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LATEST EXAM [NEW VERSION]
1. A client with acute chest pain is suspected of having an acute myocardial infarction. Which action
should the nurse take first?
A. Encourage ambulation
B. Place the client on a cardiac monitor
C. Offer a large meal
D. Restrict all fluids
Correct Answer: B
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs.
2. Which finding is most consistent with this client's condition? The nurse is caring for a client with
the cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Restrict all fluids
D. Place the client on a cardiac monitor
Correct Answer: D
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
3. Which mechanism best explains the client's presentation? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Place the client on a cardiac monitor
B. Encourage ambulation
C. Offer a large meal
D. Restrict all fluids
Correct Answer: A
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
,oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
4. Which complication is the nurse most concerned about? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Place the client on a cardiac monitor
D. Restrict all fluids
Correct Answer: C
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
5. Which nursing action is the priority? The nurse is caring for a client with the cardiovascular
problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Place the client on a cardiac monitor
D. Restrict all fluids
Correct Answer: C
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
6. Which teaching point should the nurse include? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Place the client on a cardiac monitor
B. Encourage ambulation
C. Offer a large meal
D. Restrict all fluids
Correct Answer: A
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
7. Which physiologic change would the nurse expect? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Restrict all fluids
D. Place the client on a cardiac monitor
Correct Answer: D
,Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
8. Which finding requires the most immediate follow-up? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Place the client on a cardiac monitor
C. Offer a large meal
D. Restrict all fluids
Correct Answer: B
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
9. Which statement demonstrates correct understanding? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Place the client on a cardiac monitor
B. Encourage ambulation
C. Offer a large meal
D. Restrict all fluids
Correct Answer: A
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
10. Which diagnostic finding would support the condition? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Restrict all fluids
D. Place the client on a cardiac monitor
Correct Answer: D
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
11. Which risk factor most strongly contributes to this problem? The nurse is caring for a client with
the cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Place the client on a cardiac monitor
C. Offer a large meal
D. Restrict all fluids
Correct Answer: B
, Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
12. Which intervention helps reduce the cardiovascular risk? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Place the client on a cardiac monitor
D. Restrict all fluids
Correct Answer: C
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
13. Which symptom pattern is most characteristic? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Restrict all fluids
D. Place the client on a cardiac monitor
Correct Answer: D
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
14. Which pathophysiologic process is occurring? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Place the client on a cardiac monitor
B. Encourage ambulation
C. Offer a large meal
D. Restrict all fluids
Correct Answer: A
Rationale: Continuous cardiac monitoring is a priority because acute myocardial ischemia can
precipitate life-threatening dysrhythmias. The nurse should also rapidly assess vital signs,
oxygenation, pain, and other emergency needs. Apply the underlying cardiovascular mechanism to
the clinical cue rather than choosing an answer based only on one symptom.
15. Which outcome best indicates improvement? The nurse is caring for a client with the
cardiovascular problem described by this review topic.
A. Encourage ambulation
B. Offer a large meal
C. Place the client on a cardiac monitor
D. Restrict all fluids
Correct Answer: C