HESI Prep: Cardiovascular

A client with heart failure weighed 175 lb yesterday, and today's weight is 181 lb. How many milliliters of fluid has the client retained?

2700 mL One liter of fluid equals 1000 mL, each liter of fluid is equal to one kg of weight. 175 lbs= 79.4 kg and 181 lbs = 82.1 kg. 82.1 kg- 79.4 kg= 2.7 kg = 2700 mL

Which physiological response occurs first when a client experiences sudden hypovolemia caused by hemorrhage? A. Peripheral vasoconstriction B. Elevation of serum cortisol level C. Release of immature erythrocytes D. Increased antidiuretic hormone

A Initial response to hemorrhage is initiation of the sympathetic NS, leading to increased in heart rate and peripheral vasoconstriction, which shunts blood to essential core organs. The other responses also occur, but more slowly.

Which instruction will the nurse include when teaching a client who is to wear a Holter monitor for 24 hours at home? A. Keep a record of the day's activities B. Avoid going through laser-activated doors C. Record the pulse and BP every 4 hours D. Delay taking prescribed medications until the monitor is removed

A The purpose of monitoring is to correlate dysrhythmias with the client's reported activity.

Which information would the nurse include in teaching a client who is advised to wear compression stockings for varicose veins? A. Put the stockings on at the first sign of discomfort B. Don the stockings before getting out of bed in the morning C. Ensure that the cuff of the stockings reaches the middle of the knees D. Substitute elastic bandages for compression stockings if they are more comfortable

B To prevent distension of veins, stockings should be applied before the legs are placed in a dependent position, before getting out of bed in the morning.

Which clinical finding can the nurse expect to identify when assessing a client with varicose veins? Select all that apply: A. Discolored toenails B. Reports of leg fatigue C. Localized heat in calf D. Reddened areas on a calf E. Tortuous veins in leg F. Pain in lower extremities when standing

B, E, F

How would the nurse interpret the rhythm when a client's rhythm strip shows that the P and QRS waves are consistent, with a P wave preceding every QRS complex and a PR interval of 0.26 seconds? A. Complete heart block B. Normal sinus rhythm C. First degree atrioventricular block D. Second degree AV block

C In first degree AV block, P and QRS waves are consistent in shape. A P wave precedes every QRS, and the PR interval is greater than 0.20 seconds.

What is the mean arterial pressure for a client who has a BP of 180/95 mmHg?

123 Formula: (Systolic BP + 2x Diastolic BP / 3)

Which action would the nurse take first after finding a hospitalized client who is unconscious and unresponsive? A. Initiate a code B. Check for a carotid pulse C. Compress the lower sternum D. Give 2 full lung inflations

A After the nurse has established unresponsiveness, the initial action is to initiate a code, because successful resuscitation usually requires defibrillation and a team of healthcare personnel.

Which term describes the inheritance pattern of hemophilia A? A. X-linked recessive B. Y-linked recessive C. X-linked dominant D. Y-linked dominant

A Daughters who have the gene are carriers, and sons with the gene have the condition

Which response would the nurse make when a client who is scheduled to have a coronary artery bypass graft surgery asks the nurse what benefit can be expected from the surgery? A. This surgery significantly decreased symptoms in most clients B. This procedure will enable you to return to work after healing occurs C. Studies have consistently shown that this surgery increases an individual's life span D. Evidence indicates that surgery can prevent progression of coronary artery disease

A The majority of those who have this surgery will have marked relief from their symptoms because the flow of blood to myocardial cells is increased.

Which position would a nurse place a client after ligation, dissection, and removal of varicose veins? A. Supine with knee support of the bed raised B. In a semi-fowler position with knees flexed C. Supine with the legs elevated at a 15 degree angle D. In a semi-fowler position with the feet against a headboard

C Legs should be elevated to promote venous return by gravity

Which action would the nurse take when caring for a client on the first post-op day after a femoral-popliteral bypass graft? A. Keep the client on bed rest B. Have the client sit in a chair C. Assist the client with ambulation D. Position the client with the knees flexed

C Mobility via ambulation will reduce venous stasis as well as promote arterial perfusion and healing.

Which action will the nurse take when measuring a client's pulmonary artery wedge pressure? A. Deflate the balloon as soon as the PAWP is measured B. Have the client bear down when measuring the PAWP C. Place the client in high-fowler's to measure the PAWP D. Advance the catheter if a typical PAWP tracing is not obtained

A Although the balloon must be inflated to measure the PAWP, it is deflated as soon as the PAWP is obtained to allow blood to continue to flow through the pulmonary artery

Which symptom will the nurse expect in a client with varicose veins who is scheduled for sclerotherapy? A. Feeling of heaviness in both legs B. Burning pain in the legs with exercise C. Calf pain on dorsiflexion of foot D. Pallor of lower extremities

A Impaired venous return causes increased pressure, with symptoms of fatigue and heaviness.

Which lymph nodes would the nurse expect to be affected first when a client is diagnosed with Hodgkin disease? A. Cervical B. Axillary C. Inguinal D. Mediastinal

A Painless enlargement of cervical lymph nodes is the first sign of Hodgkin disease, followed by axillary, then inguinal, with mediastinal occurring as the disease progresses.

Which intervention would the nurse perform when caring for a client in the emergency department reporting chest pain? (Select all that apply) A. Provide oxygen B. Assess vitals C. Obtain a 12-lead EKG D. Draw blood for cardiac enzymes E. Auscultate heart sounds F. Administer nitroglycerin

A, B, C, D, E, F

Which group of patients would the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? A. Children B. Older adults C. Young adults D. Middle-aged persons

B Non-Hodgkin lymphoma incidence increases with age, disease is most common in men and older adults.

Where will the nurse place the V1 lead when obtaining a 12 lead EKG? A. Fifth intercostal, left midaxillary B. Second intercostal, left sternal border C. Fourth intercostal, right sternal border D. Fifth intercostal, left midclavicular

C Positions for these 6 leads are as follows: V1 4th intercostal, right sternal border, V2: fourth intercostal, left sternal border, V3: halfway between V2 and V4, V4: fifth intercostal, left midclavicular, V5: fifth intercostal, left anterior axillary, V6: fifth intercostal, left midaxillary

Which action will the nurse include when developing a plan of care for a client who had a cardiac catheterization via a femoral insertion site? A. Ambulating the client 2 hours after the procedure B. Checking vitals every 15 minutes for 8 hours C. Maintaining the supine position for a minimum of 4 hours D. Keeping the client NPO for 4 hours after the procedure

C The supine position prevents hip flexion, decreasing the risk for clot disruption and bleeding at the catheter insertion site

Which clotting factor would a nurse explain is deficient to the parents of a child newly diagnosed with hemophilia A? A. Factor II B. Factor XII C. Factor IX D. Factor VIII

D Factors II and XII are part of the clotting cascade, Factor IX is associated with hemophilia type B

Which over-the-counter medication would the nurse teach a client taking antihypertensive medication to avoid? A. Omeprazole B. Acetaminophen C. Docusate sodium D. Pseudoephedrine

D Pseudoephedrine stimulates the sympathetic NS and may increase blood pressure, it should be avoided by clients with hypertension

Which cause of high urinary output would a nurse suspect when a client's urinary output is 3 times the fluid intake after a cardiac cath? A. An expected effect of the dye used with the procedure B. Increased cardiac output as a result of the procedure C. Improvement of urinary functioning after the catheterization D. A result of the prescribed IV rate of 50 mLh

A The dye used is hypertonic and has a diuretic effect.

Which clinical manifestation is more likely to occur in women with coronary artery disease compared with men? Select all that apply: A. Severe fatigue B. Sense of unease C. Substernal chest pain D. Shortness of breath E. Pain radiating down the arm

A, B, D

Which clinical manifestation would the nurse expect when assessing a client who is diagnosed with cardiogenic shock? Select all that apply: A. Tachycardia B. Restlessness C. Warm, moist skin D. Decreased urinary output E. Bradypnea

A, B, D

Which physiological change in the cardiovascular system is related to the aging process? A. Less sensitivity to beta adrenergic drugs B. tachycardia when changing position C. Development of systolic murmurs D. Shortening of the PR, QRS, and QT intervals E. Increase in systolic BP

A, C, E

Which clinical manifestation would the nurse expect when a client develops internal bleeding after abdominal surgery? Select all that apply. A. Pallor B. Polyuria C. Bradypnea D. Tachycardia E. Hypertension

A, D Pallor occurs with hemorrhage as the peripheral blood vessels constrict in an effort to shunt blood to the vital organs at the center of the body. Heart rate accelerates as the body attempts to increase blood flow and oxygen to body tissues.

Which nursing intervention is the priority when a child returns to the pediatric intensive care unit after cardiac surgery with a left chest tube attached to water-seal drainage, an intravenous line running of D5 1/2 NS at 4 mL/h, and a double-lumen nasogastric tube connected to continuous suction with a cardiac monitor and a dressing on the left side of the chest? A. Auscultate breath sounds B. Testing the level of consciousness C. Measuring drainage from both tubes D. Determining suction pressure of the NG tube

B Assessing the LOC provides the nurse with information about how awake the client is and how to be able to clear the throat/protect the airway

Which finding by the nurse would be concerning after a client has had a permanent demand pacemaker implanted? A. Blood on the dressing B. Pulse rate 40 bpm C. BP of 104/76 mmHg D. Pain at the incisional site

B Because a demand pacemaker would be set at a rate of at least 60 bpm, a pulse of 40 bpm indicates a need for rapidly assessing the cardiac monitor for the failure of the pacemaker or sense the client's underlying rate and notification of the healthcare provider

Which action would the nurse take regarding the new prescription of a client who is receiving methotrexate for acute lymphocytic leukemia and develops a temp. of 101 F after the provider prescribes aspirin 650 mg every 4 hours as needed? A. Express concern about the dosage prescribed B. Request a prescription for an antacid C. Express concern about the type of antipyretic prescribed D. Ask if the frequency should be every 6 hours instead

C Both ALL and methotrexate may cause thrombocytopenia, with resulting bleeding risk. Aspirin is contraindicated with thrombocytopenia because of it's inhibitory effect on platelet aggregation.

Which complication will the nurse anticipate when caring for a client in late hypovolemic shock? A. Hypokalemia B. Metabolic Acidosis C. Respiratory Alkalosis D. Decreased PCO2 levels

B Decreased cellular oxygen caused by poor perfusion increases conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis.

How frequently will the nurse plan to assess the BP when a patient is admitted to the postanesthesia care unit after surgery? A. Every 3-5 minutes B. Every 10-15 minutes C. Every 20-30 minutes D. Every 40-60 minutes

B During the first 2 post-op hours, BP is monitored every 10-15 minutes to detect unstable vitals signs that could indicate shock. Every other option is either too long or too frequent to be necessary.

Which statement indicates that further teaching is needed after the nurse completes teaching for a client with foot pain who has peripheral arterial disease? A. I will wear socks B. I will elevate my foot C. I will increase fluid intake D. I will drink a moderate amount of alcohol

B Elevating the leg decreases the flow of blood to the lower extremity because it must flow without the assistance of gravity.

Which grade on the phlebitis scale would a nurse document when caring for a client receiving intravenous fluids who complains of pain at the insertion site and is found to have erythema and edema? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

B Grade 2 represents as pain at the access site with erythema or edema. Grade 1 presents as erythema with or w/o pain, Grade 3 presents as pain at the access site, erythema/edema, streak formation, and a palpable cord. Grade 4 presents as pain at the access site with erythema or edema, streak formation, palpable cord more than 1 inch long, and purulent drainage

Which statement would be documented when a nurse observes spikes on the cardiac monitor at a regular rate but no QRS following the spikes in a client who has a newly implanted demand pacemaker? A. Failure to sense B. Failure to capture C. Loss of battery power D. Pacer wire displacement

B If pacemaker spikes are present, the pacemaker is firing appropriately, but the lack of resulting QRS complexes indicates that it is not stimulating or "capturing" the heart.

Which information would the nurse include when explaining the purpose of a thallium scan to the client who has a history of chest pain? A. It monitors action of the heart valves B. It assesses myocardial ischemia and perfusion C. It visualizes ventricular systole and diastole D. It identifies the adequacy of the conduction system

B Thallium imaging is used to assess myocardial ischemia or necrotic muscle tissue related to angina or myocardial infarction. Necrotic or scar tissue does not extract the thallium isotope, leading to cold spots

Which action by a client with peripheral arterial disease indicates that more teaching about how to manage the disease is needed? A. Applying a hot water bottle to the abdomen B. Using a heating pad to warm the extremities C. Drinking a warm cup of tea when feeling chilly D. Turning the room thermostat above 72 degrees

B The client's extremities are less able to respond to thermal stress because of peripheral vascular problems, and burns may occur with the application of a heating pad to the extremities

Which information would the nurse teach the client before a femoral arteriogram is started? A. radioactive dye will be injected into the femoral vein B. Local anesthesia will be used to decrease pain at the site C. Contrast media will be injected into a small vessel of the foot D. Medication will be administered intravenously to induce sleep

B The contrast media is not radioactive, and is not injected into the foot. The client will be awake during the procedure

Which clinical manifestation would the nurse expect to find in a client with hypokalemia? A. Thirst B. Anorexia C. Leg cramps D. Rapid, thready pulse E. Dry mucous membranes

B, C The GI manifestations associated with hypokalemia are caused by decreased neuromuscular irritability of the GI tract- resulting in anorexia, nausea, vomiting, and decreased peristalsis

Which action would the nurse implement when an older adult is brought to the ED after being found in the street without a coat during a snowstorm? Select all that apply. A. Massage extremities gently B. Obtain a rectal temperature C. Assess fingers for areas of frostbite D. Determine client's level of consciousness E. Ask for client identification

B, C, D, E

When discharging a client who has had insertion of a coronary artery stent, for which signs and symptoms will a nurse instruct the client to seek immediate medical attention? A. Dyspnea with vigorous exertion B. Unexplainable profuse diaphoresis C. Indigestion not relieved by antacids D. Fatigue the day after a vigorous walk E. Acute chest pain after rigorous exercise F. Continued chest pain after nitroglycerin use

B, C, E, F

Which action will the nurse take to create negative pressure in the system after emptying the drainage collection chamber for a postoperative client's portable closed suction wound drainage device? A. Attaching the device to a wall suction unit B. Milking the tubing toward the suction device C. Compressing the device while closing the air plug D. Keeping the device in a position lower than the site of insertion

C Compresssing the device expels air in the unit, and closing the plug while it is compressed reestablishes the closed system and creates negative pressure.

Which action would the nurse take when performing external cardiac compression? A. Extend fingers over the sternum and chest with the heels of each hand side by side B. Place the fingers of 1 hand on the sternum and the fingers of the other hand on top of them C. Interlock the fingers with the heel of 1 hand on the sternum and the heel of the other on top of it. D. Clench the hand into a fist and place the fleshy part of a clenched fist on the lower sternum

C This position provides the best leverage for depressing the sternum, adequately compressing the heart and forcing the blood into the arteries

Which action would the nurse take when a client complains of tingling in the leg after undergoing a cardiac catheterization through a femoral access site? A. Apply pressure to the femoral puncture site B. Evaluate the affected leg for redness/swelling C. Compare femoral, popliteal, and pedal pulses in both legs D. Offer reassurance that tingling is common after this procedure

C Tingling indicates decreased arterial circulation to the extremity, which may be caused by an arterial embolus or a hematoma at the puncture site

Which physiological alteration would be expected with a higher-than-normal red blood cell count? A. Increased blood pH B. Decreased hematocrit C. Increased blood viscosity D. Decreased immune response

C Blood's internal resistance to flow is increased because of excessive accumulation of RBCs in the blood. Hematocrit will be higher, RBCs do not affect immunity.

Which clinical finding is the nurse most likely to identify when completing a history and physical assessment of a client with complete heart block? A. Syncope B. Headache C. Tachycardia D. Hemiparesis

A With complete atrioventricular block, the ventricles take over the pacemaker function in the heart but at a much slower rate than that of the sinoatrial node. As a result, there is decreased cerebral circulation, causing syncope.

Which action would the nurse perform when a client is in ventricular fibrillation? Select all that apply A. Initiating CPR B. Assessing the EKG C. Using a defibrillator D. Obtaining electrolytes E. Administering epinephrine

A, B, C, D, E All are key nursing interventions when a patient is in v-fib.

Which information would be used to determine the cause of premature atrial contractions observed on a client's EKG? Select all that apply. A. Stress Level B. Tobacco Use C. Caffeine intake D. Electrolyte levels E. Home medications

A, B, C, D, E All are potential causes of a PVC! As well as chronic conditions (hyperthyroidism, COPD, coronary heart disease)

Which assessment finding of a client with heart failure would prompt the nurse to contact the healthcare provider? Select all that apply. A. Fatigue B. Orthopnea C. Pitting edema D. Dry, hacking cough E. 4-pound weight gain

A, B, C, D, E All are signs of worsening heart failure and should be reported.

Which nursing action is most important for a client with an abdominal aortic aneurysm? A. Administering supplemental oxygen B. Maintaining a low BP C. Keeping the client in the supine position D. Monitoring femoral and pedal pulses

B Maintaining a low BP reduces the risk of aortic rupture.

Which explanation will the nurse give when a client who is admitted for a CABG surgery asks about the purpose of pacemaker wires inserted during surgery? A. Defibrillation of the heart after surgery B. Prevention of slow heart rate after surgery C. Maintenance of a rate of at least 100 bpm during surgery D. Inhibition of too-rapid heart rate during the post-op period

B Pacing wires are sometimes placed during the CABG so that pacing is rapidly available in case of bradycardia during the post-op period

Which action is included in nursing care for a client who just had a cardiac catheterization? A. Maintain semi-fowler position B. Monitor the pulse and BP C. Take the temperature hourly until it stabilizes D. Encourage frequent coughing and deep breathing

B Pulse rate and BP are monitored to detect tachycardia and hypotension, which may indicate postprocedure bleeding

Which suggestion would the nurse make for a client with heart failure? A. "Take a hot bath before bedtime" B. "Avoid emotionally stressful situations C. "Avoid sleeping in an AC room" D." Exercise daily to a pulse rate of 100 bpm"

B Stressful situations increase the body's oxygen demands

Which assessment finding after an open reduction and internal fixation of a fractured hip would cause the nurse to suspect and monitor for s/s of a fat embolism? A. Fever/Chest pain B. Positive Homan's sign C. Loss of sensation in the operative leg D. Tachycardia/petechiae over chest

D Tachycardia is caused by impaired gas exchange from the embolus, petechiae are caused by occlusion of small vessels within the skin.

How will the nurse calculate pulse pressure for a hospitalized client? A. Calculate the difference between the radial and apical pulse rates B. Subtract the diastolic BP from the systolic BP C. Add the systolic pressure plus 2 times the diastolic pressure and divide the total by 3 D. Determine the difference between mean arterial pressure and central venous pressure

B

Which topic is most important for the nurse to include when teaching about prevention of coronary artery disease for a 50-year old man who is 6 ft tall, weighs 293 lbs, smokes 1 pack a day, and has siblings with CAD? Select all that apply: A. Age B. Height C. Weight D. Tobacco Use E. Family history

C, D The focus of teaching about CAD prevention would be on modifiable risk factors such as weight and tobacco use.

Which complication is most likely to occur in the immediate postoperative period after a client has had a splenectomy? A. Infection B. Peritonitis C. Hemorrhage D. Intestinal obstruction

C Because the spleen is highly vascular, hemorrhage may occur in the immediate postoperative period.

Which information can be obtained from monitoring the pulmonary artery pressure? A. Stroke volume B. Lung function C. Coronary artery patency D. Left ventricular functioning

D The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated.

Which response would the nurse give to a client whose total cholesterol level is found to be 210 mg/dL at a screening session at a health fair and asks the nurse what to do in light of this result? A. "Your cholesterol is high, and you may need medication" B. This is within the acceptable range, and no action is required" C. "Your level is low, you should eat more foods that contain cholesterol" D. "Your cholesterol is elevated slightly. A diet low in saturated fats should be followed"

D A level more than 200 mg/dL is mildly elevated and the initial intervention would be making changes in diet and activity level. It is not high enough to require medication at this time

Which instruction would the nurse include in the teaching plan when a client is at high risk for heart disease? A. Avoid eating between meals B. Limit unsaturated fats in the diet C. Decrease the amount of fat-binding fiber D. Increase the quantity of complex carbohydrates

D The fiber component of complex carbs helps bind and eliminate dietary cholesterol and fosters growth of intestinal microorganisms to break down the bile salts and release cholesterol component for excretion

How far would the nurse depress the lower sternum when performing cardiac compression on an adult client? A. 0.75 to 1 inch B. 0.5 to 0.75 inches C. 1 to 1.4 inches D. 2 to 2.4 inches

D Per CPR guidelines. Infants are 1.5 inches, Children up to age of puberty sound be 2 inches, Adolescents should be 2 to 2.4 inches.

In what order does normal cardiac conduction occur through the heart?

SA node, AV node, Bundle of His, bundle branches, Purkinje fibers