The Client with Cardiac Problems

Which are the indication that a client with left-sided heart failure is developing pulmonary edema? Select all that apply A. Distended jugular veins B. Dependent edema C. Anorexia D. Coarse crackles E. Tachycardia

E F

The nurse is caring for a client who has just returned from have a percutaneous transluminal balloon angioplasty with femoral access. In which order, from first to last, should the nurse obtain information about the client? 1. VS and O2 Sat 2. Pedal pulses 3. Color and sensation of extremities 4. Catheterization site

1 2 4 3

Furosemide is administered IV to a client with heart failure. How soon should the nurse begin to see evidences of the drugs desired effects? A. 5-10 minutes B. 30-60 minutes C. 2-4 hours D. 6-8 hours

A

Which set of postural vital signs in a client with hypertension should the nurse report to the HCP? 1. Supine 124/76, 88 Sitting 124/74, 92 Standing 122/74, 92 2. Supine 120/70, 70 Sitting 102/64, 86 Standing 100/60, 92 3. Supine 138/86, 74 Sitting 136/84, 80 Standing 134/82, 82 4. Supine 100/70, 72 Sitting 100/68, 74 Standing 98/68, 80

2

Cardiac telemetry shows that a client who is up to the bathroom has converted from normal sinus rhythm with a rate of 72 BPM to atrial fibrillation with a ventricular response rate of 100 bpm. In what order should the nurse perform interventions from first to last? 1. Assess VS 2. Assist the client to bed 3. Initiate IV access 4. Obtain a stat 12-lead EKG

2 1 3 4

A nurse is working the day shift on a cardiac unit receives the following shift report. At the conclusion of the shift report, it is 0730. Put the following clients in order from first to last in order of which patient the nurse should assess from first to last? 1. Client 1: Admitted yesterday morning with hypokalemia. Awaiting repeat electrolyte lab results drawn at 0600. 2. Client 2: Experienced chest pain at 0630. Pain resolved after two nitroglycerin tablets 3. Client 3: Scheduled for oral antihypertensive medication at 0900. Incontinent of urine during the night 4. Client 4: Scheduled for coronary artery bypass surgery at 0800. The client's family is in the client's room

2 4 3 1

An adult comes into the ER with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting dx is acute myocardial infarction. PRescriptions include O2 NC 4/L min, CBC, chest radiograph, a 12 lead EKG, and 2 mg IV morphine sulfate. What should the nurse do first? A. Administer the morphine B. Obtain a 12-lead EKG C. Obtain the blood work D. Prescribe the chest radiograph

A

An older client with a hx of heart failure is admitted to the ED with pulmonary edema. During admission, what should the nurse assess first? A. BP B. Skin Breakdown C. Serum potassium level D. Urine output

A

How should the nurse instruct the client with unstable angina to use a sublingual nitroglycerin tablets when the chest pain occurs? A. Sit down and then take one tablet every 2 to 5 minutes until the pain stops B. Sit down and then take one tablet and rest for 15 minutes. Call the PCP if the pain persists after 15 minutes C. Sit down and then take one tablet; then if the pain persists, take additional two tablets in five minutes. Call the HCP is pain persists after 15 minutes. D. Sit down and take one tablet, if the pain persists after 5 minutes, call enough

A

The client who experiences angina has been told to follow a low-cholesterol diet. Which meal would be best? A. A change in the pattern of the chest pain B. Pain during sexual activity C. Pain during an argument D. Pain during or after physical activity

A

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur at the apex. What should the nurse do first? A. Assess for changes in VS B. Draw an arterial blood gas C. Evaluate heart sounds with the client leaning forward D. Obtain a 12-lead EKG

A

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: A. Anxiety r/t altered body image B. Depression r/t altered health status C. Altered tissure perfusion D. Lack of knowledge regarding the post-op course

A

What is the major goal of nursing care for a client with heart failure and pulmonary edema? A. Increased cardiac output B. Improve respiratory status C. Decreased peripheral edema D. Enhance comfort

A

A client is scheduled for a cardiac catheterization. The nurse should do which pre-op tasks? Select all that apply A. Verify if the client has stopped taking anticoagulants if instructed by the HCP B. Check for iodine sensitivity C. Verify that written consent has been obtained D. Withhold food and water before the procedure E. Insert a urinary drainage catheter

A B C D

A client diagnosed with primary hypertension is taking chlorothiazide. The nurse determines teaching about this medication is effective when the client makes what statements? Select all that apply A. Ill weigh myself everyday at the same time B. I won't drink alcoholic beverages while on this medication C. I'll reduce salt intake in my diet D. If l have severe dizziness, I'll reduce my dosage E. If I have prolonged exposure to sunlight, I'll use sunscreen F. I'll take the drug before I go to bed

A B C E

A client who has diabetes is taking metoprolol for hypertension. What should the nurse instruct the client to do? Select all that apply A. Take the tablets with food at the same time each day B. Do not crush or chew the tablets C. Notify the HCP if pulse is 82 bpm D. Have a blood glucose level drawn every 6 to 12 months during therapy E. If I have prolonged exposure to sunlight. I'll use sunscreen. F. I'll take the drug before I go to bed

A B C E

A client returns to the nursing unit following successful synchronized cardioversion using transthoracic wall patches. What should the nurse assess when the client returns to the room? Select all that apply A. VS B. Skin of the chest wall C. Arterial puncture site D. LOC E. Cardiac rhythm

A B D E

The UAP reports to the nurse that a client is "feeling SOB". The client's BP was 124/78 mm Hg 2 hours ago with a HR of 82 bpm: the UAP reports that the BP is not 84/44 mmHg with a heart rate of 54 bpm, and the client stated, "I just don't feel good." What actions should the nurse take? Select all that apply A. Confirm the client's VS and complete a quick assessment B. Inform the charge nurse of the change in condition, and initiate the hospital's rapid/emergency response team C. Make a quick check on other patients before spending the amount of time required to take care of the patient D. Position the client in a semi-Fowler's position E. Stay will the cilet and be reassuring F. Call the HCP and report the situation in SBAR format

A B D E F

A client is taking clonidine for tx of hypertension. The nurse should teach the client about which common adverse effects of this drug? A. Dry mouth B. Hyperkalemia C. Impotence D. Pancreatitis E. Sleep disturbances

A C E

The nurse should assess the client with left-sided heart failure for which findings? A. Dyspnea B. Jugular vein distension C. Crackles D. Right upper quadrant pain E. Oliguria F. Decreased O2 sat levels

A C E F

A client with acute chest pain is receiving IV morphine sulfate.. Which is an expected effect of morphine? Select all that apply A. Reduces myocardial oxygen consumption B. Promotes reduction in RR C. Prevents ventricular remodeling D. Reduces blood pressure and heart rate E. Reduces anxiety and fear

A D E

A client experiences initial indications of dizziness after having an Iv infusion of lidocaine hydrochloride started. The nurse should further assess the client for which symptoms? A. Palpations B. Tinnitus C. Urinary Frequency D. Lethargy

B

A client returns from a left heart catheterization. The right groin was used for catheter access. In which location should the nurse palpate the distal pulse on this client? A. Anterior to the right tibia B. Dorsal surface of the right foot C. Posterior to the right knee D. Right mid inguinal period

B

A client with heart failure is taking furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notees that the client is confused. The telemetry strip shows first-degree atrioventricular block. What other sign shouold the nurse assess next? A. Hyperkalemia B. Digoxin toxicity C. Fluid defecit D. Pulmonary edema

B

A middle-aged client with a hx of hypertension reports having indigestion. The nurse connects the client to a cardiac monitor, which reveals eight premature ventricular contractions per minute. What should the nurse do next? A. Call the PCP B. Start an IV infusion C. Obtain a portable chest radiograph D. Draw blood for laboratory studies

B

A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nurse administers furosemide and nitroprusside as prescribed. The nurse notices a sudden drop in the pulmonary artery diastolic pressure and pulmonary artery wedge pressure. What should the nurse assess next? A. 12-lead EKG B. BP C. Lung sounds D. Urine output

B

When administering a thrombolytic drug to a client experiencing an MI and who has premature ventricular contractions, which is the unexpected outcome of the drug? A. Promote hydration B. Dissolve clots C. Prevent kidney failure D. Treat dysrhythmias

B

Which is the most appropriate diet for a client during the acute phase of an MI? A. Liquids as desired B. Small, easily digested meals C. Three regular meals a day D. NPO

B

What instructions should the nurse give the client who will be starting a prescription for Simvastatin 40 mg/day client? Select all that apply A. Take once a day in the morning B. If you miss a dose, take it when you remember it. C. Limit greens such as lettuce in the diet to prevent bleeding D. Be sure to take the pill with food E. Report muscle pain or tenderness to your HCP F. Continue to follow a diet that is low in saturated fats

B E F

A client has a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter the nurse wedges the catheter. What information will the nurse obtain from this procedure? A. Cardiac output B. Right atrial blood flow C. Left end-diastolic pressure D. Cardiac index

C

A client is taking nifedipine. What instruction should the nurse give the client? A. Monitor the BP monthly B. Perform daily weights C. Inspects gums daily D. Limit intake of leafy greens

C

A client returned from the cardiac catheterization laboratory after a balloon valvuloplasty for mitral stenosis. Which finding requires immediate nursing action? A. There is a low, grade one intensity mitral regulation murmur B. SPO2 is 94% of 2L via NC C. The client has become more somnolent D. Urine output decreased from 60 mL/h to 40mL over the last hour

C

A client suddenly develops paroxysmal supraventricular tachycardia at a rate of 180 bpm. Current VS: BP 90/45 mmHg, HR 180 bpm, RR 30 min, O2 sat 90% on room air. The client is diaphoretic and reports dizziness. What should the nurse do first? A. Ask the client about current caffeine use B. Administer atropine per agency policy C. Prepare defibrillator for synchronized cardioversion D. Start CPR

C

The nurse is caring for a group of clients. Which client should the nurse see first? A. A client with an hx of sinus tachycardia who is to receive a beta-blocker B. A client with stable angina who took one sublingual nitroglycerin tablet 30 min ago C. A client with a placement of a coronary atery stent 30 min ago D. A client with new onset atrial fibrilation who has a HR of 95

C

The nurse is in the ICU and is given a report by the nurse in a step-down unit about a client who has a coronary artery bypass surgery. Which is the most effective way to assure essential information about the client is reported? A. Give the report face-to-face with both nurses in a quiet room B. Audiotape the report for further reference and documentation C. Use a printed checklist with information individualized for the client D. Document essential transfer information in the client's medical record

C

Which position is best for a client with heart failure who has orthopnea? A. Semi-sitting (semi-fowler's) with legs elevated on pillows B. Lying on the right side with a pillow between the legs C. Sitting upright with legs resting on the mattress D. Lying on the back with head lowered

C

The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse, and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? A. Obtain a hx of which drugs the client has recently used B. Administer the prescribed dose of morphine C. Position the electrode on the chest D. Take VS

C D B A

When caring for a client with newly diagnosed cardiac dysrhythmia, which lab values are the priority to monitor? Select all that apply A. BUN 20 mg/dL B. Hct 40% C. Sodium of 124 mEq/L D. Potassium of 3.1 mEq/L E. Hgb of 14 g/dL F. Calcium of 8.5 mEq/L G. PTT of 12 sec with an INR of 1

C D F

A client was admitted with an exacerbation of heart failure breath at 0200. At 0700, which information is the most important for the nurse who admitted the client to communicate during the hand-off of care report to the nurse taking care of the client? A Admission weight of 210 lb B. Elevated B-type natriuretic peptide of 600 mg/mL C. Reaching 250 mL by incentive spirometer D. Urinary output of 120 mL

D

The nurse notices that a client's HR has decreased from 63 BPM to 50 BPM on the monitor. What should the nurse do first? A. Administer atropine 0.5 mg IV push B. Auscultate for abnormal heart sounds C. Prepare for transcutaneous pacing D. Take the client's BP

D

When performing the Heimlich Maneuver on a conscious adult, where should the nurse deliver the rescuer inward and upward thrusts? A. Above the umbilicus B. At the level of the xiphoid process C. Over the clients midabdominal area D. Below the xiphoid process and above the umbilicus

D

Which is an expected outcome for a client on the 2nd day of a hospitalization after an MI? A. The client continues to have severe chest pain B. The client participates in a cardiac rehabilitation walking program C. The client can identify MI risk factors D. The client can perform personal self-care activities without pain

D

The nurse is caring for a group of clients on a med/Surg nursing unit. Which task could the nurse delegate to the UAP? Select all that apply A. Assess pedal pulses on a client who just returned from a cardiac angiogram B. Administer O2 via NC to a client with a SpO2 of 89% C. Administer acetaminophen to a client with a pain level of 5/10 D. Perform VS and O2 sat on a client returning from the catheterization lab E. Obtain I&O on a client experiencing heart failure

D E