Perfusion

A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step?

to clear medication and prevent clot formation

The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is:

"Leg exercises help prevent blood clots in your legs."

The rapid response team has been called to manage an unwitnessed cardiac arrest in a client's hospital room. The estimated maximum time a person can be without cardiopulmonary function and still not experience permanent brain damage is:

4 to 6 minutes

A nurse is calculating the cardiac output of an adult with a stroke volume of 75 mL and a pulse of 78 beats/minute. What number would the nurse document for this assessment?

5,850 mL

A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize?

A cuff that is too small will give a false high blood pressure

The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse?

An extra heart sound

A client is prescribed furosemide to manage heart failure. What laboratory values should the nurse monitor while the client receives this medication? Select all that apply

Complete blood count Serum potassium

The results of which serologic test should the nurse have on the medical record before a client is started on tissue plasminogen activator or alteplase recombinant?

partial thromboplastin time

An 18-month-old with a congenital heart defect is to receive digoxin twice a day. Which instructions should the nurse give the parents?

Digoxin enables the heart to pump more effectively with a slower and more regular rhythm

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

The nurse assessing a patient with an exacerbation of heart failure identifies which of the following symptoms as a cerebrovascular manifestation of heart failure (HF)?

Dizziness

A nurse educator is teaching a small group of clients about hypertension and dietary changes that will assist in lowering blood pressure readings. The nurse is specifically discussing the (Dietary Approaches to Stop Hypertension (DASH) diet and teaches the clients that the food group with the largest number of servings per day is which of the following?

Grains and grain products

When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects:

Inadequate fluid volume

What is the most important goal of nursing care for a client who is in shock?

Manage inadequate tissue perfusion

Cardiogenic shock is most commonly seen in which patient population?

Myocardial infarction

Which valve lies between the right ventricle and the pulmonary artery?

Pulmonic

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

Observe stools for blood.

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities?

Participate in a regular walking program.

Which of the following describes the amount of blood presented to the ventricle just before systole?

Preload

A patient who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly develops complaints of chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the patient for other signs and symptoms of which of the following problems?

Pulmonary embolism

Which of the following dysrhythmias are common in older patients?

Sinus bradycardia

A diastolic blood pressure of 90 mm Hg is classified as which of the following?

Stage 1 hypertension

Which of the following are signs/symptoms of perforation?

Sudden, severe upper abdominal pain

A 67-year-old female client is being discharged postoperative following pelvic surgery. The patient care instructions to prevent the development of a pulmonary embolus would include which of the following?

Tense and relax muscles in lower extremities

A nurse is assessing the blood pressure of a client using the Korotkoff sound technique. The nurse notes that the phase I sound disappears for 2 seconds. What should the nurse document on the progress record?

There is an auscultatory gap

The nurse is monitoring a client admitted with a myocardial infarction (MI) who is at risk for cardiogenic shock. The nurse should report which change on the client's chart to the health care provider (HCP)?

decreased urine output

A client has a left tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the fracture despite the morphine injection administered 30 minutes previously. Which area should be the nurse's next assessment?

distal pulse

A client with heart failure has bilateral +4 edema of the right ankle that extends up to midcalf. The client is sitting in a chair in no evident distress with the legs in a dependent position. The nurse should first:

elevate the client's legs on a foot stool

The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:

maintain catheter patency

The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should first:

stay with the client during the first 15 minutes of infusion