Cardiovascular System | Myocardial Infarction And Heart Failure NCLEX Quiz 17

1.

A nurse caring for a client in one room is told by another nurse that a second client has developed severe pulmonary edema. On entering the 2nd client’s room. the nurse would expect the client to be:

A.

Slightly anxious
B.

Mildly anxious
C.

Moderately anxious
D.

Extremely anxious

Correct Answer
D. Extremely anxious

Explanation
Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning. suffocation. or smothering.

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2.

A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin (Lanoxin). a nurse checks the client’s most recent:

A.

Digoxin level
B.

Sodium level
C.

Potassium level
D.

Creatinine level

Correct Answer
C. Potassium level

Explanation
The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.

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3.

A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for:

A.

Hypovolemia
B.

UTI
C.

Glomerulonephritis
D.

Acute renal failure

Correct Answer
D. Acute renal failure

Explanation
The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion. hemolysis. low cardiac output. or vasopressor medication therapy. Renal insult is signaled by decreased urine output and increased BUN and creatinine levels. The client may need medications such as dopamine (Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.

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4.

A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation?

A.

Encourage the client to cough and deep breathe
B.

Premedicate the client with an analgesic
C.

Provide the client with a walker
D.

Remove telemetry equipment because it weighs down the hospital gown.

Correct Answer
B. Premedicate the client with an analgesic

Explanation
The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest. decrease myocardial oxygen consumption resulting from pain. and allow better participation in activities such as coughing. deep breathing. and ambulation.Options A and C will not help in tolerating ambulation.Option D: Removal of telemetry equipment is contraindicated unless prescribed.

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5.

A client’s electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second. and the QRS complex measures 0.08 second. The nurse interprets this rhythm is:

A.

Normal sinus rhythm
B.

Sinus bradycardia
C.

Sinus tachycardia
D.

Sinus dysrhythmia

Correct Answer
A. Normal sinus rhythm

Explanation
The client's electrocardiogram strip shows a normal sinus rhythm because the atrial and ventricular rates are within the normal range of 60-100 complexes per minute. The PR interval is also within the normal range of 0.12-0.20 seconds, indicating normal conduction from the atria to the ventricles. The QRS complex duration is also normal, measuring 0.08 seconds. Therefore, all the parameters of the electrocardiogram are within normal limits, indicating a normal sinus rhythm.

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6.

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because:

A.

It is uncomfortable for the client. giving a sense of impending doom.
B.

It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.
C.

It is almost impossible to convert to a normal sinus rhythm.
D.

It can develop into ventricular fibrillation at any time.

Correct Answer
D. It can develop into ventricular fibrillation at any time.

Explanation
Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart.Option A: Client’s frequently experienced a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate. cardioversion (client awake). or defibrillation (loss of consciousness).Option B: The low cardiac output that results can lead quickly to cerebral and myocardial ischemia.Option D: Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.

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7.

A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for:

A.

Thrombocytopenia and weight gain
B.

Anorexia. nausea. and visual disturbances
C.

Diarrhea and hypotension
D.

Fatigue and muscle twitching

Correct Answer
B. Anorexia. nausea. and visual disturbances

Explanation
The first signs and symptoms of digoxin toxicity in adults include abdominal pain. N/V. visual disturbances (blurred. yellow. or green vision. halos around lights). bradycardia. and other dysrhythmias.

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8.

A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day. most often in the morning. On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as:

A.

Stable angina
B.

Unstable angina
C.

Variant angina
D.

Nonanginal pain

Correct Answer
C. Variant angina

Explanation
Variant angina. or Prinzmetal’s angina. is prolonged and severe and occurs at the same time each day. most often in the morning.Option A: Stable angina is induced by exercise and is relieved by rest or nitroglycerin tablets.Option B: Unstable angina occurs at lower and lower levels of activity and rest. is less predictable and is often a precursor of myocardial infarction.

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9.

The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following?

A.

Obtaining an infusion pump for the medication
B.

Monitoring BP q4h
C.

Monitoring urine output hourly
D.

Obtaining serum potassium levels daily

Correct Answer
A. Obtaining an infusion pump for the medication

Explanation
IV nitro infusion requires an infusion pump for precise control of the medication.Option B: BP monitoring would be done with a continuous system. and more frequently than every 4 hours.Option C: Hourly urine outputs are not always required.Option D: Obtaining serum potassium levels is not associated with nitroglycerin infusion.

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10.

Aspirin is administered to the client experiencing an MI because of its:

A.

Antipyretic action
B.

Antithrombotic action
C.

Antiplatelet action
D.

Analgesic action

Correct Answer
B. Antithrombotic action

Explanation
Aspirin does have antipyretic. antiplatelet. and analgesic actions. but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.

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