Alterations in Cardiovascular System NCLEX Part 2

Which diagnostic study can determine when cellular metabolism becomes anaerobic and when pH decreases? A. Arterial blood gas (ABG) levels B. Complete blood count (CBC) C. Electrocardiogram(ECG) D. Lung scan

A. ABG levels reflect cellular metabolism and indicate hypoxia. A CBC is performed to determine various constituents of venous blood. An ECG shows the electrical activity of the heart. A lung scan is performed to view functionality of the lungs.

What is the most common symptom in a client with abdominal aortic aneurysm? A. Abdominal pain B. Diaphoresis C. Headache D. Upper back pain

A. Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Diaphoresis and headache aren't associated with abdominal aortic aneurysm. Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm.

The nurse knows that a 45-year-old client with severe hypertension will experience increased workload of the heart due to which of the following? A. Increased after load B. Increased cardiac output C. Overload of the heart D. Increased preload

A. After load refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Hypertension increases afterload, as the left ventricle has to work harder to eject blood against vasoconstriction. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole

The nurse is counseling a client on types of cardiomyopathy associated with childbirth. The nurse should teach the client about which of the following? A. Dilated B. Hypertrophic obstructive C. Myocarditis D. Restrictive

A. Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic obstructive cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't a form of cardiomyopathy; it's an inflammation of the cardiac muscle. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial.

While assessing a client with dilated cardiomyopathy, the nurse notices that the electrocardiogram (ECG) rhythm no longer has any P waves, only a fine wavy line. The ventricular rhythm is irregular with a QRS duration of 0.08 seconds. The heart rate is 110 beats/minute. The nurse interprets this rhythm as: A. atrial fibrillation. B. ventricular fibrillation. C. atrial flutter. D. sinus tachycardia.

A. Atrial fibrillation is defined as chaotic, asynchronous, electrical activity in the atrial tissue. On an ECG, uneven baseline fibrillating waves appear rather than distinguishable P waves. Ventricular fibrillation is a chaotic rhythm with no QRS complexes. In atrial flutter, there are flutter waves that are "sawtooth" in appearance. P waves are present in sinus tachycardia.

Which physiological change would indicate that the baroreceptors in the carotid artery walls and aorta are functioning? A. Changes in blood pressure B. Changes in arterial oxygen tension C. Changes in arterial carbon dioxide tension D. Changes in heart rate

A. Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Decreases in pulsatile pressure cause a reflex increase in heart rate.

A nurse is caring for a client with cardiomyopathy and is aware that the client is at high risk for developing: A. heart failure. B. diabetes mellitus. C. myocardial infarction (MI). D. pericardial effusion.

A. Because the structure and function of the heart muscle are affected, heart failure most commonly occurs in clients with cardiomyopathy. Diabetes mellitus is unrelated to cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in clients with pericarditis.

A charge nurse is preparing client care assignments for the next shift. A client who underwent femoral-popliteal bypass surgery is scheduled to return from the postanesthesia care unit. Which staff member should receive this client? A. Registered nurse with 1 year of experience B. Licensed practical nurse (LPN) with 5 years of experience C. Nursing assistant with 15 years of experience D. Charge nurse with 10 years of experience

A. Because this client requires frequent neurovascular assessments, a registered nurse should receive him. An LPN, although she's experienced and can collect data, doesn't have the education to perform the physical assessment required by this client. The nursing assistant lacks the necessary assessment skills. The charge nurse needs to be available to direct the care of other clients.

A nurse is teaching a client about cardiomyopathy and determines further teaching is needed when the client states: A. "It is caused by a plaque in the arteries." B. "It is caused by a virus." C. "It is caused by bacteria." D. "It is caused by certain drugs."

A. Cardiomyopathy isn't usually caused by plaque in the arteries or atherosclerosis. The etiology in most cases is viral or bacterial infection or cardiotoxic effects of drugs or alcohol.

Which client is most at risk for developing deep vein thrombosis (DVT)? A. A 62-year-old female recovering from a total hip replacement B. A 35-year-old female 2 days postpartum C. A 33-year-old male runner with Achilles tendonitis D. An ambulatory 70-year-old male who is recovering from pneumonia

A. DVT is more common in immobilized clients who have had surgical procedures such as total hip replacement. Pregnancy can cause varicose veins, which can lead to venous stasis, but it isn't a primary cause of DVT. Clients who are recovering from an injury or pneumonia may have decreased mobility, but these clients don't have the highest risk of developing DVT.

Which drug is most commonly used to treat cardiogenic shock? A. Dopamine B. Enalapril (Vasotec) C. Furosemide (Lasix) D. Metoprolol (Lopressor)

A. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure; neither is a desired effect in the treatment of cardiogenic shock.

The nurse would assess a client with varicose veins for which symptoms? A. Fatigue and pressure B. Fatigue and cool feet C. Sharp pain and fatigue D. Sharp pain and cool feet

A. Fatigue and pressure are classic signs of varicose veins, secondary to increased blood volume and edema. Sharp pain and cool feet are symptoms of alteration in arterial blood flow.

A client admitted with angina complains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which action should the nurse take first? A. Activate the resuscitation team. B. Open the client's airway. C. Check for breathing. D. Check for signs of circulation.

A. Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and feeling for no more than 10 seconds). If the client isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse.

The nurse in the cardiac unit is reviewing the conditions of the assigned clients to determine if a risk for cardiogenic shock is present. The client most at risk presents with which condition? A. Acute myocardial infarction (MI) B. Coronary artery disease (CAD) C. Decreased hemoglobin level D. Hypotension

A. Of all clients with an acute MI, 15% suffer cardiogenic shock secondary to the myocardial damage and decreased function. CAD causes MI. A decreased hemoglobin level is a result of bleeding. Hypotension is the result of a reduced cardiac output produced by the shock state.

The nurse is teaching a client about angina. Which statement by the nurse would be most accurate regarding the primary treatment goal? A. Reversal of ischemia B. Reversal of infarction C. Reduction of stress and anxiety D. Reduction of associated risk factors

A. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed. Reduction of associated risk factors, such as stress and anxiety, is a progressive, long-term treatment goal that has cumulative effects. Reduction of these factors will decrease the risk for angina, but this usually isn't an immediate goal.

A client comes to the emergency department with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a blood pressure of 82/45 mm Hg, a heart rate of 120 beats/minute, and a respiratory rate of 38 breaths/minute. The client's medical history includes diabetes mellitus, hypertension, and heart failure. Which disorder should the nurse suspect? A. Pulmonary edema B. Pneumothorax C. Cardiac tamponade D. Pulmonary embolus

A. Shortness of breath, tachypnea, low blood pressure, tachycardia, diffuse crackles, and a cough producing pink, frothy sputum are late signs of pulmonary edema. Pneumothorax causes sudden, sharp pleuritic pain exacerbated by chest movement, breathing, and coughing; shortness of breath; and absent breath sounds on the affected side. Cardiac tamponade produces muffled heart sounds, pulsus paradoxus, and jugular vein distention. Pulmonary embolus may cause fever, cough, hemoptysis, and a pleural friction rub.

The nurse is ambulating a client. After ambulating 50 feet, the client experiences chest pain. What should be the priority intervention by the nurse? A. Sit the client down. B. Get the client back to bed. C. Obtain an electrocardiogram (ECG). D. Administer sublingual nitroglycerin.

A. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. When the client's condition is stabilized, he can be returned to bed. An ECG can be obtained after the client is sitting down. After the ECG, sublingual nitroglycerin would be administered.

While palpating a client's abdomen, the nurse notes a pulsating abdominal mass. This may indicate which condition? A. Abdominal aortic aneurysm B. Enlarged spleen C. Gastric distention D. Gastritis

A. The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. An enlarged spleen, gastric distention, and gastritis do not cause pulsation.

A client with a myocardial infarction has received a thrombolytic agent. What is the most important intervention by the nurse? A. Avoid puncture wounds. B. Monitor potassium levels. C. Maintain a supine position. D. Encourage fluids.

A. Thrombolytic agents are declotting agents that place the client at risk for hemorrhage from puncture wounds. All unnecessary needle sticks and invasive procedures should be avoided. The potassium level should be monitored in all cardiac clients, not just those receiving a thrombolytic agent. Although no specific position is required, most cardiac clients seem more comfortable in semi-Fowler's position. The client's fluid balance must be carefully monitored, so it may be inappropriate to encourage fluids at this time.

Which oral medication is administered to prevent further thrombus formation? A. Warfarin (Coumadin) B. Heparin C. Furosemide (Lasix) D. Metoprolol (Lopressor)

A. Warfarin prevents vitaminK from synthesizing certain clotting factors. This oral anticoagulant can be given long term. Heparin is a parenteral anticoagulant that interferes with coagulation by readily combining with antithrombin; it can't be given by mouth. Neither furosemide nor metoprolol affects anticoagulation.

An 18-year-old client who recently had an upper respiratory infection is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis? A. Erythema marginatum, subcutaneous nodules, and fever B. Tachycardia, finger clubbing, and a loud second heart sound (S2 ) C. Dyspnea, cough, and palpitations4 D. Dyspnea, fatigue, and syncope

A. Diagnosis of rheumatic fever requires that the client have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham's chorea, subcutaneous nodules, and erythema marginatum (transient, nonpruritic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, and a prolonged PR interval on electrocardiography. Tachycardia, finger clubbing, and a loud S2 suggest transposition of the great arteries (a cyanotic congenital heart defect). Dyspnea, cough, and palpitations occur with mitral insufficiency. Dyspnea, fatigue, and syncope indicate aortic insufficiency.

After unsuccessful cardiopulmonary resuscitation efforts, the nurse must prepare an Islamic client for the morgue. Which nursing action should the nurse take? A. Allowing the client's family to perform the ritualistic washing B. Doing nothing; the Burial Society will perform a ritual cleansing C. Doing nothing; only the family and close friends may touch the body D. Providing routine post mortem care

A. Physical care at death for a person of the Islamic faith consists of ritualistic washing by the family, with the client's body positioned toward Mecca. The Burial Society may perform ritual cleansing for clients of the Jewish faith. Hindu clients believe that only family and close friends should touch the body. Routine postmortem care is appropriate for Christian clients.

What is the most appropriate initial action by the nurse for a client coughing up pink, frothy sputum? A. Call for help. B. Call the physician. C. Start an I.V. line. D. Suction the client.

A. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the client is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions should immediately follow.

Which statement by a nurse to the health care aide best explains the need to promptly report changes in respiratory rate for a client diagnosed with heart failure? A. "Pulmonary edema, a life-threatening condition, can develop in minutes." B. "Severe acute respiratory syndrome (SARS) is a complication of heart failure." C. "Pneumonia is a consequence of inadequate ventilation with heart failure." D. "Pneumothorax, a life-threatening condition, can develop in minutes."

A. Pulmonary edema, a life-threatening complication of heart failure, can develop in minutes, secondary to a sudden fluid shift from the pulmonary vasculature to the lung interstitial alveoli. SARS and pneumonia are caused by infections. Pneumothorax is a collection of air or gas in the pleural space, causing the lung to collapse.

A client who experienced a myocardial infarction (MI) tells the nurse he is fearful of dying. The most appropriate response by the nurse is: A. "Tell me about your feelings right now." B. "When the doctor arrives, everything will be fine." C. "This is a bad situation, but you'll feel better soon." D. "Please be assured we're doing everything we can to make you feel better."

A. "Tell me about your feelings right now." Validation of a client's feelings is the most appropriate response. It gives the client a feeling of comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing an MI will feel or get better, and therefore, these responses are inappropriate.

A client is ordered to start receiving digoxin 0.25 mg P.O. What is the priority assessment by the nurse administering the medication? A. Apical pulse B. Blood pressure C. Radial pulse D. Respiratory rate

A. Apical Pulse An apical pulse is essential for accurately assessing the client's heart rate before administering digoxin. The apical pulse is the most accurate pulse point in the body. Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and, therefore, won't always accurately depict the heart rate. Digoxin has no effect on respiratory function.

A hospitalized client with heart failure suddenly develops dyspnea at rest, disorientation, confusion, and crackles in the lung bases on auscultation. The most important intervention(s) by the nurse would be? Select all that apply. A. Insert a Foley catheter B. Monitor urinary output. C. Administer nasal oxygen. D. Administer a rapid-acting diuretic. E. Place the client in a modified Trendelenburg position. F. Administer a 500-ml intravenous (I.V.) normal saline solution bolus.

A. B. C. D. Acute pulmonary edema is a life-threatening event in which the left ventricle of the heart fails to eject sufficient blood. The pressure in the lungs increases because of the accumulated blood. Interventions should be done to decrease this pressure. The client is placed in a high Fowler's position to assist in breathing. The nurse ensures that vascular access is present, but I.V. fluids are not administered because this will increase body fluid. Oxygen is administered, and the physician prescribes a rapid-acting diuretic to eliminate body fluid. A Foley catheter is inserted to assess urinary output after diuretic administration and to minimize exertion related to voiding.

What clinical manifestations would the nurse expect to find in a client who has superficial thrombophlebitis? Select all that apply. A. Redness noted along the vein B. Induration noted along the vein C. Warmth palpated along the vein D. Tenderness on palpation of the vein E. Diminished pulses in the affected extremity F. Dilated blue-colored veins noted along the length of the extremity

A. B. C. D. Superficial thrombophlebitis is an inflammation of a superficial vein accompanied by the formation of a clot. Clinical manifestations of superficial thrombophlebitis include redness, induration, warmth, and tenderness along a vein. Discomfort may be relieved by applying heat. Activity is encouraged as prescribed, and a supportive wrap or stocking should be applied. Diminished pulses and dilated blue-colored veins are not manifestations of superficial thrombophlebitis.

A nurse monitors a client with a tumor of the esophagus for signs of superior vena cava (SVC) syndrome. The nurse would assess the client for which of the following? Select all that apply. A. Nosebleeds B. Edema in the eyes C. Edema in the hands D. Difficulty breathing E. Mental status changes F. Weight loss with complaints of looseness of clothing, especially around the neck

A. B. C. D. E. SVC syndrome occurs when the SVC is compressed or obstructed by tumor growth. The manifestations result from the blockage of blood flow in the venous system of the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar (Stokes' sign). As the compression worsens, edema in the hands and arms, dyspnea, erythema of the upper body, and epistaxis occur. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension.

The nurse is performing an admission assessment on a client who has been diagnosed with a cardiovascular disease. The nurse would anticipate the data to include which of the following? Select all that apply. A. Fatigue B. Chest pain C. Weight loss D. Light-headedness E. Dependent edema F. Difficulty breathing in an upright position

A. B. D. E. Cardiovascular disease is any abnormal condition characterized by dysfunction of the heart and blood vessels. Common clinical manifestations of cardiovascular disease include chest pain, irregularities of the heart rhythm, cyanosis, fatigue, light-headedness, weight gain, dependent edema, and respiratory manifestations such as dyspnea. The client complains of difficulty breathing when lying in a flat position, not when in an upright position.

What is the class of medications that protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A. Beta-adrenergic blockers B. Calcium channel blockers C. Opioids D. Nitrates

A. Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Opioids reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

Prioritize the steps for performing an electrocardiogram (ECG). A. Washhands. B. Clean the gel from the client's skin. C. Apply conductive gel to the client's skin. D. Disconnect the electrodes from the client. E. Attach electrodes to the client's skin and obtain a reading. F. Explain the importance of lying still, breathing normally, and refraining from talking during the test.

A. F. C. E. D. B The ECG is a noninvasive tool for evaluating the heart rhythm and displays the electrical activity of the heart. The nurse first washes the hands and then explains the procedure to the client, including the importance of lying still, breathing normally, and refraining from talking during the test. The nurse next applies conductive gel to the client's skin, attaches electrodes to the client's skin, and adjusts the monitor to obtain a reading. Once the reading is obtained, the nurse disconnects the electrodes from the client and cleans the gel from the client's skin.

After an anterior-wall myocardial infarction (MI), which problem is indicated by auscultation of crackles in the lungs? A. Left-sided heart failure B. Pulmonic valve malfunction C. Right-sided heart failure D. Tricuspid valve malfunction

A. Left-sided heart failure The left ventricle is responsible for most of the cardiac output. An anterior-wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.

When auscultating the abdominal region of a client with abdominal aortic aneurysm, the nurse hears a bruit. How does the nurse interpret this finding? A. It is a normal finding. B. It reflects a partial arterial occlusion. C. It indicates a collection of fluid in the lungs. D. It shows an inflammation of the peritoneal surface.

B. A bruit is a vascular sound that reflects partial arterial occlusion. It is not a normal finding. Fluid in the lungs is called crackles, and inflammation of the peritoneal surface produces a friction rub.

A nurse is planning discharge instructions for a client who is being treated for ventricular tachycardia. Which of the following rationales for including bananas in the client's diet is most accurate? A. Bananas are high in carbohydrate. B. Bananas are high in potassium. C. Bananas are low in sodium. D. Bananas are high in fiber.

B. A low serum potassium level increases the risk of ventricular tachycardia. Therefore, the client should be instructed to eat potassium-rich foods such as bananas.

A client is scheduled for testing to diagnose an abdominal aortic aneurysm. The most definitive test would be? A. Abdominal X-ray B. Aortogram C. Computed tomography (CT) scan D. Ultrasound

B. An aortogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound don't give a direct view of the vessels and don't yield as accurate a diagnosis as the aortogram.

A client's rhythm strip shows a regular rhythm with atrial and ventricular rates of 70 beats/minute, a PR interval of 0.24 seconds, and a QRS duration of 0.08 seconds. The nurse interprets this rhythm as: A. normal sinus rhythm (NSR). B. NSR with 1-degree atrioventricular (AV) block. C. sinus arrhythmia. D. accelerated junctional rhythm.

B. An increased PR interval is indicative of a 1-degree AV block. NSR and sinus arrhythmia have normal PR intervals. The PR interval (if present) is less than 0.12 seconds in accelerated junctional rhythm.

The nurse is teaching a client about blood pressure and hormones. Which of the following responses indicates the client understands which hormone raises arterial pressure and promotes venous return? A. AngiotensinI B. AngiotensinII C. Thyroid hormone D. Insulin

B. Angiotensin II is a potent vasoconstrictor, thereby promoting venous return. Angiotensin I is a precursor that is converted in the pulmonary vasculature to angiotensin II. Neither thyroid hormone nor insulin has vasoconstrictive properties.

Which class of drugs is most widely used in the treatment of cardiomyopathy? 1. Anticoagulants 2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Nitrates

B. By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Anticoagulants may sometimes be used to reduce the risk of emboli, but this practice is considered controversial. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren't as effective as beta-adrenergic blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.

The nurse is assessing a client with heart failure. The client is experiencing tachycardia, decreased blood pressure, and decreased peripheral pulses. The nurse interprets these symptoms as indicative of what? A. Anaphylactic shock B. Cardiogenic shock C. Distributive shock D. Myocardial infarction (MI)

B. Cardiogenic shock is shock related to reduced cardiac output and ineffective pumping of the heart. Anaphylactic shock results from an allergic reaction. Distributive shock results from changes in the intravascular volume distribution and is usually associated with increased cardiac output. MI isn't a shock state, although a severe MI can lead to shock.

Which condition is linked to more than 50% of clients with abdominal aortic aneurysms? A. Diabetes mellitus B. Hypertension C. Peripheral vascular disease D. Syphilis

B. Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Diabetes mellitus doesn't have a direct link to aneurysm. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn't as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm.

A client arriving in the emergency department (ED) is receiving cardiopulmonary resuscitation from paramedics, who are giving ventilations through an endotracheal (ET) tube that they placed in the client's home. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate of 55 beats/minute with a palpable pulse. Which action should the nurse take first? A. Start an I.V. line and administer amiodarone, 300 mg I.V. over 10 minutes. B. Check ET tube placement. C. Obtain an arterial blood gas (ABG) sample. D. Administer atropine, 1 mg I.V.

B. ET tube placement should be confirmed as soon as the client arrives in the ED. Once the airway is secured, oxygenation and ventilation should be confirmed using an end-tidal carbon dioxide monitor and pulse oximetry. Next, the nurse should make sure I.V. access is established. If the client experiences symptomatic bradycardia, atropine is administered as ordered, 0.5 to 1 mg every 3 to 5 minutes to a total of 3 mg. Then the nurse should try to find the cause of the client's arrest by obtaining an ABG sample. Amiodarone is indicated for ventricular tachycardia, ventricular fibrillation, and atrial flutter —not symptomatic bradycardia.

Which sound will be heard during the first phase of Korotkoff's sounds? A. Disappearance of sounds B. Faint, clear tapping sounds C. A murmur or swishing sounds D. Soft, muffling sounds

B. In phase I, auscultation produces a faint, clear tapping sound that gradually increases in intensity. Phase II produces a murmur sound and precedes phase III, the phase marked by an increased intensity of sound. Phase IV produces a muffling sound that gives a soft blowing noise. Phase V, the final phase, is marked by the disappearance of sounds.

A nurse determines that a client with varicose veins understands the cause of primary varicose veins when the client states which cause? A. Hypertension B. Pregnancy C. Thrombosis D. Trauma

B. Primary varicose veins have a gradual onset and progressively worsen. In pregnancy, the expanding uterus and increased vascular volume impede blood return to the heart. The pressure places increased stress on the veins. Hypertension has no role in varicose vein formation. Thrombosis and trauma cause valvular incompetence and so are secondary causes of varicosities—not primary.

The nurse is caring for a preoperative client with an abdominal aortic aneurysm. The client is most at risk for: A. hypertension. B. aneurysm rupture. C. cardiac arrhythmias. D. diminished pedal pulses.

B. Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Cardiac arrhythmias aren't directly linked to an aneurysm. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but aren't life threatening.

The nurse assesses a client with an abdominal aortic aneurysm and is most concerned when the client presents with which of the following? A. Lower back pain, increased blood pressure, decreased red blood cell (RBC) count, and increased white blood cell (WBC) count B. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count C. Severe lower back pain, decreased blood pressure, decreased RBC count, decreased WBC count D. Intermittent lower back pain, decreased blood pressure, decreased RBC count, increased WBC count

B. Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased. The WBC count increases as cells migrate to the site of injury.

The nurse determines that a client at risk for the development of cardiogenic shock would present with which of the following? A. Decreased heart rate B. Decreased cardiac index C. Decreased blood pressure D. Decreased cerebral blood flow

B. The cardiac index, a figure derived by dividing the cardiac output by the client's body surface area, is used for identifying whether the cardiac output is meeting a client's needs. Heart rate, blood pressure, and decreased cerebral blood flow are less useful in detecting the risk of cardiogenic shock.

When hypertension occurs, which responses by the kidneys help normalize blood pressure? A. The kidneys retain sodium and excrete water. B. The kidneys excrete sodium and excrete water. C. The kidneys retain sodium and retain water. D. The kidneys excrete sodium and retain water.

B. The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic blood pressure by regulating blood volume. Sodium or water retention would only further increase blood pressure. Sodium and water travel together across the membrane in the kidneys; one can't travel without the other.

Which term best describes the findings on cautious palpation of the vein in typical superficial thrombophlebitis? A. Dilated B. Knotty C. Smooth D. Tortuous

B. The knotty feeling is secondary to the emboli adhering to the vein wall. Varicose veins may be described as dilated and tortuous. Normal veins feel smooth.

Which condition is associated with a predictable level of pain that occurs as a result of physical or emotional stress? A. Anxiety B. Stable angina C. Unstable angina D. Variantangina

B. The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Anxiety generally isn't described as painful. Unstable angina doesn't always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exertion or stress.

A client with abdominal aortic aneurysm asks the nurse in which area are abdominal aortic aneurysms most commonly located. The best response by the nurse is: A. distal to the iliac arteries. B. distal to the renal arteries. C. adjacent to the aortic arch. D. proximal to the renal arteries.

B. The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn't surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.

What is the first intervention for the nurse to implement for a client experiencing myocardial infarction (MI)? A. Administer morphine. B. Administer oxygen. C. Administer sublingual nitroglycerin. D. Obtain an electrocardiogram(ECG).

B. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublingual nitroglycerin are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

The nurse determines further teaching is necessary when a client with cardiomyopathy states: A. dilated cardiomyopathy decreases cardiac output. B. cardiac output increases in hypertrophic obstructive cardiomyopathy. C. cardiac output is not affected by hypertrophic obstructive cardiomyopathy. D. restrictive cardiomyopathy decreases cardiac output.

B. Cardiac output isn't affected by hypertrophic obstructive cardiomyopathy because the size of the ventricle remains relatively unchanged. Dilated cardiomyopathy and restrictive cardiomyopathy decrease cardiac output.

A 54-year-old client is admitted with an acute inferior-wall myocardial infarction (MI). During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which nursing diagnosis takes priority for this client? A. Anxiety B. Risk for decreased cardiac tissue perfusion C. Acute pain D. Ineffective family therapeutic regimen management

B. MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is risk for decreased cardiac tissue perfusion. Anxiety, acute pain, and ineffective family therapeutic regimen management are appropriate but don't take priority.

A nurse is preparing a client for cardiac catheterization. What is the priority assessment for the nurse to obtain? A. Weight and height B. Allergy to iodine or shellfish C. Apical heart rate D. Cardiac rhythm

B. Since cardiac catheterization involves the injection of a radiopaque dye, it's most important for the nurse to determine if the client has allergies to iodine or shellfish. The other three parameters are also part of the assessment, but none is the most critical assessment.

The heart rhythm of a client who has experienced cardiac arrest and is receiving cardiopulmonary resuscitation (CPR) deteriorates to ventricular fibrillation. What is the most important action of the nurse? A. Administer 1 mg of epinephrine I.V. B. Defibrillate with 360 joules. C. Continue CPR. D. Administer vasopressin 40 units I.V.

B. To attempt to convert the rhythm, the nurse should first defibrillate the client with 360 joules. If this is unsuccessful, she would then continue CPR for five cycles and attempt to defibrillate again. Epinephrine and vasopressin may be given but not until after the first two defibrillation attempts.

A client is suspected of having deep venous thrombosis (DVT). The nurse anticipates that which diagnostic studies will be prescribed? Select all that apply. A. Platelet count B. D-dimer blood test C. Electrocardiography D. Venous duplex scanning E. Magnetic resonance imaging (MRI) F. International normalized ratio (INR)

B. D. DVT is a disorder involving a thrombus in one of the deep veins of the body, most commonly the iliac or femoral veins. Venous duplex scanning is a primary diagnostic test for DVT because it allows visualization of the vein, which provides a reliable diagnosis of venous thrombus. The D-dimer blood test is also used in evaluation of DVT. The D-dimer is a product of fibrin degradation and is indicative of fibrinolysis, which occurs with thrombosis. A platelet count will not provide information related to the presence of DVT. An INR is a blood test used to evaluate the effectiveness of warfarin (Coumadin) therapy. Electrocardiography evaluates the electrical activity of the heart. An MRI may be used for a variety of reasons, such as to detect the presence of a tumor. It will not diagnose DVT.

A client is experiencing acute pulmonary edema. What is the best position for the nurse to place the client in? A. Lying flat in bed B. Left side-lying C. High Fowler's position D. Semi-Fowler's position

C. A high Fowler's position promotes ventilation and facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen the breathing and increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as high Fowler's position will.

A client has a continuous blood pressure reading of 142/90 mm Hg. The reading is interpreted as indicative of what? A. Stage 2 hypertension B. Prehypertension C. Stage 1 hypertension D. Normal

C. According to the Seventh Joint National Committee (JNC 7), a systolic blood pressure of 140 to 159 mm Hg or a diastolic pressure of 90 to 99 mm Hg represents stage 1 hypertension. A systolic pressure greater than or equal to 160 mm Hg or diastolic pressure greater than or equal to 100 mm Hg represents stage 2 hypertension. A systolic pressure of 120 to 139 mm Hg or diastolic pressure of 80 to 89 mm Hg represents prehypertension. A systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg are considered normal.

Four clients have been admitted to the cardiac intensive care unit after experiencing acute myocardial infarctions. The nurse reviews each client's chart to determine the assessment of cardiac damage and risk for development of cardiogenic shock. What is the percentage of damage that places the client at risk for shock? A. 10% B. 25% C. 40% D. 90%

C. At least 40% of the heart muscle must be involved for cardiogenic shock to develop. In most circumstances, the heart can compensate for up to 25% damage. An infarction involving 90% of the heart would result in death.

During the assessment of a client who had an abdominal aortic repair, the nurse notes a hematoma in the perineal area. The nurse interprets this as: A. hernia. B. stage 1 pressure ulcer. C. retroperitoneal rupture at the repair site. D. rapid expansion of the aneurysm.

C. Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesn't cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma won't form.

Which condition is caused by increased hydrostatic pressure and chronic venous stasis? A. Venous occlusion B. Cool extremities C. Nocturnal calf muscle cramps D. Diminished blood supply to the feet

C. Calf muscle cramps result from increased pressure and venous stasis secondary to varicose veins. An occlusion is a blockage of blood flow. Cool extremities and diminished blood supply to the feet are symptoms of arterial blood flow changes.

Which term would the nurse use to describe persistently elevated blood pressure with an unknown cause? A. Accelerated hypertension B. Malignant hypertension C. Primary hypertension D. Secondary hypertension

C. Characterized by a progressive, usually asymptomatic blood pressure increase over several years, primary hypertension is the most common type. Malignant hypertension, also known as accelerated hypertension, is rapidly progressive, uncontrollable, and causes a rapid onset of complications. Secondary hypertension occurs secondary to a known, correctable cause.

A client with a newly developed deep vein thrombosis (DVT) complains of pain. How does the nurse expect the client to describe the pain? A. Dull ache B. No pain C. Sudden onset D. Tingling

C. DVT is associated with deep leg pain of sudden onset, which occurs secondary to the occlusion. A dull ache is more commonly associated with varicose veins. If the thrombus is large enough, it will cause pain. A tingling sensation is associated with an alteration in arterial blood flow.

One hour after I.V. furosemide (Lasix) is administered to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which electrolyte imbalance should the nurse suspect? A. Hypocalcemia B. Hypermagnesemia C. Hypokalemia D. Hypernatremia

C. Furosemide is a potassium-depleting diuretic that can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia. Hypocalcemia, which slows conduction through the atrioventricular junction, can cause such bradyarrhythmias as atrioventricular block. Hypermagnesemia may lead to bradycardia, not tachycardia. Hypernatremia may cause sinus tachycardia as a result of water loss.

A client is admitted to the step-down unit with an abdominal aortic aneurysm. The nurse would be most concerned if the client experienced: A. hypotension. B. cramping in the legs. C. sudden, severe back pain. D. diaphoresis.

C. If expansion and impending rupture of an abdominal aneurysm is suspected, the nurse assesses for onset of sudden and severe pain in the back or lower abdomen, which may radiate to the groin.

A client with new onset of atrial fibrillation is receiving warfarin (Coumadin) to help prevent thromboemboli. The warfarin dosage will reach therapeutic levels when the international normalized ratio (INR) falls within which range? A. 1 to 2 B. 1.5 to 2.5 C. 2 to 3 D. 2.5 to 3.5

C. In a client with atrial fibrillation, warfarin reaches therapeutic levels when the INR is 2 to 3. Lower ratios are below the therapeutic range. A range of 2.5 to 3.5 is too high for a client on warfarin and increases the hemorrhage risk.

The nurse is reviewing a client's echocardiogram report, which states, "hypertrophy of the ventricular septum." The client should be further evaluated for which type of cardiomyopathy? A. Congestive B. Dilated C. Hypertrophic obstructive D. Restrictive

C. In hypertrophic obstructive cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy. Congestive isn't a form of cardiomyopathy.

The nurse is preparing to assess a client for jugular vein distention. How should the nurse position the head of the client's bed? A. HighFowler's B. Raised 10 degrees C. Raised 30 degrees D. Supine

C. Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Increased pressure can't be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). In high Fowler's position, the veins would be barely discernible above the clavicle.

The nurse should prepare a client for which treatment to eliminate varicose veins? A. Ablation therapy B. Cold therapy C. Ligation and stripping D. Radiation

C. Ligation and stripping of the vein can rid the vein of varicosity.This invasive procedure will take care of current varicose veins only; it won't prevent others from forming. The other procedures aren't used for varicose veins.

A client who was recently diagnosed with an aneurysm asks the nurse if any genetic disease is closely linked to an aneurysm. What is the best response by the nurse? A. Cystic fibrosis B. Hemophilia C. Marfan's syndrome D. Sickle cell anemia

C. Marfan's syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with this syndrome are more likely to develop an aneurysm. Although cystic fibrosis, hemophilia, and sickle cell anemia are all genetic diseases, they haven't been linked to aneurysms.

A 57-year-old client with a history of bronchial asthma is prescribed propranolol (Inderal) to control hypertension. Before administering propranolol, which action should the nurse take first? A. Monitor apical pulse rate. B. Instruct the client to take the medication with food. C. Question the physician about the order. D. Caution the client to rise slowly when standing.

C. Propranolol and other beta-adrenergic blockers are contraindicated in a client with bronchial asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician. Taking propranolol with food enhances its absorption. Because propranolol can cause light-headedness, the client should be told to rise slowly when standing.

The nurse should assess a client with secondary varicose veins for which signs and symptoms? A. Pallor and severe pain B. Severe pain and edema C. Edema and pigmentation D. Absent hair growth and pigmentation

C. Secondary varicose veins result from an obstruction of the.deep veins. Incompetent valves lead to impaired blood flow, and edema and pigmentation result from venous stasis. Severe pain, pallor, and absent hair growth are symptoms of an altered arterial blood flow.

The nurse is assessing a client for an abdominal aortic aneurysm. Which area does the nurse palpate? A. Right upper quadrant B. Directly over the umbilicus C. Middle lower abdomen to the left of the midline D. Middle lower abdomen to the right of the midline

C. The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.

A client with acute pulmonary edema caused by heart failure asks the nurse which area of the heart is usually damaged. What is the best response by the nurse? A. Left atrium B. Right atrium C. Left ventricle D. Right ventricle

C. The left ventricle is responsible for the majority of force for cardiac output. If the left ventricle is damaged, the output decreases and fluid accumulates in the interstitial and alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium and right ventricle were damaged, right-sided heart failure would result.

If medical treatment for cardiomyopathy fails, the nurse should prepare the client for which of the following procedures? A. Cardiac catheterization B. Coronary artery bypass graft( CABG) C. Heart transplantation D. Intra-aortic balloon pump (IABP)

C. The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible. Cardiac catheterization is an invasive diagnostic procedure for coronary artery disease. CABG is a surgical intervention used for atherosclerotic vessels. An IABP is an invasive treatment that assists the failing heart; however, it's only a temporary solution.

A 23-year-old client develops cardiac tamponade when the car he was driving hits a telephone pole; he wasn't wearing a seat belt. The nurse helps the physician perform a pericardiocentesis. Which outcome would indicate that the treatment has been effective? A. Neck vein distention B. Pulsus paradoxus C. Increased blood pressure D. Muffled heart sounds

C. Cardiac tamponade is associated with decreased cardiac output, which in turn reduces blood pressure. By removing a small amount of blood, pericardiocentesis increases blood pressure. Neck vein distention, pulsus paradoxus, and muffled heart sounds indicate persistent cardiac tamponade, meaning that pericardiocentesis hasn't been effective.

What is the most appropriate action for a nurse to take when administering a new blood pressure medication to a client? A. Administer the medication to the client without explanation. B. Inform the client of the new drug only if he asks about it. C. Inform the client of the new medication, its name and use, and the reason for the change in medication. D. Administer the medication, and inform the client that the physician will later explain the medication.

C. Informing the client of the medication, its use, and the reason for the medication change is important to the care of the client. Teaching the client about his treatment regimen promotes compliance. The other responses are inappropriate.

Which of the following parameters increases as myocardial oxygen consumption increases? A. Preload, after load, and cerebral blood flow B. Preload, after load, and renal blood flow C. Preload, after load, contractility, and heart rate D. Preload, after load, cerebral blood flow, and heart rate

C. Myocardial oxygen consumption increases as preload, after load, contractility, and heart rate increase. Cerebral blood flow and renal blood flow don't directly affect myocardial oxygen consumption.

A 35-year-old client was admitted to the coronary care unit (CCU) 2 days ago with an acute myocardial infarction. Which action would breach client confidentiality? A. The CCU nurse gives a verbal report to the nurse on the telemetry unit before transferring the client to that unit. B. The CCU nurse notifies the on-call physician about a change in the client's condition. C. The emergency department (ED) nurse calls up the latest electrocardiogram results to check the client's progress. D. At the client's request, the CCU nurse updates the client's wife on his condition.

C. The ED nurse is no longer directly involved with the client's care and thus has no legal right to information about his present condition. Anyone directly involved in his care (such as the telemetry nurse and the on-call physician) has the right to information about his condition. Because the client requested that the nurse update his wife on his condition, doing so doesn't breach confidentiality.

Which statement by the nurse accurately explains the need for a client with hypertension to obtain an annual eye exam? A. "By examining your corneas, aN ophthalmologist can visualize microvascular hemorrhages in your eyes." B. "By examining the fovea in your eyes, an ophthalmologist can visualize microvascular venous occlusions in your eyes." C. "By examining the retina in your eyes, an ophthalmologist can detect changes in the arteries in your eyes." D. "By examining the sclera of your eyes, an ophthalmologist can detect changes in the arteries in your eyes."

C. The retina is the only site in the body where arteries can be seen without invasive techniques. Changes in the retinal arteries signal similar damage to vessels elsewhere. The cornea is the nonvascular, transparent fibrous coat where the iris can be seen. The fovea is the point of central vision. The sclera is the fibrous tissue that forms the outer protective covering over the eyeball.

The nurse is aware that antihypertensives should be used cautiously in clients already taking which other drug? A. Ibuprofen(Advil) B. Diphenhydramine (Benadryl) C. Thioridazine D. Vitamins

C. Thioridazine affects the neurotransmitter norepinephrine, which causes hypotension and other cardiovascular effects. Administering an antihypertensive to a client who already has hypotension could have serious adverse effects. Ibuprofen is an anti-inflammatory that doesn't interfere with the cardiovascular system. Although diphenhydramine does have histaminic effects such as sedation, it isn't known to decrease blood pressure. Vitamins aren't drugs and don't interfere with cardiovascular function.

A client admitted for a lower extremity deep vein thrombosis is experiencing dyspnea, chest pain, and diminished breath sounds. The nurse suspects this client may be developing which condition? A. Hemothorax B. Pneumothorax C. Pulmonary embolism D. Pulmonary hypertension

C. A pulmonary embolism is a blood clot that forms in a vein, travels to the lungs, and lodges in the pulmonary vasculature. A hemothorax refers to blood in the pleural space. A pneumothorax is caused by an opening in the pleura. Pulmonary hypertension is an increase in pulmonary artery pressure, which increases the workload of the right ventricle.

A nurse is monitoring a client for manifestations of cardiac tamponade. It is important for the nurse to assess the client for which of the following? Select all that apply. A. Bradycardia B. Hypertension C. Kussmaul's sign D. Muffled heart sounds E. Widened pulse pressure F. Distended neck veins on inspiration

C. D. F. Cardiac tamponade is a life-threatening condition caused by the accumulation of fluid in the pericardium. This fluid, which can be blood, pus, or air in the pericardial sac, accumulates fast and in sufficient quantity to compress the heart and restrict blood flow in and out of the ventricles. The following are manifestations of cardiac tamponade and should be reported immediately: elevated venous pressure, distended neck veins, and Kussmaul's sign (distended neck veins on inspiration); hypotension and narrowed pulse pressure; tachycardia; dyspnea, restlessness, and anxiety; cyanosis of the lips and nails; diaphoresis; muffled heart sounds; pulsus paradoxus; decreased friction rub; decreased QRS voltage; and electrical alternans.

The nurse is aware that a client who has just experienced a myocardial infarction (MI) is most at risk for developing: A. cardiogenic shock. B. heartfailure. C. arrhythmias. D. pericarditis.

C. arrhythmias Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after MI.

The nurse is planning care for a client in cardiogenic shock. What is the priority goal? A. Correct hypoxia. B. Prevent infarction. C. Correct metabolic acidosis. D. Increase myocardial oxygen supply.

D. A balance must be maintained between oxygen supply and demand. Ina shock state, the myocardium requires more oxygen. If it can't get more oxygen, the shock worsens. Increasing the oxygen will also play a large role in correcting metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention isn't an appropriate goal for this condition.

A 63-year-old client has Prinzmetal's angina. To reduce the risk of coronary artery spasms, which type of medication is the physician most likely to prescribe? A. Beta-adrenergic blocker B. Angiotensin-converting enzyme (ACE) inhibitor C. Inotropic vasodilator D. Calcium channel blocker

D. A calcium channel blocker, such as diltiazem (Cardizem), is indicated in managing Prinzmetal's angina because it reduces the incidence of coronary artery spasm. A beta-adrenergic blocker, such as metoprolol (Lopressor), treats angina by decreasing myocardial oxygen needs and has no effect on coronary artery spasms. An ACE inhibitor, such as enalapril (Vasotec), is used to manage hypertension. An inotropic vasodilator, such as milrinone, is indicated for short-term I.V. therapy in heart failure.

A client has a reduced serum high-density lipoprotein (HDL) level and an elevated low-density lipoprotein (LDL) level. Which dietary modification is appropriate for this client? A. Fiber intake of less than 10% of total calories daily B. Less than 40% of calories from fat C. Cholesterol intake of less than 300 mg daily D. Less than 7% of calories from saturated fat

D. A client with low serum HDL and high serum LDL levels should get less than 7% of daily calories from saturated fat. Fiber intake should be at least 15% of total daily calories, total fat intake should be only 25% to 35% of daily calories, and cholesterol intake should be less than 200 mg daily.

A paradoxical pulse occurs in a client who had coronary artery bypass graft (CABG) surgery 2 days ago. Which surgical complication should the nurse suspect? A. Left-sided heart failure B. Aortic regurgitation C. Complete heart block D. Pericardial tamponade

D. A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat, with a regular rhythm). Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak). Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure).

While assessing a client with deep vein thrombosis (DVT), which of the following terms indicates calf pain experienced by the client due to sharp dorsiflexion of the foot? A. Dyskinesia B. Eversion C. Positive Babinski's reflex D. Positive Homans' sign

D. A positive Homans' sign (elicited by quickly dorsiflexing the foot), when accompanied by other findings, is diagnostic of DVT. Alone, however, Homans' sign can't be used to diagnose DVT because other conditions of the calf can produce a positive Homans' sign. Dyskinesia is the inability to perform voluntary movement. Eversion is the outward movement of the transverse tarsal joint. A positive Babinski's reflex is an extensor plantar response.

Which is the most important instrument used as a diagnostic and monitoring tool for determining the severity of a shock state? A. Arterial line B. Indwelling urinary catheter C. Electrocardiogram( ECG) monitor D. Pulmonary artery catheter

D. A pulmonary artery catheter is used to give accurate pressure measurements within the heart, which aids in determining the course of treatment. An arterial line, an indwelling urinary catheter, and an ECG monitor all provide valuable information related to the severity of a shock state but aren't the most important instrument.

A client with acute pulmonary edema has been taking an angiotensin- converting enzyme (ACE) inhibitor. The nurse teaches him that this medication has been ordered for which reason? A. To promote diuresis B. To increase contractility C. To decrease contractility D. To reduce blood pressure

D. ACE inhibitors are given to reduce blood pressure by inhibiting aldosterone production, which in turn decreases sodium and water reabsorption. ACE inhibitors also reduce production of angiotensin II, a potent vasoconstrictor. Diuretics are given to promote diuresis. Inotropic agents increase contractility. Negative inotropic agents decrease contractility.

The nurse is performing a cardiac assessment on her client and auscultates a fourth heart sound (S4). The nurse interprets this as indicative of which of the following? A. Dilated aorta B. Normally functioning heart C. Decreased myocardial contractility D. Failure of the ventricle to eject all the blood during systole

D. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart.

A client has undergone ligation and stripping. What is the best intervention for the nurse to implement postoperatively? A. Sitting B. Bed rest C. Ice packs D. Elastic leg compression

D. Elastic leg compression helps venous return to the heart, thereby decreasing venous stasis. Sitting and bed rest are contraindicated because both promote decreased blood return to the heart and venous stasis. Although ice packs would help reduce edema, they would also cause vasoconstriction and impede blood flow.

Which of the following statements, if made by the client, indicates an understanding of why furosemide (Lasix) is administered to treat hypertension? A. It dilates peripheral blood vessels. B. It decreases sympathetic cardio acceleration. C. It inhibits the angiotensin-converting enzyme. D. It inhibits reabsorption of sodium and water in the loop of Henle.

D. Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop of Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action on angiotensin.

The nurse is providing teaching for a client who experienced an acute episode of pulmonary edema. What is the most important instruction for the nurse to provide? A. Limit caloric intake. B. Restrict carbohydrates. C. Measure weight twice per day. D. Call the physician if there is weight gain of more than 3 lb (1.5 kg) in 1 day.

D. Gaining 3 lb in 1 day is indicative of fluid retention that would increase the workload of the heart, thereby putting the client at risk for acute pulmonary edema. Limiting caloric intake doesn't influence fluid status. Restricting carbohydrates wouldn't affect fluid status. The body needs carbohydrates for energy and healing. The client must be weighed in the morning after the first urination. If the client is weighed later in the day, the finding wouldn't be accurate because of fluid intake during the day.

While assessing a client diagnosed with angina, the client asks what causes it. Which of the following responses by the nurse would be the most appropriate? A. Increased preload B. Decreased after load C. Coronary artery spasm D. Inadequate oxygen supply to the myocardium

D. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased after load causes increased cardiac output. Coronary artery spasm is responsible for variant angina.

The nurse is assessing a client who is displaying the earliest sign of cardiogenic shock. The nurse would document this assessment finding as: A. cyanosis. B. decreased urine output. C. presence of fourth heart sound (S4). D. altered level of consciousness.

D. Initially, the decrease in cardiac output results in a decrease in cerebral blood flow that causes restlessness, agitation, or confusion. Cyanosis, decreased urine output, and presence of an S4 are all later signs of shock.

A client with angina pectoris has a stat electrocardiogram (ECG) performed during an episode of chest pain. The nurse reviews the ECG and notes myocardial ischemia. This would be displayed as: A. increased QRS duration. B. shortened PR interval. C. pathological Q-wave formation. D. T-wave inversion.

D. Ischemic changes are represented on an ECG by T-wave inversion. An increased QRS duration suggests a bundle-branch block. A shortened PR interval indicates a junctional rhythm. Pathological Q waves are present with myocardial infarction.

After undergoing a cardiac catheterization, a client has a large puddle of blood under his buttocks. The most important intervention by the nurse is: A. call for help. B. obtain vital signs. C. ask the client to "lift up." D. apply gloves and assess the groin site.

D. Observing standard precautions is the first priority when dealing with any body fluid. Assessment of the groin site is the second priority. This establishes where the blood is coming from and determines how much blood has been lost. The goal in this situation is to stop the bleeding. The nurse would call for help if it were warranted after the assessment of the situation. After determining the extent of the bleeding, vital signs assessment is important. The nurse should never move the client, in case a clot has formed. Moving can disturb the clot and cause rebleeding.

The nurse anticipates that a client with intermittent claudication will receive which medication? A. Analgesics B. Warfarin(Coumadin) C. Heparin D. Pentoxifylline (Trental)

D. Pentoxifylline decreases blood viscosity, increases red blood cell flexibility, and improves flow through small vessels. Analgesics are administered for pain relief. Warfarin and heparin are anticoagulants.

The nurse evaluates her teaching by asking the student nurse which term is used to describe the amount of stretch on the myocardium at the end of diastole. Which is the most accurate response? A. Afterload B. Cardiac index C. Cardiac output D. Preload

D. Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines preload. After load is the force against which the ventricle must expel blood. Cardiac index is the individualized measurement of cardiac output, based on the client's body surface area. Cardiac output is the amount of blood the heart is expelling per minute.

A nurse is caring for a 78-year-old female client with sick sinus syndrome who is awaiting permanent pacemaker placement. The nurse is aware that which assessment finding indicates that the client is experiencing an initial drop in cardiac output? A. Decreased blood pressure B. Alteration in level of consciousness (LOC) C. Decreased blood pressure and diuresis D. Increased blood pressure and fluid volume

D. The body compensates for a decrease in cardiac output with a rise in blood pressure, due to the stimulation of the sympathetic nervous system and an increase in blood volume as the kidneys retain sodium and water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.

The nurse performs an assessment on a newly admitted client. The data include dyspnea, cough, weight gain, weakness, and edema. The nurse interprets these as signs and symptoms of: A. pericarditis. B. hypertension. C. myocardial infarction (MI). D. heart failure.

D. These are the classic symptoms of heart failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. MI is usually exhibited by chest pain and diaphoresis.

The nurse is providing discharge instructions for a client with varicose veins. The nurse determines the need for further teaching when the client makes which statement? A. "Exercise will make me feel better." B. "I have to elevate my legs." C. "Lying down can relieve my symptoms." D. "Wearing tight clothes will not affect me."

D. Tight clothing, especially below the waist, increases vascular volume and impedes blood return to the heart. Exercise, leg elevations, and lying down usually relieve symptoms of varicose veins.

A client with an impending myocardial infarction (MI) is experiencing angina. The nurse would document the angina as? A. Variant angina B. Chronic stable angina C. Microvascular angina D. Unstable angina

D. Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months. Variant angina is related to coronary artery spasm, chronic stable angina is predictable and relieved by rest and nitrates, and microvascular angina is related to impairment of vasodilator reserve in normal coronary arteries.

Which condition is most closely associated with weight gain, nausea, and a decrease in urine output? A. Angina pectoris B. Cardiomyopathy C. Left-sided heart failure D. Right-sided heart failure

D. Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output.

A client is admitted to the unit with intermittent claudication. Which of the following responses by the nurse would most accurately explain the cause of the condition to the client? A. Inadequate blood supply B. Elevated leg position C. Dependent leg position D. Inadequate muscle oxygenation

D. When a muscle is starved of oxygen, it produces pain much like that of angina. Inadequate blood supply would cause necrosis. Leg position either alleviates or aggravates the condition.

A client's aneurysm has ruptured. What is the priority intervention? A. Antihypertensive medication administration B. Aortogram C. Beta-adrenergic blocker administration D. Surgical intervention

D. When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.

A 38-year-old client comes to the emergency department complaining that his heart "suddenly began to race." After attaching him to the cardiac monitor, the nurse observes atrial tachycardia. Which rhythm strip characteristics indicate this arrhythmia? A. Atrial rate greater than the ventricular rate, sawtooth P waves B. Irregular rhythm, indiscernible atrial rate, absent P waves C. Regular atrial and ventricular rhythms, rate of 123 beats/minute D. Regular atrial and ventricular rhythms, P wave hidden in the T wave, rate of 210 beats/minute

D. With atrial tachycardia, the rhythm is regular, the P wave is hidden in the preceding T wave, and the rate ranges from 140 to 250 beats/minute. A ventricular rate that varies with the degree of atrioventricular block, along with sawtooth P waves, characterizes atrial flutter. Irregular ventricular response and absent P waves characterize atrial fibrillation. Regular and equal atrial and ventricular rhythms and a rate of 100 to 160 beats/minute characterize sinus tachycardia.

A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide? A. "Eat foods high in potassium." B. "Take daily potassium supplements." C. "Discontinue sodium restrictions." D. "Avoid salt substitutes."

D. Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue.

Which blood gas abnormality is initially most suggestive of pulmonary edema? A. Anoxia B. Hypercapnia C. Hyperoxygenation D. Hypocapnia

D. In an attempt to compensate for increased work of breathing due to hyperventilation, carbon dioxide (CO2) decreases, causing hypocapnia. If the condition persists, CO2 retention occurs and hypercapnia results. Although oxygenation is relatively low, the client isn't anoxic. Hyperoxygenation would result if the client was given oxygen in excess. However, secondary to fluid buildup, the client would have a low oxygenation level.

Which of the following drug classes should be administered to a client with heart failure to maximize cardiac performance? A. Beta-adrenergic blockers B. Calcium channel blockers C. Diuretics D. Inotropic agents

D. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.

A client is admitted with deep vein thrombosis (DVT). Which of the following interventions would be most appropriate to relieve the pain? A. Application of heat B. Bed rest C. Exercise D. Leg elevation

D. Leg elevation alleviates the pressure caused by thrombosis and occlusion by assisting venous return. The application of heat would dilate the vessels and pool blood in the area of the thrombus, increasing the risk of further thrombus formation. Bed rest adds to venous stasis by increasing the risk of thrombosis formation. When DVT is diagnosed, exercise isn't recommended until the clot has dissolved.

A 59-year-old female client is experiencing chest pain at rest that is unresponsive to nitroglycerine. The physician diagnoses unstable angina and alerts the nurse that the client will require treatment with immediate surgical intervention. Which treatment is most appropriate? A. Cardiac catheterization B. Echocardiogram C. Heart transplantation D. Percutaneous transluminal coronary angioplasty (PTCA)

D. PTCA can alleviate the blockage and restore blood flow and oxygenation. Cardiac catheterization is a diagnostic tool—not a treatment. An echocardiogram is a noninvasive diagnostic test. Heart transplantation involves replacing the client's heart with a donor heart and is the treatment for end-stage cardiac disease.

A nurse is assessing a bedridden client and notes sacral edema. The nurse determines that the edema is most likely the result of which of the following? A. Diabetes mellitus B. Pulmonary emboli C. Chronic kidney disease D. Right-sided heart failure

D. Right-sided heart failure The most accurate area on the body to assess dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and chronic kidney disease aren't directly linked to sacral edema.

A client who is being evaluated for myocardial infarction (MI) asks the nurse which diagnostic tool is most commonly used to determine the location of myocardial damage. The best response by the nurse is: A. cardiac catheterization. B. cardiac enzymes. C. echocardiogram. D. electrocardiogram (ECG).

D. electrocardiogram (ECG) The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction (MI). Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately. Cardiac enzymes are used to diagnose MI but can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed.

Which term refers to the condition of blood coagulating faster than normal, causing thrombin and other clotting factors to multiply? A. Embolus B. Hypercoagulability C. Venous stasis D. Venous wall injury

Hypercoagulability is the condition of blood coagulating faster than normal, causing thrombin and other clotting factors to multiply. This condition, along with venous stasis and venous wall injury, accounts for the formation of deep vein thrombosis. An embolus is a blood clot or fatty globule that formed in one area and is carried through the bloodstream to another area.

The nurse anticipates that a client with right-sided heart failure will exhibit which of the following? A. Adequate urine output B. Polyuria C. Oliguria D. Polydipsia

Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren't associated with right-sided heart failure.

A client with angina pectoris comes to the emergency room. Which of the following drugs can the nurse expect to administer? A. Aspirin B. Furosemide (Lasix) C. Nitroglycerin D. Nifedipine (Procardia)

c. Nitroglycerin is administered to reduce the myocardial demand, which decreases ischemia and relieves pain. In addition, nitroglycerin dilates the vasculature, thereby reducing preload. Aspirin is administered to reduce the risk of myocardial infarction in clients with unstable angina. Furosemide is a loop diuretic that won't directly reduce pain or prevent angina. Nifedipine is a calcium channel blocker primarily used to decrease coronary artery spasm, as in variant angina.