much slower rate than that of the SA Node. As a result, there's decreased cerebral circulation, causing syncope.

Which manifestation would indicate to the RN that a client at 28 weeks gestation with previously diagnosed mitral valve stenosis is experiencing cardiac difficulties?

Syncope on exertion

Which finding in a client who has just been admitted indicates that the RN will anticipate assisting with insertion of a temporary pacemaker?

Third-degree heart block

Which change would the RN expect to find in a client with left ventricular heart failure and supraventricular tachycardia when the prescribed digoxin 0.25 mg daily is therapeutically effective? (SATA)

Diuresis Decreased edema Decreased pulse rate

Which autoimmune disease can result in damage to the heart?

Rheumatic fever Rationale: Rheumatic fever is an example of an autoimmune disease that can potentially result in permanent damage to the heart, including damage to valves and heart failure.

Which action will the RN take before delivering the prescribed shock when assisting with cardioversion?

Shout "clear" to all persons at the bedside Rationale: The nurse verbalizes "clear" to all caregivers at the bedside to ensure no one is touching the client or bed when the shock is administered so that electricity is delivered to the client alone.

The RN notices reddish linear streaks in the nail bed of the client. Which systemic condition would the RN suspect in the client based on these assessment findings?

Subacute bacterial endocarditis

Which type of medication is indicated for management of cardiogenic shock?

Sympathomimetic Rationale: Sympathomimetics are vasopressors that induce arterial constriction, which increased venous return and cardiac output.

In addition to the regular pregnancy diet and prenatal vitamins and minerals, which supplements may be needed by a pregnant client with rheumatic heart disease? (SATA)

Iron Folic Acid Rationale: Because pregnant women with heart disease are more likely to have anemia, there may be an additional need for iron and for folic acid.

A client experiences a lateral crushing chest injury. Assessment findings include obvious right-sided paradoxical motion of the chest and multiple rib fractures, resulting in a flail chest. The RN would monitor the client for which complication?

Mediastinal shift Rationale: Mediastinal structures move toward the uninjured lung, reducing oxygenation and venous return.

Which consideration would influence the plan of care for a PP client with a history of rheumatic heart disease?

Monitoring during the first 40 hours is required because of stress on the cardiovascular system

Which question will be relevant to ask when obtaining the health history of a client with mitral valve stenosis?

"Did you ever have strep throat during childhood?" Rationale: Streptococcal infections occurring in childhood may result in damage to heart valves, particularly the mitral valve.

Which statement by a client who is seen for follow-up in the heart failure clinic is most important for the nurse to communicate to the health care provider?

"I wake up at night short of breath."

Which response would a RN give when a client with a prosthetic heart valve asks why it is important to take antibiotics before a dental procedure?

"The antibiotic is taken to prevent infection around your artificial heart valve."

Which response would a RN give to a client with heart block who requires implantation of a permanent pacemaker and expresses concern about having an increased risk of accidental electrocution?

"The voltage emitted isn't strong enough to electrocute."

Which client would the RN assess first?

65 y/o who reports tearing abdominal pain and has a history of uncontrolled hypertension

When the nurse is auscultating a client's heart, where would S1 be loudest?

Apex of the heart Rationale: The first heart sound produced is produced by closure of the mitral and tricuspid valve; it's best heard at the apex of the heart.

Which medication prescribed for a client with an acute episode of heart failure would the RN question?

Beta blocker Rationale: Beta blockers reduce cardiac output and are contraindicated for clients with acute heart failure, although they are frequently used to prevent progression of chronic heart failure.

Which catecholamine receptor is responsible for increased heart rate?

Beta-1 receptor

How would the RN document the high-pitched, scratchy heart sounds that are associated with pericarditis and occur as the heart contracts and relaxes within the inflamed pericardial sac?

Pericardial friction rubs Rationale: Pericardial friction rubs are high-pitched, scratchy sounds that are associated with pericarditis and occur as the heart contracts and relaxes within the inflamed pericardial sac.

A pregnant client with a history of rheumatic heart disease expresses concern about the impending birth. Which intervention would the RN tell her to expect?

Regional analgesia Rationale: Regional analgesia, such as an epidural, will relieve the stress of pain, and it doesn't compromise cardiovascular function.

Which action would the RN take first when a client's BP decreases to 90/70 mm Hg and their heart rate decreases to 50 BPM during nasotracheal suctioning?

Stop the suctioning procedure immediately Rationale: Nasotracheal suctioning can result in vagal stimulation and bronchospasm. Vagal stimulation can result in hypotension, bradycardia, heart block, ventricular tachycardia, or other dysrhythmias and require immediate intervention.

An informed consent hasn't been obtained yet for an unconscious client scheduled for surgery. Which course of action does the nurse expect to be taken to deal with the situation?

The surrogate decision maker designated by the client will give consent. Rationale: If the client has legally designated a surrogate decision maker through a special POA, the consent for the surgery would be obtained from them. The client's spouse may give informed consent only if authorized to do so on the client's behalf.

How will the nurse document the abnormal heart sound heard in early diastole during the cardiac assessment of an older adult?

Third heart sound (S3) Rationale: The third heart sound (S3) is a low-intensity sound heard after S2 (early diastole). It may be normal in young adults, but indicates left sided heart failure in adults. Systolic murmurs are turbulent sounds that occur between the normal S1 and S2 heart sounds. A fourth heart sound (S4) would be heard late in diastole just before S1.

When assessing a client with right ventricular heart failure, the RN would expect which finding? (SATA)

~Dependent edema ~Swollen hands and fingers ~Right upper quadrant discomfort Rationale: With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails. Upper right quadrant discomfort is expected because venous congestion in the systemic circulation results in hepatomegaly.

Which manifestation in a client with heart failure indicates digoxin toxicity? (SATA)

~Nausea ~Yellow vision ~Irregular pulse Rationale: S/S of digoxin toxicity include nausea, visual disturbances (blurred or yellow vision), bradycardia, headache, dizziness, and confusion.

Which statement by a client is consistent with a diagnosis of heart failure?

"I have trouble breathing when I climb a flight of stairs." Rationale: Dyspnea on exertion occurs with heart failure because of the heart's inability to meet the O2 needs of the body.

Which response would be given by the RN when a client admitted for mitral valve surgery tells the nurse, "I am not worried at all about the surgery!" ?

"I think you may still have questions about the surgery."

Which statement indicates to the RN providing discharge medication education to a client prescribed warfarin that teaching was effective?

"I will avoid taking aspirin and NSAIDs."

Which client statement indicates a need for more education after the RN has taught about self-care to a client who has had a mitral valve replacement?

"I will start a vigorous aerobic exercise program." Rationale: Strenuous physical exercise should be avoided because the heart may initially be unable to accommodate the associated increase in cardiac output. Clients are usually referred to a cardiac rehabilitation program for supervised exercise.

How would the nurse describe cardiogenic shock when a family member of a client asks for more information about the condition?

A failure of the circulatory pump

Which action would the nurse implement first for a client whose serum potassium level has increased to 5.8 mEq/L?

Assess vital signs Rationale: Vital signs provide valuable information regarding a client's cardiorespiratory status. Hyperkalemia causes cardiac dysrhythmias.

Which type of medication will the nurse be prepared to administer when a client exhibits severe bradycardia?

Atropine (anticholinergic) Rationale: Will block parasympathetic effects, causing an increased heart rate.

Which complication would a nurse try to avoid by slowly administering a parenteral preparation of potassium?

Cardiac arrest

Which action would the RN take first in a client with abdominal aortic aneurysm who is suddenly pale and reports feeling light-headed and having abdominal pain?

Check the BP for hypotension Rationale: The history of abdominal aortic aneurysm, with new symptoms of pallor, lightheadedness, and abdominal pain, suggests bleeding or dissection of the aneurysm. The RN would first check BP and report hypotension immediately to the HCP, anticipating the needs to give IV fluids and prepare the client for emergency surgery.

After the initial assessment, which earthquake survivor with chest trauma would the disaster management RN treat first?

Client C with cyanosis, air hunger, violent agitation, tracheal deviation away from affected side.

Which type of lung sounds would the RN expect to hear when caring for a client with heart failure?

Crackles Rationale: Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration.

In which area would the nurse place the stethoscope when taking an apical pulse?

D

Where would the nurse place the stethoscope to listen for mitral valve insufficiency (regurgitation)?

D Rationale: Point D is the mitral area at the 5th intercostal place at the left midclavicular line (apex of the heart), where the mitral valve murmurs can be best heard. Point A is the aortic area at the 2nd intercostal space to the right of the sternum, where aortic valve murmurs are best heard. Point B is the pulmonic area at the 2nd intercostal space to the left of the sternum; this area best reflects problems of the pulmonic valve.

Which explanation would the RN include when teaching a client with heart failure about the reason for a low-sodium diet?

Decreased fluid retention

Which response indicates that a beta blocker prescribed for ventricular tachycardia is working effectively?

Decreased heart rate

Which treatment option will the nurse anticipate the need to teach the client about when caring for a client with symptomatic bradycardia caused by heart block?

Demand pacemakers Rationale: Treatment for symptomatic bradycardia typically includes the placement of a temporary or permanent demand pacemaker to prevent the heart rate from dropping below a preset rate.

A client had a bypass graft because of an abdominal aortic aneurysm. Postoperative prescriptions include measurements of the client's abdominal girth. Which serious problem may be indicated by an increasing abdominal girth? 1. Graft leakage 2. Bowel puncture 3. Abdominal infection 4. Postoperative flatulence

Graft leakage

Which type of shock is associated with a ruptured abdominal aneurysm?

Hypovolemic shock

Which education would the nurse teach the parent of an infant with a cardiac defect about an early sign of heart failure?

Increased heart rate Rationale: Increased HR (tachycardia) results from sympathetic stimulation in the setting of heart failure; it's the body's attempt to increase cardiac output and increase O2 supply to the body's cells.

Which early sign of heart failure would the nurse recognize in an infant who has a congenital heart defect with left-to-right shunting of blood?

Increased respiratory rate Rationale: Because the lungs are stressed by pulmonary edema, a quicker respiratory rate is the first and most reliable indicator of early heart failure in infants.

Which finding by the RN is most important to communicate to the health care provider when assessing a client who has aortic stenosis and is scheduled for aortic valve replacement?

Multiple dental caries Rationale: Multiple dental caries increase the risk for endocarditis in clients with valvular disease, and caries should be treated before surgery.

Which clinical manifestations will the RN assess for in a client with a serum potassium level of 6.4 mEq/L? (SATA)

Muscle weakness Irregular heart rhythm Hyperactive bowel tones

Which action would the RN take first when a client suddenly reports lightheadedness and BP drops while waiting in the preoperative holding area for endovascular repair of an abdominal aortic aneurysm?

Notify the surgeon immediately Rationale: Because the client's symptoms indicate a likely rupture of the aneurysm, immediate surgical intervention is needed.

Which information about a client who has heart failure would the nurse communicate to the health care provider before administration of the prescribed digoxin?

Potassium level of 2.3 mEq/L Rationale: Symptoms of digoxin toxicity, including life-threatening dysrhythmias, can occur when digoxin is administered to a client with hypokalemia.

Which assessment finding for a client with heart failure who is taking digoxin will be most important to communicate to the health care provider?

Premature ventricular contractions Rationale: Digoxin toxicity can manifest with premature ventricular contractions (PVCs) or other ventricular dysrhythmias such as ventricular tachycardia or fibrillation.

When a client with a heart murmur reports gaining weight in spite of nausea and anorexia, which additional information would be a priority for the nurse to obtain?

Presence of a cough and exertional dyspnea Rationale: Weight gain in a client with a murmur may indicate heart failure, and the RN would assess for other clinical manifestations of heart failure such as dyspnea and cough that may need rapid treatment.

A client has thin, dark red vertical lines about 1 to 3 mm long in the nails. Which disease is associated with this physiologic alteration in the client? (SATA)

Trichinosis Bacterial endocarditis

When taking the health history for a client admitted with heart failure, which assessment finding will the RN expect the client to report?

Using several pillows at night to sleep

Which assessment finding would indicate improvement in a 4-month-old infant admitted to the pediatric unit with a diagnosis of congestive heart failure?

Weight loss during next 2 days Rationale: Weight loss indicates fluid loss. Water retention is a classis sign of congestive heart failure.

Which instruction would the nurse give a UAP to perform while caring for a client prescribed captopril (ACE Inhibitor)? (SATA)

~Obtain BP ~Measure I & O ~Weigh the client every morning ~Notify the RN if the client has a dry cough ~Assist the client to change positions slowly

Which clinical finding would the nurse expect when assessing a client who has cardiogenic shock? (SATA)

~Pallor ~Agitation ~Tachycardia ~Narrow pulse pressure

Which clinical manifestation would the RN expect when assessing a client who is diagnosed with cardiogenic shock? (SATA)

~Tachycardia ~Restlessness ~Decreased urinary output Rationale: The heart rate increases and the respiratory rate increases in an attempt to meet the O2 demands of the body.

The nurse signs as a witness to informed consent provided by the client. Which concept does the signature of the nurse imply? (SATA)

~The signature of the client is authentic. ~Consent has been given voluntarily. ~The client appears to be competent to give consent.

When assessing a client with cardiogenic shock, which clinical manifestations will the RN expect to find? (SATA)

Dyspnea Diaphoresis Tachycardia