Med Surg Cardio C

The nurse monitors a client receiving treatment for hypertension. Which BP reading indicates to the nurse that the treatment is successful? 1.) 118/78 2.) 154/80 3.) 190/100 4.) 138/96

1.) 118/78

The nurse performs a physical assessment on a client diagnosed with mitral valve stenosis and chest pain. The nurse auscultates an early systolic murmur. Which action does the nurse perform next? 1.) Complete the assessment and then notify the HCP 2.) Call the rapid response team 3.) Document the murmur in the medical record 4.) Collect vital sign data and document findings in the medical record

1.) Complete the assessment and then notify the HCP

A client diagnosed with DVT receives heparin 1,000 units per hour by continuous IV infusion. Which finding indicates to the nurse that the heparin has the desired therapeutic effect at its current dosage? 1.) PTT 2 times the control value 2.) PT is 2 times the control value 3.) PTT is 1 times the control value 4.) PT is 1 times the control value

1.) PTT 2 times the control value

The nurse admits a client who underwent a left leg angiography. Which client observation is concerning? (SATA) 1.) The client reports tingling in the left foot 2.) The skin on the left foot is paler than on the right 3.) There is a small increase in dark red drainage on the dressing 4.) Left pedal pulse has changed from 2+ palpable to audible by doppler 5.) The left lower leg is cooler to the touch than the right

1.) The client reports tingling in the left foot 2.) The skin on the left foot is paler than on the right 4.) Left pedal pulse has changed from 2+ palpable to audible by doppler 5.) The left lower leg is cooler to the touch than the right

The nurse teaching a client receiving an antihypertensive medication prior to d/c. The nurse determines that further teaching is necessary when the client makes which statement? 1.) "I should check with my HCP before taking OTC medications" 2.) "I can stop taking the medication when my BP goes down" 3.) "I will follow up with my HCP to monitor my progress" 4.) "I will change my positions slowly"

2.) "I can stop taking the medication when my BP goes down"

A client is diagnosed with angina, and the nurse instructs the client about care at home. The nurse determines that teaching is effective if the client makes which statement? 1.) "If I have chest pain, I should stop my activity and take an aspirin" 2.) "If I have chest pain, I should stop my activity and take a nitroglycerin tablet" 3.) "I can take another aspirin if my chest pain doesn't subside in 30 minutes" 4.) "If I have chest pain, I should rest for 30 minutes and then take a nitroglycerin tablet"

2.) "If I have chest pain, I should stop my activity and take a nitroglycerin tablet"

The nurse observes an adult suddenly collapse on the street. The nurse finds the person unresponsive. Which action does the nurse take first? 1.) Check for normal breathing 2.) Call the emergency response number 3.) Deliver two rescue breaths 4.) Begin chest compressions

2.) Call the emergency response number

The nurse is working on a MS unit and enters a client's room. The client is unresponsive, pulseless, and apneic. The nurse calls for help and begins to administer CPR to the pt. Which is the most important action for the nurse to take? 1.) Call EMS to assist with CPR as they have more practice 2.) Compress the chest at a rate of at least 100 compressions per minute 3.) Give 3 shocks before beginning CPR 4.) Give the client a rescue breath over 15 seconds prior to initiating compressions

2.) Compress the chest at a rate of at 100 compressions per minute

A client suddenly develops a systolic BP that is markedly lower during inhalations, as well as distant heart sounds. An ECG shows sinus tachy with an electrical beat-to-beat alternation seen in V2 and V4 leads. Which diagnostic exam does the nurse expect the HCP to prescribe next? 1.) CT of chest 2.) Echocardiography 3.) Cardiac Catheterization 4.) Chest radiograph

2.) Echocardiography

The nurse administers a sublingual tablet of 0.3mg to a client diagnosed with angina pectoris. Which action does nitroglycerin cause? 1.) Improved release of endorphins 2.) Reduction of preload and afterload 3.) Increased myocardial oxygen demand 4.) Decreased myocardial contractility

2.) Reduction of preload and afterload

The nurse provides care for a client 3 hours after cardiac catheterization via the right femoral artery. Which assessment finding requires immediate intervention by the nurse? 1.) The client is sleepy but arousable 2.) Right foot capillary refill is 6 seconds 3.) The respiratory rate is 18 breaths per minute 4.) The right foot feels warm to the touch

2.) Right foot capillary refill is 6 seconds

The nurse teaches a client diagnosed with a MI about the appropriate diet. The nurse determines teaching is effective if the client selects which menu? 1.) Ham and cheese sandwich, potato chips, milk, and an apple 2.) Sliced baked turkey, baked potato, fresh green beans, and a pear 3.) Broiled fish, french fries, creamed spinach, and custard 4.) Fried chicken, tossed salad, biscuits with butter, and ice cream

2.) Sliced baked turkey, baked potato, fresh green beans, and a pear

The nurse understands the primary purpose of promoting rest for a client following a MI includes which rationale? 1.) Facilitates accurate cardiac monitoring 2.) Promotes sleep and better oxygenation 3.) Decreases the workload on the heart 4.) Allows regeneration of the myocardium

3.) Decreases the workload on the heart

The nurse provides care for a client 12 hours after aortofemoral bypass. It is most important for the nurse to place the client in which position? 1.) Sim position 2.) High fowler with knee gatched 3.) Full supine 4.) Flat prone

3.) Full supine

A toddler client undergoes a preparation for an ECG. Which action is most important for the nurse to take? 1.) Place the ECG leads in the correct position 2.) Explain the procedure to the toddler 3.) Have the parent hold the toddler on the lap 4.) Give the toddler the prescribed sedation

3.) Have the parent hold the toddler on the lap

When formulating a nursing care plan for a client following a myocardial infarction, the nurse includes which goal? 1.) The client will return to the pre-illness activity 2.) The client will achieve the optimum level of health 3.) The client will be free from pain and dysrhythmias 4.) The client will eliminate all stress from the lifestyle

3.) The client will be free from pain and dysrhythmias

The nurse teaches a class about cardiac glycosides to student nurses. Which statement about cardiac glycosides does the nurse include in the education? 1.) They increase conduction through the AV node 2.) They decrease the refractory period 3.) They increase blood flow to all organs 4.) They increase and strengthen the heartbeat

3.) They increase blood flow to all organs

The home care nurse visits a client with a new permanent pacemaker implanted in the area below the left clavicle. It is most important for the nurse to respond to which client statement? 1.) "It will be good to be back under my electric blanket again when I sleep" 2.) "I try to move my left arm around several times a day" 3.) "My spouse signed up for a CPR class" 4.) "I know my wound is healing because I see drainage from the incision site"

4.) "I know my wound is healing because I see drainage from the incision site"

An older adult client has a medical history of HTN. The nurse anticipates the client needs further teaching when the client makes which statement? 1.) "I will watch my diet to be sure to restrict salt and sodium" 2.) "I will take my blood pressure every morning before I take my medications" 3.) "I will start an exercise program per my doctor's instructions to assist in losing weight" 4.) "I will try to quit smoking, but I smoke when I drink and I drink everyday"

4.) "I will try to quit smoking, but I smoke when I drink and I drink everyday"

After receiving a shift change report, the nurse recognizes which client is at risk for developing hyperkalemia? 1.) An older adult admitted for 3+ pitting edema receiving furosemide IV 2.) A client admitted for DKA currently on a continuous insulin infusion 3.) An adult client with diarrhea for 3 days on a continuous pantoprazole infusion 4.) An older adult diagnosed with HF and prescribed spiro and lisinopril

4.) An older adult diagnosed with HF and prescribed spiro and lisinopril

A client is admitted to the hospital with intermittent episodes of palpitations. The client reports feeling faint and dizzy. The nurse notes occasional PVCs on the cardiac monitor. Which is the nurse's first action? 1.) Determine if the monitor leads are correctly applied 2.) Call the rapid response team for this lethal rhythm 3.) Obtain the code cart and the defibrillator 4.) Take the client's vital signs and further assess the client

4.) Take the client's vital signs and further assess the client

The nurse provides care for a client following a MI infarction. Which information, obtained during the health history, is most significant when planning for the client's d/c? 1.) The client takes daily vitamin supplements 2.) The client has a history of pneumonia 3.) The client plays golf once a week 4.) The client has a high-stress job

4.) The client has a high-stress job