Lewis Chapter 35 Exam
Questions with
Answers
User [Date] [Course title]
,A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled
for cardiac catheterization. Which medication would need to be withheld for 24 hours before the
procedure and for 48 hours after the procedure?
1.Regular insulin
2.Glipizide (Glucotrol)
3.Repaglinide (Prandin)
4.Metformin (Glucophage) - Correct Answer: 4.
Metformin (Glucophage) needs to be withheld 24 hours before and for 48 hours after cardiac
catheterization because of the injection of contrast medium during the procedure. If the contrast
medium affects kidney function, with metformin in the system, the client would be at increased risk for
lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before
and 48 hours after cardiac catheterization.
A client in sinus bradycardia, with a heart rate of 45 beats/minute, complains of dizziness and has a
blood pressure of 82/60 mm Hg. Which prescription should the nurse anticipate will be prescribed?
1.Defibrillate the client.
2.Administer digoxin (Lanoxin).
3.Continue to monitor the client.
4.Prepare for transcutaneous pacing. - Correct Answer: 4.
Hypotension and dizziness are signs of decreased cardiac output. Transcutaneous pacing provides a
temporary measure to increase the heart rate and thus perfusion in the symptomatic client.
Defibrillation is used for treatment of pulseless ventricular tachycardia and ventricular fibrillation.
Digoxin will further decrease the client's heart rate. Continuing to monitor the client delays necessary
intervention.
The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme
dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse
immediately asks another nurse to contact the health care provider and prepares to implement which
priority interventions? Select all that apply.
1.Administering oxygen
2.Inserting a Foley catheter
,3.Administering furosemide (Lasix)
4.Administering morphine sulfate intravenously
5.Transporting the client to the coronary care unit
6.Placing the client in a low Fowler's side-lying position - Correct Answer: 1,2,3,4
Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary
edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of
the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler's position
to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A
Foley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate
reduces venous return (preload), decreases anxiety, and also reduces the work of breathing.
Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be
necessary at all if the client's response to treatment is successful.
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins
coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the
client's breath sounds?
1.Stridor
2.Crackles
3.Scattered rhonchi
4.Diminished breath sounds - Correct Answer: 2.
Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production
of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Rhonchi and diminished breath
sounds are not associated with pulmonary edema. Stridor is a crowing sound associated with
laryngospasm or edema of the upper airway.
A client with myocardial infarction is developing cardiogenic shock. Because of the risk of myocardial
ischemia, what condition should the nurse carefully assess the client for?
1.Bradycardia
2.Ventricular dysrhythmias
3.Rising diastolic blood pressure
4.Falling central venous pressure - Correct Answer: 2.
, Classic signs of cardiogenic shock as they relate to myocardial ischemia include low blood pressure and
tachycardia. The central venous pressure would rise as the backward effects of the severe left
ventricular failure became apparent. Dysrhythmias commonly occur as a result of decreased
oxygenation and severe damage to greater than 40% of the myocardium.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours.
The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour
was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL and the
serum creatinine level is 2.2 mg/dL. On the basis of these findings, the nurse would anticipate that the
client is at risk for which problem?
1.Hypovolemia
2.Acute kidney injury
3.Glomerulonephritis
4.Urinary tract infection - Correct Answer: 2.
The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low
cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output
and increased blood urea nitrogen and creatinine levels. The client may need medications to increase
renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question
indicate the presence of hypovolemia, glomerulonephritis, or urinary tract infection.
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular.
The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64
beats/minute. Which would be a correct interpretation based on these characteristics?
1.Sinus bradycardia
2.Sick sinus syndrome
3.Normal sinus rhythm
4.First-degree heart block - Correct Answer: 3.
Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The
PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second,
respectively.
Questions with
Answers
User [Date] [Course title]
,A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled
for cardiac catheterization. Which medication would need to be withheld for 24 hours before the
procedure and for 48 hours after the procedure?
1.Regular insulin
2.Glipizide (Glucotrol)
3.Repaglinide (Prandin)
4.Metformin (Glucophage) - Correct Answer: 4.
Metformin (Glucophage) needs to be withheld 24 hours before and for 48 hours after cardiac
catheterization because of the injection of contrast medium during the procedure. If the contrast
medium affects kidney function, with metformin in the system, the client would be at increased risk for
lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before
and 48 hours after cardiac catheterization.
A client in sinus bradycardia, with a heart rate of 45 beats/minute, complains of dizziness and has a
blood pressure of 82/60 mm Hg. Which prescription should the nurse anticipate will be prescribed?
1.Defibrillate the client.
2.Administer digoxin (Lanoxin).
3.Continue to monitor the client.
4.Prepare for transcutaneous pacing. - Correct Answer: 4.
Hypotension and dizziness are signs of decreased cardiac output. Transcutaneous pacing provides a
temporary measure to increase the heart rate and thus perfusion in the symptomatic client.
Defibrillation is used for treatment of pulseless ventricular tachycardia and ventricular fibrillation.
Digoxin will further decrease the client's heart rate. Continuing to monitor the client delays necessary
intervention.
The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme
dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse
immediately asks another nurse to contact the health care provider and prepares to implement which
priority interventions? Select all that apply.
1.Administering oxygen
2.Inserting a Foley catheter
,3.Administering furosemide (Lasix)
4.Administering morphine sulfate intravenously
5.Transporting the client to the coronary care unit
6.Placing the client in a low Fowler's side-lying position - Correct Answer: 1,2,3,4
Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary
edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of
the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler's position
to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A
Foley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate
reduces venous return (preload), decreases anxiety, and also reduces the work of breathing.
Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be
necessary at all if the client's response to treatment is successful.
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins
coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the
client's breath sounds?
1.Stridor
2.Crackles
3.Scattered rhonchi
4.Diminished breath sounds - Correct Answer: 2.
Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production
of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Rhonchi and diminished breath
sounds are not associated with pulmonary edema. Stridor is a crowing sound associated with
laryngospasm or edema of the upper airway.
A client with myocardial infarction is developing cardiogenic shock. Because of the risk of myocardial
ischemia, what condition should the nurse carefully assess the client for?
1.Bradycardia
2.Ventricular dysrhythmias
3.Rising diastolic blood pressure
4.Falling central venous pressure - Correct Answer: 2.
, Classic signs of cardiogenic shock as they relate to myocardial ischemia include low blood pressure and
tachycardia. The central venous pressure would rise as the backward effects of the severe left
ventricular failure became apparent. Dysrhythmias commonly occur as a result of decreased
oxygenation and severe damage to greater than 40% of the myocardium.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours.
The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour
was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL and the
serum creatinine level is 2.2 mg/dL. On the basis of these findings, the nurse would anticipate that the
client is at risk for which problem?
1.Hypovolemia
2.Acute kidney injury
3.Glomerulonephritis
4.Urinary tract infection - Correct Answer: 2.
The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low
cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output
and increased blood urea nitrogen and creatinine levels. The client may need medications to increase
renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question
indicate the presence of hypovolemia, glomerulonephritis, or urinary tract infection.
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular.
The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64
beats/minute. Which would be a correct interpretation based on these characteristics?
1.Sinus bradycardia
2.Sick sinus syndrome
3.Normal sinus rhythm
4.First-degree heart block - Correct Answer: 3.
Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The
PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second,
respectively.
