NCLEX 303 FINAL STUDY GUIDE – SOLVED QUESTIONS WITH STEP-BY STEP EXPLANATIONS

1. The physician is treating a client in the cardiac care unit for atrial arrhythmia and prescribes propranolol (Inderal), 10 mg P.O. three times a day. Propranolol inhibits the action of sympathomimetics at beta1-receptor sites. Where these sites are mainly located? 1Uterus 2Blood vessels 3Bronchi 4Heart - ANSWER Correct Answer: 4 2. RATIONALES: Beta1-receptor sites are mainly located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi. 3. In presenting a workshop on parameters of cardiac function, which conditions should the nurse list as those most likely to lead to a decrease in preload? 1Hemorrhage, sepsis, and anaphylaxis 2Myocardial infarction, fluid overload, and diuresis 3Fluid overload, sepsis, and vasodilation 4Third spacing, heart failure, and diuresis - ANSWER Correct Answer: 1 4. RATIONALES: Preload is the volume in the left ventricle at the end of diastole. It's also referred to as end-diastolic volume. Preload is reduced by any condition that reduces circulating volume, such as hemorrhage, sepsis, and anaphylaxis. Hemorrhage reduces circulating volume by loss of volume from the intravascular space. Sepsis and anaphylaxis reduce circulating volume by increased capillary permeability. Diuresis, vasodilation, and third spacing also reduce preload. Preload would increase with fluid overload and heart failure. 5. A client is admitted for treatment of Prinzmetal's angina. When developing the care plan, the nurse keeps in mind that this type of angina is triggered by: 1. activities that increase myocardial oxygen demand. 2. an unpredictable amount of activity. 3. coronary artery spasm. 4. the same type of activity that caused previous angina episodes. - ANSWER Correct Answer: 3 6. RATIONALES: Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; however, anginal pain is increasingly severe. 7. The nurse is caring for a cardiac client who requires various cardiac medications. When the nurse helps the client out of bed for breakfast, the client becomes dizzy and asks to lie down. The nurse helps the client lie down, puts up the side rails, and obtains the client's blood pressure, which is 84/50 mm Hg. It's time for the nurse to administer the client's medications: nitroglycerin, metoprolol (Lopressor), and furosemide (Lasix). Which action is best taken by the nurse? 1. Withhold the medications and notify the physician. 2. Administer the medications immediately. 3. Encourage the client to sit up and eat breakfast. 4. Administer the nitroglycerin and metoprolol and withhold the furosemide. - ANSWER Correct Answer: 1 8. RATIONALES: The nurse should withhold the three medications and notify the physician. Each of these medications has the potential to lower the client's blood pressure. Administering them together when the client is already hypotensive may severely lower the client's blood pressure. The client may continue to experience dizziness when sitting up so breakfast should be held until his blood pressure stabilizes. 9. The physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test is used to determine a client's response to oral anticoagulant drugs? 1. Bleeding time 2. Platelet count 3. Prothrombin time (PT) 4Partial thromboplastin time (PTT) - ANSWER Correct Answer: 3 10. RATIONALES: PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample after calcium ions and tissue thromboplastin are added and compares this time with the fibrin clotting time in a control sample. Anticoagulant dosages should be adjusted, as needed, to maintain PT at 1.5 to 2.5 times the control value. PTT determines the effectiveness of heparin therapy and helps evaluate bleeding tendencies. Roughly 99% of bleeding disorders are diagnosed from PT and PTT values. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reveals the number of circulating platelets in venous or arterial blood. 11. A client with a history of I.V. drug abuse is admitted to the medical-surgical unit for evaluation for infective endocarditis. 12. Nursing assessment is most likely to reveal that this client has: 1. retrosternal pain that worsens during supine positioning. 2. pulsus paradoxus. 3. a scratchy pericardial friction rub. 4. Osler's nodes and splinter hemorrhages. - ANSWER Correct Answer: 4 13. RATIONALES: Infective endocarditis occurs when an infectious agent enters the bloodstream, such as from I.V. drug abuse or during an invasive procedure or dental work. Typical assessment findings in clients with this disease include Osler's nodes (red, painful nodules on the fingers and toes), splinter hemorrhages, fever, diaphoresis, joint pain, weakness, abdominal pain, a new or altered heart murmur, and Janeway's lesions (small, hemorrhagic areas on the fingers, toes, ears, and nose). The other options are common findings in clients with pericarditis, not infective endocarditis. 14. A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and family to expect which common symptom that typically resolves spontaneously? 1. Depression 2. Ankle edema 3. Memory lapses 4. Dizziness - ANSWER Correct Answer: 1 15. RATIONALES: For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves on its own and doesn't require medical intervention; however, family members should be aware that symptoms don't always resolve on their own. They should also be instructed about worsening symptoms of depression and when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure; because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition after CABG surgery that warrants immediate physician notification. 16. A client with severe angina and electrocardiogram changes is seen by a nurse practitioner in the emergency department. 17. In terms of serum testing, it's most important for the nurse to order cardiac: 1. creatine kinase. 2. lactate dehydrogenase. 3. myoglobin. 4. troponin. - ANSWER Correct Answer: 4 18. RATIONALES: The client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of MI is troponin level. The other tests can show evidence of muscle injury but they're a less specific indicator of myocardial damage than troponin. 19. The home care nurse visits a client diagnosed with atrial fibrillation who is prescribed warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? 1. "I will watch my gums for bleeding when I brush my teeth." 2. "I will use an electric razor to shave." 3. "I will eat four servings of fresh, dark greens vegetables every day." 4. "I will report any unexplained or severe bruising to my doctor right away." - ANSWER Correct Answer: 3 20. RATIONALES: Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and any severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving. 21. A client with deep vein thrombosis has an I.V. infusion of heparin sodium infusing at 1,500 U/hour. The concentration in the bag is 25,000 U/500 ml. How many milliliters of solution should the nurse document as intake from this infusion for an 8-hour shift? - ANSWER Correct Answer: 240 22. RATIONALES: First, calculate how many units are in each milliliter of the medication: 25,000 U/500 ml = 50 U/ml Next, calculate how many milliliters the client receives each hour: 1 ml/50 U × 1,500 U/hour = 30 ml/hour Lastly, multiply by 8 hours: 30 ml/hour × 8 hours = 240 ml 23. An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. On a 12 lead ECG, which leads record electrical events in the septal region of the left ventricle? 1. Leads I, aVL, V5, and V6 2. Leads II, III, and aVF 3. Leads V1 and V2 4. Leads V3 and V4 - ANSWER Correct Answer: 4 24. RATIONALES: Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle. 25. A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, the nurse should include which instruction? 1. "Avoid drinking alcohol and straining at stool, and eat a low protein snack at night." 2. "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." 3. "Flex your calf muscles, avoid alcohol, and change positions slowly." 4. "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." - ANSWER Correct Answer: 3 26. RATIONALES: Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension. 27. A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. 28. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension? 1. Pyelonephritis 2. Dissecting aortic aneurysm 3. Pheochromocytoma 4. Untreated hypertension - ANSWER Correct Answer: 4 29. RATIONALES: Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as monoamine oxidase inhibitors with aged cheeses). 30. A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-a-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg three times daily with meals. The nurse should provide which instruction concerning long-term care? 1. "Practice meticulous foot care." 2. "Consider cutting down on your smoking." 3. "Reduce your level of exercise." 4. "See the physician if complications occur." - ANSWER Correct Answer: 1 31. RATIONALES: Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe the feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications unless the physician approves. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. The client must see the physician regularly to evaluate the effectiveness of the therapeutic regimen, not just when complications occur. 32. The nurse is evaluating a client who had a myocardial infarction (MI) 7 days ago. Which outcome indicates that the client is responding favorably to therapy? 1. The client demonstrates the ability to tolerate increasing activity without chest pain. 2. The client exhibits a heart rate above 100 beats/minute. 3. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking. 4. The client states that sublingual nitroglycerin usually relieves chest pain. - ANSWER Correct Answer: 1 33. RATIONALES: The ability to tolerate increasing activity without chest pain indicates a favorable response to therapy in a client who is recovering from an MI or who has a history of coronary artery disease. The client should have a normal electrocardiogram with no arrhythmias and a regular heart rate of 60 to 100 beats/minute. Smoking is a cardiovascular risk factor that the client must be willing to eliminate. A client who responds favorably to therapy shouldn't have chest pain. 34. The nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? 1. "When I finish the rehabilitation program I'll never have to worry about heart trouble again." 2. "I won't be able to jog again even with rehabilitation." 3. "Rehabilitation will help me function as well as I physically can." 4. "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor." - ANSWER Correct Answer: 3 35. RATIONALES: Cardiac rehabilitation helps the client reach his activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education. 36. A client with chest pain doesn't respond to nitroglycerin. On admission to the emergency department, the health care team obtains an electrocardiogram and begins infusing I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? 1. Within 12 hours 2. Within 24 hours 3. Within 24 to 48 hours 4. Within 5 to 7 days - ANSWER Correct Answer: 1 37. RATIONALES: For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 12 hours after onset of chest pain or other signs or symptoms of MI. Within the first 24 hours after an MI, sudden death is most likely to occur. I.V. heparin therapy begins after administration of a thrombolytic agent and usually continues for 5 to 7 days. 38. The nurse is educating a client who's at risk for coronary artery disease (CAD). The nurse tells the client that CAD has many risk factors. Risk factors that can be controlled or modified include: 1. gender, obesity, family history, and smoking. 2. inactivity, stress, gender, and smoking. 3. obesity, inactivity, diet, and smoking. 4. stress, family history, and obesity. - ANSWER Correct Answer: 3 39. RATIONALES: The risk factors for coronary artery disease that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that can't be controlled. 40. When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which statement by the client most strongly suggests angina pectoris? 1. "The pain lasted about 45 minutes." 2. "The pain resolved after I ate a sandwich." 3. "The pain got worse when I took a deep breath." 4. "The pain occurred while I was mowing the lawn." - ANSWER Correct Answer: 4 41. RATIONALES: Angina pectoris is chest pain caused by a decreased oxygen supply to the myocardium. Lawn mowing increases the cardiac workload; this, in turn, increases the heart's need for oxygen and may precipitate angina. Anginal pain typically is self limiting and lasts 5 to 15 minutes. Food consumption doesn't reduce this pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain. 42. A client comes to the physician's office for a complete physical examination required for employment. The physician assesses the client's arms and legs for evidence of peripheral vascular disease. What is the most commonly used overall indicator of arm and leg circulation? 1. Exercise testing 2. Ankle-brachial index 3. Limb blood pressure 4. Allen's test - ANSWER Correct Answer: 2 43. RATIONALES: The ankle-brachial index is the most commonly used overall indicator of arm and leg circulation. Exercise testing reveals the severity of intermittent claudication and suggests how extensively this condition affects the client's lifestyle. Limb blood pressure is the single best indicator of arm or leg perfusion, but its significance is limited to the limb being examined; limb blood pressures may vary greatly if peripheral vascular disease is present in one limb but not the other. Allen's test is used to evaluate blood flow in the arm. 44. An 84-year-old male is returning from the operating room (OR) after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates leftsided heart failure? 1. Jugular vein distention 2. Right upper quadrant pain 3. Bibasilar fine crackles 4. Dependent edema - ANSWER Correct Answer: 3 45. RATIONALES: Bibasilar fine crackles are a sign of alveolar fluid, a sequelae of left ventricular fluid, or pressure overload. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition. 46. The nurse is awaiting the arrival of a client from the emergency department. The client has a left ventricular myocardial infarction and is being admitted. In caring for this client, the nurse should be alert for which signs and symptoms of leftsided heart failure? 1. Jugular vein distention 2. Hepatomegaly 3. Dyspnea 4. Crackles 5. Tachycardia 6. Right upper quadrant pain - ANSWER Correct Answer: 3,4,5 47. RATIONALES: Signs and symptoms of left-sided heart failure include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; fatigue; nonproductive cough and crackles; hemoptysis; point of maximal impulse displaced toward the left anterior axillary line; tachycardia and S3 and S4 heart sounds; and cool, pale skin. Jugular vein distention, hepatomegaly, and right upper quadrant pain are all signs of right-sided heart failure. 48. A client with mitral valve prolapse is advised to have elective mitral valve replacement. Because the client is a Jehovah's Witness, she declares in her advance directive that no blood products are to be administered. As a result, the consulting cardiac surgeon refuses to care for the client. It would be most appropriate for the nurse caring for the client to: 1. realize the surgeon has the right to refuse to care for the client. 2. advise the surgeon to arrange for an alternate cardiac surgeon. 3. tell the client that she can donate her own blood for the procedure. 4. inform the client that her decision could shorten her life. - ANSWER Correct Answer: 1 49. RATIONALES: Physicians have an ethical and legal right to refuse to care for any client in a nonemergency situation when standard medical care isn't acceptable to the client. It isn't the responsibility of the surgeon to find an alternate. Jehovah's Witnesses don't believe in receiving blood transfusions. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client's right of autonomy. 50. The nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? 1. Serve the client his usual diet. 2. Order a high-fiber diet. 3. Encourage plenty of fluids. 4. Serve dairy products. - ANSWER Correct Answer: 3 51. RATIONALES: Adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test. 52. A client admitted with a massive myocardial infarction rapidly develops cardiogenic shock. Ideally, the physician would use the intra-aortic balloon pump (IABP) to support the injured myocardium. However, this client has a history of unstable angina pectoris, aortic insufficiency, hypertension, and diabetes mellitus. Which condition contraindicates use of the IABP? 1. Unstable angina pectoris 2. Aortic insufficiency 3. Hypertension 4. Diabetes mellitus - ANSWER Correct Answer: 2 53. RATIONALES: A history of aortic insufficiency contraindicates use of the IABP. Other contraindications for this therapy include aortic aneurysm, central or peripheral atherosclerosis, chronic end stage heart disease, multisystemic failure, chronic debilitating disease, bleeding disorders, and a history of emboli. Unstable angina pectoris that doesn't respond to drug therapy is an indication for IABP, not a contraindication. Hypertension and diabetes mellitus aren't contraindications for IABP. 54. The nurse correctly instructs a client with peripheral vascular disease that stress-reduction techniques: 1. are helpful only because they assist in smoking cessation. 2. are helpful because stress stimulates the release of vasoconstricting catecholamines. 3. are helpful because they distract the client from focusing on claudication pain. 4. haven't proved useful in clients with peripheral vascular disease. - ANSWER Correct Answer: 2 55. RATIONALES: The stress-induced release of vasoactive catecholamines, such as epinephrine, causes vasoconstriction, which directly aggravates peripheral vascular disease by intensifying the ischemic burden of the affected tissues. Vasoconstriction also indirectly aggravates atherogenesis by inducing hypertension. Stress reduction techniques make it easier for clients to avoid bad habits, such as smoking; however, this isn't the only reason why they're useful. Claudication is a signal of muscle ischemia and shouldn't be ignored 56. A client is recovering from an acute myocardial infarction (MI). During the first week of recovery, the nurse should stay alert for which abnormal heart sound? 1. Opening snap 2. Graham Steell's murmur 3. Ejection click 4. Pericardial friction rub - ANSWER Correct Answer: 4 57. RATIONALES: A pericardial friction rub, which sounds like squeaky leather, may occur during the first week after an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other. Certain stenosed valves may cause a brief, high-pitched opening snap heard early in diastole. Graham Steell's murmur is a high-pitched, blowing murmur with a decrescendo pattern; heard during diastole, it indicates pulmonary insufficiency, such as from pulmonary hypertension or a congenital pulmonary valve defect. An ejection click, associated with mitral valve prolapse or a rigid, calcified aortic valve, causes a high-pitched sound during systole. 58. While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as: 1. a first heart sound (S1). 2. a third heart sound (S3). 3. a fourth heart sound (S4). 4. a murmur. - ANSWER correct Answer: 2 59. RATIONALES: An S3 is heard following an S2, which commonly occurs in clients 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 an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves. 60. Before discharge, which instruction should the nurse give to a client receiving digoxin (Lanoxin)? 1. "Take an extra dose of digoxin if you miss one dose." 2. "Call the physician if your heart rate is above 90 beats/minute." 3. "Call the physician if your pulse drops below 80 beats/minute." 4. "Take digoxin with meals." - ANSWER Correct Answer: 2 61. RATIONALES: The nurse should instruct the client to notify the physician if his heart rate is greater than 90 beats/minute because cardiac arrhythmias may occur with digitalis toxicity. To prevent toxicity, the client should be instructed never to take an extra dose of digoxin if a dose is missed. The nurse should show the client how to take her pulse and to call the physician if her pulse rate drops below 60 beats/minute — not 80 beats/minute, which is a normal pulse rate and doesn't warrant action. Digoxin shouldn't be administered with meals because this slows the absorption rate. 62. A client who suffered blunt chest trauma in a car accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, the nurse should encourage the client to assume which position? 1. Semi-Fowler's 2. Leaning forward while sitting 3. Supine 4. Prone - ANSWER Correct Answer: 2 63. RATIONALES: When the client leans forward, the heart pulls away from the diaphragmatic pleurae of the lungs, helping relieve chest pain caused by pericarditis. The semi-Fowler, supine, and prone positions don't cause this pulling-away action and therefore don't relieve chest pain associated with pericarditis. 64. In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? 1. Cyanosis of the lips 2. Bilateral crackles 3. Productive cough 4. Leg edema - ANSWER Correct Answer: 4 65. RATIONALES: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, neck vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough. 66. The nurse is preparing a client for cardiac catheterization. The nurse knows that she must provide which nursing intervention when the client returns to his room after the procedure? 1. Withhold analgesics for at least 6 hours after the procedure. 2. Assess the puncture site frequently for hematoma formation or bleeding. 3. Inform the client that he may experience numbness or pain in his leg. 4. Restrict fluids for 6 hours after the procedure. - ANSWER Correct Answer: 2 67. RATIONALES: Because the diameter of the catheter used for cardiac catheterization is large, the puncture site must be checked frequently for hematoma formation and bleeding. The nurse should administer analgesics as prescribed and needed. If the femoral artery was accessed during the procedure, the client should be instructed to report any leg pain or numbness, which may indicate arterial insufficiency. Fluids should be encouraged to eliminate dye from the client's system. 68. A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate? 1. Varicose veins are more common in men than in women. 2. Primary varicose veins are caused by deep vein thrombosis and inflammation. 3. Sclerotherapy is used to cure varicose veins. 4. The severity of discomfort isn't related to the size of varicosities. - ANSWER Correct Answer: 4 69. RATIONALES: Clients with varicose veins commonly complain of aching, heaviness, itching, moderate swelling, and unsightly appearance of the legs. However, the severity of discomfort is hard to assess and seems unrelated to the size of varicosities. Varicose veins are more common in women than in men. Primary varicose veins typically result from a congenital or familial predisposition that makes the vein wall less elastic; secondary varicosities occur when trauma, obstruction, deep vein thrombosis, or inflammation damages valves. Sclerotherapy, in which a sclerosing agent is injected into a vein, is used to treat varicose veins; it doesn't cure them. 70. When teaching a client with newly diagnosed hypertension about the pathophysiology of this disease, the nurse states that arterial baroreceptors, which monitor arterial pressure, are found in the carotid sinus and aorta. Which other area should the nurse mention as the site of arterial baroreceptors? 1. Brachial artery 2. Radial artery 3. Left ventricular wall 4. Right ventricular wall - ANSWER Correct Answer: 3 71. RATIONALES: Arterial baroreceptors are found in the left ventricular wall as well as the carotid sinus and aorta. None exist in the brachial artery, radial artery, or right ventricular wall. 72. A client with refractory angina is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The cardiologist orders an infusion of abciximab (ReoPro). Before beginning the infusion, the nurse should ensure the client has: 1. negative history of tonic-clonic seizures. 2. ampule of naloxone (Narcan) at the bedside. 3. continuous electrocardiogram (ECG) monitoring. 4. up-to-date partial thromboplastin time (PTT) result in his record. - ANSWER Correct Answer: 4 73. RATIONALES: Clients undergoing PTCA receive abciximab because it inhibits platelet aggregation and, thereby, reduces cardiac ischemic complications. Before abciximab is administered, the client should have an up-to-date PTT result available. The drug isn't contraindicated in clients with a seizure history. Abciximab isn't an opioid; therefore, an opioid antagonist doesn't need to be at the bedside. Any client with refractory angina should be on continuous ECG monitoring; however, monitoring isn't a requirement for administering abciximab. 74. For a client with cardiomyopathy, the most important nursing diagnosis is: 1. Decreased cardiac output related to reduced myocardial contractility. 2. Excess fluid volume related to fluid retention and altered compensatory mechanisms. 3. Ineffective coping related to fear of debilitating illness. 4. Anxiety related to actual threat to health status. - ANSWER Correct Answer: 1 75. RATIONALES: Decreased cardiac output related to reduced myocardial contractility is the greatest threat to the survival of a client with cardiomyopathy. Although the other options are important nursing diagnoses, they can be addressed when cardiac output and myocardial contractility have been restored. 76. A client with chest pain, dyspnea, and an irregular heartbeat comes to the emergency department. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia) with frequent premature ventricular contractions. Shortly after admission, the client has ventricular tachycardia and becomes unresponsive. After successful resuscitation, the client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate at this time? 1. Deficient knowledge (disease process) related to interventions used to treat acute illness 2. Impaired physical mobility related to complete bed rest 3. Social isolation related to restricted visiting hours in the ICU 4. Ineffective tissue perfusion (cardiopulmonary) related to arrhythmia - ANSWER Correct Answer: 4 77. RATIONALES: The client suffered a lethal arrhythmia, requiring immediate resuscitation. This arrhythmia was caused by ineffective perfusion to the heart. Therefore, the client should have the nursing diagnosis Ineffective tissue perfusion (cardiopulmonary). Client teaching should be limited to clear, concise explanations that reduce anxiety and promote cooperation. An anxious client has difficulty learning, so the knowledge deficit would continue despite attempts at teaching. Impaired physical mobility and Social isolation are necessitated by the client's critical condition; therefore, they are considered therapeutic, not problems warranting nursing diagnoses. 78. A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and prescribes sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, the nurse should provide which instruction? 1. "Be sure to take safety precautions because nitroglycerin may cause orthostatic hypotension." 2. "Replace leftover sublingual nitroglycerin tablets every 6 months to make sure they're fresh." 3. "A burning sensation after administration indicates that the nitroglycerin tablets are potent." 4. "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed, to a maximum of four doses." - ANSWER Correct Answer: 1 79. RATIONALES: Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 3 months, not every 6 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina and may repeat the dose every 10 to 15 minutes for up to three doses; if this doesn't bring relief, the client should seek immediate medical attention 80. The physician prescribes pentoxifylline (Trental), 400 mg three times daily with meals, for a client with intermittent claudication and a history of adult-onset diabetes mellitus. The nurse knows that pentoxifylline is a: 1. hemostatic agent. 2. tissue plasminogen activator. 3. thrombolytic agent. 4. blood viscosity-reducing agent. - ANSWER Correct Answer: 4 81. RATIONALES: Pentoxifylline is a hemorheologic agent that improves blood flow by decreasing blood viscosity and is used to treat intermittent claudication. A hemostatic agent is used to stop excessive bleeding. A tissue plasminogen activator is used in early management of acute myocardial infarction. A thrombolytic agent is prescribed to dissolve clots and other substances in thrombi and emboli. 82. An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make? 1. Take a mild laxative such as magnesium citrate when necessary. 2. Take a stool softener such as docusate sodium (Colace) daily. 3. Administer a tap-water enema weekly. 4. Administer a phospho-soda (Fleet) enema when necessary. - ANSWER Correct Answer: 2 83. RATIONALES: Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing a dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation. 84. The nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5 minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse knows that nitroglycerin may cause: 1. nausea, vomiting, depression, fatigue, and impotence. 2. sedation, nausea, vomiting, constipation, and respiratory depression. 3. headache, hypotension, dizziness, and flushing. 4. flushing, dizziness, headache, and pedal edema. - ANSWER Correct Answer: 3 85. RATIONALES: Headache, hypotension, dizziness, and flushing are classic adverse effects of nitroglycerin, a vasodilator. Vasodilators, beta-adrenergic blockers, and calcium channel blockers are three major classes of drugs used to treat angina pectoris. Nausea, vomiting, depression, fatigue, and impotence are adverse effects of propranolol, a betaadrenergic blocker. Sedation, nausea, vomiting, constipation, and respiratory depression are common adverse effects of morphine, an opioid analgesic used to relieve pain associated with acute myocardial infarction. Flushing, dizziness, headache, and pedal edema are common adverse effects of nifedipine, a calcium channel blocker. 86. A client with a suspected diagnosis of acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain? 1. 30 minutes to 1 hour 2. 2 to 3 hours 3. 4 to 6 hours 4. 12 to 18 hours - ANSWER Correct Answer: 3 87. RATIONALES: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days. 88. Which sign or symptom suggest that a client's abdominal aortic aneurysm is extending? 1. Increased abdominal and back pain 2. Decreased pulse rate and blood pressure 3. Retrosternal back pain radiating to the left arm 4. Elevated blood pressure and rapid respirations - ANSWER Correct Answer: 1 89. RATIONALES: Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected. 90. A septic client with hypotension is being treated with dopamine hydrochloride (Inotropin). The nurse asks a colleague to double-check the dosage that the client is receiving. There are 400 mg of dopamine hydrochloride in 250 ml, the infusion pump is running at 23 ml/hour, and the client weighs 79.5 kg. How many micrograms per kilogram per minute is the client receiving? - ANSWER Correct Answer: 7.71 91. RATIONALES: First, calculate how many micrograms per milliliter of dopamine hydrochloride are in the bag: 400 mg/250 ml = 1.6 mg/ml 92. Next, convert milligrams to micrograms: 93. 1.6 mg/ml × 1,000 mcg/mg = 1,600 mcg/ml Lastly, calculate the dose: 94. 1,600 mcg/ml × 23 ml/hour/79.5 kg 95. 79.5 kg/60 minutes/hour = 7.71 mcg/kg/minute 96. When administering dobutamine (Dobutrex), the nurse knows that its major clinical use is to: 1. increase cardiac output. 2. prevent sinus bradycardia. 3. treat hypotension. 4. treat hypertension. - ANSWER Correct Answer: 1 97. RATIONALES: Dobutamine increases cardiac output for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery. Epinephrine hydrochloride, another catecholamine agent, may be used to treat sinus bradycardia. Many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, may be used to treat acute hypotension. None of the catecholamine agents are used to treat hypertension because many of them raise blood pressure as part of their action. 98. The nurse is assessing a client's right lower leg, which is wrapped with an elastic (Ace) bandage. Which signs and symptoms suggest circulatory impairment? 1. Numbness, cool skin temperature, and pallor 2. Swelling, warm skin temperature, and drainage 3. Numbness, warm skin temperature, and redness 4. Redness, cool skin temperature, and swelling - ANSWER Correct Answer: 1 99. RATIONALES: Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include warm skin with normal return of skin color after blanching and normal sensation. 100. The nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first: 1. establish unresponsiveness. 2. call for help. 3. open the airway. 4. assess the client for a carotid pulse. - ANSWER Correct Answer: 1 101. RATIONALES: The correct sequence begins with establishing unresponsiveness. The nurse should then call for help, assess the client for breathing while opening the airway, deliver two breaths, and check for a carotid pulse. 102. Which measurement can best be used to monitor the respiratory status of a client with pulmonary edema? 1. Arterial blood gas (ABG) analysis 2. Pulse oximetry 3. Skin color assessment 4. Lung sounds - ANSWER Correct Answer: 1 103. RATIONALES: ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although any of the options can be used to detect pulmonary changes, assessment of skin color and assessment of lung fields often are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema. 104. Following a percutaneous transluminal coronary angioplasty (PTCA), a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: 1. 25 seconds or less. 2. 50 seconds or less. 3. 75 seconds or less. 4. 100 seconds or less. - ANSWER Correct Answer: 2 105. RATIONALES: Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 40 seconds or less before the sheath is removed. Removing the sheath prematurely can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath. 106. A hospitalized client experiences digoxin- (Lanoxin-) induced premature ventricular contractions (PVCs). Which type of effect do such contractions represent? 1. Toxic 2. Secondary 3. Iatrogenic 4. Idiosyncratic - ANSWER Correct Answer: 3 107. RATIONALES: Digoxin-induced PVCs are iatrogenic because the drug is mimicking a cardiac disorder. Because the client is experiencing an apparent pathological disorder, this effect isn't considered toxic, secondary, or idiosyncratic. 108. Considering a client's atrial fibrillation, the nurse must administer digoxin (Lanoxin) with caution because it: 1. affects the sympathetic division of the autonomic nervous system, decreasing vagal tone. 2. stimulates the parasympathetic division of the autonomic nervous system, increasing vagal tone. 3. can induce hypertensive crisis by constricting arteries. 4. can trigger proarrhythmia by increasing stroke volume. - ANSWER Correct Answer: 2 109. RATIONALES: The nurse must administer digoxin with caution in a client with atrial fibrillation because digoxin stimulates the parasympathetic division of the autonomic nervous system, increasing vagal tone. The vagal effect slows the heart rate, increases the refractory period, and slows conduction through the atrioventricular node and junctional tissue, thus increasing the potential for new arrhythmias to develop. Digoxin doesn't constrict arteries. Although it can trigger proarrhythmias, it does so by increasing vagal tone (not stroke volume). 110. A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: 1. hypertension. 2. high urine output. 3. dry mucous membranes. 4. pulmonary crackles. - ANSWER Correct Answer: 4 111. RATIONALES: High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures 112. The nurse records a client's history and discovers several risk factors for coronary artery disease. Which cardiac risk factors are considered controllable? 1. Diabetes, hypercholesterolemia, and heredity 2. Diabetes, age, and gender 3. Age, gender, and heredity 4. Diabetes, hypercholesterolemia, and hypertension - ANSWER Correct Answer: 4 113. RATIONALES: Controllable risk factors include hypertension, hypercholesterolemia, obesity, lack of exercise, smoking, diabetes, stress, alcohol abuse, and use of contraceptives. Uncontrollable risk factors for coronary artery disease include gender, age, and heredity. 114. A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: 1. antibiotic. 2. anticoagulant. 3. antihypertensive. 4. anticonvulsant. - ANSWER Correct Answer: 2 115. RATIONALES: During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. An antibiotic isn't given routinely during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics afterward to reduce the risk of infection. An antihypertensive agent may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures. 116. An anxious client who suffered an acute myocardial infarction is transferred from the coronary care unit (CCU) to the telemetry unit. The client asks the charge nurse if he can have the same nurse care for him every day. How should the charge nurse respond? 1. "Different nurses will be assigned to you each day to avoid your becoming dependent on one nurse." 2. "It is important for you to receive care from a variety of nurses so you can evaluate your care." 3. "We will try to assign you the same nurse as often as possible." 4. "It is our policy to rotate client care assignments to ensure quality care for everyone." - ANSWER Correct Answer: 3 117. RATIONALES: The charge nurse should try to accommodate the client's wishes by assigning him a familiar nurse whenever possible. This should help decrease the client's anxiety. Preventing dependency should not be a concern; allaying his anxiety should. The client should not be concerned with evaluating the quality of care rendered by multiple nurses. Providing continuity of care helps ensure quality care. 118. A 53-year-old client is about to undergo cardiac catheterization for which he signed an informed consent. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed? 1. Medicate the client and document his comment. 2. Medicate the client and notify the physician about the comment. 3. Explain that cardiac catheterization doesn't involve open heart surgery, and then medicate the client. 4. Withhold the medication and notify the physician immediately. - ANSWER Correct Answer: 4 119. RATIONALES: The nurse should withhold the medication and notify the physician that the client doesn't understand the procedure. The physician then has the obligation to explain the procedure better to the client and determine whether or not the client understands. If the client doesn't understand, he can't give a true informed consent. If the medication is administered before the physician explains the procedure, the sedation may interfere with the client's ability to clearly understand the procedure. The nurse can't just medicate the client and document her finding; she must notify the physician. 120. The visiting nurse is teaching a client with heart failure about taking his medications. The client requires six different medications that are taken at four different times per day. The client is confused about when to take each medication. 121. How should the nurse intervene? 1. Ask the client's family to take turns coming to the house at each administration time to assist the client with his medications. 2. Teach a family member to fill a medication compliance aid once a week so the client can independently take his medications. 3. Ask the physician if the client can take fewer pills each day. 4. Come to the client's house each morning to prepare the daily allotment of medications. - ANSWER Correct Answer: 2 122. RATIONALES: The nurse should intervene by asking a family member to fill a compliance aid each week with the client's weekly supply of medications in the appropriate time slots. Family members can't be expected to come to the client's house four times each day to administer medications. The physician shouldn't change the dosing regimen just for convenience. The home care nurse can't visit the client each morning to prepare the daily medication regimen. 123. A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V. infusion. Which statement by the client indicates that this drug is producing its therapeutic effect? 1. "I have a bad headache." 2. "My chest pain is decreasing." 3. "I feel a tingling sensation around my mouth." 4. "My blood pressure must be up because my vision is blurred." - ANSWER Correct Answer: 2 124. RATIONALES: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure. 125. A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is most probably: 1. anterior. 2. posterior. 3. lateral. 4. inferior. - ANSWER Correct Answer: 1 126. RATIONALES: An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. The other types of MI aren't usually associated with heart failure 127. The physician prescribes several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question? 1. heparin sodium (Heparin sodium injection) 2. dexamethasone (Decadron) 3. methyldopa (Aldomet) 4. phenytoin (Dilantin) - ANSWER Correct Answer: 1 128. RATIONALES: Administration of heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain. In a client with hemorrhagic stroke, dexamethasone may be used to decrease cerebral edema and pressure; methyldopa, to reduce blood pressure; and phenytoin, to prevent seizures. 129. A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene? 1. Administer I.V. fluids as ordered. 2. Administer a vasodilator as prescribed. 3. Insert an indwelling urinary catheter as ordered. 4. Instruct the client to sit up for several minutes before standing. - ANSWER Correct Answer: 4 130. RATIONALES: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. 131. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension. 132. How long after oral administration can the nurse expect to see digoxin's (Lanoxin) peak effect? 1. 2 to 5 minutes 2. 10 to 20 minutes 3. 30 minutes to 2 hours 4. 2 to 6 hours - ANSWER Correct Answer: 4 133. RATIONALES: The peak effect of digoxin occurs 2 to 6 hours after an oral dose and 1 to 4 hours after an I.V. dose. Digoxin's onset of action ranges from 30 minutes to 2 hours after an oral dose and from 5 to 30 minutes after an I.V. dose. 134. The unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught? 1. The percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity 2. The quality of teaching by the nurses who educate the acute MI clients on the telemetry unit 3. The amount of education the acute MI clients received on the telemetry unit 4. The nurses' assessment of the quality of client education about resuming sexual activity after an acute MI - ANSWER Correct Answer: 1 135. RATIONALES: The unit council needs to assess the number of clients diagnosed with an acute MI on the telemetry unit who were actually taught about resuming sexual activity. The unit council needs to identify the number of clients who were taught, not the quality of the teaching. Only education about resuming sexual activity is pertinent to this performance improvement study. The nurses' assessment of the quality of client education is not pertinent to this study either. 136. A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? 1. Heart rate 2. Respiratory rate 3. Blood pressure 4. Temperature - ANSWER Correct Answer: 3 137. RATIONALES: Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration. 138. A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: 1. skin rash. 2. peripheral edema. 3. dry cough. 4. postural hypotension. - ANSWER Correct Answer: 2 139. RATIONALES: Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective. 140. A client is prescribed hydralazine for blood pressure management. The nurse is teaching the client about hydralazine therapy. When should the client take his hydralazine? 1. Upon arising in the morning 2. Just before bedtime 3. On an empty stomach 4. With food - ANSWER Correct Answer: 4 141. RATIONALES: Oral hydralazine should be taken with food to promote absorption. 142. What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock? 1. Cardiac pacemaker 2. Hypothermia-hyperthermia machine 3. Defibrillator 4. Intra-aortic balloon pump - ANSWER Correct Answer: 4 143. RATIONALES: Counterpulsation with an intra-aortic balloon pump may be indicated for temporary circulatory assistance in clients with cardiogenic shock. Cardiac pacemakers are used to maintain the heartbeat at a predetermined rate. 144. Hypothermia-hyperthermia machines are used to cool or warm clients with abnormalities in temperature regulation. The defibrillator is commonly used for termination of life-threatening ventricular rhythms. 145. The monitor technician on the telemetry unit asks the charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin (Coumadin). Which response by the charge nurse is best? 1. "It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." 2. "Warfarin controls heart rate in the client with atrial fibrillation." 3. "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." 4. "Warfarin prevents clot formation in the atria of clients with atrial fibrillation." - ANSWER Correct Answer: 4 146. RATIONALES: Blood pools in the atria of clients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the client at risk for stroke. Warfarin is prescribed in most clients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. Digoxin is typically prescribed to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation. 147. A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is given because it: 1. eliminates pain, reduces cardiac workload, and increases myocardial contractility. 2. lowers resistance, reduces cardiac workload, and decreases myocardial oxygen demand. 3. raises the blood pressure, lowers myocardial oxygen demand, and eliminates pain. 4. increases venous return, lowers resistance, and reduces cardiac workload. - ANSWER Correct Answer: 2 148. RATIONALES: When given to treat acute MI, morphine sulfate eliminates pain, reduces venous return to the heart, reduces vascular resistance, reduces myocardial workload, and reduces the oxygen demand of the heart. Morphine sulfate doesn't increase myocardial contractility, raise blood pressure, or increase venous return. 149. A client with end-stage heart failure is preparing for discharge. The client and his caregiver meet with the home care nurse and voice their concern that setting up a hospital bed in the bedroom will leave him feeling isolated. Which suggestion by the home care nurse best addresses this concern? 1. Place a chair in the bedroom so guests can visit with the client. 2. Set up the hospital bed in the family room so the client can be part of household activities. 3. Set up the hospital bed in the bedroom so the client can rest in a quiet environment. 4. Set up the hospital bed in the bedroom so the client can be assessed in a quiet environment. - ANSWER Correct Answer: 2 150. RATIONALES: The client should be kept actively involved in the household to prevent feelings of isolation. This can be accomplished by setting up the hospital bed in the family room. Placing a chair in the bedroom allows the client periods of isolation when visitors aren't present. It's important for the client to have periods of rest; however, that can be accomplished without keeping the client isolated in a bedroom. The needs of the client should be considered before the needs of the nurse who assesses the client during an occasional visit. 151. A client with mitral stenosis is scheduled for mitral valve repl