RN Targeted Medical Surgical Cardiovascular Online Practice 2023

Left sided heart failure vs right sided

left-sided heart failure: BNP that is greater than the expected reference range, nondistended jugular neck veins, dry hacking cough, S3 gallop, and bibasilar crackles. Left-sided heart failure will demonstrate manifestations related to decreased cardiac output and pulmonary congestion which occurs as the left ventricle fails.

right-sided heart failure include a BNP that is greater than the expected reference range. weight gain, jugular neck vein distention, ascites, and dependent edema. These manifestations indicate systemic congestion that occurs as the right ventricle fails.

medication for myocardial infarction.

morphine, oxygen, nitroglycerine, and aspirin

Morphine is the drug of choice for reducing pain and anxiety. Oxygen therapy is initiated at the onset of chest pain to increase the amount of oxygen delivered to the myocardium and to decrease pain. Aspirin prevents platelet aggregation and decreases mortality from a myocardial infarction and coronary artery disease. Nitroglycerine is a potent vasodilator which improves blood flow to the heart muscle and reduces pain.

a nurse is caring for a client who has endocarditis. which of the following findings should the nurse recognize as a potential complication?

A. friction rub

B. dependent rubor

C. intermittent claudication

D. cardiac murmur

D. Cardiac murmur

A new or worsening cardiac murmur is a potential complication of endocarditis due to inflammation of the endocardium and possible damage to the heart valves.

A nurse in the emergency department is caring for a client who had an anterior MI. The client's history reveals she is 1 week post-op open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated?

A. administering IV morphine sulfate

B. administering oxygen at 2 L/min via nasal cannula

C. Helping the client to the bedside commode

D. assisting with thrombolytic therapy

D. Assisting with thrombolytic therapy

The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.

A nurse is assessing a client in the emergency room who has a bradydysrhythmia. Which of the following findings should the nurse expect?

A. confusion

B. friction rub

C. hypertension

D. warm dry skin

Confusion

Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.

A nurse is caring for a client who presents to the ER with a BP of 254/138 mmhg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first?

A. initiate seizure precautions

B. tell the client to report vision changes

C. elevate the head of the clients bed

D. start a peripheral IV

Elevate the head of the client's bed.

The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.

A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The client is conscious with a HR of 200-210 bpm and has a faint radial pulse. The nurse should anticipate assisting with which of the following interventions?

A. Initiate chest compressions

B. vagal stimulation

C. administration of atropine IV

D. defibrillation

Vagal stimulation

The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.

a nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.

Inspection of this location allows the nurse to assess for pulsations of the apex area of the heart, which is considered the apical pulse or point of maximal impulse. The point of maximal impulse is located at the left fifth intercostal space in the midclavicular line.

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds (30-40 seconds)?

A. increase the heparin infusion rate by 2 ml/hr

B. continue to monitor the heparin infusion as prescribed

C. request a prothrombin time

D. stop the heparin infusion

Stop the heparin infusion.

The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.

A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease?

A. a client who has hypothyroidism

B. a client who has diabetes mellitus

C. a client whose daily caloric intake consists of 25% fat

D. a client who consumes two 12 oz (0.35L) bottles of beer a day

A client who has diabetes mellitus

Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease.

A nurse is admitting a client who has a leg ulcer and a history of DM. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer?

A. explore the client's family history of peripheral vascular disease

B. note the presence or absence of pain at the ulcer site

C. inquire about the presence or absence of claudication

D. ask if the client has had a recent infection

C. Inquire about the presence or absence of claudication.

Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.

a nurse is planning a presentation for a group of clients who have hypertension. which of the following lifestyle modifications should the nurse include? SATA

limited alcohol intake

regular exercise program

decreased magnesium intake

reduce potassium intake

tobacco cessation

limited alcohol intake

regular exercise program

tobacco cessation

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately?

A. slurred speech

B. irregular pulse

C. dependent edema

D. persistent fatigue

Slurred speech (s/s of stroke)

The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately.

A nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. Which of the following client findings should the nurse report to the provider?

A. mediastinal drainage 100 ml/hr

B. blood pressure 160/80 mm Hg

C. temp 37.1 C (98.8F)

D. Potassium 4.0 mEq/L (3.5-5.0 mEq/L)

B. Blood pressure 160/80 mm Hg

The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.

Mediastinal drainage of up to 150 mL/hr is expected during this time.

A nurse is caring for a client who has a history of DVT and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy?

A. Hgb 14 g/dL (12 to 16g/DL)

B. minimal bruising of extremities

C. decreased blood pressure

D. INR 2.4 (2.0 to 3.0)

INR 2.4 (2.0 to 3.0)

The nurse should identify that an INR of 2.4 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.

A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following?

A. tendon pain

B. persistent cough

C. frequent urination

D. constipation

Persistent cough

A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication.

A nurse is caring for a client who has a history of angina and is schedules for exercise electrocardiagraphy at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling?

A. " im still hungry after the bowl of cereal i ate at 7 am"

B. " i didnt take my heart pills this morning because the doctor told me not to"

C. " i have had chest pain a couple of times since i saw my doctor in the office last week"

D. "I smoked a cigarette this morning to calm my nerves about having this procedure."

"I smoked a cigarette this morning to calm my nerves about having this procedure."

Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test.

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure?

A. " i cant get rid of these hiccups"

B. " i feel dizzy when I stand"

C. " my incision site stings"

D. " i have a headache"

"I can't get rid of these hiccups."

Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.

a nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Which of the following areas of the strip should the nurse examin to observe for atrial depolarization

P wave, of the rhythm strip to evaluate for atrial depolarization.

QRS complex, of the rhythm strip to evaluate for ventricular depolarization.

T wave, of the rhythm strip to evaluate for ventricular repolarization.

A nurse is caring for a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect?

A. dyspnea on exertion

B. tracheal deviation

C. pericardial rub

D. weight loss

Dyspnea on exertion

The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output.

A nurse is assessing a client who has pulmonary edema related to hear failure. Which of the following findings indicates effective treatment of the client's condition?

A. absence of adventitious breath sounds

B. presence of nonproductive cough

C. decrease in RR at rest

D. SpO2 86% on room air

Absence of adventitious breath sounds

Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving.

A nurse is caring for a client who is being treated for HF and has prescriptions for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication?

A. shortness of breath

B. lightheadedness

C. dry cough

D. metallic taste

Lightheadedness

Furosemide, a loop diuretic, can cause a substantial drop in blood pressure due to fluid loss, resulting in lightheadedness or dizziness.

A nurse is providing teaching for a client who is 2 days post-op following a heart transplant. Which of the following statements should the nurse include in the teaching?

A. "You might no longer be able to feel chest pain."

B. " your level of activity intolerance will not change"

C. " after 6 months, you will no longer need to restrict your sodium intake."

D. "you will be able to stop taking immunosuppressants after 12 months"

"You might no longer be able to feel chest pain."

Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.

A nurse is caring for a client who was admitted for a treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first?

A. obtain the clients current weight

B. review serum electrolyte values

C. determine the time of the last digoxin dose

D. check the clients urine output

Review serum electrolyte values.

Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.

A nurse is caring for a client in the first hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider?

A. serosanguineous drainage on dressing

B. client reports 6 on a pain scale of 1-10 with coughing

C. urine output of 20 ml/hr

D. increase in temperature from

Urine output of 20 mL/hr

Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.

A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching?

A. apply the new patch to the same site as the previous patch

B. place the patch on an area of skin away from skin folds and joints

C. keep the patch on 24 hr per day

D. replace the patch at the onset of angina

ANS:

B. Place the patch on an area of skin away from skin folds and joints.

The nurse should instruct the client to rotate the patch site to help prevent skin irritation.

The nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly.

The nurse should instruct the client to have a patch-free interval of 10 to 12 hr each day to prevent tolerance to the medication.

The nurse should emphasize that nitroglycerin patches offer ongoing prevention of angina attacks. The nurse should instruct the client that patches do not treat angina attacks because they do not take effect immediately.

A nurse is providing discharge teaching for a client who has HF. The nurse should instruct the client to report which of the following findings immediately to the provider?

A. Weight gain of 0.9 kg (2 lb) in 24 hr

B. increase of 10 mmHg in systolic blood pressure

C. dyspnea with exertion

D. dizziness when rising quickly

Weight gain of 0.9 kg (2 lb) in 24 hr

When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse?

A. "my arthritis is really bothering me because I haven't taken my aspirin in a week"

B. " my blood pressure shouldnt be high because i took my blood pressure medication this morning."

C. " i took my warfarin last night according to my usual schedule"

D. " i will check my blood sugar because i took a reduced dose of insulin this morning"

"I took my warfarin last night according to my usual schedule."

Clients who are scheduled for a CABG should not take anticoagulants such as warfarin for several days prior to the surgery to prevent excessive bleeding.

atrial fibrillation.

greatest risk for developing heart failure and stroke because the client has manifestations of atrial fibrillation.

In prioritizing hypotheses, using the safety risk reduction priority framework, the nurse should identify the client is at greatest risk for developing heart failure and stroke because the client has manifestations of atrial fibrillation. These manifestations include shortness of breath, hypotension, palpitations, and dizziness. The client also presents with risk factors of atrial fibrillation which include a history of smoking, diabetes, and obstructive sleep apnea. Atrial fibrillation can result in decreased cardiac output which can lead to heart failure and pooling of blood, which can lead to blood clots. Immediate treatment should be initiated to reduce the risk of heart failure and stroke.

The DASH diet is a lifestyle modification used to manage hypertension

The client indicates an understanding to consume 4 to 5 servings of vegetables,

7 to 8 servings of grains,

2 to 3 servings of dairy each day.

4 to 5 servings of nuts, seeds, and dry beans weekly.