PNVN 1631 Exam#1 Cardio_ PNVN1631_ Medical - Surgical Nursing I {Score for this quiz: 66.17 out of 80}

PNVN 1631 Exam#1 Cardio Due Oct 4 at 8am Points 80 Questions 80 Available Oct 4 at 4am - Oct 4 at 9pm 17 hours Time Limit 135 Minutes Instructions Attempt History Attempt Time Score LATEST Attempt 1 37 minutes 66.17 out of 80  Correct answers are hidden. Score for this quiz: 66.17 out of 80 Submitted Oct 4 at 11:21am This attempt took 37 minutes. Read the questions carefully and choose the best options for each item question. This is a 80- item questions, please be mindful of your time. When done, click submit. Good luck and thank you. Question 1 1 / 1 pts The nurse clarifies that the master pacemaker of the heart is the: bundle of His. atrioventricular (AV) node. left ventricle. sinoatrial (SA) node.The SA node is the master pacemaker of the heart. Question 2 1 / 1 pts The patient has been hospitalized for hypertensive episodes three times in the last months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse’s immediate course of action would be to: have a serious talk with him and his family about compliance. reteach him about his medications. collect more information to identify his reasons for noncompliance. arrange for home visits after discharge. Nursing interventions include measures to prevent disease progression and complications. Reteaching about medication will not identify the cause of noncompliance. Question 3 1 / 1 pts The nurse finds a client tensing while lying in bed staring at the cardiac monitor. The client states, "There sure are a lot of wiresaround there. I sure hope we don't get hit by lightning!" Which is the nurse's best response? “Yes the equipment is a little scary. Can we talk about how the cardiac monitor works?” “Would you like a mild sedative to help you relax?” “I know about your concerns. Your family can stay with you every night if you want to.” “Oh don’t worry, the weather is supposed to be sunny and clear today.” Question 4 1 / 1 pts A nurse is collecting data on a child with a diagnosis of rheumatic fever. Which of the following questions would the nurse initially ask the mother of the child? “Has the child had any diarrhea?” “Has the child been vomiting?” “Does the child complain of chest pain?” “Has the child complained of a sore throat within the past few weeks or months?”Rationale: Rheumatic fever characteristically presents 2 to 6 weeks following an untreated or partially treated group A ß-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether any family members have had a sore throat or unexplained fever within the past 2 months. Although options 1, 2, and 3 may be asked during data collection, they would not be the initial concerns for a child with rheumatic fever. Test-Taking Strategy: Eliminate options 1 and 2 first because they are comparable or alike and both relate to the gastrointestinal system. From the remaining options, recalling that rheumatic fever characteristically presents 2 to 6 weeks following an untreated or partially treated group A ß-hemolytic streptococcal infection of the upper respiratory tract will direct you to option 4. If you had difficulty with this question, review the etiology related to rheumatic fever. Question 5 1 / 1 pts The client is to receive Lopressor (metoprolol tartrate) 0.05 grams po every day. Each scored tablet contains 50 mg. How many tablets would the client receive? 2 1/2 1 1 1/2Question 6 1 / 1 pts Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest? Encourage passive leg exercises and turning. Position pillows behind the knees. Assess peripheral pulses. Limit fluid intake. Using active or passive leg exercises for a patient on bed rest will prevent clot formation. Assessing pulses is not a preventive measure. Adequate hydration promotes fluidity of the blood and decreases the risk of clot formation. Placing pressure against the popliteal space will increase the risk of clot formation. Question 7 1 / 1 pts The patient is on the cardiac monitor undergoing a diagnostic procedure. Suddenly, the health care provider says, “The patient is having ventricular fibrillation!” Which piece of equipment is the most vital? Bag-valve mask Temporary pacemaker Crash cartDefibrillator AHN Study guide resource p.51 Incorrect Incorrect Question 8 0 / 1 pts A client had abdominal aortic aneurysm graft procedure 2 days ago. This morning, the client says, "I don't feel any better than I did before surgery." The appropriate response by the nurse is: "It's only the second day post-op. Cheer up." "This is a normal frustration; it'll get better." "You will feel better in a week or two." "You are concerned that you don't feel any better after surgery." Rationale: Paraphrasing is restating the client's message in the nurse's own words. Option 3 uses the therapeutic communication technique of paraphrasing. The client is frustrated and is searching for understanding. Question 9 1 / 1 pts The physician ordered Timentin (ticarcillin) 500 mg in 50 mL to infuse over 30 minutes. The drop factor is 15 gtt/mL. Calculatethe flow rate in drops per minute. 18 42 38 25 Question 10 1 / 1 pts What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin? Use the sublingual form only. Store the drug in a dark container, free from light and moisture. Allow for a daily 8- to 12-hour nitrate free period. Administer subsequent doses parenterally. An 8- to 12-hour nitrate free period will eliminate the development of tolerance to nitroglycerin. Route of administration and medication storage methods do not affect tolerance. Question 11 1 / 1 ptsThe nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times? With any meal At bedtime In the morning Late in the afternoon Diuretics should be scheduled for morning administration to avoid causing the patient nocturia. Question 12 1 / 1 pts The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having: menopausal complications. hepatitis A. indigestion. urinary infection.Indigestion, gallbladder attack, anxiety attack, and depression are frequent misdiagnoses for women having an MI. Question 13 1 / 1 pts Which of the following makes a correct pathway of blood through the heart? right atrium, tricuspid valve, left atrium, aortic valve, left ventricle right atrium, left atrium, pulmonary artery, pulmonary veins, aorta right atrium, pulmonary artery, mitral valve, left ventricle, aorta right atrium, mitral valve, pulmonary veins, left ventricle, aorta Question 14 1 / 1 pts A patient, age 34, is diagnosed with infective endocarditis. The nurse identifies the nursing diagnosis of Activity intolerance related to generalized weakness for him. Which intervention does the nurse plan while he is febrile?Decreased activity and rest Allowing moderate activity if heart rate is not above 100 Activity as tolerated Monitoring vital signs during ambulation During the acute phase, it is essential to maintain the patient on decreased activity and provide a calm, quiet environment. Incorrect Incorrect Question 15 0 / 1 pts The client with hypertension has been prescribed a low-sodium diet. The nurse teaching this client about foods that are allowed should plan to include which of the following in a list provided to the client? Boiled shrimp Tomato soup Summer squash Instant oatmealRationale: Foods that are lower in sodium are fruits and vegetables (“summer squash”) because they do not contain physiological saline. Highly processed or refined foods (“tomato soup” and “instant oatmeal”) are higher in sodium unless they are specifically noted as “low sodium.” Saltwater fish and shellfish are higher in sodium. Test-Taking Strategy: Begin to answer this question by eliminating “boiled shrimp” as being highest in sodium. Eliminate the other incorrect options because they are processed foods. Review the foods that are high and low in sodium if you had difficulty with this question. Question 16 1 / 1 pts The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask? “Do you have a toothache?” “Have you contacted your physician about your dental appointment?” “Do you think you should wait that long for your tooth extraction?’ “Is your dentist board certified?”Patients with endocarditis are put on a protocol of prophylactic antibiotics for any invasive procedure. The dentist and physician should be contacted before the extraction. Question 17 1 / 1 pts The clinic nurse is obtaining cardiovascular data on a client. The nurse prepares to check the client's apical pulse and places the stethoscope in which position? Midsternum equal with the nipple line At the midline of the chest just below the xiphoid process At the midclavicular line at the fifth left intercostal space At the midaxillary line on the left side of the chest Rationale: The heart is located in the mediastinum. Its apex or distal end points to the left and lies at the level of the fifth intercostal space. A stethoscope should be placed in this area to pick up heart sounds most clearly. The other options are incorrect because they do not represent the anatomical positioning of the heart's apex. Incorrect Incorrect Question 18 0 / 1 ptsA trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? Vitamin K Protamine sulfate Enoxaparin (Lovenox) Warfarin sodium (Coumadin) Protamine sulfate is the antidote to heparin. With the patient’s risk of fluid volume deficit as a result of trauma, the primary intervention would be to counteract the effects of heparin to prevent hemorrhage. Warfarin is an anticoagulant and would not counteract hemorrhage. Lovenox is chemically related to heparin and would not counteract hemorrhage. Vitamin K is used to control the bleeding that results from use of warfarin (Coumadin), not heparin. Incorrect Incorrect Question 19 0 / 1 pts Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective? Weight loss of more than 2 lb/wk. LDL cholesterol levels have decreased.Urinary output is decreased Blood pressure has decreased. The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressure-elevating (vasoconstricting) and sodium-retaining effects of angiotensin II are thus blocked. Weight loss, although advisable for treatment of hypertension, is not affected by ARBs. ARBs do not affect cholesterol levels. Urine output is not affected by ARBs. Question 20 1 / 1 pts A patient with angina pectoris is being discharged with nitroglycerin tablets. Which of the instructions does the nurse include in the teaching? “Continue with your activity. If the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 20 minutes, then go lie down.” “When your chest pain begins, lie down and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.” “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”“Place one nitro tablet under your tongue. If a burning sensation and headache occur, call your doctor immediately.” Sit and stand slowly after taking nitroglycerin. Place nitroglycerin tablets under the tongue at the onset of anginal pain; the second tablet can be taken after 5 minutes and the third tablet after another 5 minutes if pain is unrelieved. Then, if pain is not relieved, go to the hospital. Question 21 1 / 1 pts The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into: atrial fibrillation and possible emboli. ventricular tachycardia and death. sinus tachycardia and syncope. sinus bradycardia and fatigue. PVCs are capable of progressing into ventricular tachycardia and death. Question 22 1 / 1 ptsRestlessness, diaphoresis, severe dyspnea, tachypnea, bloodtinged frothy sputum, audible wheezing, and crackles are signs and symptoms of heart failure. peripheral edema. respiratory failure. pulmonary edema. Signs and symptoms of pulmonary edema are restlessness; vague uneasiness; agitation; disorientation; diaphoresis; severe dyspnea; tachypnea; tachycardia; pallor or cyanosis; cough producing large quantities of blood-tinged, frothy sputum; audible wheezing and crackles; cold extremities. Incorrect Incorrect Question 23 0 / 1 pts The physician tells the nurse that a patient is hypokalemic. He has been taking a thiazide medication for treatment of his high blood pressure. The nurse should instruct him to increase his dietary intake of which of the following? Sodium Green leafy vegetables Low-fat productsBananas and citrus fruits Thiazide may lead to significant loss of potassium. The patient should take the medication with a full glass of orange juice (unless not permitted by his or her diet). Other potassium-rich foods include bananas. Question 24 1 / 1 pts A nurse is caring for a client on a cardiac monitor who is alone in a room at the end of the hall. The client has a short burst of ventricular tachycardia (VTach) followed by ventricular fibrillation (Vfib) the client suddenly loses conciousness. Which intervention should the nurse do first? Run to get the defibrillator from an adjacent nursing unit Start oxygen by cannula at 10L/min and lower the head of the bed Go the nurse’s station quickly and call a code Call for help and initiate CPR AHN p. 317 When VF occurs, the nurse remains with the client and initiates CPR until a defibrillator is available and attached to the clientIncorrect Incorrect Question 25 0 / 1 pts The nurse is working with a client receiving an intravenous heparin sodium drip. The nurse should review which of the following laboratory studies to determine the therapeutic effect of heparin for the client? Prothrombin time (PT) Bleeding time Thrombin time Partial thromboplastin time (PTT) Rationale: The PTT will assess the therapeutic effect of heparin, and the PT is one test that will assess for the therapeutic effect of warfarin (Coumadin). Thrombin time and bleeding time are hematological studies that may be prescribed for clients with coagulopathy or other disorders. Test-Taking Strategy: Focus on the medication and recall that it is an anticoagulant. Eliminate “bleeding time” and “thrombin time” because they are not commonly prescribed during anticoagulant therapy. Choose between the remaining two options, knowing the differences between the value measured for heparin and the one measured for warfarin. If you had difficulty with this question, review care to the client receiving heparin. Incorrect Incorrect Question 26 0 / 1 ptsA client with an abdominal aortic aneurysm (AAA) is not a candidate for surgery because the aneurysm is not yet large enough. The client is fearful that the aneurysm will rupture, causing death. The nurse plans to assist the client in coping with this fear by emphasizing what the client can do for selfmonitoring. Which of the following items would be unnecessary for the nurse to include in discussions with the client? Reporting abdominal or back pain Antiviral prophylaxis before invasive procedures Management of hypertension Importance of follow-up computerized tomography (CT) scans Rationale: Psychosocial care of the client with medical management of an AAA includes listening to the client's concerns and reinforcing the rationales for ongoing medical surveillance. This includes periodic CT scanning to monitor the size of the aneurysm and careful adherence to medication and diet therapy for hypertension. The client is instructed to report any sensation of abdominal fullness or abdominal or back pain to the physician without delay. Question 27 1 / 1 pts A client is admitted to the hospital with possible rheumatic heart disease. The nurse collects data from the client and checks the client for which signs or symptoms?Fever and sore throat Vaginal itching Burning on urination Skin scratches Rationale: Rheumatic heart disease can occur as a result of infection with group A beta-hemolytic streptococcal infections. It is frequently triggered by streptococcal pharyngitis, which is assessed by noting for the presence of sore throat and fever. The other options are unrelated to this problem and indicate possible yeast infection, skin lesions, and urinary tract infection, respectively Question 28 1 / 1 pts During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure? “I have to urinate every 2 hours, even during the night.” “I go barefoot most of the time because my feet are so hot.” “I have no appetite and I have lost 3 lb in the last week.”“I have to sleep in my recliner and I have this hacking cough.” Left ventricular failure is often among the first of signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough. Question 29 1 / 1 pts A client brings the following medications to the clinic for a yearly physical. The nurse realizes which medication has been prescribed to treat heart failure? Amiodarone Digoxin Potassium chloride WarfarinRationale: Digoxin strengthens the heartbeat and decreases the heart rate. It is used in the treatment of heart failure. Potassium chloride increases the potassium level. Although digoxin does lower the potassium level, potassium chloride is not specifically administered for heart failure. Warfarin and amiodarone do not treat heart failure. Question 30 1 / 1 pts Which drug will be administered to a patient being admitted with severe digoxin intoxication? Amiodarone (Cordarone) Spironolactone (Aldactone) Digitalis glycoside Digoxin immune Fab (Digibind) The antidote for digoxin intoxication is digoxin immune Fab (Digibind). Amiodarone is an antidysrhythmic and would not treat digoxin intoxication. Spironolactone is a diuretic and does not treat digoxin intoxication. Giving more of the same type of drug does not treat drug intoxication. Question 31 1 / 1 ptsThe physician has ordered 500 mL NS to run over 6 hours with a drop factor of 20 gtt/mL. What is the correct IV flow rate in gtt/min? 27 gtt/min 83 ml/hr 28 gtt/min 84 ml/hr Question 32 1 / 1 pts Edema and pulmonary congestion are treated with: Diuretics, restriction of sodium diet and fluid intake Increase in fluids, no activity restrictions Bed rest, normal diet, weights four times daily Unlimited activity, high protein diet, weights weekly Edema and pulmonary congestion are treated with diuretics, a sodium-restricted diet, and restriction of fluid intake. Weigh the patient daily to monitor fluid retention. Question 33 1 / 1 ptsHow frequently are nitroglycerin tablets discarded and prescriptions refilled? Yearly Monthly Every 6 months Every 2 months Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded. Nitroglycerin has a longer shelf life than 1 or 3 months but does not have a shelf life as long as 1 year. Question 34 1 / 1 pts What is the major cause of cardiac valve disease? Long history of malnutrition Pregnancy Rheumatic fever Obesity Rheumatic fever, a streptococcal infection, is the major cause of cardiac valve disease.Question 35 1 / 1 pts The physician has ordered D NS to run at 125 mL/hour with a drop factor of 20 gtt/mL. What is the correct IV flow rate in gtt/min? 5 41 42 43 44 Incorrect Incorrect Question 36 0 / 1 pts A client with myocardial infarction and suspected blood clot on the leg is a candidate for alteplase (Activase) thrombolytic therapy. The nurse assisting in the care of this client is aware that it will be necessary to monitor for which frequent adverse effect if the client receives this treatment? Muscle weakness Allergic reaction Bleeding InfectionRationale: Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots. Because of its action, the principal adverse effect is bleeding. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare. Allergic reaction is not a frequent response. Muscle weakness is not an adverse effect of this medication. Test-Taking Strategy: Focus on the name of the medication. Recalling that medication names that end with the letters “-ase” are thrombolytics will direct you to option 2. Review the action and adverse effects of alteplase if you had difficulty with this question. Question 37 1 / 1 pts A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include: substernal pain that radiates down the left arm. epigastric pain that radiates to the jaw. indigestion, nausea, and eructation. fatigue, shortness of breath, and dyspnea. The pain often radiates down the left inner arm to the little finger and also upward to the shoulder and jaw.Question 38 1 / 1 pts Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)? “I eat a banana every morning with breakfast.” “I don’t drink alcohol or caffeine.” “I try to eat more green leafy vegetables, especially broccoli, spinach, and kale.” “I try to eat a well-balanced, low-fat diet.” Avoid marked changes in eating habits, such as dramatically increasing foods high in vitamin K (e.g., broccoli, spinach, kale, greens). Limit alcohol intake to small amounts. Question 39 1 / 1 pts Which agents are preferred for the initial treatment of hypertension? ACE inhibitors and angiotensin receptor antagonists Calcium ion agonists and central-acting alpha agonists Direct vasodilators and peripherally acting adrenergic antagonistsThiazide diuretics and beta-adrenergic blockers Preferred agents include diuretics and beta-adrenergic blockers. ACE inhibitors, angiotensin receptor antagonists, calcium ion agonists, and central-acting alpha agonists are alternative agents. Direct vasodilators and peripherally acting adrenergic antagonists are adjunctive agents. Question 40 1 / 1 pts A nurse is required to care for a 34 y/o, who is being given digoxin. Which of the following pulse rates indicates that the nurse should withold the drug and alert the primary health care provider? Apical rate less than 60 beats per minute Radial pulse rate less than 90 beats per minute Apical rate less than 70 beats per minute Radial pulse rate more than 100 beats per minute Question 41 1 / 1 pts A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up and asks if the medication should be discontinued. What is the nurse’s best response?“Stop taking the medication immediately.” “Rise to a sitting or standing position slowly; your symptoms will resolve.” “Cut the pill in half and take a reduced dosage.” “I will schedule you to visit the healthcare provider today.” Dizziness is a common initial adverse effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling. Medications should not be stopped immediately unless a serious adverse effect occurs. Because this is a common occurrence with ACE inhibitors, there is no need for a visit to the healthcare provider. A change in dosage will not alter the effect and should not be made without the advice of the primary care provider. Question 42 1 / 1 pts Prior to the administration of a beta-adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin. Which is the priority nursing action? Reevaluate the patient in 2 hours. Withhold the medication and notify the healthcare provider.Administer the medication as ordered. Obtain a serum blood level. These symptoms warrant the nurse’s withholding the dose and then notifying the healthcare provider. The medication should not be administered if the patient’s heart rate is low or the patient is experiencing symptoms of heart failure and poor perfusion. The patient should be assessed frequently after the medication is held and the healthcare provider is notified, but action needs to be taken immediately. Therapeutic blood levels for beta-adrenergic medications are not typically measured. Question 43 1 / 1 pts The nurse is listening to a 56-year-old client’s apical heart rate before giving digoxin (Lanoxin) and notes that the heart rate is 48 beats/min. Which of the following would be an appropriate course of action taken by the nurse? Administer the digoxin; the heart rate would be considered normal because of the client’s age. Withhold the digoxin, and reevaluate the heart rate in 4 hours. Administer half the prescribed dose to avoid a further decrease in heart rate.Withhold the digoxin; assess for signs of decreased cardiac output and digoxin toxicity. Rationale: The normal heart rate is 60 to 100 beats/min in an adult. If the nurse notes a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would further evaluate the client for signs and symptoms of digoxin toxicity. When clients are bradycardic, they may have symptoms of decreased cardiac output so this would also be assessed. Test-Taking Strategy: Eliminate “withhold the digoxin, and reevaluate the heart rate in 4 hours” because although the digoxin should be withheld the client needs more immediate reassessment of the apical heart rate. Eliminate “administer half the prescribed dose to avoid a further decrease in heart rate” because giving half the prescribed dose can decrease the heart rate even further and because this action would require a physician’s prescription. “Administer the digoxin; the heart rate would be considered normal because of the client’s age” can be eliminated because this is not an expected finding related to the client’s age. Review the normal parameters related to the heart rate and the effects of digoxin if you had difficulty with this question. Question 44 1 / 1 pts The nurse identifies the nursing diagnosis of Ineffective tissue perfusion related to decreased arterial blood flow for a patient with chronic arterial insufficiency. In evaluating the patient outcomes after patient teaching, which statement by the patient does the nurse recognize as indicating a need for further instruction?“I will change my position every hour and avoid long periods of sitting with my legs crossed.” “I will wear loose clothing that doesn’t bind across my legs or waist.” “I will drink hot coffee several times a day to increase the circulation and warmth in my feet.” “For about 40 minutes each day, I will walk to the point of pain, then rest, then walk again once I’m ok until I develop pain again.” Avoiding vasoconstriction from nicotine, caffeine, and stress is an important precaution for patients with decreased arterial blood flow. Question 45 1 / 1 pts A nurse is assisting in the care of a client with myocardial infarction who should reduce intake of saturated fat and cholesterol. The nurse should help the client comply with diet therapy by selecting which of the following food items from the dietary menu? Pork chop, baked potato, cauliflower in cheese sauce, ice cream Baked salmon, steamed broccoli, herbed rice, sliced strawberriesCheeseburger, pan-fried potatoes, whole kernel corn, sherbet Spaghetti and sweet sausage in tomato sauce, vanilla pudding with 2% milk Rationale: A client trying to lower fat and cholesterol in the diet should decrease the use of fatty cuts of meats such as beef, lamb or pork, organ meats, sausage, hot dogs, bacon, and sardines; avoid vegetables prepared in butter, cream, or other sauces; use low-fat milk products instead of whole milk products and cream; and decrease the amount of commercially prepared baked goods. Option 2 is the only option that identifies low-fat and lowcholesterol foods. Test-Taking Strategy: Use the process of elimination, and focus on the subject, a low-fat and low-cholesterol diet. It may help you to eliminate incorrect options if you first evaluate the meat and milk food groups and then look at the quality of the vegetables, breads, and cereals. Fruits are generally low in fat and cholesterol unless they are in a sweetened sauce. Review foods high in fat and cholesterol if you had difficulty with this question. Incorrect Incorrect Question 46 0 / 1 pts The nurse is providing instruction to a patient who was recently prescribed an ACE inhibitor for hypertension. Which is an adverse effect of this medication? HypokalemiaChronic cough Nervousness Constipation Chronic cough may develop in as many as one-third of patients receiving ACE inhibitors. Constipation, hypokalemia, and nervousness are not adverse effects of this medication. Question 47 1 / 1 pts A client seeks treatment in the physician's office for unsightly varicose veins, and sclerotherapy is recommended. Before leaving the examining room, the client says to the nurse, "Can you tell me again how this sclerotherapy is done?" In formulating a response, the nurse informs the client that sclerotherapy consists of: Tying off the vein at the upper end to prevent stasis from occurring Surgical removal of the veins Tying off the vein at the lower end to prevent stasis from occurring Injecting an agent into the vein that causes them to shrinkAnswer: A Rationale: Sclerotherapy is the injection of a sclerosing agent into a varicosity. The agent damages the vessel and causes aseptic thrombosis, which results in vein closure. With no blood flow through the vessel, there is no distention. The surgical procedure for varicose veins is vein ligation and stripping. This procedure involves tying off the varicose vein and large tributaries, and then removal of the vein with the use of hook and wires via multiple small incisions in the leg. Question 48 1 / 1 pts The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this arrhythmia as: sinus bradycardia. sinus tachycardia. ventricular tachycardia. atrial fibrillation. Sinus tachycardia has a P wave followed by the QRS and the T. All the components of the complex are present and in the correct order, but the rate is over 100 beats/min. Incorrect Incorrect Question 49 0 / 1 ptsA client has a history of left-sided heart failure. The nurse would look for the presence of which of the following to determine whether the problem is currently active? Presence of ascites Bilateral lung crackles Jugular vein distention Pedal edema bilaterally Rationale: The client with heart failure may present with different symptoms depending on whether the right or the left side of the heart is failing. Breath sounds are an accurate indicator of left-sided heart function. Peripheral edema, jugular vein distention, and ascites all can be present due to insufficiency of the pumping action of the right side of the heart. Test-Taking Strategy: Use principles of blood flow to answer this question. Read each option carefully, recalling that the symptoms of heart failure appear in the circulatory areas behind the failing chamber. The correct option is the one that relates to the pulmonary system, because blood flows into the left side of the heart from the lungs. Review the signs of left- and right-sided heart failure if you had difficulty with this question. Question 50 1 / 1 pts A patient has been having increased bilateral leg cramps for a few weeks. The health care provider has diagnosed her with peripheral vascular disease (PVD). In caring for this patient, anurse would expect her to be started on a vasodilator drug that has which of the following effects? Opens arteries by relaxing smooth muscle, allowing more blood to reach the vessels Slows venous circulation, allowing arterial blood to flow more easily to vessels Decreases arterial blood flow, allowing more blood to reach the vessels Blocks closed vessels, allowing collateral circulation to other vessels Vasodilator drugs relax the smooth muscle of peripheral arterial blood vessels and help lead to better circulation to the arms and legs. Question 51 1 / 1 pts A client with heart disease who is taking digoxin (Lanoxin) complains of having no appetite, nauseous. The nurse notes that the client also has a low serum potassium (K ) level. The nurse checks the results of the digoxin level obtained this morning, anticipating that the level is likely to be: + High LowUncertain Within therapeutic range Rationale: A high digoxin level would indicate digoxin toxicity, which is compatible with the client’s complaint of anorexia and the low serum K+ level (which can precipitate digoxin toxicity). After drawing this initial conclusion, the next step would be for the nurse to notify the registered nurse or another health care provider for further action. Test-Taking Strategy: Focus on the data in the question. Recalling that anorexia is an early sign of digoxin toxicity will direct you to option 2. Review the manifestations associated with digoxin toxicity if you had difficulty with this question. Question 52 1 / 1 pts Which nursing intervention reduces myocardial oxygen demand? Being calm, quiet and rested and elevating the head of the bed 30 to 45 degrees Encouraging participation in cardiac workout like aerobics Positioning patient in supine position Supplying a portable oxygen unit during strenous activityBed rest and semi-Fowler’s position reduce myocardial oxygen demands. Question 53 1 / 1 pts The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between: 1 and 2. 2 and 3. 4 and 5. 3 and 4. The desired INR for the monitoring of anticoagulant therapy is between 2 and 3. Question 54 1 / 1 pts A client being seen in the emergency department for complaints of chest pain confides in the nurse about regular use of cocaine as a recreational drug. The nurse takes which most important action in delivering holistic nursing care to this client?Teaches about the effects of cocaine on the heart and offer referral for further help Explains to the client to decrease use to reduce damage to the heart Tells the client it is important to stop before myocardial infarction occurs he dies Reports the client to the police for illegal drug use Rationale: To provide the most holistic care, the nurse should teach the client about the effects of cocaine on the heart and also offer referral for further help with this possible addiction. Question 55 1 / 1 pts During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure? “I go barefoot most of the time because my feet are so hot.” “I have to sleep in my recliner and I have this hacking cough. ” “I have to urinate every 2 hours, even during the night.”“I have no appetite and I have lost 3 lb in the last week.” Evolve-Elsevier Chapter online resources Question 56 1 / 1 pts A patient has a diagnosis of heart failure. When the nurse walks into his room, he is in orthopneic position, meaning: complaining of sudden awakenings from sleep because of shortness of breath. complaining of pain in lower extremities. sitting or standing in order to breathe deeply and comfortably. unable to respond to simple questions. Orthopnea is an abnormal condition in which a person must sit or stand in order to breathe deeply and comfortably. Question 57 1 / 1 ptsThe nurse identifies the problem of a potential complication— pulmonary edema—for a patient in acute congestive heart failure (CHF). For which early symptom of this problem does the nurse assess? Decreased urinary output Pink, frothy sputum Bradycardia Lethargy and faintness Frothy sputum is produced from air mixing with the fluid in the alveoli; the sputum is blood-tinged from blood cells that have exuded into the alveoli. Incorrect Incorrect Question 58 0 / 1 pts The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient? “Report any headaches following self-administration to your healthcare provider.” “Carry the medication with you at all times.” “Carry the medication in a pocket directly next to the body.”“Store nitroglycerin in a clear glass container with a tight lid.” Nonhospitalized patients should carry nitroglycerin at all times. Headache is an expected adverse effect. Heat causes the medication to deteriorate, so being carried next to the body would cause it to become ineffective. Tablets are degraded by sunlight. Question 59 1 / 1 pts The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K? Potato Pasta Spinach Fruit Green leafy vegetables contain vitamin K. Question 60 1 / 1 ptsWhen providing discharge teaching to a patient with endocarditis regarding prevention of infections, what would the nurse stress? Use only aspirin for mild pain. Take antibiotics as prescribed. Avoid crowds. Weigh yourself daily. Patient teaching focuses on identifying causes, infective endocarditis precautions, dietary requirements, and gradually increasing activity levels, as well as teaching the need for prophylactic antibiotics before any invasive procedure if the patient has preexisting valvular heart disease. Question 61 1 / 1 pts A 56-year-old patient was admitted to the emergency department with a myocardial infarction. Cardiac enzymes were drawn. In a patient with a myocardial infarction, which laboratory values would be abnormal? Decreased levels of levels of CK, LDH, myoglobin and increased troponin 1 Elevated levels creatine phosphokinase (CK-MB), lactic dehydrogenase (LDH), myoglobin and troponin 1Decreased levels of CK-MB, LDH, and troponin 1 Elevated levels of ESR, decreased levels of CK, LDH, and troponin 1 Serum cardiac markers are certain proteins that are released into the blood in large quantities from necrotic heart muscle after a myocardial infarction. These markers, specifically cardiac serum enzymes and troponin 1, are important screening diagnostic criteria for acute MI. Question 62 1 / 1 pts The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention? Lay the patient flat to reduce hypotension and the symptoms of cardiogenic shock. Place patient upright with legs in dependent position to reduce the symptoms of pulmonary edema. Place patient in side-lying position to reduce the symptoms of atrial fibrillation. Lay the patient flat and elevate the feet to increase venous return in cardiogenic shock.Signs and symptoms of pulmonary edema are restlessness; vague uneasiness; agitation; disorientation; diaphoresis; severe dyspnea; tachypnea; tachycardia; pallor or cyanosis; cough producing large quantities of blood-tinged, frothy sputum; audible wheezing and crackles; and cold extremities. The legs in a dependent position will decrease venous return and ease the pulmonary edema. Incorrect Incorrect Question 63 0 / 1 pts A patient receives a prescription for anticoagulant medication for treatment of arterial emboli. What dietary information should the nurse give? Avoid eating saturated fats by limiting use of butter, oils, and red meats. Eat fruits such as citrus and bananas that provide potassium Take extra dairy products to ensure calcium intake and vitamin D Do not increase intake of dark-green vegetables because of vitamin K Evolve-Elsevier Study guide resource p.53Question 64 1 / 1 pts The physician has ordered clindamycin (Cleocin phosphate) 900 mg in 75 mL over 30 minutes with a drop factor of 15 gtt/mL. What is the correct IV flow rate in gtt/min? 37 38 75 150 Question 65 1 / 1 pts The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)? Cocaine use Viral infections Vitamin B1 deficiencies PregnancyCardiomyopathy caused by cocaine abuse triggers intense vasoconstriction of the coronary arteries and peripheral vasoconstriction. Cocaine also causes high circulating levels of catecholamines, which may further damage myocardial cells, leading to ischemic or dilated cardiomyopathy. The cardiomyopathy produced is difficult to treat. Interventions deal mainly with the HF that ensues. Question 66 1 / 1 pts During the nursing history and physical assessment of a patient with left-sided heart failure, which finding might the nurse expect related to the patient’s diagnosis? Orthopnea with bubbling crackles throughout the lungs Periorbital and facial edema Increased urinary output, especially during waking hours Anorexia with weight loss of 3 pounds in 1 week Left ventricular failure; the first is the signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough.Question 67 1 / 1 pts A patient recently prescribed felodipine (Plendil) for treatment of hypertension is experiencing dizziness when rising to a standing position. Which action will the nurse take? Advise the patient to increase dietary sodium. Encourage the patient to sit down if feeling faint. Inform the patient to discontinue the medication. Instruct the patient to monitor weight daily. If faintness or dizziness occurs, the nurse instructs the patient to sit or lie down and to change positions more slowly. Advising the patient to increase dietary sodium, informing the patient to discontinue the medication, and instructing the patient to monitor weight are not accurate interventions. Question 68 1 / 1 pts After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of: infective endocarditis. congestive heart failure. aortic block. Collection of subjective data includes noting patient complaints of influenza-like symptoms with recurrent fever, undue fatigue, chest pain, and chills. Objective data may reveal the significant signs of petechiae in the conjunctiva and mouth. Both subjective data and objective data are indicative of infective endocarditis. Question 69 1 / 1 pts A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do? Decrease the medication dosage for 1 week, and then resume the original order. Increase the dosage per healthcare provider directions. Change positions slowly. Discontinue the medication immediately.Many adverse effects are dose related and resolve with reducing the dosage or discontinuing therapy. Patients should be taught to rise slowly from a supine or sitting position and sit or lie down if feeling faint. Medication should be discontinued only for serious adverse effects and with the consent of the healthcare provider. Changes in dose should be done only with the consent of the healthcare provider. Increasing the dose will likely increase the symptoms. Question 70 1 / 1 pts A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit following the procedure. The nurse provides instructions to the client regarding the procedure and home care measures. Which of the following statements by the client indicates an understanding of the instructions? "I am so relieved that I can eat anything that I want to now." "I am so relieved that my heart is repaired." "I need to cut down on cigarette smoking." "I need to adhere to my dietary restrictions."Rationale: Following angioplasty, the client needs to be instructed of the specific dietary restrictions that must be followed. Following the recommended dietary and lifestyle changes assists to prevent further atherosclerosis. Abrupt closure of the artery can occur if the recommended dietary and lifestyle changes are not followed. Cigarette smoking needs to be stopped. An angioplasty does not repair the heart. Question 71 1 / 1 pts The elderly patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse’s most helpful response would be: “When nitroglycerin is not relieving the pain, lie down and rest.” “If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals, call your physician and come to the hospital.” “Continue to take nitroglycerin sublingually at 5-minute intervals until the pain is relieved.” “Use oxygen at home to relieve pain when nitroglycerin is not successful.”Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify the physician. Nitroglycerin administered sublingually usually relieves angina symptoms but does not relieve the pain from an MI. Administering nitroglycerin more than three times will probably not relieve the pain. Incorrect Incorrect Question 72 0 / 1 pts A client receiving total parenteral nutrition (TPN) has a history of congestive heart failure. The physician has ordered furosemide (Lasix) 40 mg orally daily to prevent fluid overload. The nurse monitors which laboratory value to identify an adverse effect from this medication? Potassium level Sodium level Magnesium level Glucose level Answer: B Rationale: Furosemide is a non-potassium-sparing diuretic, and insufficient replacement of potassium may lead to hypokalemia. Although the glucose, sodium, and magnesium levels may be monitored, these laboratory values are not specific to administering furosemide.Question 73 1 / 1 pts A patient has heart failure. His physician’s orders include complete bed rest. The nurse knows that this order means he gets complete bedrest and must remain as quiet as possible, with any task requiring physical effort, will be done for him. is confined to bed but is allowed to go to the bathroom as needed. is confined to bed but may assume responsibility for all of his personal care. is encouraged to rest as much as possible but can ambulate. Complete bed rest: Lowering oxygen requirements of the body systems with head of the bed elevated to 45 degrees to reduce myocardial oxygen demand and decrease circulating volume returning to the heart. Question 74 1 / 1 pts A client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client’s blood pressure and administers nitroglycerin grains 1/150 sublingually. 5 minutes later the client is still experiencing chest pain. If the blood pressure is still stable, the nurse should take which action next?Administer another nitroglycerin tablet. Call for a 12-lead electrocardiogram (ECG) to be performed. Wait an additional 15 minutes, then give a second nitroglycerin tablet. Apply 10 L of oxygen via nasal cannula. Rationale: Nitroglycerin tablets are usually ordered one every 5 minutes as needed (PRN) for chest pain up to a total dose of three tablets. The nurse in this question should administer the second tablet. The client with known angina pectoris should have low-flow oxygen at a rate of 1 to 3 L/minute via nasal cannula. A 12-lead ECG would be done if ordered by standing protocol or by individual physician order. Test-Taking Strategy: Focus on the data in the question and the strategic word “next.” Recalling that nitroglycerin tablets are usually ordered one every 5 minutes for chest pain up to a total dose of three tablets will direct you to the correct option. Review the procedure for the administration of nitroglycerin if you had difficulty with this question. Question 75 1 / 1 pts The patient/client is to receive Augmentin (amoxicillin/clavulanate potassium) 0.25 g po every 8 hours. The medication Augmentin (amoxicillin/clavulanate potassium) is available as an oral suspension 125 mg per 5 mL. How many teaspoons should the nurse instruct the patient/client to take?2 3 4 1 Question 76 1 / 1 pts Dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distention, and abdominal distention are signs and symptoms of: cardiac dysrhythmias. valvular heart disease. left-sided heart failure. right-sided heart failure. Inability of the right ventricle to pump blood forward into the lungs results in peripheral congestion. Edema is a sign of increased fluid in interstitial tissue and appears in dependent areas of the body such as the sacrum when supine and the feet and ankles while in an upright position. Question 77 1 / 1 ptsThe nurse is caring for a client who is developing pulmonary edema. The client exhibits respiratory distress, but the blood pressure is unchanged from the client's baseline. As an immediate action before help arrives, the nurse should perform which action? Begin assembling medications that are anticipated to be given. Suction the client vigorously. Call the respiratory therapy department to request a ventilator. Place the client in high-Fowler's position. Rationale: The client in pulmonary edema is placed in high-Fowler's position if the blood pressure is adequate. Vigorous suctioning may deplete the client of vital oxygen at a time when the respiratory system is compromised. Assembling medications is useful but not critical to the immediate wellbeing of the client. The client may or may not need mechanical ventilation. Partial Partial Question 78 0.5 / 1 pts Which of the following are signs of digoxin (Lanoxin) toxicity? (Select all that apply.) Ringing in the earsHeadache Visual disturbance Bradycardia Vomiting Hematuria Partial Partial Question 79 0.67 / 1 pts The nurse would assess closely for signs of right-sided heart failure which include: (Select all that apply.) distended jugular veins. cough. increasing abdominal girth. shortness of breath. orthopnea. edema of feet and ankles. Question 80 1 / 1 pts Which patient teaching would help to prevent venous stasis? (Select all that apply.)Dangle legs when sitting. Massage extremities to help maintain blood flow. Elevate legs when lying in bed or sitting. Avoid crossing the legs at the knee. Wear elastic stockings when ambulating. Avoid prolonged sitting or standing. Avoid crossing the legs at the knee. Elevate legs when sitting. Wear elastic stockings when ambulatory. Do not massage extremities because of danger of embolization of clots (thrombus breaking off and becoming an embolus). Quiz Score: 66.17 out of 80