Quizzes About Health

134 Questions  I  By RNSTUDENT29
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Health Quizzes & Trivia
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  • 1. 
    A client has had a recent myocardial infarction involving the left ventricle. Which assessment finding is expected?
    • A. 

      Faint S1 and S2 sounds on auscultation

    • B. 

      Decreased cardiac output

    • C. 

      Increased blood pressure

    • D. 

      Increased strength of peripheral pulses


  • 2. 
    A client with a stenotic mitral valve has presented to the clinic for further evaluation. Which intervention is the highest priority?
    • A. 

      Assessment of blood pressure

    • B. 

      Assessment of heart rate

    • C. 

      Intravenous fluids

    • D. 

      Administration of digoxin


  • 3. 
    What assessment finding will the nurse expect as the client’s mean arterial blood pressure decreases below 60 mm Hg?
    • A. 

      Increased cardiac output

    • B. 

      Hypertension

    • C. 

      Chest pain

    • D. 

      Decreased heart rate


  • 4. 
    A client’s heart rate and rhythm is regular. What does the nurse assume from this finding?
    • A. 

      The coronary arteries have no atherosclerosis.

    • B. 

      Blood pressure is stable.

    • C. 

      Conductivity of the cells in the heart is normal.

    • D. 

      Automaticity of the cells in the conduction system is normal.


  • 5. 
    The client presents with a heart rate of 40 beats/min. The nurse expects that an electrophysiological study may determine an alteration in which structure?
    • A. 

      Sinoatrial (SA) node

    • B. 

      Bachmann’s bundle

    • C. 

      Bundle of His

    • D. 

      Purkinje fibers


  • 6. 
    A client brought to the emergency room following a myocardial infarction is found to be hypotensive. Which compensatory change is expected as a result of baroreceptor stimulation?
    • A. 

      Increased heart rate

    • B. 

      Vasodilation

    • C. 

      Hypoxemia

    • D. 

      Decreased respiratory rate


  • 7. 
    A client with a history of having several myocardial infarctions has excessive filling of the ventricles as a result. Which physiologic response will the nurse expect to see in this client?
    • A. 

      Decreased cardiac output

    • B. 

      Increased blood pressure

    • C. 

      Increased pulse pressure

    • D. 

      Increased mean arterial pressure


  • 8. 
    A client’s heart disease has resulted in a reduction of stroke volume. Which compensatory mechanism is expected?
    • A. 

      Increased blood pressure

    • B. 

      Decreased mean arterial pressure

    • C. 

      Increased heart rate

    • D. 

      Decreased respiratory rate


  • 9. 
    The nurse has administered a drug that causes vasoconstriction. Which finding indicates an expected response?
    • A. 

      Increased diastolic blood pressure

    • B. 

      Decreased heart rate

    • C. 

      Increased systolic blood pressure

    • D. 

      Increased mean arterial pressure


  • 10. 
    The client is being given a drug that blocks the action of the sympathetic nervous system. Which assessment finding does the nurse expect?
    • A. 

      Increased blood pressure

    • B. 

      Increased heart rate

    • C. 

      Increased cardiac output

    • D. 

      Decreased heart rate


  • 11. 
    Which client does the nurse determine is at high risk for cardiovascular disease?
    • A. 

      Older adult with asthma

    • B. 

      Asian-American woman with breast cancer

    • C. 

      Middle-aged African-American man with diabetes mellitus

    • D. 

      Postmenopausal woman on estrogen hormone replacement therapy


  • 12. 
    Which illness in the client’s history would alert the nurse to the possibility of an abnormality of the heart valves?
    • A. 

      Tuberculosis

    • B. 

      Recurrent viral pneumonia

    • C. 

      Rheumatic fever

    • D. 

      Asthma


  • 13. 
    A nurse is performing an admission assessment on an older adult client with multiple chronic diseases. The nurse finds the heart rate to be 48 beats/min. What will the nurse do first?
    • A. 

      Document the finding as normal.

    • B. 

      Evaluate the client for a pulse deficit.

    • C. 

      Assess the client’s medications.

    • D. 

      Administer atropine.


  • 14. 
    Which client is most at risk for cardiovascular disease?
    • A. 

      A woman on hormone replacement therapy

    • B. 

      A woman who has never been pregnant

    • C. 

      A woman with elevated HDL (high-density lipoprotein) levels

    • D. 

      A woman with abdominal obesity


  • 15. 
    Which client is most at risk for peripheral vascular disease?
    • A. 

      A middle-aged man who smokes

    • B. 

      A middle-aged woman with a sedentary lifestyle

    • C. 

      An older man who is moderately obese

    • D. 

      A young adult with family history of coronary artery disease


  • 16. 
    Which client statement alerts the nurse to the occurrence of heart failure?
    • A. 

      “I get short of breath when I climb stairs.”

    • B. 

      “I see halos floating by.”

    • C. 

      “I have trouble remembering things.”

    • D. 

      “I have lost my appetite”.


  • 17. 
    Which statement made by a client would alert the nurse to the presence of edema?
    • A. 

      “I wake up to go to the bathroom at night.”

    • B. 

      “My shoes fit tighter by the end of the day.”

    • C. 

      “I seem to feel more anxious lately.”

    • D. 

      “I drink at least eight full glasses of water a day.”


  • 18. 
    A client has been diagnosed as having New York Heart Association Class I functional status. What will the nurse teach the client?
    • A. 

      “You have no limitations on ordinary physical activity.”

    • B. 

      “The discomfort you experience may occur with ordinary physical activity.”

    • C. 

      “You will not be able to do more than simple activity.”

    • D. 

      “The discomfort you have may be present even at rest.”


  • 19. 
    Which assessment finding indicates arterial insufficiency?
    • A. 

      Dependent edema

    • B. 

      Dependent rubor

    • C. 

      Bluish discoloration of the toes

    • D. 

      Clubbing of the fingers


  • 20. 
    The nurse determines that the client has clubbing. Which is the best intervention?
    • A. 

      Calling the health care provider

    • B. 

      Assessing capillary refill

    • C. 

      Assessing the client’s pulse oxygen level

    • D. 

      Monitoring the client’s heart rate


  • 21. 
    The client’s blood pressure is 134/88 mm Hg. Which is the nurse’s best intervention?
    • A. 

      Calling the health care provider because this is severe hypertension

    • B. 

      Reassessing the blood pressure in 1 month because this is stage 2 hypertension

    • C. 

      Reassessing the client’s blood pressure at the next yearly physical

    • D. 

      Teaching the client lifestyle modifications to decrease the blood pressure


  • 22. 
    The nurse assesses the client’s cardiac status. Which finding requires immediate intervention?
    • A. 

      Swishing sound heard on either side of the neck

    • B. 

      Bounding pulses

    • C. 

      Pulse rate of 90 beats/min

    • D. 

      Blood pressure of 140/90 mm Hg


  • 23. 
    A client consistently reports feeling dizzy and lightheaded when moving from a supine position to a sitting position. Which assessment takes priority at this time?
    • A. 

      Pulse oximetry

    • B. 

      Blood pressure

    • C. 

      Respiratory rate

    • D. 

      Neurologic evaluation


  • 24. 
    Which technique will the nurse use to assess the point of maximal impulse (PMI)?
    • A. 

      With the client in a supine position at a 45-degree angle, compress the upper right abdomen for 30 to 40 seconds and observe for neck vein distention.

    • B. 

      Measure the blood pressure in both upper arms. The arm with the highest pressure should be used for blood pressure measurement thereafter.

    • C. 

      Apply the bell of the stethoscope over the skin of the carotid artery while the client holds his or her breath.

    • D. 

      With the client in the supine position, inspect the chest for prominent precordial pulsations.


  • 25. 
    Which technique will the nurse use to auscultate the second heart sound?
    • A. 

      Bell of the stethoscope at the base of the heart

    • B. 

      Diaphragm of the stethoscope at the base of the heart

    • C. 

      Bell of the stethoscope at the left sternal border of the heart

    • D. 

      Diaphragm of the stethoscope at the left sternal border of the heart


  • 26. 
    The nurse hears a splitting of S1 on auscultation of a young adult client. Which is the nurse’s best action?
    • A. 

      Repeat the auscultation using the diaphragm of the stethoscope.

    • B. 

      Repeat the auscultation with the client lying on the left side.

    • C. 

      Notify the health care provider.

    • D. 

      Document the finding.


  • 27. 
    The nurse hears an atrial gallop (S4) in an older adult client. Which is the best intervention?
    • A. 

      Administer a diuretic.

    • B. 

      Document the finding.

    • C. 

      Decrease the intravenous flow rate.

    • D. 

      Evaluate the client’s medications.


  • 28. 
    The client asks the nurse to explain about his heart murmur. Which is the nurse’s best response?
    • A. 

      It is the rushing sound that blood makes moving through narrow places.

    • B. 

      It is the sound of the heart muscle stretching in an area of weakness.

    • C. 

      It is a term doctors use to describe how well the blood circulates in the heart.

    • D. 

      It is the sound the heart makes when it has to work too hard.


  • 29. 
    A client has returned from an angiography via the left femoral artery. Two hours after the procedure, the nurse notes that the left pedal pulse is weak. Which is the nurse’s first action?
    • A. 

      Elevates the left leg and applies a sandbag to the entrance site

    • B. 

      Increases the flow rate of the intravenous fluids to 125 mL/hr

    • C. 

      Assesses the color and temperature of the left leg

    • D. 

      Documents the finding as left pedal pulse of +1/4


  • 30. 
    Which assessment finding after a left-sided cardiac catheterization requires immediate intervention?
    • A. 

      Intake less than output

    • B. 

      Bruising at the insertion site

    • C. 

      Weak hand grasps and confusion

    • D. 

      Discomfort in the leg


  • 31. 
    Which client assessment takes priority prior to a cardiac catheterization?
    • A. 

      The level of anxiety

    • B. 

      The ability to move side to side

    • C. 

      Knowledge of the procedure

    • D. 

      Assessment for allergies to iodine and shellfish


  • 32. 
    Prior to a resting electrocardiography, which direction is the most important for the nurse to give the client?
    • A. 

      “You cannot eat or drink before the procedure.”

    • B. 

      “You must lie as still as possible during the procedure.”

    • C. 

      “You are likely to feel warmth as the dye enters the heart.”

    • D. 

      “Increase your fluid intake to at least 3 L on the day of the test.”


  • 33. 
    A nurse is monitoring a client undergoing exercise electrocardiography (stress test). Which assessment finding necessitates that the test be stopped?
    • A. 

      The client’s heart rate reaches 140 beats/min.

    • B. 

      The client’s blood pressure is 100/80 mm Hg.

    • C. 

      The client’s respiratory rate exceeds 36 breaths/min.

    • D. 

      The client’s electrocardiogram (ECG) indicates significant ST segment depression.


  • 34. 
    A client who has survived a cardiac arrest is scheduled for an electrophysiology study (EPS). Which is the highest priority to teach this client?
    • A. 

      “You will feel warmth as dye is injected.”

    • B. 

      “Electrophysiology is a controlled event.”

    • C. 

      “Keep a log of activities during the procedure.”

    • D. 

      “You need to lie on your left side during the procedure.”


  • 35. 
    A client who is scheduled for echocardiography today asks why this test is being performed. How will the nurse respond?
    • A. 

      “This procedure is the best way to assess the structure of your heart noninvasively.”

    • B. 

      “This procedure is to assess for abnormal electrical impulses from the sinoatrial node.”

    • C. 

      “This procedure will evaluate the oxygen saturation in your blood.”

    • D. 

      “This is the best way to evaluate the coronary arteries for any blockages that may be present.”


  • 36. 
    For which of the following clients is magnetic resonance imaging of the heart contraindicated?
    • A. 

      A young woman who is lactating

    • B. 

      An older man with an implanted pacemaker

    • C. 

      A woman who had a thallium scan yesterday

    • D. 

      A man 10 days after a myocardial infarction


  • 37. 
    The results of a client who underwent myocardial nuclear perfusion imaging (MNPI) with thallium during exercise show diffuse uptake of the thallium in all areas of the heart 10 minutes after injection. What is the interpretation of this finding?
    • A. 

      Normal cardiac function at rest, but exercise induces widespread myocardial ischemia

    • B. 

      Impaired myocardial perfusion even at rest, client at high risk for sudden cardiac death

    • C. 

      Test results are inconclusive, more invasive testing needed to assess cardiac function

    • D. 

      No myocardial scarring or impairment of myocardial perfusion at rest or after exercise


  • 38. 
    A nurse obtains a pulmonary artery pressure reading of 25/12 mm Hg in a client recovering from a myocardial infarction. Which is the nurse’s first intervention based on these findings?
    • A. 

      Compares the results with previous readings

    • B. 

      Increases the IV fluid rate because these readings are low

    • C. 

      Immediately notifies the physician of the elevated pressures

    • D. 

      Documents the finding and continues to monitor


  • 39. 
    A nurse is preparing to measure a client’s pulmonary artery wedge pressure (PAWP). In what position will the nurse place the client for the most accurate results?
    • A. 

      Supine, with the head elevated to 45 degrees

    • B. 

      Supine, with the head elevated to 30 degrees

    • C. 

      Reverse Trendelenburg position at 15 degrees

    • D. 

      Supine, flat


  • 40. 
    A client’s mixed venous oxygen saturation (SvO2) is 44%. Which is the nurse’s primary intervention?
    • A. 

      This indicates a normal finding. No intervention is necessary.

    • B. 

      Decrease the client’s oxygen percentage.

    • C. 

      Increase the client’s oxygen percentage.

    • D. 

      The client has oxygen toxicity. Call the health care provider.


  • 41. 
    A client’s cardiac catheterization has shown an 80% blockage of the right coronary artery (RCA). While waiting for bypass surgery, what is essential to have on hand?
    • A. 

      Furosemide (Lasix)

    • B. 

      External pacemaker

    • C. 

      Lidocaine

    • D. 

      Central venous catheter


  • 42. 
    A client post–myocardial infarction is placed on a beta blocker. Which statement best indicates that the client understands the action of this medication?
    • A. 

      “It will decrease my blood pressure.”

    • B. 

      “It will make me urinate more.”

    • C. 

      “I will take this medication at the first indication of chest pain.”

    • D. 

      “This will help prevent cardiac disease.”


  • 43. 
    Which client statement alerts the nurse to the possibility of cardiovascular disease (CVD)?
    • A. 

      “I’m so busy at work and home; there just aren’t enough hours in a day.”

    • B. 

      “I enjoy taking my children to their soccer games. I get to spend time with them.”

    • C. 

      “I hope this isn’t going to take long, I have an important meeting in an hour that I can’t miss.”

    • D. 

      “It’s our 25th wedding anniversary this weekend and I don’t know what to get my wife.”


  • 44. 
    Which laboratory value is indicative of a myocardial infarction?
    • A. 

      Troponin T = 0.8 ng/mL

    • B. 

      Myoglobin = 85 mcg/L

    • C. 

      CK creatine kinase = 180 units/L

    • D. 

      HDL = 60 mg/dL


  • 45. 
    Which laboratory result alerts the nurse that a female client is at high risk for cardiovascular disease?
    • A. 

      Homocysteine = 25 mmol/dL

    • B. 

      Highly sensitive C-reactive protein = 1 mg/dL

    • C. 

      Microalbuminuria, trace

    • D. 

      CK-MB = 1%


  • 46. 
    An older adult has returned from a cardiac catheterization. After the initial assessment done by the RN, which activities can the nurse delegate to the unlicensed assistive personnel?
    • A. 

      Assessing for dysrhythmias

    • B. 

      Measuring intake and output

    • C. 

      Assessing urine color and changes

    • D. 

      Assessing pulses every 15 minutes


  • 47. 
    A client with a history of renal insufficiency is scheduled for a cardiac catheterization. What will the nurse expect to do for this client precatheterization? (Select all that apply.)
    • A. 

      Assess laboratory results.

    • B. 

      Assess for allergies to iodine.

    • C. 

      Keep the client NPO.

    • D. 

      Assess pulses, marking them with indelible ink.

    • E. 

      Insert a central venous catheter.

    • F. 

      Have the client sign a consent form.

    • G. 

      Administer acetylcysteine (Mucomyst).


  • 48. 
    A female client is admitted to rule out ischemic heart disease. Which symptoms are indicative of heart disease? (Select all that apply.)
    • A. 

      Hypertension

    • B. 

      Fatigue despite adequate rest

    • C. 

      Indigestion

    • D. 

      Abdominal fullness

    • E. 

      Anxiety

    • F. 

      Feeling of choking

    • G. 

      Abdominal pain


  • 49. 
    A client with heart failure develops an increase in preload. Which mechanism contributes to this increase?
    • A. 

      A reduction in sympathetic stimulation

    • B. 

      Stimulation of coronary baroreceptors

    • C. 

      Activation of the renin-angiotensin-aldosterone system

    • D. 

      Arterial vasodilation and subsequent increase in oxygen consumption


  • 50. 
    A client is admitted with early-stage heart failure. Which immediate compensatory response would the nurse expect to see in this client?
    • A. 

      Decreased stroke volume, causing decreased urinary output

    • B. 

      Arterial vasodilation, resulting in pooling of blood in the extremities

    • C. 

      Stimulation of adrenergic receptors, causing an increase in heart rate

    • D. 

      Myocardial hypertrophy, resulting in an initial increase in oxygen saturation


  • 51. 
    A client is admitted with early-stage heart failure. Which assessment finding does the nurse expect?
    • A. 

      A drop in blood pressure and urine output

    • B. 

      An increase in creatinine and lower extremity edema

    • C. 

      An increase in heart rate and respiratory rate

    • D. 

      An increase in oxygen saturation


  • 52. 
    A client with systolic dysfunction has an ejection fraction of 38%. The nurse expects to observe which physiologic change?
    • A. 

      An increase in stroke volume

    • B. 

      A decrease in tissue perfusion

    • C. 

      An increase in oxygen saturation

    • D. 

      A decrease in arterial vasoconstriction


  • 53. 
    Which client is most at risk of developing left-sided heart failure?
    • A. 

      Middle-aged woman with aortic stenosis

    • B. 

      Middle-aged man with pulmonary hypertension

    • C. 

      Older woman who smokes two packs of cigarettes daily

    • D. 

      Older man who has had a right ventricular myocardial infarction


  • 54. 
    Which client statement alerts the nurse to possible heart failure?
    • A. 

      “I am drinking more water than usual.”

    • B. 

      “I have been awakened by the need to urinate at night.”

    • C. 

      “I have to stop halfway up the stairs to catch my breath.”

    • D. 

      “I have experienced blurred vision on several occasions.”


  • 55. 
    A client with a history of myocardial infarction calls the clinic to report the onset of a cough that is troublesome only at night. What direction will the nurse give to the client?
    • A. 

      “Come to the clinic for evaluation.”

    • B. 

      “Increase fluid intake during waking hours.”

    • C. 

      “Use an over-the-counter cough suppressant before going to sleep.”

    • D. 

      “Use two pillows to facilitate drainage of postnasal secretions.”


  • 56. 
    Which statement made by a client would alert the nurse to the possibility of right-sided heart failure?
    • A. 

      “I sleep with four pillows at night.”

    • B. 

      “My shoes fit really tight.”

    • C. 

      “I wake up coughing every night.”

    • D. 

      “I have trouble catching my breath.”


  • 57. 
    Which client is at highest risk for the development of high-output heart failure?
    • A. 

      Young woman taking oral contraceptives

    • B. 

      Middle-aged man who broke an ankle while training for a marathon

    • C. 

      Older adult with dehydration 5 years after having a myocardial infarction

    • D. 

      Young woman taking large doses of Synthroid to promote weight loss


  • 58. 
    The nurse notes that the client’s apical pulse is displaced to the left. What conclusion can be drawn from this assessment?
    • A. 

      This is a normal finding.

    • B. 

      The heart is hypertrophied.

    • C. 

      The left ventricle is contracted.

    • D. 

      The client has pulsus alternans.


  • 59. 
    The nurse assesses a client and notes the presence of an S3 gallop. Which is the nurse’s priority intervention?
    • A. 

      Assess for symptoms of left-sided heart failure.

    • B. 

      Document this as a normal finding.

    • C. 

      Call the health care provider immediately.

    • D. 

      Transfer the client to the intensive care unit.


  • 60. 
    A client asks the nurse why it is important to be weighed every day if he or she has right-sided heart failure. How will the nurse respond?
    • A. 

      “Weight is the best indication that you are gaining or losing fluid.”

    • B. 

      “Weighing you every day will help us make sure that you’re eating properly.”

    • C. 

      “The hospital requires that all inpatients be weighed daily.”

    • D. 

      “You need to lose weight to decrease the incidence of heart failure.”


  • 61. 
    A client has been admitted to the intensive care unit with worsening pulmonary manifestations of heart failure. Which primary collaborative intervention should the nurse perform?
    • A. 

      Maintain the head of the bed in a high Fowler’s position.

    • B. 

      Keep the client on bedrest, with passive range of motion.

    • C. 

      Limit visitors and activity to a minimum.

    • D. 

      Administer loop diuretics.


  • 62. 
    Which nursing diagnosis would be considered a priority for the client with heart failure?
    • A. 

      Anxiety related to hospitalization

    • B. 

      Altered Health Maintenance

    • C. 

      Impaired Gas Exchange

    • D. 

      Altered Comfort


  • 63. 
    The client with heart failure is experiencing respiratory difficult. Which is the nurse’s priority action?
    • A. 

      Place the client in a high Fowler’s position.

    • B. 

      Suction the client.

    • C. 

      Auscultate the client’s heart and lungs.

    • D. 

      Place the client on fluid restriction.


  • 64. 
    The client with heart failure is prescribed enalapril (Vasotec). What is the nurse’s focus for teaching?
    • A. 

      Avoiding salt substitutes

    • B. 

      Taking medication with food

    • C. 

      Avoiding aspirin or aspirin-containing products

    • D. 

      Holding this medication if the pulse rate is below 74 beats/min


  • 65. 
    Which is the priority intervention for a client who has received the first dose of captopril (Capoten)?
    • A. 

      Administer this medication 1 hour before meals to aid absorption.

    • B. 

      Instruct the client to ask for assistance when arising from bed.

    • C. 

      Give the medication with milk to prevent stomach upset.

    • D. 

      Monitor the potassium level for hypokalemia.


  • 66. 
    The client with moderate heart failure is being discharged. Which is of priority to teach the client?
    • A. 

      “Avoid drinking more than 3 quarts of liquids each day.”

    • B. 

      “Stop your activity and rest at the first sign of chest pain.”

    • C. 

      “Weigh yourself every day in the morning before breakfast.”

    • D. 

      “Do not take a double dose if you forget to take your digoxin.”


  • 67. 
    The client who just started taking isosorbide dinitrate (Isordil) complains of a headache. What is the nurse’s first action?
    • A. 

      Titrate oxygen to relieve headache.

    • B. 

      Hold the next dose of Isordil.

    • C. 

      Instruct the client to drink water.

    • D. 

      Administer PRN acetaminophen.


  • 68. 
    The client with heart failure has been ordered to receive a daily nitroglycerin transdermal patch. Which is the priority nursing intervention?
    • A. 

      Placing an occlusive dressing over the patch

    • B. 

      Removing the patch overnight

    • C. 

      Rotating the skin site of nitroglycerin administration

    • D. 

      Administering a larger loading dose before the initiation of therapy


  • 69. 
    Which intervention is essential to teach the client starting on digoxin therapy?
    • A. 

      “Avoid taking aspirin or aspirin-containing products.”

    • B. 

      “Increase fluid intake to at least 3000 mL/day.”

    • C. 

      “Do not take this medication if your pulse rate is below 80 beats/min.”

    • D. 

      “Do not take this medication within 1 hour of taking an antacid.”


  • 70. 
    A client is taking triamterene-hydrochlorothiazide (Dyazide) and furosemide (Lasix). Which assessment finding alerts the nurse to a serious side effect?
    • A. 

      Cough

    • B. 

      Headache

    • C. 

      Bradycardia

    • D. 

      Hypokalemia


  • 71. 
    A client with heart failure is going through rehabilitation to increase his or her activity tolerance. The nurse will stop the client’s activity if which symptom is assessed?
    • A. 

      Oxygen saturation of 95%

    • B. 

      Respiratory rate of 20 breaths/min

    • C. 

      Systolic blood pressure change from 136 to 96 mm Hg

    • D. 

      Heart rate increase from 86 to 100 beats/min


  • 72. 
    An older adult client with heart failure has developed atrial fibrillation. What diagnostic or laboratory test would the nurse expect to be ordered?
    • A. 

      Serum anion gap

    • B. 

      Serum sodium level

    • C. 

      T4 (thyroxine) and TSH (thyroid-stimulating hormone)

    • D. 

      Serum creatinine


  • 73. 
    Which assessment finding alerts the nurse to the possibility of pulmonary edema in an older adult?
    • A. 

      Confusion

    • B. 

      Dysphagia

    • C. 

      Sacral edema

    • D. 

      Irregular heart rate


  • 74. 
    A client with a history of heart failure is being discharged. Which instruction will assist the client in the prevention of complications associated with heart failure?
    • A. 

      “Drink at least 2 L of fluids daily.”

    • B. 

      “Eat six small meals daily instead of three larger meals.”

    • C. 

      “When you feel short of breath, take an additional diuretic.”

    • D. 

      “Weigh yourself daily wearing the same amount of clothing.”


  • 75. 
    A client has been admitted to the acute care unit for an exacerbation of heart failure. Which is the nurse’s priority intervention?
    • A. 

      Assessing respiratory status

    • B. 

      Monitoring the serum electrolyte levels

    • C. 

      Administering intravenous fluids

    • D. 

      Inserting a Foley catheter


  • 76. 
    Which assessment finding supports a diagnosis of impaired tissue perfusion in the client with heart failure?
    • A. 

      Carotid bruit

    • B. 

      A dry hacking cough

    • C. 

      A positive Allen’s test

    • D. 

      Dyspnea on exertion


  • 77. 
    Which assessment finding does the nurse expect in the client with mitral valve prolapse?
    • A. 

      Rumbling apical diastolic murmur

    • B. 

      Midsystolic click and late systolic murmur

    • C. 

      An S3 coupled with a high-pitched systolic murmur

    • D. 

      Continuing, loud diastolic murmur radiating to the left axilla


  • 78. 
    What clinical manifestation alerts the nurse to the possibility that the client’s mitral stenosis has progressed?
    • A. 

      The client’s oxygen saturation is 92%.

    • B. 

      The client has dyspnea on exertion.

    • C. 

      The client has a systolic crescendo-decrescendo murmur.

    • D. 

      The client experiences a loss of strength in the upper extremities.


  • 79. 
    Which assessment finding does the nurse expect in a client diagnosed with aortic stenosis?
    • A. 

      Bounding arterial pulse

    • B. 

      Slow, faint arterial pulse

    • C. 

      Narrowed pulse pressure

    • D. 

      Elevated systolic and diastolic pressures


  • 80. 
    Which assessment finding does the nurse expect in the client with mitral insufficiency?
    • A. 

      A systolic click on auscultation

    • B. 

      A high-pitched holosystolic murmur

    • C. 

      Angina with exertion

    • D. 

      A cough with hemoptysis


  • 81. 
    The client who has had a prosthetic valve replacement asks the nurse why he must take anticoagulants for the rest of his life. How will the nurse respond?
    • A. 

      “You are at greater risk for a heart attack, and the anticoagulants can reduce that risk.”

    • B. 

      “Blood clots form more easily on artificial replacement valves.”

    • C. 

      “The vein taken from your leg reduces circulation in the leg, making blood return to the heart much slower.”

    • D. 

      “The surgery left a lot of small clots in your heart and lungs. The anticoagulants will slowly dissolve these.”


  • 82. 
    A client has just undergone a balloon valvuloplasty. For which complication of this procedure should the nurse monitor this client?
    • A. 

      Bleeding

    • B. 

      Acute tubular necrosis

    • C. 

      Short-term memory loss

    • D. 

      Pulmonary hypertension


  • 83. 
    A client is preparing to be discharged home following mitral valve replacement. Which statement indicates that the client requires further education?
    • A. 

      “I won’t be able to carry heavy loads for at least 6 months.”

    • B. 

      “I will have my teeth cleaned by the dentist in 2 weeks.”

    • C. 

      “I will avoid eating foods high in vitamin K.”

    • D. 

      “I can use my electric razor to shave.”


  • 84. 
    A young adult presents with a fever, symptoms of heart failure, and a murmur. Which additional data will the nurse obtain?
    • A. 

      Family history of coronary artery disease

    • B. 

      Recent travel to third-world countries

    • C. 

      Whether the client is responsible for cleaning pet litter boxes

    • D. 

      History of any systemic infection or dental work within the past month


  • 85. 
    Which precautions are appropriate when providing care to a client with infective endocarditis?
    • A. 

      Standard precautions

    • B. 

      Enteric precautions

    • C. 

      Protective isolation

    • D. 

      Respiratory isolation


  • 86. 
    The home care nurse is assessing the client receiving antibiotic therapy in the home for infective endocarditis. Which of the following clinical manifestations requires re-evaluation of the treatment regimen?
    • A. 

      Temperature: 101.6° F

    • B. 

      Clubbing of fingers

    • C. 

      Petechiae

    • D. 

      Pulse pressure of 36 mm Hg


  • 87. 
    The nurse has difficulty hearing heart sounds in a client with pericarditis. Which is the priority action of the nurse?
    • A. 

      Assessing heart sounds with a Doppler

    • B. 

      Increasing the intravenous flow rate

    • C. 

      Administering oxygen by non–rebreather mask

    • D. 

      Assessing the client for Beck’s triad


  • 88. 
    Which assessment finding does the nurse expect in a client with pericarditis?
    • A. 

      An irregular heart rate that speeds up and slows down

    • B. 

      A friction rub at the left lower sternal border

    • C. 

      The presence of a gallop rhythm


  • 89. 
    A nurse is caring for a client admitted with tachycardia, a pericardial friction rub, and the development of a murmur. Which finding in the client’s history leads the nurse to suspect rheumatic carditis?
    • A. 

      The client was vacationing in the tropics 2 weeks ago.

    • B. 

      The client has had a sore throat for 1 week.

    • C. 

      The client is currently taking antibiotics.

    • D. 

      The client has a history of alcoholism.


  • 90. 
    Which instructions are essential in a teaching plan for a client with hypertrophic cardiomyopathy (HCM)?
    • A. 

      “Take your digoxin at the same time every day.”

    • B. 

      “You should begin an aerobic exercise program.”

    • C. 

      “You should report episodes of dizziness or fainting.”

    • D. 

      “You may have a maximum of two alcoholic drinks weekly.”


  • 91. 
    The nurse cautions the client who has received a heart transplant to change positions slowly. Why is this instruction a priority?
    • A. 

      Rapid position changes can create shear forces and disrupt vascular sutures.

    • B. 

      The new vascular connections are more sensitive to position changes, leading to increased intravascular pressure.

    • C. 

      The new heart is denervated and unable to respond to decreases in blood pressure caused by position changes.

    • D. 

      The recovering heart diverts blood flow away from the brain when the client stands, increasing the risk for stroke.


  • 92. 
    Which teaching is essential for a client discharged after a heart transplant who is prescribed cyclosporine (Sandimmune)?
    • A. 

      “Use a soft-bristled toothbrush.”

    • B. 

      “Avoid crowds and people who are sick.”

    • C. 

      “Change positions slowly to avoid hypotension caused by the medication.”

    • D. 

      “Do not take this medication if your pulse rate is lower than 60 beats/min.”


  • 93. 
    A client is classified (staged) at level A heart failure. What will the nurse teach the client?
    • A. 

      “Take digoxin daily.”

    • B. 

      “Limit activity when short of breath.”

    • C. 

      “Control blood pressure at 140/80 or below.”

    • D. 

      “Maintain a no added salt diet.”


  • 94. 
    A client with end-stage heart failure is awaiting a transplant. The client appears depressed and states, “I know a transplant is my last chance but I don’t want to become a vegetable.” What is the nurse’s best response?
    • A. 

      “Would you like to speak with a priest?”

    • B. 

      “I’ll get a psychiatrist to talk with you.”

    • C. 

      “Do you want to come off the transplant list?”

    • D. 

      “Would you like information about advanced directives?”


  • 95. 
    Which question will best help the nurse to assess the activity level of a client with a history of heart failure?
    • A. 

      “Do you have trouble breathing or chest pain?”

    • B. 

      “Are you able to walk up stairs without fatigue?”

    • C. 

      “Do you wake up suddenly during the night with breathlessness?”

    • D. 

      “Do you become fatigued or develop heaviness in your arms or legs that you didn’t have before?” “Do you become fatigued or develop heaviness in your arms or legs that you didn’t have before?” “Do you become fatigued or develop heaviness in your arms or legs that you didn’t have before?”


  • 96. 
    A client with heart failure has a blood pressure of 140/60 mm Hg. How will the nurse interpret this finding?
    • A. 

      Normal proportional pulse pressure

    • B. 

      Severely compromised cardiac output

    • C. 

      Hypertensive blood pressure

    • D. 

      Narrowed pulse pressure


  • 97. 
    An older adult client with heart failure states, “I don’t know what to do. I don’t want to be a burden to my daughter, but I can’t do it alone. Maybe I should die.” Which is the nurse’s best response?
    • A. 

      “Would you like to talk about it more?”

    • B. 

      “You’re lucky to have such a devoted daughter.”

    • C. 

      “You feel as though you are a burden.”

    • D. 

      “You seem depressed. I’ll get the doctor to order an antidepressant.”


  • 98. 
    An older adult client is admitted with fluid volume excess. Which diagnostic or laboratory study would best assist in the diagnosis of heart failure?
    • A. 

      Echocardiography

    • B. 

      Chest x-ray

    • C. 

      T4, TSH

    • D. 

      Arterial blood gases


  • 99. 
    How will the nurse position the client in severe heart failure?
    • A. 

      High Fowler’s, pillows under arms

    • B. 

      Semi-Fowler’s, with legs elevated

    • C. 

      High Fowler’s, with legs elevated

    • D. 

      Semi-Fowler’s, on their left side


  • 100. 
    A nurse is instructing a client with heart failure on energy conservation. Which is the best instruction?
    • A. 

      “Walk until you become short of breath and then walk back home.”

    • B. 

      “Gather everything you need for a chore before you begin.”

    • C. 

      “Pull rather than push or carry items heavier than 5 pounds.”

    • D. 

      “Take a walk after dinner every day.”


  • 101. 
    A client with heart failure is due to receive enalapril (Vasotec). The blood pressure is 98/50 mm Hg. Which is the nurse’s best action?
    • A. 

      Administer the Vasotec.

    • B. 

      Wait 1 hour and then administer the Vasotec.

    • C. 

      Hold the Vasotec.

    • D. 

      Notify the physician.


  • 102. 
    A client in severe heart failure is to receive nesiritide (Natrecor). Which intervention is essential prior to starting this medication?
    • A. 

      Insert a separate IV access.

    • B. 

      Prepare a test bolus dose.

    • C. 

      Prepare the piggyback line.

    • D. 

      Administer IV Lasix first.


  • 103. 
    In Healthy People 2010, which is a priority of the primary nurse caring for older adults with heart failure?
    • A. 

      Reduce hospitalizations by treating more clients at home.

    • B. 

      Provide follow-up care by the multidisciplinary team.

    • C. 

      Perform follow-up phone calls, delegated to the unit secretary.

    • D. 

      Evaluate client compliance with medications by the home health aide.


  • 104. 
    Which conditions are caused by left-sided heart failure? (Select all that apply.)
    • A. 

      Hypertensive disease

    • B. 

      Crackles heard

    • C. 

      Enlarged liver and spleen

    • D. 

      Confusion

    • E. 

      Pulmonary hypertension

    • F. 

      Dependent edema

    • G. 

      S3/S4 gallop

    • H. 

      Cough worsens at night


  • 105. 
    Which laboratory results does the nurse expect in the client with heart failure? (Select all that apply.)
    • A. 

      Hemoglobin, 14.2 g/dL; hematocrit (Hct), 32.8%

    • B. 

      Serum sodium, 130 mEq/L

    • C. 

      Serum potassium, 4.0 mEq/L

    • D. 

      Serum creatinine, 1.0 mg/dL

    • E. 

      Proteinuria

    • F. 

      Microalbuminuria


  • 106. 
    A client with atherosclerosis asks a nurse which factors are responsible for this condition. What is the nurse’s best response?
    • A. 

      “Injury to the arteries causes them to spasm, reducing blood flow to the extremities.”

    • B. 

      “Excess fats in your diet are stored in the lining of your arteries, causing them to constrict.”

    • C. 

      “A combination of platelets and fats accumulate, narrowing the artery and reducing blood flow.”

    • D. 

      “Excess sodium from hypertension causes direct injury to the arteries, reducing blood flow and eventually causing obstruction.”


  • 107. 
    The nurse recognizes which client is at greatest risk for developing intimal injury leading to atherosclerosis?
    • A. 

      A client with diabetes who also smokes one pack of cigarettes daily

    • B. 

      A client with decreased low-density lipoprotein (LDL) and increased high-density lipoprotein (HDL) levels

    • C. 

      A client with inherited hypolipidemia

    • D. 

      A client with a sedentary lifestyle


  • 108. 
    A client with hyperlipidemia, who is being treated with dietary fat restrictions and an exercise program, asks the nurse why his serum lipid levels are still elevated. What is the nurse’s best response?
    • A. 

      “You may need to restrict your fat intake to less than 30% of total calories.”

    • B. 

      “You may have a genetic predisposition to hyperlipidemia.”

    • C. 

      “Your arteries may already be damaged.”

    • D. 

      “You may need to lose some weight to lower your cholesterol levels.”


  • 109. 
    On auscultation of the carotid arteries of a client with atherosclerosis, the nurse hears a swishing sound over the right carotid. Which would be the nurse’s best action?
    • A. 

      Performing carotid massage

    • B. 

      Notifying the health care provider

    • C. 

      No action is necessary because this is a normal finding.

    • D. 

      Simultaneously palpating the carotid arteries bilaterally


  • 110. 
    What specific instructions should the nurse give to the client with atherosclerosis who is attempting to stop cigarette smoking with the use of a nicotine patch?
    • A. 

      “Abruptly discontinuing this patch can cause high blood pressure.”

    • B. 

      “Abruptly discontinuing this patch can cause nausea and vomiting.”

    • C. 

      “Smoking while using this patch increases the risk of respiratory infections.”

    • D. 

      “Smoking while using this patch increases the risk of a heart attack.”


  • 111. 
    The client with hypercholesterolemia and atherosclerosis reports skin flushing and itching while taking nicotinic acid. Which is the nurse’s best response?
    • A. 

      “Take this product with meals.”

    • B. 

      “Take this product at bedtime.”

    • C. 

      “Avoid taking aspirin with this product.”

    • D. 

      “Avoid smoking cigarettes while taking this product.”


  • 112. 
    The nurse incorporates which dietary teaching into the plan for a client with an LDL level of 142 mg/dL who has been placed on a Step One diet?
    • A. 

      “Your saturated fat intake should be less than 10% of your total calories.”

    • B. 

      “Your saturated fat intake should be 30% of your total calories.”

    • C. 

      “Your total cholesterol intake should be less than 200 mg/day.”

    • D. 

      “Your total cholesterol intake should be more than 300 mg/day.”


  • 113. 
    Which breakfast food recommendations are most appropriate for a client who has been placed on a low-cholesterol diet?
    • A. 

      Eggs, skim milk, whole wheat toast, decaffeinated coffee

    • B. 

      Skim milk, cereal, banana, decaffeinated coffee

    • C. 

      Toast, margarine, one slice of bacon, coffee

    • D. 

      Blueberry muffin, orange juice, coffee


  • 114. 
    In reviewing the menu selections of a client who is ordered a low-cholesterol diet, the nurse questions which selection?
    • A. 

      Oatmeal

    • B. 

      Eggs

    • C. 

      Banana

    • D. 

      Wheat toast


  • 115. 
    In reviewing admission orders for a new client, the nurse consults with the health care provider about the order for lovastatin (Mevacor) in the client with which disorder?
    • A. 

      Diabetes mellitus

    • B. 

      Peptic ulcer disease

    • C. 

      Rheumatoid arthritis

    • D. 

      Cirrhosis


  • 116. 
    Which instruction will be given to a client who is about to begin treatment with simvastatin?
    • A. 

      “This drug can cause constipation.”

    • B. 

      “Take this drug on an empty stomach.”

    • C. 

      “Report any muscle tenderness to your health care provider.”

    • D. 

      “You may experience flushing of the skin with this medication.”


  • 117. 
    A client diagnosed with essential hypertension asks how this type of hypertension develops. Which is the nurse’s best response?
    • A. 

      “There is no known cause for this type of hypertension.”

    • B. 

      “You have an underlying condition that caused your hypertension.”

    • C. 

      “The steroids you were taking may have caused your hypertension.”

    • D. 

      “You were born with a congenital narrowing of the aorta that caused your hypertension.”


  • 118. 
    The client has been diagnosed with Cushing’s syndrome. Which assessment will the nurse perform to detect vascular complications of this illness?
    • A. 

      Auscultation of heart and lung sounds

    • B. 

      Assessing blood pressure regularly

    • C. 

      Daily weighing using the same scale

    • D. 

      Monitoring urine output every 24 hours


  • 119. 
    Which additional physical assessment will the nurse include in the examination of a client diagnosed with hypertension?
    • A. 

      Skin examination for telangiectasis

    • B. 

      Otoscopic examination of the inner ear

    • C. 

      Funduscopic examination of the retina

    • D. 

      Neurologic examination of the cranial nerves


  • 120. 
    A nurse is caring for a client with newly diagnosed hypertension. Which dietary teaching will be included in the plan of care for this client?
    • A. 

      “Avoid the use of canned or processed foods.”

    • B. 

      “Avoid drinking any alcohol products.”

    • C. 

      “You may use salt substitutes freely for flavoring.”

    • D. 

      “You may cook with salt, but do not add additional salt when your food is served.”


  • 121. 
    A client is to begin taking hydrochlorothiazide (Microzide) for control of hypertension. Which instruction will be given to this client before beginning therapy?
    • A. 

      “You may develop a slower pulse rate.”

    • B. 

      “You may notice some swelling in your feet.”

    • C. 

      “You may develop a cough.”

    • D. 

      “Your diet should include foods high in potassium.”


  • 122. 
    Which client statement indicates a need for further teaching about hypertension therapy?
    • A. 

      “Losing weight may reduce my need for blood pressure medication.”

    • B. 

      “Keeping my blood pressure under control reduces my risk for a heart attack.”

    • C. 

      “When my blood pressure becomes normal, I will no longer need to take medication.”

    • D. 

      “When I get out of bed in the morning, I should first sit for a few moments and then stand.”


  • 123. 
    A client is starting lisinopril (Prinivil) therapy. The nurse will monitor for the development of which potential side effect?
    • A. 

      Pedal edema

    • B. 

      Orthostatic hypotension

    • C. 

      Orthopnea

    • D. 

      Bradycardia


  • 124. 
    A nurse is about to administer the first dose of captopril (Capoten) to a client with hypertension. Which is the priority nursing intervention?
    • A. 

      Take the client’s apical pulse for 1 full minute before drug administration.

    • B. 

      Place the client in the Trendelenburg position to facilitate blood flow to the heart.

    • C. 

      Explain to the client to remain in bed for 3 hours after drug administration.

    • D. 

      Instruct the client to drink 3 L of fluid daily when taking this medication.


  • 125. 
    A client with hypertension has been prescribed clonidine hydrochloride (Catapres). Which instruction will the nurse give to this client?
    • A. 

      “Take this medication at bedtime.”

    • B. 

      “Call your health care provider if a rash develops.”

    • C. 

      “You will need to have your blood counts monitored regularly.”

    • D. 

      “Take this medication by puncturing the capsule and placing the liquid contents under your tongue.”


  • 126. 
    Which client will benefit most from receiving treatment for hypertension with an angiotensin ACE inhibitor and a calcium channel blocker?
    • A. 

      An African-American man

    • B. 

      A Hispanic woman

    • C. 

      A white man

    • D. 

      A woman of Asian descent


  • 127. 
    The nurse assesses for which client outcome as indicative of effective hypertension management?
    • A. 

      The client has not developed pedal edema.

    • B. 

      There is no evidence of sexual dysfunction.

    • C. 

      There is no indication of target organ damage.

    • D. 

      The client’s blood pressure reading is stable at 148/94 mm Hg.


  • 128. 
    In assessing a client with complaints of claudication after walking a distance of one block, the nurse notes a painful ulcer on the toes of the client’s right foot. The nurse correlates these findings with which condition?
    • A. 

      Diabetic foot ulceration

    • B. 

      Peripheral arterial disease

    • C. 

      Peripheral venous disease

    • D. 

      Deep vein thrombosis


  • 129. 
    Which additional assessment finding does the nurse expect in the client with a venous ulcer on the left ankle?
    • A. 

      There is dependent rubor and absence of hair.

    • B. 

      The skin surrounding the ulcer is mottled and the toenails are thickened.

    • C. 

      There is a brownish discoloration of the lower extremity at the ulcer site.

    • D. 

      The extremity is cold and gray-blue in color.


  • 130. 
    The client with chronic peripheral arterial disease and claudication tells the nurse that burning pain often awakens him from sleep. What is the nurse’s interpretation of this change?
    • A. 

      The client has inflow disease.

    • B. 

      The client has outflow disease.

    • C. 

      The client’s disease is worsening.

    • D. 

      The client’s disease is stable.


  • 131. 
    Which statement made by the client with peripheral arterial disease concerning positioning of edematous lower extremities requires further clarification?
    • A. 

      “I may sleep with my affected leg hanging from the bed.”

    • B. 

      “I will elevate my legs above the level of my heart.”

    • C. 

      “I can sit upright in a chair for comfort.”

    • D. 

      “I will avoid crossing my legs.”


  • 132. 
    Which intervention will the nurse suggest to promote vasodilation in a client with peripheral arterial disease?
    • A. 

      Performing gradually increasing exercise, such as walking

    • B. 

      Using a heating pad on the affected limb

    • C. 

      Taking aspirin on a daily basis

    • D. 

      Abstaining from smoking


  • 133. 
    Which client statement indicates a need for additional teaching about pentoxifylline therapy for peripheral arterial disease?
    • A. 

      “I stopped drinking coffee and tea.”

    • B. 

      “I wear cotton socks underneath my wool socks to prevent itching.”

    • C. 

      “I stopped taking the medication after 2 weeks because my pain did not get relief.”

    • D. 

      “I use a magnifying mirror to check the soles of my feet and toes for sores or blisters.”


  • 134. 
    For which complication will the nurse monitor in the immediate post–procedure period in the client with peripheral arterial disease who has just undergone laser-assisted angioplasty?
    • A. 

      Bleeding

    • B. 

      Aspiration

    • C. 

      Hypertensive crisis

    • D. 

      Chest pain


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