NCLEX 3500: Cardiac – Flashcards
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Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's: 1. electrocardiogram (ECG). 2. urine output. 3. creatine kinase (CK) and troponin levels. 4. blood pressure and heart rate.
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question
Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's: 1. electrocardiogram (ECG). 2. urine output. 3. creatine kinase (CK) and troponin levels. 4. blood pressure and heart rate.
answer
established to recognize health care organizations that achieve excellence in nursing practice
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A client is admitted to an acute care facility with pneumonia. When auscultating heart sounds, the nurse notes a fixed split of the second heart sound (S2) — a pathological split that doesn't vary with respirations. A fixed S2 split is the hallmark of: 1. right bundle-branch block. 2. left bundle-branch block. 3. atrial septal defect. 4. aortic stenosis.
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established to recognize health care organizations that achieve excellence in nursing practice
question
A client is admitted to an acute care facility with pneumonia. When auscultating heart sounds, the nurse notes a fixed split of the second heart sound (S2) — a pathological split that doesn't vary with respirations. A fixed S2 split is the hallmark of: 1. right bundle-branch block. 2. left bundle-branch block. 3. atrial septal defect. 4. aortic stenosis.
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established to recognize health care organizations that achieve excellence in nursing practice
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A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V. infusion. Which statement by the client indicates that this drug is producing its therapeutic effect? 1. "I have a bad headache." 2. "My chest pain is decreasing." 3. "I feel a tingling sensation around my mouth." 4. "My blood pressure must be up because my vision is blurred."
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Correct Answer: 2 RATIONALES: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
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A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V. infusion. Which statement by the client indicates that this drug is producing its therapeutic effect? 1. "I have a bad headache." 2. "My chest pain is decreasing." 3. "I feel a tingling sensation around my mouth." 4. "My blood pressure must be up because my vision is blurred."
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Correct Answer: 2 RATIONALES: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
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A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V. infusion. Which statement by the client indicates that this drug is producing its therapeutic effect? 1. "I have a bad headache." 2. "My chest pain is decreasing." 3. "I feel a tingling sensation around my mouth." 4. "My blood pressure must be up because my vision is blurred."
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Correct Answer: 1 RATIONALES: Assigning the same nurse to the client when possible provides continuity of care and stability, thereby reducing his anxiety. The client needs uninterrupted periods of rest; however, providing as much rest as possible may leave the client feeling isolated. Feelings of isolation can increase the client's anxiety, and having visitors can help distract the client. A room close to nurses' station would provide this client with a sense of security because the nurses are close by in the event of an emergency.
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Before administering digoxin (Lanoxin), a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the: 1. lungs. 2. kidneys. 3. feces. 4. skin.
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Correct Answer: 2 RATIONALES: After digoxin is metabolized, the kidneys eliminate remaining digoxin as unchanged drug. Therefore, a client with renal dysfunction will require a decreased digoxin dosage. Although some drugs may be eliminated by other routes, digoxin isn't known to be eliminated by way of the lungs, feces, or skin.
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Before administering digoxin (Lanoxin), a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the: 1. lungs. 2. kidneys. 3. feces. 4. skin.
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Correct Answer: 1 RATIONALES: This ECG shows sinus arrhythmia with a rate of 70 beats/minute. In this benign arrhythmia, the rhythm is irregular; the impulse originates in the sinoatrial node and travels down the conduction system normally. The P-P interval is irregular; a P wave precedes every QRS complex; and the R-R interval is irregular, increasing with inspiration and decreasing with expiration. Sinus arrhythmia commonly is associated with vagal inhibition caused by respiration. It seldom causes symptoms and doesn't call for atropine or other treatment. Continuing to monitor for lengthening PR intervals isn't necessary because the PR interval doesn't increase with sinus arrhythmia. Because this arrhythmia isn't caused by an electrolyte imbalance, evaluating serum electrolyte studies isn't warranted.
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Before administering digoxin (Lanoxin), a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the: 1. lungs. 2. kidneys. 3. feces. 4. skin.
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Correct Answer: 1 RATIONALES: This ECG shows sinus arrhythmia with a rate of 70 beats/minute. In this benign arrhythmia, the rhythm is irregular; the impulse originates in the sinoatrial node and travels down the conduction system normally. The P-P interval is irregular; a P wave precedes every QRS complex; and the R-R interval is irregular, increasing with inspiration and decreasing with expiration. Sinus arrhythmia commonly is associated with vagal inhibition caused by respiration. It seldom causes symptoms and doesn't call for atropine or other treatment. Continuing to monitor for lengthening PR intervals isn't necessary because the PR interval doesn't increase with sinus arrhythmia. Because this arrhythmia isn't caused by an electrolyte imbalance, evaluating serum electrolyte studies isn't warranted.
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Before administering digoxin (Lanoxin), a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the: 1. lungs. 2. kidneys. 3. feces. 4. skin.
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Correct Answer: 1 RATIONALES: This ECG shows sinus arrhythmia with a rate of 70 beats/minute. In this benign arrhythmia, the rhythm is irregular; the impulse originates in the sinoatrial node and travels down the conduction system normally. The P-P interval is irregular; a P wave precedes every QRS complex; and the R-R interval is irregular, increasing with inspiration and decreasing with expiration. Sinus arrhythmia commonly is associated with vagal inhibition caused by respiration. It seldom causes symptoms and doesn't call for atropine or other treatment. Continuing to monitor for lengthening PR intervals isn't necessary because the PR interval doesn't increase with sinus arrhythmia. Because this arrhythmia isn't caused by an electrolyte imbalance, evaluating serum electrolyte studies isn't warranted.
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Before administering digoxin (Lanoxin), a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the: 1. lungs. 2. kidneys. 3. feces. 4. skin.
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Correct Answer: 1 RATIONALES: The nurse should withhold the three medications and notify the physician. Each of these medications has the potential to lower the client's blood pressure. Administering them together when the client is already hypotensive may severely lower the client's blood pressure. The client may continue to experience dizziness when sitting up so breakfast should be held until his blood pressure stabilizes.
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A client with a permanent pacemaker and a long history of cardiac disease is admitted to the coronary care unit for evaluation for heart failure. The nurse observes the following electrocardiogram (ECG) pattern. What does this pattern indicate? 1. Use of a DDD pacemaker with a rate of 78 beats/minute 2. Use of a VVI pacemaker with a rate of 72 beats/minute 3. Use of an AVI pacemaker with a rate of 76 beats/minute 4. Use of an AAI pacemaker with a rate of 80 beats/minute
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Correct Answer: 2 RATIONALES: In the pacemaker identification code, the first letter stands for the heart chamber being paced (atrium, ventricle, or both [D]); the second letter stands for the chamber being sensed (atrium, ventricle, both, or none [O]); and the third letter stands for the pacemaker's response to the sensed event (inhibited, triggered, both, or none). This ECG indicates use of a VVI pacemaker, which paces and senses the ventricle and is inhibited by a sensed event (a spontaneous QRS complex). A spike precedes every QRS complex stimulated by the pacemaker. Sensing that the client's intrinsic rate is below 72 beats/minute, the pacemaker triggers a ventricular impulse. The other options give incorrect rates; also, if the atrium were being paced, a spike would precede each P wave, indicating atrial contraction.
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During digoxin (Lanoxin) therapy, the nurse should closely monitor the client's: 1. serum potassium and magnesium levels. 2. urine glucose and ketones. 3. serum potassium and creatine kinase (CK) levels. 4. urine potassium and CK levels.
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Correct Answer: 2 RATIONALES: In the pacemaker identification code, the first letter stands for the heart chamber being paced (atrium, ventricle, or both [D]); the second letter stands for the chamber being sensed (atrium, ventricle, both, or none [O]); and the third letter stands for the pacemaker's response to the sensed event (inhibited, triggered, both, or none). This ECG indicates use of a VVI pacemaker, which paces and senses the ventricle and is inhibited by a sensed event (a spontaneous QRS complex). A spike precedes every QRS complex stimulated by the pacemaker. Sensing that the client's intrinsic rate is below 72 beats/minute, the pacemaker triggers a ventricular impulse. The other options give incorrect rates; also, if the atrium were being paced, a spike would precede each P wave, indicating atrial contraction.
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During digoxin (Lanoxin) therapy, the nurse should closely monitor the client's: 1. serum potassium and magnesium levels. 2. urine glucose and ketones. 3. serum potassium and creatine kinase (CK) levels. 4. urine potassium and CK levels.
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Correct Answer: 2 RATIONALES: In the pacemaker identification code, the first letter stands for the heart chamber being paced (atrium, ventricle, or both [D]); the second letter stands for the chamber being sensed (atrium, ventricle, both, or none [O]); and the third letter stands for the pacemaker's response to the sensed event (inhibited, triggered, both, or none). This ECG indicates use of a VVI pacemaker, which paces and senses the ventricle and is inhibited by a sensed event (a spontaneous QRS complex). A spike precedes every QRS complex stimulated by the pacemaker. Sensing that the client's intrinsic rate is below 72 beats/minute, the pacemaker triggers a ventricular impulse. The other options give incorrect rates; also, if the atrium were being paced, a spike would precede each P wave, indicating atrial contraction.
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A client with chest pain receives nitroglycerin on the way to the acute care facility. Based on an electrocardiogram obtained on admission, the physician suspects a myocardial infarction (MI) and prescribes I.V. morphine to relieve continuing pain. A primary goal of nursing care for this client is to recognize life-threatening complications of an MI. The major cause of death after an MI is: 1. cardiogenic shock. 2. cardiac arrhythmia. 3. heart failure. 4. pulmonary embolism.
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Correct Answer: 2 RATIONALES: Cardiac arrhythmias cause roughly 40% to 50% of deaths after MI. Heart failure, in contrast, accounts for 33% and cardiogenic shock for 9% of post-MI deaths. Pulmonary embolism, another potential complication of an MI, is less common.
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The home care nurse visits a client diagnosed with atrial fibrillation who is prescribed warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? 1. "I will watch my gums for bleeding when I brush my teeth." 2. "I will use an electric razor to shave." 3. "I will eat four servings of fresh, dark greens vegetables every day." 4. "I will report any unexplained or severe bruising to my doctor right away."
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Correct Answer: 3 RATIONALES: Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and any severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
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A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. `Practice meticulous foot care.` 2. `Consider cutting down on your smoking.` 3. `Reduce your level of exercise.` 4. `See the physician if complications occur.`
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Correct Answer: 3 RATIONALES: Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and any severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
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A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. `Practice meticulous foot care.` 2. `Consider cutting down on your smoking.` 3. `Reduce your level of exercise.` 4. `See the physician if complications occur.`
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Correct Answer: 3 RATIONALES: Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and any severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
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A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. `Practice meticulous foot care.` 2. `Consider cutting down on your smoking.` 3. `Reduce your level of exercise.` 4. `See the physician if complications occur.`
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Correct Answer: 3 RATIONALES: Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and any severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
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A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. `Practice meticulous foot care.` 2. `Consider cutting down on your smoking.` 3. `Reduce your level of exercise.` 4. `See the physician if complications occur.`
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Correct Answer: 3 RATIONALES: Troponin is a myocardial cell protein that is elevated in the serum when myocardial damage has occurred during a myocardial infarction (MI). It's the best serum indicator of MI and is more indicative of cardiac damage than creatine kinase. Hb values and liver panel components aren't as useful in the diagnosis of MI as a troponin level.
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The nurse on the telemetry unit is faced with various situations. Which situation takes priority? 1. A client's cardiac monitor suddenly reveals sinus tachycardia with isolated premature ventricular contractions. 2. A client's cardiac rhythm suddenly changes from normal sinus rhythm to uncontrolled atrial fibrillation. 3. A client is requesting help to go to the bathroom. 4. The cardiologist is asking the nurse to make rounds with him to his clients.
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Correct Answer: 2RATIONALES: The client whose cardiac rhythm suddenly changes from normal sinus rhythm to uncontrolled atrial fibrillation takes priority. This cardiac rhythm change may cause clots to shower from the atria placing the client at risk for a stroke. The client whose cardiac monitor reveals sinus tachycardia with isolated premature ventricular contractions isn't experiencing a life-threatening situation; therefore, he doesn't take priority. The nurse can ask her ancillary staff member to assist the client to the bathroom. Making rounds with the physician can wait until the nurse addresses the needs of the client in atrial fibrillation.
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After having several Stokes-Adams attacks over 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and spouse. Which safety precaution is appropriate for a client with a pacemaker? 1. Stay at least 2? away from microwave ovens. 2. Never engage in activities that require vigorous arm and shoulder movement. 3. Avoid going through airport metal detectors. 4. Avoid having magnetic resonance imaging (MRI).
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Correct Answer: 4 RATIONALES: A client with a pacemaker should avoid having an MRI because the magnet may disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens; nonetheless, the client should stay at least 5? away from microwaves, not 2?. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards of the pacemaker because its metal casing and programming magnet may trigger the metal detector.
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After having several Stokes-Adams attacks over 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and spouse. Which safety precaution is appropriate for a client with a pacemaker? 1. Stay at least 2? away from microwave ovens. 2. Never engage in activities that require vigorous arm and shoulder movement. 3. Avoid going through airport metal detectors. 4. Avoid having magnetic resonance imaging (MRI).
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Correct Answer: 4 RATIONALES: Although changes in all these findings are seen in hyperkalemia, ECG changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.
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A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? 1. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction 2. Anxiety related to an actual threat to health status, invasive procedures, and pain 3. Disabled family coping related to knowledge deficit and a temporary change in family dynamics 4. Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time
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Correct Answer: 1 RATIONALES: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis because myocardial function may be depressed from anesthetics or a long cardiopulmonary bypass time, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. The other options may be relevant but take lower priority at this time because maintaining cardiac output is essential to sustaining the client's life.
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A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? 1. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction 2. Anxiety related to an actual threat to health status, invasive procedures, and pain 3. Disabled family coping related to knowledge deficit and a temporary change in family dynamics 4. Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time
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Correct Answer: 1 RATIONALES: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis because myocardial function may be depressed from anesthetics or a long cardiopulmonary bypass time, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. The other options may be relevant but take lower priority at this time because maintaining cardiac output is essential to sustaining the client's life.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
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Correct Answer: 4 RATIONALES: Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this isn't how they prevent DVT. Elevating the extremity will decrease edema but won't prevent DVT.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
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Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
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Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
answer
Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
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Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
answer
Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
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The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
answer
Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
question
The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
answer
Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
question
The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1. encouraging ambulation to prevent pooling of blood. 2. providing warmth to the extremity. 3. elevating the extremity to prevent pooling of blood. 4. forcing blood into the deep venous system.
answer
Correct Answer: 1 RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy.
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A client develops heart failure. The physician prescribes inamrinone lactate (Inocor), 0.75 mg/kg I.V. over 3 minutes followed by 5 mcg/kg/minute with continuous I.V. infusion. Which laboratory test results should the nurse obtain before starting inamrinone therapy? 1. Platelet count and liver enzyme levels 2. Hemoglobin levels and hematocrit 3. Creatine kinase (CK) level 4. White blood cell (WBC) count
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Correct Answer: 1 RATIONALES: Before starting inamrinone therapy, the nurse should determine the client's baseline platelet count and liver enzyme levels because inamrinone may cause thrombocytopenia and liver enzyme alterations. The drug isn't known to cause anemia or affect the CK level or WBC count.
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A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: 1. place a heating pad around the affected calf. 2. elevate the affected leg as high as possible. 3. keep the affected leg level or slightly dependent. 4. shave the affected leg in anticipation of surgery.
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Correct Answer: 3 RATIONALES: While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg may cause accidental trauma from cuts or nicks.
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When a client is started on oral or I.V. diltiazem (Cardizem), the nurse should monitor for which potential complication? 1. Flushing 2. Heart failure 3. Renal failure 4. Hypertension
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Correct Answer: 2 RATIONALES: The chief adverse effects of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reactions that have been reported include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication. Heart failure is a lifethreatening reaction.
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When a client is started on oral or I.V. diltiazem (Cardizem), the nurse should monitor for which potential complication? 1. Flushing 2. Heart failure 3. Renal failure 4. Hypertension
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Correct Answer: 2 RATIONALES: The chief adverse effects of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reactions that have been reported include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication. Heart failure is a lifethreatening reaction.
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A client with chronic heart failure is examined in the outpatient department to investigate recent onset of peripheral edema and increased shortness of breath. Physical findings include bilateral crackles, a third heart sound (S3), distended neck veins, elevated blood pressure, and pitting edema of the ankles. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? 1. Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours 2. Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours 3. A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling 4. A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling
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Correct Answer: 1 RATIONALES: Pitting edema is documented as a +1 when a depression is barely detectable on release of thumb pressure and when foot and leg contours are normal. A detectable depression of less than 5 mm accompanied by normal leg and foot contours warrants a +2 rating. A deeper depression (5 to 10 mm) accompanied by foot and leg swelling is evaluated as +3. An even deeper depression (more than 1 cm) accompanied by severe foot and leg swelling rates a +4.
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A 32-year-old female with systemic lupus erythematosus (SLE) complains that her hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these sign and symptoms? 1. Peripheral vascular disease 2. Raynaud's disease 3. Arterial occlusive diseases 4. Buerger's disease
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Correct Answer: 2 RATIONALES: Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.
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A 32-year-old female with systemic lupus erythematosus (SLE) complains that her hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these sign and symptoms? 1. Peripheral vascular disease 2. Raynaud's disease 3. Arterial occlusive diseases 4. Buerger's disease
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Correct Answer: 2 RATIONALES: Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.
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A 32-year-old female with systemic lupus erythematosus (SLE) complains that her hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these sign and symptoms? 1. Peripheral vascular disease 2. Raynaud's disease 3. Arterial occlusive diseases 4. Buerger's disease
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Correct Answer: 3 RATIONALES: To best hear an Austin Flint murmur, the nurse should place the stethoscope at the apex of the heart. An Austin Flint murmur produces a soft, low-pitched, rumbling, middiastolic or presystolic bruit. Placing the stethoscope over the carotid artery, at the base of the heart, or at the left fifth intercostal space would make this murmur more difficult to hear.
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The staff nurse is caring for a client who is a potential heart donor. The client's family is concerned that the recipient will have access to personal donor information. Which response by the nurse demonstrates knowledge of the organ donation process? 1. `I will have the transplant coordinator speak with you to answer your questions.` 2. `There is never contact between the donor's family and the recipient.` 3. `The recipient is allowed to ask questions about the donor and have them answered.` 4. `It is important that the recipient know where to send Thank-You cards.`
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Correct Answer: 3 RATIONALES: To best hear an Austin Flint murmur, the nurse should place the stethoscope at the apex of the heart. An Austin Flint murmur produces a soft, low-pitched, rumbling, middiastolic or presystolic bruit. Placing the stethoscope over the carotid artery, at the base of the heart, or at the left fifth intercostal space would make this murmur more difficult to hear.
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The physician prescribes digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which electrolyte imbalance may predispose the client to digitalis toxicity? 1. Hypermagnesemia 2. Hypercalcemia 3. Hypernatremia 4. Hypokalemia
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Correct Answer: 4 RATIONALES: During digoxin therapy, conditions that may predispose a client to digitalis toxicity include hypokalemia, hypomagnesemia, hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia, hypercalcemia, and hypernatremia aren't associated with a risk for digitalis toxicity.
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The physician prescribes digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which electrolyte imbalance may predispose the client to digitalis toxicity? 1. Hypermagnesemia 2. Hypercalcemia 3. Hypernatremia 4. Hypokalemia
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Correct Answer: 4 RATIONALES: During digoxin therapy, conditions that may predispose a client to digitalis toxicity include hypokalemia, hypomagnesemia, hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia, hypercalcemia, and hypernatremia aren't associated with a risk for digitalis toxicity.
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The nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? 1. Straw-colored urine 2. Reduced hematocrit 3. Clay-colored stools 4. Elevated urobilinogen in the urine
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Correct Answer: 3 RATIONALES: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
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The nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication would be used to treat his bradycardia? 1. Atropine 2. Dobutamine (Dobutrex) 3. Amiodarone (Cordarone) 4. Lidocaine (Xylocaine)
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Correct Answer: 3 RATIONALES: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
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The nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication would be used to treat his bradycardia? 1. Atropine 2. Dobutamine (Dobutrex) 3. Amiodarone (Cordarone) 4. Lidocaine (Xylocaine)
answer
Correct Answer: 3 RATIONALES: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
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The nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication would be used to treat his bradycardia? 1. Atropine 2. Dobutamine (Dobutrex) 3. Amiodarone (Cordarone) 4. Lidocaine (Xylocaine)
answer
Correct Answer: 3 RATIONALES: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
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The nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication would be used to treat his bradycardia? 1. Atropine 2. Dobutamine (Dobutrex) 3. Amiodarone (Cordarone) 4. Lidocaine (Xylocaine)
answer
Correct Answer: 3 RATIONALES: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
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The nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should: 1. elevate the client's head to 90 degrees. 2. press the right upper abdomen. 3. press the left upper abdomen. 4. lie the client flat in bed.
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Correct Answer: 3 RATIONALES: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
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The nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should: 1. elevate the client's head to 90 degrees. 2. press the right upper abdomen. 3. press the left upper abdomen. 4. lie the client flat in bed.
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Correct Answer: 2 RATIONALES: Because class II antiarrhythmics such as esmolol inhibit sinus node stimulation, they may produce bradycardia. Hypotension with peripheral vascular insufficiency also may occur, especially with esmolol. Class II antiarrhythmics don't alter body temperature, ocular pressure, or cerebral perfusion pressure.
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The nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should: 1. elevate the client's head to 90 degrees. 2. press the right upper abdomen. 3. press the left upper abdomen. 4. lie the client flat in bed.
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Correct Answer: 1 RATIONALES: With adequate fluid replacement, fluid volume in the intravascular space expands, raising the client's blood pressure. The hemoglobin level reflects red blood cell concentration, not overall fluid status. Temperature and heart rate aren't directly related to fluid status.
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The nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, the nurse should consider which finding significant? 1. Croup 2. Rheumatic fever 3. Severe staphylococcal infection 4. Medullary sponge kidney
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Correct Answer: 2 RATIONALES: Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, eventually may lead to hypertension but doesn't damage heart structures.
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When administering low doses of dopamine (Intropin), the nurse knows that dopamine activates which receptors? 1. Alpha 2. Beta1 3. Dopaminergic 4. Beta2
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Correct Answer: 3 RATIONALES: Dopamine activates dopaminergic receptor sites only at low doses. At normal or high doses, dopamine activates alpha and beta1 receptor sites. Dopamine doesn't activate beta2 receptor sites.
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When administering low doses of dopamine (Intropin), the nurse knows that dopamine activates which receptors? 1. Alpha 2. Beta1 3. Dopaminergic 4. Beta2
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Correct Answer: 3 RATIONALES: Dopamine activates dopaminergic receptor sites only at low doses. At normal or high doses, dopamine activates alpha and beta1 receptor sites. Dopamine doesn't activate beta2 receptor sites.
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The nurse is teaching a client about maintaining a healthy heart. The nurse should include which point in her teaching? 1. Smoke in moderation. 2. Use alcohol in moderation. 3. Consume a diet high in saturated fats and low in cholesterol. 4. Exercise one or two times per week.
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Correct Answer: 2 RATIONALES: Alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.
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A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride (Xylocaine), an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within: 1. 1 to 2 minutes after I.V. bolus administration. 2. 1 to 2 minutes after continuous I.V. infusion. 3. 10 to 15 minutes after I.V. bolus administration. 4. 10 to 15 minutes after continuous I.V. infusion.
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Correct Answer: 1 RATIONALES: Lidocaine exerts its antiarrhythmic effect in 1 to 2 minutes after I.V. bolus administration. A continuous I.V. infusion will maintain lidocaine's antiarrhythmic effect for as long as the drip is used. Lidocaine provides antiarrhythmic effects for only 15 minutes after the I.V. infusion is stopped.
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A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride (Xylocaine), an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within: 1. 1 to 2 minutes after I.V. bolus administration. 2. 1 to 2 minutes after continuous I.V. infusion. 3. 10 to 15 minutes after I.V. bolus administration. 4. 10 to 15 minutes after continuous I.V. infusion.
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Correct Answer: 1 RATIONALES: Lidocaine exerts its antiarrhythmic effect in 1 to 2 minutes after I.V. bolus administration. A continuous I.V. infusion will maintain lidocaine's antiarrhythmic effect for as long as the drip is used. Lidocaine provides antiarrhythmic effects for only 15 minutes after the I.V. infusion is stopped.
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A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pinktinged, foamy sputum. The nurse should recognize these as signs and symptoms of: 1. right-sided heart failure. 2. acute pulmonary edema. 3. pneumonia. 4. cardiogenic shock.
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Correct Answer: 2 RATIONALES: Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock would show signs of hypotension and tachycardia.
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Within hours after suffering a massive myocardial infarction, a client experiences cardiogenic shock. All vital functions are being monitored closely; an intra-arterial catheter has been inserted to detect changes in arterial blood pressure. Which statement comparing intra-arterial and cuff blood pressure readings is accurate? 1. Intra-arterial readings should be at least 10 mm Hg higher than cuff readings. 2. Intra-arterial readings should be at least 10 mm Hg lower than cuff readings. 3. Cuff readings are easier to obtain than intra-arterial readings. 4. Cuff readings detect excessive peripheral vasoconstriction more accurately than intra-arterial readings.
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Correct Answer: 1 RATIONALES: Intra-arterial blood pressure readings should be at least 10 mm Hg higher than cuff readings. Placement of an indwelling catheter for intra-arterial monitoring allows continuous recording of arterial pressure, eliminating the need to locate the client's brachial pulse and place a stethoscope on the arm for each reading. This makes intra-arterial readings easier, not harder, to obtain than cuff readings. Intra-arterial pressure monitoring can detect blood pressure in clients with excessive peripheral vasoconstriction, low cardiac output, and fluctuating hemodynamic status — even when cuff measurements can't.
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Within hours after suffering a massive myocardial infarction, a client experiences cardiogenic shock. All vital functions are being monitored closely; an intra-arterial catheter has been inserted to detect changes in arterial blood pressure. Which statement comparing intra-arterial and cuff blood pressure readings is accurate? 1. Intra-arterial readings should be at least 10 mm Hg higher than cuff readings. 2. Intra-arterial readings should be at least 10 mm Hg lower than cuff readings. 3. Cuff readings are easier to obtain than intra-arterial readings. 4. Cuff readings detect excessive peripheral vasoconstriction more accurately than intra-arterial readings.
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Correct Answer: 1 RATIONALES: Intra-arterial blood pressure readings should be at least 10 mm Hg higher than cuff readings. Placement of an indwelling catheter for intra-arterial monitoring allows continuous recording of arterial pressure, eliminating the need to locate the client's brachial pulse and place a stethoscope on the arm for each reading. This makes intra-arterial readings easier, not harder, to obtain than cuff readings. Intra-arterial pressure monitoring can detect blood pressure in clients with excessive peripheral vasoconstriction, low cardiac output, and fluctuating hemodynamic status — even when cuff measurements can't.
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A client requested a do-not-resuscitate (DNR) order upon admission to the hospital. He now tells the nurse that he wants the medical team to do everything possible to help him get better and is concerned about the DNR order. Which response by the nurse is best? 1. "It is too late to change your mind now." 2. "We will have to ask your physician if this is possible." 3. "Why do you want to do this?" 4. "It's not a problem to rescind your DNR order; I'll let your physician know your wishes right away."
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Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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A client requested a do-not-resuscitate (DNR) order upon admission to the hospital. He now tells the nurse that he wants the medical team to do everything possible to help him get better and is concerned about the DNR order. Which response by the nurse is best? 1. "It is too late to change your mind now." 2. "We will have to ask your physician if this is possible." 3. "Why do you want to do this?" 4. "It's not a problem to rescind your DNR order; I'll let your physician know your wishes right away."
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Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, the nurse should include which expected outcome? 1. `Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours.` 2. `Client will verbalize the intention to avoid exercise.` 3. `Client will verbalize the intention to stop smoking.` 4. `Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol.`
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Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, the nurse should include which expected outcome? 1. `Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours.` 2. `Client will verbalize the intention to avoid exercise.` 3. `Client will verbalize the intention to stop smoking.` 4. `Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol.`
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Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should: 1. administer oxygen. 2. have the client take deep breaths and cough. 3. place the client in high Fowler's position. 4. perform chest physiotherapy.
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Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should: 1. administer oxygen. 2. have the client take deep breaths and cough. 3. place the client in high Fowler's position. 4. perform chest physiotherapy.
answer
Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should: 1. administer oxygen. 2. have the client take deep breaths and cough. 3. place the client in high Fowler's position. 4. perform chest physiotherapy.
answer
Correct Answer: 4 RATIONALES: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client's motives can make the client feel defensive and shut down communication with the nurse.
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A client with substernal chest pain that radiates to the jaw is admitted to the coronary care unit. The client subsequently develops hypotension and suffers cardiac arrest. Which calcium preparation is injected into the ventricle during cardiac arrest? 1. calcium carbonate (BioCal) 2. calcium chloride 3. calcium glubionate (Neo-Calglucon) 4. calcium lactate
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Correct Answer: 2 RATIONALES: Calcium chloride is the only calcium preparation that should be injected into the ventricle during cardiac arrest, if appropriate.
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The home care nurse is visiting a left-handed client who has an automated implantable cardioverter-defibrillator implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? 1. `Be sure to enjoy your time with your grandson.` 2. `You cannot shoot a rifle left-handed because the rifle's recoil will traumatize the AICD site.` 3. `Being that close to a rifle might make your AICD fire.` 4. `You will need to take an extra dose of your antiarrhythmic before you shoot.`
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Correct Answer: 2 RATIONALES: Calcium chloride is the only calcium preparation that should be injected into the ventricle during cardiac arrest, if appropriate.
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The home care nurse is visiting a left-handed client who has an automated implantable cardioverter-defibrillator implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? 1. `Be sure to enjoy your time with your grandson.` 2. `You cannot shoot a rifle left-handed because the rifle's recoil will traumatize the AICD site.` 3. `Being that close to a rifle might make your AICD fire.` 4. `You will need to take an extra dose of your antiarrhythmic before you shoot.`
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Correct Answer: 2 RATIONALES: Calcium chloride is the only calcium preparation that should be injected into the ventricle during cardiac arrest, if appropriate.
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The home care nurse is visiting a left-handed client who has an automated implantable cardioverter-defibrillator implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? 1. `Be sure to enjoy your time with your grandson.` 2. `You cannot shoot a rifle left-handed because the rifle's recoil will traumatize the AICD site.` 3. `Being that close to a rifle might make your AICD fire.` 4. `You will need to take an extra dose of your antiarrhythmic before you shoot.`
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Correct Answer: 2 RATIONALES: Calcium chloride is the only calcium preparation that should be injected into the ventricle during cardiac arrest, if appropriate.
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The home care nurse is visiting a left-handed client who has an automated implantable cardioverter-defibrillator implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? 1. `Be sure to enjoy your time with your grandson.` 2. `You cannot shoot a rifle left-handed because the rifle's recoil will traumatize the AICD site.` 3. `Being that close to a rifle might make your AICD fire.` 4. `You will need to take an extra dose of your antiarrhythmic before you shoot.`
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Correct Answer: 1 RATIONALES: Diabetes mellitus, smoking, and hypertension are other major risk factors for CAD. Elevated HDL levels aren't a risk factor for CAD; in fact, increased HDL levels seem to protect against CAD. Ischemic heart disease is another term for CAD, not a risk factor. Alcoholism hasn't been identified as a major risk factor for CAD.
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A client hospitalized for treatment of hypertension is being prepared for discharge. The nurse should be sure to cover which teaching topic? 1. Maintaining a low-potassium diet 2. Skipping a medication dose if dizziness occurs 3. Maintaining a low-sodium diet 4. Receiving I.V. antihypertensive medications
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Correct Answer: 3 RATIONALES: The nurse must teach the hypertensive client how to modify the diet to restrict sodium and saturated fats. In addition to teaching about adverse effects of prescribed antihypertensives, the nurse must discuss the actions and dosages of these drugs. Option 1 is incorrect because a client receiving antihypertensives also may take a diuretic as part of the drug regimen and thus may require dietary potassium supplements and high-potassium foods to avoid electrolyte disturbances. Instead of skipping medication if dizziness occurs (option 2), the client should notify the physician of this symptom. The client receiving antihypertensives at home takes them by mouth, not I.V., making option 4 incorrect.
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A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur? 1. Pansystolic, blowing, high-pitched 2. Systolic, harsh, crescendo-decrescendo 3. Diastolic, blowing, decrescendo 4. Diastolic, rumbling, low-pitched
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Correct Answer: 4 RATIONALES: Mitral stenosis causes a diastolic, rumbling, low-pitched murmur heard at the apex. A pansystolic, blowing, high-pitched murmur characterizes mitral insufficiency. A systolic, harsh, crescendo-decrescendo murmur occurs with aortic insufficiency. A diastolic, blowing, decrescendo murmur accompanies aortic insufficiency.
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The nurse is teaching a client who will be discharged soon with a prescription for warfarin (Coumadin). The nurse should include which statement in discharge teaching? 1. "Increase your intake of yogurt and broccoli." 2. "This drug will dissolve any clots you may still have." 3. "If you miss a dose, double the next dose." 4. "Avoid aspirin while taking warfarin."
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Correct Answer: 4 RATIONALES: Because aspirin decreases platelet agglutination and interferes with clotting, concomitant use of aspirin with warfarin, an anticoagulant, may lead to excessive anticoagulant effects — and bleeding. Warfarin therapy doesn't necessitate dietary changes. Although warfarin interrupts the normal clotting cycle, it doesn't dissolve clots that have already formed. The client should take warfarin exactly as prescribed to maintain the desired level of anticoagulation. Doubling a dose could lead to bleeding.
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The physician is treating a client in the cardiac care unit for atrial arrhythmia and prescribes propranolol (Inderal), 10 mg P.O. three times a day. Propranolol inhibits the action of sympathomimetics at beta1-receptor sites. Where these sites are mainly located? 1. Uterus 2. Blood vessels 3. Bronchi 4. Heart
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Correct Answer: 4 RATIONALES: Beta1-receptor sites are mainly located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
question
In presenting a workshop on parameters of cardiac function, which conditions should the nurse list as those most likely to lead to a decrease in preload? 1. Hemorrhage, sepsis, and anaphylaxis 2. Myocardial infarction, fluid overload, and diuresis 3. Fluid overload, sepsis, and vasodilation 4. Third spacing, heart failure, and diuresis
answer
Correct Answer: 1 RATIONALES: Preload is the volume in the left ventricle at the end of diastole. It's also referred to as end-diastolic volume. Preload is reduced by any condition that reduces circulating volume, such as hemorrhage, sepsis, and anaphylaxis. Hemorrhage reduces circulating volume by loss of volume from the intravascular space. Sepsis and anaphylaxis reduce circulating volume by increased capillary permeability. Diuresis, vasodilation, and third spacing also reduce preload. Preload would increase with fluid overload and heart failure.
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In presenting a workshop on parameters of cardiac function, which conditions should the nurse list as those most likely to lead to a decrease in preload? 1. Hemorrhage, sepsis, and anaphylaxis 2. Myocardial infarction, fluid overload, and diuresis 3. Fluid overload, sepsis, and vasodilation 4. Third spacing, heart failure, and diuresis
answer
Correct Answer: 3 RATIONALES: Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; however, anginal pain is increasingly severe.
question
In presenting a workshop on parameters of cardiac function, which conditions should the nurse list as those most likely to lead to a decrease in preload? 1. Hemorrhage, sepsis, and anaphylaxis 2. Myocardial infarction, fluid overload, and diuresis 3. Fluid overload, sepsis, and vasodilation 4. Third spacing, heart failure, and diuresis
answer
Correct Answer: 1 RATIONALES: The nurse should withhold the three medications and notify the physician. Each of these medications has the potential to lower the client's blood pressure. Administering them together when the client is already hypotensive may severely lower the client's blood pressure. The client may continue to experience dizziness when sitting up so breakfast should be held until his blood pressure stabilizes.
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The physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test is used to determine a client's response to oral anticoagulant drugs? 1. Bleeding time 2. Platelet count 3. Prothrombin time (PT) 4. Partial thromboplastin time (PTT)
answer
Correct Answer: 3 RATIONALES: PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample after calcium ions and tissue thromboplastin are added and compares this time with the fibrin clotting time in a control sample. Anticoagulant dosages should be adjusted, as needed, to maintain PT at 1.5 to 2.5 times the control value. PTT determines the effectiveness of heparin therapy and helps evaluate bleeding tendencies. Roughly 99% of bleeding disorders are diagnosed from PT and PTT values. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reveals the number of circulating platelets in venous or arterial blood.
question
The physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test is used to determine a client's response to oral anticoagulant drugs? 1. Bleeding time 2. Platelet count 3. Prothrombin time (PT) 4. Partial thromboplastin time (PTT)
answer
Correct Answer: 4 RATIONALES: Infective endocarditis occurs when an infectious agent enters the bloodstream, such as from I.V. drug abuse or during an invasive procedure or dental work. Typical assessment findings in clients with this disease include Osler's nodes (red, painful nodules on the fingers and toes), splinter hemorrhages, fever, diaphoresis, joint pain, weakness, abdominal pain, a new or altered heart murmur, and Janeway's lesions (small, hemorrhagic areas on the fingers, toes, ears, and nose). The other options are common findings in clients with pericarditis, not infective endocarditis.
question
A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and family to expect which common symptom that typically resolves spontaneously? 1. Depression 2. Ankle edema 3. Memory lapses 4. Dizziness
answer
Correct Answer: 1 RATIONALES: For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves on its own and doesn't require medical intervention; however, family members should be aware that symptoms don't always resolve on their own. They should also be instructed about worsening symptoms of depression and when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure; because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition after CABG surgery that warrants immediate physician notification.
question
A client with severe angina and electrocardiogram changes is seen by a nurse practitioner in the emergency department. In terms of serum testing, it's most important for the nurse to order cardiac: 1. creatine kinase. 2. lactate dehydrogenase. 3. myoglobin. 4. troponin.
answer
Correct Answer: 1 RATIONALES: For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves on its own and doesn't require medical intervention; however, family members should be aware that symptoms don't always resolve on their own. They should also be instructed about worsening symptoms of depression and when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure; because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition after CABG surgery that warrants immediate physician notification.
question
The home care nurse visits a client diagnosed with atrial fibrillation who is prescribed warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? 1. "I will watch my gums for bleeding when I brush my teeth." 2. "I will use an electric razor to shave." 3. "I will eat four servings of fresh, dark greens vegetables every day." 4. "I will report any unexplained or severe bruising to my doctor right away."
answer
Correct Answer: 3 RATIONALES: Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and any severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
question
A client with deep vein thrombosis has an I.V. infusion of heparin sodium infusing at 1,500 U/hour. The concentration in the bag is 25,000 U/500 ml. How many milliliters of solution should the nurse document as intake from this infusion for an 8-hour shift?
answer
Correct Answer: 240 RATIONALES: First, calculate how many units are in each milliliter of the medication: 25,000 U/500 ml = 50 U/ml Next, calculate how many milliliters the client receives each hour: 1 ml/50 U ? 1,500 U/hour = 30 ml/hour Lastly, multiply by 8 hours: 30 ml/hour ? 8 hours = 240 ml
question
An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. On a 12-lead ECG, which leads record electrical events in the septal region of the left ventricle? 1. Leads I, aVL, V5, and V6 2. Leads II, III, and aVF 3. Leads V1 and V2 4. Leads V3 and V4
answer
Correct Answer: 4 RATIONALES: Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle.
question
A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, the nurse should include which instruction? 1. "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." 2. "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." 3. "Flex your calf muscles, avoid alcohol, and change positions slowly." 4. "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily."
answer
Correct Answer: 3 RATIONALES: Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.
question
A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, the nurse should include which instruction? 1. "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." 2. "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." 3. "Flex your calf muscles, avoid alcohol, and change positions slowly." 4. "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily."
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. `Practice meticulous foot care.` 2. `Consider cutting down on your smoking.` 3. `Reduce your level of exercise.` 4. `See the physician if complications occur.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. `Practice meticulous foot care.` 2. `Consider cutting down on your smoking.` 3. `Reduce your level of exercise.` 4. `See the physician if complications occur.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 4 RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses).
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 1 RATIONALES: Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 3 months, not every 6 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina and may repeat the dose every 10 to 15 minutes for up to three doses; if this doesn't bring relief, the client should seek immediate medical attention
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 1 RATIONALES: Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 3 months, not every 6 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina and may repeat the dose every 10 to 15 minutes for up to three doses; if this doesn't bring relief, the client should seek immediate medical attention
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 1 RATIONALES: Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 3 months, not every 6 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina and may repeat the dose every 10 to 15 minutes for up to three doses; if this doesn't bring relief, the client should seek immediate medical attention
question
The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again.` 2. `I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor.`
answer
Correct Answer: 3 RATIONALES: Headache, hypotension, dizziness, and flushing are classic adverse effects of nitroglycerin, a vasodilator. Vasodilators, beta-adrenergic blockers, and calcium channel blockers are three major classes of drugs used to treat angina pectoris. Nausea, vomiting, depression, fatigue, and impotence are adverse effects of propranolol, a betaadrenergic blocker. Sedation, nausea, vomiting, constipation, and respiratory depression are common adverse effects of morphine, an opioid analgesic used to relieve pain associated with acute myocardial infarction. Flushing, dizziness, headache, and pedal edema are common adverse effects of nifedipine, a calcium channel blocker.
question
A client with a suspected diagnosis of acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain? 1. 30 minutes to 1 hour 2. 2 to 3 hours 3. 4 to 6 hours 4. 12 to 18 hours
answer
Correct Answer: 3 RATIONALES: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
question
Which sign or symptom suggest that a client's abdominal aortic aneurysm is extending? 1. Increased abdominal and back pain 2. Decreased pulse rate and blood pressure 3. Retrosternal back pain radiating to the left arm 4. Elevated blood pressure and rapid respirations
answer
Correct Answer: 3 RATIONALES: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
question
Which sign or symptom suggest that a client's abdominal aortic aneurysm is extending? 1. Increased abdominal and back pain 2. Decreased pulse rate and blood pressure 3. Retrosternal back pain radiating to the left arm 4. Elevated blood pressure and rapid respirations
answer
Correct Answer: 3 RATIONALES: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
question
Which sign or symptom suggest that a client's abdominal aortic aneurysm is extending? 1. Increased abdominal and back pain 2. Decreased pulse rate and blood pressure 3. Retrosternal back pain radiating to the left arm 4. Elevated blood pressure and rapid respirations
answer
Correct Answer: 3 RATIONALES: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
question
Which sign or symptom suggest that a client's abdominal aortic aneurysm is extending? 1. Increased abdominal and back pain 2. Decreased pulse rate and blood pressure 3. Retrosternal back pain radiating to the left arm 4. Elevated blood pressure and rapid respirations
answer
Correct Answer: 1 RATIONALES: Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include warm skin with normal return of skin color after blanching and normal sensation.
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The nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first: 1. establish unresponsiveness. 2. call for help. 3. open the airway. 4. assess the client for a carotid pulse.
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Correct Answer: 1 RATIONALES: The correct sequence begins with establishing unresponsiveness. The nurse should then call for help, assess the client for breathing while opening the airway, deliver two breaths, and check for a carotid pulse.
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Which measurement can best be used to monitor the respiratory status of a client with pulmonary edema? 1. Arterial blood gas (ABG) analysis 2. Pulse oximetry 3. Skin color assessment 4. Lung sounds
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Correct Answer: 1 RATIONALES: ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although any of the options can be used to detect pulmonary changes, assessment of skin color and assessment of lung fields often are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema.
question
Following a percutaneous transluminal coronary angioplasty (PTCA), a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: 1. 25 seconds or less. 2. 50 seconds or less. 3. 75 seconds or less. 4. 100 seconds or less.
answer
Correct Answer: 1 RATIONALES: ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although any of the options can be used to detect pulmonary changes, assessment of skin color and assessment of lung fields often are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema.
question
Following a percutaneous transluminal coronary angioplasty (PTCA), a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: 1. 25 seconds or less. 2. 50 seconds or less. 3. 75 seconds or less. 4. 100 seconds or less.
answer
Correct Answer: 1 RATIONALES: ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although any of the options can be used to detect pulmonary changes, assessment of skin color and assessment of lung fields often are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema.
question
Considering a client's atrial fibrillation, the nurse must administer digoxin (Lanoxin) with caution because it: 1. affects the sympathetic division of the autonomic nervous system, decreasing vagal tone. 2. stimulates the parasympathetic division of the autonomic nervous system, increasing vagal tone. 3. can induce hypertensive crisis by constricting arteries. 4. can trigger proarrhythmia by increasing stroke volume.
answer
Correct Answer: 1 RATIONALES: ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although any of the options can be used to detect pulmonary changes, assessment of skin color and assessment of lung fields often are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema.
question
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: 1. hypertension. 2. high urine output. 3. dry mucous membranes. 4. pulmonary crackles.
answer
Correct Answer: 4 RATIONALES: High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures
question
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: 1. hypertension. 2. high urine output. 3. dry mucous membranes. 4. pulmonary crackles.
answer
Correct Answer: 4 RATIONALES: Controllable risk factors include hypertension, hypercholesterolemia, obesity, lack of exercise, smoking, diabetes, stress, alcohol abuse, and use of contraceptives. Uncontrollable risk factors for coronary artery disease include gender, age, and heredity.
question
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: 1. antibiotic. 2. anticoagulant. 3. antihypertensive. 4. anticonvulsant.
answer
Correct Answer: 2 RATIONALES: During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. An antibiotic isn't given routinely during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics afterward to reduce the risk of infection. An antihypertensive agent may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.
question
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: 1. antibiotic. 2. anticoagulant. 3. antihypertensive. 4. anticonvulsant.
answer
Correct Answer: 2 RATIONALES: During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. An antibiotic isn't given routinely during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics afterward to reduce the risk of infection. An antihypertensive agent may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.
question
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: 1. antibiotic. 2. anticoagulant. 3. antihypertensive. 4. anticonvulsant.
answer
Correct Answer: 4 RATIONALES: The nurse should withhold the medication and notify the physician that the client doesn't understand the procedure. The physician then has the obligation to explain the procedure better to the client and determine whether or not the client understands. If the client doesn't understand, he can't give a true informed consent. If the medication is administered before the physician explains the procedure, the sedation may interfere with the client's ability to clearly understand the procedure. The nurse can't just medicate the client and document her finding; she must notify the physician.
question
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: 1. antibiotic. 2. anticoagulant. 3. antihypertensive. 4. anticonvulsant.
answer
Correct Answer: 4 RATIONALES: The nurse should withhold the medication and notify the physician that the client doesn't understand the procedure. The physician then has the obligation to explain the procedure better to the client and determine whether or not the client understands. If the client doesn't understand, he can't give a true informed consent. If the medication is administered before the physician explains the procedure, the sedation may interfere with the client's ability to clearly understand the procedure. The nurse can't just medicate the client and document her finding; she must notify the physician.
question
A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V. infusion. Which statement by the client indicates that this drug is producing its therapeutic effect? 1. "I have a bad headache." 2. "My chest pain is decreasing." 3. "I feel a tingling sensation around my mouth." 4. "My blood pressure must be up because my vision is blurred."
answer
Correct Answer: 2 RATIONALES: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
question
A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V. infusion. Which statement by the client indicates that this drug is producing its therapeutic effect? 1. "I have a bad headache." 2. "My chest pain is decreasing." 3. "I feel a tingling sensation around my mouth." 4. "My blood pressure must be up because my vision is blurred."
answer
Correct Answer: 2 RATIONALES: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
question
The physician prescribes several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question? 1. heparin sodium (Heparin sodium injection) 2. dexamethasone (Decadron) 3. methyldopa (Aldomet) 4. phenytoin (Dilantin)
answer
Correct Answer: 1 RATIONALES: Administration of heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain. In a client with hemorrhagic stroke, dexamethasone may be used to decrease cerebral edema and pressure; methyldopa, to reduce blood pressure; and phenytoin, to prevent seizures.
question
A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene? 1. Administer I.V. fluids as ordered. 2. Administer a vasodilator as prescribed. 3. Insert an indwelling urinary catheter as ordered. 4. Instruct the client to sit up for several minutes before standing.
answer
Correct Answer: 4 RATIONALES: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension.
question
How long after oral administration can the nurse expect to see digoxin's (Lanoxin) peak effect? 1. 2 to 5 minutes 2. 10 to 20 minutes 3. 30 minutes to 2 hours 4. 2 to 6 hours
answer
Correct Answer: 4 RATIONALES: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension.
question
The unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught? 1. The percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity 2. The quality of teaching by the nurses who educate the acute MI clients on the telemetry unit 3. The amount of education the acute MI clients received on the telemetry unit 4. The nurses' assessment of the quality of client education about resuming sexual activity after an acute MI
answer
Correct Answer: 4 RATIONALES: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension.
question
A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? 1. Heart rate 2. Respiratory rate 3. Blood pressure 4. Temperature
answer
Correct Answer: 4 RATIONALES: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension.
question
A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? 1. Heart rate 2. Respiratory rate 3. Blood pressure 4. Temperature
answer
Correct Answer: 4 RATIONALES: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension.
question
A client is prescribed hydralazine for blood pressure management. The nurse is teaching the client about hydralazine therapy. When should the client take his hydralazine? 1. Upon arising in the morning 2. Just before bedtime 3. On an empty stomach 4. With food
answer
Correct Answer: 4 RATIONALES: Oral hydralazine should be taken with food to promote absorption.
question
What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock? 1. Cardiac pacemaker 2. Hypothermia-hyperthermia machine 3. Defibrillator 4. Intra-aortic balloon pump
answer
Correct Answer: 4 RATIONALES: Counterpulsation with an intra-aortic balloon pump may be indicated for temporary circulatory assistance in clients with cardiogenic shock. Cardiac pacemakers are used to maintain the heartbeat at a predetermined rate. Hypothermia-hyperthermia machines are used to cool or warm clients with abnormalities in temperature regulation. The defibrillator is commonly used for termination of life-threatening ventricular rhythms.
question
The monitor technician on the telemetry unit asks the charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin (Coumadin). Which response by the charge nurse is best? 1. "It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." 2. "Warfarin controls heart rate in the client with atrial fibrillation." 3. "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." 4. "Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
answer
Correct Answer: 4 RATIONALES: Blood pools in the atria of clients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the client at risk for stroke. Warfarin is prescribed in most clients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. Digoxin is typically prescribed to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation.
question
The monitor technician on the telemetry unit asks the charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin (Coumadin). Which response by the charge nurse is best? 1. "It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." 2. "Warfarin controls heart rate in the client with atrial fibrillation." 3. "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." 4. "Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
answer
Correct Answer: 4 RATIONALES: Blood pools in the atria of clients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the client at risk for stroke. Warfarin is prescribed in most clients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. Digoxin is typically prescribed to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation.
question
A client with end-stage heart failure is preparing for discharge. The client and his caregiver meet with the home care nurse and voice their concern that setting up a hospital bed in the bedroom will leave him feeling isolated. Which suggestion by the home care nurse best addresses this concern? 1. Place a chair in the bedroom so guests can visit with the client. 2. Set up the hospital bed in the family room so the client can be part of household activities. 3. Set up the hospital bed in the bedroom so the client can rest in a quiet environment. 4. Set up the hospital bed in the bedroom so the client can be assessed in a quiet environment.
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Correct Answer: 2 RATIONALES: The client should be kept actively involved in the household to prevent feelings of isolation. This can be accomplished by setting up the hospital bed in the family room. Placing a chair in the bedroom allows the client periods of isolation when visitors aren't present. It's important for the client to have periods of rest; however, that can be accomplished without keeping the client isolated in a bedroom. The needs of the client should be considered before the needs of the nurse who assesses the client during an occasional visit.
question
A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral stenosis? 1. Left-sided heart failure 2. Myocardial ischemia 3. Pulmonary hypertension 4. Left ventricular hypertrophy
answer
Correct Answer: 3 RATIONALES: Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation. This may lead to low cardiac output, pulmonary hypertension, edema, and right-sided (not left-sided) heart failure. Other potential complications of mitral stenosis include mural thrombi, pulmonary hemorrhage, and embolism to vital organs. Myocardial ischemia may occur in a client with coronary artery disease. Left ventricular hypertrophy is a potential complication of aortic stenosis.
question
A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents: 1. atrial repolarization. 2. ventricular repolarization. 3. atrial depolarization. 4. ventricular depolarization.
answer
Correct Answer: 3 RATIONALES: Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation. This may lead to low cardiac output, pulmonary hypertension, edema, and right-sided (not left-sided) heart failure. Other potential complications of mitral stenosis include mural thrombi, pulmonary hemorrhage, and embolism to vital organs. Myocardial ischemia may occur in a client with coronary artery disease. Left ventricular hypertrophy is a potential complication of aortic stenosis.
question
A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? 1. Consider this to be a normal finding for his age and race. 2. Recommend he have his blood pressure rechecked in 1 year. 3. Recommend he have his blood pressure rechecked within 2 weeks. 4. Recommend he see his physician immediately for further evaluation.
answer
Correct Answer: 3 RATIONALES: Although hypertension is more prevalent in the black population, a blood pressure of 150/90 mm Hg isn't considered normal. He should have his blood pressure rechecked within 2 weeks. One year is too long to wait. He need not see his physician yet.
question
A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? 1. Consider this to be a normal finding for his age and race. 2. Recommend he have his blood pressure rechecked in 1 year. 3. Recommend he have his blood pressure rechecked within 2 weeks. 4. Recommend he see his physician immediately for further evaluation.
answer
Correct Answer: 3 RATIONALES: Although hypertension is more prevalent in the black population, a blood pressure of 150/90 mm Hg isn't considered normal. He should have his blood pressure rechecked within 2 weeks. One year is too long to wait. He need not see his physician yet.
question
The nurse just received shift report for a group of clients on the telemetry unit. Which client should the nurse assess first. 1. The client with a history of atrial fibrillation 2. The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block 3. The client with a history of heart failure who has bibasilar crackles and pitting edema in both feet 4. The client with a demand pacemaker whose monitor shows normal sinus rhythm at a rate of 90 beats/minute
answer
Correct Answer: 2 RATIONALES: The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block). The client with a history of atrial fibrillation whose monitor reveals atrial fibrillation doesn't need to be assessed first. Because his rhythm is chronic, he has most likely been given an anticoagulant and isn't at immediate risk from this rhythm. The client with a history of heart failure may have chronic bibasilar crackles and pitting edema of both feet. Therefore, assessing this client first isn't necessary. The client's demand pacemaker fires only when the client's intrinsic heart rate falls below the pacemaker's set rate. In option 4, the pacemaker isn't firing because it most likely has been set at a slower rate than the client's intrinsic heart rate of 90 beats/minute.
question
The nurse just received shift report for a group of clients on the telemetry unit. Which client should the nurse assess first. 1. The client with a history of atrial fibrillation 2. The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block 3. The client with a history of heart failure who has bibasilar crackles and pitting edema in both feet 4. The client with a demand pacemaker whose monitor shows normal sinus rhythm at a rate of 90 beats/minute
answer
Correct Answer: 2 RATIONALES: The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block). The client with a history of atrial fibrillation whose monitor reveals atrial fibrillation doesn't need to be assessed first. Because his rhythm is chronic, he has most likely been given an anticoagulant and isn't at immediate risk from this rhythm. The client with a history of heart failure may have chronic bibasilar crackles and pitting edema of both feet. Therefore, assessing this client first isn't necessary. The client's demand pacemaker fires only when the client's intrinsic heart rate falls below the pacemaker's set rate. In option 4, the pacemaker isn't firing because it most likely has been set at a slower rate than the client's intrinsic heart rate of 90 beats/minute.
question
The nurse just received shift report for a group of clients on the telemetry unit. Which client should the nurse assess first. 1. The client with a history of atrial fibrillation 2. The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block 3. The client with a history of heart failure who has bibasilar crackles and pitting edema in both feet 4. The client with a demand pacemaker whose monitor shows normal sinus rhythm at a rate of 90 beats/minute
answer
Correct Answer: 2 RATIONALES: The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block). The client with a history of atrial fibrillation whose monitor reveals atrial fibrillation doesn't need to be assessed first. Because his rhythm is chronic, he has most likely been given an anticoagulant and isn't at immediate risk from this rhythm. The client with a history of heart failure may have chronic bibasilar crackles and pitting edema of both feet. Therefore, assessing this client first isn't necessary. The client's demand pacemaker fires only when the client's intrinsic heart rate falls below the pacemaker's set rate. In option 4, the pacemaker isn't firing because it most likely has been set at a slower rate than the client's intrinsic heart rate of 90 beats/minute.
question
A client is admitted to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, the nurse formulates interventions with which goal in mind? 1. Decreasing blood pressure and increasing mobility 2. Increasing blood pressure and reducing mobility 3. Stabilizing the heart rate and blood pressure and easing anxiety 4. Increasing blood pressure and monitoring fluid intake and output
answer
Correct Answer: 2 RATIONALES: The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block). The client with a history of atrial fibrillation whose monitor reveals atrial fibrillation doesn't need to be assessed first. Because his rhythm is chronic, he has most likely been given an anticoagulant and isn't at immediate risk from this rhythm. The client with a history of heart failure may have chronic bibasilar crackles and pitting edema of both feet. Therefore, assessing this client first isn't necessary. The client's demand pacemaker fires only when the client's intrinsic heart rate falls below the pacemaker's set rate. In option 4, the pacemaker isn't firing because it most likely has been set at a slower rate than the client's intrinsic heart rate of 90 beats/minute.
question
A client is admitted to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, the nurse formulates interventions with which goal in mind? 1. Decreasing blood pressure and increasing mobility 2. Increasing blood pressure and reducing mobility 3. Stabilizing the heart rate and blood pressure and easing anxiety 4. Increasing blood pressure and monitoring fluid intake and output
answer
Correct Answer: 2 RATIONALES: The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block). The client with a history of atrial fibrillation whose monitor reveals atrial fibrillation doesn't need to be assessed first. Because his rhythm is chronic, he has most likely been given an anticoagulant and isn't at immediate risk from this rhythm. The client with a history of heart failure may have chronic bibasilar crackles and pitting edema of both feet. Therefore, assessing this client first isn't necessary. The client's demand pacemaker fires only when the client's intrinsic heart rate falls below the pacemaker's set rate. In option 4, the pacemaker isn't firing because it most likely has been set at a slower rate than the client's intrinsic heart rate of 90 beats/minute.
question
While receiving a heparin infusion to treat deep vein thrombosis, a client reports that the gums bleed when brushing the teeth. What should the nurse do first? 1. Stop the heparin infusion immediately. 2. Notify the physician. 3. Administer a coumarin derivative, as prescribed, to counteract heparin. 4. Reassure the client that bleeding gums are a normal effect of heparin.
answer
Correct Answer: 2 RATIONALES: Because bleeding gums are an adverse effect of heparin that may indicate excessive anticoagulation, the nurse should notify the physician, who will evaluate the client's condition. Laboratory tests, such as partial thromboplastin time, should be performed before concluding that the client's bleeding is significant. The prescribed heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion, unless the physician orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Bleeding gums aren't a normal effect of heparin.
question
The nurse is caring for a client who is awaiting heart transplantation. The client and her family express their concerns about the financial cost of the procedure. Which intervention by the nurse is most appropriate? 1. Reassure the client and her family that the cost will be covered. 2. Contact the social worker and request that she speak to the client and her family about their financial concerns. 3. Tell the client that she will be responsible for all of her costs. 4. Have the physician speak to the client and family about the costs.
answer
Correct Answer: 2 RATIONALES: Transplantation requires a multidisciplinary team approach. A social worker is always included as part of that team. The nurse should contact the social worker and request that she speak to the client and her family about their financial concerns about the transplant. Reassuring the client that the cost will be covered is false reassurance that doesn't address the client's concern. Many insurance companies pay for the expenses surrounding a transplant; the client isn't personally responsible. The physician isn't typically involved with discussions about financial responsibilities.
question
After receiving shift report, the registered nurse in the cardiac step-down unit, must prioritize her client care assignment. She has an ancillary staff member available to help her care for her clients. Which of these clients should the registered nurse assess first? 1. The client with heart failure who is having some difficulty breathing. 2. The anxious client who was diagnosed with an acute myocardial infarction (MI) two days ago and who was transferred from the coronary care unit today. 3. The demanding client who underwent coronary bypass surgery three days ago. 4. The client admitted during the previous shift with new-onset controlled atrial fibrillation who has her call light on.
answer
Correct Answer: 1 RATIONALES: The registered nurse should care for the client with heart failure who is experiencing difficulty breathing. Breathing takes precedence over the other client needs. The ancillary staff member can answer the call light of the client admitted with controlled atrial fibrillation. She can also attend to the demanding client who underwent coronary bypass surgery three days ago. Although anxiety can be detrimental to a client with an MI, anxiety doesn't take precedence over another client's breathing difficulty.
question
After experiencing a transient ischemic attack (TIA), a client is prescribed aspirin, 325 mg P.O. daily. The nurse should teach the client that this medication has been prescribed to: 1. control headache pain. 2. enhance the immune response. 3. prevent intracranial bleeding. 4. reduce the chance of blood clot formation.
answer
Correct Answer: 4 RATIONALES: TIAs are considered forerunners of stroke. Because strokes may result from clots in cerebral vessels, aspirin is prescribed to prevent clot formation by reducing platelet agglutination. A 325-mg dose of aspirin is inadequate to relieve headache pain in an adult. Aspirin has no effect on the body's immune response. Intracranial bleeding isn't associated with TIAs, and the action of aspirin probably would worsen any bleeding present.
question
During surgery, a client develops sinus bradycardia. The physician orders atropine sulfate. Which dose and route is the nurse most likely to administer? 1. 0.6 mg I.M. 2. 1 mg I.V. 3. 2 mg I.M. 4. 2 mg I.V.
answer
Correct Answer: 2 RATIONALES: To reverse arrhythmias, bradycardia, or sinus arrest, the usual adult dosage of atropine is 0.4 to 1 mg I.V. every 2 hours as needed. The drug isn't administered I.M. for the treatment of bradycardia
question
During surgery, a client develops sinus bradycardia. The physician orders atropine sulfate. Which dose and route is the nurse most likely to administer? 1. 0.6 mg I.M. 2. 1 mg I.V. 3. 2 mg I.M. 4. 2 mg I.V.
answer
Correct Answer: 2 RATIONALES: To reverse arrhythmias, bradycardia, or sinus arrest, the usual adult dosage of atropine is 0.4 to 1 mg I.V. every 2 hours as needed. The drug isn't administered I.M. for the treatment of bradycardia
question
During surgery, a client develops sinus bradycardia. The physician orders atropine sulfate. Which dose and route is the nurse most likely to administer? 1. 0.6 mg I.M. 2. 1 mg I.V. 3. 2 mg I.M. 4. 2 mg I.V.
answer
Correct Answer: 2 RATIONALES: To reverse arrhythmias, bradycardia, or sinus arrest, the usual adult dosage of atropine is 0.4 to 1 mg I.V. every 2 hours as needed. The drug isn't administered I.M. for the treatment of bradycardia
question
A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that aren't followed by a beat. Which condition should the nurse suspect? 1. Failure to pace 2. Failure to capture 3. Failure to sense 4. Asystole
answer
Correct Answer: 2 RATIONALES: To reverse arrhythmias, bradycardia, or sinus arrest, the usual adult dosage of atropine is 0.4 to 1 mg I.V. every 2 hours as needed. The drug isn't administered I.M. for the treatment of bradycardia
question
A client signed a consent form for participation in a clinical trial for implantable cardioverter-defibrillators. Which statement by the client indicates the need for further teaching before true informed consent can be obtained? 1. "This implanted defibrillator will protect me against some of those bad rhythms my heart goes into." 2. "I wonder if there is any other way to prevent these bad rhythms." 3. "The physician will make a small incision in my chest wall and place the generator there." 4. "A wire from the generator will be attached to my heart."
answer
Correct Answer: 2 RATIONALES: Option 2 indicates that other treatment options weren't discussed with the client. Before participation in a clinical trial, the client must be informed of all other available treatment options. Options 1, 3, and 4 are all true statements about implantable cardioverter-defibrillators.
question
A client signed a consent form for participation in a clinical trial for implantable cardioverter-defibrillators. Which statement by the client indicates the need for further teaching before true informed consent can be obtained? 1. "This implanted defibrillator will protect me against some of those bad rhythms my heart goes into." 2. "I wonder if there is any other way to prevent these bad rhythms." 3. "The physician will make a small incision in my chest wall and place the generator there." 4. "A wire from the generator will be attached to my heart."
answer
Correct Answer: 2 RATIONALES: Option 2 indicates that other treatment options weren't discussed with the client. Before participation in a clinical trial, the client must be informed of all other available treatment options. Options 1, 3, and 4 are all true statements about implantable cardioverter-defibrillators.
question
A client signed a consent form for participation in a clinical trial for implantable cardioverter-defibrillators. Which statement by the client indicates the need for further teaching before true informed consent can be obtained? 1. "This implanted defibrillator will protect me against some of those bad rhythms my heart goes into." 2. "I wonder if there is any other way to prevent these bad rhythms." 3. "The physician will make a small incision in my chest wall and place the generator there." 4. "A wire from the generator will be attached to my heart."
answer
Correct Answer: 1 RATIONALES: Noncompliance is the most serious problem in managing a client with hypertension. One authority estimates that 40% to 60% of hypertensive clients fail to comply with prescribed treatment. Reasons for noncompliance include lack of symptoms, which makes the problem seem less serious; the difficulty of making required lifestyle changes, such as eating a low-sodium diet, stopping smoking, and losing or managing weight; adverse reactions to antihypertensive drugs; and the inconvenience and high cost of obtaining health care. The other options may promote or result from noncompliance. Deficient knowledge contributes to noncompliance; Excess fluid volume, caused by excess sodium intake, and Imbalanced nutrition: More than body requirements may result from noncompliance.
question
The nurse would obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? 1. Calcium and magnesium 2. Potassium and calcium 3. Magnesium and potassium 4. Potassium and sodium
answer
Correct Answer: 3 RATIONALES: Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.
question
The nurse would obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? 1. Calcium and magnesium 2. Potassium and calcium 3. Magnesium and potassium 4. Potassium and sodium
answer
Correct Answer: 3 RATIONALES: Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.
question
A client is receiving a lidocaine (Xylocaine) I.V. infusion at 2 mg/minute to treat runs of ventricular tachycardia. The client experiences hypotension, dyspnea, and irregular heartbeats, indicating heart failure. Which action can the nurse expect the physician to take first? 1. Prescribing 100 mg of lidocaine P.O. every 6 hours 2. Decreasing the lidocaine infusion to 1 mg/minute 3. Increasing the lidocaine infusion to 3 mg/minute 4. Discontinuing the lidocaine infusion
answer
Correct Answer: 2 RATIONALES: In a client with heart failure or hepatic disease, the maintenance infusion of lidocaine should be reduced by one-third to one-half. Because the client is currently receiving 2 mg/minute, the physician will probably decrease the rate to 1 mg/minute. Lidocaine isn't administered in oral form because most of an absorbed dose undergoes first-pass metabolism in the liver. Increasing the rate of the lidocaine infusion can worsen heart failure. Discontinuing lidocaine isn't warranted in the presence of life-threatening PVCs.
question
The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using: 1. antiembolism stockings. 2. oxygen. 3. diuretics. 4. anticoagulants.
answer
Correct Answer: 3 RATIONALES: Diuretics, such as furosemide (Lasix), reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.
question
The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using: 1. antiembolism stockings. 2. oxygen. 3. diuretics. 4. anticoagulants.
answer
Correct Answer: 3 RATIONALES: Diuretics, such as furosemide (Lasix), reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.
question
The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using: 1. antiembolism stockings. 2. oxygen. 3. diuretics. 4. anticoagulants.
answer
Correct Answer: 3 RATIONALES: Diuretics, such as furosemide (Lasix), reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.
question
The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using: 1. antiembolism stockings. 2. oxygen. 3. diuretics. 4. anticoagulants.
answer
Correct Answer: 3 RATIONALES: Diuretics, such as furosemide (Lasix), reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.
question
The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using: 1. antiembolism stockings. 2. oxygen. 3. diuretics. 4. anticoagulants.
answer
Correct Answer: 3 RATIONALES: Diuretics, such as furosemide (Lasix), reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.
question
The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using: 1. antiembolism stockings. 2. oxygen. 3. diuretics. 4. anticoagulants.
answer
Correct Answer: 3 RATIONALES: Diuretics, such as furosemide (Lasix), reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.
question
The nurse should monitor a client receiving lidocaine (Xylocaine) for toxicity. Which signs or symptoms in a client would suggest lidocaine toxicity? 1. Nausea and vomiting 2. Pupillary changes 3. Confusion and restlessness 4. Hypertension
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? 1. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. 2. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. 3. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. 4. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
An elderly client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? 1. Romberg's 2. Phalen's 3. Rinne 4. Homans'
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 3 RATIONALES: The nurse should observe for signs of lidocaine toxicity, such as confusion and restlessness. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard), other class IB drugs (lidocaine isn't administered orally). Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.
question
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol.` 3. `Client verbalizes an understanding of the need to seek emergency help if the heart rate increases markedly while at rest.` 4. `Client walks 4 miles in 1 hour every day.`
answer
Correct Answer: 2 RATIONALES: In option 2, the nurse is advocating for the client by telling the physician that with proper education and support, the client could most likely make the necessary lifestyle changes. Informing the physician about the number of cigarettes the client smokes each day does not indicate advocacy. In option 3, the nurse is indicating that she is doubtful that the client could make the necessary changes. Option 4 may be true; however, this example does not display client advocacy.
question
The nurse is caring for a client with end-stage heart failure. Which statement by the client best demonstrates a good understanding of an advance directive? 1. "I will rely on my doctor to do whatever is best for me." 2. "Once I decide on an advance directive, I cannot change my mind." 3. "A living will allows my decisions for health care to be known if I can't speak for myself.` 4. `A health care power of attorney will allow my daughter to use my funds to pay for my health care costs, if I can't do so"
answer
Correct Answer: 3 RATIONALES: An advance directive is a document written in the form of a living will. It expresses the client's wishes about health care, providing direction for the physician if the client becomes terminally ill and can't express his wishes. Option 1, which requires relying on the physician to decide care, takes the decision away from the client. A client can change his mind about advance directives at any time. A health care power of attorney allows the client to designate another person to make health care decisions for the client in case that the client becomes too ill to make his own decisions.
question
When measuring the radial pulse of a client with known aortic insufficiency, the nurse isn't surprised to find a `waterhammer` or Corrigan's pulse. What are the characteristics of this pulse? 1. Weak and feeble, with a slow upstroke and prolonged peak 2. Alternating strong and weak beats 3. Rapid upstroke with two systolic peaks 4. Bounding, with a rapid rise and fall
answer
Correct Answer: 4 RATIONALES: A "water-hammer" pulse is bounding, with a rapid rise and fall. A weak, feeble pulse with a slow upstroke and prolonged peak is called pulsus tardus. A pulse with alternating weak and strong beats and a regular rhythm is termed pulsus alternans. A pulse with a rapid upstroke and two systolic peaks is called pulsus bisferiens.
question
After abdominal surgery, which factor would predispose a client to deep vein thrombosis? 1. The client is 5? 9? tall and weighs 128 lb. 2. The client has been pregnant four times. 3. The client usually walks 3 miles a day. 4. The client will be immobile during and shortly after surgery.
answer
Correct Answer: 4 RATIONALES: Postoperative immobility and subsequent venous stasis predispose the client to deep vein thrombosis. Other predisposing factors for this condition include obesity and current pregnancy, which don't apply to this client. Exercise isn't a risk factor or preventive measure for deep vein thrombosis.
question
After abdominal surgery, which factor would predispose a client to deep vein thrombosis? 1. The client is 5? 9? tall and weighs 128 lb. 2. The client has been pregnant four times. 3. The client usually walks 3 miles a day. 4. The client will be immobile during and shortly after surgery.
answer
Correct Answer: 4 RATIONALES: Postoperative immobility and subsequent venous stasis predispose the client to deep vein thrombosis. Other predisposing factors for this condition include obesity and current pregnancy, which don't apply to this client. Exercise isn't a risk factor or preventive measure for deep vein thrombosis.
question
After abdominal surgery, which factor would predispose a client to deep vein thrombosis? 1. The client is 5? 9? tall and weighs 128 lb. 2. The client has been pregnant four times. 3. The client usually walks 3 miles a day. 4. The client will be immobile during and shortly after surgery.
answer
Correct Answer: 4 RATIONALES: Postoperative immobility and subsequent venous stasis predispose the client to deep vein thrombosis. Other predisposing factors for this condition include obesity and current pregnancy, which don't apply to this client. Exercise isn't a risk factor or preventive measure for deep vein thrombosis.
