Combo "Practice Med Surg Questions

Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction?1. Creatine kinase (CK-MB).2. Lactate dehydrogenase (LDH).3. Troponin4. White blood cells (WBCs)

3. Troponin

Along with the persistent, crushing chest pain, which signs/ symptoms would make the nurse suspect that the client is experiencing a myocardial infarction?1. Midepigastric pain and pyrosis.2. Diaphoresis and cool clammy skin.3. Intermittent claudication and pallor.4. Jugular vein distention and dependent edema

2. Diaphoresis and cool clammy skin.

The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first?1. Administer sublingual nitroglycerin.2. Obtain a STAT electrocardiogram.3. Have the client sit down immediately.4. Assess the client's vital signs.

3. Have the client sit down immediately.

The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement? Select all that apply.1. Administer morphine intramuscularly.2. Administer an aspirin orally.3. Apply oxygen via a nasal cannula.4. Place the client in a supine position.5. Administer nitroglycerin subcutaneously.

2. Administer an aspirin orally.3. Apply oxygen via a nasal cannula.

The client who has had a myocardial infarction is admitted to the telemetry unit from the intensive care. Which referral would be most appropriate for the client?1. Social worker.2. Physical therapy.3. Cardiac rehabilitation.4. Occupational therapy.

3. Cardiac rehabilitation.

The client is one day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first?1. Medicate the client with intravenous morphine.2. Assess the client's chest dressing and vital signs.3. Encourage the client to turn from side to side.4. Check the client's telemetry monitor.

2. Assess the client's chest dressing and vital signs.

The client diagnosed with a myocardial infarction is six hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse?1. The client is keep the affected extremity straight.2. The pressure dressing to the right femoral area is intact.3. The client is complaining of numbness in the right foot.4. The client's right pedal pulse is 3+ and bounding.

3. The client is complaining of numbness in the right foot.

The intensive care department nurse is assessing the client who is 12 hours post-myocardial infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement?1. Notify the health-care provider immediately.2. Elevate the head of the client's bed.3. Document this as a normal and expected finding.4. Administer morphine intravenously.

1. Notify the health-care provider immediately.

The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?1. The client's apical pulse is 64.2. The client's calcium level is elevated.3. The client's telemetry shows occasional PVCs.4. The client's blood pressure is 90/62.

4. The client's blood pressure is 90/62.

The client diagnosed with a myocardial infarction is on bedrest. The unlicensed assistive personnel (UAP) is encouraging the client to move the legs. Which action should the nurse implement?1. Instruct the UAP to stop encouraging the leg movements.2. Report this behavior to the charge nurse as soon as possible.3. Praise the UAP for encouraging the client to move legs.4. Take no action concerning the UAP's behavior.

3. Praise the UAP for encouraging the client to move legs.

The client diagnosed with a myocardial infarction asks the nurse, "why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response?1. "Your heart is damaged and needs about four to six weeks to heal."2. "There is necrotic myocardial tissue that puts you at risk for dysrhythmias."3. "Your doctor has ordered bedrest. Therefore, you must stay in the bed."4. "Just because your chest doesn't hurt anymore doesn't mean you are out of danger.

1. "Your heart is damaged and needs about four to six weeks to heal.

The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse?1. The client's BP is 110/70 and pulse is 90.2. The client's groin dressing is dry and intact.3. The client refuses to keep the leg straight.4. The client denies any numbness and tingling.

3. The client refuses to keep the leg straight.

The client is diagnosed with pericarditis. Which are the most common signs/symptoms the nurse would expect to find when assessing the client?1. Pulsus paradoxus.2. Complaints of fatigue and arthralgias.3. Petechiae and splinter hemorrhages.4. Increased chest pain with inspiration.

4. Increased chest pain with inspiration.

The client is diagnosed with acute pericarditis. Which sign/symptom warrants immediate attention by the nurse?1. Muffled heart sounds.2. Nondistended jugular veins.Bounding peripheral pulses.4. Pericardial friction rub.

1. Muffled heart sounds.

The client is admitted to the medical unit to rule out carditis. Which question should the nurse ask the client during the admission interview to support this diagnosis?1. "Have you had a sore throat in the last month?"2. "Did you have rheumatic fever as a child?"3. "Do you have a family history of carditis?"4. "What over-the-counter (OTC) medication do you take?

2. "Did you have rheumatic fever as a child?

The client with pericarditis is prescribed an NSAID. Which teaching instruction should the nurse discuss with the client?1. Explain the importance of tapering off the medication.2. Discuss that the medication will make the client drowsy.3. Instruct the client to take the medication with food.4. Tell the client to take the medication when the pain level is around "8.

3. Instruct the client to take the medication with food.

The client diagnosed with pericarditis is complaining of increased pain. Which intervention should the nurse implement first?1. Administer oxygen via nasal cannula.2. Evaluate the client's urinary output.3. Assess the client for cardiac complications.4. Encourage the client to use the incentive spirometer.

3. Assess the client for cardiac complications.

The client diagnosed with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this client?1. Prepare for a pericardiocentesis.2. Request STAT cardiac enzymes.3. Perform a 12-lead electrocardiogram.4. Assess the client's heart and lung sounds.

1. Prepare for a pericardiocentesis.

The female client is diagnosed with rheumatic fever and prescribed penicillin, an antibiotic. Which statement indicates the client needs more teaching concerning the discharge teaching?1. "I must take all the prescribed antibiotics."2. "I may get a vaginal yeast infection with penicillin."3. "I will have no problems as long as I take my medication."4. "My throat culture was positive for a streptococcal infection.

3. "I will have no problems as long as I take my medication.

Which potential complication should the nurse assess for in the client with infective endocarditis who has embolization of vegetative lesions from the mitral valve?1. Pulmonary embolus.2. Cerebrovascular accident.3. Hemoptysis.4. Deep vein thrombosis.

2. Cerebrovascular accident.

Which nursing diagnosis would be priority for the client diagnosed with myocarditis?1. Anxiety related to possible long-term complications.2. High risk for injury related to antibiotic therapy.3. Increased cardiac output related to valve regurgitation.4. Activity intolerance related to impaired cardiac muscle function.

4. Activity intolerance related to impaired cardiac muscle function.

The client with pericarditis is being discharged home. Which intervention should the nurse include in the discharge teaching?1. Be sure to allow for uninterrupted rest and sleep.2. Refer client to outpatient occupational therapy.3. Maintain oxygen via nasal cannula at two L/min.4. Discuss upcoming valve replacement surgery.

1. Be sure to allow for uninterrupted rest and sleep.

The client has just had a pericardiocentesis. Which interventions should the nurse implement? Select all that apply.1. Monitor vital signs every 15 minutes for the first hour. 2. Assess the client's heart and lung sounds.3. Record the amount of fluid removed as output.4. Evaluate the client's cardiac rhythm.5. Keep the client in the supine position.

1. Monitor vital signs every 15 minutes for the first hour. 2. Assess the client's heart and lung sounds.3. Record the amount of fluid removed as output.4. Evaluate the client's cardiac rhythm.

The client with infective endocarditis is admitted to the medical department. Which health-care provider's order should be implemented first?1. Administer intravenous antibiotic.2. Obtain blood cultures times two.3. Schedule an echocardiogram.4. Encourage bedrest with bathroom privileges.

2. Obtain blood cultures times two.

Arterial Blood Pressure

It is the pressure differences between the left and right sides of the heart that produce the gradient allowing systemic movement of bloodArterial blood pressure is produced by the force of left ventricular contraction overcoming the resistance of the aorta to open the aortic valve

Determinants of Systemic Blood Pressure

Cardiac output and the resistance to the ejection of blood from the heartCO = SV (stroke volume) x HR (heart rate)End-diastolic volume is the preloadSystemic vascular resistance (afterload) is determined by the radius of arteries and degree of vessel compliance

Determinants of Systemic Blood Pressure**Know**

Cardiac output and the resistance to the ejection of blood from the heartCO = SV (stroke volume) x HR (heart rate)End-diastolic volume is the preloadSystemic vascular resistance (afterload) is determined by the radius of arteries and degree of vessel compliance

Measurement of Blood Pressure

Components of blood pressure measurementSystolic blood pressure—peak pressure during cardiac systoleDiastolic blood pressure—lowest pressure during cardiac diastoleSV is the primary factor influencing systolic pressureSVR is the major determinant of diastolic pressure

Components of blood pressure measurement

Mean arterial pressure is the calculated average pressure within the circulatory system throughout the cardiac cycleMAP = (2 x diastolic pressure) + systolic pressure 3

Direct Measurement of Blood Pressure

Requires intraarterial catheter to transduce arterial fluid pulsations into electrical signals (waveforms)Catheter commonly placed in radial arteryMost accurate method of measuring blood pressure

Indirect Measurement of Blood Pressure

Commonly measured indirectly via the brachial artery using a stethoscope and sphygmomanometer or automated oscillometric systemRequires careful technique to ensure accuracyAuscultation of Korotkoff sounds

Mechanisms of Blood Pressure Regulation

Affected by neural, humoral, and renal factorsBlood pressure fluctuates over 24 hours due to physiologic changes associated with circadian rhythm

Short-Term Regulation of Systemic BloodPressure

Changes in BP are mediated through activation of the sympathetic nervous systemResults in release of neurotransmitters epinephrine and norepinephrineVasomotor center indirectly activated via baroreceptorsActivates α1 receptors in smooth muscle of arteriolesActivates β1 receptors of the heart

Long-Term Regulation of Systemic BloodPressure

Increase in extracellular fluid volume = increased CO and SVR = elevated BPIncreased serum sodium level = increased osmolality = increased ADH secretionRenin-angiotensin-aldosterone system (RAAS) important regulator of BP

Mechanisms of Blood Pressure Regulation; Long-Term Regulation of Systemic BloodPressure

Angiotensin II produces an increase in SVRAtrial natriuretic peptides cause kidneys to increase sodium and water excretion by increasing the glomerular filtration rateIntrarenal arteriolar constriction leads to increased tubular reabsorption of sodium and water

Normal Fluctuations in Systemic BloodPressure

Suprachiasmatic nuclei in the brain govern daily variations in bodily functionsNeural and hormonal regulation influences BPLifestyle influences can affect BP

Hypertension

Most common primary diagnosis in the United StatesIncreases morbidity and mortality associated with heart disease, kidney disease, peripheral vascular disease, and strokeResponsible for an annual worldwide death rate of 7 million

Definition and ClassificationHypertension

Determined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressurePrehypertension is a range of pressures between normal and stage 1 hypertension in an effort to initiate interventions early enough to prevent or deter progression of the disease process

Primary Hypertension

Idiopathic disorderMost common form of hypertensionRare prior to the age of 10

Primary Hypertension Subtypes

Isolated systolic hypertensionIsolated diastolic hypertensionCombined systolic and diastolic hypertensionSBP is a major risk factor for subsequent cardiovascular disease

Primary Hypertension Risk factors

Nonmodifiable-Family historyAgeModifiable-Dietary factorsSedentary lifestyleObesityMetabolic syndrome

Primary HypertensionOutcomes

End-organ damageIncreased myocardial work results in heart failureGlomerular damage results in kidney failureAffects microcirculation of the eyesIncreased pressure in cerebral vasculature can result in hemorrhage

Primary HypertensionTreatment interventions

Lifestyle modifications are first and most important prevention and treatment strategyDrug therapy for hypertension address heart rate, SVR, and stroke volume

Secondary Hypertension

Hypertension attributed to a specific identifiable pathology or conditionMost common form in children <10 years of ageMay be related to:Renal diseaseCoarctation of the heartPregnancyObesity/obstructive sleep apneaEndocrine disorders

Hypertensive Emergencies and Urgency

Hypertensive emergency: sudden increase in either or both systolic or diastolic blood pressure with evidence of end-organ damageRapid but controlled reduction of blood pressure using parenteral antihypertensive agents under close monitoring (typically in ICU setting)Hypertensive urgency: similar blood pressure elevation without evidence of end-organ damageOral medications to bring blood pressure under control over 24-48 hours

Low Blood Pressure

Orthostatic (postural) hypotension is a decrease in systolic blood pressure (>20 mm Hg or >10 mm Hg within 3 minutes) when moving to an upright positionExcessive increase in heart rate (by 20-30 beats/minute) may also be diagnosticMay be a result of:Problem with vasomotor or baroreceptor responseAdverse effect of drug therapyArterial stiffnessVolume depletionSecondary disease process

Low Blood Pressure Treatment

Review medication historySlow positional changesAvoid hot environmentsAvoid large or carbohydrate-heavy mealsWhen symptoms begin, squatting/bending forward or crossing legs may reduce effects

How do changes in cardiac output and systemic vascular resistance affect blood pressure?

The formula for blood pressure is: BP = cardiac output (CO) × systemic vascular resistance (SVR). Therefore, a change in either CO or SVR will result in a direct change in blood pressure (increase in CO or SVR causes an increase in BP; decrease in CO or SVR causes a decrease in BP) (pgs. 332-335).

How is blood pressure regulated on a short- and long-term basis?

Blood pressure is regulated on a short-term basis through the interaction of the carotid and aortic baroreceptors, the vasomotor center in the brainstem, and the activations of the sympathetic nervous system and inhibition of the parasympathetic nervous system influences on the heart and smooth muscle in the arterioles. Short-term regulation primarily involves heart rate and SVR. Regulation of blood pressure on a long-term basis is complex, involving the nervous system, release of hormones, and responses of the kidneys to pressure changes (pgs. 336-338).

What are the risk factors for the development of primary hypertension?

Risk factors for the development of primary hypertension include non-modifiable risk factors, such as increasing age and family history, and modifiable risk factors, such as obesity, sedentary lifestyle, metabolic syndrome, dietary factors, and tobacco use (pgs. 339-340).

How is secondary hypertension defined, and what are the common etiologies?

Secondary hypertension is due to a specific identifiable cause. The common etiologies of secondary hypertension include renal disease or disorders, coarctation of the aorta, tumors, and endocrine disorders, and may also be associated with pregnancy, or obstructive sleep apnea (pgs. 341-344).

How is hypertension detected, classified, and managed?

Hypertension is detected by routine screening in most cases as it is typically asymptomatic until it causes symptoms of end-organ damage. It is classified as prehypertension (systolic BP 121-139 mm Hg or diastolic BP 81-89 mm Hg); stage I hypertension (systolic BP 140-159 or diastolic BP 90-99 mm Hg); stage 2 hypertension (systolic BP >160 or diastolic BP >100 mm Hg). It is managed with lifestyle modifications and medications, including diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and aldosterone antagonists (pgs. 341-342).

What are the end-organ consequences of inadequately controlled hypertension?

End-organ consequences of inadequately controlled hypertension include renal failure, cardiovascular disease, heart failure, angina, myocardial infarction, stroke, and blindness from retinopathy (pgs. 340-341).

What are the differences between hypertensive emergency and hypertensive urgency and how are they managed?

Hypertensive emergencies are characterized by a sudden increase in either or both systolic and diastolic pressures accompanied by evidence of acute end-organ damage, whereas hypertensive urgency is used to describe similar elevations in blood pressure without end-organ damage. Hypertensive emergencies are managed as a medical emergency with rapid but controlled reduction of blood pressure using primarily parenteral antihypertensive agents with close monitoring in a critical care setting. Hypertensive urgency is brought under control over 24-48 hours with oral antihypertensive agents, and causative sources are explored (pg. 344-345).

What are the risk factors for orthostatic hypotension, and how is the condition managed?

Orthostatic hypotension may be the result of a number of pathologies involving the baroreceptor response, damage to the vasomotor center or the peripheral nervous system, a vasovagal reaction, cardiac dysrhythmias, or an adverse drug effect. Risk factors include advanced age, dehydration, alcohol ingestion and exposure to heat. Specific causes are treated appropriately, such as rehydration for the dehydrated state, or treatment of dysrhythmias. However, orthostatic hypotension is often caused by physiologic conditions that are not amenable to treatment and patients must be taught how to make changes to avoid hypotensive events. These include slow positional changes, avoiding exposure to heat and large or carbohydrate-heavy meals, regular intake of fluids, and safety measures to avoid injury, such as squatting and bending forward. Compression stockings and abdominal binders may also be used (pgs. 345-346).

Which is a major determinant of diastolic blood pressure?

Vascular resistance

Which best defines systolic blood pressure?

Occurs during ventricular contraction

Which term is determined by stroke volume, speed of ejection, and arterial distensibility?

Pulse pressure

Cardiac output is the product of both

Stroke volume and heart rate

Which receptor is responsible for innervation of the arterioles?

α-1

Which statement is true about baroreceptors?

An increase in pressure causes an increase in impulse discharge.

What is another name for vasopressin?

Antidiuretic hormone

Which term is used to identify hypertension that has a specific disease as its cause?

Secondary

Which situation causes an increase in blood pressure?

Intracerebral hemorrhage

Which statement is true regarding hypertension during pregnancy?

Cardiac output (CO) is reduced by 40% to 60% during pregnancy.

Which statement is true regarding hypertension?

High blood pressure can be associated with headache and seizures

Systemic vascular resistance (SVR) can be indirectly estimated with the use of which blood pressure measurement?

Diastolic pressure

Aortic and carotid baroreceptors are activated by ___________, resulting in ___________.

decreased blood pressure; an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure

The renin-angiotensin system (RAS) alters blood pressure in response to

Decreased perfusion to the kidney

What stimulates the release of renin? (Select all that apply.)

Renal hypoperfusion, sympathetic activation, and decreased sodium delivery stimulate renin release.Increased heart rate and parasympathetic activation do not stimulate the release of renin

What causes vasodilation? (Select all that apply.)

Nitric oxide, histamine, and kinins cause vasodilation. Angiotensin II is one of the most potent vasoconstrictors. The other three choices all cause vasodilation. A vasopressor agent is any medication that tends to raise reduced blood pressure.

Which is a risk factor associated with hypertension? (Select all that apply.)

Normal aging produces a rising systolic pressure over the course of a lifetime, whereas diastolic pressure increases for approximately 50 years, levels off during the sixth decade, and remains stable or declines later on. African Americans are predisposed to hypertension. Also, tobacco use has been shown to increase the risk of hypertension. Being Caucasian is not a known risk factor for hypertension. Diets high in fat and sodium, and <u>low</u> in potassium have been found to increase the risk of developing hypertension.

Which condition is an endocrine disorder that causes elevated blood pressure? (Select all that apply.)

Endocrine disorders that result in hypertension include Cushing disease and hyperthyroidism.

Systemic blood pressure is determined by which factor(s)? (Select all that apply.)

The systemic arterial blood pressure is the physiologic result of the cardiac output (CO) and the resistance to the ejection (SVR) of blood from the heart. Cardiac output is the product of two variables: stroke volume (SV) and heart rate (HR) (CO = SV × HR). SV is the specific volume of blood leaving the heart with each contraction. Pulmonary vascular resistance (PVR) is not a factor in determining systemic blood pressure.</div

Risk factors for the development of high blood pressure are which of the following? (Select all that apply.)

The older a person is, the less elastic the blood vessels are, which results in higher systemic vascular resistance. High blood pressure occurs two to three times more frequently in the African American population than in the Caucasian population. Diets high in fat and sodium have been associated with hypertension. An association with elevated body mass index and high blood pressure has been noted; however, the exact mechanism is unclear. Chronic illness will not necessarily result in hypertension

High blood pressure can be treated with lifestyle modification related to which of the following? (Select all that apply.)

A low-sodium diet decreases sodium retention and blood volume, altering stroke volume and cardiac output, which results in a lower blood pressure. Relaxation techniques help manage stress which helps lower blood pressure. Obesity is a major risk factor for hypertension. Exercise increases vascular tone, thus decreasing systemic vascular resistance and blood pressure. Medication therapy is not considered a lifestyle modification

A client has acute rhinitis. What is the most important intervention for the nurse to perform?a.Assess for symptoms of infection.b.Ascertain whether the client has allergies.c.Question the client on the use of nasal sprays.d.Do blood and urine screenings for drug use.

a

A client has pharyngitis. Which symptom helps the nurse determine whether the infection is bacterial versus viral?a.Redness in the back of the throatb.Enlarged lymph glands in the neckc.Nasal discharged.Skin rash

d

It is suspected that a client has bacterial pharyngitis. What is the best intervention?a.Administer a broad-spectrum antibiotic.b.Have the client produce a sputum specimen.c.Obtain samples for culture and sensitivity.d.Assess a rapid antigen test (RAT).

d

The nurse is caring for a client with recurrent bacterial pharyngitis. Which is the nurse's highest priority intervention?a.Assess for symptoms of human immune deficiency virus (HIV).b.Ask about exposure to allergens.c.Perform nasal cultures.d.Teach the client about antibiotic therapy.

d

A client who has had acute tonsillitis develops drooling and reports severe throat pain. What is the nurse's priority intervention?a.Assess the throat for deviation of the uvula.b.Prepare the client for surgery.c.Teach the client about antibiotic therapy.d.Prepare the client for percutaneous needle aspiration.

a

The nurse has determined that a client has an acute sore throat. What is the nurse's best action?a.Assess whether the client can speak.b.Call an ear-nose-throat specialist.c.Administer an antibiotic.d.Give the client ice chips.

a

A client who is immune compromised develops muscle aches and fever. The client is admitted to the hospital for several days and is diagnosed with influenza. At discharge, the client asks when he can go back to work. What is the nurse's best response?a."You should be able to return to work in 5 days."b."You can return to work as soon as you feel ready."c."You cannot return to work for several weeks."d."You will need to have cultures performed before returning to work.

c

A client is worried about contracting influenza. What is the nurse's best response to the client?a."Flu is no longer a prevalent problem."b."Did you receive a flu vaccine this year?"c."Current flu strains are generally mild."d."If you develop symptoms, antibiotics will cure you.

b

The nurse assesses a client with pneumonia and notes decreased lung sounds on the left side and decreased lung expansion. What is the nurse's best action?a.Have the client cough and deep breathe.b.Check oxygen saturation and notify the health care provider.c.Perform an arterial blood gas analysis.d.Increase oxygen flow to 10 L/min.

b

An older adult is admitted to the emergency department with respiratory symptoms. Which client symptom requires the nurse to intervene immediately?a.Confusionb.Scattered wheezingc.Cracklesd.Flushed cheeks

a

Which is the highest priority goal to set for a client with pneumonia?a.Absence of cyanosisb.Maintenance of SaO2 of 95%c.Walking 20 feet three times dailyd.Absence of confusion

b

The nurse is teaching a client with pneumonia ways to clear secretions. Which intervention is the most effective?a.Administering an antitussive medicationb.Administering an antiemetic medicationc.Increasing fluids to 2 L/day if toleratedd.Having the client cough and deep breathe hourly

c

A client who works in a day care facility is admitted to the emergency department. The client is diagnosed with pneumonia, and a sputum culture is taken. Infection with Streptococcus pneumoniae is confirmed. What is the nurse's primary action?a.Have emergency intubation equipment nearby.b.Teach the client about the treatment.c.Isolate the client.d.Perform chest physiotherapy.

c

What is the priority nursing intervention when caring for a client with severe acute respiratory syndrome (SARS)?a.Maintaining Standard Precautionsb.Administering antibioticsc.Assessing oxygenationd.Making sure the client stays hydrated

c

The newly employed nurse received a bacillus Calmette-Guérin (BCG) vaccine before moving to the United States. The nurse needs to receive a tuberculin (TB) test as part of the pre-employment physical. What does the nurse do?a.The nurse should not receive the tuberculin test.b.The nurse will need a two-step TB test.c.The nurse will need a chest x-ray instead.d.A physician should examine the nurse before the TB test is given.

c

The nurse is caring for several clients on a respiratory floor. The nurse should place the client with which condition in isolation?a.Fever and weight lossb.Negative QuantiFERON TB gold testc.Negative acid-fast bacillus (AFB) staind.Positive nucleic acid amplification test (NAAT)

d

A client has multidrug-resistant tuberculosis (TB). What is the most important fact for the nurse to teach the client?a."You will need to take medications longer than clients with other strains."b."You will need to remain in the hospital until cultures are negative."c."You will need to wear a mask when you go out in public."d."You will need to have drug cultures done weekly.

c

The nurse is worried that a client who is not entirely reliable is being discharged home on therapy for multidrug-resistant tuberculosis. What strategy is the best to use for this client?a.Directly observed therapyb.IV drug administrationc.Remaining in the hospitald.Isolation

a

A client is admitted with suspected avian influenza. The family asks the nurse what kind of care the client will get. Which statement by the nurse is correct?a."He will be given standard antibiotic agents and will be placed in contact isolation."b."He will be placed on airborne and contact isolation."c."Oseltamivir (Tamiflu) will reduce complications of this infection."d."All family members should be tested for evidence of the same disease.

b

Which client does the nurse caution to avoid taking over-the-counter decongestants for manifestations of a cold or flu?a.Young man with a latex allergyb.Middle-aged woman with hypertensionc.Teenage woman who is taking oral contraceptivesd.Older man who has had type 1 diabetes mellitus for 20 years

b

An older client reports having a cold and a "full bladder." What does the nurse obtain for or from the client?a.Order for a Foley catheterb.Order for a one-time catheterizationc.Urine specimend.History focusing on current medications

d

A client has a peritonsillar abscess. Which priority instruction does the nurse provide to this client?a."If you notice an enlarged node on the side of your neck where the abscess is, call your health care provider."b."Stay home from work or school until your temperature has been normal for 24 hours."c."You may gargle with warm water that has a teaspoon of salt in it as often as you like."d."Take the antibiotic for the entire time it is prescribed, not just until you feel better.

d

An older adult client with heart failure asks if she should get a flu shot. Which is the nurse's best response?a."Yes, because of your heart failure you are at greater risk for complications."b."Yes, if it has been longer than 5 years since your last flu vaccination."c."No, your heart failure makes you too weak to get the live virus vaccine."d."No, the vaccine will interact with your heart medications.

a

Which person is at greatest risk for developing a community-acquired pneumonia?a.Middle-aged teacher who typically eats a diet of Asian foodsb.Older adult who smokes and has a substance abuse problemc.Older adult with exercise-induced wheezingd.Young adult aerobics instructor who is a vegetarian

b

Which is the nurse's best response to an older adult client who is hesitant to take the pneumococcal vaccination and influenza vaccine in the same year?a."You need both injections. A risk factor for getting pneumonia is infection with influenza."b."Take both injections. They will protect you against respiratory problems for this year."c."The flu shot may protect you against influenza but not against bacteria that cause pneumonia."d."You should get the pneumococcal vaccination so you won't infect other people.

c

Which is a priority teaching intervention for the client who is using a nicotine patch?a."Abruptly discontinuing this patch can cause high blood pressure."b."Abruptly discontinuing this patch can cause nausea and vomiting."c."Smoking while using this patch increases the risk for pneumonia."d."Smoking while using this patch increases the risk for a heart attack.

d

A client is admitted with left lower lung pneumonia. Which assessment finding does the nurse correlate with this condition?a.Expiratory wheeze on the right sideb.Dullness to percussion on the lower left sidec.Crepitus of the skin around the left lungd.Crackles heard on expiration bilaterally

b

The nurse auscultates the following lung sound in the client with pneumonia. What is the best intervention? (Click the media button to hear the audio clip.)a.Have the client cough and deep breathe.b.Prepare to administer a bronchodilator.c.Have the client use an incentive spirometer.d.Administer IV fluids.

c

A client has a tuberculin skin test as a pre-employment physical requirement. Which statement by the nurse is best made to the client who has the test result seen in the photograph below?a."Your PPD is negative. No further follow-up is necessary."b."You will need to have a second PPD."c."You will need to have titers drawn."d."You will need further testing.

d

What teaching is appropriate for a client with acute rhinitis and sinusitis? (Select all that apply.)a.Using hot packs over the sinusesb.Fluid restrictionc.Saline irrigationsd.Staying in a dry climatee.Taking echinaceaf.Antifungal medications

a,c,e

A client enters the clinic with an acute sore throat and a temperature of 101.5° F (38.5° C). What diagnostic testing does the nurse educate the client about? (Select all that apply.)a.Complete blood count (CBC)b.Throat culturec.Monospot testd.Arterial blood gase.Biopsyf.HIV testing

a,b,c

What is the best way for the nurse to decrease the risk of ventilator-associated pneumonia (VAP) in a ventilator-dependent client? (Select all that apply.)a.Provide prophylactic antibiotics.b.Provide frequent oral care.c.Keep the head of the bed elevated.d.Maintain good hand hygiene.e.Perform chest percussion frequently.

b,c,d

A client who previously had a bacillus Calmette-Guérin (BCG) vaccine has a positive tuberculosis (TB) test. What symptoms assist in determining that the client has active disease? (Select all that apply.)a.Nauseab.Weight lossc.Insomniad.Ankle edemae.Night sweatsf.Increased urination

a,b,e

A client started on therapy for tuberculosis infection is reporting nausea. What does the nurse teach this client? (Select all that apply.)a.Eat a diet rich in protein, iron, and vitamins.b.Do not drink fluids with medications.c.Take medications at bedtime.d.Space medications 12 hours apart.e.Take medications with milk.f.Take an antiemetic daily.

a,c,f

The nurse is caring for a client who is suspected of having severe acute respiratory syndrome (SARS). What actions by the nurse are most appropriate? (Select all that apply.)a.Wash hands when entering the client's room and use Standard Precautions.b.Wear a gown and goggles when entering the client's room.c.Teach the client to wear a mask at all times when someone is in the room.d.Use a disposable particulate mask respirator when the client is coughing.e.Keep the door to the client's room open to allow close monitoring.f.Place the client in a negative airflow room, if available in the facility.

b,d,f

The nurse is caring for a client who has inhalation anthrax. What nursing actions are of the highest priority? (Select all that apply.)a.Placing the client in an isolation roomb.Teaching the client how to use a maskc.Teaching the client about long-term antibiotic therapyd.Using handwashing and other Standard Precautionse.Reporting suspected cases to the proper authorities

c,d,e

A client's cardiac status is being observed by telemetry monitoring. The nurse observes a P wave that changes shape in lead II. What conclusion does the nurse make about the P wave?a. It originates from an ectopic focus.b. The P wave was replaced by U waves.c. It is from the sinoatrial (SA) node.d. Multiple P waves are present.

A

The nurse is assessing the client's electrocardiography (ECG). What does the P wave on the ECG tracing represent?a. Contraction of the atriab. Contraction of the ventriclesc. Depolarization of the atriad. Depolarization of the ventricles

C

A nurse notes that the PR interval on a client's electrocardiograph (ECG) tracing is 0.14 second. What action does the nurse take?a. Assess serum cardiac enzymes.b. Administer 1 mg epinephrine IV.c. Administer oxygen via nasal cannula.d. Document the finding in the client's chart.

D

When analyzing a client's electrocardiograph (ECG) tracing, the nurse observes that not all QRS complexes are preceded by a P wave. What is the nurse's interpretation of this observation?a. The client has hyperkalemia causing irregular QRS complexes.b. Ventricular tachycardia is overriding the normal atrial rhythm.c. The client's chest leads are not making sufficient contact with the skin.d. Ventricular and atrial depolarizations are initiated from different sites.

D

The nurse observes a prominent U wave on the client's electrocardiograph (ECG) tracing. What is the most appropriate action for the nurse to take?a. Document the finding as a normal variant.b. Review the client's daily electrolyte results.c. Move the crash cart closer to the client's room.d. Call for an immediate electrocardiogram.

B

The client's heart rate increases slightly during inspiration and decreases slightly during expiration. What action does the nurse take?a. Evaluate for a respirator disorder.b. Assess the client for chest pain.c. Document the finding in the chart.d. Administer antidysrhythmic drugs.

C

A client with tachycardia is experiencing clinical manifestations. Which manifestation requires immediate intervention by the nurse?a. Mid-sternal chest painb. Increased urine outputc. Mild orthostatic hypotensiond. P wave touching the T wave

A

A client is experiencing sinus bradycardia with hypotension and dizziness. What medication does the nurse administer?a. Atropine (Atropine)b. Digoxin (Lanoxin)c. Lidocaine (Xylocaine)d. Metoprolol (Lopressor)

A

A client experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. What instruction does the nurse include in the client's teaching plan?a. "Minimize or abstain from caffeine."b. "Lie on your side until the attack subsides."c. "Use your oxygen when you experience PACs."d. "Take quinidine (Cardioquin) daily to prevent PACs.

A

The nurse identifies a client's rhythm to be a sustained supraventricular tachycardia. What medication does the nurse administer?a. Atropine (Atropine)b. Epinephrine (Adrenalin)c. Lidocaine (Xylocaine)d. Diltiazem (Cardizem)

D

A client has a heart rate averaging 56 beats/min with no adverse symptoms. What activity modifications does the nurse suggest to avoid further slowing of the heart rate?a. "Make certain that your bath water is warm (100° F)."b. "Avoid bearing down or straining while having a bowel movement."c. "Avoid strenuous exercise, such as running, during the late afternoon."d. "Limit your intake of caffeinated drinks to no more than 2 cups per day.

B

The nurse is assessing clients at a community clinic. Which client does the nurse assess most carefully for atrial fibrillation?a. Middle-aged client who takes an aspirin dailyb. Client who is dismissed after coronary artery bypass surgeryc. Older adult client after a carotid endarterectomyd. Client with chronic obstructive pulmonary disease

B

The nurse is caring for a client on a cardiac monitor. The monitor shows a rapid rhythm with a "saw tooth" configuration. What physical assessment findings does the nurse expect?a. Presence of a split S1 and wheezingb. Anorexia and gastric distressc. Shortness of breath and anxietyd. Hypertension and mental status changes

C

The nurse is caring for a client with atrial fibrillation. What manifestation most alerts the nurse to the possibility of a serious complication from this condition?a. Sinus tachycardiab. Speech alterationsc. Fatigued. Dyspnea with activity

B

The nurse is caring for a client with chronic atrial fibrillation. Which drug does the nurse expect to administer to prevent a common complication of this condition?a. Sotalol (Betapace)b. Warfarin (Coumadin)c. Atropine (Atropine)d. Lidocaine (Xylocaine)

B

The nurse is caring for a client admitted for myocardial infarction. The client's monitor shows frequent premature ventricular contractions (PVCs). What dysrhythmia does the nurse remain alert for?a. Sinus tachycardiab. Rapid atrial flutterc. Ventricular tachycardiad. Atrioventricular junctional rhythm

C

A client with myocardial ischemia is having frequent early, wide ventricular complexes seen on the cardiac monitor. Which medication does the nurse administer?a. Lanoxin (Digoxin)b. Amiodarone (Cordarone)c. Dobutamine (Dobutamine)d. Atropine sulfate (Atropisol)

B

The nurse has administered adenosine (Adenocard). What is the expected therapeutic response?a. Increased intraocular pressureb. A brief tonic-clonic seizurec. A short period of asystoled. Hypertensive crisis

C

A client's electrocardiograph (ECG) tracing shows a run of sustained ventricular tachycardia. What is the nurse's first action?a. Assess airway, breathing, and level of consciousness.b. Administer an amiodarone bolus followed by a drip.c. Cardiovert the client with a biphasic defibrillator.d. Begin cardiopulmonary resuscitation (CPR).

A

A client with unstable ventricular tachycardia is receiving amiodarone by intravenous infusion. The nurse notes that the client's heart rate has decreased from 68 to 50 beats/min. The client is asymptomatic. What is the nurse's priority intervention?a. Stop the infusion and flush the IV.b. Slow the amiodarone infusion rate.c. Administer a precordial thump.d. Place the client in a side-lying position.

B

A client with ischemic heart disease has an electrocardiograph (ECG) tracing that shows a PR interval of 0.24 second. What is the nurse's best action?a. Document the finding in the chart.b. Measure blood pressure.c. Notify the health care provider.d. Administer oxygen.

A

The physician is about to perform carotid sinus massage on a client with supraventricular tachycardia. What equipment is most important for the nurse to have ready?a. Emesis basinb. Magnesium sulfatec. Resuscitation cartd. Padded tongue blade

C

The nurse is caring for a client with a complete heart block (third-degree atrioventricular [AV] block). What is the nurse's priority intervention?a. Perform a cardioversion.b. Assist with carotid massage.c. Begin external pacing.d. Administer adenosine (Adenocard) IV.

C

A client with third-degree heart block is admitted to the telemetry unit. The nurse observes wide QRS complexes on the monitor with a heart rate of 35 beats/min. What priority assessment does the nurse perform?a. Pulmonary auscultationb. Pulse strength and amplitudec. Level of consciousnessd. Mobility and gait stability

C

The nurse is caring for a client with a temporary pacemaker. The client's bedside monitor shows a spike followed by a QRS complex. What is the nurse's best action?a. Remove the pacemaker; it is not needed.b. Decrease the threshold of the pacemaker.c. Document the finding in the client's chart.d. Set the pacemaker to the synchronous mode.

C

A client with ventricular tachycardia (VT) is unresponsive and has no pulse. The nurse calls for assistance and a defibrillator. What is the nurse's priority intervention while waiting for the defibrillator to arrive?a. Perform a pericardial thump.b. Initiate cardiopulmonary resuscitation.c. Start an 18-gauge IV in the antecubital.d. Ask the client's family about code status.

B

A client has an epicardial pacemaker. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiograph (ECG) tracing. How does the nurse interpret this event?a. Loss of captureb. Ventricular fibrillationc. Failure to sensed. A normal tracing

A

The nurse is assisting with resuscitation of a client. What priority intervention does the nurse perform before defibrillating a client?a. Make sure the defibrillator is set to the synchronous mode.b. Deliver a precordial thump to the upper portion of the sternum.c. Test the equipment by delivering a smaller shock at 100 J.d. Ensure that all personnel are clear of contact with the client and the bed.

D

The nurse is recovering a client after insertion of an implantable cardioverter-defibrillator (ICD). What complication must the nurse intervene for immediately?a. 2/4 bilateral peripheral edemab. Heart rate of 56 beats/minc. Temperature of 96° F (35.5° C)d. Muffled heart sounds

D

A client was admitted for a permanent pacemaker insertion. What priority instruction does the nurse include in the client's discharge teaching?a. "Do not submerge your pacemaker, take only showers."b. "Report pulse rates lower than your pacemaker setting."c. "If you feel weak, apply pressure over your generator."d. "Have your pacemaker turned off before having an MRI.

B

The nurse is providing discharge instructions for a client with an implantable cardioverter-defibrillator (ICD). What statement by the client indicates a good understanding of the instructions?a. "I should wear a snug-fitting shirt over the ICD."b. "I will avoid sources of strong electromagnetic fields."c. "I can't perform activities that increase my heart rate."d. "Now I can discontinue my antidysrhythmic medication.

B

A client has a consistently regular heart rate of 128 beats/min. Which related physiologic alterations does the nurse assess for? (Select all that apply.)a. Decrease in cardiac outputb. Increase in cardiac outputc. Increase in blood pressured. Decrease in blood pressuree. Increase in urine output

A,D

A client is admitted with early-stage heart failure. Which assessment finding does the nurse expect?a. A decrease in blood pressure and urine outputb. An increase in creatinine and extremity edemac. An increase in heart rate and respiratory rated. A decrease in respirations and oxygen saturation

C

A client with systolic dysfunction has an ejection fraction of 38%. The nurse assesses for which physiologic change?a. Increase in stroke volumeb. Decrease in tissue perfusionc. Increase in oxygen saturationd. Decrease in arterial vasoconstriction

B

The nurse is assessing clients on a cardiac unit. Which client does the nurse assess most carefully for developing left-sided heart failure?a. Middle-aged woman with aortic stenosisb. Middle-aged man with pulmonary hypertensionc. Older woman who smokes cigarettes dailyd. Older man who has had a myocardial infarction

A

The nurse is assessing a client in an outpatient clinic. Which client statement alerts the nurse to possible left-sided heart failure?a. "I have been drinking more water than usual."b. "I have been awakened by the need to urinate at night."c. "I have to stop halfway up the stairs to catch my breath."d. "I have experienced blurred vision on several occasions.

C

A client with a history of myocardial infarction calls the clinic to report the onset of a cough that is troublesome only at night. What direction does the nurse give to the client?a. "Please come into the clinic for an evaluation."b. "Increase your fluid intake during waking hours."c. "Use an over-the-counter cough suppressant."d. "Sleep on two pillows to facilitate postnasal drainage.

A

The nurse is assessing a client admitted to the cardiac unit. What statement made by the client alerts the nurse to the possibility of right-sided heart failure?a. "I sleep with four pillows at night."b. "My shoes fit really tight lately."c. "I wake up coughing every night."d. "I have trouble catching my breath.

B

The nurse notes that the client's apical pulse is displaced to the left. What conclusion can be drawn from this assessment?a. This is a normal finding.b. The heart is hypertrophied.c. The left ventricle is contracted.d. The client has pulsus alternans.

B

The nurse assesses a client and notes the presence of an S3 gallop. What is the nurse's best intervention?a. Assess for symptoms of left-sided heart failure.b. Document this as a normal finding.c. Call the health care provider immediately.d. Transfer the client to the intensive care unit.

A

A client asks the nurse why it is important to be weighed every day if he has right-sided heart failure. What is the nurse's best response?a. "Weight is the best indication that you are gaining or losing fluid."b. "Daily weights will help us make sure that you're eating properly."c. "The hospital requires that all inpatients be weighed daily."d. "You need to lose weight to decrease the incidence of heart failure.

A

A client has been admitted to the intensive care unit with worsening pulmonary manifestations of heart failure. What is the nurse's best action?a. Place the client in a high Fowler's position.b. Begin cardiopulmonary resuscitation (CPR).c. Promote rest and minimize activities.d. Administer loop diuretics as prescribed.

D

A client with heart failure is experiencing acute shortness of breath. What is the nurse's priority action?a. Place the client in a high Fowler's position.b. Perform nasotracheal suctioning of the client.c. Auscultate the client's heart and lung sounds.d. Place the client on a 1000 mL fluid restriction.

A

A client with heart failure is prescribed enalapril (Vasotec). What is the nurse's priority teaching for this client?a. "Avoid using salt substitutes."b. "Take your medication with food."c. "Avoid using aspirin-containing products."d. "Check your pulse daily.

A

The nurse is administering captopril (Capoten) to a client with heart failure. What is the priority intervention for this client?a. Administer this medication before meals to aid absorption.b. Instruct the client to ask for assistance when arising from bed.c. Give the medication with milk to prevent stomach upset.d. Monitor the potassium level and check for symptoms of hypokalemia.

B

The client who just started taking isosorbide dinitrate (Imdur) reports a headache. What is the nurse's best action?a. Titrate oxygen to relieve headache.b. Hold the next dose of Imdur.c. Instruct the client to drink water.d. Administer PRN acetaminophen.

D

The client with heart failure has been prescribed intravenous nitroglycerin and furosemide (Lasix) for pulmonary edema. Which is the priority nursing intervention?a. Insert an indwelling urinary catheter.b. Monitor the client's blood pressure.c. Place the nitroglycerin under the client's tongue.d. Monitor the client's serum glucose level.

B

The nurse is starting a client on digoxin (Lanoxin) therapy. What intervention is essential to teach this client?a. "Avoid taking aspirin or aspirin-containing products."b. "Increase your intake of foods high in potassium."c. "Hold this medication if your pulse rate is below 80 beats/min."d. "Do not take this medication within 1 hour of taking an antacid.

D

A client is taking triamterene-hydrochlorothiazide (Dyazide) and furosemide (Lasix). What assessment finding requires action by the nurse?a. Coughb. Headachec. Pulse of 62 beats/mind. Potassium of 2.9 mEq/L

D

The rehabilitation nurse is assisting a client with heart failure to increase activity tolerance. During ambulation of the client, identification of what symptom causes the nurse to stop the client's activity?a. Decrease in oxygen saturation from 98% to 95%b. Respiratory rate change from 22 to 28 breaths/minc. Systolic blood pressure change from 136 to 96 mm Hgd. Increase in heart rate from 86 to 100 beats/min

C

The nurse is concerned that an older adult client with heart failure is developing pulmonary edema. What manifestation alerts the nurse to further assess the client for this complication?a. Confusionb. Dysphagiac. Sacral edemad. Irregular heart rate

A

A client with a history of heart failure is being discharged. Which priority instruction will assist the client in the prevention of complications associated with heart failure?a. "Avoid drinking more than 3 quarts of liquids each day."b. "Eat six small meals daily instead of three larger meals."c. "When you feel short of breath, take an additional diuretic."d. "Weigh yourself daily while wearing the same amount of clothing.

D

A client has been admitted to the acute care unit for an exacerbation of heart failure. Which is the nurse's priority intervention?a. Assess respiratory status.b. Monitor electrolyte levels.c. Administer intravenous fluids.d. Insert a Foley catheter.

A

The nurse is caring for a client with mitral valve stenosis. What clinical manifestation alerts the nurse to the possibility that the client's stenosis has progressed?a. Oxygen saturation of 92%b. Dyspnea on exertionc. Muted systolic murmurd. Upper extremity weakness

B

The nurse is caring for a client diagnosed with aortic stenosis. What assessment finding does the nurse expect in this client?a. Bounding arterial pulseb. Slow, faint arterial pulsec. Narrowed pulse pressured. Elevated systolic pressure

C

A client who has had a prosthetic valve replacement asks the nurse why he must take anticoagulants for the rest of his life. What is the nurse's best response?a. "The prosthetic valve places you at greater risk for a heart attack."b. "Blood clots form more easily in artificial replacement valves."c. "The vein taken from your leg reduces circulation in the leg."d. "The surgery left a lot of small clots in your heart and lungs.

B

The nurse is discharging a client home following mitral valve replacement. What statement indicates that the client requires further education?a. "I will be able to carry heavy loads after 6 months of rest."b. "I will have my teeth cleaned by the dentist in 2 weeks."c. "I will avoid eating foods high in vitamin K, like spinach."d. "I will use an electric razor instead of a straight razor to shave.

B

The nurse is obtaining the admission health history for a young adult who presents with fever, dyspnea, and a murmur. What priority data does the nurse inquire about?a. Family history of coronary artery diseaseb. Recent travel to Third World countriesc. Pet ownership, especially cats with litter boxesd. History of a systemic infection within the past month

D

The nurse is providing care to a client with infective endocarditis. What infection control precautions does the nurse use?a. Standard Precautionsb. Bleeding Precautionsc. Reverse isolationd. Contact isolation

A

A client with pericarditis is admitted to the cardiac unit. What assessment finding does the nurse expect in this client?a. Heart rate that speeds up and slows downb. Friction rub at the left lower sternal borderc. Presence of a regularly gallop rhythmd. Coarse crackles in bilateral lung bases

B

The nurse is providing discharge education to a client with hypertrophic cardiomyopathy (HCM). What priority instruction will the nurse include?a. "Take your digoxin at the same time every day."b. "You should begin an aerobic exercise program."c. "You should report episodes of dizziness or fainting."d. "You may have only two alcoholic drinks daily.

C

The nurse reminds the client who has received a heart transplant to change positions slowly. Why is this instruction a priority?a. Rapid position changes can create shear and friction forces, which can tear out internal vascular sutures.b. The new vascular connections are more sensitive to position changes, leading to increased intravascular pressure.c. The new heart is denervated and is unable to respond to decreases in blood pressure caused by position changes.d. The recovering heart diverts blood flow away from the brain when the client stands, increasing the risk for stroke.

C

A client is being discharged home after a heart transplant with a prescription for cyclosporine (Sandimmune). What priority education does the nurse provide with the client's discharge instructions?a. "Use a soft-bristled toothbrush and avoid flossing."b. "Avoid large crowds and people who are sick."c. "Change positions slowly to avoid hypotension."d. "Check your heart rate before taking the medication.

B

A client with end-stage heart failure is awaiting a transplant. The client appears depressed and states, "I know a transplant is my last chance, but I don't want to become a vegetable." What is the nurse's best response?a. "Would you like to speak with a priest or chaplain?"b. "I will consult a psychiatrist to speak with you."c. "Do you want to come off the transplant list?"d. "Would you like information about advance directives?

D

The nurse is assessing a client with a history of heart failure. What priority question assists the nurse to assess the client's activity level?a. "Do you have trouble breathing or chest pain?"b. "Are you able to walk upstairs without fatigue?"c. "Do you awake with breathlessness during the night?"d. "Do you have new-onset heaviness in your legs?

B

An older adult client with heart failure states, "I don't know what to do. I don't want to be a burden to my daughter, but I can't do it alone. Maybe I should die." What is the nurse's best response?a. "Would you like to talk about this more?"b. "You're lucky to have such a devoted daughter."c. "You must feel as though you are a burden."d. "Would you like an antidepressant medication?

A

An older adult client is admitted with fluid volume excess. Which diagnostic study does the nurse facilitate as a priority?a. Echocardiographyb. Chest x-rayc. T4 and thyroid-stimulating hormone (TSH)d. Arterial blood gas

A

The nurse is caring for a client with severe heart failure. What is the best position in which to place this client?a. High Fowler's, pillows under armsb. Semi-Fowler's, with legs elevatedc. High Fowler's, with legs elevatedd. Semi-Fowler's, on the left side

A

The nurse is instructing a client with heart failure about energy conservation. Which is the best instruction?a. "Walk until you become short of breath and then walk back home."b. "Gather everything you need for a chore before you begin."c. "Pull rather than push or carry items heavier than 5 pounds."d. "Take a walk after dinner every day to build up your strength.

B

A client with heart failure is due to receive enalapril (Vasotec) and has a blood pressure of 98/50 mm Hg. What is the nurse's best action?a. Administer the Vasotec.b. Recheck the blood pressure.c. Hold the Vasotec.d. Notify the health care provider.

A

A client in severe heart failure has a heparin drip infusing. The health care provider prescribes nesiritide (Natrecor) to be given intravenously. Which intervention is essential before administration of this medication?a. Insert a separate IV access.b. Prepare a test bolus dose.c. Prepare the piggyback line.d. Administer furosemide (Lasix) first.

A

The nurse is assessing a client with left-sided heart failure. What conditions does the nurse assess for? (Select all that apply.)a. Pulmonary cracklesb. Confusion, restlessnessc. Pulmonary hypertensiond. Dependent edemae. S3/S4 summation gallopf. Cough worsens at night

A,B,E,F

The nurse is evaluating the laboratory results for a client with heart failure. What results does the nurse expect? (Select all that apply.)a. Hematocrit (Hct), 32.8%b. Serum sodium, 130 mEq/Lc. Serum potassium, 4.0 mEq/Ld. Serum creatinine, 1.0 mg/dLe. Proteinuriaf. Microalbuminuria

A, B, E, F

A client with atherosclerosis asks a nurse which factors are responsible for this condition. What is the nurse's best response?a. "Injury to the arteries causes them to spasm, reducing blood flow to the extremities."b. "Excess fats in your diet are stored in the lining of your arteries, causing them to constrict."c. "A combination of platelets and fats accumulates, narrowing the artery and reducing blood flow."d. "Excess sodium causes injury to the arteries, reducing blood flow and eventually causing obstruction.

C

The nurse is working with clients at a health fair. Which teaching takes priority to reduce the risk of atherosclerosis?a. Instructing a diabetic client not to smoke or use any tobaccob. Teaching diet changes to a client with elevated cholesterol levelsc. Suggesting limiting alcohol to an older client with hypolipidemiad. Encouraging exercise to an obese client who lives a sedentary lifestyle

A

A client with hyperlipidemia who is being treated with dietary fat restrictions and an exercise program asks the nurse why his serum lipid levels are still elevated. What activity by the nurse is most appropriate?a. Developing a very low-fat diet that the client will adhere tob. Explaining familial tendencies in hyperlipidemiac. Referring the client to a registered dietitian for weight lossd. Educating the client on antihyperlipidemic medications

B

A client with atherosclerosis is attempting to stop cigarette smoking with the use of a nicotine patch. Which statement by the client indicates a good understanding of smoking cessation education?a. "Abruptly discontinuing this patch can cause high blood pressure."b. "Abruptly discontinuing this patch can cause nausea and vomiting."c. "Smoking while using this patch increases the risk of respiratory infection."d. "Smoking while using this patch increases the risk of a heart attack.

D

A client with hypercholesterolemia and atherosclerosis is prescribed nicotinic acid (Niaspan). Which instruction does the nurse provide the client?a. "This medication may make you flush."b. "Take this medication on an empty stomach."c. "You will not need to change your diet with this medication."d. "Take this medication when you experience chest pain.

A

The nurse incorporates dietary teaching into the plan for a client with a low-density lipoprotein (LDL) level of 158 mg/dL. What dietary instruction by the nurse is most appropriate?a. "You should keep your saturated fat intake below 10% of your total calories."b. "This result is normal, so continue your current dietary practices."c. "Your total cholesterol intake should be less than 300 mg/day."d. "You should restrict protein sources to fish and chicken only.

A

The nurse is assisting the hospitalized client with his food selections for breakfast. The client is on a low-cholesterol diet. What recommendations are most appropriate for this client?a. Cheese omelet, skim milk, whole wheat toast, coffeeb. Skim milk, oatmeal, banana, orange juice, coffeec. Whole wheat French toast, a side of bacon, coffeed. Blueberry muffin, orange juice, decaffeinated coffee

B

The nurse is reviewing the menu selections of a client who has ordered a low-cholesterol diet. What meal items does the nurse question?a. Vegetarian wrapb. Cheesesteak sandwichc. Fruit salad with yogurtd. Grilled fish sandwich

B

After reviewing the client's chart upon admission to the unit, the nurse consults the health care provider about a new order for lovastatin (Mevacor). What triggered the nurse's action?a. Blood glucose of 182 mg/dLb. History of peptic ulcersc. History of high cholesterold. Elevated liver enzymes

D

A client with high cholesterol is beginning treatment with simvastatin (Zocor). What priority instruction does the nurse give this client?a. "Increase your intake of dietary fiber to minimize constipation."b. "Take this drug on an empty stomach to promote absorption."c. "Report any muscle tenderness to your health care provider."d. "You may experience flushing of the skin with this medication.

C

A client has been diagnosed with Cushing's syndrome. What assessment does the nurse perform to detect vascular complications associated with this illness?a. Auscultation of heart and lung soundsb. Assessment of blood pressurec. Daily weight using the same scaled. Monitoring of urine output every 24 hours

B

The nurse is providing care for a client with hypertension. What priority physical assessment does the nurse include in examination of this client?a. Skin examination for telangiectasiab. Otoscopic examination of the inner earc. Funduscopic examination of the retinad. Neurologic examination of the cranial nerves

C

The nurse is caring for a client with newly diagnosed hypertension. What statement by the client indicates adequate understanding of his or her diet restrictions?a. "I will give my canned soups to the food pantry."b. "I'm going to miss my evening glass of wine."c. "I will mostly use salt substitutes for flavoring."d. "I can have regular coffee only in the morning.

A

The nurse is assessing a client's understanding of his hypertension therapy. What client statement indicates a need for further teaching?a. "If I lose weight, I might be able to reduce my blood pressure medication."b. "If my blood pressure stays under control, I will reduce my risk for a heart attack."c. "When my blood pressure is normal, I will no longer need to take medication."d. "When getting out of bed in the morning, I will sit for a few moments then stand.

C

A nurse is about to administer the first dose of captopril (Capoten) to a client with hypertension. Which is the priority nursing intervention?a. Take the client's apical pulse for 1 full minute before drug administration.b. Place the client in Trendelenburg position to facilitate blood flow to the heart.c. Educate the client to sit on the side of the bed for a few minutes before rising.d. Instruct the client to drink 3 L of fluid daily when taking this medication.

C

The nurse is a assessing a client with hypertension. Which client outcome is indicative of effective hypertension management?a. Pedal edema is not present in the lower legs.b. No complaints of sexual dysfunction occur.c. No indication of renal impairment is present.d. The blood pressure reading is 148/94 mm Hg.

C

The nurse is assessing a client who reports claudication after walking a distance of one block. The nurse notes a painful ulcer on the fourth toe of the client's right foot. What condition do these findings correlate with?a. Diabetic foot ulcerationb. Peripheral arterial diseasec. Peripheral venous diseased. Deep vein thrombosis

B

The nurse notes a venous ulcer on the client's left ankle. What additional assessment finding does the nurse expect in this client?a. Absence of hair on the left lower extremityb. Skin surrounding the ulcer mottled but blanchablec. Brownish discoloration of the lower extremityd. Cold and gray-blue lower extremity

C

A client with chronic peripheral arterial disease and claudication tells the nurse that burning pain often awakens him from sleep. What is the nurse's interpretation of this change?a. The client has inflow disease.b. The client has outflow disease.c. The client's disease is worsening.d. The client's disease is stable.

C

The nurse is educating a client before a right leg atherectomy. What priority education does the nurse provide?a. "You may use the bathroom after the procedure."b. "You will be sedated for 6 hours after the procedure."c. "You will not need to take a daily aspirin anymore."d. "You may be on heparin during the procedure.

D

The nurse is caring for a client with peripheral arterial disease. What priority nursing intervention does the nurse perform to promote vasodilation?a. Increase the client's exercise regimen daily.b. Apply a heating pad to the affected limb.c. Administer an aspirin on a daily basis.d. Educate the client to abstain from smoking.

D

The nurse is recovering a client with peripheral arterial disease who has just undergone percutaneous transluminal angioplasty. What complication does the nurse monitor for in the immediate postprocedure period?a. Bleedingb. Aspirationc. Hypertensive crisisd. Chest pain

A

The nurse is monitoring a client who has returned to the unit after arterial revascularization. The client reports pain in the affected limb that is similar to the pain experienced before the procedure. What is the nurse's best action?a. Assess the peripheral pulses in the limb.b. Elevate the affected extremity on pillows.c. Administer pain medication as prescribed.d. Place a warm blanket on the operative limb.

A

A client is recovering after an embolectomy. What clinical manifestations consistent with compartment syndrome does the nurse watch for?a. Elevated temperature and excessive diaphoresisb. Loss of sensation and pallor near the surgical sitec. Swelling, pain, and tension of the affected limbd. Increased pulse and warmth below the surgical site

C

The nurse is caring for a client who develops compartment syndrome after an embolectomy for peripheral arterial disease. What is the nurse's best action?a. Perform passive range-of-motion exercise to improve distal blood flow.b. Prepare the client for return to the operative suite for surgical correction.c. Medicate the client for pain and place the client in a knee-chest position.d. Loosen the dressing and elevate the extremity to the level of the heart.

D

The new graduate nurse is assessing a client with an unrepaired abdominal aortic aneurysm. What assessment technique requires further education by the supervising nurse?a. Measurement of abdominal girthb. Observation of abdominal wall movementc. Auscultation of any area of the abdomend. Palpation of the abdominal midline area

D

A client with a diagnosed abdominal aortic aneurysm (AAA) develops lower back pain radiating to the groin. What is the nurse's interpretation of this information?a. The aneurysm clotted and is obstructing blood flow.b. The aneurysm is expanding and is preparing to rupture.c. The client feels the inflammation of the aneurysm.d. This is a normal sensation associated with an AAA.

B

The nurse is preparing a client with an aortic aneurysm for surgery. The nurse notes that the client's systolic blood pressure has increased by 30 mm Hg compared with the reading 1 hour ago. What is the nurse's best action?a. Measure abdominal girth.b. Auscultate the abdomen.c. Increase the IV infusion rate.d. Reassess the blood pressure.

A

A nurse is recovering a client who has undergone surgical repair of an abdominal aortic aneurysm (AAA). The client develops coolness of the extremities and reports a bloated feeling in the abdomen. What is the nurse's best action?a. Measure the abdominal girth and check pulses.b. Raise the head of the bed to 90 degrees.c. Assess cardiac output and blood pressure.d. Auscultate and then palpate the abdomen.

A

The nurse is providing discharge education to a client after repair of an abdominal aortic aneurysm (AAA). What priority instruction does the nurse include?a. "No restrictions on driving your car are necessary."b. "Avoid sleeping on your left side for 6 weeks."c. "Avoid lifting heavy objects for about 3 months."d. "You will have a distended abdomen for 2 weeks.

C

The nurse is caring for a client with Buerger's disease. What client education does the nurse provide to minimize disease progression?a. "Keep environmental temperatures warm."b. "Avoid highly stressful activities."c. "Use a heating pad on your extremities."d. "Abstain from all forms of tobacco.

D

The nurse is assessing the extremities of a client with Buerger's disease. What clinical manifestation does the nurse correlate with this disease?a. Reddened, with diminished distal pulsesb. Cold and pale, with proximal bounding pulsesc. Cyanotic, with decreased deep tendon reflexesd. Brownish discoloration, with pitting edema

A

The nurse is providing disease management education to a client with Raynaud's disease. What intervention does the nurse suggest to prevent complications of this disease?a. "Take vasoconstrictive agents when you have symptoms."b. "Wear warm clothing when exposed to cool temperatures."c. "Avoid placing alcohol-based lotion on affected extremities."d. "Check the strength of pulses in your arms and legs daily.

B

The nurse is caring for a client who is receiving heparin therapy for a venous thromboembolism (VTE). The client's activated partial thromboplastin time (aPTT) before heparin therapy was 30 seconds. Which aPTT result indicates that anticoagulation is adequate at this time?a. 15 secondsb. 30 secondsc. 60 secondsd. 150 seconds

C

The health care provider has prescribed a client sodium warfarin (Coumadin) while he is still receiving intravenous heparin. Which is the nurse's best action?a. Administer both heparin and warfarin as prescribed.b. Turn off the heparin before administering the warfarin.c. Clarify the warfarin order with the nursing supervisor.d. Hold the warfarin dose until the heparin is discontinued.

A

The nurse is discharging home a client at risk for venous thromboembolism (VTE) on low-molecular-weight heparin. What instruction does the nurse provide to this client?a. "You must have your aPTT checked every 2 weeks."b. "Massage the injection site after the heparin is injected."c. "Notify your health care provider if your stools appear tarry."d. "An IV catheter will be placed to administer your heparin.

C

The nurse is providing health education to a client with chronic venous stasis ulcers. What priority instruction does the nurse include?a. "Apply antiembolism stockings before getting out of bed in the morning."b. "Clean venous ulcers with Betadine before applying a dressing."c. "Take 1 low-dose aspirin (81 mg) daily to prevent inflammation."d. "Remove and reapply a new DuoDerm dressing to your ulcers each day.

A

The nurse is assessing for skin changes in an African-American client admitted with peripheral arterial disease. What does the nurse monitor for?a. Excess hair growthb. Pitting edema in the feetc. Cyanosis of the nail bedsd. Loss of toenails

C

The nurse assesses a client's legs. Which assessment finding indicates arterial insufficiency?a. Ankle discoloration and pitting edemab. Dependent mottling and absence of hairc. Pain with activity but not while restingd. Full veins present in dependent extremity

B

The nurse is reviewing a client's laboratory results. The nurse correlates elevations in which values as risk factors for atherosclerosis? (Select all that apply.)a. Total cholesterol, 280 mg/dLb. High-density cholesterol, 50 mg/dLc. Triglycerides, 200 mg/dLd. Serum albumin, 4 g/dLe. Low-density cholesterol, 160 mg/dL

A,C,E

An older adult client is prescribed furosemide (Lasix) for control of hypertension. What client education does the nurse provide? (Select all that apply.)a. "Confusion can occur when taking this medication."b. "Drink at least 3 liters of water every day."c. "Arise slowly from a chair or from your bed."d. "Persistent coughing is a side effect of this drug."e. "You should eat foods high in potassium.

A,C,E

The nurse is caring for a client who is experiencing excessive bleeding after receiving unfractionated heparin. What orders does the nurse anticipate from the health care provider? (Select all that apply.)a. Laboratory draw for activated partial thromboplastin time (aPTT)b. Administer vitamin Kc. Laboratory draw for prothrombin time (PT)/international normalized ratio (INR)d. Administer protamine sulfatee. Administer enoxaparin (Lovenox)

A,D

The nurse is taking the history of a client with suspected coronary artery disease (CAD). Which situation correlates with stable angina?a. Chest discomfort at rest and inability to tolerate mowing the lawnb. Chest discomfort when mowing the lawn and subsiding with restc. Indigestion and a choking sensation when mowing the lawnd. Jaw pain that radiates to the shoulder after mowing the lawn

B

The nurse is assessing a client who has a history of stable angina. The client describes a recent increase in the number of attacks and in the intensity of the pain. Which question does the nurse ask to assess the client's change in condition?a. "How many cigarettes do you smoke daily?"b. "Do you have pain when you are resting?"c. "Do you have abdominal pain or nausea?"d. "How frequently are you having chest pain?

B

The community health nurse assesses clients at a health fair. Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease?a. "Would you please state your full name and birth date?"b. "Have you ever had an exercise tolerance stress test?"c. "In what activities do you participate on a daily basis?"d. "Does anyone in your family have a history of heart disease?

C

The nurse teaches a client who is newly diagnosed with coronary artery disease. Which instruction does the nurse include to minimize complications of this disease?a. "Rest is the best medicine at this time. Do not start an exercise program."b. "You are a man; therefore there is nothing you can do to minimize your risks."c. "You should talk to your provider about medications to help you quit smoking."d. "Decreasing the carbohydrates in your diet will help you lose weight.

C

The emergency department nurse is assessing an 82-year-old client for a potential myocardial infarction. Which clinical manifestation does the nurse monitor for?a. Pain on inspirationb. Posterior wall chest painc. Disorientation or confusiond. Numbness and tingling of the arm

C

Eight hours after presentation to the emergency department with reports of substernal chest pain, a client's laboratory results demonstrate myoglobin levels of 55 ng/mL. What does the nurse do next?a. Prepare the client for an emergency coronary bypass graft surgery.b. Administer nitroglycerin to prevent further myocardial cell death.c. Assess the client to identify another potential cause of the chest pain.d. Provide client education related to complications of myocardial infarctions.

C

The nurse evaluates diagnostic results for a client who has chest pain. Which laboratory test is most specific for acute coronary syndromes?a. Troponin markersb. Serum lactate dehydrogenase (LDH)c. Serum myoglobind. Creatine kinase (CK)-MB isoenzyme

A

While evaluating a client's electrocardiogram (ECG) before surgery, the preoperative nurse identifies large, wide Q waves. What is the nurse's best interpretation of this finding?a. An acute myocardial infarction is occurring.b. The client had a myocardial infarction in the past.c. The ventricles are enlarged and failing.d. The ECG is a common variation of normal sinus rhythm.

B

The nurse is providing care for a client admitted to the hospital with reports of chest pain. After receiving a total of three nitroglycerin sublingual tablets, the client states, "The pain has not gotten any better." What does the nurse do next?a. Place the client in a semi-Fowler's position.b. Administer intravenous nitroglycerin.c. Begin supplemental oxygen at 2 L/min.d. Notify the health care provider.

D

The nurse assesses a client who has received thrombolytic therapy after having a myocardial infarction. Which clinical manifestation indicates to the nurse that reperfusion has been successful?a. ST-segment depressionb. Cessation of diaphoresisc. Sudden onset of pleuritic chest paind. Onset of ventricular dysrhythmias

D

A client who presented with an acute myocardial infarction is prescribed thrombolytic therapy. The client had a stroke 1 month ago. Which action does the nurse take?a. Administer the medication as prescribed.b. Perform a CT scan before administering the medication.c. Contact the health care provider to discontinue the prescribed therapy.d. Administer the therapy with a normal saline bolus.

C

The nurse is administering thrombolytic therapy to a client who had a myocardial infarction. Which intervention does the nurse implement to reduce the risk of complications in this client?a. Administer prescribed heparin.b. Apply ice to the injection site.c. Place the client in Trendelenburg position.d. Instruct the client to take slow deep breaths.

A

The nurse is assessing a client who has been prescribed a nonselective beta-blocking agent. Which adverse effect does the nurse monitor for in this client?a. Headacheb. Postural hypotensionc. Nonproductive coughd. Wheezing

D

The nurse is assisting a client to walk in the hall on the third day after a myocardial infarction. Which clinical manifestation indicates to the nurse that the client is not ready to advance to the next level of activity?a. Facial flushingb. Onset of chest painc. Heart rate increase of 10 beats/min at completion of the activityd. Systolic blood pressure increase of 10 mm Hg at completion of the activity

B

The nurse is assessing a client who has left ventricular failure secondary to a myocardial infarction. Which clinical manifestation of poor organ perfusion does the nurse monitor for in this client?a. Headacheb. Hypertensionc. Urine output of less than 30 mL/hrd. Heart rate of 55 to 60 beats/min

C

The nurse is caring for a client who had a myocardial infarction. The client develops increased pulmonary congestion; an increase in heart rate from 80 to 102 beats/min; and cold, clammy skin. Which action does the nurse implement before notifying the health care provider?a. Administer oxygen.b. Increase the IV flow rate.c. Place the client in supine position.d. Prepare the client for surgery.

A

The nurse is teaching a client who is prescribed a calcium channel blocking agent after a percutaneous transluminal coronary angioplasty (PTCA). Which instruction does the nurse include in this client's teaching?a. "Change position slowly."b. "Avoid crossing your legs."c. "Weigh yourself daily."d. "Decrease salt intake.

A

A client who is post percutaneous transluminal coronary angioplasty (PTCA) reports severe chest pain. Which action does the nurse take first?a. Administer the prescribed IV morphine.b. Administer the prescribed sublingual nitroglycerin.c. Assess the client's vital signs and notify the health care provider.d. Perform an immediate 12-lead ECG.

C

The nurse is teaching a client prescribed sublingual nitroglycerin for chest pain. Which statement indicates that the client needs further teaching?a. "I carry my medicine around in a clear plastic bag so that I can get to it easily if I have chest pain."b. "Even if I have not used any of the nitroglycerin from one refill, I get another refill every 3 months."c. "If I still have chest pain after I have taken 3 nitroglycerin tablets, I will go to the hospital."d. "When my nitroglycerin tablet tingles under my tongue, I know that it is strong enough to work.

A

The nurse is assessing a client who had percutaneous transluminal coronary angioplasty (PTCA) 1 hour ago. Which complication does the nurse monitor for?a. Hypertensive crisisb. Hyperkalemiac. Infectiond. Bleeding

D

The nurse is assessing a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) and is ordered to receive an IV infusion of abciximab (ReoPro). Which clinical manifestation does the nurse monitor for in this client?a. Bleedingb. Joint painc. Pedal edemad. Excessive thirst

A

The nurse is assessing a client who has a serum potassium level of 4.5 mEq/L after coronary artery bypass graft (CABG) surgery. Which action does the nurse take?a. Notify the health care provider.b. Document the finding.c. Administer prescribed diuretics.d. Administer prescribed potassium replacements.

B

The nurse is assessing a client who is 6 hours postoperative from coronary artery bypass graft surgery. The client's mediastinal tubes are not draining. Which action does the nurse implement at this time?a. Replace the drainage tubing.b. Check for kinks in the tubing.c. Irrigate the tubing with normal saline.d. Document the finding.

B

The nurse is caring for an 80-year-old client who has had coronary artery bypass graft surgery. Which assessment does the nurse prioritize for this client?a. Skinb. Otoscopicc. Mental statusd. Gastrointestinal

C

The nurse is planning discharge education for a client after coronary artery bypass graft surgery. Which instruction does the nurse include in this client's teaching?a. "Remember to drink at least 3 liters of fluid daily."b. "You should abstain from sexual activity for 6 months."c. "Take your pulse before, midway through, and after exercising."d. "Stop taking your antihyperlipidemic medication at this time.

C

The nurse is planning a community health promotion program for cardiovascular disease. Which risk factors of coronary artery disease (CAD) does the nurse include in the education? (Select all that apply.)a. Cigarette smokingb. Use of alcoholc. Insomniad. Hypertensione. Obesityf. Depression

A,D,E

The nurse is monitoring the electrocardiogram (ECG) of a client who has a myocardial infarction. Which changes does the nurse expect to see in the ECG tracing? (Select all that apply.)a. ST-segment depressionb. T-wave inversionc. Normal Q wavesd. ST-segment elevatione. T-wave elevationf. Abnormal Q wave

B,D,F

The nurse administers intravenous dobutamine (Dobutrex) to a client who has heart failure. Which clinical manifestations indicate that the client's status is improving? (Select all that apply.)a. Decreased heart rateb. Increased heart ratec. Increased contractilityd. Decreased contractilitye. Increased respiratory rate

B,C

A client is hospitalized after a myocardial infarction. Which hemodynamic parameters does the nurse correlate with cardiogenic shock? (Select all that apply.)a. Decreased cardiac outputb. Increased cardiac outputc. Increased mean arterial pressure (MAP)d. Decreased MAPe. Increased afterloadf. Decreased afterload

A,D,E