Med Surg 2 All Exam Questions Exam 1, 2 & 3

Med Surg 2 All Exam Questions Exam 1, 2 & 3 Med Surg 2 All Exam Questions Exam 1, 2 & 3 1. A client is sent home with a Holter monitor. The most important information the client should receive from the nurse a. Keep a record of daily activities 2. A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure? a. Allergy to iodine or shellfish. 3. In developing a standard teaching plan for the outpatient unit where stress testing is performed, the nurse should include information that: a. The test may cause the client to experience chest pain 4. The diagnostic study that should provide the nurse with the most relevant information related to cardiac perfusion is a. Thallium 201 scintigoraphy 5. In advising a client with higher levels of HDL in proportion to LDL, an appropriate outcome is that this client: a. Is less likely to develop CAD 6. Nursing care of a client immediately after a PTCA should include: a. Encouraging oral fluids for the client 7. A nurse is caring for a client who has had angiography with the entrance site in the left femoral artery. 2 hours after the procedure, the nurse is unable to palpate the left pedal pulse. The priority action at this time would be to: a. Attempt to locate pulse using a Doppler 8. The client participates in a thallium imaging during exercise. The nuclear camera results obtained 10 minutes later show diffuse uptake of the thallium in all areas of the heart. What does this mean for the nurse? a. The test shows no myocardial scarring or impairment of myocardial perfusion 9. The CK-MB level is markedly elevated in a client with chest pain 12 hours after admission. The nurse interprets this finding as evidence of: a. Cellular tissue necrosis 10. CK-MB and troponin levels are ordered for a client. The client asks the nurse for the test. The nurse bases the response on the knowledge that: a. The presence of myocardial damage occurring several days earlier can be validated best by the troponin level. (P.743 text: often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage) 11. The nurse is about to perform a physical assessment of the distal extremities for a client with Buerger’s disease. What clinical manifestations should the nurse expect to see in this client? a. Extremities are reddened and distal pulses are diminished 12. A nurse caring for a client who is overweight, HTN, and smokes is newly diagnosed with thromboangitis obliterans (Buerger’s disease). The priority for teaching should focus on: a. Smoking cessation 13. After walking one block the client complains of muscular, cramp-like pain to his lower extremities that is relieved by rest. Based on the clinical findings, the nurse should further assess the patient for possible: a. Peripheral arterial disease 14. A client comes to the health care provider with complaints of pain after walking five blocks is experiencing intermittent claudication, the nurse should ask: a. Does pain always occur when you walk that distance? 15. A female client with severe arterial disease has difficulty falling asleep due to pain in her legs. The first action by the nurse would be to: a. Assist the client to dangle her legs 16. A nurse is educating a client who has R ayn au d ’s d is eas e . Which intervention is aimed at preventing complications? a. Wear warm clothing when exposed to cool temperature 17. A client who has returned to the unit after arterial revascularization states, “The pain is similar to the pain felt before the procedure.” What would be the nurse’s priority action? a. Assess peripheral pulses of the extremities 18. A client recovering from aortofemoral bypass surgery has developed swelling, pain, and complains of tightness of the operative limb. What complication of the procedure is most likely the cause of the client’s symptoms? a. Compartment syndrome 19. A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The nurse interprets that the neurovascular status is: a. Normal because of increased blood flow through the leg 20. A nurse is caring for a client who has early peripheral vascular disease. While inspecting the lower extremities the nurse should expect to find: a. Decreased peripheral pulse 21. A nurse is caring for a young client who is brought to the ED after experiencing a rapid heart rate and chest discomfort. The client reports using cocaine adding that “everybody always tells me coke is bad for your heart. What does cocaine do?” The nurse should respond: a. “a fight or flight reaction occurs when cocaine is used, stressing the heart, often beyond its capacity. 22. A nurse is caring for a client who has an MI. The client reports chest pain and EKG shows intermittent premature ventricular contractions. The nurse’s first priority for this client would be to: a. Relief of pain and pain management 23. A client is admitted to the tele unit with a diagnosis of MI within the last 24 hours. The immediate care plan for this client should include which of the following measure: a. Use a bedpan commode for bowel movement 24. The client is undergoing progressive ambulation on the third day after an MI. Which clinical manifestation should indicate to the nurse that the client should not be advanced yet to the next level? a. Onset of chest pain 25. The nurse is caring for a client who had PTCA 1 hour ago. Which of the following is a priority assessment at this time? a. Bleeding (P. 751, complication after the procedure may include abrupt closure of the coronary artery. and variety of vascular complication such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion). 26. A nurse has just received a client from the cardiac cath lab. Nursing care of a client immediately after a PTCA should include: a. Encouraging oral fluids for the client 27. A nurse is monitoring a client with CHF. Which of the following would require further evaluation by the nurse? a. Weight gain of 1.5 pounds in 24 hours 28. A nurse in a cardiac step down unit is preparing discharge instruction, which includes dietary information. Which breakfast food recommendations should be most appropriate for a client with coronary heart disease? a. Skim milk, whole wheat toast, decaf coffee 29. While caring for a client with angina, the nurse plans interventions that decrease Myocardial oxygen demand and promote coronary blood flow. Appropriate interventions are those that primarily prevent: a. An increase in heart rate 30. A client who has experienced a myocardial infarction develops left ventricular heart failure. For which sign of poor organ perfusion should the nurse monitor this client? a. Urine output of <30ml/hr 31. A nurse is assessing a client who has a diagnosis of left ventricular heart failure. Which of the following statements if made by the client would be of concern to the nurse? a. I cannot climb the stair in my house without becoming short of breath. 32. A nurse should determine that teaching regarding a 2 gram Na diet for a client who has a history of cardiac disease, is effective if the client states: “I can eat most foods as long as I do not add salt when cooking or at the table.” 33. When the client with left sided heart failure develops bilateral 2+ pitting edema of the ankles, the nurse should assess that this could be early manifestation of: a. Right sided failure A client with CHF has tachypnea, severe dyspnea, and a SaO2 of 84%. The nurse identifies a nursing diagnosis of impaired gas exchange r/t increased preload & mechanical failure. An appropriate nursing intervention for this diagnosis is to: Place the client in a high-fowlers position with the feet dangling. The nurse has written an outcome goal “demonstrates tolerance for increased activity” for a client diagnosed with CHF. Which intervention should the nurse implement to assist the client to achieve this outcome? Plan for frequent rest periods 34. A nurse is developing a teaching plan for a client with congestive heart failure, which of the following outcomes indicates to the nurse that the treatment is effective? All that apply a. Clients weight today is 79.5 kg and yesterday’s weight was 80.2 kg b. Urinary output of 480cc over the previous 24 hours c. Auscultated clear lung sounds bilaterally d. Able to walk to the bathroom without dyspnea 35. The nurse assesses 2+ pitting edema on the left lower extremities and 3+ pitting edema on the right lower extremity of a client admitted 2 days ago with acute MI. Following this assessment, which is the nurse’s best next action? a. Review the daily weight since admission 36. During the initial home visit, the nurse is teaching a client with heart failure how to prevent complications and future hospitalizations. Which of the following statements if made by the client indicates the client’s understanding? I will call my health care provider if: a. I become increasingly SOB at rest b. I gain 2 pounds in one day c. I have to sleep sitting up in a reclining chair 37. Which of the following statements is an indication that the client needs more teaching regarding a treatment regimen for heart failure? a. I should only weigh myself once a month and watch for fluid retention 38. A client diagnosed with essential HTN asks the nurse to explain how this type of HTN develops. What is the nurse’s best response? a. There is no known cause for this type of HTN 39. A nurse is performing a physical assessment on a client who has HTN. Which of the following assessment should the nurse plan to include in the assessment? a. Fundoscopic examination for changes in retinal vessels (The retinas are examined and laboratory studies are performed to assess possible target organ damage). 40. For a client complaining of leg pain at rest after transluminal angioplasty, the nurse initially should: a. Assess the limb for temperature and perfusion 41. A nurse is providing care to a client who is being treated for HTN crisis. A priority for the nurse would be to monitor the BP carefully during the first 2 hours to prevent: a. Renal ischemia (P.864) 42. A client in HTN crisis has a sustained BP of 180/120 and is being treated with HTN protocol. The nurse recognizes that the optimum pressure target for the client in the first 2 hours of reduction therapy is: a. 150/95 43. An otherwise healthy 28 YO woman has just been diagnosed with stage I HTN. She says she has a glass of wine once or twice a week and eats “fast food” frequently because of her busy schedule. Which topic should the nurse plans on including in the client-teaching plan? a. Low-sodium food choices when eating out 44. Which of the following BP findings for an adult client with no other medical problems should be evaluated further for HTN? All that apply a. 138-78 b. 140/96 c. 124/86 45. A nurse is assessing a client who has untreated HTN. Which of the following manifestations should concern the nurse as indicating possible “target organ” damage? All that apply a. Retinal changes b. BUN 28 and creatinine 1.8 c. Headaches 46. A client recently diagnosed with peripheral arterial disease reports in the lower extremities after walking five blocks. Which of the following questions should the nurse ask to determine if the disease is progressing? a. Do you have the pain while resting 47. The nurse is caring for a client who has been diagnosed with cardiovascular disease. Which of these assessment findings is most consistent with a nursing diagnosis of decreased cardiac output related to mechanical failure of heart? a. Diminished pedal pulses 48. The nurse and an UAP are caring for 4 clients on the tele unit. Which nursing task should the nurse delegate to the UAP? a. Help position the client who’s having a portable x-ray. 49. A care team composed of an RN, LPN, and UAP in a long-term care facility developed a plan for ongoing assessment of all residents who have a diagnosis of heart failure. Which of these activities included in the plan is most appropriate to delegate to nursing assistant staff? a. Weigh all residents with heart failure each morning 50. The client who has just had an IV started in the right cephalic vein tells the nurse that the wrist and hand below the IV site feels like there are “pins and needles” in them. What is the nurse’s next action should be to? a. Discontinue the IV and restart it at another site 1. A nurse should inform a client who is diagnosed with angina that angina pain usually differs from the pain of a myocardial infarction (MI) in that angina pain -Is often relieved by rest. 2. While caring for a client with angina, the nurse plans interventions that decrease myocardial oxygen demand and promote coronary blood flow. Appropriate interventions are those that primarily prevent -An increase in heart rate 3. When instructing a client in the proper administration of sublingual nitroglycerin (NTG), the nurse should include in the teaching plan that the client should -Repeat the dosage every 5 minutes for three times if pain is not relieved. 4. A nurse is instructing a client who has stable angina. Which of these client responses would indicate to the nurse that the client has a proper understanding of their conditions? - “My chest pain can occur if I overexert myself.” 5. Why is the administration of aspirin recommended along with nitroglycerin when a client is experiencing angina-like chest pain? -Aspirin inhibits platelet aggregation and clot formation 5. A nurse is working in the emergency department (ED) when a client arrives complaining of substernal and left arm discomfort that has been going on for about 3 hours. All of these baseline lab tests are drawn. Which of these lab values will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standards orders? -Troponin 6. A nurse is performing an assessment on a client who had a cardiac catheterization three hours ago. Which of the following findings would require immediate intervention? -Catheterized extremity cold with decreased peripheral pulses. A nurse is discussing pre-procedure instructions with a client who is scheduled for a resting ECG. Which of the following instructions should the nurse give to the client? You must lie as still as possible during the procedure A client is admitted to the emergency room after developing severe chest pain while mowing the lawn. He has dull pain in the mid-chest area and a normal ECG. The physician orders a cardiac catheterization with coronary angiography and possible PTCA. The nurse prepares the client for the procedure by explaining that it is used to: visualize any blockages in the coronary arteries and, if necessary, to dilate an obstructed artery with the use of a small balloon 7. A nurse is performing a cardiac assessment on a client. In auscultating heart sounds, the nurse hears the closure of the aortic and pulmonic valves. The nurse documents this as -The S2 heart sound. 8. A client who is admitted for chest pain asks the nurse the reason for having an exercise stress test. The nurse should explain to a client that an exercise ECG is useful as one means of detecting -Coronary artery disease. While ambulating a client, the nurse observes changes in mental status, orientation and chest pain. These manifestations would substantiate a nursing diagnosis of activity intolerance. The nurse is preparing a community presentation for a group of women about risk factors for cardiovascular disease. Which of the following clients is at risk for CV disease? A woman (SELECT ALL THAT APPLY) With elevated LDL levels With abdominal obesity A client with LV HF is discharged with a prescription for furosemide (Lasix) 40 mg p.o. daily. The client complains to the home care nurse that they need to get up several times during the night to urinate. The nurse’s first question should be, “What time do you take your daily furosemide?” 14. A client is scheduled for a cardiac catheterization. Which of these actions should the nurse implement? SELECT ALL THAT APPLY -Check for iodine sensitivity -Verify that written consent has been obtained -Withhold food and oral fluids 15. A nurse is caring for a client who has a history of coronary artery disease. That client asks the nurse how can the HCP find out the extent of the disease process. The nurse explains that the best diagnostic test to determine the location and extent of coronary artery disease would be a/an -Cardiac catheterization 17. A nurse is participating in a community health screening. Which of the following findings presents the highest risk for the development of coronary atherosclerotic heart disease -Postmenopausal female, uncontrolled type 2 diabetes, family history of heart disease 18. When developing an educational plan for a client with a diagnosis of coronary artery disease, the nurse should explain that SELECT ALL THAT APPLY -Weight reduction can reduce blood pressure. -Weight reduction can reduce cholesterol. -Weight reduction can decrease risk for DM. 19. A nurse is developing a program for a group of individuals attending a community seminar on atherosclerotic heart disease. Which client is most at risk of developing internal injury leading to atherosclerosis? A client -With diabetes who smokes one pack of cigarettes/day. 20. A nurse is a cardiac step down unit is preparing discharge instructions, which include dietary information. Which breakfast food recommendations should be most appropriate for a client with coronary heart disease? -Skim milk, oatmeal, banana, decaffeinated coffee 23. When taking a history from a client, which of these questions should the nurse ask when assessing a client for paroxysmal nocturnal dyspnea? - “Are you waking up SOB?” 24. The nurse is assessing an older client admitted with SOB 3+ bilateral pitting edema, and crackles at bases on auscultation. Which of the following should the nurse assess first? -Blood pressure 26. A nurse is caring for a client who has been admitted with heart failure after experiencing a MI six months ago. The client asks the nurse how he developed heart failure. The nurse explains the etiology of hear failure after MI as the -Impairment of the contractile function of the ventricle. 27. A nurse is assessing a client with left sided heart failure and finds bilateral 2+pitting edema of the ankles. Which of the following signs or symptoms should the nurse also anticipate findings? -Jugular venous distention. 29. A nurse is caring for a client with an admitting diagnosis of HF. The medical record contains a notation that the client is orthopnea. The most appropriate nursing intervention to assist with this client’s problem would be to -Provide several additional pillows for sleeping. 31. A client who experiences a MI develops left ventricular heart failure. For which sign of poor organ perfusion should the nurse monitor this client? -Urine output of 50 mL in two hours 32. A nurse is caring for a client with congestive heart failure. A priority assessment at this time would be to -Obtain daily weights. 33. The nurse assesses the complex marked as “A” on the following 6 second strip as a -PVC (premature ventricular contraction). 34. A client who has A-Fib is ambulating in the hallway on the coronary step down unit and suddenly tells the nurse, “I feel really dizzy.” After assisting the client to sit down, which of the following interventions should become a priority for the nurse? SELECT ALL THAT APPLY -Check the client’s apical heart rate. -Take the client’s blood pressure. 35. In reviewing an ECG tracing from a client undergoing preadmission testing for surgery, the nurse observes the presence of a large, wide Q wave in several leads. The nurse interprets this to mean the Client has had a myocardial infarction in the past. A nurse is caring for a client admitted to the telemetry unit with dysrhythmias and left ventricular heart failure. Which of the following is a priority assessment for the nurse? Auscultate breath sounds. A nurse is caring for a client with episodes of PVCs. The client shows VFib on the telemetry at the nurse’s station. After validating the information, which action should the telemetry nurse implement first? Call a STAT code. 36. The nurse is caring for a client with newly diagnosed hypertension. What dietary teaching should be included in the plan of care for this client? - “Avoid the use of canned or processed foods.” 37. A client is diagnosed with hypertension. Initial nursing assessment reveals a body mass index of 30, reports a sedentary lifestyle, and smoked half a pack of cigarettes daily. For the behavioral change with the most immediate and positive impact on his blood pressure, the nurse should focus on -Regular exercise. 39. A client is being treated for hypertension. Which of the following outcomes demonstrates to the nurse effective management of a client’s hypertension? -There is no indication of target organ damage. 40. The RN is teamed with a LPN in caring for a group of clients on the cardiac unit. Which action by the LPN indicated the need by the RN to intervene immediately? The LPN -Assists a client to the bathroom 30 minutes after the client has returned from a cardiac catheterization. (because the pt. need to be on bed rest for 4-6 hours with keep affected extremity straight 1-2 hours) 43. A client is admitted with a diagnosis of MI. Which information should the nurse include in the discharge planning? -Begin walking for short periods every day. Chart 27-12 P. 750 44. A nurse is caring for a client admitted to the hospital with a complaint of chest pain. After receiving a total of three nitroglycerin sublingual tablets, the client states that there is no change in their pain level. Which of these actions should the nurse implement first? -Notify the HCP. 45. When a client with a history of coronary artery disease is at home and experiences chest pain or suspects they are having a heart attack, the HCP will typically advise the client to - Ingest aspirin 46. Along with persistent, crushing chest pain, which clinical manifestation should lead the nurse to suspect the client is experiencing a MI? - Diaphoresis and cool, clammy skin (p.742/rr, p99: cool, pale, moist skin diaphoresis, nausea, fear, anxiety)