Cardiac LvL 1 - 7 (prep U)

A 68-year-old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The nurse should first: offer pain medication for the chest heaviness. administer oxygen via nasal cannula. inform the health care provider (HCP) of the chest heaviness. inquire about the onset, duration, severity, and precipitating factors of the heaviness. (x) 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 (x) Serum potassium (x) International Normalized Ratio Prothrombin time (PT) Thrombin time An obese diabetic client has bilateral leg aching is to start a cardiac rehabilitation with an exercise program. Using which exercise equipment will be most helpful to the client? stationary bicycle (x) treadmill elliptical trainer stair climber When assessing a client with left-sided heart failure, the nurse expects to note: ascites. jugular vein distention. air hunger. (x) pitting edema of the legs.

Lvl 5

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: anticoagulant. (x) antibiotic. antihypertensive. anticonvulsant. During a home visit, the nurse assesses a client who is taking hydrochlorothiazide and lisinopril for the treatment of hypertension. Which finding would indicate the nurse should inform the health care provider of a possible need to change medication therapy? Potassium level is 4.1 mEq/L. Client has a persistent cough. (x) Blood pressure is 132/80 mm Hg. Client is experiencing nocturia. A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? Magnesium level of 2.5 mg/dl (0.1 mmol/L) Calcium level of 7.5 mg/dl (0.4 mmol/L) Sodium level of 152 mEq/L (152 mmol/L) Potassium level of 3.1 mEq/L (3.1 mmol/L) (x) A nurse is caring for a client who is experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. What is the nurse's priority action? Administer atropine 0.5 mg IV push as ordered. (x) Notify the attending physician. Administer a 500 ml IV bolus of normal saline solution (0.9% NaCl). Administer lidocaine 100 mg IV push as ordered

LvL 3

Question 1 of 5 The nurse should adjust a client's heparin dose according to a prescribed anticoagulation order based on maintaining which laboratory value at what therapeutic level for anticoagulant therapy? Prothrombin time, 1.5 to 2.5 times the normal control. International Normalized Ratio, 2 to 3 seconds. Thrombin clotting time, 10 to 15 seconds. Partial thromboplastin time, 1.5 to 2.5 times the normal control. (x) A client is diagnosed with thrombophlebitis. What nursing action would demonstrate the appropriate level of activity for this client? Bed rest with the affected extremity in the dependent position Bed rest with all normal activities as long as there no increased pain on the affected site Bed rest, keeping the affected extremity flat Bed rest with elevation of the affected extremity A client is hospitalized following a report of dizziness, shortness of breath, and chest pain. Based on the ECG rhythm, the client is scheduled for a transesophageal echocardiogram (TEE) today. Which nursing interventions would be appropriate at this time? Initiate a heparin drip. Encourage the client to ambulate to the bathroom. Prepare the client for immediate electrical cardioversion. Administer oxygen via nasal cannula as prescribed. The nurse is caring for a client with peripheral artery disease who has just returned from having a percutaneous transluminal balloon angioplasty. Which finding requires immediate attention from the nurse? a change in the intensity of the pulse from the baseline pain "2 out of 10" at the catheterization site shiny skin and a hairless appearance on the affected leg the presence of an ulcer on the limb of the catheterization site

LvL 6

A client whose condition remains stable after a myocardial infarction gradually increases activity. To determine whether the activity is appropriate for the client the nurse should assess the client for: edema. cyanosis. dyspnea. (x) weight loss. A client is discharged after an aortic aneurysm repair with a synthetic graft to replace part of the aorta. The nurse should instruct the client to notify the health care provider (HCP) before having: blood drawn. an x-ray examination. an IV line inserted. major dental work. (x) In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? Cyanosis of the lips Bilateral crackles Productive cough Leg edema (x) The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client: "This drug will constrict your blood vessels and keep your blood pressure from getting too low." "This drug will slow your heart rate down." "This drug will dilate your blood vessels and lower your blood pressure." (x) "This drug helps your heart beat more forcefully." Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider (HCP)? a change in the pattern of the chest pain (x) pain during sexual activity pain during an argument pain during or after a physical activity when given the option to report something to a nurse, the most important is a change in baseline. Never forget this. Following abdominal surgery, which factor predisposes a client to deep vein thrombosis? The client will be immobile during and shortly after surgery. (X) The client usually walks 3 miles (4.8 kilometers) a day. The client is 5 feet 9 inches (172.5 cm) tall and weighs 128 lb (58 kg). The client has been pregnant four times A client is in hypovolemic shock. To determine the effectiveness of fluid replacement therapy, the nurse should monitor the client's: blood pressure. (X) temperature. heart rate. hemoglobin level. A client with severe angina pectoris and ST-segment elevation on an electrocardiogram is being seen in the emergency department. In terms of diagnostic laboratory testing, it's most important for the nurse to advocate ordering a: creatine kinase level. troponin level. hemoglobin (Hb) level. (X) liver panel. A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control? Diabetes, hypercholesterolemia, and heredity Diabetes, age, and gender Age, gender, and heredity Diabetes, hypercholesterolemia, and hypertension (X) The nurse is caring for an elderly man who walks 2 miles every morning. The nurse notes that during his morning walk, he called his daughter and stated that he thought that he was having a heart attack. Which symptom, identified by the client, is the most common and consistent with that of a heart attack (myocardial infarction)? Sternal pain Dyspnea Edema Palpitations A client signed a consent form for participation in a clinical trial for implantable cardioverter-defibrillators. Which statement by the client indicates the need for further teaching before true informed consent can be obtained? "This implanted defibrillator will protect me against some of those bad rhythms my heart goes into." "A wire from the generator will be attached to my heart." "I wonder if there is any other way to prevent these bad rhythms." (X) "The physician will make a small incision in my chest wall and place the generator there." Which is a priority for exercising for a client who has just had a myocardial infarction? strength training program jogging exercise program risk modification education (x) low-back training program A client is receiving pentoxifylline for intermittent claudication (WHAT IS THIS, AGAIN?). The nurse should determine the effectiveness of the drug by asking if the client: can wiggle the toes. has greater circulation AEB less pain in the legs. (x) is less dizzy. is urinating more frequently. explain: Although pentoxifylline's precise mechanism of action is unknown, its therapeutic effect is to increase blood flow, and the client should have improved circulation in the legs as evident by less pain. The client does not have nerve impairment and should be able to wiggle the toes. Urination is not improved by taking pentoxifylline. Dizziness is a side effect of the drug, not an intended outcome. A client with Raynaud's phenomenon is considering having a sympathectomy. This nurse should tell the client that the surgery is performed: when all other treatment alternatives have failed. (x) in the early stages of the disease to prevent further circulatory disturbances. when the client is unable to control stress-related vasospasm. when the disease is controlled by medication. explain: Sympathectomy is scheduled only after other treatment alternatives have been explored and have failed. Medication and stress management are beneficial strategies to prevent advancement of the disease process. If the disease is controlled by medication, there is no reason for surgery. The nurse is teaching a group of women about risk for varicose veins. Which client is at risk for varicose veins? a client who has had a cerebrovascular accident a client who has had thrombophlebitis (x) a client who has had transient ischemic attacks a client who has had anemia A client with sepsis begins having labored breathing, confusion, and lethargy. What complication should the nurse assess for in this client? Acute respiratory distress syndrome (ARDS) (x) Chronic obstructive pulmonary disease (COPD) Mitral valve prolapse Anaphylaxis A client is taking verapamil hydrochloride as an antihypertensive. Which statement made by the nurse instructs the client about an adverse effect of verapamil? "A low-residue diet will help prevent the occurrence of diarrhea." "You should obtain a complete blood count routinely to monitor for potential bone marrow depression." "Restrict your fluid intake to decrease the chance of developing fluid retention." "Take your pulse and report any irregular heartbeats." (x) Which condition most commonly results in coronary artery disease (CAD)? Myocardial infarction Atherosclerosis (x) Renal failure Diabetes mellitus A client arrives in the emergency department with an ischemic stroke. Because the health care team is considering administering tissue plasminogen activator (t-PA) administration, the nurse should first: ask what medications the client is taking. determine if the client is scheduled for any surgical procedures. identify the time of onset of the stroke. (x) complete a history and health assessment. The nurse is assessing a client who is at risk for cardiac tamponade from chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if his blood pressure is 108/82 mm Hg? Record your answer using a whole number. Ans: 26

LvL 1

During digoxin therapy, a nurse should closely monitor a client's: serum potassium and magnesium levels. urine potassium and CK levels. urine glucose and ketones. serum potassium and creatine kinase (CK) levels.

LvL 4

A client arrives in the emergency department reporting intense pain in the abdomen and tells the nurse that it feels like a heartbeat in the abdomen. Which nursing assessment would indicate potential rupture of an aortic aneurysm? The client has been taking an antihypertensive for the past 3 years but forgot to take it today. The blood pressure and pulse are within normal limits, but the client's skin color is pale and slightly diaphoretic. The client reports increasing severe back pain. (x) The client reports feeling nauseated. A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy? The client demonstrates ability to tolerate more activity without chest pain. (x) The client exhibits a heart rate within normal limits. The client requests information regarding smoking cessation. The client is able to verbalize the action of all his prescribed medications The nurse instructs a client with coronary artery disease in the proper use of nitroglycerin. The client has had 2 previous episodes of coronary artery disease. At the onset of chest pain, what should the client do? Call 911 when three nitroglycerin tablets taken every 5 minutes are not effective. (x) Call 911 when five nitroglycerin tablets taken every 5 minutes are not effective. Take one tablet and then immediately call 911. Go to the emergency department if two nitroglycerin tablets taken 5 minutes apart are not effective. The nurse is obtaining the pulse of a client who has had a femoral-popliteal bypass surgery 6 hours ago. Which assessment provides the most accurate information about the client's postoperative status? fem pulse dorsalis pedis pulse (x) apical pulse A fourth heart sound (S4) indicates a: dilated aorta. normally functioning heart. decreased myocardial contractility. failure of the ventricle to eject all blood during systole. (x)

LvL 2

A client comes to the emergency department reporting of severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which of the following should the nurse do first when the client is admitted to the coronary care unit? Begin telemetry monitoring. (x) Obtain a health history. Auscultate heart sounds. Evaluate the client's pain. Which clinical manifestation would be most indicative of complete arterial obstruction in the lower extremities? aching pain burning sensations numbness and tingling coldness (x) The nurse is preparing the client with a cerebrovascular accident for discharge to home. Which will influence the client's continuing progress in rehabilitation at home? the family's ability to provide support to the client (x) the client's ability to ambulate availability of a home health aide to care for the client frequency of follow-up visits with the health care provider A client takes isosorbide dinitrate as an antianginal medication. Which statement indicates that the client understands the adverse effects of the drug? "I should take my pulse before taking the medication." "I should take isosorbide dinitrate with food." "I will need to change positions slowly so I will not get dizzy." (x) "It is important that I report any swelling in my ankles." During surgery, a client develops sinus bradycardia. The physician orders atropine sulfate. Which dose and route should the nurse use? 0.6 mg I.M. 1 mg I.V. (x) 2 mg I.M. 2 mg I.V. When assessing a client with left-sided heart failure, the nurse expects to note: ascites. pitting edema of the legs. air hunger. (x) jugular vein distention. The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially? Respiratory alkalosis (x) Respiratory acidosis Metabolic acidosis Metabolic alkalosis

LvL 7