Prep U Practice Questions (Perfusion)
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? "When I finish the rehabilitation program I'll never have to worry about heart trouble again." "I won't be able to jog again even with rehabilitation." "Rehabilitation will help me function as well as I physically can." "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."
"Rehabilitation will help me function as well as I physically can." Explanation: The client demonstrates understanding of cardiac rehabilitation when stating that it helps reach individual activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education.
A client is admitted to a skilled health facility after total hip replacement. The client asks if the nurse would explain the types of cells that circulate in the blood. The nurse would include which information? "There are three distinct cells that circulate in the blood: red blood cells, white blood cells, and platelets." "There are three distinct cells that circulate in the blood: red blood cells, white blood cells, and potassium cells." "There are three distinct cells that circulate in the blood: red blood cells, white blood cells, and sodium cells." "There are three distinct cells that circulate in the blood: red blood cells, white blood cells, and carbon dioxide cells."
"There are three distinct cells that circulate in the blood: red blood cells, white blood cells, and platelets." Explanation: There are three distinct cells that circulate in the blood: red blood cells, white blood cells, and platelets. Potassium, sodium, and carbon dioxide are electrolytes, not cells.
The nurse needs to administer enoxaparin 40 mg subcutaneously daily prophylactically for deep vein thrombosis in a client who had a left hip replacement. The drug is available as 60 mg/0.6mL. How many milliliters will the nurse give? Record your answer using one decimal place.
0.4 Explanation: Calculating dosage using the formula method requires knowing the Desired Dose (D), the Have (H) or dosage on hand, and the Supply (S) or volume on hand. To calculate the volume to administer, divide the Desired Dose by the Have and multiply the result by the Supply. In this case, the Desired Dose is 40 mg, the Have is 60 mg, and the Supply is 0.6 mL. (D/H) x S = Volume to administer (40 mg/60 mg) x 0.6 mL = 0.4 mL.
Which particular area(s) should be examined to assess peripheral edema? Upper arms Under the sacrum Lips, earlobes Feet, ankles
Feet, ankles Explanation: When right-sided heart failure occurs, blood accumulates in the vessels and backs up in peripheral veins, and the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. Other prominent areas prone to edema are the fingers, hands, and over the sacrum. Cyanosis can be detected by noting color changes in the lips and earlobes.
A nurse is caring for a client with lower extremity peripheral vascular disease. Which pulse will be the priority assessment for this client? brachial femoral radial dorsalis pedis
dorsalis pedis Explanation: Assessment of pulses provides information regarding blood flow to an area. The client with lower extremity peripheral vascular disease is at risk for decreased blood flow to the lower extremities. The dorsalis pedis pulse can be palpated on the dorsal surface of the foot, with a diminished or absent pulse indicating decreased blood flow to the lower extremity. Diminished dorsalis pedis pulses are the most common pulse irregularity present in clients with peripheral vascular disease and would be the priority for assessment. Brachial and radial pulses provide information regarding blood flow to upper extremities. Assessment of the femoral pulse is important, but not the priority.
When the nurse is administering furosemide 20 mg to a client in congestive heart failure, what phase of the nursing process does this represent? assessment planning implementation evaluation
implementation Explanation: Implementation refers to the action phase of the nursing process, in which nursing care is provided. Assessment is necessarily the first phase, allowing planning of appropriate nursing interventions. Evaluation occurs after intervention to determine the effectiveness of nursing care and need for adjustment or further action.
The nurse is teaching a newly diagnosed hypertensive client how to take his or her own BP at home. The client asks why it is so important to do this. What is the nurse's best response? "Because it is required by your insurance." "Monitoring your BP at home will assist in controlling your BP, thereby decreasing your risk for heart attack and stroke." "Your BP measurements at home are more accurate than the ones we do in the health care setting." "You must do this because the doctor ordered it."
"Monitoring your BP at home will assist in controlling your BP, thereby decreasing your risk for heart attack and stroke." Explanation: Teaching a client to monitor his or her BP at home has been shown to increase compliance with a treatment plan, thereby assisting in the control of blood pressure and decreasing the risk for stroke and heart attack. The other three answers are not appropriate statements to encourage the client's participation in this activity.
A nurse is caring for a client with excess abdominal fat. Which of the following is a risk associated with excessive abdominal fat about which the nurse should inform the client? Emaciation Cachexia Cardiovascular disease Anorexia
Cardiovascular disease Explanation: Excess abdominal fat may lead to cardiovascular disease, hypertension, and diabetes mellitus. Anorexia is the loss of appetite. Emaciation is characterized by excessive leanness. Cachexia is the general wasting away of body tissue.
A nurse prepares to care for a client who has just been admitted to the health care facility. Which activity will the nurse perform first? Collect data. Formulate nursing diagnoses. Develop a care plan. Write client outcomes.
Collect data. Explanation: The nurse will first collect relevant data from various sources. Based on the data collected, the nurse will formulate a plan of care including nursing diagnoses, interventions, and appropriate client outcomes.
A nurse needs to measure the pulse of a client admitted to the healthcare facility. Which site would the nurse most likely use? Femoral Temporal Pedal Radial
Radial Explanation: The radial artery is the site most commonly assessed in a clinical setting. The radial pulse is palpated on the thumb side of the inner aspect of the wrist. Deep palpation is required to detect the femoral pulse beneath the subcutaneous tissue, in the anterior, medial aspect of the thigh, just below the inguinal ligament about halfway between the anterior superior iliac spine and the symphysis pubis. The pulsation of the temporal artery is palpated in front of the upper part of the ear; however, it is not the site most commonly assessed in the clinical setting. The pedal pulse or dorsalis pedis pulse can be felt on the dorsal aspect of the foot; however, the dorsalis pedis pulse may be congenitally absent in some clients.
When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalize blood pressure? Increase iodine intake. Increase intake of fluids. Avoid intake of low-fat diet. Reduce sodium intake.
Reduce sodium intake. Explanation: The nurse advises the client with essential hypertension to reduce sodium intake. The nurse also advises the client to reduce oral fluid to decrease circulating blood volume and systemic vascular resistance and adhere to a low-fat diet.
The nurse is assisting the client to manage the cardiovascular risk factors of hyperlipidemia and hypertension. The client asks the nurse what type of a diet would be best to follow. What is the best response by the nurse? A diet low in sodium, fat, cholesterol A diet high in trans fats and potassium A diet with restricted fruits and fluids A diet with high sodium, fruits, vegetables
A diet low in sodium, fat, cholesterol Explanation: Diets that are restricted in sodium, fat, and cholesterol are commonly prescribed to manage the cardiovascular risk factors of hypertension and hyperlipidemia. The lowered sodium, fat, and cholesterol diets aid with decreasing water retention and fatty substances. Cardiovascular risk factors do not involve potassium levels and limiting fruits and fluids. Cardiovascular risks factors are lowered by eating fruits and vegetables to lower cholesterol levels.
A client has been prescribed a new antihypertensive medication and is reporting dizziness. Which is the best way for the nurse to assess blood pressure? Assess the blood pressure in the supine, sitting, then standing positions. Ask the client to ambulate first, then assess the blood pressure. Take the blood pressure on both arms, and compare the values. Assess the blood pressure at the beginning and the end of the examination.
Assess the blood pressure in the supine, sitting, then standing positions. Explanation: By measuring the client's blood pressure in the supine, sitting, and standing positions, the nurse can assess for postural hypotension. Asking the client to ambulate first and taking the blood pressure on both arms will not provide the most accurate information. Assessing at the beginning and end of the exam is incorrect because this measures a deficit and is not a tool for investigating hypotension.
A nurse educator is providing information about hypertension to a small group of clients. A participant asks "What can I do to decrease my blood pressure and thus my risk for heart problems?" The nurse describes modifiable and nonmodifiable risk factors. Which of the following risk factors can the client modify? Dyslipidemia Age (older than 55 years for men, 65 years for women) Family history of cardiovascular disease Ethnicity
Dyslipidemia Explanation: Modifiable risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, and physical inactivity.
A nurse is providing preoperative teaching to a client who will soon undergo a cardiac bypass. The nurse's teaching plan includes exercises of the extremities. What is the purpose of teaching a client leg exercises prior to surgery? Leg exercises increase the client's muscle mass postoperatively. Leg exercises improve circulation and prevent venous thrombosis. Leg exercises help to prevent pressure sores to the sacrum and heels. Leg exercise help increase the client's level of consciousness after surgery.
Leg exercises improve circulation and prevent venous thrombosis. Explanation: Exercise of the extremities includes extension and flexion of the knee and hip joints (similar to bicycle riding while lying on the side) unless contraindicated by type of surgical procedure (e.g., hip replacement). When the client does leg exercises postoperatively, circulation is increased, which helps to prevent blood clots from forming. Leg exercises do not prevent pressure sores to the sacrum, or increase the client's level of consciousness. Leg exercises have the potential to increase strength and mobility, but are unlikely to make a change to muscle mass in the short term.
