VNSG 1409 Med-Surg Exam 1 Chapter 21-26
Questions With Correct Answers
A patient ask the nurse what are the actions of the arteries? - ANSWER The
arterties carry blood from the heart to capillaries
The nurse is accessing the heart rate for a person who plays basketball and
runs back. What findings are anticipated? - ANSWER Bradycardia
The nurse is caring for a patient recovering from a cardiac catherization with a
right femoral artery entry site. Which action should the nurse take? - ANSWER
Encourage oral fluid
The nurse is caring for a patient admitted with chest pain and suspected
myocardial infarction (MI). The elevation of which laboratory value supports this
finding? - ANSWER Troponin
The nurse is caring for a group of patients. Which factor plays a leading role in
cardiovascular disease? - ANSWER Lifestyle choice
The nurse is explaining the regulation of blood pressure (BP) to a patient newly
diagnosed with hypertension. What tissues within the artery wall that help
maintain diastolic BP should the nurse identify for the patient? - ANSWER
Smooth muscle and elastic connective tissue
The nurse instructs a patient on stopping the prescribed medication warfarin
(Coumadin) before surgery. What is the reason for this? - ANSWER It increases
bleeding risk
A patient has sustained damage to the sinoatrial (SA) and atrioventricular (AV)
nodes. Which heart rates indicate that the patient's bundle of His node has taken
over as the pacemaker for the heart? - ANSWER 20-35 beats per minute
The nurse is reinforcing teaching to a patient about to undergo a cardiac
catheterization. Which statement made by the patient indicates a need for
additional teaching? - ANSWER This test will access the electrical system of my
heart
,The nurse is reviewing laboratory values for a patient and notes a potassium
level of 6.4 mEq/L. Which finding can the nurse expect the patient to report? -
ANSWER Slow, irregular heartbeat
The nurse is applying knee-high antiembolism stockings. What action should the
nurse take? - ANSWER Apply stockings up to 1 to 2 inches below the kneecap
The nurse is assessing a patient and notices the radial pulse has fewer beats
than the apical pulse. Which action should the nurse take? - ANSWER Notify the
HCP
The nurse is caring for a patient who had a cardiac catheterization using the
radial approach for entry. What activity level can the patient do afterward? -
ANSWER Up as tolerated
The patient is ordered to wear a 24-hour Holter monitor device. What
instructions should the patient be given when an event occurs? - ANSWER Push
the event button
A patient is ordered to wear a Holter monitor for a week. What should the nurse
instruct the patient about bathing? - ANSWER Take a sponge bath
The nurse is assessing a patient and notes that the nailbed angle exceeds 180
degrees and feels spongy when squeezed. How should the nurse document
these findings? - ANSWER Severe clubbing noted, HCP notified
The nurse takes the BP of a patient with a result of 120/80 mm Hg. Which action
should the nurse take? - ANSWER Document the finding as normal.
The nurse is auscultating heart sounds and notes an S3 heart sound. The nurse
knows an S3 sound may be heard in a patient with which condition? - ANSWER
Fluid overload
The nurse is caring for a patient recovering from a transesophageal
echocardiogram. Which action should the nurse take? - ANSWER Keep patient
NPO until gag reflexes are present
The nurse is caring for a patient receiving hemodynamic monitoring. Which
action should the nurse take? - ANSWER Monitor the site for infection
The nurse is reviewing the medication history for a patient about to undergo
cardiac surgery. Which medication should the nurse report to the surgeon? -
ANSWER Aspirin
The nurse is caring for a patient with a potassium level of 7.6 mEq/L. Which
diagnostic testing is priority? - ANSWER Electrocardiogram
, The nurse is assessing a patient and notes a grating sound. How should the
nurse document this finding? - ANSWER Perdicardial friction rub
A patient being treated for a severe blood loss has a BP of 90/56 mm Hg and
urine output of 10 mL over the last hour. Which physiological mechanism will be
activated to improve the situation? - ANSWER Renin-angiotensin-aldosterone
While collecting data, the nurse notes that the patient expectorates pink, frothy
sputum. Which health problem should the nurse consider is occurring in this
patient? - ANSWER Heart failure
The nurse is caring for a patient with venous blood flow problems. What findings
of the legs are anticipated? - ANSWER Brown discoloration, and blue when
hanging dependently
The nurse is caring for a patient with decreased arterial blood flow. Which
clinical manifestations can the nurse expect to document? - ANSWER
Decreased hair distribution
Thick, brittle nails
Shiny skin
The nurse is reinforcing teaching for a patient who is to wear a Holter monitor.
Which of the following should the nurse include? - ANSWER Push the event
button when symptoms occur
Keep an accurate diary of symptoms and activities
Avoid showers or baths while wearing the monitor
The nurse is caring for a patient who is having an exercise treadmill test. What
interventions would be appropriate for the test? - ANSWER Monitor vital signs
throughout the test.
Monitor electrocardiogram before, during, and after the test.
The nurse is caring for a patient with peripheral vascular disease. Which signs
or symptoms should the nurse expect to observe in this patient? - ANSWER Pain
Paralysis
Pulselessness
Parathesia
The nurse is helping a patient get out of bed for the first time after prolonged
bedrest. Upon standing, the patient becomes lightheaded. What actions should
the nurse take? - ANSWER Use a walking belt for activity out of bed
Sit patient down
Ask about any other symptoms, like chest pain
Take orthostatic BP reading
Questions With Correct Answers
A patient ask the nurse what are the actions of the arteries? - ANSWER The
arterties carry blood from the heart to capillaries
The nurse is accessing the heart rate for a person who plays basketball and
runs back. What findings are anticipated? - ANSWER Bradycardia
The nurse is caring for a patient recovering from a cardiac catherization with a
right femoral artery entry site. Which action should the nurse take? - ANSWER
Encourage oral fluid
The nurse is caring for a patient admitted with chest pain and suspected
myocardial infarction (MI). The elevation of which laboratory value supports this
finding? - ANSWER Troponin
The nurse is caring for a group of patients. Which factor plays a leading role in
cardiovascular disease? - ANSWER Lifestyle choice
The nurse is explaining the regulation of blood pressure (BP) to a patient newly
diagnosed with hypertension. What tissues within the artery wall that help
maintain diastolic BP should the nurse identify for the patient? - ANSWER
Smooth muscle and elastic connective tissue
The nurse instructs a patient on stopping the prescribed medication warfarin
(Coumadin) before surgery. What is the reason for this? - ANSWER It increases
bleeding risk
A patient has sustained damage to the sinoatrial (SA) and atrioventricular (AV)
nodes. Which heart rates indicate that the patient's bundle of His node has taken
over as the pacemaker for the heart? - ANSWER 20-35 beats per minute
The nurse is reinforcing teaching to a patient about to undergo a cardiac
catheterization. Which statement made by the patient indicates a need for
additional teaching? - ANSWER This test will access the electrical system of my
heart
,The nurse is reviewing laboratory values for a patient and notes a potassium
level of 6.4 mEq/L. Which finding can the nurse expect the patient to report? -
ANSWER Slow, irregular heartbeat
The nurse is applying knee-high antiembolism stockings. What action should the
nurse take? - ANSWER Apply stockings up to 1 to 2 inches below the kneecap
The nurse is assessing a patient and notices the radial pulse has fewer beats
than the apical pulse. Which action should the nurse take? - ANSWER Notify the
HCP
The nurse is caring for a patient who had a cardiac catheterization using the
radial approach for entry. What activity level can the patient do afterward? -
ANSWER Up as tolerated
The patient is ordered to wear a 24-hour Holter monitor device. What
instructions should the patient be given when an event occurs? - ANSWER Push
the event button
A patient is ordered to wear a Holter monitor for a week. What should the nurse
instruct the patient about bathing? - ANSWER Take a sponge bath
The nurse is assessing a patient and notes that the nailbed angle exceeds 180
degrees and feels spongy when squeezed. How should the nurse document
these findings? - ANSWER Severe clubbing noted, HCP notified
The nurse takes the BP of a patient with a result of 120/80 mm Hg. Which action
should the nurse take? - ANSWER Document the finding as normal.
The nurse is auscultating heart sounds and notes an S3 heart sound. The nurse
knows an S3 sound may be heard in a patient with which condition? - ANSWER
Fluid overload
The nurse is caring for a patient recovering from a transesophageal
echocardiogram. Which action should the nurse take? - ANSWER Keep patient
NPO until gag reflexes are present
The nurse is caring for a patient receiving hemodynamic monitoring. Which
action should the nurse take? - ANSWER Monitor the site for infection
The nurse is reviewing the medication history for a patient about to undergo
cardiac surgery. Which medication should the nurse report to the surgeon? -
ANSWER Aspirin
The nurse is caring for a patient with a potassium level of 7.6 mEq/L. Which
diagnostic testing is priority? - ANSWER Electrocardiogram
, The nurse is assessing a patient and notes a grating sound. How should the
nurse document this finding? - ANSWER Perdicardial friction rub
A patient being treated for a severe blood loss has a BP of 90/56 mm Hg and
urine output of 10 mL over the last hour. Which physiological mechanism will be
activated to improve the situation? - ANSWER Renin-angiotensin-aldosterone
While collecting data, the nurse notes that the patient expectorates pink, frothy
sputum. Which health problem should the nurse consider is occurring in this
patient? - ANSWER Heart failure
The nurse is caring for a patient with venous blood flow problems. What findings
of the legs are anticipated? - ANSWER Brown discoloration, and blue when
hanging dependently
The nurse is caring for a patient with decreased arterial blood flow. Which
clinical manifestations can the nurse expect to document? - ANSWER
Decreased hair distribution
Thick, brittle nails
Shiny skin
The nurse is reinforcing teaching for a patient who is to wear a Holter monitor.
Which of the following should the nurse include? - ANSWER Push the event
button when symptoms occur
Keep an accurate diary of symptoms and activities
Avoid showers or baths while wearing the monitor
The nurse is caring for a patient who is having an exercise treadmill test. What
interventions would be appropriate for the test? - ANSWER Monitor vital signs
throughout the test.
Monitor electrocardiogram before, during, and after the test.
The nurse is caring for a patient with peripheral vascular disease. Which signs
or symptoms should the nurse expect to observe in this patient? - ANSWER Pain
Paralysis
Pulselessness
Parathesia
The nurse is helping a patient get out of bed for the first time after prolonged
bedrest. Upon standing, the patient becomes lightheaded. What actions should
the nurse take? - ANSWER Use a walking belt for activity out of bed
Sit patient down
Ask about any other symptoms, like chest pain
Take orthostatic BP reading
