NCLEX 10000 Cardiovascular
A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride, an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within:
1 -2 min after IV bolus admin
Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who they have cared for earlier in the week, who experienced an acute myocardial infarction, made sexual comments to them. What is the best guidance for the nurse to offer to the nursing assistants?
the nurse should explain to the client might have concerns about resuming sexual
The primary goal for the client with Buerger's disease is to prevent:
thrombus formation
The nurse is caring for a client post myocardial infarction (MI). Orders include strict bed rest and a clear, liquid diet. What is the nurse's best response to the client when inquiring about the purpose of the new diet?
to reduce the metabolic workload
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?
top of foot
The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The nurse knows that the client understands the discharge plan when the client
verbalizes safety precautions needed to prevent pacemaker malfunction
he client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The nurse knows that the client understands the discharge plan when the client
vernalized safety precautions needed to
A client with chronic heart failure is receiving digoxin, 0.25 mg by mouth daily, and furosemide, 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause:
visual disturbances
What is the most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program?
walking decreases venous congestion
The nurse is coaching an older adult who has been diagnosed with high serum lipids and leads a sedentary life-style. The goal is to increase the amount of exercise this client currently performs. After assessing the client's interests and setting an acceptable goal with the client, which exercise will offer the client the most health benefits while being practical to implement?
walking three to five times per week for 30 to 60 min
An anxious client who suffered an acute myocardial infarction is transferred from the coronary care unit to the telemetry unit. The client asks the charge nurse if he can have the same nurse care for him every day. How should the charge nurse respond?
we will try to assign you the same nurse
In order to prevent recurrent vasospastic episodes with Raynaud's phenomenon, what should the nurse instruct the client to do?
wear gloves when obtaining food from the refrigerator
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
client is about to undergo cardiac catheterization for which he signed an informed consent. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed?
withhold the medication and notify phy
An older client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the health care provider (HCP) has written a prescription to:
withhold the metformin prior to the cardiac catheterixation
A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?
within 6 hours
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?
the pain occurred while i was mowing
The nurse's unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught?
the percentage of clients on the unit diagnosed with an acute IM
The recipient of a donated organ asks the nurse, "What did the donor die from?" Which response by the nurse is most appropriate?
the transplant coordinator can give you info about the donor
The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client
this drug will dilate your blood vessels and lower you blood pressure
The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client:
this drug will dilate your blood vessels and lower your blood pressure
The nurse interviews a 22-year-old female client who is scheduled for abdominal surgery the following week. The client is obese and uses estrogen-based oral contraceptives. This client is at high risk for development of:
thrombophlebitis
The nurse is monitoring a client admitted with a myocardial infarction (MI) who is at risk for cardiogenic shock. The nurse should report which change on the client's chart to the health care provider (HCP)?
urine output
The nurse in the intensive care unit is giving a report to the nurse in a cardiac step-down unit about a client who had coronary artery bypass surgery. Which of the following is the most effective way to assure essential information about the client is reported?
use a printed checklist with info individualized for the client
in order to prevent deep vein thrombosis (DVT) following abdominal surgery, the nurse should:
use pneumatic compression stockings
As an initial step in treating a client with angina, the health care provider (HCP) prescribes nitroglycerin tablets, 0.3 mg given sublingually. This drug's principal effects are produced by
vas of peripheral vas
The client with peripheral vascular disease has been prescribed diltiazem. The nurse should determine the effectiveness of this medication by assessing the client for
vasodilation
As an initial step in treating a client with angina, the health care provider (HCP) prescribes nitroglycerin tablets, 0.3 mg given sublingually. This drug's principal effects are produced by
vasodilation of peripheral vasculature
A nurse suspects that a client has digoxin toxicity. The nurse should assess for:
vision changes
The nurse is preparing to administer 0.1 mg of digoxin intravenously. Digoxin comes in a concentration of 0.5 mg/2 ml. How many milliliters should the nurse administer? Record your answer using one decimal place.
0.4
A nurse is caring for a client with pulmonary edema. The physician writes the accompanying orders. Which order should the nurse clarify?
0.9% normal saline solution IV at 150 ml/hr
The client is to receive digoxin 0.25 mg. Available are 0.125-mg scored tablets. How many tablets should the nurse administer?
2 tab
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.
26
The rapid response team has been called to manage an unwitnessed cardiac arrest in a client's hospital room. The estimated maximum time a person can be without cardiopulmonary function and still not experience permanent brain damage is:
4-6 min
Which medication should a nurse have on hand when removing a sheath after cardiac catheterization?
Atropine
An older adult with a history of heart failure is admitted to the emergency department with pulmonary edema. On admission, what should the nurse assess first?
BP
During the first 24 hours after thrombolytic treatment for an ischemic stroke, the primary goal is to control the client's
BP
During the first 24 hours after thrombolytic treatment for an ischemic stroke, the primary goal is to control the client's:
BP
A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?
BP is 88/46
The client is admitted with left lower leg pain, a positive Homans' sign, and a temperature of 100.4° F (38° C). The nurse should assess the client further for signs of
DVT in left leg
The rapid response team arrives in the room of a client who has had a cardiac arrest. The nurse should first apply which piece of monitoring equipment?
ECG
A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?
Homans
A staff nurse is caring for a client who is a potential heart donor. The client's family is concerned that the recipient will have access to personal donor information. Which response by the nurse demonstrates knowledge of the organ donation process?
I will have the transplant coordinator speak with you to answer your question
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
Which condition most commonly results in coronary artery disease (CAD)?
aatherosclerosis
What is the primary goal for the care of a client who is in shock?
achieve adequate tissue perfusion
Which ethnic group is more likely to develop severe hypertension?
african
A client is in hypovolemic shock. To determine the effectiveness of fluid replacement therapy, the nurse should monitor the client's
blood pressure
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 nitro tab taken every 5 min
When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in:
cardiac arrhythmias
A client has sudden, severe pain in the back and chest, accompanied by shortness of breath. The client describes the pain as a "tearing" sensation. The health care provider (HCP) suspects the client is experiencing a dissecting aortic aneurysm. The emergency supply cart is brought into the room because one complication of a dissecting aneurysm is:
cardiac tamponade
Metoprolol is added to the pharmacologic therapy of a woman with diabetes diagnosed with stage 2 hypertension and initially treated with furosemide and ramipril. An expected therapeutic effect is:
decrease in heart rate
A client is recovering from coronary artery bypass graft (CABG) surgery and begins to experience chest pain, shortness of breath, and tachycardia. Further assessment reveals a widened QRS complex and an elevated ST segment. Which nursing diagnosis takes highest priority at this time?
decreased cardiac output related to depressed myocardial function
The nurse is caring for a client following a myocardial infarction and is aware that complications can occur due to damage to the myocardium. Which of the following interventions would be appropriate for this client? Select all that apply.
electrocardiogram with any chest pain continuous cardiac monitoring via telemetry auscultating apical pulse every 2 hours
A client with heart failure has bilateral +4 edema of the right ankle that extends up to midcalf. The client is sitting in a chair in no evident distress with the legs in a dependent position. The nurse should first:
elevate the clients legs on a foot stool
A client is admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these findings as:
heart rate irregular with S3
Which activity is least effective in preventing sensory deprivation during a client's stay in the cardiac care unit?
keeping the door closed to provide privacy
A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description?
protamine sulfate
An elderly client has been bedridden since a cerebrovascular accident that resulted in total right-sided paralysis. The client has become increasingly confused, is occasionally incontinent of urine, and is refusing to eat. In planning the client's care, which of the following factors should the nurse consider as most critical in contributing to skin breakdown in this client?
right sided paralysis
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?
risk for infection
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:
troponin level
A client with peripheral artery disease has chronic, severe bilateral pretibial and ankle edema the client is on complete bed rest. To maintain skin integrity, what should the nurse do?
turn the client every 1 to 2 hours
The nurse is concerned about the risks of hypoxemia and metabolic acidosis in a client who is in shock. What finding should the analyze for evidence of hypoxemia and metabolic acidosis in a client with shock?
ABG findings
Which finding is an indication of a complication of septic shock?
ARDS
The nurse is developing a care plan with an older adult with hypertension and is instructing the client that hypertension can be a "silent killer." The nurse should instruct the client to report signs of which disease that is often a result of undetected high blood pressure?
CVAs
A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following his therapeutic regimen?
HDL increased from 25
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
The nurse is instructing a client who is at risk for peripheral artery l disease how to use knee-length elastic stockings (support hose). What instructions should the teaching plan include? Select all that apply.
apply the elastic stockings before getting out of bed remove the stockings every 8 hours
The monitor technician informs the nurse that the client has started having premature ventricular contractions every other beat. What should the nurse do first?
assess the clients orientation and vital signs
A client is admitted with a 6.5-cm thoracic aneurysm. The nurse records findings from the initial assessment in the client's chart, as shown. At 1030, the client has sharp midchest pain after having a bowel movement. What should the nurse do first?
assess the clients vital signs
During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client?
assess the digoxin level
A client arrives at the emergency department with a heart rate of 210 beats/minute and the following pattern on the cardiac monitor. The nurse is correct to alert the health care provider to the presence of which disorder?
atrial flutter
A client is admitted to an acute care facility with pneumonia. When auscultating heart sounds, the nurse notes a fixed split of the second heart sound (S2) — a pathological split that doesn't vary with respirations. A fixed S2 split is the hallmark of:
atrial septal defect
A client with systemic lupus erythematosus (SLE) reports that his hands become pale, blue, and painful when exposed to the cold. Raynaud's disease is suspected. What nursing interventions should the nurse suggest to improve the signs and symptoms associated with this disease? Select all that apply.
avoid caffeine stop smoking take the prescribed calcium leran biofeedback
A client is taking spironolactone. Which change in the diet should the nurse teach the client to make when taking this drug?
avoid eating foods high in potassium
What instructions should the nurse give a client experiencing signs and symptoms related to decreased arterial insufficiency? Select all that apply.
avoid smoking and exposure take aspirin use additional bed clothes at night
The nurse should give which discharge instructions about thermal injury to a client with peripheral vascular disease? Select all that apply
avoid sunburn during the summer wear extra socks choose loose soft cotton socks
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?
bibasilar crackles
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection?
blood pressure 82/40 mm Hg and heart rate of 125 beats/ min
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order?
carvedilol
The nurse observes the cardiac rhythm (see above) for a client who is being admitted with a myocardial infarction. Which should the nurse do first?
check for a pulse
Which of the following signs and symptoms would the nurse expect in a client with angina? Select all that apply.
chest tightness chest pressure jaw pain
The nurse is assessing a client with irreversible shock. The nurse should document which finding?
circulatory collapse
The nurse is assessing a client with an atrial septal defect (ASD). Which requires immediate nursing intervention?
client having an uneven smile and facial droop
When assessing an individual with peripheral vascular disease, which clinical manifestation would indicate complete arterial obstruction in the lower left leg?
coldness of the left foot and ankle
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?
contact the physician and report findings
A client has undergone an amputation of three toes and a femoral-popliteal bypass. The nurse should teach the client that after surgery which leg position is contraindicated while sitting in a chair?
crossing the legs
Following cardiac bypass surgery, the client has been referred to a cardiac rehabilitation exercise program. The client has type 1 diabetes and has bilateral leg discomfort with walking. The nurse should advise the client to exercise using a stationary bicycle and intermittent training because of the client's:
diabetic neuropathy
A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of:
digoxin toxicity
When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI) and who has premature ventricular contractions, the expected outcome of the drug is to:
dissolve clots
A client is prescribed lisinopril for the treatment of hypertension. The client asks a nurse about possible adverse effects. Which common adverse effects of angiotensin-converting enzyme (ACE) inhibitors would the nurse include in the teaching? Select all that apply
dizziness headache hypotension
A nurse is teaching a client who will soon be discharged with a prescription for warfarin. Which statement should the nurse include in discharge teaching?
don't take aspirin while your taking war
The nurse is caring for a client in the intensive care unit. Which drug is most commonly used to treat cardiogenic shock?
dopamine
A client is admitted to the hospital for evaluation of recurrent episodes of ventricular tachycardia as observed on Holter monitoring. The client is scheduled for electrophysiology studies (EPS) the following morning. Which statement should the nurse include in a teaching plan for this client?
during the procedure the health care provider will insert
The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be which of the following?
enhance myocardial oxygenation
A young adult has been diagnosed with hypertrophic cardiomyopathy. The nurse should further assess the client for:
fatigue and shortness of breath
Which signs and symptoms accompany a diagnosis of pericarditis?
fever, chest discomfort, and elevated erthrocyte sedimentation rate
A nurse is educating a client who is at risk for coronary artery disease (CAD). The nurse knows that the client needs more education when he states that the risk factors that can be controlled or modified include:
gender, family hx, and older age
Which is the most effective means of preventing plantar flexion in a client who has had a stroke with residual paralysis?
have the client ear ankle high tennis shoes at intervals throughout
A client with peripheral vascular disease is recovering from surgery to insert an aortofemoral-popliteal bypass graft. When developing a postoperative education plan, which question by the nurse will provide the most helpful information?
how did you manage your health before admission
Prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which contradiction to administering the drug?
hx of cerebral hemorrhage
The nurse is discussing medications with a client with hypertension who has a prescription for furosemide daily. The client needs further education when the client states:
i know i should not drive after taking my furosemide
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement?
i sleep on three pillows each night
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?
i wonder if there is any other way
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:
identify the time of the onset of the stroke
A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?
ill eat four servings of fresh dark green veggies every day
A client is participating in a cardiac research study in which his physician is directly involved. Which statement by the client indicates a need for additional teaching about his rights as a research study participant?
ill have to find a new physician if i don't complete the study
The nurse is caring for a client in the coronary care unit when the cardiac monitor reveals ventricular fibrillation. The nurse should anticipate which of the following interventions?
immediate defibrillation
A nurse knows that the major clinical use of dobutamine is to
increase cardiac output
A client is admitted to the hospital with a diagnosis of suspected pulmonary embolism. Prescriptions include: oxygen 2 to 4 L/min per nasal cannula, oximetry at all times, and IV administration of 5% dextrose in water at 100 mL/h. The client has increasing dyspnea and has a respiratory rate of 32 breaths/min. The oxygen flow rate is set at 2 L/min. The nurse should first:
increase the oxygen flow rate from 2 to 4
Which of the following explains the influence of aging on the development of peripheral vascular disease
increased resistance
A client has a total serum cholesterol level of 326 mg/dL (8.44 mmol/L). The nurse explains to the client that this level:
is high and will require dietary modification
A client requested a do-not-resuscitate (DNR) order upon admission to the hospital. He now tells the nurse that he wants the medical team to do everything possible to help him get better and is concerned about the DNR order. Which response by the nurse is best?
it isn't a problem to rescind your DNR order. Ill let your physician know
Knee-high sequential compression devices have been prescribed for a newly admitted client. The client reports new pain localized in the right calf area that is noted to be slightly reddened and warm to touch upon initial assessment. What should the nurse do first?
leave the compression devices off and contact HCP to report assessment findings
The correct landmark for obtaining an apical pulse is the
left fifth intercostal space, mid clavicular line
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?
leg edema
The nurse evaluates the client's understanding of nutritional modifications to manage his hypertension when he states:
limiting my salt intake to 2 grams per day will improve my BP
A clinically obese client with moderately painful varicose veins chooses self-care options for managing the varicosities. The nurse should coach the client to follow which health care practices? Select all that apply.
lose weight wear compression stockings elevate the legs
A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?
low serum potassium level
A client with peripheral artery l disease has femoral-popliteal bypass surgery. The primary goal of the plan of care after surgery is to:
maintain circulation
What is the most important long-term goal for a client with hypertension who smokes?
make a commitment to long term life
A nurse is caring for a client with Raynaud's phenomenon secondary to systemic lupus erythematosus (SLE). Which of the client statements demonstrates an understanding of the nurse's teaching about this disorder? Select all that apply.
my hands get pale i prob got this discord because this problem is cause by temp medication might help
A nurse is assessing a client's blood pressure 8 hours after surgery. The client's blood pressure before surgery was 120/80 mm Hg, and on admission to the postsurgical nursing unit it was 110/80 mm Hg. The client's blood pressure is now 90/70 mm Hg. After determining that other vital signs are normal, what should the nurse do first?
notify the HCP
The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to:
observe careful hand washing procedure
the nurse's discharge teaching plan for the client with heart failure should emphasize the importance of:
obtaining daily weights at the same time
The results of which serologic test should the nurse have on the medical record before a client is started on tissue plasminogen activator or alteplase recombinant?
partial thromboplastin time
A client has been diagnosed with peripheral arterial occlusive disease. In order to promote circulation to the extremities, the nurse should instruct the client to
participate in a regular walking program
Before discharge from the hospital after a myocardial infarction, a client is taught to exercise by gradually increasing the distance walked. Which vital sign should the nurse teach the client to monitor to determine whether to increase or decrease the exercise level?
pulse rate
An older adult has chest pain and shortness of breath. The health care provider (HCP) prescribes nitroglycerin tablets. What should the nurse instruct the client to do?
put the tab under the tongue
The nurse is assessing a client with superficial thrombophlebitis in the greater saphenous vein of the left leg. The client has "aching" in the leg. Which finding indicates the nurse should contact the health care provider (HCP) to request a prescription to improve the client's comfort?
red, warm, palpable linear cord along the win that is painful on palpation
A physician orders aspirin, 325 mg P.O. daily for a client who has experienced a transient ischemic attack (TIA). The nurse should teach the client that the physician has ordered this medication to:
reduce the chance of blood clot formation
A client is discharged to a heart rehabilitation program. What lifestyle changes would be appropriate for the nurse to review?
reduced cholesterol levels, progressive activity levels
A client has acute arterial occlusion. The health care provider (HCP) has prescribed IV heparin. Before starting the medication, the nurse should:
review the blood coagulation lab values
A client with end-stage heart failure is preparing for discharge. The client and his caregiver meet with the home care nurse and voice their concern that setting up a hospital bed in the bedroom will leave him feeling isolated. Which suggestion by the home care nurse best addresses this concern?
set up the hospital bed in the family room so the client can be part of household activities
A client is scheduled for an arteriogram. The nurse should explain to the client that the arteriogram will confirm the diagnosis of occlusive arterial disease by:
showing the location of the obstruction
While the nurse is assisting a client to ambulate as part of a cardiac rehabilitation program, the client has midsternal burning. The nurse should:
stop and assess the client further
One goal in caring for a client with arterial occlusive disease is to promote vasodilation in the affected extremity. To achieve this goal, the nurse should encourage the client to:
stop smoking
A client with migraine headaches and a history of angina asks the nurse why the physician does not prescribe one of the newer medications for migraine, such as sumatriptan. The nurse responds that:
sumatriptan is contraindicated in clients with angina
Following diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. Which instruction would most likely help the client prevent this problem?
take nitroglycerin tab before climbing the stairs
A client is taking verapamil hydrochloride as an antihypertensive. Which statement made by the nurse instructs the client about an adverse effect of verapamil?
take you pulse and report any irregular heartbeats
When helping the client who has had a cerebrovascular accident (CVA) learn self-care skills, the nurse should:
teach the client to put on clothing on the affected side first
The nurse is administering an IV potassium chloride supplement to a client who has heart failure. When developing a plan of care for this client, the nurse should consider that:
the administration of the IV potassium chloride should not exceed 10 mEq
A nurse just received a shift report for a group of clients on the telemetry unit. Which client should the nurse assess first
the client admitted with first degree AV block whose
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 reports increasing severe back pain
Following abdominal surgery, which factor predisposes a client to deep vein thrombosis?
the client will be immobile during and shortly after surgery
A client is given amiodarone in the emergency department for a dysrhythmia. Which finding indicates the drug is having the desired effect?
the number of premature ventricular contractions is decreasing
A client is taking spironolactone to control her hypertension. Her serum potassium level is [6 mEq/L (56mmol/L)]. For this client, the nurse's priority should be to assess her:
ECG results
The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs?
baked chicken, and apple, and a slice of white bread
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond?
you can't shoot a rifle left handed because the roles recoil with trauma
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as:
a third heart sound S3
The client has had a myocardial infarction, and the nurse has instructed the client to prevent Valsalva's maneuver. The nurse determines the client is following the instructions when the client:
avoids holding the breath during activity
A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which of the following is the priority intervention?
control the pain and support breathing and oxygenation
A nurse is caring for a client returning from cardiac catheterization. The nurse helps transfer the client back to bed. Which transfer technique uses appropriate ergonomic principles?
the nurse raises the bed for transfer, maintains a wide based support during transfer, and lowers the bed before leaving the room
A middle-aged man collapses in the emergency department waiting room. The triage nurse should first:
ask the client to state his name
The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?
confusion, urine output 15 mL over the last 2 hours , orthopnea
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
dyspnea
Automated external defibrillators (AEDs) are used in cardiac arrest situations for:
early defibrillation in cases of ventricular fibrillation
The nurse is assisting a client with a stroke who has homonymous hemianopia. The nurse should understand that the client will:
eat food on only half the plate
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action?
administer oxygen, attach a cardiac monitor, take vital signs
When assessing a client with left-sided heart failure, the nurse expects to note:
air hunger
The nurse is admitting an older adult to the hospital. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first?
assess respiratory status
A nurse places electrodes on a collapsed individual who was visiting a hospitalized family member, the monitor exhibits the following. Which interventions would the nurse do first?
assess the clients airway breathing and circulation
A client who is being discharged after a hospitalization for thrombophlebitis will be riding home in a car. During the 2-hour care ride, what should the nurse should advise the client to do?
perform ankle pumps and foot range of motion exercises
A client is admitted for a revascularization procedure for arteriosclerosis in his left iliac artery. To promote circulation in the extremities, the nurse should:
position the left leg at or below the boys horz
The nurse is caring for an older adult with mild dementia admitted with heart failure. What nursing care will be helpful for this client in reducing potential confusion related to hospitalization and change in routine? Select all that apply.
reorient freq arrange for familiar pic spend time with client
The nurse is teaching a client who has deep vein thrombosis that caused a pulmonary embolus, which has now resolved. What should the nurse tell the client?
report such signs as leg swelling, discomfort , redness, or warmth
A nurse is providing discharge instructions to a client with peripheral vascular disease that include stress-reduction techniques. The client asks the nurse, "Why is reducing stress so important?" What is the nurse's best response?
stress reduction techniques are helpful because street stimulates the release of vaso
A client returns to the nursing unit following successful synchronized cardioversion using transthoracic chest wall patches. The nurse should assess which when the client returns to the room? Select all that apply.
vital signs skin of chest wall level of consciousness cardiac rhythm
What is the expected outcome of thrombolytic drug therapy for stroke?
dissolved emboli
A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for:
dependent edema
A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to:
weigh daily
Which client admitted to the emergency department should the nurse see first? A client:
experiencing a "ripping" sensation in the chest
A client is admitted to the hospital through the emergency department with chest pain. Which intervention is the priority?
assessing troponin 1 levels
Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to
revascularize the blocked coronary artery
A client has acute arterial occlusion. The health care provider (HCP) has prescribed IV heparin. Before starting the medication, the nurse should
review the blood coagulation lab values
Which is a priority for exercising for a client who has just had a myocardial infarction?
risk modification education
Three days after mitral valve replacement surgery, the client tells the nurse there is a "clicking" noise coming from the chest incision. The nurse's response should reflect the understanding that the client may be experiencing?
anxiety related to altered body image
A client is admitted with chest pain and kept overnight for stress testing the next morning. Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports (see lab report). The nurse should report which elevated laboratory value to the health care provider (HCP) prior to the stress test?
troponin
A client had a repair of a thoracoabdominal aneurysm 2 days ago. Which finding should the nurse consider unexpected and report to the health care provider (HCP) immediately?
weakness and numbness in he lower extremities
A nursing assistant (unregulated care provider, UCP) has finished taking routine vital signs of the clients assigned to her. While charting later in the shift, a nurse finds that the assistant (UCP) documented a client's blood pressure at 192/126 mm Hg. What is the most appropriate action for the nurse to take?
take the blood pressure herself
A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis?
HX of aortic valve replacement
The nurse is assessing a client who has a long history of uncontrolled hypertension. The nurse should assess the client for damage in which area of the eye?
retina
A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl (6.845 mmol/L), low-density lipoprotein (LDL) 139 mg/dl (3.603 mmol/L), and high-density lipoprotein (HDL) 32 mg/dl (0.829 mmol/L). The client asks the nurse how to lower his cholesterol. The nurse should tell the client that:
shell ask the dietitian to talk with him about modifying his diet
A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions?
stabilizing heart rate and blood pressure and easing anxiety
When performing external chest compressions on an adult during cardiopulmonary resuscitation (CPR), the rescuer should depress the sternum:
2 inches
A client with heart failure is receiving furosemide, 40 mg I.V. The physician orders [40 mEq (40 mmol/L)] of potassium chloride in 100 ml of dextrose 5% in water to infuse over 4 hours. The client's most recent serum potassium level is [3.0 mEq/L (3.0 mmol/L)]. At what infusion rate should the nurse set the I.V. pump?
25 ml/hr
In teaching the client with hypertension to avoid orthostatic hypotension, the nurse should teach the client to follow which instructions? Select all that apply.
arise slowly from bed avoid standing still for long periods
After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize her client care assignment. The nurse has an ancillary staff member available to help her care for her clients. Which of these clients should the registered nurse assess first?
the client with heart failure who is having some diff breathing
The nurse caring for a client on the cardiac unit notices that the client's cardiac monitor shows ventricular fibrillation. What is the priority action by the nurse?
immediate defibrillation
While caring for a client who has sustained a myocardial infarction (MI), the nurse notes eight premature ventricular contractions (PVCs) in 1 minute on the cardiac monitor. The client is receiving an IV infusion of 5% dextrose in water (D5W) at 125 ml per hour and oxygen at 2 L/min. The nurse should first
increase the IV infusion rate 150 mL per hour
A female client who is 32 years of age has been diagnosed with stage 1 hypertension. The client's height is 5 feet 5 inches (165 cm), and her weight is recorded as 125 pounds (56.6 kg); she reports that she frequently eats at "fast food" restaurants and enjoys a glass of wine to relax on weekends. In developing a teaching plan for this client, the nurse should address which topic?
low sodium food choices
An older adult is admitted to the telemetry unit for placement of a permanent pacemaker because of sinus bradycardia. What is a priority goal for the client within 24 hours after insertion of a permanent pacemaker?
maintain cardiac conduction stability
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:
major dental work
The nurse is caring for a client who has been diagnosed with deep vein thrombosis. When assessing the client's vital signs, the nurse notes an apical pulse of 150 bpm, a respiratory rate of 46 breaths/minute, and blood pressure of 100/60 mm Hg. The client appears anxious and restless. What should be the nurse's first course of action?
notify the health care provider
Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization?
observe the puncture site for swelling and bleeding
A client is in hypovolemic shock. In which position should the nurse place the client?
supine with the legs elevated 15 degrees
What is a priority nursing assessment in the first 24 hours after admission of the client with a thrombotic stroke?
pupil size and pupillary response
A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?
elevated ST segment
The client with peripheral artery disease reports both legs hurt when walking. What should the nurse instruct the client to do?
enroll in a supervised exercise training program
An older adult takes two 81-mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment?
explain to the client that the "ringing" may be related to the aspirin
A client with angina shows the nurse the nitroglycerin that the client carries in a plastic bag in a pocket. The nurse instructs the client that nitroglycerin should be kept in:
a dark container to shield from light
A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of:
acute pulmonary edema
A client has atrial fibrillation and a heart rate of 165 bpm. In which order from first to last should the nurse implement these prescriptions? All options must be used.
administer oxygen via nasal cannula place client on ECG obtain vital signs gather supplies
The nurse is preparing to defibrillate a client on a cardiac monitor who is in ventricular fibrillation (see photo). What should the nurse do?
after pressing the change button and calling all clear push the shock button
A client has been diagnosed with atrial fibrillation. The health care provider (HCP) prescribed warfarin to be taken on a daily basis. The nurse instructs the client to avoid using which over-the-counter medication while taking warfarin?
aspirin
Which food should the nurse teach a client with heart failure to limit when following a 2-gram sodium diet?
canned tomato juice
A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:
forcing blood into the deep venous system
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:
aspirin or clopidogrel
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction?
client walks 4 miles in 1 hours every day
A nurse is caring for a client with frequent episodes of ventricular tachycardia. The lab calls with a critically high magnesium level of 11 mg/dL on this client. What is the nurse's priority action?
obtain an order for calcium gluconate 2 g IV push over 2-5 min
The nurse is developing a discharge plan for a client who has had a myocardial infarction. Planning for discharge for this client should begin:
on admission to the hospital
Which information about sublingual nitroglycerin tablets should the nurse include when instructing the client with angina?
store the tablets in a tight, light-resistant container.
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
A client with migraine headaches and a history of angina asks the nurse why the physician does not prescribe one of the newer medications for migraine, such as sumatriptan. The nurse responds that
sumatriptan is contraindicated in clients with angina
Which indicates hypovolemic shock in a client who has had a 15% blood loss?
systolic blood pressure less than 90 mm Hg
A nurse is evaluating the 12-lead electrocardiogram (ECG) of a client experiencing an inferior wall myocardial infarction (MI). While conferring with the team, she correctly identifies which ECG changes associated with an evolving MI? Select all that apply.
t wave st segment elevation
A visiting nurse is teaching a client with heart failure about taking his medications. The client requires six different medications that are taken at four different times per day. The client is confused about when to take each medication. How should the nurse intervene?
teach a family member to fill a medication compliance aid once per week
The client asks the nurse, "Why will the health care provider not tell me exactly how much of my leg he is going to take off? Do you not think I should know that?" On which information should the nurse base the response?
the adequacy of the blood supply to the tissues
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
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?
ill keep a log of each time my ICD discharges
A nurse on the telemetry unit is faced with various monitor rhythms. Which rhythm takes priority?
a client cardiac rhythm suddenly changes from normal sinus rhythm
After receiving nitroglycerin, a client says his chest pain has diminished. The physician orders transdermal nitroglycerin, 0.2-mg/hour patch, as prophylaxis for angina pectoris. When teaching the client how to apply the transdermal system, which instruction should the nurse provide?
be sure to report skin irratation or other adverse reactions
The nurse is assessing a client admitted with a myocardial infarction with the following assessment: dyspnea, heart rate of 140 bpm, and crackles in the posterior chest. The nurse would interpret these findings as which of the following?
development of congestive heart failure
A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of
digoxin toxicity
An 80-year-old client is admitted with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for:
digoxin toxicity
nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m. (0700), before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:
assess the client for bleeding around the gums or in the stool
A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?
be sure to take after precautions because nitro may cause dizziness when you stand up
A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?
blood pressure 84/52 mm Hg
A nurse is caring for a client with end-stage heart failure who is awaiting a heart transplant. The client tells the nurse that he thinks he's going to die before a donor heart is found. He also tells the nurse that he hasn't been attending a church but wants to talk with a priest. What action should the nurse take?
contact the clergy member who is assigned to the transplant team
A client with a cerebral embolus is receiving streptokinase. The nurse should evaluate the client for which expected therapeutic outcomes of this drug therapy?
dissolved emboli
A client with heart failure has assessment findings of jugular vein distension (JVD) when lying flat in bed. Which of the following is the best nursing intervention?
elevate the head of the bed to 30 to 45 degrees and reassess JVD
The nurse is assessing a cliet who has a history of peripheral vascular disease. The nurse observes that the left great toe is black. The discoloration is likely a result of:
gangrene
A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft. The blood pressure has decreased from 124/80 mm Hg to 88/62 mm Hg. What should the nurse assess first?
pedal pulses
A client is receiving pentoxifylline for intermittent claudication. The nurse should determine the effectiveness of the drug by asking if the client:
has less pain in the legs
The nurse is taking a nursing history from a client prior to surgery. Which information in the client's history would have a significant impact on the client's recovery postoperatively? The client:
has smoked 1 pack of cigarettes a day for 12 years
A client who has been experiencing angina has a new prescription for nitroglycerin. The nurse should instruct the client to report having which potential side effect of nitroglycerin?
headache
Which statement would lead the nurse to determine that a client lacks understanding of her acute cardiac illness and the ability to make changes in her lifestyle?
i already have my airline ticket
A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures?
i have my wife look at the soles of my feet each day
A client with a history of coronary artery disease (CAD) has been diagnosed with peripheral arterial disease. The health care provider (HCP) started the client on pentoxifylline once daily. Approximately 1 hour after receiving the initial dose of pentoxifylline, the client reports having chest pain. The nurse should first:
inform the HCP
A 68-year-old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The nurse should first:
inquire about the onset, duration, severity, and precipitating factors of the heaviness
What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock?
intra-aortic balloon pump
A client is talking with the nurse about unsightly varicose veins and their discomfort. What information should the nurse provide to the client?
keep the legs elevated when sitting or laying down
Before administering digoxin, a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the:
kidneys
A client is admitted to the emergency department reporting severe abdominal pain. A radiograph reveals a large abdominal aortic aneurysm. The primary goal at this time is to:
prepare the client for emergency surgery
