NSG 555/ NSG555 Exam 3 – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 555/ NSG555 Exam 3 – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A When developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a) family history of coronary artery disease. b) increased risk associated with the patient's male sex. c) high incidence of cardiovascular disease in older people. d) elevation of the patient's serum low density lipoprotein (LDL) level. d) elevation of the patient's serum low density lipoprotein (LDL) level. Rationale: Serum LDL is the only modifiable risk factor. Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)? a) The pain increases with deep breathing. b) The pain has persisted longer than 30 minutes. c) The pain worsens when the patient raises the arms. d) The pain is relieved after the patient takes nitroglycerin. b) The pain has persisted longer than 30 minutes. Rationale: Cardiac chest pain lasting longer than 30 minutes and not relieved by rest or use of nitroglycerin could be indicative of AMI. Which information given by a patient admitted with stable angina will help the nurse confirm this diagnosis? a) The patient rates the pain at a level 3 to 5 (0 to 10 scale). b) The patient states that the pain "wakes me up at night." c) The patient says that the frequency of the pain has increased over the last few weeks. d) The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet. d) The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet. Rationale: Chronic stable angina refers to chest pain that occurs intermittently over long period of time with similar pattern of onset, duration, and intensity of symptoms. The pain of chronic stable angina usually lasts only for a few minutes before subsiding with rest, calming down, or use of sublingual nitroglycerin (NTG) After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been EFFECTIVE? a) "I can expect indigestion as a side effect of nitroglycerin." b) "I can only take the nitroglycerin if I start to have chest pain." c) "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." d) "I will help slow down the progress of the plaque formation by taking nitroglycerin." c) "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." Rationale: Chest pain that continues after use of NTG may indicate a change to acute coronary syndrome (ACS). A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI? Homocysteine C-reactive protein Cardiac-specific troponin I and troponin T High-density lipoprotein (HDL) cholesterol Cardiac-specific troponin I and troponin T Rationale: Cardiac-specific troponin I and T are highly-specific indicators of MI and have greater sensitivity and specificity than creatinine-kinase MB Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will reduce the "fight or flight" response. decrease spasm of the coronary arteries. increase the force of myocardial contraction. help prevent clotting in the coronary arteries. decrease spasm of the coronary arteries. Rationale: This statement refers to the action of a calcium channel blocker A patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? Platelet aggregation is enhanced by IV heparin infusion. Heparin will dissolve the clot that is blocking blood flow to the heart. Coronary artery plaque size and adherence are decreased with heparin. Heparin will prevent the development of new clots in the coronary arteries. Heparin will prevent the development of new clots in the coronary arteries. When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? Check blood pressure. Monitor apical pulse rate. Monitor for dysrhythmias. Ask about chest discomfort. Ask about chest discomfort. Rationale: IV nitroglycerin is given to promote coronary artery vasodilation and would be evaluated by assessing the patient's level of chest pain A patient with ST segment elevation in several electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy? "Do you take aspirin on a daily basis?" "What time did your chest pain begin?" "Is there any family history of heart disease?" "Can you describe the quality of your chest pain?" "What time did your chest pain begin?" Rationale: A patient with a STEMI is eligible for thrombolytic therapy if he or she has had chest pain for 12 hours or less During the administration of the fibrinolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences bleeding from the gums. surface bleeding from the IV site. a decrease in level of consciousness. a nonsustained episode of ventricular tachycardia. a decrease in level of consciousness. Rationale: A decrease in level of consciousness may indicate that the patient is experiencing a major bleed associated with the use of thrombolytics Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? Palpate the radial pulses bilaterally. Assess the feet for peripheral edema. Auscultate for a pericardial friction rub. Check the cardiac monitor for dysrhythmias. Auscultate for a pericardial friction rub. Rationale: The patient's signs/symptoms describe a possible progression to pericarditis A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patient's care? sildenafil (Viagra) furosemide (Lasix) diazepam (Valium) captopril (Capoten) sildenafil (Viagra) Rationale: Sildenafil (Viagra) would be the medication with the most critical implications. Sildenafil is a potent vasodilator, so adding more vasodilation may result in a hypotensive crisis When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse? Pedal pulses 1+ Heart rate 100 beats/min Blood pressure 104/56 mm Hg Chest pain level 10 on a 10-point scale Chest pain level 10 on a 10-point scale When admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first? Obtain the blood pressure. Attach the cardiac monitor. Assess the peripheral pulses. Auscultate the breath sounds. Attach the cardiac monitor. Rationale: The earlier the monitor is attached, the faster the information concerning cardiac status can be interpreted. Which information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? No change in the patient's chest pain A large bruise at the patient's IV insertion site A decrease in ST segment elevation on the electrocardiogram (ECG) An increase in cardiac enzyme levels since admission No change in the patient's chest pain Rationale: No change in the patient's chest pain is the most important to report because the patient may be in need of another intervention to relieve the MI A patient who has chest pain is admitted to the emergency department (ED), and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first? Electrocardiogram (ECG) Computed tomography (CT) scan Chest x-ray Troponin level Electrocardiogram (ECG) Rationale: An ECG will provide the most information in the least amount of time concerning the patient's cardiac status. The most sensitive test for myocardial infarction is Troponin BNP Myoglobin CK-MB Troponin Which of the following patients is having the poorest prognosis? Mr. A: BNP 100 pg/mL Mr. B: BNP 500 pg/mL Mr. C: BNP 1000 pg/mL Mr. D: BNP 2000 pg/mL Mr. D: BNP 2000 pg/mL Rationale: High BNP could indicate long-term damage Large heart (cardiomegaly) may be seen in patient with heart failure and cardiomyopathy. true false true Which of the following is correct about ECG? It is an invasive procedure in which the patient receive electrical signals. ECG is used to evaluate the structure and function of valves. It is a non-invasive test done at the bedside used to rule out MI. ECG is only indicated for patients with chest pain. It is a non-invasive test done at the bedside used to rule out MI. The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to exercise more than usual while the monitor is in place. remove the electrodes when taking a shower or tub bath. keep a diary of daily activities while the monitor is worn. connect the recorder to a telephone transmitter once daily. keep a diary of daily activities while the monitor is worn. When monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action? Patient complaint of feeling tired. Pulse change from 80 to 96 beats/minute. BP increase from 134/68 to 150/80 mm Hg. Electrocardiographic (ECG) changes indicating coronary ischemia. Electrocardiographic (ECG) changes indicating coronary ischemia. When admitting a patient for a coronary arteriogram and angiogram, which information about the patient is most important to communicate to the health care provider? The patient's pedal pulses are +1. The patient is allergic to shellfish. The patient has not eaten anything today. The patient had an arteriogram a year ago The patient is allergic to shellfish. Rationale: These procedures require the use of contrast medium, which may be contraindicated in patients with shellfish allergy. Which of the following may cause changes in ECG rhythms? Na is 136 mEq/L K is 2.8 mEq/L Ca is 8.5 mg/dL Creatine 1.0 mg/dL K is 2.8 mEq/L Which of the following is correct about BNP? BNP is released when atria stretch BNP is releases when ventricles relax. BNP indicates the progression of heart failure. High level of BNP indicates myocardial infarction. BNP indicates the progression of heart failure. Rationale: The release of BNP indicates the progression of heart failure. It is released in response to ventricular stretch The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increasing blood flow. true false true Which of the following indicate hemodynamic stability? Select all that apply. Stroke volume is 50 mL per beat. Cardiac output is 5 L/min. Mean arterial pressure (MAP) is 55 mmHg. SBP is 120 mmHg Presence of JVD. Cardiac output is 5 L/min. SBP is 120 mmHg Low preload is seen in dehydration while high preload is seen in over hydration. true false true Afterload increases in case of vasodilation and decreases in case of vasoconstriction. true false false Calculation MAP for a patent with BP of 140/83. 102 (140+83+83)/3=102 A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of asthma. peptic ulcer disease. alcohol dependency. myocardial infarction (MI). asthma Rationale: Nadolol is a beta-blocker and can cause bronchospasm, especially in patients with a history of asthma Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? 108/64 mm Hg 128/76 mm Hg 140/90 mm Hg 136/ 82 mm Hg 128/76 mm Hg Which information should the nurse include when teaching a patient with newly diagnosed hypertension? Dietary sodium restriction will control BP for most patients. Most patients are able to control BP through lifestyle changes. Hypertension is usually asymptomatic until significant organ damage occurs. Annual BP checks are needed to monitor treatment effectiveness. Hypertension is usually asymptomatic until significant organ damage occurs. The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? Serum creatinine of 2.6 mg/dL Serum potassium of 3.8 mEq/L Serum hemoglobin of 14.7 g/dL Blood glucose level of 98 mg/d Serum creatinine of 2.6 mg/dL During inspiration, the chest wall expands and causes the intrathoracic pressure to become more negative like a vacuum, which induces a reduction in blood volume returning from the lungs into the left ventricle and therefore decrease cardiac output. true false true One of the major factors that affects the myocardial blood flow is changes in oxygen demands. true false true SA node is consider the natural pacemaker of the conduction system of the heart. true false true AV node function is to delay the action potentials and allow ventricles to rest. true false true During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates decreased fluid volume. jugular vein atherosclerosis. elevated right atrial pressure. incompetent jugular vein valves. elevated right atrial pressure. Rationale: The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle eflects elevated right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis. The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is weight loss of 2 pounds overnight. hourly urine output greater than 60 mL. reduction in patient complaints of chest pain. decreased dyspnea with the head of bed at 30 degrees. decreased dyspnea with the head of bed at 30 degrees. Rationale: Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred but are not as specific to evaluating this patient's response. Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient develops a dry, hacking cough. any ventricular ectopy. a systolic BP 90 mm Hg. a heart rate 50 beats/minute. a systolic BP 90 mm Hg. Rationale: Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy. A patient who has chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment information as pulsus alternans. two-pillow orthopnea. acute bilateral pleural effusion. paroxysmal nocturnal dyspnea. paroxysmal nocturnal dyspnea. Rationale: Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period. During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of "feeling too tired to do anything." Based on these data, the best nursing diagnosis for the patient is activity intolerance related to fatigue . disturbed body image related to leg swelling. impaired skin integrity related to peripheral edema. impaired gas exchange related to chronic heart failure. activity intolerance related to fatigue. Rationale: The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems. The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient uses an additional pillow to sleep when feeling short of breath at night. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. calls the clinic when the weight increases from 124 to 130 pounds in a week. says that the nitroglycerin patch will be used for any chest pain that develops. calls the clinic when the weight increases from 124 to 130 pounds in a week. When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include canned and frozen fruits. fresh or frozen vegetables. milk, yogurt, and other milk products. eggs and other high-cholesterol foods. milk, yogurt, and other milk products. Rationale: Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000 mg sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction. The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include avoid dietary sources of potassium. take the hydrochlorothiazide before bedtime. notify the health care provider about any nausea. never take digoxin if the pulse is below 60 beats/minute. notify the health care provider about any nausea. While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate transfer to a dementia care service. referral to a home health care agency. placement in a long-term care facility. arrangements for around-the-clock care. referral to a home health care agency. Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%? Need to participate in an aerobic exercise program several times weekly Use of salt substitutes to replace table salt when cooking and at the table Importance of making a yearly appointment with the primary care provider Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors Following an acute myocardial infarction, a previously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about angiotensin-converting enzyme (ACE) inhibitors. digitalis preparations. b-adrenergic agonists. calcium channel blockers. angiotensin-converting enzyme (ACE) inhibitors. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? Serum creatine kinase (CK) Arterial blood gases (ABGs) B-type natriuretic peptide (BNP) 12-lead electrocardiogram (ECG) B-type natriuretic peptide (BNP) Rationale: BNP is secreted when ventricular pressures increase, as with heart failure, and elevated BNP indicates a probable or very probable diagnosis of heart failure. 12-lead ECGs, ABGs, and CK also may be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP. Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? Monitor blood pressure frequently. Encourage patient to ambulate in room. Titrate nesiritide rate slowly before discontinuing. Teach patient about safe home use of the medication. Monitor blood pressure frequently. A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective? "I will call for help when I need to get up to use the bathroom." "I will be sure to take the medication after eating something." "I will need to include more high-potassium foods in my diet." "I will expect to feel more short of breath for the next few days." "I will call for help when I need to get up to use the bathroom." A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? Palpate the abdomen. Assess the orientation. Check the capillary refill. Auscultate the lung sounds. Auscultate the lung sounds. A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to give IV diazepam (Valium) 2.5 mg. administer IV morphine sulfate 2 mg. increase nitroglycerin (Tridil) infusion by 5 mcg/min. increase dopamine (Intropin) infusion by 2 mcg/kg/min. administer IV morphine sulfate 2 mg. After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first? A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure (BP) of 100/56 A patient who is cool and clammy, with new-onset confusion and restlessness A patient who had dizziness after receiving the first dose of captopril (Capoten) A patient who has crackles in both posterior lung bases and is receiving oxygen A patient who is cool and clammy, with new-onset confusion and restlessness Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse? Oxygen saturation of 88% Weight gain of 1 kg (2.2 lb) Apical pulse rate of 106 beats/minute Urine output of 50 mL over 2 hours Oxygen saturation of 88% A patient has recently started taking oral digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for control of heart failure. Which assessment finding by the home health nurse is most important to communicate to the health care provider? Presence of 1 to 2+ edema in the feet and ankles Liver is palpable 2 cm below the ribs on the right side. Serum potassium level is 3.0 mEq/L after 1 week of therapy Weight increase from 120 pounds to 122 pounds over 3 days Serum potassium level is 3.0 mEq/L after 1 week of therapy An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with carvedilol (Coreg). Which of these assessment findings is most important for the nurse to report to the health care provider? Pulse rate of 56 2+ pedal edema BP of 88/42 mm Hg Complaints of fatigue BP of 88/42 mm Hg A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN? Evaluate the IV insertion site for extravasation. Document the patient's BP and heart rate every hour. Adjust the rate to keep the systolic BP 90 mm Hg. Teach the patient the reasons for remaining on bed rest. Document the patient's BP and heart rate every hour. To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patient's P wave. PR interval. QT interval. QRS complex. P wave. The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use? Print a 1-minute electrocardiogram (ECG) strip and count the number ofQRS complexes. Count the number of large squares in the R-R interval and divide by 300. Use the 3-second markers to count the number of QRS complexes in 6seconds and multiply by 10. Calculate the number of small squares between one QRS complex and the next and divide into 1500. Use the 3-second markers to count the number of QRS complexes in 6seconds and multiply by 10. A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of how many beats/minute? 15 to 20 20 to 40 40 to 60 60 to 100 40 to 60 The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as atrial fibrillation. sinus tachycardia. ventricular fibrillation. ventricular tachycardia. ventricular tachycardia. A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about electrical cardioversion. IV adenosine (Adenocard). anticoagulant therapy with warfarin (Coumadin). Incorrect insertion of an implantable cardioverter-defibrillator (ICD). anticoagulant therapy with warfarin (Coumadin). Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? The pacemaker prevents or minimizes ventricular irritability. The pacemaker paces the atria at rates up to 500 impulses/minute. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. The pacemaker stimulates a heart beat if the patient's heart rate drops too low. The pacemaker stimulates a heart beat if the patient's heart rate drops too low. A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, "It will be 6 weeks before I can take a bath or return to my usual activities." "I will notify the airlines when I make a reservation that I have a pacemaker." "I won't lift the arm on the pacemaker side up very high until I see the doctor." "I must avoid cooking with a microwave oven or being near a microwave in use." "I won't lift the arm on the pacemaker side up very high until I see the doctor." Which action should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg? Turn the synchronizer switch to the "off" position. Perform cardiopulmonary resuscitation (CPR) until the paddles are incorrect position. Set the defibrillator/cardioverter energy to 300 joules. Administer a sedative before cardioversion is implemented. Administer a sedative before cardioversion is implemented. A 19-year-old has a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate? Allow the student to participate on the swim team. Refer the student to a cardiologist for further assessment. Obtain more detailed information about the student's health history. Tell the student to stop swimming immediately if any dyspnea occurs. Allow the student to participate on the swim team. When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a T wave of 0.16 second. P-R interval of 0.18 second. Q-T interval of 0.34 second. QRS interval of 0.14 second. QRS interval of 0.14 second Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? Blood glucose 228 mg/dL Serum chloride 90 mEq/L Serum sodium 133 mEq/L Serum potassium 2.8 mEq/L Serum potassium 2.8 mEq/L A patient's cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? Defibrillate at 200 joules. Give O2 per bag-valve-mask. Give epinephrine (Adrenalin) IV. Prepare for endotracheal intubation. Defibrillate at 200 joules. A patient's cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time? Prepare for possible temporary pacemaker insertion. Administer atropine sulfate 1 mg IV per agency protocol. Document the patient's rhythm and assess the patient's response to the rhythm. Call the health care provider before giving the prescribed metoprolol (Lopressor). Call the health care provider before giving the prescribed metoprolol (Lopressor). A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? Continue to monitor the rhythm and BP. Apply the transcutaneous pacemaker (TCP). Have the patient perform the Valsalva maneuver. Give the scheduled dose of diltiazem (Cardizem). Apply the transcutaneous pacemaker (TCP). A 21-year-old student arrives at the student health center at the end of the quarter complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take first? Have the patient transported to the hospital emergency department (ED). Administer O2 at 2 to 3 L/min using nasal prongs. Ask the patient about any history of coronary artery disease. Question the patient about current stress level and coffee use. Question the patient about current stress level and coffee use. The nurse has received change-of-shift report about the following patients on the telemetry unit. Which patient should the nurse see first? A patient with atrial fibrillation, rate 88, who has a new order for warfarin (Coumadin) A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and diaphoresis. Which of these actions that are included in the hospital dysrhythmia protocol should the nurse take first? Obtain a 12-lead electrocardiogram (ECG). Give O2 at 3 to 4 L/min. Take the patient's blood pressure and respiratory rate. Notify the health care provider of the change in rhythm. Give O2 at 3 to 4 L/min. A patient whose cardiac monitor shows sinus tachycardia, rate 102, is apneic and no pulses are palpable by the nurse. What is the first action that the nurse should take? Start CPR. Defibrillate. Administer atropine per hospital protocol. Give 100% oxygen per non-rebreather mask. Start CPR. A patient is admitted to the hospital with possible acute pericarditis. The nurse will plan to teach the patient about the purpose of electrolyte levels. echocardiography. daily blood cultures. cardiac catheterization. echocardiography. To assess the patient with pericarditis for the presence of a pericardial friction rub, the nurse should: auscultate with the stethoscope diaphragm at the lower left sternal border. listen for a rumbling, low-pitched, systolic sound over the left anterior chest. feel the precordial area with the palm of the hand to detect vibration with cardiac contraction. ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub. auscultate with the stethoscope diaphragm at the lower left sternal border. Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should: check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration. note when Korotkoff sounds are audible during both inspiration and expiration. auscultate for a pericardial friction rub that increases in volume during inspiration. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP). note when Korotkoff sounds are audible during both inspiration and expiration. The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The most appropriate intervention by the nurse for this problem is to: force fluids to 3000 mL/day to decrease fever and inflammation. teach the patient to take deep, slow respirations to control the pain. remind the patient to ask for the opioid pain medication every 4 hours. position the patient in Fowler's position, leaning forward on the overbed table. position the patient in Fowler's position, leaning forward on the overbed table. A patient who has had recent cardiac surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer? Fentanyl 2 mg IV IV morphine sulfate 6 mg Oral ibuprofen (Motrin) 800 mg Oral acetaminophen (Tylenol) 650 mg Oral ibuprofen (Motrin) 800 mg Which of the following assessment data obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? Pulsus paradoxus 8 mm Hg Blood pressure (BP) of 166/96 Jugular vein distention (JVD) to the level of the jaw Level 6 (0 to 10 scale) chest pain with deep inspiration Jugular vein distention (JVD) to the level of the jaw A few days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first? Auscultate the heart sounds. Check the patient's oral temperature. Notify the patient's health care provider. Give the ordered acetaminophen (Tylenol). Auscultate the heart sounds. Rationale: The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature, giving acetaminophen (Tylenol), and notifying the health care provider also are appropriate actions but would not be done before listening for a rub. The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? "Have you been to the dentist lately?" "Do you have a history of a heart attack?" "Is there a family history of endocarditis?" "Have you had any recent immunizations?" "Have you been to the dentist lately?" Rationale: Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE. When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for: diastolic murmur. peripheral edema. right upper quadrant tenderness. complaints of shortness of breath. complaints of shortness of breath Rationale: The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease, but are not indicators of possible hypoxemia. A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which information will the nurse include? Biologic replacement valves require the use of immunosuppressive drugs. Mechanical mitral valves require replacement approximately every 5 years. Lifelong anticoagulant therapy is needed after mechanical valve replacement. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty. Lifelong anticoagulant therapy is needed after mechanical valve replacement. A patient with chronic atrial fibrillation develops sudden severe pain, pulseless, pallor, and coolness in the left leg. The nurse should notify the health care provider and: elevate the left leg on a pillow. apply an elastic wrap to the leg. assist the patient in gently exercising the leg. keep the patient in bed in the supine position. keep the patient in bed in the supine position. The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find: a positive Homans' sign. swollen, dry, scaly ankles. prolonged capillary refill in all the toes. a large amount of drainage from the ulcer. prolonged capillary refill in all the toes. Rationale: Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will have to buy some loose clothing that does not bind across m legs or waist." "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily." "I will change my position every hour and avoid long periods of sitting with my legs down." "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective? The patient avoids the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). The patient exercises indoors during the winter months. The patient places the hands in hot water when they turn pale. The patient takes pseudoephedrine (Sudafed) for cold symptoms. The patient exercises indoors during the winter months. The health care provider prescribes an infusion of argatroban (Acova)and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to: avoid giving any IM medications to prevent localized bleeding. discontinue the infusion for PTT values greater than 50 seconds. monitor posterior tibial and dorsalis pedis pulses with the Doppler. have vitamin K available in case reversal of the argatroban is needed. avoid giving any IM medications to prevent localized bleeding A patient with a venous thromboembolism (VTE) is started on enoxaparin(Lovenox) and warfarin (Coumadin). The patient asks the nurse why twomedications are necessary. Which response by the nurse is accurate? "Administration of two anticoagulants reduces the risk for recurrent venous thrombosis." "Lovenox will start to dissolve the clot, and Coumadin will prevent anymore clots from occurring." "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant." "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says, "I should increase the amount of green, leafy vegetables that I eat.” “I should wear a Medic Alert bracelet stating that I take Coumadin.” “I will need to have blood tests routinely to monitor the effects of the Coumadin.” “I will check with my health care provider before I begin or stop any medication.” "I should increase the amount of green, leafy vegetables that I eat.” A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that: sitting at the work counter, rather than standing, is recommended. compression stockings should be applied before getting out of bed. exercises such as walking or jogging cause recurrence of varicosities. taking one aspirin daily will help prevent clotting around venous valves. compression stockings should be applied before getting out of bed. Rationale: Compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended to the patient who had just had sclerotherapy. Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg? Adequate carbohydrate intake Prophylactic antibiotic therapy Application of compression to the leg Methods of keeping the wound area dry Application of compression to the leg While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information? "When I stand too long, my feet start to swell up." "Sometimes I get tired when I climb a lot of stairs." "My fingers hurt when I go outside in cold weather." "My legs cramp whenever I walk more than a block." "My legs cramp whenever I walk more than a block." When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include? "Exercise only if you do not experience any pain." "It is very important that you stop smoking cigarettes. "Try to keep your legs elevated whenever you are sitting." "Put on support hose early in the day before swelling occurs." "It is very important that you stop smoking cigarettes. Which of these patients admitted to the emergency department should the nurse assess first? 62-year-old who has gangrenous ulcers on both feet 50-year-old who is complaining of "tearing" chest pain 45-year-old who is taking anticoagulants and has bloody stools 36-year-old who has right calf tenderness, redness, and swelling 50-year-old who is complaining of "tearing" chest pain Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? Notify the surgeon and anesthesiologist. Document that the pulses are absent and recheck in 30 minutes. Review the preoperative assessment form for data about the pulses. Review the preoperative assessment form for data about the pulses. When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? Absence of flatus Loose, bloody stools Hypotonic bowel sounds Abdominal pain with palpation Loose, bloody stools A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene? The LPN/LVN places the patient in a Fowler's position for meals. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. The LPN/LVN assists the patient to ambulate 40 feet in the hallway. The LPN/LVN administers the ordered aspirin 160 mg after breakfast. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? Cessation of smoking Control of serum lipid levels Maintenance of appropriate weight Demonstration of meticulous foot care Cessation of smoking Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? Complaint of left calf pain New onset shortness of breath Red skin color of left lower leg Temperature of 100.4° F (38° C) New onset shortness of breath Rationale: New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the healthcare provider. The other findings are typical of VTE.