ATI Medical Surgical Practice Test: Cardiovascular and Hematology – Flashcards
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A nurse is caring for a client with aplastic anemia. The nurse expects the client to have which of the following symptoms? A. Headaches, paresthesias, and dizziness B. Macrocytosis, low levels of vitamin B12, and shortness of breath C. Vascular occlusions, fatigue and joint pain D. Pancytopenia, fatigue, and joint pain
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D. Pancytopenia, fatigue, and joint pain Dyspnea on exertion may also be present. in aplastic anemia, all three major blood components (RBCs, WBCs, platelets) are reduced. Manifestations usually develop gradually
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A nurse is caring for a client diagnosed with complete heart block who has a demand pacemaker inserted. the pacer is set for 72 bpm. Which EKG pattern indicates to the nurse a failure to capture? A. QRS complexes occurring at a rate of 73 bpm, and no sharp spikes B. Sharp spikes at 72 bpm; QRS complexes at 50bpm C. P waves at a rate of 78 bpm; QRS complexes at 72 bpm D. QRS complexes at a rate of 100 bpm
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B. Sharp spikes at 72 bpm; QRS complexes at 50bpm The pacemaker is firing at the set rate, but the heart rate is only beating 50 times in a minute. This may be due to poor positioning of the pacer electrode and is referred to as lack of capture
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A nurse is caring for a postop client who requires 1 unit of blood because of a hemorrhage that occurred during surgery. Within 30 minutes of hanging the unit of blood, the client develops itching and hives. Which of the following actions should the nurse take first? A. Obtain a urine specimen B. Stop the infusion of blood C. Notify the laboratory D. Notify the provider
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B. Stop the infusion of blood These are manifestations of an allergic reaction to the transfusion, and this is the proper first response to symptoms of any type of blood reaction. If a client shows manifestations of an allergic response (to blood or medication), the exposure must be stopped immediately.
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A nurse is caring for a client experiencing an acute angina attack. The nurse should monitor the client for which of the following? A. Bradycardia B. Transient diastolic murmur C. Pulsus paradoxus D. Transient abnormal PMI (point of maximal impulse)
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D. Transient abnormal PMI (point of maximal impulse) Because of the change in compliance of the left ventricle, the PMI may be abnormal during the acute attack
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A nurse is caring for a client 5 days following an MI. The client has sudden onset of shortness of breath. The nurse notes that the client appear air hungry and is coughing frothy, pink sputum. When auscultating the client's breath sounds, the nurse expects to hear which of the following bilateral sounds? A. Crackles B. Wheezes C. Rhonchi D. Friction rub
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A. Crackles A client who had a recent MI is at risk for CHF. Crackles are breath sounds caused by the movement of air through airways partially or intermittently occluded with fluid and are associated with CHF and frothy sputum.
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A nurse is instructing a client after an MI about lifestyle changes. A client returns for a follow up visit to the cardiac clinic after hospitalization for an acute MI. Which statement made by the client indicates that additional teaching is needed? A. "I should no longer eat foods high in saturated fat" B. "Before taking my medication, I will count my radial pulse rate" C. "I will exercise once a week for an hour at the health club" D. "After eating, I will rest before resuming my daily routine"
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C. "I will exercise once a week for an hour at the health club" Exercise is most effective if done at least three times a week for a minimum of 20 minutes
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A nurse is caring for a client whose AAA is extending. The manifestations that the nurse should expect to observe include which of the following? A. Sternal chest pain B. Decreased heart rate and palpitations C. Elevated blood pressure D. Back and abdominal pain
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D. Back and abdominal pain AAA involves a widening, stretching or ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is extending downward and pressing on lumbar spinal nerve roots causing pain
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A nurse is caring for a client with hemophilia who has an active bleed in a joint. The appropriate nursing intervention when providing care to this client is which of the following? A. Obtain blood samples for platelet functioning B. Prepare for replacement of the missing factor C. Provide passive range of motion D. Place the bleeding joint in the dependent position
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B. Prepare for replacement of the missing factor Hemophilia is a hereditary bleeding disorder in which it takes a long time for the blood to clot and abnormal bleeding occurs. It is caused by a deficiency in a clotting factor.
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A nurse is caring for an adult client with sickle cell disease who has a history of having received many transfusions. The nurse realizes that because of this history, the client is at risk for which of the following? A. Hypokalemia B. Lead poisoning C. Hypercalcemia D. Iron toxicity
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D. Iron toxicity Excessive iron may come from overuse of supplements or from receiving frequent blood transfusions, as in sickle cell anemia. Clients who have a history of repeated, frequent transfusions are at risk for development of hemosiderosis
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A nurse is caring for a client with right sided congestive heart failure (CHF). The nurse knows that a manifestation of right sided CHF is which of the following? A. Decreased capillary refill B. Dyspnea C. Orthopnea D. Peripheral edema
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D. Peripheral edema Peripheral edema is caused by weakness in the right side of the heart caused by a blood backup into the venous system. Blood return from the venous system to the right atrium is impaired by a weakened right heart. The subsequent systemic venous backup leads to development of edema.
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A nurse assesses a client who has fluid volume excess. Which of the following manifestations indicates fluid volume excess? (Select all that apply.) A. Jugular vein distension B. Decreased hematocrit C. Postural hypotension D. Increased heart rate E. Fever
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A. Jugular vein distension B. Decreased hematocrit D. Increased heart rate A The increase in venous pressure due to excessive circulating blood volume results in neck vein distension. B. The hematocrit measures packed cell volume of red blood cells expressed as a percentage of total blood volume. With fluid volume excess, the hematocrit can decrease because of excessive hemodilution. E. Fluid volume excess or hypervolemia is an expansion of fluid volume in the extracellular fluid compartment. This results in increased heart rate and bounding pulses.
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A nurse is preparing to transfuse a unit of blood to a client. The nurse must verify which factor? A. Clients DOB B. Expiration date and time C. Color of blood D. Donor identification number
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B. Expiration date and time Checking the expiration date on all medications and intravenous products is a standard of nursing practice. In addition, the nurse is responsible for ensuring the client receives the correct unit of blood by checking the identity of the blood product, the client, and the compatibility (blood type and Rh factor) of the blood and the client.
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A nurse is caring for a client diagnosed with angina pectoris and is scheduled to undergo a percutaneous transluminal coronary angioplasty (PTCA). The nurse explains to the client that PTCA is used to do which of the following? A. Repair a heart valve that is stenosed B.Bypass a blocked coronary artery C. Repair an aneurysm in the left ventricle D. Dilate an obstructed coronary artery
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D. Dilate an obstructed coronary artery A PTCA dilates an obstructed coronary artery. A catheter with an inflatable balloon tip is inserted into the obstructed coronary artery. The balloon is inflated, compressing atherosclerotic plaque against the coronary artery wall, resulting in dilation of the artery.
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A nurse is caring for a client with pericarditis. Which of the following manifestations should the nurse expect to find on assessment? A. Bradycardia with ST depression B. Relief of chest pain with deep inspiration C. Dyspnea with a rapid respiratory rate D. Chest pain that increases when sitting upright
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C. Dyspnea with a rapid respiratory rate When pericarditis is present, the client will experience dyspnea and tachypnea. Chest pain with pericarditis will increase with deep inspiration due to increased pressure on the inflamed pericardial sac. This will make the client reluctant to take deep breaths resulting in dyspnea and tachypnea.
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A nurse is caring for a client following a vein ligation and stripping for varicose veins. Following this surgery, the nurse should know to place the client in which of the following positions? A. Supine with legs elevated at a 15 degree angle B. Flat with the knee gatch engaged C. In a semi-Fowlers position with knees flexed at a 45 degree angle D. Flat with an SCD on both legs
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A. Supine with legs elevated at a 15 degree angle Postoperatively, the client's legs should be elevated to promote venous return by gravity. The importance of periodic positioning of the legs above the heart should be stressed to the client during discharge teaching.
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A nurse is caring for a client with a cardiac contusion. The nurse understands that blunt chest trauma commonly results in damage to which of the following? A. Left atrium B. Left ventricle C. Right ventricle D. Right atrium
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C. Right ventricle The right ventricle lies directly behind the sternum. In a blunt injury, the impact of the right ventricle against the sternum will cause the greatest area of damage.
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A nurse administered a transfusion of fresh frozen plasma (FFP) to a client. Four hours later, the client has repeat laboratory work drawn. Which value should the nurse analyze to evaluate the client's response to the transfusion? A. Prothrombin time B. White blood cell count C. Platelet count D. Hematocrit
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A. Prothrombin time FFP is plasma rich in clotting factors. It is given to treat acute clotting disorders, and the desired effect is a decrease in the prothrombin time.
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A nurse is caring for a client with a history of congestive heart failure at risk for development of fluid volume excess. The nurse realizes that a late manifestation of fluid overload is which of the following A. Weight gain of 1 kg in 1 day B. Pitting edema of 3+ C. Urine output of 20 mL/hr D. Blood pressure of 170/84 mmHg
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B. Pitting edema of 3+ Pitting edema, a visible finger indentation after application of pressure, alerts the nurse that the client has retained fluid and demonstrates that the client has fluid in their tissues. Pitting edema is rated on a scale of mild (+1) to severe (+3); therefore, pitting edema of +3 is a late indication that the client has developed fluid overload.
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A nurse is caring for a client with pernicious anemia. The nurse should know that to treat this condition, the client will require which of the following? A. Ferrous sulfate supplementation B. Increased dietary intake of folic acid C. Monthly injections of vitamin B12 D. Blood transfusions
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C. Monthly injections of vitamin B12 Pernicious anemia is caused by a lack of intrinsic factor needed to absorb vitamin B12 from the gastrointestinal tract. Monthly vitamin B12 injections are the definitive treatment to correct the vitamin B12 deficiency.
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A nurse realizes that a client whose blood type is B positive is being transfused with a unit of O negative fresh frozen plasma (FFP). Which of the following is an appropriate nursing action to take? A. Continue to monitor the client for manifestations of a transfusion reaction B. Remove the unit of plasma immediately and start an IV infusion of normal saline solution C. Discontinue the transfusion and repeat the type and crossmatch D. Prepare to administer a dose of diphenhydramine IV
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A. Continue to monitor the client for manifestations of a transfusion reaction Routine monitoring of the transfusion for manifestations of a transfusion reaction is standard practice. O negative plasma is compatible with a B positive recipient who can receive either B or O plasma.
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A nurse is caring for a client who had a myocardial infarction (MI) 24 hr ago. At this time, it is essential for the nurse to look for which of the following? A. Sepsis B. Pericarditis C. Ventricular dysrhythmias D. Pulmonary emboli
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C. Ventricular dysrhythmias After a myocardial infarction, the electrical conduction system of the heart can be irritable and prone to arrhythmia. Ischemic tissue caused by the infarction can also interfere with normal conduction patterns of the heart's electrical system.
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A nurse is caring for a client with dyspnea who is diagnosed as having congestive heart failure (CHF) related to mitral stenosis. The nurse is aware the cause of the dyspnea is due to which of the following? A. Increased intra-aortic pressure B. Fluid accumulation in the lungs C. Decreased systemic venous return D. Constriction of pulmonary arteries
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B. Fluid accumulation in the lungs A defect in the mitral valve will cause a backup of blood in the pulmonary vein, which returns oxygenated blood to the left atrium. This backup of blood leads to engorgement of the capillaries of the lung field and to an accumulation of fluid in the lungs.
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A nurse is caring for a client on telemetry who has an irregular radial pulse. The progress notes say that the client has had atrial flutter. Which EKG pattern does the nurse recognize as corresponding to atrial flutter? A. P waves occurring at 0.16 sec before each QRS B. An atrial rate of 300, with 80 QRS per min C. Ventricular rate of 82 with an atrial rate of 80 D. An irregular ventricular rate of 125, with a wide QRS pattern
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B. An atrial rate of 300, with 80 QRS per min This indicates a lack of conduction between the atria and ventricles, which resulted in additional atrial beats that weren't conducted.
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A client reports to a nurse that she is using several herbal and dietary supplements including flaxseed oil. The nurse recognizes that the health benefit of this supplement is to provide increased dietary A. omega-3 fatty acids B. anti-oxidants C. vitamins A, D and K D. beta-carotene
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A. omega-3 fatty acids Flaxseed oil contains Omega-3 fatty acids which have been shown to help lower the risk of cardiovascular disease and stroke.
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A nurse is caring for a client with suspected hypovolemic shock. Which solution is appropriate for the nurse to administer in this circumstance? A. 0.45% sodium chloride B. Dextrose 5% in 0.9% sodium chloride C. Dextrose 10% in water D. 0.9% sodium chloride
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D. 0.9% sodium chloride Two IV solutions are used for acute volume expansion: 0.9% sodium chloride and lactated Ringer's solution. Sodium chloride is a physiologic isotonic solution that replaces lost volume in the blood stream.
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A nurse is preparing to infuse a blood transfusion using packed cells (250 mL) to a client in 4 hr. The blood set delivers 10 gtts per mL. What is the proper drip rate to use for the unit of packed cells? (Round the answer to the nearest whole number.)
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250 mL x 10 gtt per min divided by 4 hr x 60 min = 2,500 total drops divided by 240 total min = 10 gtts per min
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A nurse is caring for a client who wants to know when the therapeutic results of epoetin alfa (Epogen, Procrit) will take effect. The nurse bases her response on the knowledge that epoetin alfa will improve hemoglobin and hematocrit levels in which of the following time frames? A. 24 hours B. 3-4 days C. 2-4 weeks D. 2 months
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C. 2-4 weeks Epoetin alfa is a synthetic version of human erythropoietin. Epoetin alfa is used to treat anemia associated with kidney disease or medication therapy. It increases and maintains the red blood cell level so that blood transfusions are not needed. It takes about 2 to 4 weeks for epoetin alfa to cause an increased level of Hgb and HCT.
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A nurse is assessing a client in the clinic with a history of arteriosclerosis obliterans. When assessing the client's lower extremities and ankles, the nurse will expect to observe which manifestation of this condition? A. Pitting edema B. Areas of reddish, brown pigmentation C. Thin, shiny skin with minimal body hair D. Sunburned appearance with desquamation
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C. Thin, shiny skin with minimal body hair Arteriosclerosis obliterans is a disease of the blood vessels characterized by narrowing of the arteries in the legs and feet. This causes a decrease in blood flow to the distal extremities which can lead to tissue damage. Common symptoms are intermittent claudication (leg pain with exercise), cold or numb feet at rest, loss of hair on the lower legs, and weakened pulses.
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A nurse is caring for a client admitted with a suspected dissecting aortic aneurysm. The nurse should monitor the client for which of the following? A. Back pain B. Bradycardia C. Lower extremity weakness D. Hypertension
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A. Back pain Back pain is a cardinal sign that will cause the nurse to suspect a dissecting aortic aneurysm. Other key manifestations of a dissecting aortic aneurysm include hypotension and tachycardia.
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A nurse is caring for a client with congestive heart failure (CHF) whose electrocardiogram (EKG) shows a flattening of the T wave. Which of the following laboratory results should the nurse anticipate with this EKG change? A. Potassium 2.8 mEq/L B. Digitalis level of 2 ng/mL C. Hemoglobin of 9.8g D. Serum calcium 8.0 mg
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A. Potassium 2.8 mEq/L A flattened T wave or the development of U waves is indicative of a low-potassium level.
