NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
The nurse is preparing to administer a blood transfusion to a patient. Which means of identification
does the RN use to ensure the blood is administered to the correct patient? - ANSWER compare name
and ID tag number on the blood product tag with the patient's ID band
The nurse observes a patient with AB negative blood type receiving a transfusion of type O negative
packed RBCs. What action does the nurse take first? - ANSWER assess and record the client's vital signs
You are the charge nurse and the student asked the universal donor blood type. Which is it? - ANSWER
Type O-
Which of the following medications should patients who require transfusion therapy receive if they are
at risk for transfusion associated circulatory overload? - ANSWER diuretics
An ABO acute hemolytic reaction includes which of the following? - ANSWER occurs in the first 15
minutes of transfusion
The nurse is assessing a patient with a history of heart failure who is receiving a unit of packed RBCs.
resp rate is 32 breaths/min and BP is 140/90. Which action does the nurse take? - ANSWER slow the rate
of the transfusion
A nurse is preparing to administer packed RBCs for a patient with severe anemia. what action will
prevent acute hemolytic reaction - ANSWER obtain help from another nurse to confirm correct patient
and blood product
A nurse is transfusing packed RBCs for a patient with anemia due to chemotherapy. the patient reports a
sudden headache and chills. temperature spike of 2°. notify the physician and do all of the following
except: - ANSWER infuse dextrose 5% in water through the IV
DO stop the infusion, remove tubing from patients IV, and obtain a urine specimen
,NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
Calculate stroke volume given these criteria: HR 83, BP 102/66, CVP 11, PCWP 16, CO 5L/min - ANSWER
60mL (CO= SV x HR. remember to convert L to mL when necessary!!)
If stroke volume decreases, cardiac output can be maintained if the ... - ANSWER heart rate increases
The best definition of preload is - ANSWER the amount of tension on the ventricular walls at end
diastole
The resistance against which the ventricles pump blood is known as - ANSWER afterload
Normal adult cardiac output - ANSWER 5-8L/min
A patient is prescribed lovastatin for hyperlipidemia. What should the nurse instruct this patient about
the medication? - ANSWER promptly report muscle pain or tenderness to the physician
the S1 heart sound indicates what - ANSWER the closure of the mitral and tricuspid valves
A patient presents with chest pain after shoveling snow. the nurse explains that in most cases, angina
pectoris is due to - ANSWER atherosclerosis
The nurse is assessing heart sounds of a patient scheduled for mitral valve replacement surgery. which
sounds should the nurse expect to auscultate? - ANSWER diastolic murmur at the apex
Cardiac tamponade is a medical emergency. signs and symptoms include muffled heart sounds, falling
arterial pressure, rising venous pressure. you also remember that cardiac tamponade includes all of the
following except - ANSWER hypertension (DOES include pulsus paradoxus, hypotension, and
tachycardia)
,NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
The RN is caring for a patient with acute coronary syndrome. Which is the priority nursing diagnosis? -
ANSWER ineffective tissue perfusion: cardiopulmonary related to underlying coronary heart disease
If the vagus nerve is stimulated while suctioning a patient - ANSWER the heart rate will decrease
Identify the arrhythmia - ANSWER torsades de pointes
A patient comes in diagnoses with an MI. What is the priority nursing action? - ANSWER administer
morphine for pain
A prolonged QT interval is important due to the fact that these patients are more at risk for cardiac
arrhythmias. a prolonged QT interval does what? - ANSWER increased relative refractory period of the
heart
The RN is caring for a patient with a recent permanent pacemaker post op. the RN must instruct family
and patient ... - ANSWER how to take and record the pulse rate and notify the HCP if 5bpm lower or
higher than preset pacemaker rate
The nurse is caring for a patient recovering from coronary angioplasty with stent placement. Which
intervention is a priority for the patient at this time? - ANSWER maintaining leg extension of the affected
side
A patient is admitted with pericarditis. What should the nurse expect on assessment? - ANSWER friction
rub at the sternal border
The RN identifies that a patient has sinus bradycardia 45bpm. what is the priority action - ANSWER
assess the mental status and blood pressure
Given the desired effects of nitroglycerin, what will be its expected effects on preload? - ANSWER it will
be decreased
, NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
When a patient has an episode of angina, they should be instructed to take sublingual nitro according to
the AHA guidelines of: - ANSWER one tablet under the tongue every 5 minutes up to 3 tablets when
chest pain occurs, and if unrelieved with rest and nitro after 5 minutes call 911
The nurse is planning teaching for a client with a fib regarding long term anticoagulant therapy. which
explanation should be used for the reasoning behind this therapy - ANSWER because the atria are
quivering, blood flows sluggishly through them and clots can form along the heart wall, which could
then loosen and travel to the lungs or brain
When teaching a client with an MI, the rn explains that the pain is caused by: - ANSWER insufficient
oxygen reaching the heart muscle
The RN notes a grating heart sound when auscultating the apical pulse of a patient with pericarditis.
What should the RN do with this assessment data? - ANSWER note the finding in the patient's medical
record
A major complication of afib is - ANSWER thromboembolic events
A nurse is determining whether the patient's rhythm strip demonstrates proper firing of the SA node.
Which demonstrates that it is functioning properly? - ANSWER a p wave precedes every QRS complex
The patient with this ecg is complaining of dizziness, nausea, and is diaphoretic. Which drug should be
administered? - ANSWER atropine sulfate
On the ecg strip, what formation is this? - ANSWER QRS complex
On the ecg strip, what arrhythmia is present - ANSWER A-fib
On this ecg strip, what arrhythmia is shown - ANSWER Premature ventricular contraction (PVC)
Review 422 correct complete solutions.
NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
The nurse is preparing to administer a blood transfusion to a patient. Which means of identification
does the RN use to ensure the blood is administered to the correct patient? - ANSWER compare name
and ID tag number on the blood product tag with the patient's ID band
The nurse observes a patient with AB negative blood type receiving a transfusion of type O negative
packed RBCs. What action does the nurse take first? - ANSWER assess and record the client's vital signs
You are the charge nurse and the student asked the universal donor blood type. Which is it? - ANSWER
Type O-
Which of the following medications should patients who require transfusion therapy receive if they are
at risk for transfusion associated circulatory overload? - ANSWER diuretics
An ABO acute hemolytic reaction includes which of the following? - ANSWER occurs in the first 15
minutes of transfusion
The nurse is assessing a patient with a history of heart failure who is receiving a unit of packed RBCs.
resp rate is 32 breaths/min and BP is 140/90. Which action does the nurse take? - ANSWER slow the rate
of the transfusion
A nurse is preparing to administer packed RBCs for a patient with severe anemia. what action will
prevent acute hemolytic reaction - ANSWER obtain help from another nurse to confirm correct patient
and blood product
A nurse is transfusing packed RBCs for a patient with anemia due to chemotherapy. the patient reports a
sudden headache and chills. temperature spike of 2°. notify the physician and do all of the following
except: - ANSWER infuse dextrose 5% in water through the IV
DO stop the infusion, remove tubing from patients IV, and obtain a urine specimen
,NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
Calculate stroke volume given these criteria: HR 83, BP 102/66, CVP 11, PCWP 16, CO 5L/min - ANSWER
60mL (CO= SV x HR. remember to convert L to mL when necessary!!)
If stroke volume decreases, cardiac output can be maintained if the ... - ANSWER heart rate increases
The best definition of preload is - ANSWER the amount of tension on the ventricular walls at end
diastole
The resistance against which the ventricles pump blood is known as - ANSWER afterload
Normal adult cardiac output - ANSWER 5-8L/min
A patient is prescribed lovastatin for hyperlipidemia. What should the nurse instruct this patient about
the medication? - ANSWER promptly report muscle pain or tenderness to the physician
the S1 heart sound indicates what - ANSWER the closure of the mitral and tricuspid valves
A patient presents with chest pain after shoveling snow. the nurse explains that in most cases, angina
pectoris is due to - ANSWER atherosclerosis
The nurse is assessing heart sounds of a patient scheduled for mitral valve replacement surgery. which
sounds should the nurse expect to auscultate? - ANSWER diastolic murmur at the apex
Cardiac tamponade is a medical emergency. signs and symptoms include muffled heart sounds, falling
arterial pressure, rising venous pressure. you also remember that cardiac tamponade includes all of the
following except - ANSWER hypertension (DOES include pulsus paradoxus, hypotension, and
tachycardia)
,NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
The RN is caring for a patient with acute coronary syndrome. Which is the priority nursing diagnosis? -
ANSWER ineffective tissue perfusion: cardiopulmonary related to underlying coronary heart disease
If the vagus nerve is stimulated while suctioning a patient - ANSWER the heart rate will decrease
Identify the arrhythmia - ANSWER torsades de pointes
A patient comes in diagnoses with an MI. What is the priority nursing action? - ANSWER administer
morphine for pain
A prolonged QT interval is important due to the fact that these patients are more at risk for cardiac
arrhythmias. a prolonged QT interval does what? - ANSWER increased relative refractory period of the
heart
The RN is caring for a patient with a recent permanent pacemaker post op. the RN must instruct family
and patient ... - ANSWER how to take and record the pulse rate and notify the HCP if 5bpm lower or
higher than preset pacemaker rate
The nurse is caring for a patient recovering from coronary angioplasty with stent placement. Which
intervention is a priority for the patient at this time? - ANSWER maintaining leg extension of the affected
side
A patient is admitted with pericarditis. What should the nurse expect on assessment? - ANSWER friction
rub at the sternal border
The RN identifies that a patient has sinus bradycardia 45bpm. what is the priority action - ANSWER
assess the mental status and blood pressure
Given the desired effects of nitroglycerin, what will be its expected effects on preload? - ANSWER it will
be decreased
, NURS 404 Final Exam Cumulative
Review 422 correct complete solutions.
When a patient has an episode of angina, they should be instructed to take sublingual nitro according to
the AHA guidelines of: - ANSWER one tablet under the tongue every 5 minutes up to 3 tablets when
chest pain occurs, and if unrelieved with rest and nitro after 5 minutes call 911
The nurse is planning teaching for a client with a fib regarding long term anticoagulant therapy. which
explanation should be used for the reasoning behind this therapy - ANSWER because the atria are
quivering, blood flows sluggishly through them and clots can form along the heart wall, which could
then loosen and travel to the lungs or brain
When teaching a client with an MI, the rn explains that the pain is caused by: - ANSWER insufficient
oxygen reaching the heart muscle
The RN notes a grating heart sound when auscultating the apical pulse of a patient with pericarditis.
What should the RN do with this assessment data? - ANSWER note the finding in the patient's medical
record
A major complication of afib is - ANSWER thromboembolic events
A nurse is determining whether the patient's rhythm strip demonstrates proper firing of the SA node.
Which demonstrates that it is functioning properly? - ANSWER a p wave precedes every QRS complex
The patient with this ecg is complaining of dizziness, nausea, and is diaphoretic. Which drug should be
administered? - ANSWER atropine sulfate
On the ecg strip, what formation is this? - ANSWER QRS complex
On the ecg strip, what arrhythmia is present - ANSWER A-fib
On this ecg strip, what arrhythmia is shown - ANSWER Premature ventricular contraction (PVC)
