Ati lpn med surg cardiac exam
Total Questions : 33
Showing 25 questions, Sign in for moreA nurse is reinforcing teaching with a client who has peripheral vascular disease (PVD). The nurse should recognize that which of the following statements by the client indicates a need for further teaching?
Explanation
A. "I will avoid crossing my legs at the knees." Crossing the legs can restrict blood flow and should be avoided in PVD.
B. "I will use a thermometer to check the temperature of my bath water." Due to reduced sensation, checking the water temperature can prevent burns.
C. "I will not go barefoot." Going barefoot increases the risk of injury or infection, especially with impaired circulation.
D. "I will wear stockings with elastic tops." Stockings with tight elastic tops can restrict blood flow, worsening symptoms in PVD.
A nurse is collecting data from a client who has atrial fibrillation. When documenting the quality of the client's pulse, which of the following terms should the nurse use?
Explanation
A. Slow: Atrial fibrillation typically leads to an irregular, often rapid pulse, not necessarily slow.
B. Irregular: Atrial fibrillation causes an irregular pulse due to uncoordinated atrial contractions.
C. Bounding: A bounding pulse is associated with conditions like high cardiac output or fluid overload, not atrial fibrillation.
D. Not palpable: The pulse in atrial fibrillation is usually palpable but irregular.
A nurse at a provider's office receives a telephone call from a client who reports nausea and has unrelieved chest pain after taking a nitroglycerin tablet 5 min ago. Which of the following is an appropriate response by the nurse?
Explanation
A. Advise the client to come into the office. The client needs immediate emergency intervention, not a routine office visit.
B. Advise the client to take an antacid. Chest pain unrelieved by nitroglycerin may indicate myocardial infarction; an antacid would not help.
C. Instruct the client to call 911. Persistent chest pain unrelieved by nitroglycerin warrants emergency attention due to potential heart attack.
D. Tell the client to take another nitroglycerin tablet in 15 min. The protocol allows taking an additional dose in 5 minutes, but emergency services should be called for unrelieved chest pain.
A nurse is reinforcing teaching to a client who has a chronic illness about the DASH diet. Which of the following meals best fits the DASH diet?
Explanation
A. Enriched cereal in whole milk. Whole milk is high in saturated fats, which the DASH diet aims to limit.
B. Turkey sandwich on whole wheat bread, green beans, and banana. This meal is balanced, low in saturated fats, high in fiber, and aligns well with the DASH diet principles.
C. Pork sausage and baked beans. Pork sausage is high in saturated fats and sodium, which should be limited in the DASH diet.
D. Hamburger, steak fries, and an orange. While the orange is DASH-friendly, the hamburger and fries are high in fats and sodium.
A nurse is collecting data on a client who has mitral valve stenosis. Which of the following findings should the nurse expect?
Explanation
A. Barrel chest. A barrel chest is commonly seen in chronic obstructive pulmonary disease (COPD) rather than mitral valve stenosis.
B. Bradycardia. Bradycardia is not typically associated with mitral valve stenosis, as symptoms often include rapid or irregular heartbeat.
C. Clubbing of the fingers. Clubbing is associated with chronic hypoxia, often due to pulmonary conditions, not specifically with mitral valve stenosis.
D. Heart murmur. Mitral valve stenosis causes turbulent blood flow through the narrowed valve, resulting in a characteristic murmur.
A nurse is collecting data for a client who experienced a myocardial infarction prior to a cardiac arrest. Which of the following laboratory tests will identify early injury to the cardiac muscle?
Explanation
A. Creatine kinase-myocardial band (CK-MB) test: While CK-MB is also a marker of myocardial injury, it is less specific than troponin and can be elevated in other conditions, such as muscle injury.
B. Troponin T test. The Troponin T test is highly specific and sensitive for myocardial injury and is considered the gold standard for diagnosing a myocardial infarction. Troponin levels rise within hours of cardiac muscle injury and remain elevated for days, providing an early and reliable indicator of cardiac muscle damage.
C. Brain natriuretic peptide (BNP) test. BNP levels are used to assess heart failure and do not indicate acute cardiac muscle injury.
D. Creatine kinase (CK) test. CK measures overall muscle injury, not specific to cardiac muscle.
A nurse is caring for a client with peripheral artery disease who has an arterial ulcer. Which of the following best describes the mechanism for developing the clinical problem?
Explanation
A. Swelling of the lower extremity can create a wound that is difficult to heal. Swelling typically relates to venous ulcers, not arterial ulcers, which are caused by reduced blood flow.
B. Decreased blood flow to the area can cause the wound and decrease the healing. Peripheral artery disease causes decreased blood flow, leading to poor oxygenation and slow healing of arterial ulcers.
C. Lower extremity compression stockings likely caused the wound to occur. Compression stockings are used in venous insufficiency and do not cause arterial ulcers.
D. Increased blood sugar associated with the condition is likely the cause of the wound not healing. While high blood sugar can impair healing, decreased blood flow is the primary cause of arterial ulcers in PAD.
A nurse is reviewing the laboratory findings of a client who experienced an acute myocardial infarction 6 days ago. Which of the following laboratory values should the nurse expect to remain elevated at this time?
Explanation
A. Creatinine phosphokinase (CPK): CPK levels peak within 24 hours after an MI and return to normal within 2-3 days.
B. Myoglobin: Myoglobin rises within hours but returns to normal within 24 hours after MI.
C. Creatinine kinase-MB (CK-MB): CK-MB peaks 12-24 hours post-MI and returns to baseline within 2-3 days.
D. Troponin T: Troponin T remains elevated for up to 10-14 days after an MI, providing long-term evidence of myocardial injury.
A nurse is reviewing the laboratory values for a client who has heart failure and is taking bumetanide. For which of the following results should the nurse notify the provider?
Explanation
A. Calcium 10 mg/dL: This calcium level is within the normal range (8.6-10.2 mg/dL) and does not require intervention.
B. Sodium 136 mEq/L: This sodium level is within the normal range (135-145 mEq/L).
C. Potassium 2.3 mEq/L: This potassium level is critically low; bumetanide is a loop diuretic that can cause hypokalemia, which can lead to dangerous cardiac dysrhythmias.
D. Magnesium 1.4 mEq/L: While slightly low, this magnesium level is only mildly decreased and not as immediately concerning as the potassium level.
A nurse is collecting data from a client who has heart failure and takes chlorothiazide sodium. Which of the following findings should the nurse identify as indicating hypokalemia?
Explanation
A. Bounding peripheral pulses: Hypokalemia typically causes weak, thready pulses rather than bounding ones.
B. Decreased deep-tendon reflexes: Hypokalemia can cause muscle weakness and decreased deep-tendon reflexes due to impaired neuromuscular function.
C. Hyperactive bowel sounds: Hypokalemia generally causes decreased or hypoactive bowel sounds due to slowed smooth muscle contraction.
D. Restlessness: Restlessness is not a typical sign of hypokalemia; hypokalemia more commonly causes weakness, lethargy, or fatigue.
A nurse is reinforcing discharge teaching for a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication?
Explanation
A. "I'll use my electric razor for shaving." This is correct as using an electric razor helps prevent cuts, which is important since warfarin increases bleeding risk.
B. "I'll be sure to eat foods with lots of vitamin K." Vitamin K reduces the effectiveness of warfarin; clients should be consistent with their intake of vitamin K to avoid fluctuations in INR.
C. "It's okay to have a couple of glasses of wine with dinner." Alcohol can increase the effect of warfarin and the risk of bleeding. Clients should avoid or limit alcohol intake.
D. "I'll take aspirin for my headaches." Aspirin also has anticoagulant effects and can increase bleeding risk when taken with warfarin.
A nurse is collecting data from the medical record of an older adult client and sees that the client is taking Amiodarone. The client, has reported feeling frequently tired and unable to tolerate the heat. Which of the following conditions should the nurse suspect?
Explanation
A. Elevated thyroid hormone levels. While amiodarone can cause thyroid dysfunction, elevated thyroid levels (hyperthyroidism) would typically present with symptoms like increased energy or restlessness.
B. Low blood glucose levels. Low blood glucose is not related to amiodarone. Symptoms of hypoglycemia include sweating, hunger, and confusion, not heat intolerance or fatigue.
C. Elevated blood glucose levels. Hyperglycemia is not a known side effect of amiodarone.
D. Low thyroid hormone levels. Amiodarone can induce hypothyroidism, which may cause fatigue and heat intolerance. Regular thyroid monitoring is recommended with long-term amiodarone use.
A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?
Explanation
A. Warm extremities. PAD typically leads to cold extremities due to poor blood flow.
B. Intermittent claudication. Intermittent claudication, or muscle pain during exercise, is a classic symptom of PAD caused by limited blood supply to the muscles.
C. Darkened skin color near extremities. Darkened skin is more common in venous insufficiency, not PAD. PAD can cause pale or bluish skin.
D. Edema. Edema is typically associated with venous insufficiency, not PAD.
A nurse is caring for a client who experienced severe head trauma. The client's partner asks the nurse why they are concerned about the mean arterial pressure (MAP). The nurse should explain that MAP determines which of the following?
Explanation
A. Cerebral blood flow. MAP is crucial for maintaining adequate cerebral perfusion pressure, ensuring enough blood flow to the brain.
B. The client's intake and output needs. MAP does not directly influence intake and output needs; it is more directly related to blood flow and tissue perfusion.
C. Regulation of blood pressure. MAP is a measure of average blood pressure but not a regulator of it.
D. Resorption of cerebrospinal fluid. CSF resorption is not directly influenced by MAP; it’s regulated by intracranial pressure and other factors.
A nurse is collecting data from a client who has hypertension and a prescription for propranolol. A history of which of the following conditions should be reported to the provider?
Explanation
A. Depression: While propranolol can sometimes worsen symptoms of depression, this is not as critical as the impact on conditions like heart failure.
B. Glaucoma: Propranolol does not typically affect glaucoma; however, some beta-blockers are used to treat glaucoma.
C. Migraine: Propranolol is sometimes used to prevent migraines, so a history of migraines would not require discontinuation.
D. Heart failure: Propranolol can exacerbate heart failure by reducing myocardial contractility. Clients with heart failure require careful monitoring or an alternative medication.
A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.)
Explanation
A. Smoking: Smoking is a modifiable risk factor as quitting smoking reduces the risk of atherosclerosis.
B. Hypertension: High blood pressure can be managed through lifestyle changes and medication, making it a modifiable risk factor.
C. Hypercholesterolemia: High cholesterol levels can be controlled through diet, exercise, and medications, making it modifiable.
D. Obesity: Obesity is a modifiable risk factor, as weight loss through diet and exercise can reduce the risk of atherosclerosis.
E. Genetic predisposition: Genetic predisposition is non-modifiable, meaning individuals cannot change their inherited risk for atherosclerosis.
A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take first?
Explanation
A. Suggest that the client rests before eating the meal. Although rest can help with nausea, it does not address the potential issue of digoxin toxicity, which can cause nausea.
B. Check the client's vital signs. Checking vital signs, especially heart rate, is the priority because nausea can indicate digoxin toxicity, which affects heart function.
C. Request a dietary consult. A dietary consult may be helpful if the client continues to refuse meals, but it does not address the immediate potential for digoxin toxicity.
D. Request an order for an antiemetic. Although an antiemetic may help with nausea, assessing for toxicity takes priority.
A nurse is caring for a client who asks why she is being prescribed aspirin 325 mg daily following a myocardial infarction. The nurse should instruct the client that aspirin is prescribed for clients who have coronary artery disease for which of the following effects?
Explanation
A. To prevent blood clotting: Aspirin is an antiplatelet agent, and it reduces blood clot formation, which helps prevent further cardiac events after an MI.
B. To reduce inflammation: Although aspirin has anti-inflammatory properties, this is not the primary reason for its use in post-MI clients.
C. To prevent fever: Aspirin can reduce fever, but this is not its purpose in MI prevention.
D. To provide analgesia: Aspirin can relieve pain, but in this context, it is used to prevent blood clotting, not as an analgesic.
Order: Magnesium Sulfate 1 gram in 100mLs 0.09% NaCl over 2 hours. IV tubing has a drop factor of 30 gtt/mL. How many drops per minute will you give?
Explanation
A. 25 gtt/min: Calculating the correct rate reveals that this is not the correct answer.
B. 1500 gtt/min: This rate is too high; the calculation does not support this answer.
C. 50 gtt/min: To calculate: (100 mL / 120 min) × 30 gtt/mL = 50 gtt/min.
D. 83 gtt/min: This is too high based on the calculation.
A client who has had a significant myocardial infarction receives a referral to the cardiac rehabilitation unit. During his first visit to the unit, he tells the nurse that he doesn't understand why he needs to be there because there is nothing more to do as the damage is done. Which of the following responses should the nurse make?
Explanation
A. "Cardiac rehabilitation cannot undo the damage to your heart, but it can help you get back to your previous level of activity safely." This response is therapeutic and educative, helping the client understand that while damage cannot be reversed, rehabilitation supports safe recovery and improved quality of life.
B. "Your doctor is the expert here, and I'm sure he would only recommend what is best for you." This response does not address the client’s concerns and lacks supportive or educational value.
C. "You are probably right and I agree with you, but I still think you should go." This dismissive response fails to provide support, education, or empathy.
D. "It's not unusual to feel that way at first, but once you learn the routine, you'll be fine." Although this statement offers some support, it lacks the educational element needed to address the client’s concerns about the purpose of rehabilitation.
A nurse is caring for a client who reports an area of redness, warmth, tenderness and pain in the right calf. Which of the following actions should the nurse anticipate when notifying the provider of this finding?
Explanation
A. Schedule deep tissue massage with physical therapy. Massaging the area is contraindicated in cases of suspected deep vein thrombosis (DVT), as it can dislodge the clot, leading to a pulmonary embolism.
B. Monitor Homan's sign. Homan’s sign (pain in the calf upon dorsiflexion) is no longer considered a reliable or safe assessment for DVT due to the risk of dislodging a clot.
C. Obtain platelet aggregation studies. Platelet aggregation studies are not specific to diagnosing a DVT; instead, imaging is preferred.
D. Arrange for a venous duplex ultrasound. A venous duplex ultrasound is a non-invasive test that can confirm the presence of a DVT in the affected extremity.
A nurse at a provider's office is collecting data from a client who reports taking pseudoephedrine for sinus problems. The nurse should recognize that which of the following conditions from the client's history places the client at risk for harm while taking pseudoephedrine?
Explanation
A. Overweight. While weight can affect medication metabolism, it does not specifically increase risk with pseudoephedrine.
B. Migraine headaches. Migraine headaches are not contraindicated with pseudoephedrine, although some stimulants can increase headaches.
C. Eczema. Pseudoephedrine does not typically affect eczema.
D. Hypertension. Pseudoephedrine is a decongestant that can increase blood pressure, so it should be used with caution in clients with hypertension.
A nurse is reinforcing teaching with an older adult client who has had a newly inserted permanent pacemaker. Which of the following manifestations should the nurse include in the teaching as a pacemaker malfunction that the client should report to the provider?
Explanation
A. Fatigue. Fatigue can be a common symptom of various health conditions, including heart disease, and is not specific to pacemaker malfunction.
B. Rapid pulse. A rapid pulse or palpitations may signal a malfunction where the pacemaker is pacing too quickly or erratically.
C. Increased urine output. Increased urine output is not related to pacemaker function and does not indicate a malfunction.
D. Sneezing. Sneezing is unrelated to pacemaker malfunction and does not warrant provider notification.
Following admission, a client with a vascular occlusion of the right lower extremity calls the nurse and reports difficulty sleeping because of cold feet. Which of the following nursing actions should the nurse take to promote the client's comfort?
Explanation
A. Obtain a pair of slipper socks for the client. Slipper socks can provide warmth without applying direct heat, which is safer for clients with impaired circulation.
B. Increase the client's oral fluid intake. Increasing fluids does not directly address cold feet and may be contraindicated depending on the client’s condition.
C. Rub the client's feet briskly for several minutes. Rubbing can damage skin and tissue in clients with poor circulation and should be avoided.
D. Place a moist heating pad under the client's feet. Heating pads can cause burns and further impair circulation in clients with vascular issues.
A nurse is collecting data from a client who is receiving continuous cardiac monitoring that is indicating premature ventricular contractions (PVCs). Which of the following findings should the nurse expect when assessing the client?
Explanation
A. S3 heart sounds. An S3 sound is more indicative of heart failure rather than PVCs specifically.
B. Increase in point of maximum impulse (PMI). PMI is typically displaced in conditions like ventricular hypertrophy or heart failure, not PVCs.
C. Irregular pulsations. PVCs are extra beats that interrupt the heart’s normal rhythm, leading to irregular pulsations on palpation.
D. Bradycardia. PVCs usually occur in the context of normal or elevated heart rates rather than bradycardia.
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