PN3 FINAL EXAM ( Professional Nursing III Final Exam ) Latest Updated Fall 2025/26 | Complete Questions and Answers - Rasmussen College.

PN3 FINAL EXAM ( Professional Nursing III Final Exam ) Latest Updated Fall 2025/26 | Complete Questions and Answers - Rasmussen College. PN3 FINAL EXAM CHAPTERS MODULE 1 ● Comprehensive Review for NCLEX RN, Chapter 26 ● Medical-Surgical Nursing, Chapters 19, 20 & 65 Chapter 19: Concepts of Cancer Development Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse learning about cellular regulation understands that which process occurs during the S phase of the cell cycle? 2. A nurse asks the staff development nurse what “apoptosis” means. What response best? 3. A nurse is learning the difference between normal cells and benign tumor cells. What information does this include? 4. A nurse learns that which of the following is the single biggest risk factor for developing cancer? 5. Which statement about carcinogenesis is accurate? 6. The nurse caring for oncology clients knows that which form of metastasis is the most common? 7. A nurse is assessing a client with glioblastoma. What assessment is most important? 8. A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching? 9. A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the client’s chart that the cancer classification is TISN0M0. What does the nurse conclude about this client’s cancer? 10. A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer risk. What response by the nurse is best? MULTIPLE RESPONSE 1. The nurse learning about cancer development remembers characteristics of normal cells. Which characteristics does this include? (Select all that apply.) 2. The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.)’ 3. A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse most likely to engage? (Select all that apply.) 4. A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) Chapter 20: Concepts of Care for Patients With Cancer Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? 2. A nurse is caring for a client admitted for Non-Hodgkin’s lymphoma and chemotherapy. The client reports nausea, flank pain, and muscle cramps. What action by the nurse is most important? 3. A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best? read 4. A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a 5. A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? 6. A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? Assessing the IV site and blood return every hour 7. A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client’s oral chemotherapy medications. What action by the nurse is most appropriate? 8. The nurse working with oncology clients understands that which age-related change increases the older client’s susceptibility to infection during chemotherapy? 9. The nurse has educated a client on precautions to take with thrombocytopenia. What statement by the client indicates a need to review the information? 10. A client has a platelet count of 9800/mm3 (9800  109/L). What action by the nurse is most appropriate? 11. A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL (61 mmol/L). The client is symptomatic but refuses blood transfusions. What medication does the nurse prepare to administer? 12. A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? 13. A client is receiving rituximab. What assessment by the nurse takes priority? 14. A client is receiving rituximab and asks how it works. What response by the nurse is best? 15. Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients would the nurse assess first? 16. A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? 17. The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? 18. A client with long-standing heart failure being treated for cancer has received a dose of ondansetron for nausea. What action by the nurse is most important? 20. A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? 21. A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? 22. A client is having a catheter placed to deliver chemotherapy beads into a liver tumor via the femoral artery. What action by the nurse is most important? 23. A nurse works on an oncology unit and delegates personal hygiene to assistive personnel (AP). What action by the AP requires intervention from the nurse? 24. A client with cancer has anorexia and mucositis, and is losing weight. The client’s family members continually bring favorite foods to the client and are distressed when the client won’t eat them. What action by the nurse is best? 25. A client in the emergency department reports difficulty breathing. The nurse assesses the client’s appearance as depicted below: What action by the nurse is most important? MULTIPLE RESPONSE 1. The nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia Increased risk of infection from white blood cell deficits Nutritional deficits such as early satiety and cachexia Potential for reduced gas exchange Various motor and sensory deficits Increased risk of bone fractures 2. A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) 3. A client receiving radiation therapy reports severe skin itching and irritation. What actions does the nurse delegate to assistive personnel (AP)? (Select all that apply.) 4. A client has thrombocytopenia. What actions does the nurse delegate to assistive personnel (AP)? (Select all that apply.) 5. A client has mucositis. What actions by the nurse will improve the client’s nutrition? (Select all that apply.) 6. A client’s family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.) 7. A client receiving chemotherapy has a white blood cell count of 1000/mm3 (1  109/L). What actions by the nurse are most appropriate? (Select all that apply.) Chapter 65: Concepts of Care for Patients with Breast Disorders Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse is teaching a 45-year-old woman about her fibrocystic breast changes. Which statement by the client indicates a lack of understanding? 2. The nurse is examining a woman’s breast and notes multiple small mobile lumps. Which question would be most appropriate for the nurse to ask? 3. The nurse is working with a male client who has gynecomastia. What action by the nurse is most appropriate? 4. Which finding in a female client by the nurse would receive the highest priority for further diagnostics? 5. A nurse has taught a female client about the modifiable risk factors for breast cancer. Which statement made by the client indicates that more teaching is needed? 6. A younger woman from an unfamiliar culture is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropr 7. A client has just returned from a right radical mastectomy. Which action by the assistive personnel (AP) would require the nurse consider to intervene? 8. A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is needed? 9. During dressing changes, the nurse assesses a client who had breast reconstruction. Which finding would cause the nurse to take immediate action? 10. A client is starting hormonal therapy with tamoxifen to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug? 11. A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide, and fluorouracil for breast cancer. Which side effect seen in the client would the nurse report to the primary health care provider immediately? 12. A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? 13. A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase 125 U/L (2.2 mckat/L) Total calcium 12 mg/dL (3 mmol/L) Hematocrit 39% (0.39) Hemoglobin 14 g/dL (140 mmol/L) Which test results indicate to the nurse that some further diagnostics are needed? MULTIPLE RESPONSE 1. The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) 2. The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods would be included in the plan? (Select all that apply.) 3. After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the client’s electronic medical record? (Select all that apply.) 4. A woman is interested in alternative and complementary treatments for the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which therapies wound the nurse suggest? (Select all that apply.) MODULE 2 ● Medical-Surgical Nursing, Chapter 8 Chapter 08: Concepts of Care for Patients at End of Life Ignatavicius: Medical-Surgical Nursing, 10th Edition 1. A nurse cares for a dying client. Which manifestation of dying does the nurse treat first? 2. A nurse plans care for a client who is nearing end of life. Which question will the nurse ask when developing this client’s plan of care? 3. A nurse is caring for a client who has lung cancer and is dying. Which prescription does the nurse question? 4. A nurse is caring for a dying client whose adult child confides frequent crying episodes to the nurse. How does the nurse respond? 5. After teaching a client about advance directives, a nurse assesses the client’s understanding. Which statement indicates that the client correctly understands the teaching? 6. A nurse teaches a client who is considering being admitted to hospice. Which statement does the nurse include in this client’s teaching? 7. A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to death.” How would the nurse respond? 8. The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client’s anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse’s teaching? 9. A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action will the nurse take first? 10. A nurse assesses a client who is dying. Which sign or symptoms does the nurse assess to determine whether the client is near death? 11. A nurse is caring for a client who is terminally ill. The client’s spouse states, “I am concerned because he does not want to eat.” How does the nurse respond? 12. A nurse discusses palliative care with a client and the client’s family. A family member expresses concern that the loved one will receive only custodial care. How will the nurse respond? 13. An intensive care nurse discusses withdrawal of care with a client’s family. The family expresses concerns related to discontinuation of therapy. How will the nurse respond? 14. A hospice nurse is caring for a variety of clients who are dying. Which end-of-life and death ritual is paired with the correct religion? MULTIPLE RESPONSE 1. A hospice nurse is caring for a dying client and family members. Which interventions does the nurse implement? (Select all that apply.) Teach family members about physical signs of impending death. Encourage the management of adverse symptoms. Encourage reminiscence by both client and family members. Allow the client and family to voice concerns and fears. 2. A nurse admits an older adult client to the hospital. Which criteria does the nurse use to determine if the client can make his or her own medical decisions? (Select all that apply.) Can communicate treatment preferences. Is oriented enough to understand information provided. Can evaluate and deliberate information. 3. A hospice nurse plans care for a client who is experiencing pain. Which complementary therapies does the nurse incorporate in this client’s pain management plan? (Select all that apply.) a. Play music that the client enjoys. . b. Rub lavender lotion on the client’s feet. c. Involve the client in guided imagery. 4. A nurse teaches a client’s family members about signs and symptoms of approaching death. Which of the following does the nurse include in this teaching? (Select all that apply.) a. Decreased appetite b. Congestion and gurgling c. Incontinence ● Medical-Surgical Nursing, Chapters 10, 12 & 23 Chapter 10: Concepts of Emergency and Trauma Nursing Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. An emergency department nurse assesses a client who has been raped. With which health care team member would the nurse collaborate when planning this client’s care? 2. The emergency department team is performing cardiopulmonary resuscitation on a client when the client’s spouse arrives. Which action would the nurse task the spouse if he or she wishes to be present during the resuscitation. 3. An emergency department nurse is triaging victims of a multi-casualty event. Which client would receive care first? 4. While triaging clients in a crowded emergency department, a nurse assesses a client who presents with symptoms of tuberculosis. Which action would the nurse take first? 5. A nurse is triaging clients in the emergency department (ED). Which client would the nurse prioritize to receive care first? 6. A nurse is evaluating levels and functions of trauma centers. Which function is appropriately paired with the level of the trauma center? 7. Emergency medical technicians arrive at the emergency department with an unresponsive client who has an oxygen mask in place. Which action would the nurse take first? 8. A trauma client with multiple open wounds is brought to the emergency department in cardiac arrest. Which action would the nurse take prior to providing advanced cardiac life support? 9. A nurse is triaging clients in the emergency department. Which client would be considered “urgent”? 10. An emergency department nurse is caring for a client who has died from a suspected homicide. Which action does the nurse take? 11. An emergency department (ED) case manager is consulted for a client who is homeless. Which intervention would the case manager provide? 12. An emergency department nurse is caring for a client who is homeless. Which action would the nurse take to gain the client’s trust? 13. A nurse is triaging clients in the emergency department. Which client would the nurse classify as “nonurgen 14. What is the primary goal of a triage system used by the nurse with clients presenting to the emergency department? 15. An elderly client who has fallen from a roof is transported to the emergency department by ambulance. The client was unconscious at the scene but is conscious on arrival and is triaged as urgent. What is the priority assessment the nurse includes during the primary survey of the patient? MULTIPLE RESPONSE 1. A nurse is caring for clients in a busy emergency department. What actions would the nurse take to ensure client and staff safety? (Select all that apply.) 2. An emergency department (ED) nurse is preparing to transfer a client to the trauma intensive care unit. Which information would the nurse include in the nurse-to-nurse hand-off report? (Select all that apply.) 3. An emergency department nurse is caring for a trauma patient. Which interventions does the nurse perform during the primary survey? (Select all that apply.) 4. The complex care provided during an emergency requires interprofessional collaboration. Which team members are paired with the correct responsibilities? (Select all that apply.) 5. A nurse prepares to discharge an older adult client home from the emergency department (ED). What actions does the nurse take to prevent future ED visits? (Select all that apply.) Chapter 12: Concepts of Disaster Preparedness Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A hospital responds to a local mass casualty event. What action would the nurse supervisor take to prevent staff posttraumatic stress disorder during and after the event? 2. A client who is hospitalized with burns after losing the family home in a fire becomes angry and screams at a nurse when dinner is served late. How would the nurse respond? 3. A nurse is field-triaging clients after an industrial accident. Which client condition would the nurse triage with a red tag? 4. An emergency department (ED) charge nurse prepares to receive clients from a mass casualty within the community. What is the role of this nurse during the event? 5. An emergency department manager wants to mitigate the possible acute and chronic stress after mass casualty events in the staff. What action would the manager take? 6. A nurse is caring for a client whose spouse died in a recent mass casualty accident. The client says, “I can’t believe that my spouse is gone and I am left to raise my children all by myself.” How would the nurse respond? 7. A nurse cares for victims during a community-wide disaster drill. One of the victims asks, “Why are the individuals with black tags not receiving any care?” How does the nurse respond? 8. A nurse wants to become involved in community disaster preparedness and is interested in helping setup and staff first-aid stations or community acute care centers in the event of a disaster. Which organization is the best fit for this nurse’s interests? 9. A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but is concerned about maintaining licensure in several different states. Which statement best addresses these concerns? 10. After a hospital’s emergency department (ED) has efficiently triaged, treated, and transferred clients from a community disaster to appropriate units, the hospital incident command officer wants to “stand down” from the emergency plan. Which question would the nursing supervisor ask at this time? 11. A nurse is volunteering in a temporary shelter for survivors of a hurricane. Which client does the nurse anticipate has the highest need for further assessment and referral? 12. An emergency department charge nurse notes an increase in sick calls and bickering among the staff after a week with multiple trauma incidents. What action would the nurse take? 13. A nurse is constructing a personal preparedness plan in case of a disaster. What does the nurse consider in making this plan? MULTIPLE RESPONSE 1. Emergency medical services (EMS) brings a large number of clients to the emergency department following a mass casualty incident. The nurse identifies the clients with which injuries with yellow tags? (Select all that apply.) 2. A nurse triages clients arriving at the hospital after a mass casualty. Which clients are correctly classified? (Select all that apply.) 3. A hospital prepares to receive large numbers of casualties from a community disaster. Which clients would the nurse identify as appropriate for discharge or transfer to another facility? (Select all that apply.) 4. A hospital prepares for a mass casualty event. Which functions are correctly paired with the personnel role? (Select all that apply.) 5. A new graduate nurse has started working on a medical-surgical unit. What actions would the nurse take to be prepared for a disaster? (Select all that apply.) Know the institution’s Emergency Response Plan. Chapter 23: Concepts of Care for Patients With Skin Problems MULTIPLE CHOICE 1. A nurse teaches a client who has pruritus. Which statement by the client shows a need to review the information? 2. A nurse assesses clients on a medical-surgical unit. Which client is at greatest risk for pressure injury development? 3. A nurse is caring for a client with an electrical burn. The client has entrance wounds on the hands and exit wounds on the feet. What information is most important to include when planning care? 4. A nurse cares for a client who has a stage 3 pressure injury with copious exudate. What type of dressing does the nurse use on this wound? 5. A nurse is caring for a client who has a nonhealing pressure injury on the right ankle. Which action would the nurse take first? 6. A client has been brought to the emergency department after being covered in fertilizer after an explosion and fire at a warehouse. What action by the nurse is best? 7. After teaching a client who has a stage 2 pressure injury, a nurse assesses the client’s understanding. Which dietary choice by the client indicates a good understanding of the teaching? 8. A nurse assesses clients on a medical-surgical unit, all of whom have stage 2 or 3 pressure injuries. Which client would the nurse evaluate further for a wound infection? 9. A nurse is teaching a client and family about self-care at home for the client’s wound infected with methicillin-resistant Staphylococcus aureus. What statement by the client indicates a need to review the information? 10. A nurse is assessing a client who has a recent diagnosis of melanoma for understanding of treatment choices. What statement by the client indicates good understanding of the information? 11. A nurse assesses an older client who is scratching and rubbing white ridges on the skin between the fingers and on the wrists. Which action would the nurse take? 12. A client contacts the clinic to report a life-long mole has developed a crust with occasional bleeding. What instruction by the nurse is most appropriate? 13. A nurse is teaching a client who has itchy, raised red patches covered with a silvery white scale how to care for this disorder. What statement by the client shows a need for further information? 14. A nurse performs a skin screening for a client who has numerous skin lesions. Which lesion does the nurse evaluate first? 15. A nurse assesses a young female client who is prescribed tazarotene. Which question should the nurse ask prior to starting this therapy? 16. A nurse is assessing clients with pressure injuries. Which wound description is correctly matched to its description? 17. A new nurse reads a client has a wound “healing by second intention” and asks what that means. Which description by the charge nurse is most accurate? 18. A nurse assesses a client who has psoriasis. Which action would the nurse take first? 19. A nurse is caring for a client whose Braden Scale score is 9. What intervention demonstrates a lack of evidence-based knowledge? 20. A nurse evaluates the following data in a client’s chart: Admission Note Laboratory Results Wound Care Note A 66-year-old male with a health history of a cerebral vascular accident and left-side paralysis White blood cell count: 8000/mm3 (8  109/L) Prealbumin: 15.2 mg/dL (152 mg/L) Albumin: 4.2 mg/dL (42 mg/L) Lymphocyte count: 2000/mm3 (2  109/L) Sacral ulcer: 4  2  1.5 cm Based on this information, which action would the nurse ta ke? 21. A nurse evaluates the following data in a client’s chart: Admission Note Prescriptions Wound Care A 78-year-old male with a past medical history of atrial fibrillation is admitted with a chronic leg wound Warfarin sodium (Coumadin) Sotalol (Betapace) Negative-pressure wound therapy (NPWT) to leg wound Based on this information, which action would the nurse take first? MULTIPLE RESPONSE 1. A nurse plans care for a client who is immobile. Which interventions would the nurse include in this client’s plan of care to prevent pressure sores? (Select all that apply.) 2. A nurse is working with a client who has a painful rash consisting of grouped weeping and crusting lesions in distinct lines. What actions by the nurse are most appropriate? (Select all that apply.) 3. The nurse learns that which age-related changes increase the potential for complications of burns? (Select all that apply.) 4. A nurse assesses a client who presents with an increase in psoriatic lesions. Which questions would the nurse ask to identify a possible trigger for worsening of this client’s psoriatic lesions? (Select all that apply.) “Have you been under a lot of stress lately?” 5. A nurse cares for a client who reports discomfort related to eczematous dermatitis. Which nonpharmacologic comfort measures would the nurse implement? (Select all that apply.) 6. The nurse in the emergency department would arrange to transfer which burned clients to a burn center? (Select all that apply.) MODULE 5, 6, 7 ● Medical-Surgical Nursing, Chapter 30-35 Chapter 30: Assessment of the Cardiovascular System Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse assesses a client who had a myocardial infarction and has a blood pressure of 88/58 mm Hg. Which additional assessment finding would the nurse expect? 2. A nurse assesses a client after administering a prescribed beta blocker. Which assessment would the nurse expect to find? 3. A nurse assesses clients on a medical-surgical unit. Which client would the nurse identify as having the greatest risk for cardiovascular disease? 4. A nurse assesses an older adult client who has multiple chronic diseases. The client’s heart rate is 48 beats/min. What action would the nurse take first? 5. An emergency department nurse obtains the health history of a client. Which statement by the client would alert the nurse to the occurrence of heart failure? 6. A nurse obtains the health history of a client who is newly admitted to the medical unit. Which statement by the client would alert the nurse to the presence of edema? 7. A nurse assesses female client who is experiencing a myocardial infarction. Which clinical manifestation would the nurse expect? 8. A nurse assesses a client 2 hours after a cardiac angiography via the left femoral artery. The nurse notes that the left pedal pulse is weak. What action would the nurse take next? 9. A nurse assesses a client who is recovering after a left-sided cardiac catheterization. Which assessment finding requires immediate intervention? 10. A nurse assesses a client who is scheduled for a cardiac catheterization. Which assessment would the nurse complete as the priority prior to this procedure? 11. A nurse cares for a client who is prescribed magnetic resonance imaging (MRI) of the heart. The client’s health history includes a previous myocardial infarction and pacemaker implantation. What action would the nurse take? 12. A nurse assesses a client who is recovering from a myocardial infarction. The client’s blood pressure is 140/88 mm Hg. What action would the nurse take first? 13. A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA) and is scheduled for bypass surgery. Which intervention would the nurse be prepared to implement while this client waits for surgery? 14. A nurse teaches a client with diabetes mellitus and a body mass index of 42 who is at high risk for coronary artery disease. Which statement related to nutrition would the nurse include in this client’s teaching? 15. A nurse cares for a client who has advanced cardiac disease and states, “I am having trouble breathing while I’m sleeping at night.” What is the nurse’s best response? 16. A nurse cares for a client who is recovering from a myocardial infarction. The client states, “I will need to stop eating so much chili to keep that indigestion pain from returning.” What is the nurse’s best response? 17. A nurse prepares a client for cardiac catheterization. The client states, “I am afraid I might die.” What is the nurse’s best response? 18. An emergency department nurse triages clients who present with chest discomfort. Which client would the nurse plan to assess first? 19. A nurse assesses a client who has aortic regurgitation. In which location in the illustration shown below would the nurse auscultate to best hear a cardiac murmur related to aortic regurgitation? A MULTIPLE RESPONSE 1. A nurse is caring for a client with a history of renal insufficiency who is scheduled for a cardiac catheterization. What actions would the nurse take prior to the catheterization? (Select all that apply.) 2. An emergency department nurse assesses a female client. Which assessment findings would alert the nurse to request a prescription for an electrocardiogram? (Select all that apply.) 3. A nurse assesses a client who is recovering after a coronary catheterization. Which assessment findings in the first few hours after the procedure require immediate action by the nurse? (Select all that apply.) 4. A nurse reviews a client’s laboratory results. Which findings would alert the nurse to the possibility of atherosclerosis? (Select all that apply.) 5. A nurse prepares a client for a pharmacologic stress echocardiogram. What actions would the nurse take when preparing this client for the procedure? (Select all that apply.) 6. A nurse cares for a client who is recovering from a right-sided heart catheterization. For which complications of this procedure would the nurse assess? (Select all that apply.) Chapter 31: Concepts of Care for Patients With Dysrhythmias Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse assesses a client’s electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How would the nurse interpret this observation? . 2. A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate? 3. A nurse is assessing clients on a medical-surgical unit. Which client would the nurse identify as being at greatest risk for atrial fibrillation? 4. A nurse assesses a client with atrial fibrillation. Which manifestation would alert the nurse to the possibility of a serious complication from this condition? 5. A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication would the nurse expect to find on this client’s medication administration record to prevent a common complication of this condition? 6. A nurse administers prescribed adenosine to a client. Which response would the nurse assess for as the expected therapeutic response? 7. A telemetry nurse assesses a client who has a heart rate of 35 beats/min on the cardiac monitor. Which assessment would the nurse complete next? 8. A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client’s electrocardiogram. What action would the nurse take next? 9. A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which intervention is appropriate for the nurse to perform prior to defibrillating this client? 10. After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the client’s understanding. Which statement by the client indicates correct understanding of the teaching?.” 11. A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What intervention would the nurse implement to address this client’s concerns? 12. A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. What action would the nurse take prior to the cardioversion? 13. A nurse prepares to discharge a client with a cardiac dysrhythmia who is prescribed home health care services. Which priority information would be communicated to the home health nurse upon discharge? 14. A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? 15. A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement would the nurse include in this client’s teaching? 16. The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, “Why do you want to know if I use cocaine?” What is the nurse’s best response? 17. A nurse supervises an assistive personnel (AP) applying electrocardiographic monitoring. Which statement would the nurse provide to the AP related to this procedure? 18. A nurse assesses a client’s electrocardiogram (ECG) and observes the reading shown below: How would the nurse document this client’s ECG strip? 19. A nurse cares for a client who is on a cardiac monitor. The monitor displayed the rhythm shown below: What action would the nurse take first? 20. A nurse performs an admission assessment on a 75-year-old client with multiple chronic diseases. The client’s blood pressure is 135/75 mm Hg and oxygen saturation is 94% on 2 L per nasal cannula. The nurse assesses the client’s rhythm on the cardiac monitor and observes the reading shown below: What action would the nurse take first? 21. The nurse is caring for a client on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below: After calling for assistance and a defibrillator, what action would the nurse take next? 22. After assessing a client who is receiving an amiodarone intravenous infusion for unstable ventricular tachycardia, the nurse documents the findings and compares these with the previous assessment findings: Vital Signs Nursing Assessment Time: 08:00 Temperature: 98° F (36.7° C) Heart rate: 68 beats/min Blood pressure: 135/60 mm Hg Respiratory rate: 14 breaths/min Oxygen saturation: 96% Oxygen therapy: 2 L nasal cannula Time: 10:00 Temperature: 98.2° F (36.8° C) Heart rate: 50 beats/min Blood pressure: 132/57 mm Hg Respiratory rate: 16 breaths/min Oxygen saturation: 95% Oxygen therapy: 2 L nasal cannula Time: 08:00 Client alert and oriented. Cardiac rhythm: normal sinus rhythm. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Time: 10:00 Client alert and oriented. Cardiac rhythm: sinus bradycardia. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Client voids 420 mL of clear yellow urine. Based on the assessments, what action would the nurse take? MULTIPLE RESPONSE 1. A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations would the nurse assess? (Select all that apply.) 2. A nurse teaches a client with a new permanent pacemaker. Which instructions would the nurse include in this client’s teaching? (Select all that apply.) a. “Until your incision is healed, do not submerge your pacemaker. Only take showers.” b. “Report any pulse rates lower than your pacemaker settings.” c. “Do not lift your left arm above the level of your shoulder for 8 weeks.” 3. A nurse is teaching a client who has premature ectopic beats. Which education would the nurse include in this client’s teaching? (Select all that apply.) a. Smoking cessation b. Stress reduction and management c. Adverse effects of medications Chapter 32: Concepts of Care for Patients With Cardiac Problems Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse assesses clients on a cardiac unit. Which client would the nurse identify as being at greatest risk for the development of left-sided heart failure? 2. A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? 3. A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure? 4. While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next? 5. A nurse cares for a client with right-sided heart failure. The client asks, “Why do I need to weigh myself every day?” How would the nurse respond? 6. A nurse is teaching a client with heart failure who has been prescribed enalapril. Which statement would the nurse include in this client’s teaching? . 7. After administering the first dose of captopril to a client with heart failure, the nurse implements interventions to decrease complications. Which intervention is most important for the nurse to implement? 8. A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take? 9. A nurse teaches a client who is prescribed digoxin therapy. Which statement would the nurse include in this client’s teaching? 10. A nurse teaches a client who has a history of heart failure. Which statement would the nurse include in this client’s discharge teaching? 11. A nurse admits a client who is experiencing an exacerbation of heart failure. What action would the nurse take first? . 12. A nurse assesses a client with mitral valve stenosis. What clinical sign or symptom would alert the nurse to the possibility that the client’s stenosis has progressed? 13. A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, “Why will I need to take anticoagulants for the rest of my life?” What is the best response by the nurse? “ 14. After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the client’s understanding. Which client statement indicates a need for additional teaching? 15. A nurse cares for a client with infective endocarditis. Which infection control precautions would the nurse use? 16. A nurse assesses a client with pericarditis. Which assessment finding would the nurse expect to find? 17. After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, “Why is this important?” How would the nurse respond? 18. A nurse is providing discharge teaching to a client recovering from a heart transplant. Which statement would the nurse include? 19. A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, “I know a transplant is my last chance, but I don’t want to become a vegetable.” How would the nurse respond? 20. A nurse assesses a client who has a history of heart failure. Which question would the nurse ask to assess the extent of the client’s heart failure? 21. A nurse cares for an older adult client with heart failure. The client states, “I don’t know what to do. I don’t want to be a burden to my daughter, but I can’t do it alone. Maybe I should die.” What is the best response by the nurse? 22. A nurse teaches a client with heart failure about energy conservation. Which statement would the nurse include in this client’s teaching? 23. A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side of the neck. Which nonpharmacologic comfort measure would the nurse implement? 24. A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia would the nurse assess? MULTIPLE RESPONSE 1. A nurse is assessing a client with left-sided heart failure. For which clinical manifestations would the nurse assess? (Select all that apply.) a. Pulmonary crackles b. Pulmonary hypertension c. Cough that worsens at night 2. A nurse evaluates laboratory results for a client with heart failure. Which results would the nurse expect? (Select all that apply.) a. Hematocrit: 32.8% b. Serum sodium: 130 mEq/L (130 mmol/L) c. Proteinuria d. Microalbuminuria 3. A nurse assesses clients on a cardiac unit. Which clients would the nurse identify as at greatest risk for the development of acute pericarditis? (Select all that apply.) a. A 36-year-old woman with systemic lupus erythematosus (SLE) b. A 42-year-old man recovering from coronary artery bypass graft surgery c. An 80-year-old man with a bacterial infection of the respiratory tract 4. After teaching a client with congestive heart failure (CHF), the nurse assesses the client’s understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.) a. “I’ll read the nutritional labels on food items for salt content.” b. “I will eat oatmeal for breakfast instead of ham and eggs.” c. “Substituting fresh vegetables for canned ones will lower my salt intake.” 5. A nurse collaborates with assistive personnel (AP) to provide care for a client with congestive heart failure. Which instructions would the nurse provide to the AP when delegating care for this client? (Select all that apply.) a. “Reposition the client every 2 hours.” b. “Accurately record intake and output.” c. “Use the same scale to weigh the client each morning.” 6. A nurse prepares to discharge a client who has heart failure. Based on national quality measures, what actions would the nurse complete prior to discharging this client? (Select all that apply.) a. Ensure that the client is prescribed a beta blocker. b. Document a discussion about advanced directives. c. Confirm that a postdischarge nurse visit has been scheduled. d. Care transition record transmitted to next level of care within 7 days of discharge. 7. A nurse prepares to discharge a client who has heart failure. Which questions would the nurse ask to ensure this client’s safety prior to discharging home? (Select all that apply.) a. “Are your bedroom and bathroom on the first floor?” b. “What social support do you have at home?” c. “What spiritual beliefs may impact your recovery?” 8. A nurse assesses a client who is recovering from a heart transplant. Which assessment findings would alert the nurse to the possibility of heart transplant rejection? (Select all that apply.) a. Shortness of breath b. Abdominal bloating c. New-onset bradycardia d. Fatigue 9. A nurse is caring for a client who was admitted with hypertrophic cardiomyopathy (HCM). What interprofessional care does the nurse anticipate providing? (Select all that apply.) a. Administering beta blockers b. Preparing for a cardiac catheterization c. Instructing the client to avoid strenuous exercise Chapter 33: Concepts of Care for Patients With Vascular Problems Ignatavicius: Medical-Surgical Nursing, 10th Edition 1. A nurse is assessing the peripheral vascular system of an older adult. What action by the nurse would cause the supervising nurse to intervene? 2. The nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel. What meal selection indicates that the client is managing this condition well with diet? 3. A nurse is working with a client who takes clopidogrel. The client’s recent laboratory results include a blood urea nitrogen (BUN) of 33 mg/dL and creatinine of 2.8 mg/dL. What action by the nurse is best? 4. A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? 5. A client asks what “essential hypertension” is. What response by the registered nurse is best? 6. A nurse is interested in providing community education and screening on hypertension. In order to reach a priority population, to what target audience would the nurse provide this service? 7. A client has hypertension and high risk factors for cardiovascular disease. The client is overwhelmed with the recommended lifestyle changes. What action by the nurse is best? 8. The nurse is caring for four hypertensive clients. Which drug–laboratory value combination would the nurse report immediately to the health care provider? 9. A nurse is assessing a client with peripheral artery disease (PAD). The client states that walking five blocks is possible without pain. What question asked next by the nurse will give the best information? 10. An older client with peripheral vascular disease (PVD) is explaining the daily foot care regimen to the family practice clinic nurse. What statement by the client may indicate a barrier to proper foot care? 11. A nurse is caring for four clients. Which one would the nurse see first? 14. A client had a percutaneous angioplasty for renovascular hypertension 3 months ago. What assessment finding by the nurse indicates that an important outcome for this client has been met? 15. A client is 4 hours postoperative after a femoral-popliteal bypass. The client reports throbbing leg pain on the affected side, rated as 7/10. What action by the nurse is most important? 16. A client had a femoral-popliteal bypass graft with a synthetic graft. What action by the nurse is most important to prevent wound infection? 17. A client is receiving an infusion of alteplase for an intra-arterial clot. The client begins to mumble and is disoriented. What action by the nurse is most important? 18. A new nurse is caring for a client with an abdominal aneurysm. What action by the new nurse requires the nurse’s mentor to intervene?. 19. A nurse is caring for a client with a deep vein thrombosis (DVT). What nursing assessment indicates that an important outcome has been met? 20. A client has a deep vein thrombosis (DVT). What comfort measure does the nurse delegate to the assistive personnel (AP)? 21. A nurse is assessing an obese client in the clinic for follow-up after an episode of deep vein thrombosis. The client has lost 20 lb (9.09 Kg) since the last visit. What action by the nurse is best? 22. A nurse wants to provide community service that helps meet the goals of Healthy People 2020 (HP2020) related to cardiovascular disease and stroke. What activity would best meet this goal? 23. A client has been diagnosed with a deep vein thrombosis and is to be discharged on warfarin. The client is adamant about refusing the drug because “it’s dangerous.” What action by the nurse is best? 24. A client with a history of heart failure and hypertension is in the clinic for a follow-up visit. The client is on lisinopril and warfarin. The client reports new-onset cough. What action by the nurse is most appropriate? 25. A nurse is caring for a client with a nonhealing arterial lower leg ulcer. What action by the nurse is best? 26. A client has peripheral arterial disease (PAD). What statement by the client indicates misunderstanding about self-management activities? 27. The nurse is assessing a client on admission to the hospital. The client’s leg appears as shown below: What action by the nurse is best? a. Assess the client’s ankle-brachial index. MULTIPLE RESPONSE 1. What nonpharmacologic comfort measures would the nurse include in the plan of care for a client with severe varicose veins? (Select all that apply.) b. Applying elastic compression stockings c. Elevating the legs when sitting or lying d. Reminding the client to do leg exercises 2. A nurse is preparing a client for a femoropopliteal bypass operation. What actions does the nurse delegate to the assistive personnel (AP)? (Select all that apply.) a. Raising the side rails on the bed b. Recording baseline vital signs 3. A client has been bedridden for several days after major abdominal surgery. What action does the nurse delegate to the assistive personnel (AP) for deep vein thrombosis (DVT) prevention? (Select all that apply.) a. Apply compression stockings. b. Assist with ambulation. c. Offer fluids frequently. 4. A nurse is caring for a client on IV infusion of heparin. What actions does this nurse include in the client’s plan of care? (Select all that apply.) a. Assess the client for bleeding. b. Monitor the daily activated partial thromboplastin time (aPTT) results. c. Stop the IV for aPTT above baseline. d. Use an IV pump for the infusion. 5. A client is being discharged on warfarin therapy. What discharge instruction is the nurse required to provide? (Select all that apply.) a. Dietary restrictions b. Follow-up laboratory monitoring c. Possible drug–drug interactions d. Reason to take medication 6. Which statements by the client indicate good understanding of foot care in peripheral vascular disease? (Select all that apply.) a. “I will keep my feet dry, especially between the toes.” b. “Lotion is important to keep my feet smooth and soft.” c. “Washing my feet in room-temperature water is best.” 7. A nurse is caring for a client with a nonhealing arterial ulcer. The primary health care provider has informed the client about possibly needing to amputate the client’s leg. The client is crying and upset. What actions by the nurse are best? (Select all that apply.) a. Ask the client to describe his or her current emotions. b. Assess the client for support systems and family. c. Offer to stay with the client if he or she desires. 8. The nurse working in the emergency department knows that which factors are commonly related to aneurysm formation? (Select all that apply.) a. Atherosclerosis b. History of hypertension c. History of smoking d. Hyperlipidemia 9. A client with a known abdominal aortic aneurysm reports dizziness and severe abdominal pain. The nurse assesses the client’s blood pressure at 82/40 mm Hg. What actions by the nurse are most important? (Select all that apply.) b. Assess distal pulses every 10 minutes. c. Notify the Rapid Response Team. d. Take vital signs every 10 minutes. 10. A client presents to the emergency department with a thoracic aortic aneurysm. Which findings are most consistent with this condition? (Select all that apply.) b. Difficulty swallowing c. Hoarseness 11. The nurse is reviewing risk factors in a client who has atherosclerosis. Which findings are most concerning? (Select all that apply.) a. Elevated low-density lipoprotein (LDL-C) b. Decreased levels of high-density lipoprotein cholesterol (HDL-C) c. History of smoking Chapter 34: Critical Care of Patients With Shock Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse is caring for a client who suffered massive blood loss after trauma. How does the nurse correlate the blood loss with the client’s mean arterial pressure (MAP)? 2. A nurse is caring for a client after surgery. The client’s respiratory rate has increased from 12 to 18 breaths/min and the pulse rate increased from 86 to 98 beats/min since the client was last assessed 4 hours ago. What action by the nurse is best? 3. The nurse gets the hand-off report on four clients. Which client would the nurse assess first? 4. A nurse is caring for a client after surgery who is restless and apprehensive. The assistive personnel (AP) reports the vital signs and the nurse sees that they are only slightly different from previous readings. What action does the nurse delegate next to the AP? 5. A client is in shock and the nurse prepares to administer insulin for a blood glucose reading of 208 mg/dL (11.6 mmol/L). The spouse asks why the client needs insulin as the client is not a diabetic. What response by the nurse is best? 6. A nurse caring for a client notes the following assessments: white blood cell count 3800/mm3 (3.8  109/L), blood glucose level 198 mg/dL (11 mmol/L), and temperature 96.2° F (35.6° C). What action by the nurse takes priority? 7. A nurse works at a community center for older adults. What self-management measure can the nurse teach the clients to prevent shock? 8. A client arrives in the emergency department after being in a car crash with fatalities. The client has a nearly amputated leg that is bleeding profusely. What action by the nurse takes priority? 9. A nurse is caring for a client who has a diagnosis of multiple organ dysfunction syndrome (MODS) who will be receiving sodium nitroprusside via IV infusion. What action by the nurse causes the charge nurse to intervene? 10. A nurse on the general medical-surgical unit is caring for a client in shock and assesses the following: Respiratory rate: 10 breaths/min Pulse: 136 beats/min Blood pressure: 92/78 mm Hg Level of consciousness: responds to voice Temperature: 101.5° F (38.5° C) Urine output for the last 2 hours: 40 mL/hr. What action by the nurse is best? 12. A nurse is caring for several clients at risk for shock. Which laboratory value requires the nurse to communicate with the primary health care provider? 13. A nurse receives hand-off report from the emergency department on a new admission suspected of having septic shock. The client’s qSOFA score is 3. What action by the nurse is best? 14. A client is being discharged home after a large myocardial infarction and subsequent coronary artery bypass grafting surgery. The client’s sternal wound has not yet healed. What statement by the client most indicates a higher risk of developing sepsis after discharge? 15. A client with MODS has been started on dobutamine. What assessment finding requires the nurse to communicate with the primary health care provider immediately? MULTIPLE RESPONSE 1. The nurse studying shock understands that the common signs and symptoms of this condition are directly related to which problems? (Select all that apply.) a. Anaerobic metabolism b. Hypotension 2. The nurse caring for hospitalized clients includes which actions on their care plans to reduce the possibility of the clients developing shock? (Select all that apply.) a. Assessing and identifying clients at risk b. Performing proper hand hygiene c. Removing invasive lines as soon as possible d. Using aseptic technique during procedures 3. The nurse caring frequently for older adults in the hospital is aware of risk factors that place them at a higher risk for shock. For what factors would the nurse assess? (Select all that apply.) a. Altered mobility/immobility b. Decreased thirst response c. Diminished immune response d. Malnutrition e. Use of diuretics 4. A client is in the early stages of shock and is restless. What comfort measures does the nurse delegate to the assistive personnel (AP)? (Select all that apply.) a. Bringing the client warm blankets b. Giving the client hot tea to drink c. Reorienting the client as needed d. Sitting with the client for reassurance 5. The nurse is caring for a client with suspected septic shock. What does the nurse prepare to do within 1 hour of the client being identified as possibly having sepsis? (Select all that apply.) a. Administer antibiotics. b. Draw serum lactate levels. c. Infuse vasopressors. d. Obtain blood cultures. e. Administer rapid bolus of IV crystalloids. Chapter 35: Critical Care of Patients With Acute Coronary Syndromes Ignatavicius: Medical-Surgical Nursing, 10th Edition 1. A client is receiving an infusion of tissue plasminogen activator (tPA). The nurse assesses the client to be disoriented to person, place, and time. What action by the nurse is best? 2. A client received tissue plasminogen activator (tPA) after a myocardial infarction and now is on an intravenous infusion of heparin. The client’s spouse asks why the client needs this medication. What response by the nurse is best? 3. A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client’s O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best? 4. A nurse is caring for a client who had a myocardial infarction. The nurse is confused because the client states that nothing is wrong and yet listens attentively while the nurse provides education on lifestyle changes and healthy menu choices. What response by the charge nurse is best? 5. A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 0.5 mm Hg. What action by the nurse is most appropriate? 6. A client has hemodynamic monitoring after a myocardial infarction. What safety precaution does the nurse implement for this client? 7. A client has intra-arterial blood pressure monitoring after a myocardial infarction. The nurse notes that the client’s heart rate has increased from 88 to 110 beats/min, and the blood pressure dropped from 120/82 to 100/60 mm Hg. What action by the nurse is most appropriate? 8. A client is in the preoperative holding area prior to an emergency coronary artery bypass graft (CABG). The client is yelling at family members and tells the doctor to “just get this over with” when asked to sign the consent form. What action by the nurse is best? 9. A client is in the clinic a month after having a myocardial infarction. The client reports sleeping well since moving into the guest bedroom. What response by the nurse is best? 10. A client in the cardiac stepdown unit reports severe, crushing chest pain accompanied by nausea and vomiting. What action by the nurse takes priority? 11. An older adult is on cardiac monitoring after a myocardial infarction. The client shows frequent dysrhythmias. What action by the nurse is most appropriate? 12. The nurse is preparing to change a client’s sternal dressing. What action by the nurse is most important? 13. A client has progressed to Killip class III heart failure after a myocardial infarction. What does the nurse anticipate the client’s care to include? 14. A nurse is in charge of the coronary intensive care unit. Which client would the nurse see first? 15. A client with coronary artery disease (CAD) asks the nurse about taking fish oil supplements. What response by the nurse is best? 16. A client has presented to the emergency department with an acute myocardial infarction (MI). What action by the nurse is best for optimal client outcomes? A nurse is caring for four client s. Which client would the nurse assess first? 17. A nurse is caring for a client who is intubated and has an intra-aortic balloon pump. The client is restless and agitated. What action would the nurse perform first for comfort? 18. The nurse is caring for a client with a chest tube after a coronary artery bypass graft. The drainage stops suddenly. What action by the nurse is most important? 19. A client is to receive a dopamine infusion. What does the nurse do to prepare for this infusion? 20. A client had an acute myocardial infarction. What assessment finding indicates to the nurse that a significant complication has occurred? A client presents to the emergency department with an acute myocardial infarction (MI) at 15:00 (3:00 p.m.). The facility has 24-hour catheterization laboratory abilities. To improve client outcomes, by what time would the client have a percutaneous coronary intervention performed? 90mins 21. The primary health care provider requests the nurse start an infusion of milrinone on a client. How does the nurse explain the action of this drug to the client and spouse? 22. A client had an inferior wall myocardial infarction (MI). The nurse notes the client’s cardiac rhythm as shown below: What action by the nurse is most important? 23. A nurse prepares a client for coronary artery bypass graft surgery. The client states, “I am afraid I might die.” What is the nurse’s best response? MULTIPLE RESPONSE 1. A nurse is caring for a client who had coronary artery bypass grafting 2 days ago. What actions does the nurse delegate to the assistive personnel (AP)? (Select all that apply.) a. Assist the client to the chair for meals and to the commode. b. Ensure that the client wears TED hose or sequential compression devices. c. Take and record a full set of vital signs per hospital protocol. 2. A nurse studying acute coronary syndromes learns that the pain of a myocardial infarction (MI) differs from stable angina in what ways? (Select all that apply.) a. Accompanied by shortness of breath b. Feelings of fear or anxiety c. No relief from taking nitroglycerin d. Pain occurs without known cause e. Can be precipitated by exertion or stress 3. A client is 1-day postoperative after a coronary artery bypass graft. What nonpharmacologic comfort measures does the nurse include when caring for this client? (Select all that apply.) a. Assist the client into a position of comfort in bed. b. Provide complementary therapies such as music. c. Remind the client to splint the incision when coughing. 4. Prior to discharge, a client who had an acute myocardial infarction and coronary artery bypass graft asks the nurse about sexual activity. What information does the nurse provide? (Select all that apply.) a. “Your usual sexual activity is not likely to damage your heart.” b. “Start having sex when you are most rested, like in the morning.” c. “Use a comfortable position that doesn’t stress your incision.” 5. A nurse is studying hemodynamic monitoring. Which measurements are correctly matched with the physiologic cause? (Select all that apply.) a. Right atrial pressure 12 mm Hg: right ventricular failure b. Pulmonary artery pressure 20/10 mm Hg: normal finding c. Pulmonary artery occlusion pressure 20 mm Hg: mitral regurgitation d. Pulmonary artery occlusion pressure 2 mm Hg: afterload reduction Normal right atrial pressure is 0 to 8 mm Hg; high readings can indicate right ventricular failure; low readings often signify hypovolemia. Normal pulmonary artery pressure ranges from 15 to 30 mm Hg systolic to 3 to 12 mm Hg diastolic. Pulmonary artery occlusion pressure ranges from 5 to 12 mm Hg; high values may indicate left ventricular failure, hypervolemia, mitral regurgitation, or intracardiac shunting. A decreased PAOP is seen with hypovolemia or afterload reduction. MODULE 8 Medical-Surgical Nursing, Chapters 57 & 62 MODULE 9 ● Medical-Surgical Nursing, Chapter 41 MODULE 10 ● Medical-Surgical Nursing, Chapter 47 Chapter 41: Critical Care of Patients With Neurologic Emergencies Ignatavicius: Medical-Surgical Nursing, 10th Edition 1. A client is in the emergency department reporting a brief episode during which he was dizzy, unable to speak, and felt numbness in his left leg. Currently the client’s neurologic examination is normal. About what drug would the nurse plan to teach the patient? 2. The nurse is preparing a client for discharge from the emergency department after experiencing a transient ischemic attack (TIA). Before discharge, which factor