COTAC EXAM 2

A nurse is orienting a newly licensed nurse on the care of a client who is to have a line placed fro hemodynamic monitoring. Which of . the following statements by the following statements by the newly licensed nurse indicates effectiveness of the teaching?

"A chest x-ray is needed to verify placement after the procedure."

A nurse is caring for a client who asks her why provider prescribed a daily aspirin. Which of the following is an appropriate response by the nurse?

"Aspirin reduces the formation of blood clots that could cause a heart attack."

A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. The client asks the nurse how to determine the appropriate amount of fluids he is allowed. Which of the following statements is an appropriate response by the nurse?

"Pour the amount of fluid you drink into an empty two liter bottle to keep track of how much you drink."

A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition?

Absence of adventitious breath sounds.

To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory test result will the nurse plan to review?

BNP

A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern? (Select all that apply)

Capillary refill of affected limb of 6 seconds Mottled appearance of the limb

A nurse is caring for a client who has pericarditis. Which of the following findings should the nurse expect?

Friction Rub

A nurse is admitting a client who has a suspected occlusion of a . graft of the abdominal aorta. Which of the following manifestation should the nurse expect?

Increase in abdominal girth

A nurse is assessing a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect?

Pallor on elevation of the limbs, and rubor when the limbs are dependent.

MI

occurs because of sustained cardiac ischemia

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure.

"I can't get rid of these hiccups."

A nurse is teaching a client who has HF about the need to limit sodium in the diet to 2000 mg daily. Which of the following foods should the nurse should the nurse recommend for the client? (Select all that apply)

1 slice of cheddar cheese 3 oz Atlantic salmon 3 oz roasted chicken breast

A nurse is caring for a client who is 8 hours postoperative following a coronary artery bypass graft (CABG). Which of the following client findings should the nurse report?

Blood pressure 160/80 mm Hg.

Generally, this is BAD.

DEAD.

A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. The nurse should identify that which of the following findings indicate the medication is effective?

INR 2.0

A nurse is assessing a client who has splinter hemorrhages in her nail beds and reports a fever. The nurse should identify these findings as manifestations of which of the following disorders?

Infective endocarditis

A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer?

Inquire about the presence or absence of claudication

A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication?

Lightheadedness

A nurse is planning a presentation for a group of clients who have hypertension. Which of the following lifestyle modifications should the nurse include? (Select all that apply)

Limit alcohol intake. Regular exercise program. Tobacco cessation.

A nurse is providing discharge teaching for a client who has a prescription for furosemide 40 mg PO daily. The nurse should instruct the client to take this medication which of the following times a day?

Morning

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?

Smoking cessation

A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Which of the following areas of the strip should the nurse examine to observe for atrial depolarization.

The P wave shows atrial depolarization.

A severe, lethal heart rhythm characterized by an irregular waveform; no cardiac output is occurring.

Ventricular Fibrillation

Hypertension is

a systolic of 140 or more or a diastolic of 90 or more

ACS

occurs with prolonged coronary ischemia that is not immediately reversible.

In paroxysmal nocturnal dyspnea

the person is short of breath during the night

Diastolic Failure

ventricles cannot relax and fill

A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statements by the client indicates understanding of the teaching?

"I will have my prothrombin time checked on a regular basis."

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/min.

40-60

A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals she is 1 week postoperative following an open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated?

Assisting with thrombolytic therapy

A nurse is interpreting the ECG strip of a client who has bradycardia. Which of the following cardiac components should the nurse identify as the role of the P wave?

Atrial Depolarization

A nurse is assessing a client who is undergoing hemodynamic monitoring. The client has a CVP of 7 mm Hg and a PAWP of 17 mm Hg. Which of the following findings should the nurse expect? (select all that apply)

Bilateral Crackles in the lungs Jugular Vein Distention Hepatomegaly

Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be important to report to the health care provider before the MRI?

Cardiac pacemaker

A group of diseases that directly affect myocardial structure or function; may be classified as dilated, hypertrophic, or restrictive.

Cardiomyopathy

A nurse is reviewing manifestations of a thoracic aortic aneurysm with a newly hired nurse. Which of the following findings should the nurse include in discussion? (Select all that apply)

Cough SOB Altered swallowing

A nurse is completing the admission physical assessment of a client who has a history of mitral valve insufficiency. Which of the following findings should the nurse expect?

Crackles in the lung bases. Due to pulmonary congestion related to mitral valve insufficiency.

A nurse is caring for a client who had an onset of chest pain 24 hours ago. The nurse should recognize that an increase in which of the following diagnostic of a myocardial infarction (MI)?

Creatine Kinase-MB

A nurse is teaching a middle-age client about hypertension. Which of the following information should the nurse include in the teaching?

Diuretics are the first type of medication to control HTN

A nurse educator is reviewing expected findings in a client who has right-sided valvular heart disease with a group of nurses. Which of the following findings should the nurse include in the discussion? (Select all that apply)

Dyspnea Client reports fatigue Peripheral edema

A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect?

Dyspnea on exertion

A nurse is caring for a client who just had a cardiac catheterization. Which of the following nursing interventions should the nurse include in the client's plan of care? (Select all that apply.)

Have the client remain in bed up to 6 hrs. Keep the client's hip and leg extended, check peripheral pulses in the affected extremity.

A nurse is caring for a client who is admitted to the emergency department with a blood pressure of 266/147 mm Hg. The client reports a headache and double vision. The client states that . she ran out of her diltiazem 3 days ago, and is unable to purchase more.Which of the following action should the nurse take first?

Obtain IV access and prepare to administer an IV antihypertensive

A nurse is on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client?

Paecmaker insertion

A nurse is teaching a client who is starting to take an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify his provider if he experiences which of the following adverse effects of this medication?

Persistent cough

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hours. Which of the following client statements indicates a need for further clarification by the nurse?

"I took my warfarin last night according to my usual schedule."

A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching?

"I will call my doctor if my pulse rate is less than 60/min."

A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching?

"I will notify the airport screeners about my pacemaker."

A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25 mg/day. Which of the following statement by the client indicates an understanding of the teaching?

"I will report any changes in heart rate to my provider."

A nurse is caring for a client who has a DVT and has been taking unfractionated heparin for a week. Two days ago, the provider also prescribed warfarin. The client asks about receiving both warfarin and heparin at the same time. Which of the following statements should the nurse give?

"It takes 3-4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued.

A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? (Select all that apply).

A client who has metabolic acidosis A client who has COPD A client who underwent stent placement in a coronary artery.

A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse expect?

Bleeding from the incisional site

A nurse is teaching a client who has been a new diagnosis of severe peripheral arterial disease. Which of the following instructions should the nurse include?

Place both legs in dependent position while sleeping

A nurse is preparing a client for a coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure?

Previous allergic reaction to shellfish

A nurse is completing the admission assessment of a client who will undergo peripheral bypass graft surgery on the left leg.Which of the following findings should the nurse expect?

Report of intermittent claudication in the affected leg Claudication (pain or cramping)

A nurse is caring for a client who was admitting for treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first?

Review serum electrolyte values.

A nurse is admitting a client who has suspected rheumatic endocarditis. The nurse should anticipate a prescription from the provider for which of the following lab tests to assist in the conformation of this diagnosis?

Throat culture Show the strept infection which is the leading cause of rheumatic endocarditis.

A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of MI and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzyme would confirm that the MI occurred 14 days ago?

Troponin T

A nurse is caring for a postoperative client 1 hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider?

Urine output of 20 mL/hr.

A nurse is teaching a client who is scheduled for an angiography. Which of the following statements should the nurse include in the teaching?

"You will need to keep your affected leg straight following the procedure."

A student nurse is observing a cardio-version procedure and hears the team leader call out, "Stand Clear." The student should recognize the purpose of this action is to alert personnel that...

... They cannot be in contact with equipment connected to the client

A nurse is completing discharge teaching wit a client who has heart failure and is encouraged to increase potassium in his diet. Which of the following foods selections should the nurse include as having the highest include as having the highest source of potassium? (Select all that apply)

1 medium baked potato

A nurse is caring for a client who is 4 hr postoperative following a coronary artery bypass grafting (CABG) surgery. He is able to inspire 200 mL with the incentive spirometer, then refuses to cough because he is tired and it hurts too much. Which of the following actions should the nurse take?

Administer IV bolus analgesic, and return in 15 minutes.

A nurse in the emergency department is admitting a client who has a possible dissecting abdominal aortic aneurysm. Which of the following actions is the priority for the nurse to take?

Administer IV fluids as prescribed Risk of inadequate circulation

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 distinguish angina from MI?

Angina can be relieved by nitro and rest.

A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.

Apex area, also known as the apical pulse, left fifth intercostal space in the midclavicular line.

A nurse is caring for a client who has chronic venous insufficiency and prescription for thigh-high compression stockings. Which of the following actions should the nurse take?

Apply the stockings in the morning upon awakening and before getting out of bed.

A nurse is admitting a client who has complete heart block as demonstrated by ECG.The client's heart rate is 34/min and BP 83/48 mm Hg.The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first?

Apply transcutaneous pacemaker pads.

A nurse is planning postoperative care for a client following a surgical placement of a synthetic graft to repair an aneurysm. Which of the following interventions should the nurse include in the plan of care? (Select all that apply)

Assess pedal pulses Monitor for an increase in pain below the graft site Administer anti-platelet agents

A nurse is caring for a client who has a prescription for an after-load-reducing medication. The nurse should identify that this medication is administered for which of the following types of shock?

Cardiogenic

A nurse is caring for four clients. Which of the following clients should the nurse identify as being at risk of acquiring rheumatic endocarditis?

Child who has streptococcal pharyngitis

A nurse at a provider's office is reviewing the lab test results for a group of clients. The nurse should identify that which of the following results indicates the client is at risk for heart disease (Select all that apply).

Cholesterol (total) 245 mg/dL LDL 140 mg/dL

A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values?

Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL.

A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is . set as WI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? (Select all that apply)

Cool and clammy foot with capillary refill of 5 seconds. Persistent hiccups

A nurse is screening a male client for hypertension. The nurse should identify that which of the following actions by the client increase his risk for hypertension? (Select all that apply)

Eating popcorn at the movie theater Consuming 36 oz of beer daily

A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should she take first?

Elevate the head of the client's bed

A nurse in the emergency department is caring for a client who had an allergic reaction related to a bee sting. The client is experiencing wheezing and swelling of the tongue. Which of the following medications should the nurse anticipate administering first?

Epinephrine IV

A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? (Select all that apply)

Follow-up ECG Energy Setting Used Skin conditions under the electrodes.

This infection of the innermost layer of the heart frequently affects the valves.

Infectious endocarditis

A nurse is reviewing the serum laboratory findings for a client who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report to the provider?

K 2.3 mEq/L

A nurse working on a cardiac unit is admitting a client who is to undergo a cardio-version and is reviewing the health record. Which of the following data requires that the nurse notify the provider to cancel the procedure? Dyspnea with exertion for 3 years Client reports taking medications for the past 6 weeks: iron supplement, multivitamin, antilipemic, and nitroglycerin. VS: @ 0800 T: 99 F BP: 142/86 P 88/min RR 20 min MAR: Ferrous Sulfate 200 mg PO 0800 and 2000, Diazepam 2 mg PO 0800 and 2000, Isosorbide 2.5 mg PO 4 times a day AC and HS

Medication history. *pt undergoing a cardio-version needs to be on blood thinners 4-6 weeks prior to procedure.

A nurse in an emergency department is completing an assessment on a client who is in shock. Which of the following findings should the nurse expect? (Select all that apply)

Seizure activity Respiratory rate 42/min Weak, thready pulse

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately?

Slurred Speech

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds?

Stop the heparin infusion.

A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? (Select all that apply)

Surgical repair of an atrial septal defect at the age of 2 Hypertension for 5 years Diastolic murmur present

A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following manifestations are expected findings? (Select all that apply)

Tachypnea Persistent cough Orthopnea

A nurse in an urgent care clinic is obtaining a history from a client who has type II diabetes mellitus and recent diagnosis of hypertension. This is the second time in two weeks that the client experienced hypoglycemia. Which of the following client data should the nurse report to the provider?

Takes metoprolol daily after meals

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication?

Valvular disease

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find?

Weak peripheral pulses

A nurse is admitting a client to the coronary care unit following placement of a temporary pacemaker. Which of the following actions should the nurse use to promote client safety? (Select all that apply)

Wear gloves when handling the pacemaker leads. Minimize the client's shoulder movements.

A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider?

Weight gain of 0.9 kg (2 lb) in 24 hours.

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?

"I smoked a cigarette this morning to calm my nerves about having this procedure."

A nurse is teaching a client who has a new diagnosis of an aneurysm. The client asks the nurse to explain what causes an aneurysm to rupture. Which of the following statements should the nurse to give?

"It is due to hypertension."

A nurse educator is reviewing the use of cardiopulmonary bypass during surgery for a CABG with a group of nurses. Which of the following statements should the nurse include in the discussion? (Select all that apply)

"The client's demand for oxygen is lowered." "Motion of the heart ceases." "Rewarming . of the client takes place."

A cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. Which of the following statements by a newly hired nurse indicates understanding of the review?

"This means the pacemaker fires in an asynchronous pattern."

A nurse is caring for a 72 year old client who is to undergo a percutaneous balloon valvuloplasty. The client's daughter asks the nurse to explain the expected outcome of this procedure. Which of the following responses should the nurse give?

"This will permit your mother to resume her activities of daily living."

A nurse is providing teaching for a client who has 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching?

"You might no longer be able to feel chest pain."

A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease?

A client who has diabetes mellitus

A nurse is planning care for a client who has septic shock. Which of the following actions is the priority for the nurse to take?

Administer antibiotic therapy

A nurse is caring for a client who has HF and reports increased shortness of breath. The nurse increases the client's oxygen per protocol. Which of the following actions should the nurse take first?

Assist the client into high-Fowler's position.

Complete absence of any electrical activity from the heart.

Asystole

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include in the teaching? (Select all that apply)

Avoid the consuming grapefruit while taking this medication Monitor for the presence of black, tarry stools

A nurse in an emergency room is assessing a client who has a bradydysrhythmia. Which of the following findings should the nurse monitor for?

Confusion

A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication?

Grapefruit Juice

A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching?

Place the patch on an area of skin away from skin folds and joints.

A nurse in a clinic is caring for a client who had been on long term NSAID therapy to treat myocarditis. Which of the following lab findings should the nurse report to the provider?

Platelets 100,000/mm3

A nurse planning care for a client who has a PIC line in the right arm. Which of the following interventions should the nurse include in the plan of care? (Select all that apply)

Use a 10 mL syringe to flush the PICC line. Cleanse ports with alcohol for 15 seconds prior to use. Maintain a transparent dressing over the insertion site.

A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. A nurse should prepare to assist with which of the following interventions?

Vagal Stimulation