Med Surg ATI Cardiovascular and Respiratory Test Questions with Answers
Rated A
A nurse is caring for a client who is postoperative following
Position the client supine with his legs elevated when in
vein ligation and stripping for varicose veins. Which of the
bed.
following actions should the nurse take?
A nurse is caring for a client who has an abdominal aortic
aneurysm and is scheduled for surgery. The client's vi-
tal signs are blood pressure 160/98 mm Hg, heart rate
102/min, respirations 22/min, and SpO2 95%. Which of
The nurse should administer antihypertensive medication
the following actions should the nurse take?
for the elevated blood pressure because hypertension can
cause a sudden rupture of the aneurysm due to pressure
Administer antihypertensive medication for blood pres-
on the arterial wall.
sure.
Monitor that urinary output is 20 mL/hr.
Withhold pain medication to prepare for surgery.
Take vital signs every 2 hr.
A nurse is caring for a client who has hemophilia. The Prepare for replacement of the missing clotting factor.
client reports pain and swelling in a joint following an
injury. Which of the following actions should the nurse Hemophilia is a hereditary bleeding disorder in which
take? blood clots slowly and abnormal bleeding occurs. It is
caused by a deficiency in the most common clotting fac-
Obtain blood samples to test platelet function. tor, factor VIII (hemophilia A). Aggressive factor replace-
Prepare for replacement of the missing clotting factor. ment is initiated to prevent hemarthrosis that can result in
Administer aspirin for the client's pain. long-term loss of range of motion in repeatedly attected
Place the bleeding joint in the dependent position joints.
Petechiae and ecchymosis
A nurse is assessing a client for manifestations of aplastic
anemia. Which of the following findings should the nurse
The client who has aplastic anemia will have manifesta-
expect?
tions of petechiae and ecchymosis. Dyspnea on exertion
Plethoric appearance of facial skin
also can be present. In aplastic anemia, all three major
Glossitis and weight loss
blood components (red blood cells, white blood cells,
Jaundice with an enlarged liver
and platelets) are reduced or absent, which is known as
Petechiae and ecchymosis
pancytopenia. Manifestations usually develop gradually.
, Med Surg ATI Cardiovascular and Respiratory Test Questions with Answers
Rated A
A nurse is assessing a client who has right-sided heart
failure. Which of the following findings should the nurse Dependent edema
expect?
Blood return from the venous system to the right atrium is
Decreased capillary refill impaired by a weakened right heart. The subsequent sys-
Dyspnea temic venous backup leads to development of dependent
Orthopnea edema.
Dependent edema
A nurse is caring for a client who has a demand pacemaker
inserted with the rate set at 72/min. Which of the follow-
Telemetry monitoring shows QRS complexes occurring at
ing findings should the nurse expect?
a rate of 74/min with no pacing spikes.
-Telemetry monitoring shows QRS complexes occurring at
a rate of 74/min with no pacing spikes.
The nurse should not expect pacer spikes when the client's
-The client is experiencing premature ventricular com-
pulse is greater than the set rate of 72/min, because the
plexes at 12/min.
client's intrinsic rate overrides the set rate of the pacemak-
-Telemetry monitoring shows pacing spikes with no QRS
er.
complexes
-The client is experiencing hiccups
A nurse is transfusing a unit of O-negative fresh frozen
plasma to a client whose blood type is B positive. Which
of the following actions should the nurse take? Remove the unit of plasma immediately and start an IV
infusion of normal saline solution.
Continue to monitor for manifestations of a transfusion
reaction. A client who receives FFP that is not compatible can expe-
Remove the unit of plasma immediately and start an IV rience a hemolytic transfusion reaction. The nurse should
infusion of normal saline solution. stop the transfusion and infuse 0.9% sodium chloride
Continue the transfusion and repeat the type and cross- solution with new tubing.
match.
Prepare to administer a dose of diphenhydramine IV
Rated A
A nurse is caring for a client who is postoperative following
Position the client supine with his legs elevated when in
vein ligation and stripping for varicose veins. Which of the
bed.
following actions should the nurse take?
A nurse is caring for a client who has an abdominal aortic
aneurysm and is scheduled for surgery. The client's vi-
tal signs are blood pressure 160/98 mm Hg, heart rate
102/min, respirations 22/min, and SpO2 95%. Which of
The nurse should administer antihypertensive medication
the following actions should the nurse take?
for the elevated blood pressure because hypertension can
cause a sudden rupture of the aneurysm due to pressure
Administer antihypertensive medication for blood pres-
on the arterial wall.
sure.
Monitor that urinary output is 20 mL/hr.
Withhold pain medication to prepare for surgery.
Take vital signs every 2 hr.
A nurse is caring for a client who has hemophilia. The Prepare for replacement of the missing clotting factor.
client reports pain and swelling in a joint following an
injury. Which of the following actions should the nurse Hemophilia is a hereditary bleeding disorder in which
take? blood clots slowly and abnormal bleeding occurs. It is
caused by a deficiency in the most common clotting fac-
Obtain blood samples to test platelet function. tor, factor VIII (hemophilia A). Aggressive factor replace-
Prepare for replacement of the missing clotting factor. ment is initiated to prevent hemarthrosis that can result in
Administer aspirin for the client's pain. long-term loss of range of motion in repeatedly attected
Place the bleeding joint in the dependent position joints.
Petechiae and ecchymosis
A nurse is assessing a client for manifestations of aplastic
anemia. Which of the following findings should the nurse
The client who has aplastic anemia will have manifesta-
expect?
tions of petechiae and ecchymosis. Dyspnea on exertion
Plethoric appearance of facial skin
also can be present. In aplastic anemia, all three major
Glossitis and weight loss
blood components (red blood cells, white blood cells,
Jaundice with an enlarged liver
and platelets) are reduced or absent, which is known as
Petechiae and ecchymosis
pancytopenia. Manifestations usually develop gradually.
, Med Surg ATI Cardiovascular and Respiratory Test Questions with Answers
Rated A
A nurse is assessing a client who has right-sided heart
failure. Which of the following findings should the nurse Dependent edema
expect?
Blood return from the venous system to the right atrium is
Decreased capillary refill impaired by a weakened right heart. The subsequent sys-
Dyspnea temic venous backup leads to development of dependent
Orthopnea edema.
Dependent edema
A nurse is caring for a client who has a demand pacemaker
inserted with the rate set at 72/min. Which of the follow-
Telemetry monitoring shows QRS complexes occurring at
ing findings should the nurse expect?
a rate of 74/min with no pacing spikes.
-Telemetry monitoring shows QRS complexes occurring at
a rate of 74/min with no pacing spikes.
The nurse should not expect pacer spikes when the client's
-The client is experiencing premature ventricular com-
pulse is greater than the set rate of 72/min, because the
plexes at 12/min.
client's intrinsic rate overrides the set rate of the pacemak-
-Telemetry monitoring shows pacing spikes with no QRS
er.
complexes
-The client is experiencing hiccups
A nurse is transfusing a unit of O-negative fresh frozen
plasma to a client whose blood type is B positive. Which
of the following actions should the nurse take? Remove the unit of plasma immediately and start an IV
infusion of normal saline solution.
Continue to monitor for manifestations of a transfusion
reaction. A client who receives FFP that is not compatible can expe-
Remove the unit of plasma immediately and start an IV rience a hemolytic transfusion reaction. The nurse should
infusion of normal saline solution. stop the transfusion and infuse 0.9% sodium chloride
Continue the transfusion and repeat the type and cross- solution with new tubing.
match.
Prepare to administer a dose of diphenhydramine IV
