Day 2: Test Taking Strategy

Which assessment data make the client the least likely candidate for implantation of an implantable cardioverter-defibrillator (ICD)? 1. Three episodes of cardiac arrest unrelated to MI 2. Syncopal episodes related to ventricular tachycardia 3.Confirmed ventricular dysrhythmias, despite medication therapy 4. An episode of cardiac arrest related to myocardial infarction (MI)

4. An episode of cardiac arrest related to myocardial infarction (MI) Rationale:An implantable cardioverter-defibrillator (ICD) detects and delivers an electric shock to terminate life-threatening episodes of ventricular tachycardia and ventricular fibrillation. These devices are implanted in clients who are considered high risk, including those who have survived sudden cardiac death unrelated to MI, those who are refractive to medication therapy, and those who have syncopal episodes related to ventricular tachycardia.

Which assessment finding is associated with cardiac tamponade? 1. Bradycardia 2. Hypertension 3. Bounding heart sounds 4. Distended jugular veins

4. Distended jugular veins Rationale:Assessment findings with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention, and a falling blood pressure, accompanied by pulsus paradoxus (a drop in inspiratory blood pressure by greater than 10 mm Hg). Test-Taking Strategy(ies):Focus on the subject, the signs of cardiac tamponade. Think about the effects on pressure dynamics in the chest when the pericardial sac is rapidly filling with blood or fluid. This will assist in eliminating the incorrect options.Review:Signs of cardiac tamponade.

Which diagnostic or laboratory result would support the presence of ischemia in a client diagnosed with angina? 1. Increased serum potassium levels 2. Decreased serum phosphorus levels 3. Electroencephalogram (EEG) wave increases 4. ST segment depression on electrocardiogram (ECG)

4. ST segment depression on electrocardiogram (ECG) Rationale:Ischemia may be detected on an ECG by changes in the ST wave or by T-wave inversion. Ischemia represents a decreased amount of oxygen to the myocardium. Potassium, phosphorus, and EEG results are not directly related to coronary ischemia. Test-Taking Strategy(ies):Focus on the subject, ischemia and ECG results. Note the relationship between the client's diagnosis of angina and the correct option to direct you to that option.Review:Angina. Tip for the Nursing Student:For the client with a cardiac disorder, ensure that the ECG and chest radiography reports are documented in the client's record.

A client reporting episodes of increasingly severe chest pain will have an exercise stress test scheduled. The client states, "Maybe I shouldn't bother having this test. I wonder if I should just take more medication instead." The nurse should make which therapeutic response to the client? 1. "Can you tell me more about how you're feeling?" 2."Don't you really want to control your heart disease?" 3."Most people tolerate the procedure well without any complications." 4."Don't worry. We're prepared to manage any cardiac emergency if necessary."

1. "Can you tell me more about how you're feeling?" Rationale:Anxiety and fear are often present before diagnostic testing. The nurse should explore a client's feelings and concerns. The correct option is open-ended and is the only option that is phrased to engender trust and sharing of concerns by the client. The remaining options are neither nontherapeutic statements nor open-ended questions, and, therefore, limit communication. Test-Taking Strategy(ies):Focus on the subject, client anxiety before an exercise stress test. Use therapeutic communication techniques. There is only one option that addresses the client's feelings. Remember to focus on client feelings.Review:Therapeutic communication techniques.

A client is admitted to a telemetry unit with a potassium (K+) level of 6.3 mEq/L (6.3 mmol/L). In analyzing the cardiac rhythm, which electrocardiogram (ECG) changes should the nurse anticipate? 1. A sinus rhythm with a peaked T wave 2. A sinus tachycardia with an extra U wave 3. A sinus rhythm with a depressed ST segment 4. A sinus tachycardia with a prolonged QT interval

1. A sinus rhythm with a peaked T wave Rationale:Potassium levels greater than 5 mEq/L (5 mmol/L) indicate a hyperkalemia that can be detected on ECG by the presence of a tall, peaked T wave. A depressed ST segment and a U wave are present with hypokalemia when the potassium level is less than 3.5 mEq/L (3.5 mmol/L). A prolonged QT interval is indicative of hypocalcemia when the calcium level is less than 9 mg/dL (2.25 mmol/L). Test-Taking Strategy(ies):Focus on the subject, the effects of the stated potassium level on the client's ECG. Note that the client is experiencing hyperkalemia. Recalling the basic ECG changes related to hyperkalemia is necessary to answer this question.Review:The electrocardiogram (ECG) changes that occur with hyperkalemia.

The nurse is planning care for a client who is experiencing anxiety after a myocardial infarction. Which priority nursing intervention should be included in the plan of care? 1. Answer questions with factual information. 2. Provide detailed explanations of all procedures. 3. Encourage family involvement during the acute phase. 4.Administer an antianxiety medication to promote relaxation.

1. Answer questions with factual information. Rationale:Accurate information reduces fear, strengthens the nurse-client relationship, and assists the client with dealing realistically with the situation. Providing detailed information may increase the client's anxiety. Information should be provided simply and clearly. Encouraging family involvement may or may not be helpful. Medication should not be used unless necessary. Test-Taking Strategy(ies):Note the strategic word, priority, and the word anxiety in the question. Eliminate option 2 first because of the word detailed. Eliminate option 4 next because medication should not be the first intervention to alleviate anxiety; however, it may be necessary if other strategies are not effective. From the remaining options, eliminate option 3 because limiting family involvement does not reduce anxiety in all situations.Review:the measures to reduce anxiety.

A client newly diagnosed with angina pectoris asks the nurse how to prevent angina attacks. Which instruction should the nurse incorporate in a teaching session? 1. Avoid straining during bowel movements. 2. Plan all activities for early in the morning. 3. Eat fewer, larger meals for more efficient digestion. 4.Adjust medication doses freely until symptoms do not recur.

1. Avoid straining during bowel movements. Rationale:Anginal episodes are triggered by events, such as eating heavy meals, straining during bowel movements, smoking, overexertion, emotional upset, or temperature extremes. Medication therapy is monitored and regulated by the health care provider. Test-Taking Strategy(ies):Focus on the subject, prevention of angina attacks. Basic knowledge of the causes of chest pain and the principles of medication therapy helps eliminate the incorrect options. Option 2 contains the closed-ended word "all" and, therefore, should be eliminated. Options 3 and 4 are incorrect statements.Review:Teaching points for the client with angina

What should the nurse plan to include when developing a discharge teaching plan for a client diagnosed with chronic arterial insufficiency? Select all that apply. 1. Avoid the use of tobacco products. 2.Wear rounded-toe shoes with soft insoles. 3.Wash the feet daily with warm water and mild soap, and dry well. 4.Use a mirror weekly to visualize the hard-to-access places of the feet. 5.Seek assistance from a podiatrist for the removal of any ingrown toenails.

1. Avoid the use of tobacco products. 2.Wear rounded-toe shoes with soft insoles. 3.Wash the feet daily with warm water and mild soap, and dry well. 5.Seek assistance from a podiatrist for the removal of any ingrown toenails. Rationale:Foot care for the client with vascular disease includes the daily inspection and cleansing of the feet with warm water and a mild soap; drying well, especially between the toes; and wearing shoes that fit well without pressure areas. The client is also instructed to avoid crossing the legs at the knees or ankles and to avoid the use of tobacco products to prevent vasoconstriction. Conditions such as ingrown toenails, corns, and calluses should be treated by a podiatrist to avoid further complications Test-Taking Strategy(ies):Focus on the subject, client instructions for chronic arterial insufficiency. Recall that vascular disease can result in the impairment of the tissues of the feet. Eliminate option 4 because of the word weekly, knowing that this practice should be incorporated daily. The remaining options are all appropriate to incorporate in the teaching plan.Review:Foot care for the client with vascular disease.

Which intervention should the nurse anticipate will be prescribed for a client diagnosed with an inoperable abdominal aortic aneurysm (AAA)? 1. Bed rest 2. Restricting fluids 3. Antihypertensives 4. Maintaining a low-fiber diet

3. Antihypertensives Rationale:The medical treatment for AAA is controlling blood pressure. Hypertension creates added stress on the blood vessel wall, increasing the likelihood of rupture. There is no need for the client to be on bed rest or restrict fluids. A low-fiber diet is not helpful and will cause constipation. Test-Taking Strategy(ies):Focus on the subject, abdominal aortic aneurysm. Recalling the relationship between pathophysiology of AAA and hypertension will direct you to the correct option.Review:Abdominal aortic aneurysm (AAA).

The nurse is evaluating the status of a client who is recovering from myocardial infarction. Which set of assessment data does the nurse identify as being satisfactory? 1. Blood pressure 118/74 mm Hg, pulse 72 beats per minute, capillary refill 1 second, oxygen saturation 98% 2. Blood pressure 120/60 mm Hg, pulse 80 beats per minute, capillary refill 4 seconds, oxygen saturation 94% 3. Blood pressure 100/50 mm Hg, pulse 110 beats per minute, capillary refill 3 seconds, oxygen saturation 93% 4. Blood pressure 110/70 mm Hg, pulse 86 beats per minute, capillary refill 5 seconds, oxygen saturation 92%

1. Blood pressure 118/74 mm Hg, pulse 72 beats per minute, capillary refill 1 second, oxygen saturation 98% Rationale:A normal blood pressure (BP) for an adult is a systolic BP less than 140 mm Hg and a diastolic BP less than 90 mm Hg. The normal heart rate ranges from 60 to 100 beats per minute. Capillary refill times should be within 3 seconds. Normal oxygen saturation is 95% to 100%. Test-Taking Strategy(ies):Focus on the subject, vital signs with myocardial infarction. Note the word satisfactory in the question. Recalling the normal blood pressure, pulse, capillary refill time, and oxygen saturation level will direct you to the correct option.Review:Myocardial infarction Tip for the Nursing Student:Interventions for the client who develops cardiogenic shock as a complication of myocardial infarction include administering morphine sulfate intravenously as prescribed to decrease pulmonary congestion and relieve pain, administering oxygen as prescribed, and preparing for intubation and mechanical ventilation.

The nurse is assigned to care for a client who underwent percutaneous coronary intervention (PCI) via cardiac catherization of his right groin. The nurse assesses the client's right groin and notices faint distal pulses, hematoma formation at the insertion site, and decreased sensation and motion by the client. What action should the nurse take? 1. Call the health care provider immediately. 2. Place pressure on the insertion site for 5 minutes. 3.Get the client out of bed and encourage early ambulation. 4.Repeat the assessment on the extremity with the next set of vital signs.

1. Call the health care provider immediately. Rationale:Neurovascular status (color, temperature, peripheral pulses, motion, and sensitivity) are frequently assessed on a cardiac client post-PCI. Hematoma formation, faint distal pulses, and decreased sensation and motion of the extremity by the client indicate re-stenosis of the affected area. Therefore, the health care provider should be contacted immediately with those critical findings. The nurse can place pressure to prevent further extension of the hematoma; however, the priority is to call the health care provider to deal with re-stenosis of the stented area. The client should remain on bed rest for 6 hours post-catherization. Option 4 is incorrect since it doesn't address the current assessment findings. Test-Taking Strategy(ies):Focus on the subject, care for the client post-PCI. Recall the interventions related to the postoperative client. Eliminate option 3 because the client should remain in bed for at least 6 hours post-catherization. Focusing on the data in the question and recalling the signs of re-stenosis of the stented area will lead you to the correct answer.Review:Femoral-popliteal bypass graft Tip for the Nursing Student:Cardiac catheterization is an invasive test involving insertion of a catheter into the heart and surrounding vessels. Dye is injected through the catheter and information is obtained about the structure and performance of the heart chambers and valves and the coronary circulation.

Which complication of an angioplasty is the nurse monitoring for when assessing the client's mental status? 1. Cerebral emboli 2. Cerebral hemorrhage 3. Increased intraocular pressure 4.Reactions from the contrast medium

1. Cerebral emboli Rationale:Angioplasty involves using a balloon-tipped catheter to displace or flatten the plaque built up along the arterial walls, thereby enlarging the diameter of the vessel. There is a chance for a small piece of the plaque to become dislodged, which could create an embolus. Cerebral hemorrhage and increased intraocular pressure are not directly related to postangioplasty complications. Reactions from the contrast most likely would occur immediately, not when the client returns to the nursing unit. Tip for the Nursing Student:Unstable angina occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration, and severity over time.

The nurse auscultates the lungs of an adult client diagnosed with valvular heart disease. Which finding heard during auscultation indicates a problem with cardiac output? 1. Crackles 2. S3 heart sound 3.Ventricular gallop 4.Bronchial breath sounds

1. Crackles Rationale:A low cardiac output will cause an increased buildup of blood in the heart and pulmonary system, causing crackles to be heard in the lung fields. An S3 heart sound is also known as a ventricular gallop and is an abnormal finding if heard in an adult older than 30 years. S3 is the third heart sound produced during the rapid filling phase of ventricular diastole, when blood flows from the atrium to a noncompliant ventricle. Bronchial breath sounds are normal breath sounds heard over the manubrium in the large tracheal airways. These sounds are loud and high pitched and have a hollow or harsh quality. Test-Taking Strategy(ies):Focus on the subject, a problem with cardiac output, and note that the question addresses an adult client. Eliminate options that are comparable or alike in that they are heart sounds, not lung sounds. Next, eliminate option 4, because it is a normal finding.Review:Valvular heart disease and breath and heart sounds.

When considering the risk for heart failure, what should the nurse monitor the client diagnosed with infective endocarditis for on an ongoing basis? 1. Crackles, peripheral edema, and weight gain 2.Confusion, decreasing level of consciousness, and aphasia 3.Respiratory distress, chest pain, and use of accessory muscles 4.Flank pain with radiation to the groin, accompanied by hematuria

1. Crackles, peripheral edema, and weight gain Rationale:The client with infective endocarditis may experience both left- and right-sided heart failure, and thus the nurse assesses the client for both pulmonary and peripheral symptoms, such as crackles, peripheral edema, and weight gain. Option 3 contains symptoms that occur with pulmonary embolism, which is not related to the question. Options 2 and 4 relate to emboli to the brain and kidney, respectively. The vegetation around the infected cardiac area could travel as emboli to these areas, but they are a less common complication of this disorder. Test-Taking Strategy(ies):Focus on the subject, signs/symptoms of heart failure. Recalling that body fluid accumulates in heart failure will direct you to the correct option.Review:Infective endocarditis and heart failure.

The client after a root canal is diagnosed with infective endocarditis. Which signs/symptoms are indicative of this complication? Select all that apply. 1. Petechiae 2. Pulsus paradoxus 3. Positive Murphy sign 4. Positive blood culture 5. New regurgitant murmur 6.Temperature 101.2° F (38.4° C)

1. Petechiae 4. Positive blood culture 5. New regurgitant murmur 6.Temperature 101.2° F (38.4° C) Rationale:Infective endocarditis is an infection of the endocardium of the heart. The invading organism gains access to the bloodstream and lodges itself on the endocardium. Most common causes of infective endocarditis include dental procedures; skin rashes, lesions, or abscesses; infections; and surgery or invasive procedures. Manifestations include petechiae, fever, positive blood culture, new cardiac murmur, anorexia, and weight loss. Pulsus paradoxus is found with cardiac tamponade. Positive Murphy sign is indicative of gallbladder disease. Test-Taking Strategy(ies):Focus on the subject, signs/symptoms of infective endocarditis. Think about the pathophysiology of infective endocarditis. Next, recalling that pulsus paradoxus is related to cardiac tamponade will assist in eliminating option 2. Remembering that Murphy sign is associated with gallbladder disease will assist in eliminating option 3.Review:Infective endocarditis.

A client diagnosed with a small venous stasis ulcer has a new prescription to be out of bed. The nurse plans to obtain what equipment to best enhance circulatory status of the ulcerated area? 1. Reclining chair 2. Overhead trapeze 3.Bedside commode 4.Warm, heavy blankets

1. Reclining chair Rationale:The client should have a reclining chair to allow the legs to be elevated when she or he is not resting in bed. Positioning the client with the legs elevated allows gravity to drain the extremities while she or he is at rest, thereby increasing venous drainage from the affected leg. An overhead trapeze would be used for a client who needs assistance in repositioning himself or herself in bed. A bedside commode may be helpful for a client with limited mobility, but it does not increase circulation to the leg. Warm, heavy blankets could put extra weight on the ulcer and actually reduce circulation by causing added vasodilation. Test-Taking Strategy(ies):Focus on the subject, enhancing circulatory status. Note the strategic word, best, and the words out of bed in the question. Recall that the client with a venous problem has impaired venous drainage from the extremity, and eliminate each of the options that does not assist with venous drainage through leg elevation.Review:Care to the client with a venous problem.

On assessment of the client diagnosed with Buerger's disease, the nurse notes the presence of superficial thrombophlebitis of the lower leg. Based on this information, what should the nurse specifically include in the psychosocial history? 1. Smoking history 2. Recent exposure to allergens 3. History of streptococcal infections 4. Familial tendency toward peripheral vascular disease

1. Smoking history Rationale:The mixture of arterial and venous manifestations (claudication and thrombophlebitis, respectively) in the young client suggests thromboangiitis obliterans (Buerger's disease). This is a relatively uncommon disorder, which is characterized by inflammation and thrombosis of smaller arteries and veins. This disorder is typically found in young adult males who smoke. The cause is unknown but is suspected to have an autoimmune component. None of the remaining options are precipitating factors to this condition. Test-Taking Strategy(ies):Focus on the subject, psychosocial history related to Buerger's disease. The incorrect options are unrelated to the client's diagnosis and are physiological, not psychosocial, assessments.Review:Buerger's disease

Which assessment finding should the nurse identify as an indication of a potential complication associated with varicose veins? 1. The client reports leg edema and skin breakdown. 2. Legs are unsightly in appearance and distress the client. 3. The client reports aching and feelings of heaviness in the legs. 4.The legs become distended as a result of a Trendelenburg's test.

1. The client reports leg edema and skin breakdown. Rationale:Complications of varicose veins include leg edema, skin breakdown, ulceration of the legs, trauma leading to rupture of a varicosity, deep vein thrombosis, or chronic insufficiency. The client with varicose veins may be distressed about the unsightly appearance of the varicosities. Complaints of heaviness and aching in the legs are common. Option 4 describes Trendelenburg's test findings, which are indicative of varicose veins. In the test, the client lies down and elevates the legs to empty the veins. A tourniquet is then applied to occlude the superficial veins, after which the client stands and the tourniquet is released. If the veins are incompetent, they will quickly become distended due to backflow. Test-Taking Strategy(ies):Focus on the subject, varicose veins. Noting the words potential complication in the question and skin breakdown in option 1 will direct you to the correct option.Review:Varicose veins.

A client is admitted to the hospital with unstable angina. Which activity should the nurse include in the daily care plan of a client diagnosed with unstable angina? 1. Serve 3 large meals per day. 2. Allow amply time for rest and relaxation. 3. Permit visitors to have liberal visiting hours. 4.Tell visitors that they are not allowed to smoke near the client.

2. Allow amply time for rest and relaxation. Rationale:The client requires plenty of rest and relaxation to prevent decreased blood supply to the myocardium as a result of increased demands. Large meals are contraindicated because of the increased metabolic requirement for digestion and consumption. Visitors are limited to ensure proper rest. Most acute care facilities are smoke-free, and no smoking is allowed on nursing units. Test-Taking Strategy(ies):Focus on the subject, a client with unstable angina. Remembering that clients with angina require rest will direct you to the correct option.Review:Angina Tip for the Nursing Student:Chest pain that occurs with unstable angina may not be relieved with nitroglycerin. The health care provider is notified if chest pain is unrelieved by rest and nitroglycerin.

The registered nurse is supervising a new nurse in changing a lower leg dressing for a client diagnosed with an arterial ischemic leg ulcer. The registered nurse will suggest which method of securing the dressing on the client's leg? 1. Putting strips of tape around the client's leg 2. Applying tape to a circular bandage, not the skin 3.Putting small pieces of tape above and below the dressing 4.Covering the dressing with a hydrocolloid dressing material

2. Applying tape to a circular bandage, not the skin Rationale:With an arterial leg ulcer, the nurse applies tape only to the bandage itself. Tape is never used directly on the skin because it could cause further tissue damage. Hydrocolloid dressings are not indicated for use as a method of taping another dressing. Test-Taking Strategy(ies):Focus on the subject, wound care techniques for an arterial ischemic leg ulcer. Think about the effect of each action in the options. Recalling that tape is not applied to the skin will direct you to the correct option.Review:Arterial ischemic leg ulcer.

The nurse working at a health screening clinic gathers data to identify the client's risk factors for coronary artery disease. Which of the client's risk factors are modifiable? Select all that apply 1. African American 2. Cigarette smoker 3. Physically inactive 4. 45-year-old female 5. Family history of heart disease 6.Personal history of diabetes mellitus

2. Cigarette smoker 3. Physically inactive 6.Personal history of diabetes mellitus Rationale:Modifiable risk factors for coronary artery disease are those that can be modified or reduced with treatment. These include cigarette smoking, physical inactivity, diabetes mellitus, hypertension, an elevated serum cholesterol level, and obesity. Nonmodifiable risk factors are those that cannot be modified or reduced by treatment and include factors such as heredity, race, age, and gender. Those clients whose parents had coronary heart disease are at higher risk. Increasing age influences both the risk and severity of the disease. Although men are at higher risk for heart attacks at a younger age, the risk for women increases significantly at menopause. The incidence of coronary artery disease is more prevalent among African American women. Test-Taking Strategy(ies):Focus on the subject, modifiable risk factors associated with coronary artery disease. Recalling that modifiable risk factors are those that can be modified or reduced by treatment will assist you with selecting the correct option. Look at each risk factor listed, and select the risk factors that can be changed. Tip for the Nursing Student:Coronary artery disease is a narrowing or obstruction of one or more coronary arteries. Symptoms occur when the coronary artery is occluded to the point that inadequate blood supply to the muscle occurs, causing ischemia.

The nurse receives a report that a client is experiencing depression after an acute myocardial infarction. The nurse verifies that a client is experiencing depression after an acute myocardial infarction when which client behavior is noted? 1. Ignoring activity restrictions 2. Crying intermittently during the day 3. Talking about rehabilitation measures 4. Hesitant to be transferred from the coronary care unit

2. Crying intermittently during the day Rationale:The emotional and behavioral reactions of a client after acute myocardial infarction are varied. Depression may be manifested by withdrawal, crying, and/or apathy. Option 1 is indicative of denial. Option 3 indicates realistic acceptance. Option 4 is indicative of dependency and possible fear. Test-Taking Strategy(ies):Focus on the subject, that the client is experiencing depression. Recalling the manifestations that occur in depression will direct you to the correct option.Review:Depression post-myocardial infarction.

A client is admitted to the hospital with chest pain. The nurse informs the client about the importance of notifying a staff member immediately if chest pain occurs, knowing that what is the common initial reaction exhibited by clients with chest pain? 1. Anger 2. Denial 3. Hostility 4. Depression

2. Denial Rationale:Most clients experiencing chest discomfort use rationalization and deny that they are experiencing pain. Anger, hostility, and depression may occur, but denial and rationalization are the most common reactions. Test-Taking Strategy(ies):Focus on the subject, the grieving process. Note the strategic word, initial. Remember that denial is the initial and most common defense mechanism exhibited by clients with chest pain.Review:The psychosocial effect related to chest pain and cardiac disease.

A client admitted to the hospital diagnosed with coronary artery disease reports dyspnea when at rest. The nurse determines that which intervention should be of help to the client? 1. Providing a walker to aid in ambulation 2. Elevating the head of the bed to at least 45 degrees 3. Performing continuous monitoring of oxygen saturation 4. Placing an oxygen cannula at the bedside for use if needed

2. Elevating the head of the bed to at least 45 degrees Rationale:The management of dyspnea is generally directed toward alleviating the cause. Symptom relief can be achieved or at least aided by placing the client at rest with the head of the bed elevated. In severe cases, supplemental oxygen is used. Monitoring of oxygen saturation detects early complications but does not help the client. Likewise, placing an oxygen cannula at the bedside for use would not help the client. Test-Taking Strategy(ies):Focus on the subject, dyspnea and coronary artery disease. The words of help to the client in the question direct you to look for the item that is going to have the best immediate effect from the client's perspective. This will direct you to option 2.Review:Dyspnea and coronary artery disease.

The nurse assigned to care for a client with a history of coronary artery disease (CAD) determines that which information documented in the medical record is most directly related to CAD? 1. Edema 2. Hyperlipidemia 3. Low triglyceride levels 4. Decreased urinary output

2. Hyperlipidemia Rationale:CAD occurs as a result of accumulation of fatty plaque in the coronary arteries or because of arteriosclerotic changes. Elevated serum cholesterol and triglyceride levels (hyperlipidemia) play a major role in the development of CAD. Edem Test-Taking Strategy(ies):Focus on the subject, coronary artery disease. Note the strategic word, most, and the words directly related in the question. Recalling that CAD occurs from accumulation of fatty plaque in the coronary arteries will direct you to the correct option.Review:Coronary artery disease (CAD). Tip for the Nursing Student:Statins are used in the management of hyperlipidemia.

Which beverage should the nurse give to the client diagnosed with angina? 1. Cola 2. Juice 3. Coffee 4.Iced tea

2. Juice Rationale:Clients experiencing angina should not consume caffeinated beverages because of the vasoconstrictive effect associated with caffeine. Except option 2, all the remaining options are items that contain caffeine. Test-Taking Strategy(ies):Focus on the subject, angina. Note options that are comparable or alike because they all contain caffeine and therefore can be eliminated.Review:Angina. Tip for the Nursing Student:High doses of ergot alkaloids can cause the client to experience angina because these medications produce arterial vasoconstriction.

When a client diagnosed with acute inferior myocardial infarction is placed on bed rest, the nurse includes measures in the plan of care to avoid which potential complication related to this intervention? 1. Arthritis 2. Diarrhea 3. Constipation 4.Increased chest pain

3. Constipation Rationale:Constipation occurs as a result of inactivity and is an undesirable complication for cardiac clients because straining or bearing down triggers the Valsalva maneuver, which increases cardiac workload. The remaining options are unrelated to bed rest. Test-Taking Strategy(ies):Focusing on the subject, bed rest, will direct you to the correct option.Review:The complications associated with bed rest.

The nurse assessing a client with a diagnosis of abdominal aortic aneurysm (AAA) determines which assessment findings are most likely related to the AAA? Select all that apply. 1. Headache 2. Pulsatile abdominal mass 3. Hyperactive bowel sounds 4. Systolic bruit over the area of the mass 5. Subjective sensation of the heart beating in the abdomen

2. Pulsatile abdominal mass 4. Systolic bruit over the area of the mass 5. Subjective sensation of the heart beating in the abdomen Rationale:Not all clients with an AAA exhibit signs/symptoms, and when they occur they may include a subjective feeling of their heart beating in the abdomen when lying supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass. Headache and hyperactive bowel sounds are not associated with an AAA. Test-Taking Strategy(ies):Focus on the subject, the manifestations of an AAA. Note the strategic words, most likely. Eliminate options that are comparable or alike and contain a circulatory component that suggests a relationship to the AAA.Review:Signs and symptoms of abdominal aortic aneurysm (AAA).

The nurse notes bilateral 2+ edema in the lower extremities of a client diagnosed with coronary artery disease who was admitted 2 days ago. Based on this finding, which action should the nurse implement? 1. Obtain daily weights starting on the following morning. 2. Review the intake and output records since admission. 3. Change the time of diuretic administration from morning to evening. 4. Request a sodium restriction of 1 g/day from the health care provider.

2. Review the intake and output records since admission. Rationale:Edema is the accumulation of excess fluid in the interstitial spaces, which can be determined by intake greater than output and by a sudden increase in weight. To determine the extent of fluid accumulation, the nurse first reviews the intake and output records for the last 2 days. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms. Test-Taking Strategy(ies):Focus on the subject, fluid retention with coronary artery disease. Use the steps of the nursing process to answer the question. The correct option is the only option that addresses assessment.Review:Edema and coronary artery disease.

A client has a slow, regular pulse. On the monitor, the nurse notes regular QRS complexes with no associated P waves and a ventricular rate of 60 beats per minute. The nurse suspects that there is a problem at which part of the cardiac conduction system? 1. Purkinje fibers 2. Sinoatrial node 3. Atrioventricular node 4.Bundle of His (AV bundle)

2. Sinoatrial node Rationale:A normal P wave indicates that the impulse that depolarized the atrium was initiated in the sinoatrial node. A change in the form or the absence of a P wave can indicate a problem at this part of the conduction system, with the resulting impulse originating from an alternate site lower in the conduction pathway. None of the remaining options impact the P wave by changing the form or creating an absence of the P wave. Test-Taking Strategy(ies):Focus on the subject, no P wave and a ventricular rate below 60 beats per minute. The question identifies a regular QRS complex and a ventricular rate of 60 beats per minute, indicating an intact atrioventricular node; therefore, the problem lies higher in the conduction system. Correlate a P wave with the sinoatrial node.Review:Conduction system of the heart.

The nurse caring for a client who has been treated with cardioversion will perform which assessment first? 1. Blood pressure 2. Status of airway 3. Oxygen flow rate 4. Level of consciousness

2. Status of airway Rationale:Nursing responsibilities after cardioversion include maintenance of a patent airway, oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection. Airway, however, is always the highest priority. Test-Taking Strategy(ies):Focus on the subject, cardioversion. Note the strategic word, first. Use the ABCs—airway, breathing, and circulation—to direct you to the correct option.Review:Cardioversion. Tip for the Nursing Student:Oxygen administration should be held during the cardioversion procedure.

The nurse recognizes which signs as indications that a client who recently experienced a myocardial infarction (MI) may be developing cardiogenic shock? 1. Oliguria, bradypnea, and warm dry skin 2. Tachycardia, confusion, and hypotension 3. Bradycardia, hypertension, and a pale appearance 4. Peripheral edema, distended neck veins, and hepatic engorgement

2. Tachycardia, confusion, and hypotension Rationale:Classical clinical manifestations of cardiogenic shock include tachycardia; altered sensorium (confusion); hypotension; tachypnea; oliguria; and cold, clammy, cyanotic skin. The remaining options are incorrect because they contain signs not associated with cardiogenic shock. Option 4 identifies manifestations of right-sided heart failure, not cardiogenic shock. Test-Taking Strategy(ies):Focus on the subject, cardiogenic shock. Thinking about the signs of hypovolemic shock will assist in directing you to the correct option, because the signs of both types of shock are comparable or alike.Review:Signs of cardiogenic shock.

The home care nurse is planning adaptations needed for activities of daily living for a client experiencing reduction in cardiac output. Which suggestion should the nurse incorporate in discussions with the client? 1. Force fluids to 3000 mL/day to promote renal perfusion. 2. Take in adequate daily fiber to prevent straining at stool. 3. Consume 1 to 2 oz of liquor each night to promote vasodilation. 4. Try to engage in vigorous activity to strengthen cardiac reserve.

2. Take in adequate daily fiber to prevent straining at stool. Rationale:Standard home care instructions for a client with this problem include, among others, lifestyle changes such as instituting a bowel regimen to prevent straining and constipation, avoiding alcohol intake, avoiding activities that increase the demands on the heart, and maintenance of fluid and electrolyte balance. Straining during a bowel movement could trigger a vasovagal episode. Test-Taking Strategy(ies):Focus on the subject, reduction in cardiac output. Eliminate option 3 because alcohol intake is avoided, not limited. Next, eliminate option 4 because of the word vigorous and option 1 because of the word force.Review:Reduction in cardiac output.

The cardiac catheterization of a client reveals 99% occlusion of the left anterior descending (LAD) coronary artery. The nurse explains to the client that which area of the heart is affected? 1. Left atrium 2. Right ventricle 3. Left ventricle and septum 4. Right ventricle and septum

3. Left ventricle and septum Rationale:The LAD perfuses most of the left ventricular muscle mass and the septum. The areas identified in options 1, 2, and 4 are not affected by the LAD Test-Taking Strategy(ies):Focus on the subject, 99% occlusion of the LAD coronary artery. Note the word left in the question. This will assist in eliminating options 2 and 4. Recalling that the left ventricle is primarily responsible for pumping the blood to the body will assist in directing you to the correct option.Review:The anatomy of the coronary arteries

A client diagnosed with angina pectoris tells the nurse that about experiencing severe chest pain while watching television, while going down stairs, and after falling asleep. Which type of angina does the client exhibit? 1. Variant angina 2. Unstable angina 3. Nocturnal angina 4. Intractable angina

2. Unstable angina Rationale:Unstable angina is triggered by an unpredictable amount of exertion or emotion, and may occur at night. The attacks increase in number, duration, and severity over time. Variant angina is triggered by coronary artery spasm, and the attacks are of longer duration than those of classic angina and tend to occur early in the day and at rest. Nocturnal angina may be associated with dreaming that occurs with rapid-eye-movement (REM) sleep. Intractable angina is chronic and incapacitating and is refractory to medical therapy. Test-Taking Strategy(ies):Focus on the subject, types of angina. If necessary, look at the adjectives before the word angina in each option to help guide you to the correct answer. Compare each adjective with the description provided in the question.Review:The characteristics of the various types of angina.

The nurse inspects a client's right lower extremity and finds an open area 3 by 4 cm in size that has a deep reddish base. The surrounding skin is edematous, with a brownish tinge to it. Pedal pulses are palpable in the right leg. The nurse interprets that the ulcerated area is a result of which predisposing condition? 1. Atrial fibrillation 2. Venous insufficiency 3. Arterial insufficiency 4.Pulmonary embolism

2. Venous insufficiency Rationale:The ulcer described in the question has the characteristics of a venous stasis ulcer. These ulcers are caused by conditions resulting in chronic venous congestion in the extremities. Examples of such conditions include venous insufficiency and chronic deep vein thrombosis. Atrial fibrillation may cause cardiac thrombi, which could break loose and travel to anywhere in the body, including the legs. If this occurred, it would also cause acute onset of the classic symptoms found in clients with pulmonary embolism. Pulmonary embolism is a complication of deep vein thrombosis. Arterial insufficiency is accompanied by pain, and typical findings include pale, cool extremities that have diminished or absent pedal pulses. Test-Taking Strategy(ies):Focus on the subject, interpretation of a client's ulcerated area. Discriminate among the findings that characterize arterial versus venous disease. Eliminate options 3 and 4 first, because they are not directly related to the symptoms presented in the question. From the remaining options, noting the words pedal pulses are palpable will direct you to the correct option.

The ambulatory care nurse has provided instructions on self-care to a client diagnosed with chronic venous insufficiency. The nurse determines that the client needs further teaching if the client makes which statement? 1. "I need to avoid prolonged standing or sitting." 2."I can cross my legs at the knee but not the ankle." 3."I need to elevate the foot of the bed 6 inches during sleep." 4."I should continue to wear elastic hose for at least 6 to 8 weeks."

2."I can cross my legs at the knee but not the ankle." Rationale:Clients with chronic venous insufficiency are advised to avoid crossing the legs, sitting in chairs where the feet don't touch the floor, and wearing garters or sources of pressure above the legs (such as girdles). The client should also avoid prolonged standing or sitting. The client should sleep with the foot of the bed elevated to promote venous return during sleep. The client should wear elastic hose for 6 to 8 weeks and perhaps for life. Test-Taking Strategy(ies):Focus on the subject, chronic venous insufficiency. Use the concept of gravity when answering questions that relate to peripheral vascular problems. Note the strategic words, needs further teaching. These words indicate a negative event query and the need to select the incorrect client statement. Recall that venous problems are characterized by insufficient drainage of blood from the legs returning to the heart and that interventions are aimed at promoting blood flow out of the legs and back to the heart. The correct option does not promote venous drainage.Review:Chronic venous insufficiency.

A client diagnosed with heart failure is being treated with digoxin and furosemide. Which selection would be the best dinner choice from the daily menu? 1. Beef ravioli, spinach soufflé, and Italian bread 2.Baked pollock, mashed potatoes, and carrot-raisin salad 3.Roasted chicken breast, brown rice, and stewed tomatoes 4.Beef vegetable soup, macaroni and cheese, and a dinner roll

2.Baked pollock, mashed potatoes, and carrot-raisin salad Rationale:Furosemide depletes potassium, and a client on digoxin and furosemide needs to maintain normal potassium levels and moderate salt intake. Hypokalemia may make the client more susceptible to digoxin toxicity. The recommended daily intake for potassium is 2000 mg. Option 2 is the best choice because all 3 foods are high in potassium—potato (314 mg), pollock (388 mg), and raisins (600 mg)—and low in sodium. Option 1 is not the best choice because a serving of beef ravioli has 1150 mg of sodium and no potassium. Spinach soufflé is a good source of potassium (345 mg) but a serving also contains 820 mg of sodium. Option 3 is not the best choice because a serving of roasted chicken breast contains only 218 mg of potassium and very little sodium (63 mg). A serving of stewed tomatoes contain 125 mg potassium and 230 mg sodium. A serving of brown rice contains only 42 mg potassium. Option 4 is not the best choice because a serving of beef vegetable soup contains 1002 mg of sodium and only 76 mg of potassium. A serving of macaroni and cheese has 1029 mg of sodium and no potassium. Test-Taking Strategy(ies):Focus on the subject, foods high in potassium and low in sodium. Note the strategic word, best. Focusing on the client's condition, heart failure, will assist in determining that the client requires a high-potassium and a low-sodium intake. Next review the foods in each option to direct you to the correct option.Review:Foods high in potassium, foods low in sodium, and heart failure

A client diagnosed with myocardial infarction is developing cardiogenic shock. Considering the myocardial ischemia that occurs with this complication, which finding should the nurse monitor the client for? 1. Bradycardia 2.Ventricular dysrhythmias 3. Rising diastolic blood pressure 4. Falling central venous pressure (CVP)

2.Ventricular dysrhythmias Rationale:Signs of cardiogenic shock include tachycardia and low blood pressure. Dysrhythmias commonly occur as a result of decreased oxygenation to the myocardium. The central venous pressure (CVP) would rise as the backward effects of the left ventricular failure became apparent. Test-Taking Strategy(ies):Focus on the subject, cardiogenic shock. Remember that ischemia makes the myocardium irritable, producing dysrhythmias. Also, knowledge of the classic signs of shock helps you eliminate the incorrect options.Review:Signs of cardiogenic shock.

The nurse has completed nutritional counseling with an overweight client that focuses on weight reduction to modify the risk for coronary artery disease (CAD). The nurse should determine the teaching as successful if the client states that what is a safe weight loss goal? 1. 6 pounds per week 2 .4 pounds per week 3. 2 pounds per week 4. ½ pound per day

3. 2 pounds per week Rationale:Most people, including the mildly and moderately obese, can lose only about 2 pounds per week of weight from fat loss. Weight loss beyond that level is probably due to protein and water loss alone. Test-Taking Strategy(ies):Focus on the subject, weight loss program for a client with CAD. Options that are comparable or alike in that they reflect a similar weight loss can be eliminated. The word safe before weight loss in the question implies an optimum value. Two pounds of weight loss per week is safer than six.Review:The weight loss program.

The nurse is admitting a client suspected of having myocardial infarction (MI). The nurse anticipates which laboratory test will be prescribed to definitively diagnose MI? 1. Lipid panel 2. B-natriuretic peptide (BNP) 3. Creatinine kinase (CK-MB [CK2]) 4. Comprehensive metabolic panel (CMP)

3. Creatinine kinase (CK-MB [CK2]) Rationale:Creatinine kinase is an enzyme found in the brain, myocardium, and skeletal muscle. If this enzyme appears in the blood, it is indicative of tissue injury or necrosis. CK-MB (CK2) is found specifically in myocardial muscle. The presence of this enzyme in the bloodstream definitively identifies the presence of an MI. The lipid panel and comprehensive metabolic panel may provide useful information for the treatment of this client, but they do not definitively assist in diagnosing the presence of an MI. BNP is used to evaluate the degree of heart failure and is indicated for clients who are showing signs of decompensation. Test-Taking Strategy(ies):Focus on the subject, cardiac markers. It is necessary to know the indications for each laboratory test identified in the options. Eliminate option 4 knowing that it is a comprehensive test and does not provide specific information that is useful in diagnosing an MI. From the remaining options, it is necessary to know that the CK-MB provides specific information with regard to myocardial tissue necrosis.Review:Creatinine kinase (CK-MB [CK2]) and myocardial infarction (MI).

The nurse is developing a discharge teaching plan that focuses on diet management and medications for a client diagnosed with hypertension. What action should the nurse take first in order to facilitate the client's learning process? 1. Set priorities for the client. 2. Use one teaching method consistently. 3. Determine the client's readiness to learn. 4. Plan 30-minute teaching sessions after visiting hours end.

3. Determine the client's readiness to learn. Rationale:Until the client is ready to learn, teaching sessions will be ineffective. Teaching should be in short sessions, early in the day, when the client is well rested. It is important to include the client in the development of the teaching plan and set priorities with the client. Varied teaching methods are best, such as verbal instruction, with visual aids, and the provision of written material for later reference. Test-Taking Strategy(ies):Focus on the subject, facilitating the client's learning process. Note the strategic word, first. Remember that assessment is the first step of the nursing process. The correct option addresses that process of assessment.Review:Teaching and learning principles.

A client is admitted to the hospital with possible rheumatic endocarditis. What nursing assessment data support this diagnosis? 1. Vaginal itching 2. Burning on urination 3. Fever and sore throat 4.Bug bites or skin scratches

3. Fever and sore throat Rationale:Rheumatic endocarditis occurs in many clients with rheumatic fever, which is a complication of infection with group A beta hemolytic streptococcal organisms. It is commonly triggered by streptococcal pharyngitis, which is assessed by noting the presence of a sore throat and fever. The remaining options are unrelated to this problem and indicate possible yeast infection, urinary tract infection, and skin lesions, respectively. Test-Taking Strategy(ies):Focus on the subject, rheumatic endocarditis. Recall that streptococcal infections, especially of the upper respiratory system, are largely responsible for rheumatic fever. Remembering this concept will help you eliminate each of the incorrect options.Review:Rheumatic endocarditis.

The nurse is assessing a client diagnosed with chronic arterial insufficiency. The client reports leg pain and cramping after walking 3 blocks, which is relieved when the client stops and rests. The nurse documents that the client is experiencing which clinical manifestation? 1. Venous insufficiency 2. Deep vein thrombosis 3. Intermittent claudication 4. Arterial-venous shunting

3. Intermittent claudication Rationale:Intermittent claudication is a symptom of peripheral vascular disease. It is described as a cramp like pain that occurs with exercise and is relieved by rest. Intermittent claudication is caused by ischemia and is very reproducible; that is, a predictable amount of exercise causes the pain each time. Options 1 and 2 are venous related, not arterial related. Option 4 is not associated with the client's complaint. Test-Taking Strategy(ies):Focus on the subject, chronic arterial insufficiency. Eliminate options that are comparable or alike in that they are both venous related, not arterial disorder related. From the remaining options, note the word intermittent in option 3 and note the relationship of this word to the client's complaint.Review:Intermittent claudicatio

The nurse has given a client with myocardial infarction (MI) simple instructions on preventing some of the complications of bed rest. The nurse should determine that the client needs further teaching when the client is observed performing which activity? 1. Deep breathing and coughing 2. Repositioning self from side to side 3. Isometric exercises of the arms and legs 4. Ankle circles and plantar and dorsiflexion exercises

3. Isometric exercises of the arms and legs Rationale:The client with MI should avoid activities that tense the muscles, such as isometric exercises. These increase intra-abdominal and intrathoracic pressures and can decrease the cardiac output. They can also trigger vagal stimulation, causing bradycardia. The exercises in the remaining options are acceptable. Test-Taking Strategy(ies):Focus on the subject, preventing bed rest complications in a client who had an MI. Note that the question addresses a cardiac client, and note the strategic words, needs further teaching, and the word contraindicated in the question. These words indicate a negative event query and the need to select the incorrect exercise. Eliminate the remaining options because they are basic and nonstressful exercises.Review:Myocardial infarction (MI)

The nurse is performing an assessment on a client diagnosed with unstable angina. Which occurrence related to chest pain should the nurse expect the client to report? 1. It is associated with sleep. 2. It increases when reclining. 3. It increases in severity over time. 4. It is associated with predictable physical factors.

3. It increases in severity over time. Rationale:A characteristic of unstable angina is that it tends to increase in frequency, duration, and severity over time. Option 1 describes nocturnal angina. Option 2 describes angina decubitus. Option 4 describes stable angina. Test-Taking Strategy(ies):Focus on the subject, the characteristics of unstable angina. Note the relationship between the subject and the description in option 3.Review:Various types of angina.

The nurse notes that an older client's current apical pulse is 82 beats per minute, strong but irregular. The nurse notes that prior baseline data indicated that the client's apical pulse ranged from 60 to 90 beats per minute and was strong and regular. On further assessment, the client reports "feeling tired lately." Based on this data, what intervention should the nurse implement? 1. Place the client on strict bed rest. 2. Schedule the client for a cardiac stress test. 3. Notify the client's primary health care provider. 4.Initiate a fluid restriction of 1000 mL per 24 hours.

3. Notify the client's primary health care provider. Rationale:Any change in quality or character of the heartbeat should be reported to the health care provider because this could indicate developing cardiac problems related to sclerosis, medications, or disease. With the data available, there is no need for strict bed rest or a fluid restriction. A primary health care provider's prescription must be obtained before scheduling the client for a cardiac stress test. Test-Taking Strategy(ies):Focus on the subject, a change in the heart rhythm. Eliminate the incorrect options because they require a primary health care provider's prescription.Review:Change in vital signs Tip for the Nursing Student:An apical pulse rate must be measured for 1 full minute.

A client is diagnosed with deep vein thrombosis. The nurse should include which actions in the care of this client? 1. Maintain both legs in direct alignment with the heart. 2. Apply cold packs to the affected area to relieve discomfort. 3. Promote bed rest as prescribed and encourage coughing and deep-breathing exercises. 4. Apply elastic wraps to the affected leg from the toe to groin and keep them on while on bed rest.

3. Promote bed rest as prescribed and encourage coughing and deep-breathing exercises. Rationale:The goals of nursing management are to prevent existing thrombi from becoming emboli and to prevent new thrombi from forming. Bed rest is usually prescribed to prevent emboli. Both legs are elevated to decrease venous pressure and increase blood flow. Warm packs are used to relieve discomfort. Elastic wraps from the toe to the groin are used to promote venous return and are removed and rewrapped every 4 to 8 hours. Test-Taking Strategy(ies):Focus on the subject, deep vein thrombosis. Eliminate options 1 and 2 using principles related to the effects of cold packs and the effects of gravity. Eliminate option 4 because of the time frame for keeping the elastic wraps on the leg.Review:Deep vein thrombosis.

A client has just returned from the cardiac catheterization laboratory. The nurse reviews the postprocedure prescriptions expecting to note a prescription that the client should remain on bed rest in which position? 1. High-Fowler's 2. The head of the bed elevated at least 60 degrees 3. The head of the bed elevated no more than 30 to 45 degrees 4.The foot of the bed elevated as much as tolerated by the client

3. The head of the bed elevated no more than 30 to 45 degrees Rationale:After cardiac catheterization, the affected leg is kept straight and the head is elevated no more than 30 to 45 degrees until hemostasis is adequately achieved. This makes the remaining options incorrect. Test-Taking Strategy(ies):Focus on the subject, position after a cardiac catheterization. Eliminate options that are comparable or alike because both describe similar positions. From the remaining options, remembering that the affected leg is kept straight will assist in eliminating option 4.Review:Cardiac catheterization.

A client diagnosed with hyperlipidemia at risk for coronary artery disease is beginning to limit intake of dietary cholesterol. Which meat choice should the nurse identify as being the lowest in fat? 1. Duck 2. Spare ribs 3.Baked chicken 4.Prime grade beef

3.Baked chicken Rationale:The best meat choices to lower the intake of cholesterol include skinless baked poultry, lean cuts of beef with the fat trimmed, lamb, pork (except spare ribs), veal (except ground), fish, and shellfish. Meats that have larger amounts of cholesterol include prime grades of beef, pork spare ribs, goose, duck, organ meats (liver, brain, kidney), sausage, bacon, luncheon meats, frankfurters, and caviar. Test-Taking Strategy(ies):Focus on the subject, low-fat meat. Noting the word baked in the correct option will assist in directing you to this option.Review:Foods low in fat

Which type of dressing should the nurse be prepared to apply for a client receiving treatment for an infected ischemic arterial leg ulcer? 1. Dry, sterile dressing 2.Compression dressing 3.Damp-to-dry normal-saline dressing 4.One-half-strength Betadine dressing

3.Damp-to-dry normal-saline dressing Rationale:Standard intervention for arterial leg ulcers includes the use of wet-to-damp or damp-to-dry normal-saline dressings. A damp-to-dry dressing is best when the wound needs mechanical debridement because of infection. Dry, sterile dressings do not keep the wound moist. Compression dressings are used for venous stasis ulcers. Betadine is a strong agent that could cause further damage to friable underlying tissues. Test-Taking Strategy(ies):Focus on the subject, wound care for an infected arterial leg ulcer. Think about the effect of each type of dressing on the wound. Recalling that saline is a physiological solution will direct you to the correct option.Review:Infected arterial leg ulcer

The nurse is assessing a client with a diagnosis of acute pulmonary edema who is mechanically ventilated. The nurse determines that the client is experiencing anxiety if the client exhibits which signs? 1. Hypotension, confusion, and combative behaviors 2. Bradycardia, hand clenching, and startling behaviors 3.Tachycardia, clinging to family members, and pupil dilation 4.Tachypnea, decreased level of consciousness, and palpitations

3.Tachycardia, clinging to family members, and pupil dilation Rationale:Signs of anxiety include behaviors, such as clenched hands, clinging to the family or staff, heightened awareness, wide eyes, pupil dilation, startle response, furrowed brow, or physical lashing out. Because anxiety stimulates the sympathetic nervous system, the client may also exhibit palpitations and chest pain, tachycardia, increased respiratory rate, elevated blood glucose, and hand tremors. The signs noted in option 1 would be seen with hypoxia, not anxiety. In anxious states, tachycardia is present, not bradycardia (option 2). Anxiety produces a heightened awareness, not a decreased level of consciousness (option 4).

What is the impact of a fasting blood glucose reading of 200 mg/dL (5 mmol/L) on the client with diabetes mellitus and risk for developing coronary artery disease? 1. Elevated but would not present a risk for coronary artery disease 2. Decreased, indicating a decreased risk of coronary artery disease 3. Normal, indicating adequate blood glucose control with no risk for coronary artery disease 4. Elevated, signaling the presence of diabetes mellitus, a risk factor of coronary artery disease

4. Elevated, signaling the presence of diabetes mellitus, a risk factor of coronary artery disease Rationale:A fasting blood glucose of 200 mg/dL (5 mmol/L) signals the presence of diabetes mellitus. Diabetes mellitus predisposes a client to coronary artery disease. The remaining options are inaccurate interpretations. Test-Taking Strategy(ies):Focus on the subject, diabetes and risk factors. Recalling the normal blood glucose level and recalling the association between diabetes mellitus and the risk for coronary artery disease will direct you to the correct option.Review:Normal blood glucose level and coronary artery disease Tip for the Nursing Student:For the client scheduled to have a fasting blood glucose level drawn, instruct the client to fast for 8 to 12 hours before the test. Instruct the client with diabetes mellitus to withhold morning insulin or oral hypoglycemic medication until after the blood is drawn.

A client with a history of varicose veins reports increasing leg pain and edema that worsen as the day progresses. What should the nurse include in the instructions to assist in relieving these symptoms? 1. Sitting whenever possible 2. Wearing clothing that compresses the legs 3. Standing in one place to strengthen vein walls 4. Elevating the legs above the heart level periodically

4. Elevating the legs above the heart level periodically Rationale:The nurse should inform the client of measures to reverse the effects of gravity, which include leg elevation above heart level. Elastic stockings may be helpful in promoting blood return. Other helpful measures include avoiding prolonged standing and sitting, which elevate hydrostatic pressure within the veins. The client should also eliminate external sources of venous congestion, such as tight clothing. Test-Taking Strategy(ies):Focus on the subject, a client with a history of varicose veins. Use the concepts of gravity to answer this question. Knowing that varicose veins are caused by increased hydrostatic pressure helps you choose the option that reduces venous congestion.Review:Principles of care for managing varicose veins.

The nurse is providing discharge instructions to a client who has had repair of an abdominal aortic aneurysm (AAA). Which activity will the nurse identify as being acceptable during the first 6 to 12 weeks after discharge? 1. Driving a car 2. Mowing the lawn 3. Cleaning overhead kitchen cabinets 4. Lifting grocery bags that weigh 5 pounds or less

4. Lifting grocery bags that weigh 5 pounds or less Rationale:The client is instructed to avoid lifting anything that weighs more than 15 to 20 pounds for the first 6 to 12 weeks after surgery. The client is also instructed to avoid any activities that involve pushing, pulling, or straining. Driving a car is also prohibited because of general postoperative weakness. Test-Taking Strategy(ies):Focus on the subject, abdominal aortic aneurysm (AAA). Eliminate options 2 and 3 first, because they are the most strenuous activities. From the remaining options, select option 4, because many clients are not allowed to drive after surgery.Review:Abdominal aortic aneurysm (AAA).

The nurse is planning care for a client just admitted with a diagnosis of cardiovascular insufficiency. What intervention should the nurse identify as a priority at this time? 1. The need to teach the client about medications 2. Maintenance of as large a fluid intake as allowed 3. Family instruction on how to obtain medical assistance 4. Maintenance of good body alignment while on bed rest

4. Maintenance of good body alignment while on bed rest Rationale:Good body alignment promotes rest and relaxation and decreases the workload of the cardiovascular system. Medication instruction is not a priority immediately after admission to the hospital. Adequate fluid intake is important, but a large fluid intake could stress the heart. Option 3 addresses the family, not the client. Test-Taking Strategy(ies):Focus on the subject, cardiac insufficiency. Note the strategic word, priority. Eliminate option 3 because it does not address the client of the question. Eliminate option 2 next, noting that it addresses large amounts of fluids. From the remaining options, focusing on the client's diagnosis will direct you to the correct option.Review:Cardiovascular insufficiency.

A client 36 hours post-myocardial infarction (MI) has ambulated for the first time. The nurse determines that the client best tolerated the activity when which observation was made? 1. Skin cool but slightly diaphoretic 2.Dyspnea noted only at the end of the exercise 3.Preactivity blood pressure (BP) 140/84 mm Hg, postactivity BP 110/72 mm Hg 4.Preactivity pulse rate 86 beats per minute, postactivity pulse rate 94 beats per minute

4. Preactivity pulse rate 86 beats per minute, postactivity pulse rate 94 beats per minute Rationale:The nurse assesses vital signs and the level of fatigue with each activity. The client is not tolerating the activity if there is a drop in systolic BP greater than 20 mm Hg, changes in pulse rate of greater than 20 beats per minute, dyspnea, or chest pain. Cool, diaphoretic skin is a sign of some degree of cardiovascular compromise. Test-Taking Strategy(ies):Focus on the subject, exercise and MI, and note the strategic word, best. The question asks about activity tolerance, which tells you that you are looking for normal data. Look for the option that identifies normal values or the least degree of variation. Options 1 and 2 clearly identify abnormal data. Option 3 identifies a significant drop in BP, indicating an abnormal data. An increase in pulse as reflected in the correct option is a normal expectation after exercise.

A client with a history of an abdominal aortic aneurysm suddenly complains of severe back and flank pain, accompanied by nausea. The client's pulse has increased from 80 to 94 beats per minute, and the blood pressure has dropped from 124/78 to 106/70 mm Hg. The nurse should identify what condition as the possible cause of these changes? 1. Appendicitis 2. Renal calculi 3. Sudden arterial embolus 4. Rupture of the aneurysm

4. Rupture of the aneurysm Rationale:The client's signs and symptoms are compatible with rupture of the aneurysm. Typical signs and symptoms include back and flank pain and ecchymosis of the flank and perianal area, pulsating abdominal mass, lightheadedness, nausea, and signs of shock. The client requires surgical intervention for the treatment of this emergency. The other options are incorrect. Test-Taking Strategy(ies):Focus on the subject, a client with an abdominal aortic aneurysm, and focus on the data in the question; this will direct you to the correct option. Also note the relationship between the diagnosis in the question and the correct option.Review:Aneurysms.

The nurse should expect a client experiencing an acute myocardial infarction to manifest which pattern first on the electrocardiogram? 1. Absent P waves 2. T-wave elevation 3. An abnormal Q wave 4. ST segment elevation

4. ST segment elevation Rationale:ST segment elevation usually occurs immediately or during the early stages of acute myocardial infarction. Absent P wave or P waves that are difficult to discern are noted in atrial fibrillation. T-wave inversion and abnormal Q-wave changes occur later, within hours to several days after the acute myocardial infarction. Test-Taking Strategy(ies):Focus on the subject, first pattern on electrocardiogram after a myocardial infarction. Note the strategic word, first. Eliminate option 1, recalling the absent P wave or that P waves that are difficult to discern occur in atrial fibrillation. Next, eliminate option 2, recalling that T-wave inversion (not elevation) would be noted. From the remaining options, know that abnormal Q wave occurs later.

The nurse learns that a client diagnosed with cardiac tamponade is about to have a pericardiocentesis performed. In preparation for this procedure, how should the nurse position the client? 1. Supine with slight Trendelenburg's position 2. Lying on the right side with a pillow under the head 3. Lying on the left side with a pillow under the chest wall 4. Supine with the head of bed elevated at an angle of 30 to 60 degrees

4. Supine with the head of bed elevated at an angle of 30 to 60 degrees Rationale:The client undergoing pericardiocentesis is positioned supine with the head of the bed raised to an angle of 30 to 60 degrees. This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac. The remaining options are incorrect positions because they do not facilitate the effective performance of the procedure. Test-Taking Strategy(ies):Focus on the subject, positioning for a pericardiocentesis. Visualize each of the positions described, and evaluate how the heart is sitting in the chest with each position and how easily the pericardial sac could be accessed with a needle. This should help eliminate the incorrect options.Review:Procedure for pericardiocentesis.

The nurse determines that the client with a diagnosis of heart failure is ready for discharge to home when the client can independently perform which action? 1. Dress and put on support hose. 2. Get his or her prescriptions filled. 3. Be self-sufficient at home without help. 4. Verbally describe the daily medications, doses, and times to be administered.

4. Verbally describe the daily medications, doses, and times to be administered. Rationale:Medication therapy is an essential part of the therapeutic regimen for treating heart failure. The client must have a clear understanding of which medications to take and when. Options 1 and 2 can be carried out with the assistance of someone else. Option 3 may not be realistic for this client. Test-Taking Strategy(ies):Note the client's diagnosis of heart failure and the subject of the question, that the client is ready for discharge. Eliminate option 3 first because it is unrealistic. Next eliminate options 1 and 2 because they can be accomplished by others or with the assistance of others. Remember that it is a priority that the client understands the medication regimen.Review:Heart failure.

A client diagnosed with Buerger's disease asks the nurse what can be done to alleviate the symptoms. In teaching the client about this disorder and symptom control, the nurse provides the client with which information? 1. There is no current treatment. 2. Surgery is the most successful therapy. 3. Analgesics are primarily used to control pain. 4. Warmth, exercise, and smoking cessation are most helpful.

4. Warmth, exercise, and smoking cessation are most helpful. Rationale:The main goals of treatment for Buerger's disease are the same as for peripheral arterial insufficiency. Therefore, the client is taught measures to increase circulation, which include enhancing vasodilation through warmth, exercise, and smoking cessation. Interventions are available. Surgery is not an intervention of choice. Analgesics are typically not helpful in a pain situation caused by ischemia. Test-Taking Strategy(ies):Focus on the subject, alleviating the symptoms of Buerger's disease. Thinking about the pathophysiology that creates the problem will help eliminate the options suggesting that there is no treatment at all and the high success of surgical intervention. Because pain experienced in this disorder is caused by ischemia, analgesics are unlikely to help; therefore, eliminate that choice.

Which explanation should the nurse provide to the client diagnosed with atrial fibrillation to describe the need to begin long-term anticoagulant therapy? 1."Because of this dysrhythmia, blood backs up in the legs and puts you at risk for blood clots, also called deep vein thrombosis." 2."This dysrhythmia decreases the amount of blood flow coming from the heart, which can lead to blood clots forming in the brain." 3."The antidysrhythmic medications you are taking cause blood clots as a side effect, so you need this medication to prevent them." 4."Because the atria are quivering, blood flows sluggishly through them, and clots can form along the heart wall, which could then loosen and travel to the lungs or brain."

4."Because the atria are quivering, blood flows sluggishly through them, and clots can form along the heart wall, which could then loosen and travel to the lungs or brain." Rationale:A severe complication of atrial fibrillation is the development of thrombi. The blood stagnates in the "quivering" atria because of the loss of organized atrial muscle contraction. The blood that pools in the atria can then clot, which increases the risk of pulmonary and cerebral emboli. None of the remaining options describe a correct rationale for the use of anticoagulants. Test-Taking Strategy(ies):Focus on the subject, atrial fibrillation and anticoagulant therapy. Note the relationship of the word fibrillation in the question and quivering in the correct option.Review:Physiology associated with atrial fibrillation and the use of anticoagulant therapy.

The nurse is assessing the leg pain of a client who has just undergone right femoral-popliteal artery bypass grafting. Which question would be most useful in determining whether the client is experiencing graft occlusion? 1. "Can you describe what the pain feels like?" 2."Can you rate the pain on a scale of 1 to 10?" 3."Did you get any relief from the last dose of pain medication?" 4."Can you compare this pain to the pain you felt before surgery?"

4."Can you compare this pain to the pain you felt before surgery?" Rationale:The most frequent indication that a graft is occluding is the return of pain that is similar to that experienced preoperatively. Standard pain assessment techniques also include the items described in the remaining options, but these will not help differentiate current pain from preoperative pain. Test-Taking Strategy(ies):Focus on the subject, the assessment question that will help differentiate expected postoperative pain from pain that indicates graft occlusion. Note the strategic word, most. Eliminate the options 1, 2, and 3 because they are comparable or alike and are standard pain assessment questions.

The nurse is attempting to determine the client's adjustment to a new diagnosis of coronary artery disease. Which question should the nurse ask before discharge from the hospital to elicit the most useful response? 1. "Do you understand the use of your new medications?" 2. "Are you going to schedule your follow-up health care provider visit?" 3."Do you have anyone at home to help with housework and shopping?" 4."How do you feel about the lifestyle changes you are planning to make?"

4."How do you feel about the lifestyle changes you are planning to make?" Rationale:All questions relate to aspects of posthospital care, but only the correct option explores the client's feelings about the disease and adjustment to the diagnosis. None of the remaining options address the client's adjustment to the disease. Test-Taking Strategy(ies):Focus on the subject, adjustment to a new diagnosis of coronary artery disease. Note the strategic word, most. Dealing with lifestyle changes is the umbrella option. After the client responds to this assessment question, the other questions may be appropriate to ask to elicit more specific information in an area.

The nurse provides teaching to a client regarding the pathophysiology of arteriosclerosis. Which statement by the client indicates that the teaching has been effective? 1. It is a decrease in resting heart rate." 2. "It is a buildup of plaque in the arteries." 3. "It is a loss of muscle mass around the heart." 4."It is a loss of elasticity of the arteries in my body."

4."It is a loss of elasticity of the arteries in my body." Rationale:Arteriosclerosis is described as a thickening and loss of elasticity of the arteries. Option 2 describes atherosclerosis, and options 1 and 3 are normal age-related changes noted in the older client. Test-Taking Strategy(ies):Note the strategic word, effective. Focusing on the subject, arteriosclerosis, will assist in eliminating options 1 and 3. From the remaining options, recalling that atherosclerosis relates to fatty plaques will assist in eliminating option 2. Review:Arteriosclerosis

A client who has had a chronic arterial leg ulcer is admitted for the treatment of chronic pain. Which statement is consistent with chronic pain? 1. "I don't feel like eating when I get pain in my leg." 2. "I don't think I can cope with this problem anymore." 3. The pain wakes me up from sleep sometimes at night." 4."It is so discouraging; I can't remember when I didn't have this pain."

4."It is so discouraging; I can't remember when I didn't have this pain." Rationale:The major focus of the client's complaint is the experience of pain. Pain that has a duration of longer than 6 months is defined as chronic pain, not acute pain. The statement that most closely matches pain for prolonged periods of time is option 4. Option 1 suggests a nutritional issue. Option 2 suggests that the client is having difficulty coping but this can occur with both acute and chronic pain. Option 3 suggests that the client is having trouble sleeping. Test-Taking Strategy(ies):Focus on the subject, chronic pain. Note the relationship between the subject and the client's statement, "I can't remember when I didn't have this pain," in the correct option.Review:Chronic pain

The nurse assesses a client for a characteristic of atrial fibrillation by performing which assessment? 1. Palpating the radial pulse for quality while auscultating the apical pulse volume 2. Auscultating the apical pulse for a regular pulse while palpating the radial pulse for quality 3.Palpating the radial pulse for quality while auscultating the apical pulse for an irregular rate 4.Auscultating the apical pulse for an irregular rate while palpating the radial pulse for a pulse deficit

4.Auscultating the apical pulse for an irregular rate while palpating the radial pulse for a pulse deficit Rationale:When a pulse rate is irregular, the apical pulse should be auscultated for the irregularity, and the radial pulse should be palpated for the pulse deficit. Pulse deficit is a difference between the apical rate and the radial pulse rate, which is a characteristic of atrial fibrillation. None of the remaining options assess the rate of both the apical and radial pulses. Test-Taking Strategy(ies):Focus on the subject, atrial fibrillation. The correct option is the only option that addresses assessment of both the apical and radial rates and reflects objective data. The remaining options are comparable or alike because their major focus is quality, a subjective measurement. Review:Characteristics of atrial fibrillation. Tip for the Nursing Student:When measuring the apical heart rate, the nurse should count the rate for 1 minute.

Which is the priority nursing assessment for a client after a cardiac catheterization? 1. Temperature 2. Urine output 3. Potassium level 4.Catheter insertion site

4.Catheter insertion site Rationale:During the post-cardiac catheterization period, priorities of nursing care include frequent monitoring of the blood pressure and pulse. The catheter insertion site is checked frequently for signs of bleeding and swelling. Distal pulses also are assessed. Temperature, urine output, and potassium level also should be monitored, but they are not the priority of the items identified in the options. Test-Taking Strategy(ies):Focus on the subject, cardiac catheterization. Note the strategic word, priority. Note the relationship between "catheterization" in the question and "catheter" in the correct option.Review:Postcardiac catheterization care.

The nurse is caring for a client with a diagnosis of angina. Which data should the nurse obtain immediately when the client begins to experience chest pain? 1. Blood pressure 2. Apical heart rate 3. Whether nausea is present 4.Location and intensity of pain

4.Location and intensity of pain Rationale:The nurse must assess the pain by requesting a description of intensity, location, duration, and quality of the pain. Although the nurse may check the client's vital signs and check for symptoms of nausea, assessment of the pain is the priority. Test-Taking Strategy(ies):Note the strategic word, immediately. Focus on the subject, a client with a diagnosis of angina who is experiencing chest pain, and note the relationship between the subject and the correct option.Review:Angina.

A professional athlete comes to the ambulatory care center for treatment of a sports injury. Vital signs are pulse, 53 beats per minute; respiratory rate, 20 breaths per minute; and blood pressure (BP), 110/64 mm Hg. How should the nurse interpret these vital signs? 1. Normal, as a result of the abstinence of caffeine by the athlete 2. Abnormal, as a result of the body's response to the physical injury 3. Abnormal, as a result of the stimulation of the vagus nerve with injury 4.Normal, as a result of the cardiovascular response to physical conditioning

4.Normal, as a result of the cardiovascular response to physical conditioning Rationale:Athletes often have sinus bradycardia because exercise increases the stroke volume of the heart. Because the cardiac output is a product of stroke volume and heart rate, fewer beats are needed per minute at rest to maintain the normal cardiac output. The vital signs are normal for this client. There is no mention that the client has abstained from caffeine or there is an activity that stimulated the vagus nerve. Test-Taking Strategy(ies):The subject of the question is the response of athletes to injury. Recalling that athletes normally have sinus bradycardia will direct you to the correct option.Review:The normal cardiovascular findings.

The nurse is assigned to care for a client diagnosed with angina. On entering the client's room, which finding is of primary concern for the nurse? 1. The client's lunch tray has not been touched. 2. The client reports having a sinus headache. 3. The client expresses regret about noting being able to stop smoking. 4.The client is transacting business with his laptop computer while in bed.

4.The client is transacting business with his laptop computer while in bed. Rationale:Rest and relaxation are crucial for clients with angina because stress and emotional tension can trigger episodes of pain. Although nutrition is important, the nurse should be most concerned with the finding related to stress. Although pain is a concern, a sinus headache is not cardiac-related pain. Smoke cessation is a positive initiative that can be approached after the client is stabilized. Test-Taking Strategy(ies):Note the strategic word, primary. Focusing on the subject of angina and the factors that can trigger pain will direct you to the correct option.Review:Angina. Tip for the Nursing Student:If a hospitalized client complains of chest pain and it is unrelieved after 3 nitroglycerin tablets, contact the health care provider immediately.

The nurse is preparing a client for elective cardioversion. The nurse determines that a need for further preparation for the procedure is necessary if which condition is present? 1. The client's digoxin was withheld for the last 48 hours. 2.The client received a dose of midazolam intravenously. 3.The defibrillator has the synchronizer turned on and is set at 50 joules. 4.The client is wearing a nasal cannula delivering oxygen at 2 L per minute.

4.The client is wearing a nasal cannula delivering oxygen at 2 L per minute. Rationale:During the procedure, any oxygen is removed temporarily, because oxygen supports combustion and a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before cardioversion, because it increases ventricular irritability and may cause ventricular dysrhythmias after countershock. The client typically receives a dose of an intravenous sedative such as midazolam. The defibrillator is placed on the synchronizer mode to time the delivery of the electrical impulse to coincide with the QRS and to avoid the T wave, which could cause ventricular fibrillation. Energy level is typically set at 50 to 100 joules. Test-Taking Strategy(ies):Focus on the subject, cardioversion. Note the strategic words, need for further preparation. This indicates that you are looking for what needs to be changed in this situation and, therefore, creates a negative event query. Visualizing the procedure and recalling that an electrical impulse is delivered to the client will direct you to the correct option.

The nurse in the emergency department is assessing a client with chest pain. Which observation by the nurse helps determine that the client's pain is caused by myocardial infarction (MI)? 1. The client experienced no nausea or vomiting. 2.The client reports that the pain began while pushing a lawnmower. 3.The pain was described as substernal and radiating to the left arm. 4.The pain, unrelieved by nitroglycerin, was relieved with morphine sulfate.

4.The pain, unrelieved by nitroglycerin, was relieved with morphine sulfate. Rationale:The pain of myocardial infarction (MI) may radiate to the left arm, shoulder, jaw, or neck. It typically begins spontaneously, lasts longer than 30 minutes, is frequently accompanied by associated symptoms (nausea, vomiting, dyspnea, diaphoresis, anxiety), and requires opioid analgesics for relief. The pain of angina may radiate to the left arm, is often precipitated by exertion or stress, has few associated symptoms, and is relieved by rest and nitroglycerin. Test-Taking Strategy(ies):Focus on the subject, differentiating anginal pain from that of MI. Remember that a classic hallmark of the pain from MI is that it is unrelieved by rest and nitroglycerin and requires opioid analgesics for relief.Review:Myocardial infarction (MI).

The nurse performs an assessment on a client diagnosed with acute pulmonary edema and notes the following: severe dyspnea; tachypnea; hyperpnea; expectoration of large amounts of frothy, blood-tinged sputum; wheezing; diffuse crackles bilaterally on lung auscultation; extreme restlessness; and confusion. The nurse should expect that the arterial blood gas values will indicate which condition? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

d. Respiratory alkalosis Rationale:Signs and symptoms of respiratory alkalosis include tachypnea, hyperpnea, giddiness, dizziness, syncope, convulsions, coma, weakness, paresthesia, and tetany. Etiologies of respiratory alkalosis include heart failure and pulmonary edema. The client is experiencing hyperventilation. Options 1 and 2 are incorrect, because the client is experiencing a respiratory problem, not a metabolic one. Signs/symptoms of respiratory acidosis include hypoventilation (option 3) Test-Taking Strategy(ies):Focus on the subject, arterial blood gas analysis with acute pulmonary edema. Eliminate options 1 and 2 because the presented situation is respiratory, not metabolic. For the remaining options, recall that the blood gas values of clients with acute pulmonary edema are likely to show respiratory alkalosis.Review:Acid base imbalances.