Please enter something

NCLEX Cardio

question

Before discharge, which instruction should the nurse give to a client receiving flecainide (Tambocor) to reduce the risk of heart failure?
answer

Limit fluid intake
question

The nurse is assessing a client who is at risk for cardiac tamponade due to chest trauma sustained in a motorcycle accident. What is the client’s pulse pressure if his blood pressure is 108/82 mm Hg?
answer

26
question

(SELECT ALL THAT APPLY) The nurse is preparing a teaching plan for a client who recently underwent surgery for insertion of a permanent pacemaker. Which instructions should the nurse include in the teaching plan?
answer

(1) Check heart rate for 1 minute daily (4) Report redness, swelling, or discharge at insertion site. (6) Avoid magnetic resonance imaging (MRI) diagnostic studies.
question

“(SELECT ALL THAT APPLY) Which of the following signs and symptoms should the nurse expect to find in a client with angina?
answer

(1) Chest tightness (3) Chest pressure (4) Jaw pain
question

(SELECT ALL THAT APPLY) A client is prescribed furosemide (Lasix) to manage his heart failure. What laboratory values should be monitored while the client receives this medication?
answer

(1) Complete blood count and (2) Serum potassium
question

(SELECT ALL THAT APPLY) The nurse is caring for a client who just underwent cardiac catheterization through a femoral access site. Which nursing interventions should the nurse include in the care plan for the next 8 hours?
answer

(1) Maintain pressure over the femoral access site. (3) Check the dressing and access site for bleeding. (5) Keep the extremity straight.
question

(SELECT ALL THAT APPLY) The nurse advises a client recovering from a myocardial infarction to decrease his fat and sodium intake. Which foods should the nurse instruct the client to avoid?
answer

(1) Pepperoni Pizza (3) Bacon (4) Cheese (6) Soft Drinks
question

(SELECT ALL THAT APPLY) The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)?
answer

(2) Serum troponin (3) Serum myoglobin
question

(SELECT ALL THAT APPLY) A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure?
answer

(3) Orthopnea (4) Cough (6) Crackles
question

(SELECT ALL THAT APPLY) A client is receiving heparin I.V. for the treatment of thrombophlebitis. Which laboratory value should the nurse monitor throughout heparin therapy?
answer

(3) Partial thromboplastin time (PTT) (5) Platelet count
question

The night shift nurse reports that a client admitted with a myocardial infarction has normal capillary refill. What capillary refill time would the nurse expect to find if the client’s refill time remains normal?
answer

1 to 3 seconds
question

A client is prescribed flecainide (Tambocor) to treat atrial fibrillation. How soon after administering flecainide orally can the nurse expect the drug to reach its peak concentration?
answer

2 to 3 hours
question

How long after oral administration can the nurse expect to see digoxin’s (Lanoxin) peak effect?
answer

2 to 6 hours
question

A client is admitted to the coronary care unit with a suspected diagnosis of acute myocardial infarction. 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?
answer

4 to 6 hours
question

A client is being discharged from the hospital with a permanent cardiac pacemaker that is set at 72 beats/minute. The nurse should instruct the client to report which pulse rate immediately to the physician?
answer

64 beats/minute
question

A disaster drill is in progress in the hospital. In preparation for potential admissions, the charge nurse on a cardiac step-down unit asks a nurse which one of her clients could potentially be discharged. Which is the best response?
answer

A 52-year-old client who had an endovascular graft placed for an abdominal aortic aneurysm 3 days ago
question

An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician prescribes a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client’s well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine if the client has other major risk factors for CAD, the nurse should assess for:
answer

A history of diabetes mellitus
question

A team conference has been called to discuss alternative treatment for a Jehovah’s Witness client who has a hemoglobin level of 5.5 g/dl. Which of the following facts regarding the religious beliefs of a Jehovah’s Witness should be explained to the team during the conference?
answer

A Jehovah’s Witness is forbidden from receiving blood products.
question

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as:
answer

A third heart sound (S3)
question

The most common site of aneurysm formation is in the?
answer

Abdominal aorta, just below the renal arteries.
question

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of:
answer

Acute pulmonary edema
question

For a client who has had an acute myocardial infarction (MI), which of the following interventions should be included in the plan of care to assist with bowel elimination and prevent straining?
answer

Administer a stool softener
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?
answer

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
question

When assessing a client with left-sided heart failure, the nurse expects to note
answer

Air hunger
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?
answer

Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician.
question

A client who has been experiencing severe chest pain tells the nurse that the pain has diminished and asks to go to the bathroom to have a bowel movement. What action should the nurse take?
answer

Allow the use of a bedside commode
question

A client develops atrial fibrillation after an acute myocardial infarction. The physician prescribes digoxin (Lanoxin), 0.125 mg I.M. daily. The nurse clarifies the order with the physician because I.M. administration of digoxin leads to:
answer

an increased serum creatine kinase (CK) level.
question

A client comes to the physician’s office for a complete physical examination required for employment. The physician assesses the client’s arms and legs for evidence of peripheral vascular disease. What is the most commonly used overall indicator of arm and leg circulation?
answer

Ankle-brachial index
question

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is probably:
answer

Anterior
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 which medication to be administered to the patient?
answer

Anticoagulant
question

A client comes to the emergency department with chest pain, dyspnea, and an irregular heartbeat. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia) with frequent premature ventricular contractions. Shortly after admission, the client has ventricular tachycardia and becomes unresponsive. After successful resuscitation, the client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate at this time?
answer

Anxiety related to the threat of death
question

Which interventions are appropriate when caring for a client with acute thrombophlebitis
answer

Apply warm soaks and elevate the client’s legs higher than the level of the heart.
question

The nurse correctly instructs a client with peripheral vascular disease that stress-reduction techniques
answer

Are helpful because stress stimulates the release of vasoconstricting catecholamines
question

Which measurement can best be used to monitor the respiratory status of a client with pulmonary edema
answer

Arterial blood gas (ABG) analysis
question

A client admitted to the hospital for an abdominal aneurysm repair tells a nurse that he has an advance directive. What action should the nurse take?
answer

Ask the client for a copy of the advance directive to place on his chart.
question

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:
answer

Aspirin
question

A male client has been complaining of chest pain and shortness of breath for the past 2 hours. He has a temperature of 99° F (37.2° C), a pulse of 96 beats/minute, respirations that are irregular and 16 breaths/minute, and a blood pressure of 140/96 mm Hg. He’s placed on continuous cardiac monitoring to:
answer

Assess for potentially dangerous arrhythmias
question

The nurse administers basic cardiac life support to a client in cardiac arrest after establishing unresponsiveness. Which action does the nurse perform during basic life support?
answer

Assessing the patency of the airway
question

A nurse is assigned the care of an 87-year-old client with multiple ulcerations, which require dressing changes. The nurse is also assigned the care of a 50-year-old client, who is ordered to receive 2 units of packed red blood cells. Which task can the nurse delegate to the nursing assistant?
answer

Assisting the clients with bathing
question

To avoid a falsely elevated serum digoxin level, the nurse should wait how long after administering oral digoxin (Lanoxin) to draw a blood sample?
answer

At least 8 hours
question

The licensed practical nurse discovers a client with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication would the registered nurse use to treat the client’s bradycardia?
answer

Atropine
question

At a staff meeting, a nurse-manager states that the unit performance improvement committee will perform a concurrent audit of the documentation of all coronary artery bypass clients’ clinical pathways weekly for 4 weeks. A nurse asks why this is necessary. Which response is the best explanation of the audit’s purpose?
answer

Audits are an evaluation tool used to improve compliance with hospital policy and standards
question

The nurse is teaching a client who will be discharged with a prescription for warfarin (Coumadin). The nurse should include which statement in discharge teaching?
answer

Avoid aspirin while taking warfarin.
question

Echocardiography reveals vegetation on a client’s heart valves. The nurse knows that this finding indicates:
answer

Bacterial invasion.
question

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?
answer

Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours
question

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and prescribes sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, the nurse should provide which instruction?
answer

Be sure to take safety precautions because nitroglycerin may cause orthostatic hypotension
question

An 84-year-old male is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?
answer

Bibasilar fine crackles
question

A client is in hemorrhagic shock. What data reflects the effectiveness of fluid replacement therapy?
answer

Blood pressure
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?
answer

Blood pressure
question

The physician prescribes pentoxifylline (Trental), 400 mg by mouth three times daily with meals, for a client with intermittent claudication and a history of adult-onset diabetes mellitus. The nurse knows that pentoxifylline is a:
answer

Blood viscosity-reducing agent.
question

When measuring the radial pulse of a client with known aortic insufficiency, the nurse detects a “water-hammer” or Corrigan’s pulse. What are the characteristics of this pulse?
answer

Bounding, with a rapid rise and fall
question

In caring for a client with vasovagal syncope, the nurse should know that the associated temporary loss of consciousness is most commonly related to:
answer

Bradyrhythmia
question

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. This client should be instructed to avoid which of the following?
answer

Caffeine-containing products
question

Before discharge, which instruction should the nurse give to a client receiving digoxin (Lanoxin)?
answer

Call the physician if you have a rapid heart rate.
question

A client with chest pain receives aspirin and nitroglycerin (Nitrostat) 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:
answer

Cardiac arrhythmia
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?
answer

Client walks 4 miles in 1 hour every day
question

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client’s plan of care, the nurse should include which expected outcome
answer

Client will verbalize the intention to stop smoking.
question

A client is admitted for treatment of Prinzmetal’s angina. When developing the plan of care, the nurse keeps in mind that this type of angina is triggered by:
answer

Coronary artery spasm.
question

A client is evaluated for hypertension. The physician prescribes atenolol (Tenormin), 50 mg by mouth daily. Atenolol should have which therapeutic effect on the client?
answer

Decreased cardiac output and systolic and diastolic blood pressure
question

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time?
answer

Decreased cardiac output related to depressed myocardial function, deficient fluid volume, or impaired electrical conduction
question

For a client with cardiomyopathy, the most important nursing diagnosis is
answer

Decreased cardiac output related to reduced myocardial contractility.
question

Which of the following signs and symptoms suggest that a client’s abdominal aortic aneurysm is extending?
answer

Decreased pulse rate and blood pressure
question

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals which of the following?
answer

Dependent pallor
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, spontaneously resolving symptom?
answer

Depression
question

The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using:
answer

Diuretics.
question

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic indicates myocardial ischemia?
answer

Elevated ST segment
question

The nurse is caring for a client with rheumatic fever and a nursing diagnosis of Activity intolerance related to reduced cardiac reserve and enforced bed rest. Before the nurse can eliminate this nursing diagnosis, the client must meet which outcome measurement criterion?
answer

Erythrocyte sedimentation rate returns to normal
question

The nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first
answer

Establish unresponsiveness
question

A client is diagnosed with pericarditis. The nurse anticipates that the client has which signs and symptoms?
answer

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
question

A client is diagnosed with pericarditis. The nurse anticipates that the client has which signs and symptoms?
answer

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
question

The nurse is assessing a client with heart failure. The breath sounds commonly auscultated in clients with heart failure are
answer

Fine crackles
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?
answer

Flex your calf muscles, avoid alcohol, and change positions slowly.
question

The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:
answer

Forcing blood into the deep venous system.
question

A nurse is caring for a hypertensive client who has been placed on a low-sodium diet. Which menu selection demonstrates the client’s understanding of this diet?
answer

Fresh green beans and chicken salad
question

A client is admitted to the acute care facility for treatment of heart failure. The nurse expects the physician to prescribe which drug?
answer

Furosemide (Lasix)
question

A nurse educator in the cardiac care unit is assigned to orient a newly hired nurse from the Middle East. Included in the orientation is the medication administration system. What is the best way to determine if the nurse understands the medication system?
answer

Have the nurse demonstrate the procedure.
question

The nurse is teaching a client how to take nitroglycerin (Nitrostat) to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn’t subside within 15 minutes. The nurse informs the client that nitroglycerin may cause
answer

headache, hypotension, dizziness, and flushing
question

The nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?
answer

Heart failure
question

When a client is started on oral or I.V. diltiazem (Cardizem), the nurse should monitor for which adverse reaction?
answer

Heart failure
question

A client with a history of atrial arrhythmia is receiving propranolol (Inderal), 10 mg by mouth three times per day. The nurse knows that propranolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
answer

Heart
question

Which of the following complications is most common after an abdominal aortic aneurysm resection?
answer

Hemorrhage and shock
question

The physician prescribes several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?
answer

Heparin sodium
question

A white male, age 43, is admitted to an acute care facility with a tentative diagnosis of infective endocarditis. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years ago and an aortic valve replacement 2 years ago. Which history finding is a major risk factor for infective endocarditis?
answer

History of aortic valve replacement
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?
answer

Homans
question

The physician prescribes digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which electrolyte imbalance may predispose the client to digoxin toxicity?
answer

Hypokalemia
question

A client is recovering from surgical repair of a dissecting aortic aneurysm. The nurse should evaluate the client for signs of bleeding or recurring dissection. These signs include:
answer

Hypotension and tachycardia.
question

A male client has arteriosclerosis with intermittent claudication. The nurse has worked with him to develop a walking program. Which statement by the client indicates that he understands the program?
answer

I should walk until pain occurs, then rest
question

The nurse knows that client teaching about hypertension has been effective when the client states:
answer

I shouldn’t adjust my medication without my physician’s advice.
question

A nurse is attempting to administer lisinopril to a client. The client refuses to take the pill, stating that in the past he developed a rash as an allergic reaction to the medication. Which of the following is the best response by the nurse?
answer

I will call the physician with this information
question

A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene
answer

Instruct the client to flex the calf muscles and then sit up for several minutes before standing
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 may be used to determine a client’s response to oral anticoagulant drugs?
answer

International Normalized Ratio (INR)
question

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?
answer

Intra-arterial readings should be at least 10 mm Hg higher than cuff readings.
question

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, and cold left calf. While the physician determines the appropriate therapy, the nurse should:
answer

Keep the affected leg level or slightly dependent.
question

Before administering digoxin (Lanoxin) to a client, 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:
answer

Kidneys
question

A hospitalized client experiences digoxin- (Lanoxin-) induced premature ventricular contractions (PVCs). Which type of effect do such contractions represent?
answer

Latrogenic
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?
answer

Leads V3 and V4
question

A client who suffered blunt chest trauma in a car accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, the nurse should encourage the client to assume which position?
answer

Leaning forward while sitting
question

When teaching a client with newly diagnosed hypertension about the pathophysiology of this disease, the nurse states that arterial baroreceptors, which monitor arterial pressure, are found in the carotid sinus and aorta. Which other area should the nurse mention as a site of arterial baroreceptors?
answer

Left ventricular wall
question

In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?
answer

Leg edema
question

The nurse is teaching a client who receives nitrates for the relief of chest pain. Which of the following instructions should the nurse emphasize?
answer

Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
question

A client is diagnosed with prehypertension. Which of the following would most likely be included in the client’s treatment plan?
answer

Lifestyle modification instructions
question

Before discharge, which instruction should the nurse give to a client receiving flecainide (Tambocor) to reduce the risk of heart failure
answer

Limit your fluid intake
question

A male client is receiving digoxin (Lanoxin) and furosemide (Lasix) to treat heart failure. He complains of feeling weak and having muscle cramps. His apical pulse is 76 beats/minute; respirations, 16 breaths/minute; and blood pressure, 148/86 mm Hg. What action should the nurse take?
answer

Look at the chart for his last potassium level and contact the physician.
question

A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs
answer

Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation.
question

The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?
answer

Low serum potassium level
question

A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is given because it
answer

Lowers resistance, reduces cardiac workload, and decreases myocardial oxygen demand
question

The nurse may expect to be instructed to obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?
answer

Magnesium and potassium
question

A client hospitalized for treatment of hypertension is being prepared for discharge. The nurse should be sure to cover which teaching topic?
answer

Maintaining a low-sodium diet
question

The nurse is assessing a client with heart failure. Which heart valve sound will the nurse hear best at the fifth left intercostal space at the midclavicular line?
answer

Mitral
question

A client who complained of chest pain received sublingual nitroglycerin (Nitrostat). Which statement by the client indicates that this drug is producing its therapeutic effect?
answer

My chest pain is decreasing.
question

The nurse is explaining the use of transdermal nitroglycerin (Transderm-Nitro), which is to be applied twice daily. The client demonstrates understanding when he states:
answer

My wife should be careful not to touch the patch with her fingers if she helps me
question

An increase in the creatine kinase-MB isoenzyme (CK-MB) can be caused by
answer

Myocardial necrosis
question

The nurse reviews a client’s medication history before administering a cholinergic blocking agent. Which of the following drugs may have delayed absorption because of the adverse effects of a cholinergic blocking agent?
answer

Nitroglycerin (Nitrostat)
question

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client’s blood pressure at 164/92 mm Hg and notes a 5-lb (2.3-kg) weight gain over the past 6 months. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?
answer

Noncompliance (nonadherence to therapeutic regimen)
question

A nurse is caring for a client who has been administered digoxin (Lanoxin) 0.125 mg by mouth daily. The client develops sinus bradycardia with a heart rate of 50 beats/minute. His vital signs are stable. Which of the following actions should the nurse take first?
answer

Notify the physician
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?
answer

Notify the physician.
question

A cognitively alert client is scheduled for a coronary artery bypass graft surgery in the morning. The nurse checks the chart for preoperative orders and finds that the surgical consent form hasn’t been signed. Which of the following is the best action for the nurse to take?
answer

Notify the surgeon
question

The nurse is assessing a client’s right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms would suggest circulatory impairment?
answer

Numbness, cool skin temperature, and pallor
question

The nurse is educating a client who’s at risk for coronary artery disease (CAD). The nurse tells the client that CAD has many risk factors. Risk factors that can be controlled or modified include:
answer

Obesity, inactivity, diet, and smoking.
question

A client with a history of I.V. drug abuse is admitted to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has
answer

Osler’s nodes and splinter hemorrhages
question

A client is recovering from an acute myocardial infarction (MI). During the first week of recovery, the nurse should stay alert for which abnormal heart sound?
answer

Pericardial friction rub
question

A client is receiving captopril (Capoten) for heart failure. Which finding indicates that the medication isn’t producing the desired treatment outcome and requires the nurse to notify the physician?
answer

Peripheral edema
question

A male client has been admitted to the hospital with heart failure. On entering the room, the nurse notices that the client is having difficulty breathing. Which position would be the most appropriate to help his breathing?
answer

Place the client in high Fowler’s position
question

The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should
answer

Place the client in high Fowler’s position
question

The nurse is caring for a client with hemiparesis caused by a stroke. Which intervention takes highest priority
answer

Placing the client on the affected side
question

A client is admitted to the cardiac unit with a diagnosis of heart failure. The physician prescribes furosemide (Lasix) and digoxin (Lanoxin) to manage the condition. Which laboratory value should be monitored during hospitalization?
answer

Potassium
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-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg by mouth three times daily with meals. The nurse should provide which instruction concerning long-term care?
answer

Practice meticulous foot care.
question

The nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should
answer

Press the right upper abdomen
question

The most important reason for the nurse to encourage a client with peripheral vascular disease to initiate a walking program is because it:
answer

Promotes collateral circulation.
question

A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for adverse effects of heparin, especially bleeding. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that’s specific to heparin. Which agent fits this description?
answer

Protamine sulfate
question

A nurse is developing a plan of palliative care for a client with end-stage cardiomyopathy. Which action is appropriate to include in the care plan?
answer

Provide nonpharmacological measures to reduce discomfort
question

A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?
answer

Pulmonary hypertension
question

An average-weight client complains of generalized steady abdominal pain. The nurse should suspect an abdominal aortic aneurysm, if the abdominal pain is accompanied by which finding?
answer

Pulsating mass in the periumbilical area
question

A client with mitral valve prolapse is advised to have elective mitral valve replacement. Because the client is a Jehovah’s Witness, she declares in her advance directive that no blood products are to be administered. As a result, the consulting cardiac surgeon refuses to care for the client. It would be most appropriate for the nurse caring for the client to:
answer

Realize the surgeon has the right to refuse to care for the client.
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?
answer

Recommend he have his blood pressure rechecked within 2 months.
question

After experiencing a transient ischemic attack (TIA), a client is prescribed aspirin, 325 mg by mouth daily. The nurse should teach the client that this medication has been prescribed to:
answer

Reduce platelet agglutination
question

After receiving nitroglycerin (Nitrostat), a client verbalizes relief of chest pain. The physician prescribes transdermal nitroglycerin (Nitro-Dur), 5-mg patch daily, as prophylaxis for angina pectoris. When teaching the client how to apply the transdermal system, the nurse should provide which instruction?
answer

Report skin irritation or other adverse reactions.
question

Because of a staffing shortage, a nurse is reassigned to a cardiovascular unit for a 4-hour shift. The nurse has never worked on a cardiovascular unit and doesn’t feel that she can safely care for clients on this unit. Which of the following is the most appropriate initial action for the nurse?
answer

Report to the unit and discuss her assignment with the charge nurse to identify tasks that she can perform safely.
question

Continual assessment is an important component in cardiopulmonary resuscitation (CPR). Before initiating CPR, the nurse should always assess for:
answer

Responsiveness.
question

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?
answer

Rheumatic fever
question

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis is appropriate?
answer

Risk for injury
question

During digoxin (Lanoxin) therapy, the nurse should closely monitor the client’s:
answer

Serum potassium and magnesium levels
question

A client reports recent onset of sporadic chest pain with exertion. The client also has fatigue and mild ankle swelling, which is worst at the end of the day. The nurse suspects a cardiovascular disorder. When exploring the chief complaint, the nurse should find out if the client has any other common cardiovascular symptoms, such as:
answer

Shortness of breath
question

The physician has ordered digoxin for a client with pulmonary edema. The nurse knows that digoxin has a direct and beneficial effect on myocardial contraction in the failing heart. This effect:
answer

Slows the conduction of impulses through the atrioventricular (AV) node
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?
answer

Stabilizing the heart rate and blood pressure and easing anxiety
question

Considering a client’s atrial fibrillation, the nurse must administer digoxin (Lanoxin) with caution because it
answer

Stimulates the parasympathetic division of the autonomic nervous system, increasing vagal tone
question

When assisting with an electrocardiogram (ECG), the nurse would expect to place the client in which position?
answer

Supine
question

A client is admitted to the hospital with a diagnosis of angina. As part of the discharge plan, a nurse should include which of the following instructions to reduce the risk of angina?
answer

Take frequent rest breaks during the day.
question

On a routine visit to the physician, a client with chronic arterial occlusive disease reports stopping smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, the nurse should recommend which additional measure?
answer

Taking daily walks
question

The nurse is evaluating a client who had a myocardial infarction (MI) 7 days ago. Which outcome indicates that the client is responding favorably to therapy?
answer

The client demonstrates the ability to tolerate increasing activity without chest pain.
question

A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Data collection findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. This data may reflect that:
answer

The client is going into cardiogenic shock.
question

A nurse walking down the hospital corridor hears a call for help from a client who was admitted with vascular insufficiency. She finds the client lying on the floor. The nurse assesses the client and notifies the physician of the incident. What information should the nurse chart on the incident report form?
answer

The client was observed on the floor.
question

After abdominal surgery, which factor would predispose a client to deep vein thrombosis?
answer

The client will be immobile during and shortly after surgery
question

A nurse is caring for a client with a diagnosis of pericarditis. Which statement might indicate a violation of client confidentiality?
answer

The nurse discussed the client’s diagnosis with a family friend over the telephone.
question

Which characteristic suggests that the client’s chest pain is pleuritic?
answer

The pain increases with deep inspiration and decreases when the client leans forward.
question

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which statement by the client most strongly suggests angina pectoris?
answer

The pain occurred while I was mowing the lawn.
question

A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate?
answer

The severity of discomfort isn’t related to the size of varicosities.
question

The nurse should advise the client with an axillofemoral bypass graft to avoid
answer

Tight belts
question

Which treatment would be the best therapy for a stable client with digoxin toxicity?
answer

Time and symptomatic treatment
question

A 43-year-old man was transferring a load of firewood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which immediate order by the physician?
answer

Tissue plasminogen activator (tPA)
question

A client newly diagnosed with heart failure is placed on bed rest. What is the most appropriate rationale for this action
answer

To reduce the heart’s workload
question

A client with a history of severe angina is being seen in the emergency department for chest pain. In terms of diagnostic laboratory testing, it’s most important for the nurse to advocate ordering a:
answer

Troponin level
question

A client with severe angina and electrocardiogram changes is seen in the emergency department. In terms of serum testing, the nurse can expect which laboratory test to be ordered?
answer

Troponin
question

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client’s blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension?
answer

Untreated hypertension
question

The nurse is teaching a client about maintaining a healthy heart. The nurse should include which recommendation
answer

Use alcohol in moderation
question

The nurse suspects that a 68-year-old client has digoxin toxicity. The nurse should assess fo
answer

Vision changes
question

A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity also may cause:
answer

Visual disturbances
question

A 40-year-old female client who is taking nifedipine (Procardia) for hypertension tells the nurse that she has noticed a “little swelling” in her ankles. What should be the nurse’s first response?
answer

When did you first notice this?
question

A client with chest pain doesn’t respond to nitroglycerin (Nitrostat). On admission to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?
answer

Within 3 to 6 hours
question

A client who has just been diagnosed with myocardial infarction (MI) begins to cry and tells the nurse that his brother died of a heart attack last year. Which response by the nurse is most appropriate?
answer

You sound as though you think you’re going to die.