Test 4
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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 clienic 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.
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 beatsmin. The nurse expects that an electrophysiological study may determine an alteration in which structure?
- A.
Sinoartial (SA) node
- B.
Bachmann's bundle
- C.
Bundle of His
- D.
Purkinji fibers
- 6.A client brought to the emergency room following a myocardial infarction is f ound to be hypotension. 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 sdministered 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 block 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 audlt with asthma
- B.
Asian american woman with breast cancer
- C.
Middle aged African Man with diabetes mellitus
- D.
Postmenopausal woman on estrogen hormone replacement therapy
- 12.Which illness in a 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 pulse deficit
- C.
Assess the client's medication
- D.
Administer atropine
- 14.Which cleint 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 peripherial 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 a famiy history of coronary artery disease
- 16.Which client statement alerts the nurse to the occurance 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 tot he presence of e dema
- 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.Whihc 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 deermines 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 cleint's blood pressure is 134/88 mm Hg. Which is the nurses best i ntervention?
- 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 required 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 supine position to a sitting position. Which assessment takes priority at this time
- A.
Pulse oximetry
- B.
Blood pressure
- C.
Respiratory rate
- D.
Neurological evaluation
- 24.Which technique will the nurse use to assess the point of maximal impulse (PMI)
- A.
With the client ina supine position at a 45 degree angle, compress the upper right abdimen 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 ausculate 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.
- A.
Repeat the auscultation using the diaphragm of the stethoscope
- B.
Re3peat the auscultation with the client lying on the lift side
- C.
Notify the health care provider
- D.
Document the finding
- 27.The nurse hears a splitting an atrila gallop (S4) in an older adult client. Which is the best intervention?
- A.
Admnister a diuretic
- B.
Document the finding
- C.
Decrease the intravenous flow rate
- D.
Evaluate the client's medications
- 28.The cleint aske 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 circulated in teh heart
- D.
Itr 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 the left pedal pulse is weak. Which is the nurse's first action?
- A.
Elevates the left leg and applies a sandbag to teh entrance site
- B.
Increased the flow rate of the intravenous fluids to 125 mf/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 fidnign after a left sided cardiac catheterization requires immediate intervention?
- A.
Intake less than output
- B.
Bruising at the insertion site
- C.
Weak had grasps and confusion
- D.
Discomfort in the leg
- 31.Which cleint 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 improtant 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.PriorA nurse is monotoring a client undergoing exercise electrocardiography (stress test) which assessment finding necessitiates that the test be stopped?
- A.
The client's heart rate reaches 140 beats/min
- B.
The cleint blood pressure is 100/80
- C.
The client's respiratory rate exceeds 36 breaths/min
- D.
The client's electrocardipgram indicates significatnt ST segment dipression
- 34.A client who has survived a cardiac arrest is s cheduled for an electophysiology 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 a echocardiography today asks why this test is being performed. How will the nurse respond?
- A.
This procedure is the best way to assessthe 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.
- A.
Normal cardiac function at rest, but exercise induces widespread myocardial ischemia
- B.
Impaired myocardial perfusion even at rest. cleint 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 in a client recovering from a myocardial infarction. Which is th enurse's first intervention based on these findings?
- A.
Compares the result with previous readings
- B.
Increases the IV fluid rate because these reading are low
- C.
Immediately notifies the physician of theelevated 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 thenurse 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 clocker. Which statemtn best indicates that the cleint 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.
- 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 there soccer games. I get to spend time with them
- C.
I hope this isnt going to take long, I have an important meeting in an hour that I can't miss
- D.
It our 25th wedding anniversary this weekend and I dont know what to get my wife
- 44.What laboratory value is indicative of a myocardial infarctin
- A.
Troponin T=0.8 mg/ml
- B.
Myoglobin= 85mcg/L
- C.
CK creatine Kinase=180 units/L
- D.
HDL=60 mg/dl
- 45.Which laboratory results alerts the nurse that a female client is at high risk for a cardiovascular disease?
- A.
Homocysteine = 25 mmol/dl
- B.
Highly sensiitive C reactive protein = 1mg/dl
- C.
Microalbuminuria, trace
- D.
CK-MB=1%
- 46.An older adult has returned from a cardiac catherization. After the initail assessment done by the RN, which activities can the nurse delegate tot he unlicensed assisitive personal?
- A.
Assessing for dysrhythmias
- B.
Measuring intake and output
- C.
Ssessing urin color and changes
- D.
Assessing pulses every 15 minutes
- 47.
- A.
Assess laboratory results
- B.
Administer aetylecysteine (Mucomyst)
- C.
Assess for allergies to iodine
- D.
Assess pulses, marking then with indelible ink
- E.
Insert a central, venous atheter
- F.
Have a client sign a consent form
- G.
Keep the client NPO
- 48.A female cleint is admitted to rule out ischemic heart diseas. Which symptoms are indicative of heart disease.(selecct 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.Which action will the nurse take to improve the quality of the electrocardiiographic rhythm transmission tot hemonitoring system?
- A.
Apply lotion to the client's chest before attaching the chest leads
- B.
Remove the hair from the chest area before attaching the chest leads
- C.
Instruct the client not to wear any clothing made from synthetic fabrics during the test
- D.
Apply skin protectant tot area prior to placing electrode.
- 50.What will the nurse do to ensure the validity of comparison of electrocardiograms (ECGs) taken at different times?
- A.
Remove electrodes after each ECG is completed
- B.
Place new ECG chest leads on the client before each ECG is completed
- C.
Position the client supine prior to each ECG
- D.
Ensure that electrode placement is identical for each ECG
- 51.A client's cardiac status is being observed by telemetry monitoring. A nurse observes a P wave that changes shape in lead II. What conconclusion will the nurse make from this?
- A.
The P wave is originating from an ectopic focus
- B.
The P wave is firing twice from the sinoatrial (SA) node
- C.
There is no real P wave
- D.
The P wave is normal
- 52.What does the P wave on an ECG tracing represent
- A.
Contraction of the atria
- B.
Contraction of the ventricles
- C.
Depolarization of the atria
- D.
Depolarization of the ventricles
- 53.A nurse notes that the PE interval on a client's ECG tracing is 0.14 second. What action will the nurse take?
- A.
Call the health care provider
- B.
Administer epinephrine
- C.
Administer oxygen via nasal cannula
- D.
Document the finding as the only action
- 54.The client has exactly 8.0 R-R intervals in 150 small blocks on the ECG paper. Based on this information, the nurse calculates the client's ventricular heart rate to be which of the following
- A.
40 beats/min
- B.
80 beats/min
- C.
160 beats/min
- D.
Cannot be calculated from the information provided
- 55.In analyzing a client's ECG tracing, the nurse observes that nor all QRS complexes are preceded by a P wave. What is the nurse's interpretation of this observation
- A.
The cleint has hyperkalemia
- B.
The cleint is in ventricular tachycardia
- C.
One of the chest leads is not making sufficient contact with the skin
- D.
Ventricular depolarization is being initiated at a side from atrial depolarization
- 56.The nurse observes a prominent U wave on the clients ECG tracing. What is the nurses interpretation of this finding
- A.
This is a normal finding
- B.
The client may have a potassium imbalance
- C.
The client is at risk for R on T phenomenon
- D.
The client has an evolving myocardial infarction
- 57.The cleint has a consistent and regular heart rate of 128 beats/min. Which psychologic alterations would be consistent wth this finding?
- A.
A decrease in cardiac output and blood pressure
- B.
An increase in cardiac output and blood pressure
- C.
An increase in blood pressure and decrease in cardiac output
- D.
A decrease in blood pressure and increase in cardiac output
- 58.The client's heart rate increases slightly during inspiration and decreases slightly during expiration. what action will the nurse take
- A.
Notify the physician
- B.
Assess the client for chest pain
- C.
Document the finding as the only action
- D.
Prepare to administer antidyrsthythmic drug
- 59.The client with tachycardia is experiencing clinical manifestation. Which one alerts the nurse to the need for immediate intervention
- A.
Chest pain
- B.
Increased urine output
- C.
Mild orthostatic hypotension
- D.
P wave touching the T wave
- 60.The client is experiencing sinus bradycardia withhyopotension and dizziness. Which will the nurse administer?
- A.
Atropine (Atropine)
- B.
Digoxin (Lanoxin
- C.
Lidocaine (Xylocaine)
- D.
Metroprolol (Lopressor)
- 61.The client is experiencing occasional premature atrial contraction (PAC's) accompanied by palpations. These episodes resolve spontaneously without treatment. What instruction will be included in a teaching plan for this client
- A.
Limit or abstain from caffeine
- B.
Lie on your left side until the attack subsides
- C.
Use your oxygen whenever you experience PAC's
- D.
Take your quinidine twice daily on the days that youexperience palpations
- 62.The clients ECG reveals tachycardia with a heart rate of 170 beats/min that was initiated after a premature atrial contraction. this rhythm resolved spontaneously withut treatment. WHat is the nurse;s interpretation of this finding>
- A.
Paroxysmal supra ventricular tachycardia (PSVT)
- B.
Ventricular tachycardia
- C.
Ventricular fibrillation
- D.
Rapid atrial flutter
- 63.The nurse notes absent P waves and a heart rate of 200 beats/min on the client's telemetry. How does the nurse interpret these finding
- A.
Ventricular tachycardia
- B.
Second degree heart block
- C.
Supraventricular tachycardia
- D.
Premature ventricular contraction
- 64.What will the nurse administer to a client withsustained supraventrical tachycardia?
- A.
Atropine
- B.
Epinephrine
- C.
Lidocaine
- D.
Dilitiazem
- 65.The client has a heart rate averaging 56 beats/min. The client has had no adverse symptoms associated with this bradycaredia and is not being treated for it. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate
- A.
Make certaine that your bathe water is warm (100 F)
- B.
Avoid bearing down or straining while having bowel movement
- C.
Avoid strenous exercise, such as running, during the late afternoon
- D.
Limit your intake of caffeinated drinks to no more than two cups per day
- 66.Which client is most at risk for atrial fibrillation
- A.
A middle aged client who takes an aspirin daily
- B.
A client 3 days post coronary artery bypass surgery
- C.
An older adult client post carotid endarterectomy
- D.
An older adult with diabetes mellitus and hypertension
- 67.Whiat physical assessment finding finding are expected in a client with atrial flutter and a rapid ventricular response?
- A.
The presence of a split S1 and wheezing
- B.
Anorexia and gastric distress
- C.
Shortness of breath and anxiety
- D.
Hypertension and mental status change
- 68.Which is a priority intervention for the client experiencing atrial fibrillation
- A.
Measuring urinary output
- B.
Assessing for shortness of breath
- C.
Assessing pulse oximetry every hour
- D.
Measuring blood pressure in the lying position
- 69.Which alteration, when manifested in a client with atrial fibrillation, should alert the nurse tot he possibility of an embolic stoke
- A.
A pulse deficit
- B.
Speech alterations
- C.
Distended neck veins
- D.
Hyperresponsive deep tendon reflexes
- 70.A nurse is caring for a client with a chronic atrial fibrillation who is at risk for systemic emboli. Which drug should the nurse expect to administer to prevent this complication
- A.
Sotalol (Betapace)
- B.
Heparin (Heparin)
- C.
Atropine (Atropine
- D.
Lidocaine (Xylocaine)
- 71.Which dysrhythemia may develope in a client with frequent premature ventricular contractions
- A.
Sinus tachycardia
- B.
Rapid atrial flutter
- C.
Venticular tachycardia
- D.
Atriventricular junctional rhythm
- 72.A client ECG shows slow, irregular, wide QRS complexes and regular atrial rhythm. What is the nurse's interpretation of this observation
- A.
Atrial flutter
- B.
Ventricular flutter
- C.
Atroventricular (AV conduction block
- D.
Junctional dyshythmia
- 73.A client;s ECG tracing shows normal sinus rhythm followed by a complexs of three PVC's with a return to normal sunus rhy thm. What is the nurse's interpretation of this finding/
- A.
Nonsustained ventricular tachycardia
- B.
Ventricular escape rhythm
- C.
Trial flutter
- D.
Trigeminy
- 74.A client with myocardial ischemia is having freauent PVC's. Which intervetnion will the nurse administer
- A.
Lanoxin
- B.
Lidocaine
- C.
Dobutamine
- D.
Atropine sulfate
- 75.The nurse has administered adenosine (adenocard) what is the expected therapeutic response?
- A.
Increased introcular pressure
- B.
A brief tonic clonic seizure
- C.
A short period of asystole
- D.
Hypertensive crisis
- 76.A clients ECG tracing shows a run of sustained ventricular tachycardia. What is the first action that the nurse will take.
- A.
Assess the client's airway, breathing and level of consciousness
- B.
Administer verapamil IV push
- C.
Defibrillate the client
- D.
Begin cardiopulmonary resuscitation (CPR)
- 77.Which medication will the nurse administer to prevent recurrent ventricular tachycardia?
- A.
Lidocaine (Xylocaine)
- B.
Dilitiazem (cardizem)
- C.
Adenosine (Adenocard)
- D.
Exiletine (Mexitil)
- 78.A client with unstable ventricular tachycardia is receiving amiodarone hydrochloride by intravenous infusion. The nurse notes that the client's heart rate has decreased from 68 to 50 beats/min. The client is asymptomatic. What is the nurse's priority intervention
- A.
Stop the infusion
- B.
Slow the infusion rate
- C.
Administer a precordial thump
- D.
Place the client in a side-lying position
- 79.The client withischemic heart disease has an ECG tracing that shows first degree heart block. What is the nurse's best action?
- A.
Document the finding as the only action
- B.
Measure blood pressure
- C.
Notify the physician
- D.
Administer oxygen
- 80.Which assessment will the nurse perform whenever a client has any type of dysrhthmia
- A.
Measuring blood pressure in each arm separately
- B.
Measuring apical and radial pulses for a full minute
- C.
Performing pulse oximetry testing in the upper and lower extremities
- D.
Measuring blood pressure in the lying and sitting positions
- 81.The physician is about to perform carotid sinus massage on a client withsupraventricular tachycardia. What equiptment or supplies will the nurse have ready for possible compplications.
- A.
Emesis basin
- B.
Magnesium sulfate
- C.
Resuscitation cart
- D.
Padded tongue blade
- 82.A nurse is caring for a client with second degree AV block type II. which is the nurse's priority intervention
- A.
Cardiopversion
- B.
CarCarotid massage
- C.
Prophylactic pacing
- D.
Administration of IV dioxin
- 83.A client withthird degree heart block is admitted to the telemetry unit. The nurse observes wide QRS complexes, with a heart rate of 35 beats/min on the monitor. What physical assessment parameter would be importantto incorporate for this client
- A.
Pulmonary rales
- B.
Acute hypertension
- C.
Confusion or syncope
- D.
Presence of a gallop rhythm
- 84.A client with third degree AV block presents to the emergency room with a heart rate of 40 beats/min or lower is decreased cardiac output. The consequences of this dyshythmia is poor tissue perfusion to the brain and other vital organs.
- A.
Turn off the pacemaker
- B.
Decrease the pacemaker threshold
- C.
Document the finding as the only action
- D.
Set the pacemaker to the synchronous node
- 85.Which type of pacing would be most appropriate for a client with symptomatic infranodal third degree heart block
- A.
Global pacing
- B.
Universal pacing
- C.
Synchronous pacing
- D.
Asynchronous pacing
- 86.A client is about to undergo noninvasive temporary pacing (NCP) which action is most appropriate for preparing this client for the procedure
- A.
Apply alcohol to the skin before electrode placement
- B.
Prepare the skin by washing it with soap and water
- C.
Shave the area where electrode will be placed
- D.
Place the electrodes at the V1 position
- 87.The nurse observes the presence of a pacind spike but no QRS on the client's ECG tracing. How will the nurse interpret this event?
- A.
Loss of capture
- B.
Ventricular fibrillation
- C.
Capture from ectopic focus
- D.
Normal tracing with epicaridal pacing
- 88.Which instructions will the nurse include in the teaching plan for a cient with a permenant pacemaker
- A.
Baths are not permitted, take only showers
- B.
Report pulse rates lower than your pacemaker setting
- C.
If you feel week, apply pressure over your generator for 30 seconds
- D.
Have your pacemaker turned off before having magnetic resonance imaging
- 89.How will the nurse intervent for the cient with ventricular fibrillation
- A.
Carry out difibrillation
- B.
Initiate CPR
- C.
Provide airway management
- D.
Administer oxygen via nasal cannula
- 90.The client with ventricular tachycardia is unresponsive and has no pulse. What will the nurse do first?
- A.
Carry out emergency cardioversion
- B.
Initiate CPR
- C.
Administer epinephrine
- D.
Defibrillate
- 91.A client w ith heart failure developes 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 renine -angiotension aldosterone system
- D.
Arterial vasodilation and subsequent increase in oxygen consumption
- 92.A client is admitted with early stage heart failure. Which immediate compensatory response would the nurse expect to see in this client
- A.
Decreased stoke 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
- 93.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
- 94.A client with systolic dysfunciton has an ejection fraction of 38%. the nurse expects to observe which physiologiv 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
- 95.Which client is most at risk for 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
- 96.Which client statement alerts the nurse to a 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
- 97.A client with a history of myocardial infarction calls the clinic 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 after 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
- 98.Which statement made by a client would alert the nurse to 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
- 99.Which client is at highest risk for the development of high output heart failure
- A.
Young woman taking oral contraception s
- 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
- 100.The nurse notes that the client's apical pulse is displaced to the left. What conclusion can be drawn from the assessment?
- A.
This is normal finding
- B.
The heart is hypertrophied
- C.
The left ventricle is contracted
- D.
The client has pulses alertness
- 101.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
- 102.A client asks the nurse why it is important to be wieghed 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 taht you're eating properly
- C.
The hospital requires that all impatient be weighed daily
- D.
You need to lose weight to decrease to incidence of heart failure
- 103.A client has been admitted to the intensive care unit with worsening pulmonary manifestation of heart failure. Which primary ccollaborative intervention should the nurse perform?
- A.
Maintaining the head of the bed in followers position
- B.
Keep the client on bed-rest, with passive range of motion
- C.
Limit visitors and activity to a minimum
- D.
Administer loop diuretics
- 104.Whihc nurssing 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
- 105.The client with heart failure 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 heart and lungs
- D.
Place the client on fluid restriction
- 106.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
- 107.Which is the priority intervention for a client who has recieved the first dose of captopril (Capiten)
- A.
Administer this medication 1 hour before meals to aid in absorption
- B.
Instruct the client to ask assistance when arising from bed
- C.
Give the medication with mild to prevent stomach upset
- D.
Monitor the potassium level for hypokalemia
- 108.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
- 109.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 Iisordil
- C.
Instruct the client to drink water
- D.
Administer PRN acetaminophen
- 110.The client with heart failute 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.
Administrating a larger loading dose before the initiation of therapy
- 111.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 3000ml/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
- 112.A client is taking triamterene-hydrochlorothiazide (Dyazide) and furosemide (lasix) which assessment finding alers the nurse to a serious side effect
- A.
Cough
- B.
Headache
- C.
Bradycardia
- D.
Hypokalemia
- 113.A client with heart failure is going through rehabilitation to increase his or her activitgy tolerance. The nurse will stop the cilent's activity if which symptom is assessed
- A.
Oxygen of 95%
- B.
Respiratory rate of 20 breaths/min
- C.
Systolic blood pressure change for 136 to 96 mm hg
- D.
Heart rate increase form 86 to 100 beats/min
- 114.An older adult client with heart failure has developed arterial fibrillation. what diagnositc or laboratory test would the nurse expect to be ordered
- A.
Serum anion gab
- B.
Serum sodium level
- C.
T4 (thryoxine) and TSH (thyroid stimulating hormone)
- D.
Serum creatinine
- 115.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
- 116.A client has been admitted to the acute care unity 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
- 117.Which assessment finding supports a diagnosis of impaired tissue perfusion in teh client with heart failure
- A.
Carotoid bruit
- B.
A dry hacking cough
- C.
A positive Allen's test
- D.
Dyspnea on exertion
- 118.Which assessment finding does the nurse expect in a 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.
Countinuing loud diastolic murmur radiating to the left axilla
- 119.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 pressure
- 120.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 pressure
- 121.Which assessment finding does the nurse expect in the client with mitral insufficiency?
- A.
A systolic click in auscultation
- B.
A high pitched holosystolic murmur
- C.
Angina with exertion
- D.
A cough with hemoptysis
- 122.The client who has a prosthetic valve replacemtn 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 reduced circulation in the leg, making blood return tot he heart much slower
- D.
The surgery left a lot of small clots in your heart and lungs, the anticoagulants will slowly dissolve these
- 123.A client has jsut undergone a balloon valvuloplasty, For whch complication of this procedure should the nurse monitor this client
- A.
Bleeding
- B.
Acute tubulor necrosis
- C.
Short term memory loss
- D.
Pulmonary hypertension
- 124.A cleint is preparing to be discharged home following mitral valve replacement. Which stataemtn indicates that the client requires further education
- A.
I wont be able to carry heavy loads for 6 monts
- 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
- 125.A young adult p resents with a fecer , symptoms of heart failure, and amurmur. Which additional data will the nurse obtain
- A.
Family history of coronary artery disease
- B.
Recent travel to third-world counteries
- C.
Whether the client is responsible for cleaning pet litter boxes
- D.
History of any systemic infection or dental work within the past month
- 126.Whihc precautions are appropriate when providieng care to a client with infective endocarditis
- A.
Standard percaustions
- B.
Enteric percautions
- C.
Protective isolation
- D.
Respiratory isolation
- 127.The home care nurse is assessing the client receiving antibiotic therapy in the home for inefective endocarditis, Which of the following clinical manifestations requires reevaluation of the treatment regimen?
- A.
Temperature 101.6
- B.
Clubbing of fingers
- C.
Petechiae
- D.
Pulse pressure of 36 mm Hg
- 128.The nurse has difficulty hearing heart sounds in a client with pericarditis. WHich is the priority action of the nurse
- A.
Assesing the heart sounds with a doppler
- B.
Increasing the intervenous flow rate
- C.
Administering oxygen by non-rebreather mask
- D.
Assessing the client for Beck's triad
- 129.Which assessment finding does the nurse expect in a client with pericarditis
- A.
An irregular heart rate that speeds up ans slows down
- B.
A friction rub at the left lower sternal border
- C.
The presence ofa gallop rhythm
- D.
substernal lift at the apex
- 130.A nurse is caring for a cleint admitted with tachycardia, a perciardial 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 has a sore throat for 1 week
- C.
The client is currently taking antibiotics
- D.
The client has a history of alcoholism
- 131.Which instruction 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 and fainting
- D.
You may have a maximum of two alcoholic drinks weekly
- 132.The nurse cautions the client who has recieved a heart transplant to change positions slowly, Why is the instructers priority
- A.
Rapid postion changes can create shear forces and disrupts vascular sutures
- B.
The nuew vascular connections are more sensitive to postions changes, Leading to increased intra-vascular 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
- 133.When teaching is essential for a cleint discharged after a heart transplant whi is prescribed cyclosporine (Sandimmune)
- A.
Use a soft bristled toothbrush
- B.
Avoid crows and people who are sick
- C.
Change positions slowly to avoid hyoptension caused by the medication
- D.
Do not take this medicaiton if your pulse rate is lower than 60 beats/min
- 134.A client is classified (staged) at level A heart fialure, What will the nurse teach the cleint?
- 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
- 135.A client is classified (staged) at level A heart fialure, What will the nurse teach the cleint?
- 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
- 136.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 dont want to become a vegetable. What is the nurse's best response
- A.
Would you like to speak with a priest
- B.
Ill get a psychiatrist to talk with you
- C.
Do you want to come off the transplant list
- D.
Would you like information about advance directives
- 137.Which question will best help the nurse to assess the activity lever 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 develope heaviness in your arms or legs that you didn't have before
- 138.A client with heartfailure 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
- 139.
- 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
- 140.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.
Electrocardiograph
- B.
Chest x ray
- C.
T4, TSH
- D.
Arterial blood gases
- 141.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
- 142.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
- 143.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 and then administer the Vasotec
- C.
Hold the vasotec
- D.
Notify the physician
- 144.A client in severe heart failure is to receive nesiride (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
- 145.In Health people 2010, which is a priority of the primary nurse caring forolder 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
- 146.Which conditions are caused by left sided heart fa ilure (select all that apply)
- A.
Hypertensive disease
- B.
Crackles heard
- C.
Enlarged liver and spleen
- D.
Confusion
- E.
Pulmonary hypertension
- F.
Dependent edema
- G.
S3S4 gallop
- H.
Cough worsens at night
- 147.A client with arherosclerosis asks a nurse which factors are responsible for this condition. what is the nurse's best response?
- A.
Injury to the arteries caused 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
- 148.The nurse recognizes which client is at greatest risk for developing intimal injury leading to artherosclerosis
- 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 (LDL) and increased high density lipoprotein (HDL) levels
- C.
A client with inherited hypolipidemia
- D.
A client with a sedentary lifestyle
- 149.A client with hyperlipidemia, who is being treated with dietary fat restrictions and an exercise program, asks the nurse why hi 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 % 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
- 150.On auscultation of the carotoid arteries of a client with arthersclerosis, the nurse hears a swishing sound over the rish 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
- 151.What specific instruction should the nurse give to the client with arthersclerosis who is attempting to stop cigarrette 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
- 152.The client with hypercholesterolemia and artherosclerosis reports skin flushing and itching while taking nicotine 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
- 153.The n urse 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 thatn 3
- 154.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
- 155.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
- 156.Which instruction will be given to a client who is about to begin treatment with simvastin
- A.
This drug can cause constipation
- B.
Take t his drug on an empty stomach
- C.
Report any muscle tenderness to your health care provider
- D.
You may experience flushing of the skin with these medications
- 157.A client diagnosed with essential hypertension asks how this type of hypertension develops. which is the nurse's best response
- A.
Ther is no known cause for this type of hypertension
- B.
You have an underlying condition that cause 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
- 158.The client has been diagnosed with Cushings syndrom. 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
- 159.Which additional physical assessment will the nurse include in the examination of a client diagnosed with hypertension
- A.
Skin examination for telengiectasis
- B.
Otoscopic examination of the inner ear
- C.
Funduscopic examination of the retina
- D.
Neurologic examination of the cranial nerves
- 160.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 alcoholic 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
- 161.A client is to begin taking hydrochlorthiazide (Microzide) for control of hypertension. which instruction will be given to this client before begining 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
- 162.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
- 163.A client is starting Lininopril (Prinivil) therapy. The nurse will monitor for the development of which potiental side effect
- A.
Pedal edema
- B.
Orthostatic hypotension
- C.
Orthopenea
- D.
Bradycardia
- 164.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 clients apical pulse for 1 full minute before drug administration
- B.
Place the client in the Trendleburg position to facilitate blood flow the the heart
- C.
Explain to the client to remain in bed for 3 hours after drug administration
- D.
Instruct the client to drink 3 liters of fluid daily when taking t his medication
- 165.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 t his medication by puncturing the capsule an placing the liquid contents under your tongue
- 166.Which cleint will benefit from receiving treatment for hypertension with an angiotension 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
- 167.The nurse assesses for which client outcome as indicative of effective hy pertension management
- A.
The client has not developed pedal edema
- B.
There is not evidence of sexual dysfunction
- C.
The is no indication of target organ damage
- D.
/the clients blood pressure reading is stable at 148/94
- 168.In assessing a clietn with complaint of clausication after walking a distance of one block, the nurse notes a painful ulcer on the toes of the client's right toe, The nurse correlates these findings with which condition
- A.
Diabetic foot ulceration
- B.
Peripherial arterial disease
- C.
Peripherial venous disease
- D.
Deep vein thrombosis
- 169.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 brownish discoloration of the lower extremity at the ulcer site
- D.
The extremity is cold and gray blue in color
- 170.The client with chronic peripheral arterial disease and claduication 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
- 171.Which statement made by the client with peripherial arterial disease concerning positioning of edamatous 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
- 172.Which intravention 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
- 173.Which client statment indicates a need for additional teaching about pentoxifylline therapy for peripherial arterial disease
- A.
I stopped drinking coffee and tea
- B.
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
- 174.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
- 175.A client who has returned to the unit after arterial revascularization states that pain simular tot hat before the procedure is felt in the affected limb. which is the nurses best action
- A.
Notifying the surgeon
- B.
Elevating the extremity
- C.
Administering pain medication
- D.
Placing a warm blanket on the operative limb
- 176.In monitoring the client recovering form aortofemoral bypass surgery, which clinical manifestation are consistent with compartment syndrom
- A.
Elevated temperature and diaphoresis
- B.
Loss of sensation and pallor proximal to surgical site
- C.
Swelling, pain, and tension of affected limb
- D.
Increased pulse amplitude and warmth below surgical site
- 177.Which nursing action is indiacated for the client who has developed compartment syndrome after aortoilic bypass graft surgery for peripherial arterial disease
- A.
Performing passive range of motion exercise on the artificial limp to increase flexibility
- B.
Preparing the client for return to the operative suite for surgical correction
- C.
Medicating the client for pain and placing the client in a knee chest position
- D.
loosening the dressing and elevating the extremity to the level of the heart
- 178.Which monitoring technique being performed by a new graduate nurse should be questioned in the client with an unrepaired abdominal aortic aneyrysm
- A.
Measurement of abdominal girth
- B.
Observation of abdominal wall movement
- C.
Auscultation of any area of the abdomen
- D.
Palpation of the abdominal mid line area
- 179.A cleint with a diagnosed abdominal aneurysm (AAA) developes lower back pain radiating to the groin. Which is the nurse's interpretation of this information
- A.
The aneurysm has become obstructed
- B.
The aneurysm may be undergoing expansion
- C.
The client is experiencing inflammation of the aneurysm
- D.
The client is experiencing normal sensations associated with this condition
- 180.In assessing the client with an aortic aneyrysm before surgery, a nurse notes that the clients systolic blood pressure has increased by 30 mm hg compared with the reading 1 hour ago. What is the nurse's best first action
- A.
Measuring abdominal girth
- B.
Auscultation the abdomen
- C.
Increasing the IV rate
- D.
Measuring blood pressure on both arms
- 181.A nurse is caring for a client who has undergone surgical repair of an AAA. the client has seveloped coolenss of the extremities and complains of a bloated feeling in the abdomen. What is the nurse's best action
- A.
Measuring the abdominal girth and check pulses
- B.
Raising the head of the bed to 90 degrees
- C.
Measuring the cardiac output
- D.
Irrigating the Foley catheter
- 182.Which instructions would be most appropriate to include ina teching plan for a client ready to be discharge after the repair of an AAA
- A.
You may drive your car any time
- B.
Avoid sleeping on your left side
- C.
Avoid lifting heavy objects for about 3 months
- D.
You can expect to have an increase in abdominal firth for about 6 weeks
- 183.Which intervention does the nurse teach to the client with Buerger's disease to limit disease progression
- A.
Keeping environmental temperatures comfortably warm
- B.
Avoiding injury to the hands and feet
- C.
Using a heating pad on the feet
- D.
Smoking cessation
- 184.In assessing the extremities of the client with Buerger's disease, the nurse correlaste which clinical manifestations with this disease process
- A.
Reddened, with diminished distal pulses
- B.
Cold and pale, with proximal bounding pulses
- C.
Cyanotic, with hypoflexive distal deep tendon reflexes
- D.
Brownish, with hyper-reflexive distal deep tendon reflexes
- 185.Which intervention suggested to the client with Raynaud's disease is aimed at preventing complicaitons?
- A.
Take oral vasoconstrictive agents when you have symptoms
- B.
Wear warm clothing when exposed to cool temperatures
- C.
Avoid placing lotion on affected extremities
- D.
Check the pulses in your arms and legs daily
- 186.The client is receiving heparin theraly for a venous thromboembolism (VTE). which activated partial thromplastin time (PTT) indicated that anticoagulation is adequate
- A.
The client's aPPT is half of the control value
- B.
The client aPPT is the same as the control value
- C.
The client's aPPT is twice the control value
- D.
The client's aPPT is five times the control value
- 187.The health care provider has prescribed the clietn sodium warfarin (Coumadin) while he or she is still receiving intravenous heparin. Which is the nurse's best action
- A.
Administer the medications as prescribed
- B.
Turn off the heparin drip for 1 hour before administration of the warfarin
- C.
Discontinue the heparin drip completely before warfarin administration
- D.
Hold the dose of wafarin
- 188.A client who is receiving unfractionated heparin is experiencing excessive bleeding, which mediacition will the nurse administer
- A.
Warfarin
- B.
Vitamin K
- C.
Enoxaparin
- D.
Protamine sulfate
- 189.What instructions will the nurse provide to a cient at risk for VTE who is being discharge home with low molecular weight heparin
- A.
You must have your aPTT checked every two weeks
- B.
Massage the injections site after the heparin is injected
- C.
Notify your health care provider if your stools appear tarry
- D.
You will have an IV catheter placed that you can use for intermittent injection of the heparin
- 190.Which health teacing will the nurse in teh continuing plan of care for a client with chronic venous stasis ulcers
- A.
Apply anti embolism stockings before getting out of bed in the morning
- B.
Clean the ulcer with Betadine before applying a dressing
- C.
Take one low dose aspirin daily to prevent inflammation
- D.
Remove and reapply the duoderm dressing daily
- 191.Inassessing for skin changes in an African American client admitted with peripheral artery disease. the nurse monitors for which change
- A.
Excess hair growth on the arms and legs
- B.
Pitting edema in the feet
- C.
Cyanosis of the nail bed
- D.
Loss of toe nails
- 192.In reviewing a client laboratory results, the nurse correlates elevations in which values as risk factors for arthersclerosis (select all that apply)
- A.
Total cholesterol
- B.
High density cholesterol
- C.
Triglycerides
- D.
Serum albumin
- E.
Low density cholesterol
- F.
Homocysteine
- 193.The nurse correlates which pathophysiologic process with the development of coronary artery disease(CAD)
- A.
Arterosclerotic plaques cause spasm and subsequent narrowing of the coronary vessels
- B.
Coronary vessels become inflamed and injured as a result of excess cholesterol and triglycerides
- C.
Macrophages and T cells from a connective tissue matrix in the vessel intima where lipids accumulate
- D.
Atherosclerosis causes coronary vessels to become stiff, limiting their ability to respond to increase in blood flow
- 194.The nurse is taking the history of a client with suspected CAD who has had episodes of chest discomfort whil mowing the lawn. Because the chest discomfort subsides when the client rests, the nurse correlates this with which condition
- A.
Variant angina
- B.
Stable angina
- C.
Myocardial infarction
- D.
Aortic aneurysm
- 195.The nurse correlates which clinical manifestation with a diagnosis of variant (Prinzmetal's) angina?
- A.
Chest discomfort that apears with exertion and is relieved with nitroglycerin
- B.
Chest pain occuring with minimal exertion that limits the clients activity
- C.
A burning sensation in the chest wall that is relieved with rest
- D.
Chest pressure or tightness that radiates to the arm and jaw
- 196.The client with a history of stable angina describes a recent increase in the number of attacks and the intensity of the pain. The nurse correlates this with which condition
- A.
Stable angina
- B.
Unstable angina
- C.
Acute myocardial infarction
- D.
Subendocardial necrosis
- 197.The nurse assess for which modifiable risk factor in the client with coronary artery disease
- A.
Age
- B.
Gender
- C.
Smoking
- D.
Family history
- 198.The nurse assesses for modifiable risk factors in the client with coronary artery diseasae. which intervention is the priority to assist the client in decreasing the risk for coronary artery disease
- A.
Age
- B.
Gender
- C.
Smoking
- D.
Family history
- 199.For which clinical manifestations of myocardial infarction should the nurse monitor in the older adult
- A.
Pain on inspiration
- B.
Posterior wall chest pain
- C.
Disorientation or confusion
- D.
Numbness and tingling of the arm
- 200.Which statement made by the client with coronary artery disease alerts the nurse that the client may be experiencing difficulty in adapting to the illness
- A.
I usually wait about 2 hours after I feel chest discomfort before calling my doctor to be sure it is really angina
- B.
I know I will have some chest discomfort with some activities, so I carry my nitroglycerin with me
- C.
When I was in the hospital last time for my heart attack, I felt afraid
- D.
I feel a little anxious whenever I get chest discomfort
- 201.Eight hours after presenting tot he emergency department with complaints of substernal chest pain, a client's laboratory results demonstrate that myoglobin levels have not risin . What is the nurse's interpretation of these results
- A.
The client has not experienced a myocardial infarction
- B.
The client is experiencing and evolving myocardial infarction
- C.
The client most likely has a myocardial infarction several days ago
- D.
The client has experienced a myocardial infarction within the last 24 hours
- 202.The nurse evaluates the results of which laboratory test as a diagnostic for acute coronary syndrome in the client with unstable angina
- A.
Tropinin T
- B.
Serum Lactate dehydrogenase (LDH)
- C.
Serum Myoglobin
- D.
Creatine kinase (CK)-MB isoenzyme
- 203.The nurse recognizes which laboratory test as most specific in diagnosing an acute myocardial infarction
- A.
Myoglobin
- B.
Serum LDH
- C.
CK-MB isoenzyme
- D.
Troponin T
- 204.What changes in the electrocardiogram (ECG) tracing would the nurse monitor for in the client with a myocardial infarction
- A.
ST-segment depression, flattened T wave, normal Q wave
- B.
ST-segment depression, T wave inversion, normal Q wave
- C.
ST-segment inversion, T wave elevation, abnormal Q wave
- D.
ST-segment elevation, T-wave inversion, abnormal Q wave
- 205.What is the nurse's interpretation of a large wide Q wave on the ECG of the client undergoing preadmission testing for surgery
- A.
The client is experiencing angina
- B.
The client has has a myocardial infarction in the past
- C.
The client's atria are enlarged and failing
- D.
The client's ECG pattern is common variation of normal sinus rhythm
- 206.What is the nurse's interpretation of a client's ECG that reveals ST-segment depression and T-wave inversion in leads II, III, and a Vf
- A.
An episode of angina
- B.
Variant angina
- C.
Acute myocardial infarction
- D.
Aortic thrombosis
- 207.After receiving a total of three nitroglycerin sublingual tablets, a client admitted to the hospital with complaints of chest pain states there is not change in the level of discomfort. what will the nurse do next
- A.
Place the client in a semi-Flower's position
- B.
Administer IV nitroglycerin
- C.
Administer morphine sulfate IV
- D.
Notify the health care provider
- 208.What is the priority nursing diagnosis for a client admitted with acute myocardial infarction?
- A.
Potential for decreased Tissue integrity
- B.
Potential for sensory perception alteration
- C.
Potential for impaired tissue perfusion
- D.
Potential for decreased cardiac output
- 209.The nurse correlates which tationale with the administration of aspirin plus nitroglycerin tot he client experiencing angina like chest pain
- A.
Analgesic properties without sedation
- B.
Vasoconstriction and improved blood flow
- C.
Inhibition of platelet aggregation and clot formation
- D.
Cardiotonic properties and improved contraction
- 210.A cleint brought to the emergency room has been diagnosed with an acute myocardial infacrtion and is ordered thrombolytic therapy with reteplase. The nurse correlates wihc rationale with the administration of this medicaiton
- A.
Reversing any my ocardial damage if given within 2 hours of the event
- B.
Restoring perfusion to the injured area, reducing the size of the infarct
- C.
Restoring coronary reperfusion without risk of internal bleeding
- D.
Decreaseing the necessity of precutaneous transluminal coronary angioplasty (PTCA)
- 211.The client diagnosed with acute MI is to recieve tenecteplase (TNAKase) the nurse recognizes which advantage of this medication over other fibrinolytic drugs
- A.
Restores perfusion to coronary arteries
- B.
Limits damage to the myocardium
- C.
Decreases mortality in clients with MI
- D.
Administered in a single bolus over 5 seconds
- 212.Which specific actions or precaustions will the nurse use when providing care to a client receiving thrombolytic therapy will streptokinase that differ from using tissue type plasminogen activator (t-PA)
- A.
Assess neurologic status every hour
- B.
Observe all IV sites and wounds for bleeding
- C.
Monitor the client for evidence of chest pain
- D.
Observe the client for the presence of hives or shivering
- 213.A client has recieved thrombolytic therapy after having a my ocardial infarction What clinical manifestation indicates to the nurse that reperfusion has been successful
- A.
ST-segment depression
- B.
Cessation of diaphoresis
- C.
Sudden onset of pleurtic chest pain
- D.
Onset of ventricular dysrhythmias
- 214.A client who had a stoke 1 month ago presents with an acute MI. The nurse recognizes which statement as correct regarding the administration of thrombolytic therapy to this client
- A.
No effect on administration of this therapy
- B.
Relative contraindication to administration of this therapy
- C.
Absolute contraindication for administration for this therapy
- D.
A client who had a stroke 1 month ago presents with an acute MI.
- 215.
- Which intervention reduces the risk of complications in the client with a myocardial infarction who has been treated with thrombolytic therapy
- A.
Administration of heparin
- B.
Application of ice to the injection site
- C.
Placing the client in Trendleburg position
- D.
Instructing the client to take slow deep breaths
- 216.The nurse monitors for which complcation in a client taking a nonselective beta-blocking agent?
- A.
Headache
- B.
Postural hypotension
- C.
Nonproductive cough
- D.
Wheezing
- 217.The client is undergoing progressive ambulation on the third day after a myocardial infaction. which clinical manifestation would indicate to the nurse that the client should not yet be advanced to the next level
- A.
Facial flushing
- B.
Onset of chest pain
- C.
Heart rate increase of 10 beats/min at completion of ambulation
- D.
Systolic blood pressure increases of 10 mm Hg at completion of ambulation
- 218.A client who has has a myocardial infarction complies with the treatment regimen but avoids discussing the illness with health care providers and family members. What is the nurse's interpretation of this client's behavior.
- A.
The client is usual denial
- B.
The client is clinically depressed
- C.
The client is expressing underlying anger
- D.
The client is demonstrating grief and loss
- 219.A nurse monotors for which clincal manifestation of poor prgan perfusion in the client with left ventrical failure secondary to a myocardial infarction
- A.
Headache
- B.
Hypertension
- C.
Urine output of less than 30 ml/hr
- D.
Heart rate of 55 to 60 beats/min
- 220.A client admitted to the coronary care unit with a myocardial infarction begins to develope increased pulmonary congestion, an increased in heart rate 80 to 102 beats/min, and cold, clammy skin. Which is the nurse's best action prior to nitifying the physician?
- A.
Administering oxygen
- B.
Increasing the IV flow rate
- C.
Placing the client in supine position
- D.
Preparing the client for emergency echocardiography
- 221.The nurse monitores for which resonoses as indicative of improvement in the client receiving dobutamine for management ofheart failyre
- A.
Decreased heart rate, increased pulse quality
- B.
Decreased heart rate, decreased pulse quality
- C.
Increased heart rate, increased pulse quality
- D.
Increased heart rate, decreased pulse quality
- 222.Which percaustion will the nurse teach to the client bein discharged after a percutaneous transluminal coronary angioplasty (PTCA) who is prescribed a calcium channel blocking agent.
- A.
Change position slowly
- B.
Avoid crossing your legs
- C.
Weigh yourself daily
- D.
Decrease salt intake
- 223.The client who is post PTCA complains of severe chest pain. which is the nurse's best action?
- A.
Administering IV morphine as ordered PRN
- B.
Administering sublingual nitroglycerin
- C.
Notifying the physician
- D.
Performing a 12 lead ECG
- 224.WHich statement by the client ordered sublingual nitroglycerin for chest pain indicates a need for further teaching regarding this therapy
- A.
I keep my medicine in a clear plastic bag in my purse so that I can get to it so easily if I have chest pain
- B.
Even if I have not used any of the nitroglycerin from one refill, I get another refill every 3 months
- C.
If ai still have chest pain after I have taken three nitroglycerin tablets, I will go to the hospital
- D.
When my nitroglycerin tablet tingles under my tongue, I know that it is strong enough to work
- 225.The nurse monitors for which complication in the client who has PTCA 1 hour ago
- A.
Hypertensive crisis
- B.
Hyperkalemia
- C.
Infetion
- D.
Bleeding
- 226.For which clinical manifestation does the nurse monitor in the client who has just undergone a PTCA and is ordered to receive an IV infusion of abciximab (ReoPro)
- A.
Urticaria
- B.
Joint pain
- C.
Pedal edema
- D.
Excessive thirst
- 227.The client post-coronary artery bypass graft (CABG) has a serum potassium level of 4.5 mEq/L. what is the nurse's best action?
- A.
Notify the physician
- B.
Document the finding as the only action
- C.
Decrease the IV solution flow rate
- D.
Administer potassium replacement as ordered
- 228.The nurse notes that the mediastinal tubes of a client who is 6 hours postoperative after undergoing CABG are not draining. Which action would be indicated at this time?
- A.
Replacing the tubing
- B.
Notifying the physician
- C.
Irrigating the tubing with normal saline
- D.
Documenting the finding
- 229.The nurse prioritizes which assessment in the older cleint who has had CABG surgery?
- A.
Skin assessment
- B.
Otoscopic assessment
- C.
Mental status assessment
- D.
Gastrointestinal assessment
- 230.A clinet with coronary artery disease is scheduled for a minimally invasive dierct coronary artery bypass (MIDCAB). which is the nurse's best response to the client's questions about how this procedure is different
- A.
The sternotomy incision is smaller
- B.
Cardiopulmonary bypass is not returned
- C.
There is far less incisional pain with a MIDCAB
- D.
Ther is not risk of graft closure after this procedure
- 231.The nurse includes which content in the teaching plan for a client being discharged after CABG surgery
- A.
Drink at least 3 liters of fluid a day
- B.
You should abstain for sexual activity for 6 months
- C.
Take your pulse before, midway through, and after exercising
- D.
You should discontinue your antihyperlipidemic medication at this time
- 232.In planning a community program on risk factors associated with cardiovascular diases, the nurse includes which type of information
- A.
Cigarette smoking
- B.
Use of alcohol
- C.
Insomnia
- D.
Hypertension
- E.
Obesity
- F.
Depression
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