ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
- ANS
1. A client complains of crushing chest pain that radiates to his left arm. He should be
presented with the following treatment:
1. Aspirin, oxygen, nitroglycerin, and morphine
2. Aspirin, oxygen, nitroglycerin, and codeine
3. Oxygen, nitroglycerin, meperidine, and thrombolytics
4. Aspirin, oxygen, nitroprusside, and morphine - ANSAnswer: 1. Aspirin, oxygen, nitroglycerin,
and morphine
1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the
pathophysiology of this disease process, the nurse would expect the patient to exhibit what
heart rhythm?
A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia - ANSC
Feedback:
In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial
fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
1. An older adult is newly diagnosed with primary hypertension and has just been started on a
beta-blocker. The nurse's health education should include which of the following?
A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the
beta-blocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure -
ANSAns: C
Feedback:
Elderly people have impaired cardiovascular reflexes and are more sensitive to postural
hypotension. The nurse teaches patients to change positions slowly when moving from lying
or sitting positions to a standing position, and counsels elderly patients to use supportive
devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such
as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy
products, is strongly recommended. Increasing fluids in elderly patients may be
contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk
and activity should not normally be limited.
2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is
due to be discharged home. During discharge teaching, the nurse should discuss the
importance of antibiotic prophylaxis prior to which of the following?
A) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations - ANSC
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
Feedback:
Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental
procedures involving manipulation of gingival tissue, the periapical area of the teeth or
perforation of the oral mucosa (not including routine anesthetic injections, placement of
orthodontic brackets, or loss of deciduous teeth). There are no current recommendations
around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to
people who are immunosuppressed.
2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of
blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that
these symptoms could be indicative of what?
A) Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency - ANSAns: A
Feedback:
Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood
vessel damage indicative of damage elsewhere in the vascular system as a result of
hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A
hypertensive emergency would have a more rapid onset.
2. The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the
resting state of the patient's heart?
A) P wave
B) T wave
C) U wave
D) QRS complex - ANSB
Feedback:
The T wave specifically represents ventricular muscle depolarization, also referred to as the
resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS
complex.
2. Which lifestyle changes should a client diagnosed with coronary artery disease consider?
1. Smoking cessation
2. Establishing a regular exercise routine
3. Weight reduction
4. All of the Above - ANSAnswer: 4. All of the Above
3. A client's cardiac monitor alarm sounds, indicating ventricular tachycardia. The nurse
should:
1. perform immediate defibrillation.
2. Assess the client.
3. Call the physician.
4. Administer a precordial thump. - ANSAnswer: 2. Assess the client.
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
3. A nurse is performing blood pressure screenings at a local health fair. While obtaining
subjective assessment data from a patient with hypertension, the nurse learns that the patient
has a family history of hypertension and she herself has high cholesterol and lipid levels. The
patient says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every
day. The nurse notes what nonmodifiable risk factor for hypertension?
A) Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen - ANSAns: C
Feedback:
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not
modifiable.
3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit.
During the nurse's admission interview, the patient states that she takes over-the-counter
water pills on a regular basis. How should the nurse best respond to the fact that the patient
has been taking diuretics?
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patient's oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patient's fluid balance is monitored vigilantly. - ANSC
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be
made aware. Adjusting the patient's sodium or fluid intake or fluid monitoring does not
address this important contraindication.
4. *****************************************************************An adult patient with
third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac
monitoring. What rhythm characteristic will the ECG most likely show?
A) PP interval and RR interval are irregular.
B) PP interval is equal to RR interval.
C) Fewer QRS complexes than P waves
D) PR interval is constant. - ANSC
Feedback:
In third-degree AV block, no atrial impulse is conducted through the AV node into the
ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the
ventricles. Therefore, there are more P waves than QRS complexes due to the difference in
the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not
consistent with this diagnosis.
4. A complication of peripheral vascular disease may be:
1. stasis ulcer.
2. Pressure ulcer.
3. Gastric ulcer.
4. Duodenal ulcer. - ANSAnswer: 1. stasis ulcer.
, ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative
heart transplant. The patient asks the nurse to remind him what this medication is for. How
should the nurse best respond?
A) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant. - ANSD
Feedback:
After heart transplant, patients are constantly balancing the risk of rejection with the risk of
infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf),
azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone)
to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac
output, or increase white cell counts.
4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator
should explain that hypertensive urgency differs from hypertensive emergency in what way?
A) The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive
emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage. - ANSAns:
D
Feedback:
Hypertensive emergencies are acute, life-threatening BP elevations that require prompt
treatment in an intensive care setting because of the serious target organ damage that may
occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is
no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic
monitoring of the patient's BP is required in both situations. The medications of choice in
hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral
doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting
enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive
urgencies.
5. ******************************************************** The nurse is writing a plan of care
for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the
patient?
A) Maintain a resting heart rate below 70 bpm.
B) Maintain adequate control of chest pain.
C) Maintain adequate cardiac output.
D) Maintain normal cardiac structure. - ANSC
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent
worsening complications as a result of decreased cardiac output. A resting rate of less than
70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute
coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the
physical structure of the heart.
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
- ANS
1. A client complains of crushing chest pain that radiates to his left arm. He should be
presented with the following treatment:
1. Aspirin, oxygen, nitroglycerin, and morphine
2. Aspirin, oxygen, nitroglycerin, and codeine
3. Oxygen, nitroglycerin, meperidine, and thrombolytics
4. Aspirin, oxygen, nitroprusside, and morphine - ANSAnswer: 1. Aspirin, oxygen, nitroglycerin,
and morphine
1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the
pathophysiology of this disease process, the nurse would expect the patient to exhibit what
heart rhythm?
A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia - ANSC
Feedback:
In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial
fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
1. An older adult is newly diagnosed with primary hypertension and has just been started on a
beta-blocker. The nurse's health education should include which of the following?
A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the
beta-blocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure -
ANSAns: C
Feedback:
Elderly people have impaired cardiovascular reflexes and are more sensitive to postural
hypotension. The nurse teaches patients to change positions slowly when moving from lying
or sitting positions to a standing position, and counsels elderly patients to use supportive
devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such
as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy
products, is strongly recommended. Increasing fluids in elderly patients may be
contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk
and activity should not normally be limited.
2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is
due to be discharged home. During discharge teaching, the nurse should discuss the
importance of antibiotic prophylaxis prior to which of the following?
A) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations - ANSC
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
Feedback:
Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental
procedures involving manipulation of gingival tissue, the periapical area of the teeth or
perforation of the oral mucosa (not including routine anesthetic injections, placement of
orthodontic brackets, or loss of deciduous teeth). There are no current recommendations
around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to
people who are immunosuppressed.
2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of
blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that
these symptoms could be indicative of what?
A) Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency - ANSAns: A
Feedback:
Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood
vessel damage indicative of damage elsewhere in the vascular system as a result of
hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A
hypertensive emergency would have a more rapid onset.
2. The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the
resting state of the patient's heart?
A) P wave
B) T wave
C) U wave
D) QRS complex - ANSB
Feedback:
The T wave specifically represents ventricular muscle depolarization, also referred to as the
resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS
complex.
2. Which lifestyle changes should a client diagnosed with coronary artery disease consider?
1. Smoking cessation
2. Establishing a regular exercise routine
3. Weight reduction
4. All of the Above - ANSAnswer: 4. All of the Above
3. A client's cardiac monitor alarm sounds, indicating ventricular tachycardia. The nurse
should:
1. perform immediate defibrillation.
2. Assess the client.
3. Call the physician.
4. Administer a precordial thump. - ANSAnswer: 2. Assess the client.
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
3. A nurse is performing blood pressure screenings at a local health fair. While obtaining
subjective assessment data from a patient with hypertension, the nurse learns that the patient
has a family history of hypertension and she herself has high cholesterol and lipid levels. The
patient says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every
day. The nurse notes what nonmodifiable risk factor for hypertension?
A) Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen - ANSAns: C
Feedback:
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not
modifiable.
3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit.
During the nurse's admission interview, the patient states that she takes over-the-counter
water pills on a regular basis. How should the nurse best respond to the fact that the patient
has been taking diuretics?
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patient's oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patient's fluid balance is monitored vigilantly. - ANSC
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be
made aware. Adjusting the patient's sodium or fluid intake or fluid monitoring does not
address this important contraindication.
4. *****************************************************************An adult patient with
third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac
monitoring. What rhythm characteristic will the ECG most likely show?
A) PP interval and RR interval are irregular.
B) PP interval is equal to RR interval.
C) Fewer QRS complexes than P waves
D) PR interval is constant. - ANSC
Feedback:
In third-degree AV block, no atrial impulse is conducted through the AV node into the
ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the
ventricles. Therefore, there are more P waves than QRS complexes due to the difference in
the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not
consistent with this diagnosis.
4. A complication of peripheral vascular disease may be:
1. stasis ulcer.
2. Pressure ulcer.
3. Gastric ulcer.
4. Duodenal ulcer. - ANSAnswer: 1. stasis ulcer.
, ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative
heart transplant. The patient asks the nurse to remind him what this medication is for. How
should the nurse best respond?
A) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant. - ANSD
Feedback:
After heart transplant, patients are constantly balancing the risk of rejection with the risk of
infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf),
azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone)
to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac
output, or increase white cell counts.
4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator
should explain that hypertensive urgency differs from hypertensive emergency in what way?
A) The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive
emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage. - ANSAns:
D
Feedback:
Hypertensive emergencies are acute, life-threatening BP elevations that require prompt
treatment in an intensive care setting because of the serious target organ damage that may
occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is
no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic
monitoring of the patient's BP is required in both situations. The medications of choice in
hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral
doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting
enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive
urgencies.
5. ******************************************************** The nurse is writing a plan of care
for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the
patient?
A) Maintain a resting heart rate below 70 bpm.
B) Maintain adequate control of chest pain.
C) Maintain adequate cardiac output.
D) Maintain normal cardiac structure. - ANSC
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent
worsening complications as a result of decreased cardiac output. A resting rate of less than
70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute
coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the
physical structure of the heart.
