Biochemistry Med Surg Cardiovascular Review Questions 2023 With Correct Answers

Biochem 5938020 Med Surg Cardiovascular Review Questions 2023 With Correct Answers A client complains of crushing chest pain that radiates to his left arm. He should be presented with the following treatment: 1. Aspirin, oxygen, nitroglycerin, and morphine 2. Aspirin, oxygen, nitroglycerin, and codeine 3. Oxygen, nitroglycerin, meperidine, and thrombolytics 4. Aspirin, oxygen, nitroprusside, and morphine - Answer: 1. Aspirin, oxygen, nitroglycerin, and morphine 2. Which lifestyle changes should a client diagnosed with coronary artery disease consider? 1. Smoking cessation 2. Establishing a regular exercise routine 3. Weight reduction 4. All of the Above - Answer: 4. All of the Above 3. A client's cardiac monitor alarm sounds, indicating ventricular tachycardia. The nurse should: 1. perform immediate defibrillation. 2. Assess the client. 3. Call the physician. 4. Administer a precordial thump. - Answer: 2. Assess the client. 4. A complication of peripheral vascular disease may be: 1. stasis ulcer. 2. Pressure ulcer. 3. Gastric ulcer. 4. Duodenal ulcer. - Answer: 1. stasis ulcer. 5. A key diagnostic test for heart failure is: 1. serum potassium. 2. B-type natriuretic peptide. 3. Troponin I 4. cardiac enzymes. - Answer: 2. B-type natriuretic peptide. 6. While auscultating the heart sounds of a client with mitral insufficiency, the nurse hears an extra heart sound immediately after the S2. The nurse should document this extra heart sound as a: 1. S1. MED-SURG: CARDIOVASCULAR REVIEW QUESTIONS 2023 WITHCORRECANSWRR AAAAAAAAAAAAAAAAAA(A+GGRADED ANSWERS 2. S3. 3. S4. 4. mitral murmur. - Answer: 2. S3. Rationale: An S3, is heard following an S2. This indicates that the client is experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before S1 and is caused by resistance to ventricular filling. A murmur of mitral insufficiency occurs during systole and is heard when there's turbulent blood flow across the valve. 7. A nurse administers heparin to a client with deep vein thrombophlebitis. Which laboratory value should the nurse monitor to determine the effectiveness of heparin? 1. PTT 2. HCT 3. CBC 4. PT - Answer: 1. PTT Rationale: The therapeutic effectiveness of heparin is determined by monitoring the patient's PTT, PT, HCT, and CBC don't monitor the therapeutic effectiveness of heparin. Monitoring the PT determines warfarin's effectiveness. 8. A client has just returned from cardiac catheterization. Which nursing intervention would be most appropriate? 1. Help the client ambulate to the bathroom. 2. Restrict fluids. 3. Monitor peripheral pulses. 4. Insert an indwelling urinary catheter. - Answer. 3. Monitor peripheral pulses. Rationale: After cardiac catheterization, monitor peripheral pulses to assess peripheral perfusion. Helping the client ambulate to the bathroom is incorrect because the client should be on bed rest for 4 to 8 hours after the procedure to reduce the risk of bleeding at the insertion site. Restricting fluids is incorrect because the client should be encouraged to drink fluids after the procedure, unless contraindicated. Adequate hydration reduces the risk of nephrotoxicity that can occur with the use of contrast dye. Although urine output is monitored following cardiac catheterization, the insertion of a urinary catherter isn't necessary. 9. A client is in the first postoperative day after left femoropopliteal revascularization. Which position would be most appropriate for this client? 1. On his left-sided 2. In high Fowler's position 3. On his right side 4. In a left lateral decubitus position - Answer: 3. On his right side Rationale: Following revascularization, avoid positioning the client on the surgical side. Because this client had left femoropoliteal revascularization, he may be positioned on the right side. Placing the client on the left side is incorrect because this would position the client on the operative side. Positioning the client in high Fowler's position is incorrect because the client should avoid flexion at the surgical site. Placing the client in a left lateral decubitus position is incorrect because this would place the client on the surgical side and cause flexion at the site. 10. A nurse is evaluating a client with left-sided heart failure. Which finding should the nurse expect to assess? 1. Ascites 2. Dyspnea 3. Hepatomegaly 4. Jugular vein distention - Answer: 2. Dyspnea Rationale: Dyspnea may occur in a client with left-sided heart failure. Ascites, hepatomegaly, and jugular vein distention are assessment findings in right-sided heart failure. 11. A client has developed acute pulmonary edema. Which test result should the nurse expect? 1. Interstitial edema by chest X-ray 2. Metabolic alkalosis by ABG analysis 3. Bradycardia by ECG 4. Decreased PAWP by hemodynamic monitoring - Answer: 1. Interstitial edema by chest X-ray Rationale: The chest X-ray of a client with acute pulmonary edema shows interstitial edema as a result of the heart's failure to pump adequately. Metabolic alkalosis is incorrect because the ABG analysis of a client in acute pulmonary edema shows respiratory alkalosis or acidosis. Bradycardia is incorrect because the ECG would most likely indicate tachycardia. Decreased PAWP is incorrect because PAWP rises in the client with acute pulmonary edema. 12. A nurse is performing discharge teaching for a client with PVD. The nurse should teach the client to: 1. inspect his feet weekly 2. begin a daily walking program 3. wear constrictive clothing 4. stand rather than sit when possible - Answer: 2. begin a daily walking program Rationale: The nurse should encourage the client with PVD to follow a program of walking and other leg exercises. Inspecting the feet weekly is incorrect because the nurse should teach the client to inspect his feet daily. Wearing constrictive clothing is incorrect because the client should wear loose clothing that doesn't restrict circulation. Standing when possible—rather than sitting—is incorrect because the client should avoid standing for long periods. 13. If a nurse knows a client's heart rate, what other value and formula does she need to know to calculate CO? - Answer: Stroke Volume Rationale: Cardiac output equals stroke volume (the amount of blood ejected with each beat) times heart rate. [CO = SV X HR] 14. A client comes to the clinic and states he has a history of hypertension. Which type of medication might the nurse expect the client to be taking to control his blood pressure? 1. Antilipemics 2. Antibiotics 3. ACE inhibitors 4. Antidiabetics - Answer: 3. ACE inhibitors Rationale: ACE inhibitors may be prescribed to help control high blood pressure. Other types of medications that may be prescribed include diuretics, calcium channel blockers, angiotensin II receptor blockers, and beta-adrenergic blockers. Antilipemics help lower serum cholesterol levels. Antibiotics are used to fight infection, and antidiabetics help control serum glucose levels. 15. A cardiologist prescribes digoxin (Lanoxin)125 mcg by mouth every morning for a client diagnosed with heart failure. The pharmacy dispenses tablets that contain 0.25 mg each. How many tablets should the nurse administer in each dose? Record your answer using one decimal place. - Answer: 0.5 tablet(s) Rationale: 0.5 tablets. The nurse should begin by converting 125 mcg to milligrams. 125 mcg / 1,000 = 0.125 mg. The following formula is used to calculate drug dosages: dose on hand / quality on hand = dose desired./ X. The nurse should use the following equations: 0.25 mg / 1 tablet = 0.125 mg / X. The equation then becomes 0.25(x) = 0.125. Which is 0.125 / 0.25 = X = 0.5 tablet 16. A client is prescribed diltiazem (Cardizem) to manage his hypertension. The nurse should tell the client the diltiazem will: 1. lower his blood pressure only. 2. Lower his heart rate and blood pressure. 3. Lower his blood pressure and increase his urine output 4. lower his heart rate and blood pressure and increase his urine output. - Answer: 2. Lower his heart rate and blood pressure. Rationale: Diltiazem, a calcium channel blocker, will reduce both the heart rate and blood pressure. It doesn't directly affect urine output. 17. A client reports substernal chest pain. Test results show electrocardiographic changes and an elevated cardiac troponin level. What should be the focus of nursing care? 1. Improving myocardial oxygenation and reducing cardiac workload. 2. Confirming a suspected diagnosis and preventing complications. 3. Reducing anxiety and relieving pain. 4. Eliminating stressors and providing a nondemanding environment. - Answer: 1. Improving myocardial oxygenation and reducing cardiac workload. Rationale: The client is exhibiting clinical signs and symptoms of a myocardial infarction (MI); therefore, nursing care should focus on improving myocardial oxygenation and reducing cardiac workload. Confirming the diagnosis of MI and preventing complications, reducing anxiety and relieving pain, and providing a nondemanding environment are secondary to improving myocardial oxygenation and reducing workload. Stressors can't be eliminated, only reduced. 18. A client with a myocardial infarction and cardiogenic shock is placed on an intraaortic ballon pump (IAPB). If the device is functioning properly, the balloon inflates when the: 1. tricuspid valve is closed. 2. Pulmonic valve is open. 3. Aortic valve is closed. 4. Mitral valve is closed. - Answer: 3. Aortic valve is closed. Rationale: An intra-aortic ballon pump (IAPB) inflates during diastole when the tricuspid and mitral valves are open and the aortic and pulmonic valves are closed. 19. A client with unstable angina receives routine applications of nitroglycerin ointment. The nurse should delay the next dose if the client has: 1. atrial fibrillation. 2. A systolic blood pressure below 90 mm Hg. 3. A headache. 4. Skin redness at the current site. - Answer: 2. A systolic blood pressure below 90 mm Hg. Rationale: Nitroglycerin is a vasodilator and can lower arterial blood pressure. As a rule, when the client's systolic blood pressure is below 90 mm Hg, the nurse should delay the dose and notify the physician. Nitroglycerin isn't contraindicated in a client with atrial fibrillation. Headache, a common occurrence with nitroglycerin isn't a cause for withholding a dose. Application sites should be changed with each dose, especially if skin irritation occurs. 20. A client experiences acute myocardial ischemia. The nurse administers oxygen and sublingual nitroglycerin. When assessing an electrocardiogram (ECG) for evidence that blood flow to the myocardium has improved, the nurse should focus on the: 1. widening of the QRS complex. 2. Frequency of ectopic beats. 3. Return of the ST segment to baseline. 4. Presence of a significant Q wave. - Answer: 3. Return of the ST segment to baseline. Rationale: During episodes of myocardial ischemia, an ECG may show ST-segmant elevation or depression. With successful treatment, the ST segment should return to baseline. Widening QRS complex, presence of a Q wave, and frequent ectopic beats aren't directly indicative of myocardial ischemia. 21. Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? 1. A drop in central venous pressure 2. An increase in the cardiac index 3. A rise in pulmonary artery diastolic pressure 4. A decline in mean pulmonary artery pressure - Answer: 3. A rise in pulmonary artery diastolic pressure Rationale: A rise in pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous pressure would rise in heart failure. The cardiac index would decline in heart failure. The mean pulmonary artery pressure would increase in heart failure. 22. A client with dilated cardiomyopathy, pulmonary edema, and severe dyspnea is placed on dobutamine. Which assessment finding indicates that the drug is effective? 1. Increased activity tolerance 2. Absence of arrhythmias 3. Negative Homans' sign 4. Blood pressure of 160/90 mm Hg - Answer: 1. Increased activity tolerance Rationale: Dobutamine should improve the client's symptoms and the client should experience an increase tolerance for activity. The absence of arrhythmias doesn't indicate effectiveness of dobutamine. A negative Homans' sign indicates absence of blood clots, which isn't a therapeutic effect of dobutamine. 23. A nurse administers warfarin (Coumadin) to a client with deep vein thrombophlebitis. Which laboratory valve indicates that the client has a therapeutic level of warfarin? 1. Partial thromboplastin time (PTT) 1 ½ to 2 times the control 2. Prothrombin time (PT) 1 ½ to 2 times the control 3. International Normalized Ratio (INR) of 3 to 4 4. Hematocrit (HCT) of 32% - Answer: 2. Prothrombin time (PT) 1 ½ to 2 times the control Rationale: Warfarin is at a therapeutic level when the PT is 1 ½ to 2 times the control. Values greater than this increase the risk of bleeding and hemorrhage; lower values increase the risk of blood clot formation. Heparin, not warfarin, prolongs PTT. The INR may also be used to determine whether warfarin is at a therapeutic level; however, an INR of 2 to 3, not 3 to 4, is considered therapeutic. HCT doesn't provide information on the effectiveness of warfarin. However, a falling HCT in a client taking warfarin may be a sign of hemmorrhage. 24. A client comes to the emergency department with a dissecting aortic aneurysm. The client is at greatest risk for: 1. septic shock 2. anaphylactic shock 3. cardiogenic shock 4. hypovolemic shock - Answer: 4. hypovolemic shock Rationale: A dissecting aortic aneurysm is a precursor to aortic rupture, which leads to hemorrhage and hypovolemic shock. Septic shock occurs with overwhelming infection. Anaphlactic shock is an allergic response. Cardiogenic shock is the result of ineffective cardiac function 25. A child returns to his room after a cardiac catheterization. Which nursing intervention is most appropriate? 1. Maintain the child on bed rest with no further activity restrictions. 2. Maintain the child on bed rest with the affected extremity immobilized. 3. Allow the child to get out of bed to go to the bathroom, if necessary. 4. Allow the child to sit in a chair with the affected extremity immobilized. - Answer: 2. Maintain the child on bed rest with the affected extremity immobilized. Rationale: The child should be maintained on bed rest with the affected extremity immobilized after cardiac catheterization to prevent hemorrhage. Allowing the child to move the affected extremity while on bed rest, allowing the child bathroom privileges, or allowing the child to sit in a chair with the affected extremity immobilized places the child at risk for hemorrhage. 26. A child is scheduled for echocardiography. The nurse is providing teaching to the child's mother. Which statement by the mother about echocardiography indicates the need for further teaching? 1. "I'm glad my child won't have an I.V catheter inserted for this procedure." 2. "I'm glad my child won't need to have dye injected into him before the procedure." 3. "How am I going to explain to my son that he can't have anything to eat before the test?" 4. "I know my child may need to lie on his left side and breathe in and out slowly during the procedure." - Answer: 3. "How am I going to explain to my son that he can't have anything to eat before the test?" Rationale: Echocardiography is a noninvasive procedure used to evaluate the size, shape, and motion of various cardiac structures. Therefore, it isn't necessary for the client to have an I.V catheter inserted, dye injected, or nothing by mouth, as would be the case with a cardiac catheterization. The child may need to lie on his left side and inhale and exhale slowly during the procedure. 27. An infant with a ventricular septal defect is receiving digoxin (Lanoxin). Which intervention by the nurse is most appropriate before digoxin administration? 1. Take the infant's blood pressure. 2. Check the infant's respiratory rate for 1 minute. 3. Check the infant's radial pulse for 1 minute. 4. Check the infant's apical pulse for 1 minute. - Answer: 4. Check the infant's apical pulse for 1 minute. Rationale: Before administering digoxin, the nurse should check the infant's apical pulse for 1 minute. Checking the radial pulse may be inaccurate. Checking the blood pressure and respiratory rate isn't necessary before digoxin administration because the medication doesn't affect these parameters. 28. A nurse checks an infant's apical pulse before digoxin (Lanoxin) administration and finds that the pulse rate is 90 beats/minute. Which action is most appropriate for the nurse? 1. Withhold the digoxin and notify the physician. 2. Administer the digoxin and notify the physician. 3. Administer the digoxin and document the infant's pulse rate. 4. Withhold the digoxin and document the infant's pulse rate. - Answer: 1. Withhold the digoxin and notify the physician. Rationale: The nurse should withhold the digoxin and notify the physician because an apical pulse below 100 beats/minute in an infant is considered bradycardic. The nurse should also document her findings and interventions in the medical record. Administering the drug to a bradycardic infant could further decrease his heart rate and compromise his status. Withholding the drug and not notifying the physician could compromise the existing treatment plan. 29. A child has been diagnosed with rheumatic fever. Which statement by the mother indicates an understanding of rheumatic fever? 1. "I should avoid giving my child aspirin for the arthritic pain." 2. "It's very upsetting that my child must take penicillin until he's 20 years old." 3. "I need to wear a gown, gloves, and mask to stay in my child's room." 4. "I don't know how I'll be able to keep my child away from his sister when he gets home." - Answer: 2. "It's very upsetting that my child must take penicillin until he's 20 years old." Rationale: Rheumatic fever is an acquired autoimmune-complex disorder that occurs 1 to 3 weeks after an infection of group A beta-hemolytic streptococci, in many cases as a result of strep throat that hasn't been treated with antibiotics. To prevent additional heart damage from future attacks, the child must take penicillin or another antibiotic until the age of 20 or for 5 years after the attack, whichever is longer. Children shouldn't be given aspirin because it may result in Reye's syndrome. Rheumatic fever isn't contagious, so isolation precautions aren't necessary. 30. A nurse is caring for a child with a cyanotic heart defect. Which signs should the nurse expect to observe? 1. Cyanosis, hypertension, clubbing, and lethargy. 2. Cyanosis, hypotension, crouching, and lethargy. 3. Cyanosis, irritability, clubbing, and crouching. 4. Cyanosis, confusiion, clonus, and crouching. - Answer: 3. Cyanosis, irritability, clubbing, and crouching. Rationale: The child with a cyanotic heart defect has cyanosis along with crabiness (irritability), clubbing of the digits, and crouching or squatting. The child with cyanotic heart defect doesn't typically have hypertension, lethargy, confusion, or clonus. . . . . . . .